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Is my pain after fundoplication connected to swelling?! Other experiences? Find mine!

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Posted 1/27/2015 12:48 PM (GMT 0)
Dear all,

I am new both to the forum and to my nissen fundoplication. I've suffered from reflux and heartburn since 2005. I finally decided to go for a fundo as my 80 mg of Nexium per day did not fully help me. I had my surgery 7 days ago. I had the procedure done, close to where I live, at a specialist hospital in Gothenburg Sweden ( I am Swedish... that is why my English might seem a bit odd from time to time...)

The standard procedure is to stay over night at the hospital after surgery with only a limited amount of clear fluid as intake. As I felt pretty good and had been up several hours walking already in the afternoon after surgery (slowly in the hospital corridors...) I was free to leave after seeing my doctor. I was sent home with pain killers for 3 days (paracetamol and naproxen). The pain overall in this stage was much less than I feared... something I did not expect was a sore throat after intubation.

Day 1-3 I felt OK. On day 3 I was out with my dog walking som 6 km / ~3 mi. Felt a bit tired but fine.
Felt something like reflux and consulted my doctor on day 3. He said not worry because the esofagus is hypersensitive in this stage and asked me to take up my Nexium treatment for a while... started up with 20 mg morning

The first 3 days my diet instructions was to eat "liquid foods" with nothing to chew. Ate som soups, 10% fat plain yoghurt (that I usually eat).

Day 4,5 I felt terrible, My stomach really swollen, cannot really eat more than a spoon at a time, feeling full for hours... really constipated- after using microlax a couple of times a day I got much better. This together with starting to eat fibers and more ordinary foods although chewing a lot.

Starting day 4-5 I have gotten more of a pain in the chest both when eating but also after... most pronounced in the late afternoons / evenings. Increased my Nexium to 20 mg in the morning and 20 in the evening.

Is this what many people talk about as getting swollen? Not so many speak of pain but rather a hard time to swallow... in my case I can swallow without any real difficulties but I have a rather strong pain that comes and goes. I now find it harder to burp as well (although that was limited after the surgery but definately more easy). Today on day 8 I feel sort of a lump in my chest as well...


Spoke to the hospital again describing my pain... through the nurse I got the message from my doctor to increase the Nexium to 40 mg in the morning and 20 mg in the evening.

Apart from this it is just to wait till I see the doctor next week, 15 days after surgery. I asked about the pain but I did not really get a good answer considering this apart from that I am still recovering after the surgery...

On the positive side... my stomach is working much better... feeling a bit bloated but not to bad! Also the reflux is almost not there might actually be all gone at the moment (I can tell the taste of if it even if I use Nexium...)

Is there anyone with similar experince of pain? And hopefully you can tell me it will get less with time... If not I will be much worse off after surgery than before... hope not!

I will get back with updates.

Daniel
Posted 1/27/2015 4:14 PM (GMT 0)
Hi Daniel,

Welcome to the Healing Well yeah yeah yeahWrap Club! yeah yeah yeah What you're describing is very normal. I don't know if you came across this, but here's my early recovery journal:
www.healingwell.com/community/default.aspx?f=45&m=2183443

If you read that, and the posts that follow, it might give you some information that helps you understand what is "normal" with his very challenging recovery.

You can also use the Google search box at the upper right hand of the page, and look for other threads on the topic.

Most surgeons don't prepare their patients for this recovery. Not sure if they're worried about scaring people away, or they just don't know. It takes six months for most of the recovery, and a year for the rest. I found improvements into the second year!

You're in the worst of it now. It will gradually improve. There can be some ups and downs during this part of recovery, but it's normal. I remember a lot of discomfort swallowing. I didn't even want to swallow, and had to force myself. This will resolve as you heal. Hang in there! Ask any questions that come to mind. There are quite a few experienced Nissen members here, who will be happy to provide support and information.

Happy healing,
Denise
Posted 1/27/2015 5:04 PM (GMT 0)
Thank you Denise,

I will keep on recovering!!! Just 8 days now...

As you said things go up and down.

Right now the pain in my chest is almost gone, although I have had it most of the day. I took a walk and after that the pain sort of eased. The chest pain (under the breast bone) is sometimes combined with a pain in my left shoulder... like the pain I had the first couple of days when I had shoulder pain stemming from the CO2 inflation during the surgery.

On the other hand I just got the taste of reflux in my mouth... bad taste but not acid as I am on Nexium as instructed by my surgeon.

I just checked my weight and it is down by 4 kgs (8 lbs)... This is probably close to my ideal weight. Well I am eating again so I hope not to loose to much more. My age is 42 for those of you who wonder.

I forgot to mention that I am really glad to have found this forum!!! It really helped me to worry less when I was feeling really bad 4 days past my surgery.


I will be back!

Daniel
Posted 1/28/2015 2:31 AM (GMT 0)
Hi Daniel,

A couple things come to mind regarding your response. First, walking. The shoulder pain can be alleviated at least to a large extent if you start walking. Obviously, don't overdo it. You don't have to win any races or distance contests. Just get up and walk as often as possible. I was lucky to have a treadmill, so even though it was February, I could get on the treadmill and walk. I started out very slowly, with no incline, and gradually increased my speed as I healed. I found that the more I walked, the less my shoulder hurt, and visa versa.

Next is the "reflux" in your mouth. I clearly remember getting "reflux" like that during my early weeks of recovery. There was no sour bile/acid in that reflux. It didn't come from my stomach. At your stage of recovery, your wrap is more swollen, and foods/drinks/medications get held up at the wrap site. That mixture, can reflux up your esophagus and into your mouth, mimicking that dreaded acid backflow that we had surgery to stop. Don't worry that you're having reflux. All of this will resolve over time, as you heal.

Don't worry about the weight loss. Once you start eating normally, you'll gain it all back.

Glad you've found the forum! I found it a lifesaver during my recovery.
Happy healing,
Denise
Posted 1/28/2015 9:36 PM (GMT 0)
Hi,


Thank you once more Denise!

I am convinced walking is good for me. I do have the strength for it so it is mostly a matter of taking the time and getting out despite the icy winds and sleet...

Furthermore I sincerely hope you are right when it comes to the reflux. It is definitely a different kind of reflux than before...

Now a daily update... day 9

The pain I was feeling in my chest was more or less gone for 24 hours... really an improvement... now it is back again but this time I think I have my self to blame... I ate too quick, did not chew enough and chose the wrong food... Well I was working and out travelling today and did not find any suitable food... The Chicken nuggets were OK but not the fries...

I felt that some food got stuck and after that it now hearts a bit... this time I can really understand why... I also know that I can eat pretty much everything as long as I chew well... of course excluding carbonated drinks, bread and so on. It is much easier to handle this pain as I can understand where it comes from.

Last night I was able to sleep on my side without any pain from the incisions.

My stomach is behaving well -not so bloated and no more constipation!

Overall I am doing much much better.

I'll get back with updates!

/Daniel
Posted 1/29/2015 2:12 AM (GMT 0)
Hi Daniel,

You are right about chewing foods. My surgeon set me free to eat "anything that could be chewed to a liquid" on Day 6. I was extremely appreciative of that trust, as it made my recovery much more enjoyable. Of course, there were foods I tried that didn't chew completely. The best advice when that happens, is to avoid swallowing it...keep a handy paper napkin available for depositing foods that don't chew to a liquid.

Oh yes...swallowing certain foods is very uncomfortable. In fact, I found certain foods irritated my wrap for a year or more. Entree salads and hamburger comes to mind. I could eat and swallow them just fine, but I'd have discomfort for a while afterward. I even got some dumping as a result of large salads. At some point, these foods didn't bother me anymore, and I can now eat them with no trouble at all.

My surgeon said that even mashed potatoes can create a bolus that has trouble getting through the wrap. He suggested small bites and chew, chew, chew. It was trial and error for me. It was so much better than being forced to eat only blended foods. My teeth/mouth were my blender. I enjoy eating, and chewing is the best part of eating!

During the first weeks, though, I got full on a very small amount of food. This is a result of the swelling. The brain interprets the swelling of the stomach as fullness. This subsides over time, as healing progresses.

Thanks for posting your progress. I'm sure it will help many others who are looking for information.

Happy healing!
Denise
PS...I'm confident that your "reflux" is just what I said. Don't worry for a moment.
Posted 1/29/2015 7:38 PM (GMT 0)
Yet another day past surgery and once again many thanks to you Denise! Day 10.

The pain from yesterday when I did not take enough care choosing my dinner is steadily going away. The pain in my left shoulder comes and goes. I´ve been out walking today so I have not misbehaved in that sense. I still get this reflux sensation although somewhat less today. My bowel movements have been really varied today... from just fine this morning to a more really urgent need to get out something out that was close to water... not a big deal after that.

Starting to look forward to day 15 when I will get rid of the stitches as well as the band aids on top of that. Fortunately the band-aids are still water tight.

I'll be back

/Daniel
Posted 2/2/2015 6:36 PM (GMT 0)
Hi Daniel,

I'm now 20 days post Nissens, and still only managing fluids. I keep trying semi solid foods, and end up with severe pain and nausea, so am dropping back to fluids every time. This is my second Nissens though,and I also had a sliding HH repaired, so am guessing it's just the trauma of the more extensive surgery that's slowing me down. I guess the best thing, as Denise says (and I guess you learnt from your fries incident!) to take it slowly with the diet, and be patient.

Like you, I'm still getting the reflux type symptoms, which do worry me, but deep down I know it's still early and they should go. Am thinking of picking up some gaviscon tho to soothe it!

Exercise wise, it's great that you're getting out and walking. I've done very little to be honest, but am starting to pick up the activity this week, as I'm hoping it might kick start my appetite... I've had no appetite at all up to now!

It does sound like your recovery is going along a pretty successful path, so I hope it continues for you!

Best wishes,

Kirsten
Posted 2/2/2015 7:42 PM (GMT 0)
Hi Kirsten,

Thank you for sharing your experience. I'm sure things will turn out well for you in the end this time. I suppose you just need some more time and patience as it is your second procedure.

I am now 14 days past surgery. I am feeling better day by day. I do feel something like reflux ( not yet today though!), but it is different from before and I don't really need to take anti-acids apart from my Nexium PPI. I am off to see my surgeon tomorrow. No more stiches hopefully.

I can pretty much eat anything as long as I chew and have some water along with the food. However, I got really scared at dinner tonight. I had some meat and as I tried to get the kids eating I forgot to chew... A piece of meat got stuck... painful and I almost panicked. However, some water and walking around made the meat pass. I do feel some discomfort after that but I am ok.

I still don't get really hungry. I eat anyway. I am more or less back on my normal diet (LCHF) apart from eating less of raw vegetables.

My left shoulder still hurts a bit now and then.

To summarize... I feel much better overall!

I'll be back to report my progress.

Daniel
Posted 2/4/2015 11:59 AM (GMT 0)
Day 16 after surgery.

I got rid of my stitches and saw my surgeon yesterday. 4 of the 5 incisions had healed well. One still needed some extra time and I will have to wear tape on that for another 2 weeks. The other incisions are also taped but just for a week more and not with a cover on top of the tapes. The incision that had not healed fully actually hurts a bit after the removal of the stitches.

My shoulder pain that still comes and goes is nothing to worry about according to my surgeon. There might still be some irritation left to my diaphragm and possibly some "fluid" that has not adsorbed yet.

When it comes to my feeling of reflux, my surgeon says it is extremely rare that these operations fail. However, small amounts of stomach liquids may still pass even after the fundoplication and this is wanted. His feeling is that my perception of reflux will go away and if it doesn´t I could be one of those who have an extra sensitive esofageus. I was adviced to gradually remove my PPI / Nexium when I feel ready for that. Even if I can´t get rid of all the PPI I most likely will need less. I used to be on 80 mg/day. I am now on 60. When it comes to the "rebound effect" he is not so convinced it is so great... He is quite knowledgeable when it comes to Nexium (the drug was developed a few kilometers/miles away from the hospital).

I will be back,

Daniel
Posted 2/6/2015 7:58 PM (GMT 0)
Day 18

I've really been longing for a Calzone Pizza... I had one today... Well I ate half of it directly and then shared the other half an hour later with my dog. No problem eating after chewing well and not eating too fast... I did get some reflux a few hours later...

I have now cured it with some red wine. Strangely enough, I have even before surgery always gotten better when drinking red wine, half a bottle or so. Although I still have some reflux, it is a lot better than before surgery.

I have no problem eating some PPI as long as it helps if that will be the case for the future.

My left shoulder still hurts a bit. One of the incisions as well...

I will be back.

Daniel
Posted 6/21/2015 8:53 PM (GMT 0)
Dear all,

It is now close to 6 months after surgery. I am doing well! I occasionally still have something like heartburn but it is not even close to what it used to be. I did get difficulties for a while but I suspect I tried to get rid of my PPI medication to quickly. I am taking it away slowly now. I used to eat 2 times 40 mg of esomeprazole per day... I now eat 2 times 20 mg per day and will soon try to lower it even further.

It is still painful to forget to chew what I eat... but it really depends of what kind of food it is. Food that sticks to the throat like bread and peanuts can get really painful... It usually helps to chew, take it slowly and not to forget... drink water/tea/beer/wine/coffee...

I have no problems to burp... it works but it it feels different than before my surgery.

I still have some slight pain in the stomach that I connect to the procedure... not much but I will ask my surgeon about it when I meet him next month for the routine follow up.

Overall I am fine, and I do not regret my decision to undergo surgery!

Good luck to you all!

Kind regards,

Daniel
Posted 6/23/2015 1:37 AM (GMT 0)
Hi Daniel,
I am experience something very similar to you, I am 6 days post op and I posted another thread. I am feeling terrible heartburn around the clock. It sounds like its similar to what you were calling chest pain. I am praying this will go away soon.
Thank you for sharing your experience.
Jason
Posted 6/23/2015 9:06 PM (GMT 0)
Hi Daniel,

It's great to hear that at six months post op, you're doing well! Remember, that improvements will continue throughout the first year. I had some improvements into the second year as well.

Thanks for coming back to report on your recovery! As you know, it's very helpful to others--especially those in the throes of early recovery. We all know how rough that is!

Thanks again!

Hi Jason,

I know it's scary to get reflux symptoms after going through surgery. Pretty much everyone during the first few weeks of recovery is fearful that their symptoms are indicative of a failed wrap surgery.

Please don't worry! My surgeon explained that the esophagus is a "dumb organ" and it interprets all pain as reflux. He also said that in the beginning the wrap can be swollen and misshapen, and can let through some acid. This will resolve with healing.

Another thing to keep in mind is that your wrap will become increasingly more swollen during the first two weeks or so, generally peaking on or about the 2 week mark or a little later. My surgeon warned me that my swallowing would get worse before it got better. It can also cause chest pain at the surgical site. That was a fact!

This recovery takes six months for most of the healing and a year for the rest. At six days, you are at the very roughest part of recovery. I don't know if you ran into my early recovery journal, but just in case, here it is. It might provide you with a little information that might be helpful:

www.healingwell.com/community/default.aspx?f=45&m=2183443

Hang in there! It gets better! It'll all be worth it in the end. Remember that although your outsides don't show it with those tiny incisions, your insides have undergone MAJOR surgery and your upper GI tract has been significantly revised. It has been very traumatic to your esophagus and stomach, so give it time to adjust!

Best wishes to both of you!
Denise
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