Nissen fundo recovery concerns - 3 weeks post op

Hi

I'm 3 and half weeks post nissen. I'm a 31 year old female who has lived with GERD for 10 years since having gallstone complications/gallbladder removed. I have been on 20mg nexium for the 10 years. I was always a great candidate for the drug - as long as I was on it I wouldn't have any real symptoms - I could eat almost anything I wanted but as soon as I missed one dose it was all over. Suddenly this year my reflux dramatically increased. I was on a very limited acid-free, minimal fat, bland diet and taking up to 80mg of nexium a day with no real relief so after 10 years of being warned against the fundo I decided I would give it a shot. I've been trying to eliminate nexium for a few years cause it causes so many health problems with no luck.

On the upside post surgery I don't think I've had any reflux at all! I do have a constant uncomfortable feeling similar to reflux but no acid taste in my mouth, feeling in my throat so I think it's just swelling.

I know it's early days and I thought I was recovering well. So far the recovery not been as difficult as I expecting however I'm starting to have some concerns and stressing out a little.

So far I've been on a very bland diet (similar to the acid-free diet I was on prior to surgery - no tomatoes, no vinegars, no garlic and onions, no pepper, no chocolate, etc) however my surgeon has mentioned that I should be able to eat acidic things. I've tried eating some chocolate (to increase my calorie intake) and a little tomato but have found that it irritates me - similar burning feeling to reflux but confined to my stomach. My surgeon thinks it may be gastritis (which I've had previously but thought it was only related to my gall bladder as recent tests were negative). He does not think it is related to the surgery and has recommended I go back on nexium and see what happens. This has devastated me. I am very worried I've been through this surgery for nothing and will continue to need nexium anyway. So I was wondering if anyone has had to return to their PPI's post op for a short period of time or if anyone has had gastritis after their nissen? I would like to know if it's possible that it's just the swelling around my wrap which feels like burning / gastritis pain or will this be indefinate return to nexium? Or has anyone had gatritis type symptoms of burning irritation and burping when eating acidic foods post fundo - did this clear up and how did you manage it?

My only other real concern is how exhausted I am. Although I'm trying to eat as often as possible it's difficult to get a lot of calories in on a liquid / puree diet at a half cup at a time. My surgeon is worried I'm not getting enough food in. At most I can only fit in 1/2 cup of food in at any one time - I wait an hour and half and then eat more. Is this normal for this point in my recovery? No matter how often and what liquid foods I eat I have such little energy which driving me mad.

I'm a naturally nervous person and my surgeon has made me doubt my recovery progress quite a bit so any feedback from those with experience is appreciated.
Edit: I fixed your smiley face. :)

Post Edited (burnfree) : 9/17/2012 1:59:43 AM (GMT-6)

Thanks kitt. You're so right I need to rest more often. Sadly your hubbys comments apply to me also!!

Thanks for your comments spaklingsoul. I'm trying to increase my food intake to each hour although it causes some pain at times. I have managed to put on a kilo in the past 5 days so I'm hoping with a bit of extra food my energy levels will pick up!! Fingers crossed!

I've been eating loads of protein as veggies seem to make my already intense gas even worse so I've pretty much cut them out only eating bits in chicken soup etc not as a whole meal by themselves (not so healthy but it's only short term I hope). The easiest protein boost for me has been eggs. Even when I'm spasming I can get down a soft boiled egg. Also I've made up a runny shepards pie with lots of stock and extra gravy to help get it down - good for a bit of an iron boost and feels more like a real meal. Hopefully your not on a full liquid diet for long. Wishing you all the best.

Thanks for your comments elref. It's so reassuring to hear from someone who has been through this.

Just curious how are you now 9 years post op? Have you ever had problems from the wrap in that time?

Also were you on PPIs before the surgery and did you have to keep taking them?

Post Edited (burnfree) : 9/18/2012 3:22:32 AM (GMT-6)

Hi

Can't remember what PPI's I was on back then, but like you if I didn't take then for a day I was in agony. Also, the dosage I needed to combat the reflux was also rising hence the option for surgery.

I had a full wrap and have had no refux symtoms since just after my op (as you are having now) - so have not had a PPI since, although if I do get bloated after I overeat I dwill occasionally take an antacid to ease this.

I can't vomit or burp, but this hasn't really caused me any problems.

The only thing that still causes me a problem is when food gets stuck if I eat too fast or don't chew. Not sure if this is the same for everone, but it's a very odd and unpleasant feeling for me which is difficult to describe. This happened to me quite a bit in the early days of eating normal food post op, so please remember to properly chew your food and eat a bit slower.

Hope things work out.

Les.

Hi burnfree,

First, at around 3 or 4 weeks post op, you're at the very beginning of your recovery.  Laproscopic surgery is very deceiving.  While your outsides haven't been affected much, your insides have been through MAJOR surgery.  Things have been pulled an moved and wrapped, and stitched, and repaired.  Your upper GI tract has been dramatically revised.  It will take time for your body to heal and adjust. Being tired is very understandable, so as Kitt said, listen to your body, and rest when it says it's tired.

I would suspect that the reason the PPI didn't help is because the irritation is at the wrap site.  At your point of recovery, the wrap is swollen, and that can cause some of the foods you eat and drink to be stopped at the wrap site.  They sit there, fermenting, and waiting to go down.  In the meantime they cause irritation, which mimics reflux.  The esophgagus is a "dumb organ" and it interprets all pain as reflux.

Your stomach isn't accepting much because of the swelling.  The fundus of the stomach (top part that was used for the wrap) is the part of the stomach that tells the brain that it's full.  The brain interprets the swelling as fullness, which is why you fill up extremely quickly at this point.  At your stage of recovery, I was only eating a third to at most a half a cup of food at a sitting, and maybe less.  I lost 15 pounds before my stomach started accepting enough food to stop losing weight. It's very normal to lose weight during this recovery.  Don't worry...you'll gradually begin to be able to eat more.  Honestly, I don't remember when I could eat more normal portions, but probably around four or five months post op.  It's a gradual improvement over 6 months.

Around here the rule of thumb is that it takes a full 6 months for most of the healing, and a full year for the rest.  I had one quirk (occasional dumping) that lasted into the second year and then finally disappeared.  I figured I'd have that one forever when one day I realized it wasn't happening any more!

Listen to your body.  Surrender to your recovery, and follow it where it leads you.  You can't rush this.  It is as it is.  Everyone is different, and yet some aspects of recovery seem universal.  Glad you've found us!  It's a great place to receive information and support from others who've been through what you're experiencing.

Best wishes!

Denise 

Hi clairesy,

Welcome to the Healing Well Wrapped Club! I am very sorry to hear that you're struggling still.  First, I must tell you what I'm sure you you already know--what you're going through is not a bit normal.  I am certain that you can find relief, but you may need a second opinion from another surgeon who may have more experience that this one has.  I'm assuming you live in the UK, which adds a little difficulty, as I have no idea where to suggest you go for medical attention.  There are other members of the forum who are from the UK, and they may have a recommendation regarding where to go.  I know it can be tricky.

Your stomach is not half its size due to the Nissen.  Unless you had a different procedure, with time your stomach stretches back to its original size.  By your stage of healing (even much earlier) it should be right back to its normal size.

What you're going to have is a dilation.  It's pretty commonly used when a wrap has been made over-tight and is causing swallowing problems.  The balloon will stretch the area and try to release the tight spot so food doesn't get stuck there anymore. 

If you give your surgeon opportunities to help you, and he/she doesn't provide complete relief, please research alternative health care options and get to the bottom of what's causing your problem.  You have given your healing plenty of time to resolve these issues, and since they're still with you, your doctors are responsible for getting things fixed so you can become healthy and have a good quality of life.

This forum is a good place to receive support and information from others who have been through the surgery and recovery.  I suggest you start your own thread on the main page and in the topic describe briefly the problems you're having.  You can even copy and paste your first post into the new one to introduce yourself.  Here's the link to the main page: GERD - Heartburn

Good luck!

Denise