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HELP! Told to have Operation! Told I didn't qualify!

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GERD & Acid Reflux
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Posted 1/27/2014 12:10 AM (GMT 0)
Hi! Please I need some information! Been reading posts for a while and haven't had anything to really add since I first joined. I have suffered for the last ten years taking 20mgs. of omeprazole twice a day. I still have acid reflex. I have been told I have a small, fixed hiatus hernia. Following are my symptoms; acid reflex at night, I cough, there is a feeling of something in my throat all the time, trouble swallowing, nose is full of sticky mucus 24 hours a day, my voice is different (hoarse and I can't yell or talk for long without coughing), I have a sore throat. I do NOT have bad heartburn though when I breathe I my throat feels irritated. I was on a 900 calorie diet for six months, eating nothing spicy or reflux irritating, lost 40 lbs. and still had the above symptoms. Two years ago I had an endoscopy. At that time I asked my Gastroenterologist if there was an operation to correct the hernia. He said I did not qualify for an operation. I asked again last year, he said no and suggested I get tested for allergies. I did, I have no allergies. This year I went to a new doctor for a physical and he asked me "Why don't you have the operation to fix the hernia." I told him I was told that I did not qualify for an operation. He told me that was nonsense. With all my continuing symptoms I did qualify. That the operation was outpatient. I have an appointment with a surgeon on Tuesday. I am concerned that my "enthusiasm" for getting this...quick "fix" might be premature or unfounded. What is this operation and am I right to be confused? I would LOVE to not have this condition/disease. Opinions/knowledge/information PLEASE??
Posted 1/27/2014 12:57 AM (GMT 0)
Welcome to the forum, True.

After 10 years I would be looking for help too. A gastroenterologist doesn't do surgery. But even if a surgeon says you do qualify it's a last resort, so make sure you've tried everything else first.

By "fixed" hiatal hernia I presume you mean part of the stomach is stuck in the chest. Sliders go up and down and don't cause a problem unless large. Have you had the barium swallow to see how much of the stomach is in the chest and if it's stuck there? Did the gastroenterologist do any testing - barium swallow, pH, manometry, whatever's new?

Testing for allergies is a good thing. But not all foods and additives are possible to test for. Look up food journal in the search box. Since the gastroenterologist suggested allergies, learn about sensitivities, food triggers, food intolerances too. After I found my food triggers I was able to avoid surgery for years.

The surgery won't fix food intolerances and sensitivities. It's also major surgery, not to be rushed into. I eventually did have to have it after a wreck that pushed my stomach partly into my chest. I don't regret it although as a senior it took me a long time to recover. I still have to avoid my triggers, but I understand them now.
Posted 1/27/2014 1:22 AM (GMT 0)
Alcie, thank you so much for your reply! This is what I was afraid of! I have read some of the posts here and though I do NOT understand a lot of the technical/medical aspects of the posts I DO realize that I have had NONE of the tests you, and others, have listed. If my gastroenterologist didn't do any tests what doctor does and why didn't my doctor do these tests? Do I have to "ask" I have them?

Also, why is the outpatient operation a last resort?

I am sure that the surgeon will encourage that I have the operation. After all, this is how they make their money. I am not saying there is anything wrong with that, I am just saying that he is not a "Specialist" in GERD and perhaps his idea of fixing the hernia is his solution to my problem, though in the long run.....What?

Thanks again Alcie! I feel like I am running out of time. Appointment is Tuesday! Cheers, Nancy
Posted 1/27/2014 5:25 PM (GMT 0)
Oddly, my surgeon was the one that suggested all of my tests. I saw him for an emergency procedure and he helped with all of the testing and reading results afterwards. This was obviously done with my other doctors help and guidance but I just wanted to reply saying - sometimes surgeons don't give you the "go for surgery" advice just to make money... some of them really know what they're talking about with this procedure.
Posted 1/27/2014 7:55 PM (GMT 0)
My insurance would not pay for the NF until I had the Bravo & DeMeester tests which provided proof of reflux sever enough to require the NF surgery. I had the procedure outpatient, also what my insurance company BCBS would cover. My result was excellent, I would suggest you ask your GI for these tests, they are done in combination with an upper GI endoscopy.

Cary
Posted 1/28/2014 12:47 AM (GMT 0)
Thank you so much for the info! One more question: I was told the procedure was outpatient so what makes it "Major Surgery" and a "Last Resort"? When I went to my GI who recommended I go to a surgeon he said, "every patient I know who has had this surgery says the operation was the best thing they ever did."
Posted 1/28/2014 2:13 AM (GMT 0)
AR True, I played cards yesterday with a lady in her late 70's who had the endoscopic surgery for hiatal hernia six days before. She was moving around completely normally and said she had no pain; had only mild pain right after the surgery.

She was complaining that her diet was still modified (no bread, etc.), but was doing really well.
Posted 1/28/2014 6:15 AM (GMT 0)
AR True

The surgery for this can be done as an outpatient surgery, but you may have to stay the full 23 hours or even over night. It all depends on how you are swallowing and your pain is.

With the Nissen they detach the upper part of your stomach, fundus, from the spleen and wrap that section around the area where your stomach and esophagus connect, the LES. They also will fix any overly large hernia you may have at that time. Normally this can be done as a lap surgery, but if things aren't ideal they may have to do it as an open surgery. It usually takes about 1.5 to 2.5 hours for the surgery.

What makes it a major surgery and last resort is because it has a fairly long recovery and diet restrictions until things are healed. this can be as long as a year for full healing and effect. Most are doing very well at 4 to 6 months, but some can take longer. You also may not be able to vomit and have a difficult time burping. Until things are healed well and the swelling goes down you also may have a hard time swallowing solid foods.

There are a few other options available too. The Linx is showing good results and they are working on trials for a device to implant a device to stimulate the LES to tighten it.

Before going this route you need to have tests done to see how much you are refluxing and if you are a good candidate for the surgery. Tests are, EGD, Manometry, PH study. With these they may also want a barium swallow or stomach emptying test.

No surgeon should do this surgery without having the 1st 3 tests. If you were to have a swallowing function issue and they do this surgery it will be much worse, so a manometry is needed. They also need to know how much you are refluxing and a PG study shows that. The EGD shows them exactly what the inside of your stomach and esophagus looks like and they can do biopsies to test for a few other things like barrets esophagus and H-Pylori.
Before letting a surgeon do this surgery be sure they have done 100s to 1000s of them successfully. Successfully is the key here. Also find out if they do redoes in case you would ever need it in the future.

Take care,
Bill
Posted 1/28/2014 4:32 PM (GMT 0)
THANK YOU ALL!!! I am now well armed to go to the Surgeon, find out if he can order these tests. If he can't I will ask my GP. I'll go from there. I was pretty sure that it was the recovery that was the big issue. I will take this all into consideration. We are full-time RVers presently in the Yuma area. We are scheduled to leave March 1st, though we could stay until the end of March, so I may not have time for the procedure.

Also, I am on Medicare and supplemental F insurance. Does anyone know if these tests & the procedure are covered?

On another issue: LOL I have a very hard time finding something I can drink besides H2o. I try to drink a lot of baking soda laced water during the day. It seems there is nothing else that agrees with my stomach. Sodas, Fruit Juices, crystal lite. I get really tired of water! Any suggestions?
Posted 2/6/2014 1:03 AM (GMT 0)
I TOOK NOTES WITH ME FROM THIS THREAT. THANK YOU SO MUCH!
Surgeon told me I was a candidate for surgery. Before procedure I am scheduled for: EGD with Bravo Capsule & a Baruim Swallow. There is no facility here, in Yuma AZ, that does a Manometry. I am a bit worried about this since I've had my throat stretched during the two endoscopes I've had. Surgeon asked many many questions before agreeing that after I take the preliminary tests he would proceed with the Nissen procedure. So, here I go, it is a relief! Not set in stone.

I have a question. If the Manometry Test is not available and I've had, in the past problems with swallowing, should I worry about having the procedure? I am a bit SCARED about not being able to swallow!
Posted 2/6/2014 6:28 PM (GMT 0)
Every time I read these posts I get worried about not having the Manometry test! I like the Doctor I went to here in Yuma but maybe I should I try to get up to the Mayo Clinic in Phoenix.
Posted 2/6/2014 10:20 PM (GMT 0)
Yes it is very important to have a manometry test as it highlights swallowing issues. You may have problems in swallowing after surgery if not done correctly . Also ensure you have the correct surgeon who should have done hundreds if not a thousand of these ops.
Posted 2/12/2014 3:42 AM (GMT 0)
Absolutely make sure that you do not have a swallowing problem before having fundoplication. I had surgery in 2011 and they did a partial wrap of 270 degrees due to a swallowing problem picked up on the tests. The surgeon said that a full wrap would have caused me worse swallowing issues. I have had a very successful recovery.
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