Still having HeartBurn after Nissen Fundoplication

Hi Summer

During the first two weeks things are rough. Anything is possible, according to my surgeon. Your upper GI tract has had a major revision, and there is a lot of irritation and pain in the area. It is possible that you're having reflux, but it's also possible that the "reflux" is really pain, being interpreted by your brain as reflux.

I'm glad to hear that you're seeing your surgeon this week. I think a lot of your concerns will be cleared up with that visit. He/she can order a barium swallow to see what's going on if that would help you.

I think that your idea to add PPIs for a while, is a good one.
Hang in there! Thursday will be here soon.
Denise

Thanks, some days I have the burn and other days I don't so maybe this heartburn will go away with time. I have no other issues at all. Feeling pretty good other than being hungry all the time

Summer

Hi.

I don't get it. PPI's?

Isn't the NF or LINX supposed to prevent reflux right sfter the surgery?

I mean, that's the whole point, right?

Gastricman

Gastricman,

Some surgeons keep patients on PPIs during the recovery to protect their recovering wrap from acid, and especially acid rebound.  Rag3r is right...most of what patients perceive as reflux is pain.  My surgeon told me that the esophagus is a "dumb organ" that interprets all pain as reflux.  He did say that during the early recovery "anything is possible" and that if the healing/swollen wrap is not in place due to swelling, it could let some reflux by.

You should also know that the surgery doesn't get reflux levels to zero.  In order to achieve that, the wrap would be so tight that you wouldn't be able to get food into your stomach.  It just reduces reflux to "normal" levels--like our friends who don't suffer from GERD, but get a rare bout of heartburn after eating very badly! 

Good luck in your continued search for answers!

Denise

Hi Heather,

Welcome to the Healing Well Wrapped Club! This is a great place to come for information and support.  I found it shortly before my surgery four years ago, and stuck around to help others the way I was helped.

At 6 weeks, you're clear to do what you're doing.  Of course, whenever you have a specific question about activity level, be sure to call your surgeon's office.  The main thing during the healing stage it to allow the hernia repair to strengthen.  If the hernia goes, so goes the wrap.  Here's a post from my 7 week final visit with my surgeon:

Here are some of my questions and his answers:

1. I asked him how much weight I could lift…he was a comedian...
"How much could you lift before surgery?" So I guess I'm okay to use my own judgment.

2. Any activity limitations?
None

3. Eating?
He said that I can eat anything that I chew thoroughly. Even steak, he said, can be chewed to a liquid. On the other hand, mashed potatoes can be swallowed in a big "bolus", and cause problems.

4. Alcohol?
No problem...

5. Why do I feel full so quickly after eating just a small amount?
He said it's because the swelling causes a stiffness, and that stiffness makes you feel more full than you actually are. The resident I spoke to after surgery, said you lose about 15-20% of your stomach capacity with the surgery. (Actually at week seven, I am able to eat more than even last week.)

6. I asked him about the effect of coughing on the hernia repair. (I have asthma. Although it has responded amazingly to the surgery, and is MUCH better than it was before the Nissen, I had a lung infection that hadn't resolved, then last week got the flu...To make it even more fun, the tree pollen is giving me fits.)
He said that "even water can erode stone". He said that there is a cumulative effect of coughing, straining, etc., that will eventually weaken the repair. These things are unavoidable.

So there you go...it sounds as if you're good to go at your stage.  I'm sure your surgeon released you to do your job knowing what it entailed.  No doubt you'll be sore for a while.  Just listen to your body.  If it becomes too much, talk to your doctor again and see what he/she has to say about it. 

Many here go to the gym to lift very heavy weights after surgery.  I'm 60, and not muscular, so if I lift something very heavy I can feel it at the wrap site.  Because of this I'm trying to avoid that.  Don't want my wrap to blow out!

Good luck with work!  Stick around and ask questions as they come up!

Best wishes,

Denise

Hi Denise and rager,

Thanks for the information above. It helps to clarify things!

One item that grabbed my attention is that Denise had said at her 7 week final visit...

"...I can eat anything that I chew thoroughly. Even steak, he said, can be chewed to a liquid. On the other hand, mashed potatoes can be swallowed in a big "bolus", and cause problems."

 

If this still the case after so many years post-op, why do you have to chew everything so thorougly?

If not, at what point in time did the chewing issue partially or totally resolve itself?

 

Again, thanks!

 

Gastricman

 

Post Edited (Gastricman) : 1/30/2013 1:13:32 PM (GMT-7)

Post Op visit today 10 days: You all are correct, the Dr said the pain I'm having may feel like heartburn, but more than likely it's not real heartburn. He told me to slow down on my eating and check back in a month. If things don't improve, they will do a Barium Swallow, but he is pretty sure my heartburn is nothing to worry about and it's just pain from the surgery that is not heartburn. He has done over 500 surgeries and has never heard of anyone having real heartburn after the surgery.

Another note: I tried some soft foods per the Dr's instructions, but the food was very painful going down. When it's painful, does this mean it's sticking? It hurts in my back really bad and I have to stop eating and wait for awhile.

Summer

Thanks JD,

I have slowed down with my eating and no more pain or heartburn feeling either. Feeling pretty good.

Thanks for the tips.

Hi Summer,

I am confident that when you visit your surgeon you will find that all is well and that your wrap is still perfectly formed and intact.  You are at about 21 days post op, and are still at the swelling and pain stage of recovery.  My surgeon told me that the esophagus is a "dumb organ" and it interprets all pain as reflux.

At 20 days you are at the very beginning of your healing, and aren't the least bit even CLOSE to being healed.  In fact, you are still in the surgical pain and swelling stage of healing.  It takes a full 6 months for most of the healing.  Think about it!  Six months!  Look at a calendar.  Mark when it's six months, and just see how long you have to go before you even begin to have a glimpse of how this surgery is helping.

It takes a full year (and in my case into the second year) for your body to fully adjust to the changes and for everything to get back to normal. For you to assume you're not in the 90% success cohort right now is premature, to say the least. 

Take a breath.  Know that you can't control how this healing progresses.  No matter how hard you will it to be so, you can't make your body heal and adjust any sooner that it will.  Healing takes time, and you really have no choice but wait for it to happen. 

You can help it along by listening to you body and adjusting your eating habits to follow its lead.  This recovery has a lot of ups and downs.  You feel better, eat more aggressively, you feel worse and have to take it easy for a while.  Baby that poor stomach and esophagus. It's likely that you're getting food/drink/medication held back at the wrap site as it's certainly still swollen.  That creates pain in addition to the surgical pain that remains.  As I said, the esophagus/brain interprets all pain as reflux.

Surrender to the path your recovery takes.  Stop worrying that the surgery isn't working.  It will drive you crazy.  Your healing is as it is.  Keep your thoughts positive.  Know that healing is happening, and each day is a day closer to full recovery. If you struggle against what is, instead of accepting it, your recovery will be a terrible and frustrating experience.

If, instead, you give your body the time to heal and can trust that in time this will all resolve, your recovery will be much more pleasant.  Go with the flow.  It's not fun to feel pain, but it's not forever.  You are just 21 days or so into your healing.  Give your body time!  You have had major surgery and your upper GI tract has been through a significant revision.  Your hernia has been repaired (and that takes at least 6 weeks in itself), and your stomach has been stretched and wrapped and stitched.  Give your body a break!  It's trying to heal.  It will heal.  Trust.

I know the surgery and recovery is hard.  I don't think there is a single person who hasn't worried that their surgery has been a failure.  It's normal.  But you have control of your thoughts and attitudes.  You can do this! 

Hang in there!

Denise

Summer,

Hang in there!  I know it's not easy.

(((Gentle HUGS)))

Denise

OK, I'm going to give it some more time and see how I feel.

Sumnmer gal - I agree with Denise - the doc's told me to 'slowly ween' from the PPI's because your body will react to coming off of them by producing even more acid (that 'bounceback effect'), and also that you still have to watch your diet as some foods will certainly trigger it. What DOES seem odd however is the burping, and especially so early after the surgery. I was told that I could 'eventually' burp - but not in a 'normal' fashion as I once did. And if I did so early it was a sign that the wrap was not tight enough and acid reflux could occur again.