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One year followup after Nissen

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Posted 10/21/2010 12:48 PM (GMT 0)
I am expecting a call to schedule my one-year check after my (Toupet or partial Nissen) fundoplication.  I will be asked to drink thick barium for the upper GI.  I get horribly constipated from barium, and I'm just out of the hospital from a bout of diverticulitis with an abscess, so getting constipated is to be vigorously avoided. 

The question is, is there an alternative to barium?  I know they sometimes use thin barium or other meds for lower GI contrast.  Could they mix in Miralax?

I just barely avoided being gutted like a fish, losing my entire sigmoid colon and having a colostomy this time.  I refused surgery and then was offered a drain and IV antibiotics, which seem to have worked for now.  If I get another attack it means surgery.  I have to wait at least a couple of months for even a colonoscopy, which will determine if I need elective surgery.  So I'm afraid of drinking the barium.  I had other contrast for the 5 CTs, but I don't think that will work for viewing the stomach.

 

Posted 10/21/2010 6:34 PM (GMT 0)
Hi Alcie,
It seems to me that you need to be very assertive with the doctor who is ordering the barium swallow and make clear what you've been going through. Perhaps the barium swallow isn't necessary at this time. Are you having problems? If not, what good would it do?

I'm having some problems, and the barium swallow I had showed nothing.

It doesn't seem that the payoff would be worth the risk to your health.

Just a thought--good luck finding an answer,
Denise
Posted 10/21/2010 9:14 PM (GMT 0)
A barium swallow to look for leaks and the position of the wrap is the normal 1 year followup for this surgeon. I think this test is a good one, not invasive or painful, and it gives a lot of information. You go in and get the test in the morning and then see the surgeon, probably for two minutes or less, in the afternoon.

I'm not having wrap-related problems except for the continuing intolerance of gassy foods. I did have a bad episode of trying to vomit when I took a med that disagreed with me, got an endoscopy to make sure the wrap was ok. Endo doesn't really see where things are too well though.
Then I had the diverticulitis episode and two radiologists wrote that I had a hiatal hernia, although two surgeons said the stomach is below the diaphragm. But then one radiologist missed the abscess too. So I do want to have the barium study to show for sure what's going on. Probably everything is OK.

When I get a call from scheduling I'll ask if I can have a diferent contrast medium or take something right with the barium. If I wait until I get home that evening it will already be too late to ward off severe constipation, which could bring on another bout of diverticulitis.
Posted 10/21/2010 11:51 PM (GMT 0)
I found out if I took a large dose of mineral oil or a laxative as soon as I got home I didn't get constipation from it.
My mother has diviticula. she has to be extra careful of her foods: no corn, seeds, or foods with husk coating. She takes mirilax or mineral oil everyday to keep everything flowing smoothly. ;)
They keep threating to take part of her colon with every flair she has.
Posted 10/22/2010 12:20 AM (GMT 0)
I I have a terrible problem with constipation - and the meds for nausea make it worse but EVERY day I make myself what I call "The Citrucel Smoothie/Slushie" - and it not only tastes good - it works.
You take 8 or 9 oz water, 3 ice cubes, 1 scoop Citrucel (does not cause gas like other fibers) 1 scoop miralax, one shot of mineral oil (new addition to the recipie) and 3 tablespoons of vanilla activia yogurt, blend it up and drink the whole thing. Tastes like a cream-cicle.
It's delicious and will keep things moving.....though maybe you cant have fiber, I dont know.
Posted 10/22/2010 12:00 PM (GMT 0)
Joy and ZHY -
Thanks for the suggestions. I'll have to ask my gastro doc about the seeds, etc. Previously he had told me that diverticulOSIS was no indication for avoiding seeds, that that was old thinking, never proven. But the surgeon I saw for the diverticulITIS attack said no seeds on my follow-up. I think it might be good to avoid seeds for a couple of months until I can get a colonoscopy.
The smoothie sounds pretty good, and it doesn't have anything in it I can't eat! Activia yogurt is the only brand I tolerate with my sulfite sensitivity. Yes, fiber is back in the diet - moving up on it slowly.

If I HAVE to take the barium I'll definitely take a some Miralax. I'll have to bring it with me because I have to wait around half the day for the 2-minute visit to the surgeon, who won't have anything new to say. Even if there's a new hernia I expect to be sent on my way unless it suddenly starts causing serious trouble. They don't operate around here for small problems.
Posted 10/22/2010 1:31 PM (GMT 0)
Good luck with your appointment, Alcie. Hope all goes well.
Denise
Posted 10/22/2010 10:50 PM (GMT 0)
Alcie,

If you have the barium be sure to drink lots of water and fruit juices that  you can tolerate to help flush the barium through.  Miralax sounds like a good plan and I wish you luck.

Kindly,

Kitt

Posted 10/23/2010 7:00 PM (GMT 0)
Alcie when is your appointment?      Good luck!

I had wrap done on Wed.  home on thurs. hmmmm today I am feeling something a little like acid.    I know its too soon, but of course it worries me.

I do wish you the best on your tests and hope you have good news.    Let us know how you are.

Posted 10/23/2010 8:42 PM (GMT 0)
Mitsie =
Thanks, appt next month sometime. I'm just planning ahead since I have a 2 month recovery from the diverticulitis.

Yes, don't worry about the acid just yet. Who knows what the stomach is doing at this point. I didn't have acid, but I was kept on PPIs for a couple of weeks, then allowed to stop if I felt like it. I sometimes have a little acid now. But there's never a guarantee that we won't have acid again! We go into the operation because our other symptoms are so bad we're pretty desperate for any relief. I do hope you have at least some symptoms that are gone now or at least getting better.

I'm surprised they let you out so soon. They really shouldn't. The worst swelling can come on about the third day, and can be dangerous.
Posted 10/23/2010 9:11 PM (GMT 0)
Alcie and Mitzie,
Every surgeon is different, and nobody would be released from the hospital if there was a known danger to that person. I was also released after just one overnight. I was in the hospital for about 24 hours.

While my wrap and esophagus were pretty touchy for the first week or two, there were no horrible problems. Actually, my surgeon informed me that the wrap becomes progressively more swollen for the first two weeks, peaking at the two week mark, then going down gradually after that. He wanted me to expect that my swallowing would get worse before it got better, so I wouldn't worry.

Mitzie,
I was told in my early days here that the esophagus is a "dumb organ" and interprets pain as heartburn. Your upper GI has gone through a grinder, and it'll take time for the healing to occur.

Don't worry! Things will heal and you'll do just fine.

Good luck with your appointment, Alcie!
Denise
Posted 10/24/2010 11:49 PM (GMT 0)
Alcie & Dencha

Thanks for all the information.

I'm counting on everything being ok.    I am pretty sure everything is intact.    I can feel some pressure when I swallow things.

I am wondering if maybe the burning is from my protonix.     It seemed to start when I started taking my blood pressure pills and protonix again.    Time will tell.

I am calling tomorrow for my 2 week checkup and hope I can start getting rid of the protonix maybe that will help.

Thank you.      Good luck to both of you with your tests and appointments.

Posted 10/24/2010 11:56 PM (GMT 0)
My guess is that it's not the Protonix, Mitzie.
Many people take it after surgery, to protect the new wrap from an undue amount of acid as it heals. It's more likely an irritation caused by the crushed blood pressure pills...maybe holding up at the wrap site and irritating your lower esophagus and wrap. Be sure to drink lots of water after taking the pills. It can be tricky getting some of them through the wrap. I found that cut up pills were more likely to get hung up because they have jagged edges.
You'll feel better once you've had more time to heal.
Take care!
Denise
Posted 10/25/2010 7:55 PM (GMT 0)
how long did you need to crush your pills.

I tried one without crushing it went down fine, but figured they told me to crush them for a reason.

I have a follow up appt. nov 9.    Sure would hate to crush my pills until then.

Posted 10/25/2010 9:12 PM (GMT 0)
Hi Mitzie,
If the pills go down fine, you don't have to worry. I could take some small pills without crushing. What state are you in the healing? Your wrap will get more swollen as it moves toward 2 weeks, so don't be surprised if it gets more difficult.

I could always tell if something got stuck. I was taking steroids, and the tablets were small. I found if I cut them up, it was worse...they'd get hung up.

I still don't take calcium tablets...I found a source where I can get liquid calcium/D, which works better for me. Maybe I could swallow those gigantic tablets, but I don't feel like trying!

Hang in there...your swallowing will improve over the next weeks.
Take care,
Denise
Posted 10/26/2010 4:31 AM (GMT 0)
Dencha    my surgery was Wed the 20th it will be 6 days tomorrow.    I can feel some pressure when I swallow.   I did take a couple pills whole and they seemed to go down fine.    2 of the pills I can break in half, but they seemed ok.

I have liquid calcium and liquid B's, but havent started the calcium because it has Magnesium and I am having trouble going to the bathroom too much.

Wed I can start some soft foods hoping the bathroom thing improves LOL.    So much for stool softener, but of course a person never knows maybe I will need it after I add things to my diet.

This burning I have is about the same as before the surgery.    I am thinking that maybe one of my pills is causing it.    I will do some checking things out after I have given my self some time to heal.    maybe see my reg. doc about changing my meds.

Thanks for the info.

Posted 10/26/2010 2:09 PM (GMT 0)
mitsie-
I didn't have to crush any of my pills. I just made sure to drink plenty of water with them and they went down fine. They even gave me pills at the hospital. agree with Denise that the crushed pills are probably sitting at the wrap and irritating it. If the pills will pass without crushing them I would take them whole. The less irritation you put on the wrap the better. Anything that just sits at the wrap, be it food or meds, will irritate the wrap and cause pain.

Take care,
Bill
Posted 10/26/2010 2:35 PM (GMT 0)
I had lots of trouble with chewed, crushed tablets and uncrushed tablets sticking in the exophagus and the wrap. I still do. I can feel where they are sticking. I follow all pills, even coated tablets and slippery capsules, with a little something like applesauce or at least something like milk. My morning coffee with a lot of milk works but takes 2 cups. Toast takes too long to make when you're gagging. Water just doesn't wash the particles and pills into the stomach.

Fiber works both ways, softening and thickening. I have had good luck with my doc-recommended Benefiber, which has no taste and doesn't procuce gas, for constipation and diarrhea. The trick is geting the dose right. Start with 1 tsp. Don't take fiber with your vitamins. It grabs onto the oil-based ones. I take my fiber with coffee a couple of hours after my miniscule breakfast (usually 1/4 cup oatmeal) which follows my morning meds by an hour - to let them work too. All that takes up most of the morning. So then it's vitamins with lunch. Food is good for digesting some vitamins.
Posted 10/26/2010 7:45 PM (GMT 0)
Bill thank you for the information.    I started taking my pills without crushing them today.    I put them into a little yogurt.    They seem to be going down.   Sure would think I would know if they are sticking.

Alcie     I think the benefiber sounds like something I am going to need to add into my diet.    I think I even have some in my cupboard.     Its probably too soon to add.    I am hoping that when I add some new foods to my diet things will get better.    I have been drinking Chamomile tea I think I need to check to see if that has some kind of laxative effect.

I hope you are all feeling well today.

Thank you.

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