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One month post fundoplication, still getting reflux and pain

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Posted 10/15/2010 5:41 AM (GMT 0)
Hello everyone. I've been lurking for a few weeks and am hoping some of you can help me.

I had a partial fundoplication one month ago to correct a small hiatus hernia and to help with reflux. I was experiencing reflux after the operation but took heart from the posts here from others who have also experienced this; from what I read, it did seem to pass. However, one month on, things have not improved one bit...the reflux is the same as it ever was, plus I have swallowing problems, and pain/discomfort that wasn't there before (at the site of the wrap). I am wondering why I had this procedure at all. My reflux was not debilitating, but did have a big effect on my day-to-day life; I had (have) discomfort every day, and since I have had the problem since birth, I was worried about potential cancer. I am a 40-year-old female, by the way.

One thing that keeps happening is a weird burp/hiccup - I feel air building up in my stomach, and then I take a sharp, involuntary breath in, and then immediately burp. It sounds kind of like a hiccup. Has anybody else experienced this? It is not at all comfortable.

I saw my surgeon today and he said was that the reflux should have stopped immediately after surgery, and that he wanted to do another gastroscopy to see what is going on. Sigh. I think he will simply say that the wrap is all present and correct, and that will be that. He's very experienced with the procedure, by the way.

Any thoughts? Suggestions?

Thanks everyone.
Posted 10/15/2010 5:07 PM (GMT 0)
Hi Mintie,
My immediate thought is that the "partial wrap" might not have been tight enough for your reflux issues. Fundoplication surgery is a balancing act...tight enough to keep the acid down, but loose enough to allow comfortable swallowing, and minimize bloating. From what you're experiencing, it sounds like you might have needed a little tighter wrap. (No expert, so don't quote me!)

That said, at one month (regardless of your surgeon's comment) may still feel some reflux, or reflux-like feelings. Discomfort in the wrap area is to be expected, as it's still healing and adjusting to its new configuration. That will pass.

One month (four weeks, for gosh sake) is still very early in the healing process. One more experienced member here, said that her surgeon told her that most of the healing takes place in the first six months, while the rest takes a full year.

Your upper GI tract has undergone a complete revision. Some of this will resolve on its own given more time.

As far as the burping issue...The fact that air builds up in your stomach is a good sign I would think...it's not refluxing out at will...it's not comfortable, but certainly shows some ability regarding your wrap being able to hold in its contents.

Try not to panic. Everyone is different, and each recovery is unique.
Hang in there!
Denise
Posted 10/15/2010 8:45 PM (GMT 0)
Hello and welcome to HealingWell.  You have joined a great forum and dencha has advised you well.  We have many members who have had the surgery so I am sure you will be meeting other members soon.

Kindly,

Kitt

Posted 10/16/2010 5:27 AM (GMT 0)
Thanks Denise and Kitt. I am panicking a bit, it's safe to say...it seems as if I've not only got all the old issues, but new ones as well. Denise, I wondered about the tightness/looseness too, but given the swallowing problems I have now, I don't think I could have it any tighter.

Anyway, I'd be pleased to hear what others think. Thanks!
Posted 10/16/2010 1:21 PM (GMT 0)
I had a partial wrap (270) and burping is normal for it. The pain could be from the healing. You could still be swollen. I was still on PPIs during this time. I was in the process of weaning off of them slowly.
What are you eating right now and how much?
At one month I was on full liquids with occasional can of viennas. I remember I was nibbling on my food and never had more than a 1/2 cup to 3/4 cup of food a meal. My meals were about 3 hours apart.
Posted 10/16/2010 1:58 PM (GMT 0)
Joy is the perfect person to discuss this with. Have at it, you two!
Good luck, Mintie!
Denise
Posted 10/17/2010 9:21 AM (GMT 0)
Hi Joy,

Thanks for your reply. I am vegetarian and have coeliac disease so can't have gluten, so what I am eating right now is rather limited! I'm having vegetable soups, mashed vegetables, scrambled eggs, some soft dishes like risotto, yoghurt, smoothies, porridge (made with rice flakes), apples (I can eat these as long as I take small bites and chew well), cheese, gluten-free toast (one brand is OK; another gets stuck), ice cream, vegetarian sausages, rice noodles with tofu...

I am still only eating quite small amounts - 3/4C I would say, or a cup at the very most, and eating very slowly. I did have some chocolate a couple of times and had quite a bit of pain afterwards.

With the burping, are your burps normal, ie the same as they were before the wrap, or are they the hiccup/burps as I described.

Today something out of the ordinary happened - I began to feel very, very nauseous. We were driving to a friend's house and we had to stop the car and I leaned out the door and heaved about four times (sorry if this is too graphic). It was obvious my body was trying to vomit, but couldn't. I kept bringing up a lot of clear liquid, like saliva, for the next few hours - when I say I was bringing it up, it was as if I was vomiting - it just kept collecting in my mouth. I never had nausea before the wrap. Has anyone else experienced this? It was really awful.

EDITED TO ADD: I should have said "it WASN'T as if I was vomiting" above, not "it was"!

Post Edited (Mintie) : 10/17/2010 2:20:04 PM (GMT-6)

Posted 10/17/2010 6:13 PM (GMT 0)
My burps were kind of like a hiccup/spasm. They usually happened if I overate.
Very painful...
Do you have some anti-nausea medicine for sick spells? Those first months I'd feel nauseous at times. You're not suppose to vomit any more because it can tear the stitches.
You need to keep your meals smaller. Don't go over 3/4 cup. Chew extremely well. If you need to, go back to liquid diet for awhile. At four weeks my meals were mostly still liquid due to swelling still going on. My solid foods were vienna sausages (sorry, meat), crackers, and cheese grits. You can drink whey protein drinks.
Posted 10/17/2010 8:21 PM (GMT 0)
The burps sound to be the same, but mine happen regardless of what I eat, or how much, it appears.

Yes, when I got home I took an anti-nausea pill and it did help. I feel fine (well, not nauseous) today.
Posted 10/17/2010 8:33 PM (GMT 0)
I'm getting close to my one year mark and I can break the sound barrier with them some days.
Posted 10/17/2010 9:16 PM (GMT 0)
I had the partial wrap because I have a weak swallow. I had only a tiny ability to burp, still do. I had NO reflux from day 1, expect this is what SHOULD happen, but it's entirely possible so soon after surgery - and it is still VERY early - that swelling could be interfering with where the valve is placed now. Don't panic yet! On the other hand if the surgeon wants to take a look, he probably has good reason.

Denise and Joy have been around and are experienced. Like them, I keep the anti-nausea pills handy for routine nausea. I need a new Rx now because I've needed them. Since you did vomit, you have another good reason to let the doc take a look. I got checked after I heaving violently (only a little foam came up) when sick a while ago. But I also keep paregoric around. Getting a half teaspoon of that down stops the reflex instantly. I keep a tiny container in my purse for real emergencies. I'm pretty sensitive to nausea since the fundoplication.
Posted 10/18/2010 4:17 AM (GMT 0)
hi Just wondering if they automatically give you the nausea meds or will I need to ask for them.

I am scheduled for surgery Wed the 20th.   Getting kind of nervous.

I think I am pretty well prepared with liquid things for the first few weeks.    I need to go over their food list and make sure.   I suppose it depends on how a person gets along what they can eat.

Posted 10/18/2010 11:31 PM (GMT 0)
My doctor automatically gave me mine, but if he hasn't mentioned them by now give him a holler for some liquid pain medicine and liquid Anti-nausea medicine.
Posted 10/18/2010 11:40 PM (GMT 0)
Joy - yes, they are rather loud, aren't they!

Alcie - I corrected my original post because I realised I'd left a word out. I didn't actually vomit, I just heaved. Interesting to hear you are more prone to nausea since the operation. I am wondering if this is the case with me too, as there have been a few times when I have felt "borderline", and I wasn't like that before. Has anybody else noticed they are more sensitive to nausea post-op?

Mitsie - they gave me the anti-nausea tablets for when I came home, and while I was in hospital they gave me something for nausea in the IV. Good luck with your op.

Here's another question - I know this seems unlikely, but has anybody felt nauseous after taking liquid paracetamol? I was given this in the hospital and also took some when I came home, and on three separate occasions now I have felt very sick afterwards. I had taken some right before my "heaving" episode a few days ago, too. When I think about taking it now, I almost start to retch, so I wonder if this is my body telling me that there is something in there I can't tolerate well? It's what they give to children so is pretty much the gentlest pain relief there is, but I do wonder if that's been the cause of my nausea. Anybody have any thoughts on this?
Posted 10/18/2010 11:45 PM (GMT 0)
I was prone to nausea the first two months.
You could have an intolerance of the paracetamol.
Posted 10/19/2010 2:33 AM (GMT 0)
Thanks for the goodluck wishes on my surgery.

I am really concerned.   I have had a sore throat today and I cant decide whether I am getting sick or if its the acid reflux.    I found a prescription for ceftin in my closet so I took one and will probably take one tomorrow morning and tomorrow night but after that I am sure I wont be able to take any pills.   They are really big.   I think I will tell them and see if they can give me some kind of antibiotic through the IV  I usually get a bad caugh after a sore throat.

Posted 10/28/2010 4:36 PM (GMT 0)
I had the exact same issue a month after surgery - I was convinced the 270 wrap didn't take or that I was eating something that had involuntarily undone the wrap and that my reflux had returned. It felt like exactly the same pain as before but was happening even when I didn't eat my trigger foods. At my one-month follow-up, my surgeon said that the pain was likely due to the stomach and esophagus continuing to heal itself and that the reflux-like symptoms were most likely due to gas bloat continuing to affect the system. He told me to take Gas X or Gravol when needed to deal with the pain and that it could continue for up to 3-6 months after surgery.

I carried Gas X and Gravol with me at all times, and took when necessary. I didn't touch any of my PPIs, Gaviscon, or Tums, as I was working under the assumption it was gas bloat and not reflux. After another month, I no longer need either of these (unless I've gotten carried away and eaten too much, which has happened!) I feel completely normal now, 2 months in.

Your pain is most likely just the normal healing process and hopefully, 2 weeks from your original post, you're feeling better! The stomach and esophagus have been stretched and pulled in unnatural ways and require proper healing time to get back to normal. I immediately thought it didn't work, but now I can eat and drink almost all of my trigger foods with absolutely no issues.

Good luck!
Posted 10/28/2010 9:39 PM (GMT 0)
Hi fumbled_dreams and thanks for that. It is encouraging to read and I hope to be in your position soon, but to be honest I am still very dejected about the success/failure of the surgery. I'm still having the same problems - discomfort at the wrap site, reflux/a gurgly feeling in my stomach and throat, and swallowing problems that I didn't have before the surgery. I haven't had the gastroscopy yet but I doubt that will show anything.

Before the surgery, the first pH study I had didn't show anything, so they did a second one with more sensitive equipment that also measures bile reflux. That was a positive test, but only just. I got the feeling the surgeon didn't really think there was anything wrong with me - he couldn't see any evidence of a hernia when he did a gastroscopy, and even though I told him it was seen on a barium swallow when I was 12, and also on several gastroscopies over the years, he seemed skeptical - just the feeling I got. My reflux has not typically been of the burning variety - it's more of a rumbling, gurgling discomfort in my upper abdomen and a gurgling feeling in my throat. I have tried and tried over the years to explain this but nobody seems to get it. Has anybody else here had these sorts of symptoms rather than burning reflux? When I did the second pH study I was told to consume trigger foods and drinks, so I had a lot of orange juice, spicy food, etc, and I DID get the burning then...but it's different to what I have experienced day in, day out, every day of my life so far. Any thoughts, anyone?
Posted 11/19/2010 8:01 AM (GMT 0)
Hi again everyone. It's now just over two months since my surgery and I am still getting reflux. I saw my surgeon, who did an endoscopy last week, and it showed oesophagitis and ulceration, so that explains the pain. I'm really upset about this, and on top of it all, I also have a fairly constant sore/hoarse/scratchy throat, and often have an acid taste in my mouth, NEITHER of which I ever had before the surgery. The surgeon gave me some Gaviscon to take after meals and told me to come back in three months, which seems pretty unsatisfactory to me. Does anyone have any thoughts on what might be going on with me? I'm very down about it all. Thanks.
Posted 11/19/2010 9:49 PM (GMT 0)
Hi Mitzie,
I understand your frustration. My guess is that your surgeon is hoping that with a little more time to heal your symptoms will disappear. He probably doesn't want to mess around with things this early, since it might interfere with the natural course of things.

I understand that you have no trust that things will improve, but it does make sense that your surgeon wouldn't want to jump on things without giving you a little more time to heal. Three months isn't an unreasonable amount of time to give your healing.

Will it get better in three months? Who knows. I'm sure you're answer is, "Not likely."
Good luck. I know it will be a tough three months.
Hang around here and vent as much as you need to.
Denise
Posted 11/20/2010 1:56 PM (GMT 0)
Hi Mitzie,

I had my 360 wrap 4.5 weeks ago and completely empathise with your panic.  Like you, the operation was not a medical necessity for me; my reflux was in the throat and made my hoarse/weak voice and was possibly aggravating polyps I continue to get (and need removed under general anaesthetic) on my vocal cords.  So there was sound reason for the op, but not to the extent that many people have eg where the acid is travelling to their lungs or where it makes them vomit.  So I completely understand the panic and "why did I do this, I was better off before" mindset. 

I am currently in limbo as my surgeon is on vacation for another week and a bit and I have been counting the days over the last 4 weeks until I see him again.  I have heartburn (rarely got heartburn before, unless I dropped the PPIs) more or less constantly since the op, but especially since moving to soft foods and solids, (so have reverted to liquids and soft foods again) which also refers into the centre of my back.  It is a very unpleasant sensation that is unrelenting and quite exhausting, making going about my daily life quite tough.  I also have what feels like reflux in my throat with hoarseness, with some white froth and having to clear my throat of mucus when I awake in the am as well as a little hoarsness (about the same as when I tried to come off the PPIs pre op).  All of this also means I am sleeping badly so have resorted to cold medicine to knock me out the last couple of nights.  It is easy to spiral into despair!  My hope is that, as my surgeon explained the week after my op,  this is food that is backing up ie getting stuck above the wrap and then washing up and down to the throat, rather than a failed wrap or a wrap that is not tight enough.  Food backing up can apparently produce symptoms that are very close to real reflux.  However, the LES should loosen with time, like a new pair of shoes stretching to one's feet as my surgeon explained.  the big question is how long this process takes and at what point the surgeon can objectively say that the wrap isn't performing properly.  I imagine this analysis also has some relevance to your situation?  A barium swallow x ray should identify a failed wrap (ie continued reflux) or food backing up, so perhaps you should look into this to ease your mind?  there is nothing worse than endlessly waiting for things to improve, with only your own worries for company.

It's natural to do a before and after op comparison and think it has all been a disaster, particularly for those like you and me for whom this was elective surgery.  You are not alone - please keep updated on your progress.  I hope time your conditions improve - are you being careful with diet to soothe your esopagus?

Simon

Posted 11/22/2010 12:06 AM (GMT 0)
Hi Denise and Simon,

Thanks for your replies. When I asked the surgeon if I should still be having reflux or if it should disappear immediately after surgery, he said it should have disappeared. I find him quite difficult to get a straight answer out of, though...all this is very frustrating.

Simon, I had the referred pain through to my back/shoulder/collarbone and it exhausting, as you say. That eventually lessened for me at about the four week mark, so hopefully it should start to ease off for you soon too. I found that for a while after that, if food got stuck, I would get the pain again, but nowhere near as intense. I understand what you're saying about the food backing up and the LES loosening with time, but I don't understand how, in my case, I'm getting a scratchy/hoarse throat and an acid taste in my mouth when I never ever had those symptoms before - surely they are signs of actual reflux? I'm being careful with my diet, with the occasional indiscretion, but nothing too major - a bit of chocolate now and then, for example. I don't drink tea or coffee, don't drink alcohol, don't eat meat, and am (at the moment) avoiding spicy food, so that doesn't leave much! I do wonder if my wrap wasn't tight enough; the 360 ones are rarely done here these days.

Anyway, yes, I'll update how I'm doing, and look forward to hearing about your progress too.

Mintie
Posted 11/22/2010 1:22 AM (GMT 0)
Hi Mitzie,
I totally understand your frustration and worry. I'm not sure surgeons have a clue about the recovery from this surgery.
It seems they don't do a very good job preparing patients for what to expect post-op.
I hope you get some relief soon.
Denise
Posted 11/22/2010 5:45 PM (GMT 0)

Hi Mintie,

I too am suffering, with burning heartburn and hoarseness.  Mine gets worse when I am at work, which makes me think it is reflux as my reflux has always been worse when I am stressed.  Like you I currently have the old problems plus some new, pretty uncomfortable ones.  I wonder whether the new valve is insufficiently effective to keep all of or enough of the acid down, but is then a barrier to the acid travelling back to the stomach, which means it just sits there travelling up and down the esophagus.  The symptoms are so identical to my pre op reflux when I came off the PPIs that it is extremely difficult to persuade myself that this isn't reflux.  I recently started a new job which involves presenting and I know that I won't be able to make it through a presentation with any kind of reasonable performance.  I am panicing and I think clinically depressed as I am unable to sleep, wondering what I have done and that I have permanently reduced my quality of life and as a result, that of my family.  I am like a zombie drifting through the tasks of the day, worried this is the "new me".  Awful.  Sorry to be on such a downer but I feel dreadful and can't seem to break the mindset.  Seeing the surgeon next week at which point he will tell me I'm fine, like a jedi mind trick.  i am considering whether to take him up on the offer a barium swallow before our meeting next week, but am reluctant to have such a high radiation dose X ray if he thinks it's better to wait a bit longer before assessing if the wrap has worked.  but I would like to know asap.

What did you dr say when he let you go away for 3 months - that you were still healing?  Did he offer any tests to assess if the wrap if effective? 

Simon

Posted 11/22/2010 5:47 PM (GMT 0)
btw Mintie what do you mean when you say "the 360 wraps are rarely doen here these days?"  Does here mean the US?
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