3 surgeries later...

I've had severe GERD since my mid-teens and when I was 19, I had a lap Nissen fundoplication because my GERD couldn't be controlled with lifestyle changes and I was already maxed out on the meds I could take and was having additional problems with my asthma due to GERD, etc. For a copule of years after the surgery, I didn't have any trouble with reflux - I was completely off meds for it and wasn't bothered at all. After a few years, I started on OTC Prevacid which worked okay to control the bit of reflux I started getting. When I was 23, however, I started having trouble swallowing, much worse reflux, and eventually couldn't eat at all because food all got stuck. It turned out that I had a large paraesophageal hernia (I had a hiatal hernia prior to my Nissen) so I had surgery to fix it. Six months later (January 2012), I had an even worse paraesophageal hernia that collapsed part of one of my lungs and made it so that I could not eat or drink. Two more hospitalizations and another (much more extensive) surgery later, and I was on my way to recovery again. Since my first surgery I've had chest pain that at times gets quite intense and my third surgery left me with what is seeming to be permanent nerve pain. (note: my Nissen has remained intact through this and the 2 later surgeries were just to repair the large hernias)

Here is my question... about 6 weeks ago, my reflux started getting worse again. I was on 30mg of Prevacid at the time and then that simply wasn't working. about 3 weeks ago, my doctor upped it so I'm now taking 60mg of Prevaid/day again as well as 2gm of Sucralfate. In the past 3 weeks, even with the increased meds, my GERD has gotten worse, though. I wake up in the middle of the night with chest pain again and in the morning I feel like throwing up and I have a hard time eating any normal meals without feeling sick. I'm not sure what to do at this point - I've had 3 surgeries - 2 of them within the past 13 months - both with excellent surgeons and still my GERD is becoming unbearable again. Has anyone had 4 surgeries for this (in case one of my hernias has recurred or Nissen has come undone) and is there any reason to think that a 4th would be successful (especially if I've already had 3 surgeries by 25)? Are there any other treatments that I should consider? I know I'm going to need to do something soon as it's interfering with my sleep, aggravating my asthma again, etc, but I'm out of options and don't even know what step to take at this point.

Thanks.

Thanks, Dave. My last surgery was 6 and a half months ago, so it doesn't seem like it should be from that (as I was definitely recovering from surgery for several months, but then wasn't having any problems for a couple of months after that). Do you think it could still be LES inflammation after that long? I am working toward a more soft food diet anyway as I keep feeling sick any time I eat an am having a somewhat harder time swallowing more solid foods again. Anything else that you've found helpful to reduce the inflammation?

I actually haven't had a gastric emptying test or a vagal nerve study before. I may have to check into that. When I talked to my surgeon (the one who did the most recent surgery) last, he suggested trying the higher levels of meds for a month and if I was still having a lot of trouble, then to do an upper GI series. I just cringe at the cost of getting more tests done and then still possibly being faced with the decision of whether to have surgery yet again. When I go back to him, I'll have to ask him about that, though, and see if he would be willing to do one of those tests.

Do you have any nerve damage from your surgeries? If so, have you found anything helpful for treating it? I've been taking gabapentin for the past 4 months and it has helped somewhat - it doesn't wake me up at least once an hour and I can do things like turn to see out the back of my car, but I still can't do things like lie on my left side, etc. I knew that the risk from my 3rd surgery would be a lot higher, though, because not only was it the 3rd, but it also ended up being much more extensive (over 5 hours), they found and repaired two additional holes in my diaphragm (dx as bochdalek hernias) and put in a mesh (the first surgery they just did the Nissen, the second they additionally sewed my stomach to my abdominal wall, and the third they un-sewed my stomach and put in the mesh).

Thanks for your help!

No trouble Rain -- I visited Emory to talk about having the third surgery in Atlanta, but was *really* underwhelmed by their cavalier attitudes and suggested surgical approaches. Consequently, I had surgeries #2 and #3 at Johns Hopkins in Baltimore. (I am still up here recovering, since #3 was 6 days ago.)

For me: #1 was "normal" Nissen; #2 was Nissen with large mesh repair; #3 was Nissen, additional mesh, and the gastropexy.

I am really surprised they did #2 or #3 on you without doing the gastric emptying -- its the one where they serve you radioactive eggs and then scan your stomach several times over the next 3-5 hours.

After #2, I had *some* nerve damage - mostly evidenced by bouts of dumping syndrome. I think some normal irritation at 6 months is possible, but you are definitely right to be seeking more answers at this point. Just don't freak out about it being reflux -- it really might not be. The only way to rule out irritation of some other sort is to go on soft foods for at least 2 weeks, and then see where you are.

I think the world of Johns Hopkins -- they also saved my sister-in-law's life last year.

The gastric emptying test and the pancreatic polypeptide tests both test different vagal nerve responses. The vagal nerves are two major nerves used in digestion, and both are VERY susceptible to damage during repeat procedures.