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Nissen Surgery Scheduled for 8-8-14 QUESTIONS

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Posted 7/24/2014 9:11 PM (GMT 0)
Hello, I am new to the Forum today. Like everyone else, I have struggled with GERD for years. It doesn't matter if I am sitting up, laying down, ate nothing or ate "bad food" I have reflux 24 hours per day. I had bravo monitoring done and my Demeester score was 126. My doctor said that is very high. Is it very high or have others experienced the same. I am scheduled for a lap nissen procedure August 8th. I have gained a lot of information from all of you. I have a few questions: 1. Will I have a NG tube after surgery, 2. Will I have a foley catheter? 3. Is it very painful the first and second day of surgery? 4. Does everyone have hoarseness? 5. Will they give me something for "nerves" preoperatively? 6. Will my throat be very sore. and 7. how difficult is it to swallow medications after surgery? Thank you all so much. I look forward to waking up one day and no longer have reflux. Good luck to all of you.

Added thread title

Post Edited By Moderator (dencha) : 7/25/2014 8:43:50 AM (GMT-6)

Posted 7/24/2014 10:05 PM (GMT 0)
Welcome to the forum, CCG.

1,2 yes but you won't notice them - asleep.
3 yes, but you will get pain meds - not to worry.
4 often, it will go away, not horrible.
5 only if you ask for it. You won't need anything if you do plenty of research and understand what happens. It's not really all that scary.
6 see 4.
7 can be quite difficult for a while. They should give you liquid meds. ASK for them! On this point - have a list of things like this that need to be taken care of for the person who takes you home. You may be a bit out of it and not able to remember what you need to ask. They never tell you this stuff before surgery when you have your brain working.

(8) make sure you have the doctor's recommendation for a diet before you go home. Sometimes they'll give you this well before surgery. Stock up on liquids and soft stuff like pudding that you like, enough for a few days. You may not need a whole lot, but you won't be able to drive for a couple of weeks at least. It all depends on how involved your surgery is. There is a good diet website at http://www.upmc.com/patients-visitors/education/nutrition/pages/diet-after-nissen-fundoplication-surgery.aspx
Posted 7/25/2014 3:03 PM (GMT 0)
Hi CCG0461,

Welcome to Healing well! Your DeMeester score is very high, and indicates that you are a great candidate for surgery. You are the type of patient surgeons love, because you'll definitely feel improvements. Once you've recovered your quality of life will be much improved. Keep in mind that this recovery takes six months for most of the healing, and a year for the rest. I'll answer your questions below:

1. Will I have a NG tube after surgery?
Most people don't, but nobody can tell you for sure if you will or won't. I believe it is generally done on a case by case evaluation, although my guess is that some surgeons use it routinely. I suggest you call your surgeon's office with this specific question.

I didn't know if I'd have one or not, because I'd read of their use on the forum. When I woke up in Recovery, it was one of the first things I noticed. I did not have an NG tube post surgery, or anytime while I was hospitalized.

2. Will I have a foley catheter?
Once again, a surgeon's prerogative. I did not have one. You'll have one in the OR, probably (I guess...I was asleep!), but it's uncommon to have one for any length of time.

3. Is it very painful the first and second day of surgery?
This is a very individual and subjective thing. I was pleasantly surprised that my pain level was very manageable, and I was much more comfortable post-op than I expected. Most people don't even use pain meds for more than a few days after surgery. Consider buying some liquid OTC pain medication (Tylenol/Motrin, etc.) to use once you find you don't need the heavier duty pain meds they send you home with. If you can get your surgeon to prescribe a liquid form of the pain med it is best, but if not, you can crush them and mix with applesauce, etc.

4. Does everyone have hoarseness?
Again, an individual thing...so I guess not everyone.

5. Will they give me something pre-op for "nerves"?
Absolutely. The anesthesiologist will come and talk to you one last time, then will start a med into your IV that will make you very relaxed. You'll be aware of going into the OR and getting on the table, and will hear them tell you you're about to go out, but you won't care!

6. Will my throat be very sore?
Mine wasn't a bit sore.

7. How difficult is it to swallow medications after surgery?
I never had trouble swallowing pills prior to my surgery, but I guess my wrap is a bit tight, because post-op, I've had to be careful with them. (See my answer to #3) I take liquid calcium now, and have made an effort to find medicines that I can handle via tablet. My doctors are very helpful and cooperative with this. It's not a real problem.

Good luck with your surgery!
Best wishes,
Denise
Posted 7/25/2014 6:17 PM (GMT 0)
Alcie and Dencha,
Thank you so much for your responses. I appreciate the information. I still must admit I am a bit apprehensive. I have read so much about the procedure and recovery that it has scared me. I must have the surgery as I am totally miserable and have been for a long time. I thought of a few things. 1. How long will I be on a clear liquid diet, and then full liquid and soft diet. Do you have to move to the point of regular food? I am so concerned about the ability to swallow both food and meds. I have a wonderful surgeon and that makes me feel somewhat better. I wonder how often does it require the open method rather than the lap nissen? What would cause them to do this? I am overweight and am concerned this will happen to me. Is there like a weight limit or something for lap nissen? Thanks.
Posted 7/25/2014 8:30 PM (GMT 0)
Hey, my surgery is just a few days after yours, I'm on 8/12. Thanks for posting this, I would not have thought to ask some of these questions.

From my research, the diet is going to vary slightly by surgeon, but for the most part it's something like this:
Week 1/2 - clear liquids only (soups, broths, jello, tea, etc.)
Week 2/3 - full liquids (milk, creamy soups, yogurt, pudding, etc.)
Week 3/4 - soft foods (foods that are soft and squishy and do not have to be chewed much)

Here's a diet I found online that I've been reading and working to build a shopping list from: http://www.upmc.com/patients-visitors/education/nutrition/pages/diet-after-nissen-fundoplication-surgery.aspx

I think how long you're on each stage of the diet will depend on how full your wrap is, and whether you have any other complications, too.

I found this site with information about contraindications that may lead to an open nissen: http://emedicine.medscape.com/article/1892517-overview

As for weight, it specifies morbidly obese, and defines that as a body mass index greater than 35 kg/m2.

I get pretty nervous, too. I think one thing to remember is that most of the complications you are going to read about here and elsewhere are actually a small minority of the procedures performed. Most people who have a successful operation don't come back to a forum to talk about it, instead they go off and live their life and forget all about it. :)

Good luck, and I'll be glad to hear your progress if you feel like reporting back!
Posted 7/26/2014 2:27 AM (GMT 0)
Hi CCG,

I'll try to answer your additional questions:

How long will I be on a clear liquid diet, and then full liquid and soft diet. Do you have to move to the point of regular food? I am so concerned about the ability to swallow both food and meds. I have a wonderful surgeon and that makes me feel somewhat better.

Doctor protocols vary quite a bit. Some have their patients on clear liquid, than liquid, then soft, then introducing a regular diet. Other surgeons, (mine included) have a much more liberal protocol. I was on liquids my one day in the hospital, then went home on a soft diet. After I saw my surgeon on Day 6, I was set free to eat "anything that can be chewed to a liquid/creamy consistency." He warned me to stay away from untoasted bread (toasted is fine), sandwiches, and steak for approximately eight weeks.

I appreciated the trust he gave me, allowing me to make my own careful eating choices. My teeth and mouth were my blender. Obviously, the first two weeks are very dicey, as there is surgical irritation/pain, and increasing swelling. Just listen to your body and don't swallow anything that doesn't chew to a liquid. I used to keep a paper napkin handy to deposit foods that didn't chew thoroughly. Take small bites and chew, chew, chew, and you'll do fine.

Be sure to stay away from iced drinks, as they can cause esophageal spasms. Room temperature is best in the first weeks. Also, no straws or carbonated beverages, as they increase bloating. Sipping room temp water or warm tea, helps things go down.

As healing progresses, you'll gradually be able to eat more and more comfortably. You'll always have to chew your food more carefully, but it's a healthy habit for even our non-wrapped friends. I'm five and a half years post op, and can eat anything I want without a problem, although, as I said, I chew more carefully than I did pre-Nissen.

Some people have been lucky enough to have surgeons who order them liquid pain medication for when they go home. Mine didn't, but I crushed it and mixed it with applesauce. I also made some changes to my meds and supplements...choosing smaller tablets and liquid calcium. Some people never have a moment's problem swallowing pills, but I have found it more challenging to swallow large pills since my surgery.

I wonder how often does it require the open method rather than the lap nissen? What would cause them to do this? I am overweight and am concerned this will happen to me. Is there like a weight limit or something for lap nissen?

Bill, a moderator here, had an open redo surgery, and said it was no problem at all...in some ways, it was easier to recover from than his previous lap surgery.

I don't think there's a weight limit, however, overweight people can sometimes have enough internal fat as to make it difficult to have a clear field of view for the surgical tools. No surgeon can guarantee that they won't have to move to an open procedure if necessary. After hearing about Bill's open surgery experience, I don't worry about that anymore, should I need a redo at some point. I'm sure your surgeon will try to stick to a lap version of surgery if at all possible, so don't worry. After how much you've suffered with GERD, the surgery will be a big improvement no matter which procedure your surgeon chooses.

Glad you've joined the forum...it's a great place to get information and support as you recover!

Best wishes,
Denise
Posted 7/26/2014 2:31 AM (GMT 0)
Hi Brianala,

Welcome to Healing Well! It's great that you both will be recovering at the same time and can support each other! Glad you've joined the forum!

Best wishes,
Denise
Posted 7/26/2014 2:45 AM (GMT 0)
I am very glad I found this forum. Already I feel a bit more prepared for surgery.. I still have that fear of having to have an open procedure. Thank you Brianula for your comments and the additional sites to visit. I am glad we are having this done at about the same time. I wish you were going first though, ha, ha.I have made a grocery list and will go shopping soon. Thanks again, and if anyone has other bits of information, please share.
Posted 7/26/2014 11:22 AM (GMT 0)
My two cents:

If they do a floppy, they put a spacer down your throat called a Bougie. It keeps the lower end of the esophagus open while they do the wrap. The spacer prevents the wrap from being too tight. Then they remove the spacer. Because of the spacer blocking the esophagus, I don't think they can use an NG tube.
Did you have a raspy throat after they did your endoscopy? I did. The effect of the Bougie is the same. It goes down the throat in the same manner and causes temporary raspiness. It goes away in a day or so.

Catheter. I think they have to use one. During the operation they used a general anethesia so you have no concious control of your muscles or body functions. As I understand it, when they do the actual laproscopic surgery they tilt the operating table downward so there is the added risk of you "letting loose" during surgery. In my case they put it in after I was on the operating table and was already out and I knew nothing about it until afterwards.

I am a worrier and I was extremely nervous right up to a few days before surgery. One reason was that even though I had complete confidence in my surgeon, the other rank-and-file hospital staffers in the hospital seemed to be completely in the dark as to what was going to happen. I had to do the pre-admissions check-in about a week in advance. It was a military hospital and they have many administrative routines that you have to go through. It didn't seem like anybody knew what the the HH repair or NF was. Although it was the most important decision I had ever made health-wise, to them it was just another surgery--no more signifigant than an in-grown toe nail. So, although the Surgeon had assured me that he had done many of them and that it was his favorite operation, I worried that he wouldn't be around after surgery to oversee my recovery and subsequent care. Not only that, what about if I had problems and had to go to the emergency room......would there be anybody who would know what to do????? So, during the pre-admissions I asked if they could give me anything for the nervousness. They gave me one vallium to be used the day before surgery. During the final few days prior to surgery, I relaxed myself by reationalizing that during that time on the opereating table I would be totally helpless and no amount of worrying would change it. So, I turned the whole thing over to the Surgeon and God. I relaxed and didn't even use the vallium.

Everything turned out wonderfully. My surgery went well. The primary discomfort naturally was the pain in the shoulder that everybody experiences; the sore throat and raspiness that lasted until the next day; and, that darn catheter. As I think back on it, the catheter caused me more discomfort than the operation and it was just the burning sensation that was in an "unfamiliar" location. They took it out the next day so one major discomfort went away but it was difficult to pee for a few days.

Good luck with your surgery and may God bless you and your recovery. My E-mail address is in my profile if you have any other questions that I might be able to help you with.
Posted 7/26/2014 2:46 PM (GMT 0)
One other thing I forgot to mention was my post-op diet experience. In my pre-op interviews with my Surgeon he told me on several occasions that I would be on a clear liquid diet for two weeks. So. I prepared for that by buying all kinds of clear liquids--sodium free chicken and beef broths, pre-made jellos, juices, gatorade, etc,. I also bought a pill grinder, liquid Tylonol and other liquids that others have mentioned in previous replies.

A few hours after my surgery the surgeon visited my room to check on me and told me that I could have anything that could be pureed. That was a big change from what he had told me before and I took him at his word. So, even though I did drink a lot of the broths and clear liquids, I also bought vegetable beef and other canned soups and would take half a can of those soups and puree them and thin them out with the broth. I also ate a lot of applesauce. I ground up my pills and mixed them with applesauce to make them go down easier.
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