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Post Nissan fundoplication.. 4year on

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Posted 11/2/2012 10:49 AM (GMT 0)
Hi I had the Nissan fundop 4 years ago and it has been great I hadn't been sick for 4 years this is until a few weeks ago ...

unfortunately I got a sickness bug and was sick, I was fine for a few weeks and then one day my stomach swelled up and I was in a lot of pain, this pain remained for about 4 days and all symptoms returned, including being sick several times a day, I have been to my doctor and he has referred me but I can't get an appointment until 11th decemeber!

I was just wondering if anyone had had their wrap come undone before and what the symptoms are?

Thanks
Vicky
Posted 11/2/2012 2:46 PM (GMT 0)
Hi Vicksy89,

Welcome to the Healing Well yeah yeah yeah Wrapped Club! yeah yeah yeah Sorry to hear that you got a stomach bug and you're having trouble with your wrap. 

I have a question to ask you...how many times did you vomit during your illness? 

Yes, vomiting and retching can damage even a healed wrap, it is also possible to vomit without permanent damage to the area.  The repair is much stronger than you might imagine.

There are times when your stomach and wrap become irritated and can mimic reflux.  Were you ever using anti-nausea drugs to try to stem the nausea and stop the vomiting/retching episodes?  Around here we always recommend that post-Nissen patients carry anti-nausea drugs with them at all times due to the fact that vomiting can be harmful and create painful side-effects.

I know how hard it is to wait for an appointment with a specialist while you're dealing with such uncomfortable symptoms.

In the meantime, be sure to baby your stomach and wrap...back off on solid foods and eat only smooth and bland foods.  Stay away from any GERD triggers like acidic and spicy foods, and alcohol.  Keep your meals small and frequent.  If the head of your bed isn't elevated, get it up 7 or 8 inches (17-20 cm).  Your stomach and wrap are obviously very irritated, so treat them gently for a few weeks.  Hopefully that will be enough to get you feeling better.  Do you have any PPIs or Ranitidine you can take in the meantime?  That would probably be helpful as well.  Antacids may be comforting as well. 

Good luck!  Let us know how it goes.

Denise

Posted 11/2/2012 3:45 PM (GMT 0)
Hi thanks for the response I was just sick the once, then a week after my stomach swelled up and I was in agony for about 4 days, I am now on anti nausea tablets and anti acid tablets!

I am not really holding anything down now for the past two weeks I am having acid reflux and being sick several times a day,

I am sleeping propped up again as I did prior to the surgery! Something i didn't think I would have to do again!

My gp thinks I am back at square one and that the symptoms seem to be pointing towards the wrap failing,

Until I see the consultant I won't really know but I am just worried that being sick all of the time again will cause extra damage.

Thanks
Vicky
Posted 11/2/2012 3:53 PM (GMT 0)
Hi Vicky,

Of course it's possible that your wrap has failed.  Still, it's also possible that your upper GI tract is seriously irritated.  If you're still vomiting, the irritation is continuing.  Could you change anti-nausea meds?  Have you ever discussed compazine suppositories?  I have found them to be the most helpful in stopping nausea.

Also, someone here mentioned that a hospital nurse told him/her that smelling rubbing alcohol can help stop a nausea episode from becoming a vomiting episode.  This member has found the advice helpful and therefore shared it here.  I've never tried it, but I thought I'd pass it on.  You want to avoid continued vomiting.

Good luck!  I know this is hard.

Very best wishes,

Denise

Posted 11/2/2012 3:58 PM (GMT 0)
Hi Vicky

When my wrap cam undone I had all of the old symptoms return, but I also had the following.

1. I vomited and had severe pulling pain in my lower stomach like it was being held by my lower intestines whilst pulled by my les. It was very painful and I could feel it.

2. There was blood in my vomit

3. I had shortness of breath and pain in my LH side when I tried to take a full breath, this stopped me from breathing correctly.

4. I had stomach ache, and chest ache with the pain being severe enough for hospital referral from my gp

5. I had a loose flapping kind of feeling in my chest cavity when I was walking, sounds crazy but it felt like something was loose.

6. I had an increase in appetite and also belching was very significant

One thing that I noted was that when checked out by the hospital in A & E (er) they immediately mis diagnosed as a pulled intercostal muscle as blood tests showed no sign of internal bleeding and the general knowledge of fundoplication is poor. After speaking with the surgeon before my redo he was annoyed and confirmed that a blood test would indeed not find anything.

Good luck.
Posted 11/2/2012 4:04 PM (GMT 0)
Sorry to hear that you are suffering. I also agree with Denise that you could have really irritated your GI system. Take it easy with foods. You could also look into to some natural suppliments liek ginger, oemga 3 fish oil (helps with inflammation). You could also try some Gaviscon. Hopefully you will feel better. Let us know what happens after you get the wrap checked.
Posted 11/2/2012 4:16 PM (GMT 0)
Thanks for the replies yes I had difficulty the initial 4 days when my stomach was swollen it hurt to even breathe in and walking was painful, I couldn't lean on any side!

That pain has gone now but I am still being sick continually, and the acid is constantly coming up, I'm on smaller meals to try ad prevent it but I am just feeling very drained at the moment and feel like I'm back at square one.

Has anyone had to have a redo? And if so how long did your first wrap last?

Thanks
Vicky
Posted 11/2/2012 5:25 PM (GMT 0)
Hi Vicky

I had a redo at 27 months after the first failed at 12 months, but I was an exception as I tore it lifting and then finished it off being sick. It was 75% undone with no sign of the original stitches so as the surgeon stated "it went with some force".

I had pains with breathing for approximately 6 days and lie you was very uncomfortable.
Posted 11/2/2012 5:45 PM (GMT 0)
Jonh,

I'm interested in hearing how you tore your wrap lifting.  I was lifting a heavy box not long ago and had a pain at the wrap site.  It wasn't excruciating at all...just letting me know it was there, but it was frightening.  I felt some mild discomfort for a few days, then it went away.  I swore that I would be more careful and not lift anything that was really heavy. 

Fast forward a few weeks later (a few days ago), I couldn't resist, and lifted something heavy again.  Again, I felt irritation at the site, and although I have bit of discomfort, it has gotten better gradually, until it's almost unnoticable.  Of course (like all of us who've been wrapped), I'm paranoid that I may have damaged my wrap. 

I'm not getting any reflux that I can tell, and eating is normal still. 

Do you have any idea what I might have done?  Does it sound at all familiar?

Thanks!

Denise 

Posted 11/2/2012 8:29 PM (GMT 0)
Hi Denise

I tore mine lifting a kids bike into a car boot (hatchback mondeo) whilst at full stretch holding the wheels so the bike was extended way beyond my arms. I was also bending into vehicle trying to manipulate it into position.

I had pain straight away that got rapidly worse and then affected my ability to breathe correctly, also I was very violently sick a few evenings later and this I think finished the wrap as I had tremendous pain following that. I could feel a pain in my lower stomach that felt like a ripping pain when I retched. I threw up blood at this point but I think that was the exertion.

Prior to this I had twinges when doing fly press and bench pressing at the gym with weights that were too high. When I had the twinges I got pain in the sternum and LH side just under the last rib, these would be sore for a day or two then I would no notice them.

However when I tore it I knew what it was without a doubt, the things that I most recall are the immense pain that did not abate (I have to say it did feel like a pulled muscle a bit). The pain was very high and it was stopping me sleeping, I could not also get comfortable lying down. Then there was a feeling like something was flapping inside me (again LH side). I had a lot of difficulty breathing and this was prompted my wife to tell me enough was enoug and to call out an emergency doctor who admitted me straight to hospital.

The increase in appetite came a soon as the pain died off and I was taking lansoprazole again, however with this came a lot of belching.

I have to say that I knew when it was torn as it was very violent and this was confirmed by the surgeon as none of the stitching was left and could not be found. The surgeon stated that he had never seen a tear that did not leave stitches present anywhere.

Your experience sounds like when I twinged mine lifting weights, I was never sure at the time if the twinges but knew later.

Good luck I hope all is ok.
Posted 11/2/2012 9:18 PM (GMT 0)
Hi Jonh,

Thanks very much for your description of what happened to you.  It's very helpful.  To clarify, do you (or your surgeon) think that the twinges prior to your tear were an indication of the beginning of a wrap failure, or do you think that they were unrelated.

It kills me that surgeons do not really provide people with guidance regarding what they should do post Nissen healing regarding lifting heavy (and in your case with the bike, not all that heavy) objects.  Of course during the healing stage it's pretty clear, but working on this forum I hear lots of conversations about weight lifting and surgeons saying "go for it".

I could kick myself for lifting that box of books, but was never really warned against it.

Thanks for your input!

Denise

Posted 11/3/2012 9:36 AM (GMT 0)
Hi Denise

The twinges and the tear were IMO unrelated as they felt different and were a few months apart from the last twinge to the tear. If the wrap had bean weakened (eg a stitch cme undone) then that torn stitch would have remained at the site unlike the others that all tore completely out.

The problem I had I think was due to 3 principle things

1. I had a full stomach at the time of lifting the bike
2. My posture was really poor putting strain on the abdominal muscles
3. The weight was extended considerably beyond my arm length

The only advice I was given when I had the revisin was nt to lift anything too heavy for at least 3 months, I asked for clarification on weight and he was vague. The suggestion was nothing that requires more than very little effort, I took this as being 8-10 kg with both hands when below waist and no more than 5kg above waist.

I will never do any weights again aside from some light toning.
Posted 11/3/2012 9:40 AM (GMT 0)
I should say my surgeon wa very cear that any lifting on a full stomach or eating and drinking too much can be problematic for the wrap. He stated that the wrap looked like it had been put under pressure from inside like I had an over full stomach and had drank 4pints of liquid. He said that this reassure from inside could have stressed the wrap, also that the same thing happens with being sick. In my case I think the real damage was done with being sick.
Posted 11/3/2012 3:40 PM (GMT 0)
Hi jonh,

Thanks again for your very clear and detailed description of your experience.  The books I picked up were much heavier than 20 pounds/10kg, and it was definitely a mistake.  Still, I think surgeons should provide more guidance and warnings regarding this hazard.  From what I read here on the forum, many give absolutely no warning regarding heavy weights, and in fact tell their patients that once the healing period is over they can do whatever they were doing prior to surgery, and that weight-lifting is just fine.

My experience is definitely more like your early twinges.  The second one (probably  3 weeks after the first time) I felt a sharp/small pain behind the sternum...enough to think, "ouch", but it immediately subsided upon putting the box down.  Still, afterward there was an irritated/muscle-pull feeling in the area, and it almost seemed as if there was a feeling of irritation even on the inside/wrap.  The annoying sensation lasted a few days, then gradually improved.  I never experienced any heartburn that I was aware of, and my swallowing and eating remained normal.

I guess I have to hope that this is just a warning to be more careful in the future and to wait for help when I have something to move.  (I'm a retired teacher and am tutoring, so I have lots of books and materials that I have to access so I can prepare for my teaching.  My husband was out, and I made the foolish decision that I could lift just a few boxes to get to what I needed.  I'm sure that their position wasn't ideal, and I had to lean over to pick them up...much like your bike incident.)

So...hopefully these close calls of mine will provide enough warning to keep me from crashing my wrap completely.  When I express fear to my husband, he says, "So if you have to have a redo...lots of people have had them.  It's not the end of the world."  I guess that's a comforting thought.  I've always known that it was a very good possibility that I would need one...especially since during my recovery period I coughed extremely forcefully for the full 2 and a half months until my lung infection healed.  Oh well...it is as it is, right?

I was wondering.  Why did you wait so long for your redo?  From 12 to 27 months is a long time.

Thanks again for sharing your experience!

Denise

Posted 11/3/2012 5:49 PM (GMT 0)
To have the revision you must first be referred by a doctor to a surgeon (this is uk), and I was mis-diagnosed in the hospital although I argued the case. I then had to visit my gp and I saw 4 gp's over a period of 8 months before one of them took me seriously. I was then referred and had a gastroscope in march 2012 that was done by my surgeon who immediately found the wrap was burst. I then had to have manometry and 24hr ph testing before I could be put onto the waiting list. On 16th August I saw the surgeon for the results and agreed a date then of 3rd October.

I was thoroughly fed up with the my gp's surgery and made this clear. The problem in the uk is that he gp is the only person who can refer you aside from turning up cold in A&E which would get me nowhere as it was not an accident or emergency. So I argued the case for a long time with various doctors giving me the following excuses.

1. Constipation
2. Taking a steroid called fludrocortisone (rubbish)
3. Stress
4. Imaginary

Anyhow my surgeon was non too pleased when I saw him and has promised to keep the door open after discharge this time. I have to say although let down by the gp service my surgeon/consultant is ver good.

My worry now following the last nf is that I did some damage with the pneumonia and coughing, but to date I have only had minor heartburn and a little discomfort related to reflux, considering I stopped ppi cold I am not overly worried.

Hope you have no damage and get quickly better with no ill effects.
Posted 11/3/2012 7:09 PM (GMT 0)
Jonh,

How far along in your recovery were you when you came down with the pneumonia?  I can tell you that I was checked a couple years post op, and even after having steroid effects weakening my internal tissue at the time of my surgery (requiring the sugeon to put in a few extra stitches to add strength) all was still intact.  That was after all the coughing I did immediately following the surgery.

Thanks for the good wishes..the same to you!

Denise

Posted 11/3/2012 11:48 PM (GMT 0)
Hi Denise

I had a very rough recovery, the Nissen revision was difficult due to scarring/adhesion and I was out longer than first. On day 2 my temperature was over 40 deg C and I was seeing double etc, it was then noted that my LH lung had collapsed. It was a very confusing time as I was we'll out of it and I remember only a few things, for example I remember that on day 3 or 4 in the night I ripped out my oxygen supply as I was struggling to sleep and then was awoken as my sat level was too low. I also had tonsillitis and influenza and remember over hearing the senior nurse talking to the consultant sating something about being concerned about my condition and not improving. I also remember saying to my wife I would be out the next day with maybe some antibiotics whilst on oxygen and 2 IV drips.

I can honestly say that it is the worst I have ever felt and talking with my wife a few weeks later she tells me how worried she was as I was just not really there or getting better. The crazy thing is that I suffer from an endocrine problem whereby my body does not produce correct levels of aldosterone and a treatment for this is taking a steroid called fludrocortisone. I talked the surgical team out of giving me steroids as I am on a trial not using steroids whilst my aldosterone levels are monitored. I did not want to contaminate the trial but at the same time this makes recovery hard. I will never know what the effect of this was on my recovery but what I can say is that I now know my aldosterone levels are low as I have benn passing out fairly frequently.

I guess regards the pneumonia was concerned, iwas bringing up blood in my mucus and for a time the concern was that they had punctured the les. This it seems was not the case as I am now ok.

The million dollar question, if it failed again would I have another revision?

Without a doubt, I no longer will need to watch what I eat,will not burn after each meal, I love espresso, I love spicy food, I like red wine and do not wake up having thrown up into the back of my throat.

You only get one chance at life and never doing is never knowing and I was lucky enough to have nf as an option.

Post Edited (Jonh71) : 11/3/2012 5:51:30 PM (GMT-6)

Posted 11/4/2012 3:30 AM (GMT 0)
Hi jonh,

Wow...you had a really hard time of it!  It's interesting about the steroid issue.  I'd been on high doses of steroids prior to surgery because the reflux was affecting my lungs badly and my docs were trying to keep me breathing.  Because of that, I developed adrenal insufficiency and so my docs put me on a boost of steroids at the time of my surgery.  I assume it's just what your docs wanted for you, and that you refused.  They were worried that I would crash during or after surgery without the steroids. 

Because of the high steroid doses for my lungs those years before my surgery I have very fragile skin that bruises and tears extremely easily. Even though I'm off the high doses, (and my adrenals are working better...my levels are more normal now--they were being suppresed by the steroids) my skin will always be thin.

I'm with you, though, regarding a redo.  If it's needed I'm having it.  I certainly don't want to go back to where I was pre-Nissen.

Have a great day,

Denise

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