6 months post Nissen - anyone have any ideas/ advice?

Hi Everyone,

So I'm 6 months post wrap, things are great and not so great   I now have no regurgitation, my asthma has gone and I'm completely off my Asthma meds and my Nexium. I was lucky enough to have no rebound symptoms when I came off the Nexium but wow, I didnt realise how many side effects the Nexium was causing! All my dodgy heart rythms and evil headaches have gone!!!! It's evil stuff

Anyway, I saw my surgeon 6 weeks post op and was still in pain and suffering heartburn type pains, he said this shouldn't be the case so sent me for a Barium x-ray. This showed that liquids went done ok but then the coated cookie got stuck at the wrap site but was washed down with further liquid. The dr who reported on my xray said he didnt think the wrap was intact but then said he couldnt really see it anyway so my surgeon did a Gastroscopy and found that there was no inflamation and that the wrap was intact   and he has now discharged me back to my GI. So the not so great bit is the pain and weird swallowing type things: I get heartburn and chestpain but also I get awful back pain between my shoulders, this often appears awhile after I've eaten. I don't think I had this pain before the wrap. In terms of swallowing, I find that a lot of the time I have to wash food down with liquid ( as it showed in the x-ray), sometimes I think it's gone down but then take a drink and realise im washing the food down. Tablets are a nightmare, especially the small ones! I also find that sometimes I have to try to burp to try and get food/drink past the wrap, it's as if I have to open the wrap by burping. THis doesnt happen all the time though. Does anyone else have these problems? Am I going to damage my esophagus by food getting stuck? I'm so confused, worried and I don't like the pain. Would the surgeon have seen with the scope whether it was too tight.

I'd love it if somebody could give me any advice/ ideas on what it might be?

MM

Hi Mollymarie,

Welcome to the Healing Well Wrapped Club! What you're describing doesn't sound normal.  Because your wrap is "intact" doesn't mean it is correctly constructed and working well.  I'm not a doc, but from my experience with my own wrap and others here, it sounds like your wrap is either too tight, or not correctly put together.

Another moderator here, Bill (opnwhl4) had a problem swallowing with his first wrap.  Here's his description of his first wrap experience:

 

Bill said:

Well that's an interesting story, kinda long too. Here goes.....
I had my first Nissen 6/6/06. After about 3 years of dysphagia and about 15 dilations with no help I was referred to Loyola Medical Center in Chicago. I had all the same initial tests and the finally found an abnormality on the 4th barium swallow, but they weren't sure what was causing it. After my wife and I insisting on having something done my surgeon decided to do an exploratory surgery. So on 5/18/09 I had my first redo. While in pre-op he asked me what I wanted him to do if they didn't see anything wrong or if they did find something wrong. Since he is a very experienced surgeon on Nissen redos I opted for him to do what he would want done if it was him on the table. After waking up he said he was very glad we kept after him to do the surgery because it was done incorrectly and was at a 90 degree angle at rest. No wonder food was getting stuck. Since it was done wrong it took almost 6 hours to redo it and I found out he brought in a lot of surgeons in training to see what not to do. I didn't ask enough questions of my first surgeon. I just asked if he could do it and he said sure. Since he had removed my gallbladder a year earlier I figured he could do it with no problem....WRONG.

Here's the link to his entire experience:

https://www.healingwell.com/community/default.aspx?f=45&m=2337138

You might want to get another opinion from a surgeon who's a pro at Nissens/Nissen redos.  You'd have to do some research to find the best person possible.  Think about it!

Very best wishes!

Denise

Hi Mollymarie,

I'll drop Bill an email and let him know you have questions.  I'll include a link to this thread. 

It is not normal to have those problems at your stage in recovery.  You should be able to swallow normally by 6 months, barring any unusual setbacks like vomiting/retching.  (That can irritate things and slow up your progress...by the way, do you have anti-nausea drugs handy?  You should always keep them with you once wrapped. Vomiting/retching can cause lots of problems and damage wraps.)  It's normal to have to eat more slowly and chew your food completely before swallowing, but as long as you're following that "wrapped rule" you should be able to swallow without a problem.

Your surgeon is way off base.  Maybe if you had lower GI issues or stomach was bothering you, that would be a different issue.  But swallowing problems are linked directly to the wrap--or motility issues.  Were you tested with a manometry to measure your swallowing reflex before having the surgery?  If you have swallowing reflex problems, that could make it difficult to get food past your wrap as well.

Do you live near any large medical centers/universities?  How about a Mayo Clinic, John Hopkins, Duke University, or Cleveland Clinic, etc.?  That would be a great place to start.  You want to find who does "all the Nissens" or who specializes in redos.  If you're questioning how your wrap is working, you'll need to find someone who has lots of experience fixing other surgeon's problems.

I'm very glad your asthma has resolved.  I'm an asthma sufferer, too, and my lungs were a mess before my surgery.  I would have a redo in a heartbeat if I started having lung issues again!

I'll email Bill now, and he should respond pretty quickly if he's around.

Best wishes!

Denise

Mollymarie

Howdy! Sorry to hear you are having swallowing issues still. The mashed taters stood out to me. That is a tough type of food to get down. Seems strange, but they can pile up very easily. I now have some motility issues since my esophagus tear, but it hasn't caused much of an issue for me.

Do you know if your surgeon did the wrap by sizing it with a bouge or did a floppy wrap? If it was sized with the booge it might be a bit too tight. They can dilate the wrap some, but I would be sure to go to a surgeon who is very experienced with this. Also seeing a surgeon who specializes in swallowing disorders would be helpful. My 1st redo surgeon was a swallowing specialist and that helped out in my case.

If it was a floppy wrap done then your body might be taking longer to heal. Would you list what foods are the worst and what foods are better to get down? Without knowing how much of a motility issue you have it's hard to say what would have been better, but a 270 degree wrap might have been a better choice in your case.

This may sound silly, but are you remembering to chew your food to a liquid still and waiting about 30 plus seconds between each bite? I had to keep doing this for about 9 or more months with my 1st redo. I now can tell when food goes through or not and use what ever I am drinking to help it through.

The burping to get food through is something I am very familiar with. It's hard to understand unless you have to do it. It seemed like an air pocket to me and I needed to get it up to let food go through.

I had several barium swallows after my 1st nissen and I had to swallow a 12 mm wafer and they timed how long it took to go through. They told me it should go through within about 30 seconds, but mine hung there for 20 minutes until it dissolved enough to go through.
My 1st one was done wrong and the lower part of my stomach was brought up to make the wrap instead of using the upper only. that made my esophagus sit at a 90 degree angle until I swallowed then it would try to straighten out. This made it very difficult for them to figure out what the problem was, but they did finally figure it out.

DON'T GIVE UP! Someone will be able to help you. Whether it's just backing off your diet a bit and letting things heal more or finding if something is physically wrong in there.

Please feel free to email me any time. I usually am up very late and check my email regularly, well except for the last couple days since we had a tornado and the power just came back on.

Take care,
Bill