Nissen Surgery IN NEAR FUTURE

Dear Sammi,
Welcome to Healing Well! It sounds like you're a perfect candidate for the surgery. Don't let your regular doc discourage you. Yes, there are some failures, but most are due to surgeons who are not sufficiently experienced in the Nissen procedure. Unlike some surgeries, the Nissen is a bit of an art form, and it takes lots and lots of experience. If you're in a larger city, your surgeon should have done at least over 1,000. Smaller cities...300+. The more the better.

I also had uncontrolled asthma due to reflux. I had been on PPI's for about 15 years, starting with Pilosec 20mg once a day, moving to twice a day, then 40mg twice a day, then 40mg Nexium twice a day, then 30mg Protonix twice a day...and on and on!

I found this forum at just about the time you are...I was sick and tired of being sick, and my family doc and asthma docs both thought I should have the surgery. My lungs were out of control, and I was on very high doses of steroids to keep them functional. I was trying to find the courage to have the surgery my docs thought would clear my lungs.

I had atypical symptoms...my reflux wasn't all that bad, but it was enough to create a dangerous lung condition. The GI doc was the one who wasn't excited about referring me for surgery. He dragged his feet for 4 years, and finally, told me I could "either continue with meds, or go talk to the surgeon." I chose talk to the surgeon, since the meds weren't doing the trick for me.

Once I saw the surgeon, I brought my husband back with me the next week, and scheduled surgery 3 weeks later. People here at the forum provided me with excellent and helpful information, as well as caring support.

There are so many negative posts on the internet, it can be scary to go forward with the surgery...if I hadn't found this forum, I don't know what I would have done.

That said, I don't think I could have gone on much longer with the condition my lungs were in.

They couldn't find a good time to do the surgery, as my lungs were so involved they were always bad. I had a lung infection before, during, and after the surgery. I coughed my way through recovery. I had been on so many steroids I had to have a burst of steroids for the surgery, as I had adrenal insufficiency. I was a mess.

The surgeon wasn't sure that the surgery would help me, but he said, "if the asthma is being caused by reflux, it will solve your problem."

I had the surgery in February 2009, and although it took extra time for my lungs to heal, by the 2 and a half month mark I was finally able to breathe again! I was no longer needing the nebulizer daily, and was not on prednosone. In addition I was able to reduce my inhaled steroids for the first time in years.

Is the surgery perfect? No. Since my lungs are very reactive, I still take a 40mg Protonix before dinner, and 150mg Ranitidine at bedtime as a precaution. My wrap is pretty loose, and although I don't feel any reflux, It would only take a tiny spray to cause problems. I was one who had a "normal" DeMeester score...14 when I had the surgery. Therefore "normal"--what they go for with the surgery, may not be enough for me. I'd rather be safe than sorry.

I can eat very normally now. I did lose 20 pounds, but once my eating regained normalcy, I gained that back. If you wanted to keep it off, you'd just want to keep eating smaller portions, and never go back to eating larger amounts.

My wrap has a few quirks...when I chug water I can feel it gathering at the wrap, then draining in. Salad and raw veggies (though I love them) can cause my wrap to be irritated if I eat a lot. I still do at times, but suffer the next day.

If you have the surgery your upper GI tract will be revised, so there will be some changes to the way things work. It's nothing you can't handle, especially after what you've been through.

I coughed so much during the healing stage I thought for sure I'd coughed my wrap out, but somehow it stayed together! My asthma/allergy doc wanted me to check my wrap recently, to rule out problems I was having with my lungs (due to allergy). I had a complete evaluation, and everything was perfect. Like you, reflux is not the only cause of my lung problems. The tree pollen this time of year is a killer for me, and I have to take major precautions--wash my hair before going to bed, change clothes immediately upon entering the house, etc. etc. What a pain!

Good luck with your decision! If you're anywhere near as bad as I was before my surgery, I don't see how you have a choice...that's how I felt. I couldn't go on that way, and if it worked, great! If it didn't, then I could rule out reflux as the cause of my horrible lungs. Thankfully, it worked. I am 100% better!

Take care,
Denise

Thanks for such a quick and detailed response, Denise. My lungs are in terrible shape. I went to an asthma and allergist specialist and when I mention GERD and the amount of PPI I was on he said. Have you ever thought of having the surgery to treat GERD (This was the first I ever heard of a surgery that could cure it). He said with my asthma symptoms coming on as an adult that it was a RED FLAG for sure. He thinks my allergies play a role, but it is probably my GERD that caused the onset in the first place considering I've had allergies all my life without lung problems.

Right now I am on Dulera long acting inhaler 2puffs two times a day and a fast acting one if needed. My PCP told me I had COPD and put me on about five different things that didn't work at all. I lived on Albertol inhaler having to use it up to 10 x a day to just breath. The Dulera has been a God send and my blood pressure has dropped to a normal range since I have been getting relief breathing. I also am on Nasonex Nasal Spray, Clarinex, and Singular for allergies. I've started allergy shots in hopes that I will build up some immunity after suffering 43 years. Duh!

But, back to the GERD I am hoping it relieves my breathing problems as well as the other pain it causes. The last Upper GI I had where they found the hernia, I remember the GI doctor telling me my esophagus looked like "leather". He was looking for ulcers at that time and I ended up having a diseased gallbladder which was removed.

WATER gives me the worst acid reflux ever of any drinks and I try drinking it at room temp but it still I pay for it dearly. I love water. I think the hardest part of the diet afterwards for me will be no carbonated drinks. I am a Mountain Dew lover. It and smoking are my 2 vices. (Everyone must have at least one).

As far as losing weight after the surgery and keeping it off. I've never been a big eater. I'm a snacker. I don't like sweets (cookies and cakes etc) that much but I am a meat, potatoes and bread person. I've never had a weight issue until I was put on PPIs, which makes me think that has to be the culprit. I'm only 5'1" so I can't handle much weight on me. I have been so fatigued etc for years.

Anyway, thanks for welcoming me. I will be sure to check in read others post and keep everyone posted on my journey. I hope I will be able to get the go ahead for surgery and get it scheduled asap. I can't take having to be so medicated all the time.

*Sammi*

I had the Nissen surgery several years ago, after living with GERD for about 10 years. I lived on Tums prior to that...a large bottle would last about a week. It never occured to me that this was beyond "heartburn", so I suffered in silence for a long time.

When all the various drugs I tried stopped working, my family doctor suggested I see the Gastro doctor. He did an upper and lower scope, and also had me do the 24 hour ph test. The results came back as severe GERD, so he recommended a surgeon to me who specializes in Nissen surgeries.

I saw the surgeon, and we both agreed that was the best option. Three months later, I went in to have it done.

I ended up staying in hospital for 2 days, because of some minor apnea issues. After I got home, it took about 6 weeks before I was able to eat "real" food, other than soft foods or liquids only. It was REALLY tough learning how much I could eat in a bite without choking - you have to start small and work your way back up to proper eating. I have been able to drink carbonated beverages again, as I can burp the tiniest bit...just enough to let the fizz out. I started trying it about 3 months after surgery, when I was able to eat most foods again normally.

I lost a total of 45 lbs with the surgery and I ended up putting 20lbs back on once I was able to eat. To this day, 7 years later, I still have problems eating sandwiches and/or burgers...anything that includes meat and bread together. It's something about the texture, it gets stuck in my throat, and then when I do swallow, I tend to choke a bit. Be aware that there may be a lot of that when you're first learning how to eat real food again.

I have had excellent results from this surgery, with absolutely no GERD symptoms again. I don't take any medication for it either. The one BIG thing you need to consider is this: are you the type of person who vomits on a "regular" basis ("regular" being as best a description I can think of). You lose your ability to vomit - I actually put that on my medical conditions form in my wallet, in case I'm ever found unconscious and doctors wanted to induce vomiting, say for poisoning. I only mention it because if you're the type that gets queasy easy, then just keep that in mind.

I am so glad I had the surgery done. I can eat whatever I want now, with no problems whatsoever with heartburn or GERD. Good luck if you decide to go through with it.

hugs,
Pam

Hi Sammi,
I've been thinking about your post...if your lungs are that bad, how on earth can you continue to smoke? I can't even imagine smoking even now, as an asthmatic. Aren't your doctors concerned? I would think that stopping smoking would improve your condition pretty quickly, regardless of the surgery.

When you're an asthmatic, have COPD, and are struggling the way you describe, it seems quite imperative that you find a way to give up your smokes. I know it is very difficult, as I've seen others struggle with it, but in your case it's a life-or-death situation.

My parents both smoked heavily, and that is attributed to at least some of the lung problems I have dealt with my entire life. I am extremely sensitive to cigarette smoke. My dad had some asthma, and I still remember him in the bathroom hacking up mucous in the mornings. He had two heart attacks before he died of his third at 69. My mom gave up smoking at 50, but couldn't get him to join her.

I know it's none of my business. I just can't get on the computer and try to help you through this surgery without mentioning this issue. You're considering surgery because of severe lung issues, and are continuing to assault those same lungs with smoke.

You can just remind me to MYOB, but as a part of this support system, I think it's imperative that I at least broach the subject.

Again, best wishes in making your decision. You know that we'll be here to help you through the recovery, and answer any questions you have.
Take care,
Denise

Oh, Pam. I am not one to vomit often. Only if I get a bug (which is seldom) otherwise if I do get sick it's from the GERD. So I hope that's not a problem for me.

*Sammi*

Most of the tests are not that bad.
ph testing: 24hr wire (not fun if you have a easy gag reflex) I had the BRAVO which was easy and pain free.
Endoscopy-slept right through it :)
Stomach emptying-eat some radioactive food stand in front of a special camera every few minutes
Barium swallow- drink some chalky stuff, drink some fizzy stuff, be tilted back, roll around on the table a few times
Manometry- least favorite, but very neccesary! Tube down the throat through the nose (you're numbed), drink some water

Sammi
I forgot to add that I too was a smoker of about 1/2 a pack a day. When I went in for the surgery I smoked all the way to the hospital and when I got out.... I haven't had one since the morning of my surgery..
I was in the hospital from Friday am until Sunday after noon. It takes 72 hours to get the nicotine out of your system, after that you are fighting HABIT... I am stronger than that... Maybe you can do that too, if you really want...
Sandi

Hi Sammi,
There are a few people who've posted here who have had the TIF. Since most Nissens are laproscopic, the exterior surgical recovery is very limited. In a couple days most are no longer taking the narcotic pain meds. The internal recovery is the more challenging and lengthy part.

Maybe someone else will come by with a different opinion, but it seems to me that the eating protocol and recovery is pretty similar.

The Nissen Fundoplication is considered the Gold Standard for reflux abatement. The other surgeries are still in their infancy, compared with the Nissen, that has been done for over 50 years as an open procedure, and probably 15 years as a laproscopic procedure.

Hopefully somebody will be by to share their experience with the TIF. It might be good to start a new thread to see if you can get more of those TIF people to respond.

Good luck!
Denise

Hi Sammi,
It has got to feel good to have some answers. Good luck with your future tests. You know we're here to help you through!
Denise