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Nissen Worry...A Baby

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Posted 1/28/2013 8:18 PM (GMT 0)
I feel I can deal with the healing and being uncomfortable after the Nissen. I had 2 surgeries last year, the first in January and the second in May. Needless to say I was not thrilled at all when they highly reccomended the Nissen in December
My biggest problem is that I do child care for my 3 grandchildren. The youngest is 6 months so obviously will need to be lifted to be changed, etc., not to mention he is just about at the crawling stage.

I'll take 2 weeks off, but will I be able to lift a 20 plus pound baby? I'm wondering if anyone else on here did the Nissen with a baby to take care of.
I'm wondering if I have a stretch wrap of some sort to wear, if that will help.
We also have a very large 1 year old dog, and I know after my (laproscopic) hysterectomy in Jan, my surgeon gave me a wrap to wear to protect the stitches from the dog...he's really a big baby and is still playful.
My oldest grandson may start home school in Feb, so if that's the case he'll be with me and could help.
I've looked on the weight lifting areas, but I'm not a weight lifter, just a (young) grandma smilewinkgrin
Posted 2/2/2013 3:24 AM (GMT 0)
Hi Lallabee,

I'm a grandma, too, with a busy 26 month old and a new nearly 2 month old, and I know how demanding it is.  Have you discussed the lifting issue with your doctor?  I don't think you'll be able to lift that much for 6 weeks, unless for some reason your surgeon has a different protocol.  Generally there is a much lower weight limit.  This is due to the fact that you had a hernia repair that has to heal and strengthen before it is stressed that much.

Be sure to talk to your surgeon about the lifting.  Your kids might need to find an alternate arrangement for your grandchildren until you've had more time to heal.  The lifting is an issue, because if the hernia goes, the wrap will, too.  The hernia repair holds the fundoplication in place.

Wish I had better news for you.  Check with your surgeon and see what his/her rules are post-op.

Good luck!

Denise

Posted 2/2/2013 5:29 PM (GMT 0)
Thank's Denise- I'll check with the surgeon. My hernia is very very small if that makes a difference. I don't quite understand how the hernia repair holds the fundoplication in place.
It's hard to figure this all out. I've read where this is not reversible, yet someone wrote in and said they had theirs un-done by a surgeon. Also have read that the stitches can rip out...then read where someone's surgeon said they are strong and cannot rip out.

Can you tell I'm still struggling with the decision to even do the Nissen?...LOL. Every time I make my decision to get it done and over with, someone sways that decision. The last 'swaayer's' were my husband's boss and his wife who have gone gluten free. They begged me to try gluten free for one month and then see if that helps. I just feel if the digestive specialists thought any diet change would help they would have recommended that to begin with.

My surgeon said I am an excellent candidate for the Nissen. I'm meeting with him this Thursday and hopefully my husband can come along as an extra set of ears. idea
Posted 2/3/2013 3:41 AM (GMT 0)
Hi Lalabee,

Did you have all the pre-op testing? (Barium swallow, 24hr PH monitor, manometry, endoscopy)  If you had high levels of reflux and your LES is open, not amount of diet modification will make much of a difference. 

The hernia repair keeps the stomach in place.  If the stomach were to slip through the diaphram there would be nothing to hold the top of the stomach in place, and the wrap would slip.  Most who have the Nissen have a hernia...some small, some very large.   

Good luck with your decision!

Denise

Posted 2/3/2013 8:01 AM (GMT 0)
Lallabee

Yes the nissen is reversible. They just go back in and undo what they put together. The longer it's been healed the harder it is to undo though.

Take care,
Bill
Posted 2/17/2013 7:37 PM (GMT 0)
I'm sorry to post reply so late, but am having a lot of technical issues. I tried to post, and it just went away, so I hope there isn't a half post out from me.

At any rate, I did have ALL of the mentioned tests, and am scheduled for another Manometry PH on Wednesday.
The original doctor ordered the first PH Manometry with me being on my PPI.
The surgeon (yes I'm tetative for March 11 for a Nissen !) wants another test with me off PPI. He said I only need to be off for 3 days, but the gal doing the test told me 7 days off is best, so went with her advice.
In talking with her, I also found out from her that I have Barret's esophigus...which I thought I'd heard it mentioned, but after so many tests and being a busy mom/grandma...that one slipped past me. I don't even know that much about it, but know it could lead to cancer. My grandfather died from stomach cancer so double whammy...now I realize why they urged me so strongly to get the Nissen.
SO.....I graduated from PPI to Zantac for 4 days, and from now until Wednesday I can only have TUMS. On Wednesday for the PH test, nothing.
My LES is not weak. My last manometry showed substantial reflux while on PPI...but you can have reflux on or off PPI's right?

The reason I really want this surgery are these PPI's. They are poison in my mind, and I'm through with them.
I have enough health problems, and feel like the PPI's could be a big part of them.

My last manometry showed reflux, but the surgeon wants another 24 hour PH to measuer the acid. The woman that is doing the test for me, is the same woman that did the last one.
She says it's none of her business, but she said if there's reflux there's reflux.
I told the surgeons nurse I'd tried to go off PPI's about a year ago and had major rebound, and she told me maybe I'm better now. She obviously doesn't suffer with our issues rolleyes though she is a very nice gal.

It's good to hear this procedure is reversible, and I did discuss with the surgeon my lifting question.
He told me no 'unnecessary' lifting for 3 or so weeks, then would be OK to continue caring for my youngest grandson with help in lifting him, but I'd be OK to change him, play with him, whatever I felt up to (I'll have help from my 12 year old grandson).
He assured me the Nissen wasn't going to blow out, and the no lifting is mostly for the incisions.

Hope I didn't jump around too much here. Have I mentioned I'm ADHD?
turn
Posted 2/17/2013 11:10 PM (GMT 0)
Hi Lallabee,
It sounds like you've had plenty of testing, and you have covered all bases. I do think I need to warn you that while many can go off PPIs forever after surgery, there is no absolute guarantee that you'll never need them again.

You can ask your surgeon about this possibility, but I do think you should be made aware of it, since you indicated you have an extreme aversion to taking PPIs and are getting the surgery to ensure you won't need them. Generally, when someone does need continued PPIs it is a much lower dose. As I said, not everyone does, but it's not really uncommon either.

The surgery does not get reflux to zero...just to "normal" levels--like people who don't have GERD. Zero reflux would mean the wrap would be too tight to allow you to eat!

Good luck with your upcoming test. Hopefully, the rebound won't be too unbearable.
Take care,
Denise
Posted 2/18/2013 4:31 PM (GMT 0)
Whoa... Hold on. From EVERY doctor I have (and there is a LOT of them, believe me) the Nissan is NOT reversible!!! If it was, I'd have mine 'undone' in a heartbeat!!!
Posted 2/18/2013 9:08 PM (GMT 0)
Awe I realize I may still need PPI's, but I want to give this a shot.

vinylmasters: A question I failed to ask my surgeon was is the surgery was reversible, but we'll have another meeting before the surgery. AND...why would you have yours undone in a heartbeat?
I read about a guy on here that had one un-done, because if I remember right he had the surgery then found out he didn't need it and ended sueing some docs.
At any rate, I'm sure your experience will make me question yet once again if I should have the Nissen.

I just read a note from the last manometry that says :Acid exposure time abnormally high'.
Would that be the acid that has refluxxed?

As far as stepping down on the meds, I did pretty well with the Zantac, but started with only TUMS yesterday. I ate a ton of them and was puking up acid last night, and this morning. I haven't eaten yet today, but can feel the burn down in my esophigus.

Forgive my spelling please...spellcheck is not working.

Thank you for all of your advice folks. This is a good website!
Posted 2/18/2013 9:29 PM (GMT 0)
Hi Lallabee,

Don't let people who've had bad experiences steer you away from this procedure. It is still the "gold standard" for GERD abatement. If you have a high level of reflux, you'll be thrilled with the results. Just make sure you choose your surgeon carefully. A experienced Nissen surgeon is the key to great results. A great surgeon isn't enough. It has to be a surgeon who is experienced in the art of creating great wraps!

I just wanted to warn you not to be shocked if at some point you needed a PPI. Most likely it would be temporary...sometimes you get into a stomach issue, and it is necessary as a short-term fix. And no doubt there are some people who need to take a small amount on a regular basis over the course of the wrap.

I, in fact, take 40mg Protonix before dinner, because I have asthma and my doc wants to ensure that I am protected from even a small amount of reflux that might affect my lungs. I've read studies where even people who have to take some PPI after surgery are still extremely happy with the results. I didn't want you to feel as if you were tricked. Eyes open are always better.

Enjoy your day!
Denise
Posted 2/19/2013 12:50 AM (GMT 0)
Lallabee:

The only way to 'undo' the Nissan is a gastric bypass. Once the stomach lining is sutured, the blood flow is lost in that portion of the stomach, so that part of it 'dies'. What I was told was that it was gastric sleeve' bypass, which later would probably be changed into a more typical Roux-en-Y gastric bypass. After 16 operations (that's not a typo!), the thought of two more when I knew I already had more forthcoming wasn't very pleasing to me, but I went forward with it until my GI doc stopped the process.

Please note: EVERY case is different! I'm well, ugh... *unique* I guess, because I react bad to meds, ect. and can't take PPI's. The main reason I wanted to get rid of mine is because I've had two heart attacks already, and I can't eat the heart healthy foods I need to eat after this surgery (high fiber can be VERY painful, even with Beano and Gas-X). And on top of it I have bad legs and feet and can't exercise much so the weight gain is something I do NOT need - and especially because the surgery didn't really do much at all to stop the reflux for me.

But just because this happened to me doesn't mean it will happen to you or anyone else. but I would SERIOUSLY suggest looking at and trying ALL possible alternatives BEFORE you take the plunge for this, because once it's done. there is NO going back, but rather only forward to more surgeries that have further complications. Had I have known all of this ahead of time I would have never gone forward with it in the first place. Also make sure you do NOT have bile reflux, because the Nissan will NOT help at all with that (nor will ANY reflux meds as that's a gall bladder issue, usually meaning having your gall bladder removed - which I had to do after all of this because no one bothered to send me for any other tests other than an ultrasound which can NOT show if your gall bladder is diseased or not!).

So far, the best solution I found for acid reflux was simply to eat early (NEVER late!), avoid foods that cause heartburn/reflux and eat smaller portions (or don't over eat). I take 2 pepcid's or Zantac's a day, that's it. Heartburn is gone, but the reflux stays but is manageable IF I watch these simple eating guides above.
Posted 2/19/2013 3:59 AM (GMT 0)
Hi vinalmasters,

I totally agree that a Nissen fundoplication surgery should be a last resort. It should never be taken lightly, and anyone who can manage without it should do that. However, there are some for whom there is no other choice. For example, I am asthmatic, and though my reflux wasn't all that bad, it was enough to create havoc with my lungs. It was a last resort, and there was no guarantee that it would work for me. Fortunately it was successful, and it did the job of protecting my lungs.

Actually, I would disagree with your comment regarding the Nissen surgery and bile reflux. It is definitely an option for the treatment of bile reflux, and is listed on the Mayo Clinic website as one of two surgical solutions. There is no medication like PPIs that work for bile, but the surgery has been proven helpful.

I'm sorry to hear that you've had so many surgeries and have had such a poor experience with your Nissen. I hope you find an answer soon.
Take care,
Denise
Posted 2/19/2013 12:27 PM (GMT 0)
Denise,

I am only going by what I was told by the surgeon who performed my Nissan, as well as my GI and GP. I know it didn't help me at all, and the only relief came when my gall bladder was removed. What I was told is that bile enters in a different way than acid (for whatever that is worth) so it's really not an effective way to treat it. Bile is created by the gall bladder, and when refluxed is a sign of a diseased gall bladder. It's a safe and less invasive surgery as well. Or so I've been told.... :)
Posted 2/19/2013 4:17 PM (GMT 0)
Vinylmaster,

I have read from multiple sources, that the Nissen fundoplication can be helpful in alleviating bile reflux. What your docs were saying is that it is not a cure for a diseased gallbladder. Often after a gallbladder is removed, bile reflux can continue to be a problem. That's the bile reflux I'm talking about.

Here is one such study:
www.ncbi.nlm.nih.gov/pubmed/9841990

While it's not a sure thing, for people with severe bile reflux after gallbladder removal, a Nissen is a possible solution. Not a sure thing, but of course, nothing. Another possibility for severe bile reflux issues is a Roux-en-Y. I'm not really familiar with this procedure, but here's a study.

www.ncbi.nlm.nih.gov/pubmed/10824740

There's no simple answer to any of these issues, unfortunately!
Take care,
Denise
Posted 2/19/2013 7:05 PM (GMT 0)
In my case, the gall bladder was taken AFTER the Nissan. They knew there was a big issue with bile reflux, but only did an ultrasound to look for stones. Only after I had an attack did they take the gall bladder out. BUT - they told me it (the Nissan) wouldn't help for bile reflux.... That's all I can tell you. What I DO know is I still have reflux :( I'm thinking diet is a big part of it, and want to give that Fast Tract diet a roll, but with changes because of my cardiac history. I'm wondering how much high-fiber there is in it however, because that just destroys me after the Nisson was done (even with Beano and Gas-X).
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