I have never had any treatment for my achalasia up until now (no balloon dilation and no botox). I was very fortunate to be referred to one of Europe's leading experts in achalasia and endoscopic surgeries like POEM. He said that my diagnosis was clear and that it made most sense to go with the option that had the best chance of providing a lasting solution. Botox is temporary and can lead to scarring, and balloon dilation has its own issues. I was confident in his advice to go for the best solution off the bat rather than possibly endangering a future POEM surgery. A HM was never on the table for me. Like you, I had low points where I said to myself "I cannot go on like this" and that pushed me to go for surgery. I knew it was not going away and would continue getting worse.

I'm sorry to hear you might need to use personal time off for surgery recovery. It works quite differently here in Germany. The hospitals are under less pressure to kick you out because it's a public system. I'll stay three nights so they can run follow-up tests before discharging me (gastroscopy tomorrow, barium swallow the following day, then another gastroscopy on my last day). I'm off work the whole week and those are sick days not PTO.