Heartburn worse after Nissen

Guys,
I'm desperate! I had a Nissen Fundoplication 4 days ago and I continue to have heartburn. Now it's worse than before!!! It was this bad only episodically before. Now it seems to be non stop. I can't even sleep because as soon as I lie down I feel burning where the wrap is or above, I begin sweating profusely and even become slightly nauseated. It gets better when I take vertical position, but I can't even recline. And to add to that I have the same nasty sour taste in my mouth and my wife says my breath smells like acid. I began to feel a little sour taste right after the operation. The worst part is I don't seem to get any relief from PPI's now, even though it was manageable before the surgery. My surgeon seems to be very good and experienced in Nissens and he said it is possible to feel this way after the surgery. He said I had very bad esophagitis and it is still inflamed.
And the globus sensation is intermittently back.
But I must say I don't feel food jumping up and sticking inside my chest, I don't regurgitate any food now and everything seems to go very slow through the wrap, so it's there. But why isn't it working? Am I one of the unlucky 5% failures? I'm ready to cry!!!

Hi Rummaan,
Relax. I know it's hard, because those of us who have had the surgery always panic when there is a sign of reflux afterward. At 4 days post op, you're at the very beginning of the healing process, and it takes time for everything to settle into place.

I've heard that the esophagus is a "dumb organ" that can perceives any pain as "heartburn". Your esophagus and LES and fundus have been through a lot. You will go through a lot of "scary" symptoms between now and the end of the first month. It's all part of the healing.

Keep in mind that the swelling will get progressively worse for the first two weeks, so don't be at all surprised if your swallowing gets worse before it gets better. After two weeks, things start to settle down and the swelling begins to slowly reduce.

At four days I had a strange symptom--my saliva glands began to produce saliva nonstop. Since I wasn't keen on swallowing a lot at that point, I spit a lot of it out.

Within the first two weeks I had what I perceived as a heartburn episode, and when I spoke to the surgeon, he said that in the first few weeks of healing "anything is possible". The wrap is swollen and has not have settled into place yet--allowing a little acid to escape.

If you feel like you're having some escaping acid, I'm sure your surgeon will want you on PPI's for a while. As he said, though, your irritated esophagus, along with the surgical pain and swelling, can feel like heartburn. The real positive sign in that as you said, you're not regurgitating food along with it. That's a sign that the wrap is intact and beginning to do its job.

Try not to worry. It is not uncommon at all to have heartburn feelings after the surgery. It may be heartburn, and it may not be. Give yourself time to heal, and try not to feel like you have to rush your recovery. If you can accept the path your recovery takes--you will be able to relax and let it happen--and you'll have a much better experience, and will be happier.

I know the feeling of panic that comes with any feeling of reflux after having the surgery. It's natural to worry, since you've been through a procedure in hopes of solving that problem. I've read many posts like yours, where people fear that their Nissen has failed. It's a natural fear. Try to push it out of your mind, and remember that this surgery has been done to improve your health and quality of life. It's a major change in your GI tract, and it's natural that it will take time to heal and for your body to adjust to the changes.

It's well worth the effort! You're a full fledged member of the "Wrapped Club"!

We're all here to support you through your healing process. Be sure to write any question or concern you have. As you know, others here have lots of experience and will be happy to give you information and support!

Best wishes,
Denise

My goodness, Rummaan,
You absolutely will have difficulty swallowing for a while. It's very natural, and to be expected. Some surgeons require a liquid diet for quite a while. Mine had me on liquids one day, then soft for 5, then anything I could chew to a liquid from that day on.

To this day, I chew foods very carefully, and eat slowly. Your stomach/wrap area are swollen for quite a while, which gives you the sensation of fullness. That's what keeps you from being able to eat or drink more than a tiny amount at a time.

If you esophagus was that inflamed, then all bets are off! Of course you'll be feeling "heartburn". There has been major surgery in that area, and things have been stirred up a great deal. Since you're already inflamed, all the normal post op symptoms can be exacerbated!

While your wrap is healing (an anytime after the surgery when your wrap area is irritated) if you're anything like me, you'll experience intermittent "dumping". That's what is happening when the food goes right through you. It's nothing to be concerned about.

I say that I have a "potpourri of poo"--the consistency may change daily. If I irritate my stomach or wrap, I get some diarrhea, which is followed by pudding consistency, and then "normal" consistency. All these things are to be expected. They're not to be worried about. Hope I wasn't too graphic!

Be sure to write down the questions you have for your doc, and try to have someone go in with you, so the two of you can hear what is said. If your wife (or whoever) brings a pad and writes down the things your surgeon says, it will be easier to remember later.

Never be afraid to call your surgeon's office with questions or worries. That's why they get paid the big bucks!
Good luck with your visit, and stop worrying!
Good grief...you just had a major revision of your very inflamed GI tract. Give it some time to heal.
Again...we're all here for you, so post away!
Denise

Hi Kittehmom,
"Dumping" is when the food doesn't spend enough time in the stomach, and goes straight the intestine.

Here are a couple of descriptions:

Definition: Dumping syndrome, or rapid gastric emptying, is a combination of symptoms that occur when an overly large meal, or a meal high in fat or sugar is consumed by a weight loss surgery patient. The meal is "dumped" into the small intestine when the stomach empties quickly, causing feelings of nausea, vomiting, diarrhea, stomach gas, racing heart, cramps and cold sweats.

Most episodes of dumping syndrome can be prevented by avoiding eating overly large meals and sugary foods. Prevention is important as the symptoms are not only very uncomfortable, but they also are very similar to the symptoms of a heart attack.
NOTE--I've never had that feeling. I don't get the nausea, vomiting, stomach gas (except what I hear) racing heart, cramps, or cold sweats. Instead, I can hear lots of gurgling in my stomach, and some time later (not always right away) I know I'll have very loose stools.

What is Dumping Syndrome?
Dumping syndrome is a problem that occurs in some patients after having gastric bypass surgery. It is the result of food passing too quickly into the small intestine. It is typically induced when the patient eats certain foods, such as sweets or certain carbohydrate sources (such as simple carbohydrates like sugar and some starches). It can also occur as a result of eating too much at one time.

What are the Symptoms of Dumping Syndrome?
Some symptoms of dumping syndrome include:

* nausea or queasiness
* a sense of fullness accompanied by discomfort
* cramping
* diarrhea
* general weakness
* profuse sweating
* vomiting
* heart palpitations (an increase in heart rate)


AGAIN...I don't have the extreme symptoms described here. (These are more in regard to people who've had Gastric Bypass). It does happen to those of us who had the Nissen sometimes. It's more common during the healing process that can last as long as a year. I'm a year and a half post-Nissen, and I can occasionally have it. It's usually when my wrap is irritated by something.

I have a very sensitive stomach, and I think that has something to do with it as well.

The first time I had it I was all worried, because I'd heard it can happen with damage to the Vagus Nerve. However, it's very intermittent, and doesn't really cause me all that much trouble. I know what it is, and don't worry about it. It doesn't really happen that much.

Hope that helps!
Denise

Rummaan-
Welcome to the GERD forum and please relax. Yes it is very common to have symptoms the first 2 to 4 weeks after surgery. I had them with both Nissens, nothing to get alarmed about. As far as sleeping... I couldn't lay down to sleep for about 4 weeks. I slept partially reclined on my couch or chair. Also the more you stress the worse things will be. The best advice I have is to relax and let your body heal. Oh, after things have healed some sometimes a "normal" amount of acid will be sensed as severe reflux. It happened to me after my redo. As Denise said " the esophagus is a dumb organ".

Take care,
Bill

Let's see. I'm 5 days post op now another problem creeped up. Any amount of food makes me super ful, slightly nauseousl and sweaty about 20 min after. I had half a cup of cream of wheat and half glass of water this morning and after a short while was miserable. Then later again half a cup of ensure and half a cup of water and misery again for about an hour. Then it goes away. It was not like that in the beginning, I could have a cup of broth and a cup of juice no problem. Mind you, swallowing is okay for warm liquids. What is that? I can't even finish a glass of water without feeling full afterwards. Anybody know?

Post Edited (rummaan) : 8/12/2010 6:12:33 AM (GMT-6)

Days 1 and 2:
Well, I'm on the other side! I had my surgery done yesterday morning at 9 AM. I had a hiatal hernia repair and laproscopic Nissen Fundoplication. My surgeon reported that things went well.

I did have one little complication. I have taken inhaled steroids for a long time for asthma, as well as having to take oral prednosone for about the past 10 days due to an asthma flare up. The doctor said that my tissue was very fragile as a result, so he took extra sutures in the hernia repair to ensure that it would hold.

Of course, I didn't know what to expect after waking up from surgery, and was pleasantly surprised. I had no nausea from the general anesthesia, my throat wasn't all that sore, and my lungs had handled the surgery well, with no asthma flare ups.

I had probably 3 doses of morphene through the day, before I switched to Lortab elixir. That worked very well, and is what I came home with.

My swallowing was a little spasmy at first, but got better as the day went on. I only had water all day, and a bit of chicken broth, and lemon ice at night.

Tips about the hospital stay:

Don't count on the nurses or dietary people to know what you should be eating and drinking.

Read lots about what to have and what to avoid.

I was greeted with a cup of water complete with straw. If I hadn't learned that straws are a no-no, I'd have gulped a lot of air into my stomach for no good reason.

I also had caffeinated tea on my dinner tray (which I switched out)

This morning I had a can of ginger ale and another straw. Also caffeinated coffee.

I had to ask for a gas-X product (simethicone) to be ordered, and it was a bit of a challenge to get it when I wanted it.

I'm home now, which is a huge positive.
Honestly, I've had much worse experiences with actual GERD episodes that burned my esophagus so badly that I couldn't eat a bite. This (so far) has been more comfortable than that. I've just got to remember not to get too feisty, and let myself heal.

IN THE HOSPITAL:
Everything went very easily. Pre-op and post-op procedures were fine. Recovery was a pleasant surprise. I didn't know what to expect, because I'd never had general anesthesia.

Once back in the room I just dosed on and off with the morphine. I didn't have any adverse effects from that, either. My swallowing wasn't as good in the beginning...little sips. As time went on, my swallowing got quite normal (water only), but I tried to be careful not to overload my stomach.

The nurse switched me from morphine to Loritab, so I could see if it was effective, since that's what they'd send me home with. It worked fine.

AT HOME:
Here I sit at the computer. I haven't had any pain meds since about 6 AM, so I'm feeling some discomfort.
Mainly in my left rib area...according to the resident, that's the port that gets the most activity and movement during the surgery.

I do have some of that famous left shoulder/collar bone are pain. They blame it on the co2 they pump into your gut so they can see what they're doing. It's uncomfortable, but bearable.

I had part of a soft scrambled egg, because I was really pretty hungry. It went down well, but I think my new valve is tired of working at the moment, and doesn't feel as good as it had when I didn't challenge it as much.

OVERALL:
While I know I'm in for some ups and downs, I feel that this is a very "doable" process, and I'm very glad I went through with this. I know that there are a lot of hurdles to pass, and I won't know of its ultimate success for quite a while.

I had to do this, though. Although the percentage for the lap Nissen's effectiveness in curing things other than GERD is only about 70-80%, I had to try this procedure. My doctors were just maintaining me. They had nothing else to help me, and really wanted me to give this a try.

Just before leaving for the hospital I had a severe GERD episode, and of course I could take nothing for it. I immediately started coughing and wheezing, and it took an nebulizer treatment in the hospital to get my lungs to calm back down. IT WAS A MESSAGE TO ME; This surgery will help your asthma, and the GERD definitely is irritating your lungs.

I stupidly did something I shouldn't have just now. I bit into a Dulcolax "softgel" to see if it was chewable, and got actually swallowed the liquid. It was quite irritating to my throat. Hopefully I haven't done something that will screw me up! Oh well...don't make that mistake!

I'll keep you posted.

Day 4:
1. Lung Issues

As I've shared, I have asthma issues, so my lungs are more problematic than in other cases. Do other (non asthmatic) recovering patients experience mucous in their lungs as well?

I made the mistake of trying the Unisom Melts, and they worked great in getting me to drift off to sleep again, but I ended up paying for a few extra hours of sleep with dried out mucous in my lungs, and a wheeze that won't quit. So--to anyone reading this who has asthma, I would recommend against the Unisom. (They're just Benadryl--which is an antihistimine/drying agent, that makes you sleepy) Lucky non-asthmatics, it works great for snoozing, and is definitely non habit forming.

I've been coughing way too much today, which hurts and worries me a bit. I'm also tapering off prednosone, so that could be part of the problem as well. I've emailed my doctor for advice. I'm sure this too will pass. Just one of those little bumps in the road.



2. Burps.

My surgeon told me that I wouldn't be able to burp, but burps are slipping out here and there. I'm not purposely burping, but every so often a burp is allowed--which is actually very nice, since it allows the bloating to dissipate.

The surgeon (another in the practice) who discharged me, said that I MAY be able to burp. I guess he was right!

Do I need to worry that because I can burp it will mean that reflux will also be allowed to pass out of the stomach? The resident said that the flap can allow a bit of air to escape without letting stomach contents out.

What has been the experience of others who've been through this? Are burps okay?


3. Wrap swelling over the first two weeks.

I noticed today that "lump" feeling--the feeling that I'm swallowing a big gulp of air--when I swallow food. I figure it's the beginning of the swelling, and expect that it will probably become progressively more challenging to get things swallowed, until the swelling begins to subside. So far, though, swallowing has been fairly easy. Better than I had hoped. Very "do-able", and much less scary than I expected.

Is it common to have this experience? Do the wraps always swell?

I'm determined to go with the flow of the recovery process. I wish my lungs weren't giving me fits, but oh well...that's why I'm here to begin with. The surgery isn't a magic wand! It's so important to maintain a positive attitude, and be patient, patient, patient!

Anyway...in case it helps anyone, I'm sharing my experience. If anyone has anything to add, or can help me through some of these issues, I'd appreciate it! Best wishes to all!

Day 6:
Just a quick update:

1. VISIT TO SURGEON
All was well with incisions. He assured me that I don't have to worry about healing on prednosone. I'll heal. He's not worried that the tissue/sutures won't hold through coughing. He put extra sutures in the hernia repair (it was a small hernia). He's confident that all is fine with the repairs.

BURPS--he thinks I'm fortunate that burps are escaping, and that it's very normal, and a bonus for me. Burping does not mean reflux.
From my perspective, burps have been a lifesaver. When my stomach starts feeling bloated (after drinking or eating), the pressure shifts around, until a little bit of air escapes. This may repeat several times. I don't "belch"...the burps just happen on their own.

SWELLING OF WRAP--My surgeon reinforced the fact that the wrap will continue to swell over the next two weeks. He said I could eat anything I can manage--things that can be chewed thoroughly. He said that if the wrap makes it hard to get food through, (being sure to take small bites), just sip water/tea until it goes down. It will get through.

Surrender to the recovery process...it makes it lots easier.

I'll be going back for a follow up with him in a month.


2. LUNGS
I do have some fluid in my lungs. Hopefully the antibiotic I'm taking will take care of any residual infection from my pre-surgery lung issue.
Patience is a virtue!

I did have a bout of loose stool/diarrhea...I have a tendency to react to GI issues (even my endoscopy) with that problem. Also, being on the antibiotic...

3. OUT TO DINNER
Before coming home, we stopped at Friendly's for supper. I ordered a cup of decaf tea and a bowl of clam chowder. I just worked around the clams and enjoyed the broth, potatoes, and vegetables. Of course I didn't eat a whole bowl. I get stuffed before I eat much. I was also able to eat saltines...they chew up to total mush. YUM. It was a treat to have crackers and soup ! I brought the rest of my soup home to enjoy later.

All in All...
I'm keeping active...walk daily on my treadmill--10-15 minutes at a time...no incline...1.9mph. SLOW. It feels great, though.
Things going as well as to be expected...I was prepared for pretty much anything.
Heal well!

19 Days:
Once again, I'd like to begin by reassuring those people who are searching these forums for information as they try to decide whether or not to go forward with a Nissen Fundoplication surgery. I know how hard it is to find positive comments on the web. I found so many negative blogs and forums that I waited way too long to make the decision to go forward with the surgery.

This surgery isn't as difficult to recover from as I had expected. I've posted earlier reports, so I won't repeat that here.

1. For those who want to avoid or alleviate shoulder pain (due to gas forced into body during surgery)--walk,walk, walk. Mine improved greatly with walking. In fact, when I went a couple days without walking as much, the pain came back. Once I went back to walking a lot, it went away again. The more you walk, the less pain you'll have.

2. Rib/incision pain subsided by the end of the second week--I didn't even need to ice. I think it would have healed more quickly if I hadn't been coughing so much. (I had a lung infection that started before surgery.)

3. By day 15 or 16, my stomach began accepting more food. (Not a lot, mind you...but still more than before.) Be careful not to overdo it, though. You'll be sorry if you stuff your stomach. Several small meals are better than one larger one.

4. Bready foods--even when chewed well--still seem to challenge the wrap.

5. I was able to eat stew cooked in the crock pot (for hours). Even the meat was able to be chewed to liquid form. If you can handle soft foods, you can (carefully) experiment with the slow cooker.

6. Creamy Chicken Gnocchi soup at Olive Garden is a great choice. Actually small bites/careful chewing--opens up a lot of options. Just don't swallow anything that you can't chew to a liquid/mush.

7. My doctor put me on Carafate to counteract stomach problems/acid/wrap irritation. It coats my stomach really well. I take it 4 times a day--1 hour before/2-3 hours after meals. I put the pill in a little medicine cup and add a bit of water to make a slurry that I can drink easily. It did work well to counteract the wrap irritation that was waking me up in the early morning (3AM and on).

8. Expect some irritation feelings around the wrap site. Expect some resistance at the wrap site. It's normal. Things get better, though. Just don't get too frisky with your eating. Your appetite gets better before your stomach can handle a lot. I found that when I became too frisky/eating too much, eating things that might be a bit too chewy, I paid dearly, with more wrap irritation, and stomach problems.

When that happened I backed off and started measuring my meals--a half to 2/3 of a cup is about all I can tolerate comfortably.

9. I've lost about 14 pounds, which I'm glad about. I can lose a little more without a problem. If I start losing more than I want to, I'll just pick my nutrition intake with some snacks in between meals.

10. I still have a persistent lung infection, and am now on injected antibiotics to get rid of it. I can't take antibiotics orally (except amoxicillin) without getting gastritis, which I don't need now. So I'll be going to the doc daily for some (ouchy) shots. I just want to get my lungs cleared. My asthma is the best it's been in years. So far so good there. My lung problem is the reason I finally had the surgery, and so far so good...once I get over the infection. I'm off prednosone as of tomorrow, so that's a happy development.

Hopefully this little journal helps someone who's looking for information and trying to imagine what the recovery will be like. It has been so much better that I had ever dreamed.
This is a great forum. There are many supportive and experienced members who will help you through.
Best of luck to anyone considering/or is scheduled for surgery.
Denise

Rummaan,
Hopefully those posts will give you a little road map as to what you might expect in the next weeks. Try to relax into your recovery, and trust that you are healing, and things will be just fine. The more relaxed you can be, the better your recovery will be.
Have a great day!
Denise

Denise-
Thanks for posting that for rummaan. I was thinking this would be a good place to bring it back up and you did.

rummaan- we all have gone through pretty much exactly what you are going through. It will get better, but it takes time to heal.

Take care,
Bill

Okay, 2 more days went by. I can tell that some things are better and some things are still tough. Eating seems to ease up a bit. The surgeon told me to never eat or drink (same now) anything more than 1/4 cup. I can still taste acid, but I take a few sips of water and feel better. Wrap IS swollen, wow. I can't recline or sleep for more than a couple of hours at a time, I begin getting burning under the left ribs, sweating and nausea. I got gastritis as well so may be that flared up too. As soon as I get vertical and drink a little water or get an antacid it feels better. Mornings are worse than evenings by far. I feel more bloated, more pain and anxiety. Evenings are easier but a lot more gas. Will this gas ever find a way out of my body? Sometimes I'm ready to yell "over there, buddy, cmon". General physical activity is better, walking driving etc. except for sleep. it is really fragmented. The surgeon said "all is temporary, regular picture, will all pass". I want to believe him, God I want to believe him. How's everyone doing now? It's the fasting month of Ramadan here now, so the city is dead until about 6 pm. Then - frenzy through 1 or 2 am. The hospitals work 11 am - 2 pm and 10 pm to 1 am. Crazy schedule.