Nissan Fundoplication recovery diary

Hi,

I have been suffering from GERD symptoms since an early age of 8, initially with trouble "catching my breath" which worsened then i lay on my right side, in bed. Lying this side causes more acid reflux as thats there the ends of your stomach are and the doctors put it down to anxiety and panic attacks.

Anyway, since then the symptoms have become worse and at the age of 22 it became unbearable. I was finally diagnosed with severe case of GERD and hiatal hernia (took them 14 years mind you...) and have been on 30-60 mg a day Omeprazole for the past 5 years; i am now 27.

It has now become unmanageable with medication having chronic reflux, discomfort, sour taste in mouth constantly etc.

After having several cameras down my throat, it confirmed that there is still acid erosion despite best efforts to prevent it. I also had a 24 hour pH monitoring test and a manometry, which confirmed I have chronic reflux and am a suitable candidate for Nissan Fundoplication. I've decided to go for the op as I don't want to be on medication for the rest of my life and dont want to get Oespohagus cancer; its unlikely but still a chance. I am hoping this operation will greatly improve my quality of life, particularly stopping my "panic attacks" as a result of acid reflux, permanent sour taste in mouth and feeling weak all of the time from being on PPIs daily for the last 5 years.

Please note that this operation is usually a last resort and you should try other techniques to control your reflux in first instance such as medication, eating little and often, not eating before bed, staying away from things like garlic/tomatoes etc.

I am keeping this diary as a way for me to track and monitor my recovery progress. Hopefully as this diary develops, it would also be of use to other people who are considering this procedure.

 

Post Edited (bhamboy) : 4/7/2012 10:07:29 AM (GMT-6)

Day 0

Due to go in for my op late afternoon. Nervous but optimistic about the future. Have sorted out my Playstation portable and some books to ensure I dont get bored during my 3 days in hospital.

I am fairly slim and have a BMI of 20-22, lower-borderline of average. I am nervous about losing weight, as I'm light enough as it is. Have stocked up on cream and jelly, so as soon as i can eat, I will be taking in as much calories as possible to minimise weight loss. 

The procedure is now complete. It's very strange actually, acid reflux gone, I am not in any stomach pain and I can burp as normal and swallow as normal. Have they forgot to do the wrap???!!! The only discomfort I am in Is when I breathe due to my hiata hernia repair - cant take deep breath. Apparently i had a quite large hernia for someone of my age and was told the operation was a success.

Stomach isswollen and sore. I have 5 small incision marks and the one where the camera went in, is very swollen and black, just above my belly buttom.

My first nights sleep was non-existant due to small pain whenever i breathed (from hernia repair). Am told it will go within few weeks. Drinking water is all i'm allowed currently, each sip takes 1-2 swallows to go down now... But one small step at a time...

Day 1 - Weight = 10 stone 0 lbs.

Minor weight loss so far from hardly eating past few days. Am feeling quite weak and tired.

Have had nothing but sips of water so far. I have stood up and walked around but don't push it too much - my blood pressure shot up and I felt very sick. Being sick at this stage is the last thing you want now as it would mess up the wrap and breach hernia repair. Close call...

Some pain still in back of shoulders, chest and stomach but its bearable.

Day 2 - Weight = 9 stone 13 lbs.

The consultant told me I can go home today after lunch and need to meet him in 2 weeks for a review.

I tried a small amount of runny custard and a glass of apple juice which went down ok.

Once home I had strained chicken broth for tea, which is pretty much a green tinted clear liquid. On the evening, drinking liquids was quite difficult, seems like i've took a step back but its due to the swelling and I'm told it will get better with time.

Sleep was non-existant again, I felt hot/cold at the same time and was still having pain on back of neck/shoulders.

 

Day 3 - Weight = 9 stone 10 lbs.

Have weighed myself again and realise I have lost more than I tought. Tried to have regular walks around house to keep active, raise morale and bodily functions active. I hate being bed-ridden.

Water is going down easier than yesterday but taking my liquid paracetamol is horrible. It gets stuck at the wrap and makes me feel like im going to be sick for a few minutes.

Apart from the tiny amount of custard I had yesterday, I haven't eaten in 4 days. Have just under a week of liquid diet left before I can go onto liquid/puree food diet. It seems whatever TV channel I turn to has food on it which is making me even more hungry. I am really craving a curry...

 

Day 4 - Weight = 9 stone 9 lbs.

Today is a good day. I slept for a few hours last night after taking some liquid paracetamol 20 minutes before bed. Liquids are still a bit tricky to take and am sipping slowly, but its an improvement over yesterday. I am keeping focussed on the end game - a complete recovery. So with each difficult day I have, I see it as a stepping stope to getting to where I want to be and I dont mind too much.

I'm getting a very tiny bit of reflux still but its non-acidic and seems to me clear-like liquid. The consultant says its normal at this stage.

I'm not hungry at all, my body is getting used to eating nothing. I think most of my craving for food has been a mental issue. You always want what you cant have, right?

Day 5 - Weight = 9 stone 7 lbs.

Apart from the odd twinge in back of shoulders and occasional difficulty swallowing when drinking, I have no major pain now.

I tend to get some trapped wind but its not like a normal burp, more of a lot more tiny burps, as if air is getting trapped in/around the wrap. I also get what seems like a dull burning sensation and a sharp taste in my mouth, which i think is from mucus build up in your throat; am told this will pass. The burning is not like normal acid reflux, more like healing pains. I'm told the oesophagus is a dumb organ, it interprets everything as reflux, so im not too worried.

Weight loss continued and am feeling more drained despite having a decent sleep. So I am going to try something a bit more substantial today, perhaps baby food (apple crumble flavour) mixed in with a lot of milk. I dont want to push eating food too quickly as im concentrated on the long game; it'd be silly to disrupt the healing for just a meal at this early stage.

Day 6 - Weight = 9 stone 6.5 lbs.

Slept well, on my side with a pillow supporting my stomach and it was great. Still a bit tired and week but not too bad. I ate some jelly and a bit of runny custard for breakfast which went down ok.

No pain at all but bloatedness persists, which im happy to put up with. No heartburn and the sour taste in my mouth has gone today. I know things will get worse near 10-14 day mark as swelling peaks but my body is healing well. I must stress importance of sticking to your guns and not rushing food too quickly, despite cravings.

I will try and get some walking done today for exercise and good spirits as its a nice day.

Day 7 - Weight = 9 stone 6 lbs.

Weight loss slowed down. I woke up with some minor shoulder/neck pain but stomach itself feels fine and that aside no pain at all.

Swallowing liquids is ok except when i drink too quick and it gets stuck slightly, so need to remember to slow down a bit.

Can't wait for tomorrow until i can add runny mash with gravy to the existing menu of foods that i can eat; its currently water, jelly and runny custard, so its a welcome addition.

Going the cinema this afternoon with my partner to get out the house and try to get back to some sort of normality. Im paying of course...

Now I'm in day 7, I will post a little less frequently maybe twice a week or by exception if anything significant happens in my recovery.

Days 8-12 - Weight = 9 stone 2 lbs.

No major problems, pain or discomfort. I have stuck religiously to the post-op diet.... 1st week on clear liquids. 2nd week on liquid/pureed food diet. The rare discomfort I do have is when eating E.g. (very runny) ready breck or mash, it gives me hiccups that are the most painful I have ever experienced; it made me pull a muscle in my left shoulder. But this subsides after a minute or two, once i have a few sips of water.

Occasional heartburn so minor you might not notice it, but i suspect its either because im hungry (im on a small liquid diet after all) or its healing pains. No reflux, no sour taste in mouth. Fingers crossed this does not change post week 8, when the true success of the operation can be gauged, once most of the swelling is supposed to have subsised. 

Have been to the toilet once since leaving hospital - i've never been regular anyway and with the non-existant diet im on, not surprised i have hardly been. Going that once was a struggle and was around day 3, but i dont think that strain could have damaged my hernia repair or wrap.

Have been outside the house a few times to walk for exercise and morale boost.

Post Edited (bhamboy) : 4/16/2012 3:34:45 AM (GMT-6)

Hi Bhamboy,
Great post! I think it's a wonderful idea, and will be extremely helpful for others who come to find information about surgery. Good luck today. We'll be waiting to hear from you once you're out of surgery!
Best wishes,
Denise

Hi Bhamboy,

Welcome to the Healing Well Wrapped Club! You're now a member of that very special group who've experienced the surgery and can support others with firsthand knowledge of the recovery process.

Thanks again for sharing your recovery in such a helpful way!

Did you get anti-nausea medication prescribed by your surgeon or primary doctor?  If not, you should do so ASAP.  As you so wisely said, you won't want to vomit as it can do damage to your healing wrap.

Actually those of us who are fully-healed still carry anti nausea drugs with us and always have them on hand, just in case we need them.  Even after all is healed, it's still better not to vomit, as it's possible to cause problems even the.  I have had two stomach viruses since my surgery and have found that I can vomit.  Each time I vomited once, then used an anti-nausea suppository (they work best for me, as pills add to the nausea and in my experience get vomited up at once!).  That way I avoided further vomiting and retching episodes.  Not pleasant talk, but still important.

Walking is a great way to help get rid of the shoulder pain that is so common after this surgery.

I know what you mean about food advertisements!  They're brutal!

Happy healing!

Denise

Hi Bhamboy,

It sounds as if you're making excellent progress and have a great attitude.  There was a point in my first week of healing when I had so much mucous being made that I had to spit it out, as I didn't want to swallow it because the effort was too great.

Enjoy your applesauce.  You shouldn't have touble with the texture.  Still, remember that swallowing issues will increase over the next two weeks due to increasing wrap swelling which will peak on or about 14 days.  Once swelling peaks and starts decreasing your swallowing will begin to improve.

You are right about the esophagus interpreting all pain as reflux.  Your mini-burp experience is just like my experience.  I always described it as the stomach burping itself.  That will help keep bloating at bay.

My surgeon set me free to eat anything that could be chewed to a liquid at Day 6, so it's very possible.  Of course I was very careful and never swallowed anything that wasn't chewed to baby food consistency.  It worked fine for me.

Don't worry about the eating.  Before you know it you'll be increasing the amount and texture.

Have a great day!

Happy healing...

Denise

Thanks all.

Dencha,

How long did your 'mini burps' last? Whilst I am ok with it, im still slightly worried deep down that this is because the wrap is too weak?

I can choose to expel these mini burps or jst put up with the discomfort. Would constant small burping at this stage be detrimental to my recovery, and so i should just grin and bear it?

Regarding the mucus, as per the mini burping, i have second-thought that this is because of the wrap being too weak. Presumably its being refluxed up from the stomach? or where else does it come from? I too am having to occasionally spit it out occasionally; apologies to the readers, i know it sounds grosse but there seems no other option.

Should i regress my diet (back to previous stages) when swelling peaks? as i dont want to stretch it out as ill be back to square one.

Hi Bhamboy,

Thanks for your continued updates. I have no doubt that your thread will be extremely important to others searching for information.

Enjoy the movie!

Denise

Hi Bhamboy,

Your description seems about right.  I started on regular foods early, but listened to my body and my wrap's reaction to what I ate to judge whether or not I could handle whatever it was.  Often I stuck to soups and soft things, or crispy things that chewed easily to a liquid. 

Generally if you take tiny bites and chew until whatever you're eating is creamy in texture, you'll do fine.  Still, sometimes the act of swallowing itself, and the muscle contractions involved, is enough to cause pain and discomfort in the early stages of recovery.

As far as the hiccups...they're likely from diaphram irritation, and are common.  Not everyone gets them, but there are plenty who do.  I have heard before that they're very painful, as I can imagine.  It's not something you want to be doing when things in that area are already irritated.  I think the shoulder pain you're experiencing is referred pain from the diaphram/wrap area.  It's a re-irritation of the nerves that create that problem regularly during early Nissen recovery.  Hopefully things will calm down and heal enough to keep the hiccups at bay very soon.

I found that a warm beverage--I enjoyed weak black tea--is very comforting to your healing esophgagus and wrap area.  It helps to move things through the wrap as well.  I don't know if you were ever told to stay away from very cold drinks, but they can cause spasms.

You have a great, accepting attitude, and are making excellent progress. Just keep doing what you're doing!  Every day is one day closer to complete healing.

Best wishes,

Denise

bobblues, that seems to make sense. I have started doing this now as today I have had severe stomach cramps, which i suspect is from advancing the diet too fast, in terms of mixing foods at meals. I am sticking with one type of food in each meal now.

Day 23 - Weight = 9 stone 3 lbs.

 

Today was my first consultation with my surgeon since being discharged from hospital, summarised below.

Everything seems fine except for occasional heartburn (not reflux). Was informed that anything is possible at this stage whilst I am still healing.

I am still only really on baby food and the like. Surgeon told me to push it a bit more. He outlined to me that theres nothing within reason I can do to make the stitches come loose. They should stay firm as long as he has tied them properly and hes done enough of these operations to be confident that they will stay put. When I feel up to it, I can resume sports including rock climbing, snowboarding and football, even the gym. I just need to eat properly so I have the energy to do these sports now.

I had a 5 inch hernia with some of my stomach in my chest, which is significant fomr someone only 27 yrs old. I also had a 360 degree wrap, as he wanted this to last me for life, or as long as possible, seeing as i am so young. The side effect of a full wrap is more difficulty in swallowing in the early stages.

The operation itself went perfectly. I am slim and he could easily navigate and see what he needed to see, to get the job done correctly.

I tried mashed pork fa.ggots in gravy sauce and felt very tired after. Even though it was a small amount, I imagine it was a huge meal for my stomach to handle after the operation and such a long time out eating normally.

Hi Bhamboy,

It sounds like you're doing great.  Thanks for posting your visit with your surgeon. 

Hopefully somebody will be by to answer your questions unequivocally, but I'll give it a try.  From my understanding it's a combination of those.  The stitches continue to be an important part of keeping the wrap in place, but it is aided by some scarring that occurs as well.

I'll be interested in hearing what others will be saying in response to this excellent question!

Happy healing,

Denise

Hi Bhamboy,

The weight loss is totally normal and really unavoidable.  You'll be back to your original weight once you're eating normally again.  We've all been through the weight loss thing. 

When having laproscopic surgery it's hard to remember that we've had major surgery.  While your outsides are healed and you look as if you should feel back to normal, your insides have been through a great deal of trauma.  Your lack of energy will gradually improve as you heal.  Some is your reduction of nutrition and the rest is the result of major surgery.  I

t's best to have a good long tme to heal before pushing yourself back to work.  You were wise, indeed, to provide yourself with 6 weeks to recover.  It's best, however some can't afford that luxury.

Happy healing,

Denise

Hi bhamboy the weight thing is no surprise, after my fundo I lost 10kg in 3weeks and did not really stabilise in weight until around 3 months in. I was very active running 15miles per week and resistance training 3 times per week and as I was told my metabolism was quick. Anyhow you will stabilise on weight as long as you keep eating, I found probiotic drinks and corned beef hash made with butter was a good choice for stabilising weight. I also ate a lot of cheese an potatoe pie as this again was high in calories and I could change th fat content with a lighter cheese.

I had a lump feeling in the throat early on but that was just pos op swelling and as people have said ther may be little external marks but it can be equivalent on the inside to being in a car accident. Keep on eating small high calorie meals and it will all work out. I wish you the best.