NISSEN Post-OP

Hello,

My name is Chris, and I'm a 45 yo male in Southern CA who underwent a Nissen fundoscopic wrap on Dec 19, 2008 at USC Med Center in LA. I decided to go ahead and schedule after more than 2 years of being on PPI's and not getting sufficient relief from my symptoms on meds alone. After several endo's, and the a wireless PH test lin late summer '08, my doc confirmed I was a candidate for surgery. I believe he said that on my 2nd endo, he was able to go into my stomach, turn the scope around and see back up to my tonsils fairly clearly. So I definitely have an issue with a defective Lower Esophogeal Sphincter, which was the cause of my symptoms.

I decided to go ahead and have the surgery performed. I was in the hospital for 2 nights. The surgery, normally around 1.5 hrs long according to my Dr., was performed in less than 1 hr. I got through the surgery and anesthesia OK, and then was back in my room in a cpl hours on a morphine pump. I was pretty out of it the 1st few hrs after arriving in my room, but was happy to have the pain meds. I was started out on clear liquids, but have to admit it was tough to stomach anything for awhile. I had some issues with liquid vicodin after coming off the morphine, but was glad to be out of the fuzziness and kind of shut-down mode that anesthesia and morphine does to your body. I came around slowly, thus requiring the extra night in the hospital.

I had a scare on the second day, trying to walk and move around without alot of food in my system, I got pretty nauseated and had dry heaves that afternoon. They gave me anti-nausea drugs by injection and was OK for the rest of my hospital stay. Went to stay at a friends place for an overnight, before attempting a 2 hr ride home after surgery. Got home and settled in...and I have to admit it was a tough couple of weeks right after surgery. Pain was manageable, but eating was a real challenge. My stomach would roil and bubble and roll, and it was hard to get it settled. That was the hardest part for me, always feeling agitated. I managed to get off the vicodin after a week, but the diet was difficult to adjust to.

I was better on week 3, and had managed to get to soft foods OK...with some exceptions...but did get caught on some occasions with fighting to get food down and having alot of pain in the process. I was feeling better physically, with some more food in my system, but had lost some weight and wasn't taking enough in to compensate yet. It was a fight on some days to get out of bed, being low on energy and facing issues with getting food down, and feeling sorry for myself and being depressed. Noone prepares you for the reality of recovery from surgery, and everyone snaps back at different speeds, but you do have to persevere and just get to the next day.

I am now at week 4, feeling better and trying to introduce more foods into my system. A major milestone for me was the part of a tuna sandwich I had the other day ( very slowly and in very small bites ). I do get hiccups alot when I try and go too fast. It's frustrating and I have to get rid of them before I can continue eating, but I have to remember that I am still healing and I'm NOT the way I was before, so things will be slow for awhile. I have become a fan of BEANO, and also try and chew some digestive enzymes after I eat meals. I pop alot of GAS-X to try and prevent bloating...sometimes it's successful, sometimes not. I feel the need to burp, but can't and that causes some discomfort, but overall I think I am making good progress for my time out of surgery.

I have learned more since my 4 week follow up with my Dr....mostly about feeling the familiar sensation of reflux after eating later in the day, but my Dr. explaining that the esophagus is kind of a 'dumb' organ, and only translates one kind of pain sensation. He said that food stuck in my esophagus will feel like acid reflux until it gets carried out of the tube. He also explained that the esophagus tends to 'sleep' after surgeries like this and will not totally wake-up until more time has passed, and continue it's normal motility.

I was unsure right after surgery if I had made the right choice, and now that I am a couple more weeks out, have begun to feel better and move back toward a regular diet. I am skittish about some foods, and will probably not push the envelope too hard for the next couple of weeks. I still have some discomfort after eating, but it is certainly much improved from a couple of weeks ago. I have realized I need to exercise more to get my body moving, so I don't lose more strength and to manage to eat enough small meals throughout the day to get back the weight I've lost.

I haven't covered everything here, but if anyone has any specific questions, I'm happy to share what I have experienced.

I thank you all for allowing me to share my story. I hope it helps anyone who might be looking at surgery as an option, and those who are recently recovering from a Nissen to know a little more. I wish everyone a speedy recovery if you have the surgery and to have the patience to let yourself heal.

Take care and good health,

Chris

Dear Chris,
Would you have it done again as an option ?? My husband has high grade dysplasia barrett's esophagus..We were given options of what to do but the dr. doesn't want to do surgery.. Have you heard of any of the burning procedures and if so what do you think or your dr. think of those methods ?? The Dr. wants to biopsy the heck out of it and take pieces off and try to get all the barretts which is 1 centimeter of barrett's .. Any opinion on this procedure ?? We'd value your opinion.. My husband as you has had many yrs. of endoscopy etc. I'm glad to hear you are alright. sounds like you went through a lot.. Good Luck in the future.. God bless, L.G. p.s. we are scared

Thanks Bill for your reply.....I am wondering if there are others out there that are still healing and have the same issues I'm having at 5-6 weeks.....just getting back to solid foods this last week and have that 'reflux' feeling in your throat of food being stuck? I am still having bouts of bloating, especially at night, regardless of the Gas-x and Beano I take at every meal. Getting comfortable is a challenge in bed.

It really makes me not want to eat much at night...kind of like I was before the surgery. Still not doing tomato products...I had part of a drink ( alcoholic) the other night and that didn't feel so good either. It's funny, I almost felt better 2 weeks ago than I did this past week. Still having a bit of shoulder pain and sleeping more than I thought I would.

Anyway...would love to hear your insights on the healing process, and was wondering if I should ask my Dr. on my next follow-up to give me a prescription for an anti-naseau drug just to have around if I ever get sick.

Thanks to all who read and reply...I really appreciate it.

Hope all are doing better or getting the help they need.

Take care,

Chris

Christopher,

I had food getting stuck for about 3 months after my surgery. Actually it's doing it again. I was lucky and didn't have much shoulder pain. Only the first day.
Definitely get the anti nausea meds. I didn't and I sure paid for it. Actually I forgot where they were about 2 months ago and had to deal with dry heaves for a couple hours until my wife called me back from work to tell me where they were. I recommend always knowing where they are!


Bill

Thank you Kit, Bill & Teala,

Teala...sorry to hear about your redo, I hope that you are progressing well. I don't really have anything special that I do to take care of the intermitent shoulder discomfort. I am seeing an acupuncturist to help my body recover and to move things along. He has given me some herbs to help counter the bloating, but I haven't been able to tolerate them very well so far. I take some pain killers occasionally for my shoulder pain, but it's not that severe, just uncomfortable. I figure the more I move, hopefully the better it will get.

I will definitely take your recommendations on getting the anti-nausea drugs, any one in particular that all of you would recommend? Oh and a side note...I planning on a cruise in April...do you think I'll have any problems with being seasick, or will the meds counter that? I'll be interested in hearing your opinions.

I seem to feel pretty good early in the day, my stomach is still doing flip flops later at night before bed. I would suppose that is directly connected to the amount of food I injest, but it's funny...I had half a burrito last night and decaf latte after for dinner and my stomach was pretty calm...go figure.

It's definitely a learning process...but I look forward to the day when I can eat anything and not have to worry about how I am going to feel.

I appreciate all your comments and suggestions...and Kitt..I will definitely stick with the forum.

Take care all !

Chris

Ivy, the bravo capsule is inserted during endoscopy; you'll have meds for sedation. During endoscopy your Dr. will be looking for signs of esophagitis and any other signs of reflux or disease as well as looking inside your stomach and duodenum. At the end of the examination the bravo capsule will be inserted in the wall of your esophagus; I have had it done twice and it didn't leave much of an impression upon me as far as discomfort. I seem to remember a sensation of some sort, but nothing very noteworthy.

You will be give a digital recorder to wear; this recorder receives signals from the bravo capsule, you will be given instructions by your practitioner on how and what to do. At the end of the period ( 48 hours generally) you will return the recorder to their office. The capsule will detach on its own and pass through your system unnoticed by you.

The motility study is uncomfortable, but provides an exceptional amount of information. You will be given an anesthetic for your nose and throat, a probe will be inserted up through your nose and down through your larynx into your esophagus. The best thing to do for this part is to relax, keep your chin down and allow the probe to pass through; you will be given some water to assist in the passage of the probe. I have found that it's easier to take longer drinks rather than shorter sips, but that's just me. Once the probe is in place, you will be asked to take a series of 10 or so sips of water, each one is done to register the contractions, or motility, of your esophagus. Once the test is done, it's done and, while you may have a bit of a sore throat, it will pass quickly.

You'll be okay, don't fear the tests, they may be uncomfortable, but are well worth the efforts.
Janice

Ivy,

Thank you for your wishes. I believe that Janice has answered most of your questions, but my Bravo experience was good. The placement procedure was easy ( being asleep ) and the only time I really felt any discomfort was occasionally when I swallowed heavy food.......I did have a bit of a sore throat, but that went away soon after.

Being off my Omeprazole for 14 days was easier than I thought it would be. Watched my diet, slept on my wedge and used Zantac and Tums as needed and specified by my doctor.

My doctor in Orange County was (is) Dr. Robert Lipham who teaches out of USC. I highly recommend him, and the staff at USC was very efficient in the OR and prep before my surgery.

Feel free to ask about anything specific and I'll do my best to relay my experiences.

Thanks to Janice for the great explanation on the testing.

Chris

I'd like to address a few issue with my post, so please bear with me:

Welcome KME, I hope we all can be of some help and comfort. Children are different than adults; but my 24 hour ph showed a Johnson-DeMeester of 126 or so with reluxes numbering in the hundreds; 85 is a lot, so don't get me wrong, but hundreds in mind-boggling; both underscore the need for action.

The shoulder pain is from the gas that is introduced into the abdomen during surgery; the gas is used to inflate the area for better visualization and to move the organs out of the way for surgery. While much is remove during surgery, there is some that remains and for whatever reason, this is felt in the shouder. In an adult, walking and gas-x and even chiropratic adjustments seem to alleviate this more quickly than just hoping it will go away.

Children heal much more quickly, with much fewer side effects than adults; the older you are, the tougher it is and honestly, I raised 3 boys...nothing kept them down! That may be more of a challenge for you than something surgically related; I'm thinking specifically of lifting restrictions, but listen carefully to your Dr.s

I hope this helped.

Chris, and everyone else; I hope you are getting stronger each day! Chris, week 5 and 6 seem to be the magical numbers for turning the corner..you are through the worst and each day you will feel much more normal. 90% of your healing will occur in the first 8 weeks; the final 10% will take a year, so it is not surprising that swallowing issues are still there for you. I had a particularly rough recovery and had to return to Cleveland for an emergency endoscopy and dilation at week 2. Take cues from your body, eat slowly, chew tremendously long and watch out for things like steak...test something when you feel brave enough to do so and if you have problems swallowing, wait another 2 weeks or so before trying it again.

Chris, about the use of anti-nausea meds, many of us used these at night time for 6 tp 8 weeks, one person used them even longer, so it doesn't surprise me that you are still using them and it's really okay (and wise) to do so. I used zofran during the day (they're stronger) and phenergan at night (they helped me sleep but they're not as strong), so if you sleep like a log, use the zofran..may I ask?, how old are you?, did they do an open or a lap?

By April, you will have stopped wondering if you had made a mistake and you will be happy that you went through with the surgery. Unless you have problems with sea sickness before surgery, chances are you won't have it then, but take some with you just in case (they're small!) Drinking alcohol may still be an issue though, so watch that, as will overeating, which is a temptation on a cruise!!)

A word of caution for everyone, and, unfortunately I'm living this problem right now...watch out for catching the any type of flu or intestinal bug, including food poisoning. Remember when I said the last 10% of healing takes a year? In December, 5 months post-op for me, I came down with an intestinal bug (the first time in 25 years) and in the middle of the night I was up having a horrible time. In the middle of this nastyness, mother nature decided that I needed to have more fun than I was already thoroughly involved in; I had to vomit. If this does happen, and you have the presence of mind (which I did not have!!!) see if you can get some anti-nausea meds down..early!

I did not have the presence of mind to do so and having the dry heaves in the middle of the night, whoo hoo! who can beat that! eventually, MN won and I actually did vomit some. The pain was pretty bad, but once I did get it up and out, the heaving stopped. Unfortunately, I am once again symptomatic; I'm on Protonix for heartburn, I have chest pain, intermittent pain ( a knot-like feeling) under my sternum and my voice is getting raspy. I'm scheduled for a barium swallow next week, and when speaking to my surgeons' assistant at Cleveland the other day her response was "oh, Janice, this does not sound good, it sounds like the repair slipped" So, I'll have the test up here, fax the results there and when Dr. Rice reviews them, he'll decide if all is okay and I'm just nuts, or if I have to go back for additional testing there.

So, there's my post, I'm sorry that I dragged on and on!!! Good luck every one, let us know how things are going.
Janice

hi Kme ...I am wondering why your young son is having the surgery. I am assuming that he has been on medicine and that his diet is good and he is not overweight...all things that would help him with his reflux , without surgery. I will keep him in my prayers....I have not had the surgery, had motility test and cannot swallow well enough sop my doc said no surgery. In order to be a candidate for the surgery you must be able to swallow well enough BEfORE the surgery... Let me know what brought your son to this point. Do your other children have any issues with reflux? My little two year old nephew has it quite bad and he is on medicine that controls it quite well. All the best to you and your dear son.I love my son so much that I know where your heart is at right now ...I truly do. God bless

Christopher,

I saw you are having soreness at one of the incisions. It wouldn't happen to be the one just below your left rib cage would it? That one gave me fits for at least a year. I still have pain there if I lean on it to much.


Bil

Has anyone who had the procedure drinking carbonated drinks?

Hi !
I have lots of trouble with dairy products in general.
I don't get near mashed potatoes.
I eat yogurt , which does not seem to bother me.
I will think of others but right now i am exhausted , lol !
I would add real quick that I notice more bloating if I wait to eat past the time when I am hungry.
I almost bloat up before I eat in this case.
Isn't just eating something we have to give so much thought to in our lives due to these health issues ???



Bummer ! Take care

Just a quick update,

Feeling about the same at about 7 weeks...back to doing a bit more physical activity, but still get tired after a regular day of work. Had a bad spin with a lunch last week and really had issues with swallowing...coughed up alot of saliva and eventually got it all down. Kinda scary and made me pretty tired after....brings me back to the following:

1. Slow down my eating
2. Chew your small bites REALLY well.
3. Drink some liquids with your meal...especially with dry foods or meats
4. Be patient with your healing...

I think whoever wrote that they get more bloating and gas if they don't eat regularly is experiencing the same symptoms I have. It's definitely a day by day thing...haven't tried taking any pills yet. A bit skittish on that...I had a headache last week and was lucky enough to have some leftover liquid pain reliever instead of the big liquid gel caps. So...just have to remind myself every day that I'm not quite back to 'normal' yet.

Hope everyone else is doing well and progressing in their healing process..or finding the answers they need to make themselves well.

Take care,

Chris