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Posted 4/8/2015 10:58 PM (GMT 0)
Hello everyone,

I wanted to post my Nissen Fundoplication recovery journal to encourage others who are on the fence regarding the operation. This was my first surgery and I was terrified to go forward with it, which ultimately meant suffering for much longer than I should have.

My stomach issues started at age 6 with chronic vomiting. Doctors could not find anything wrong with me but I was sent home from school daily due to vomiting. After about a year of this, I was diagnosed with asthma and the vomiting was attributed to gagging from the asthma. I was started on breathing treatments several times daily, which seemed to help with the vomiting. Periodically throughout the next 5 years, I would wake up at night projectile puking for no reason (that we knew of).

I started swimming competitively around age 10 and the vomiting returned. I was always nauseated in the mornings and started skipping meals to prevent myself from vomiting. For this same reason, I avoided rich foods and carbonated beverages, both of which seemed to make me so sick. I swam all through high school and college, and learned that I had to skip meals until after swim practice or I would be sick in the pool. Most days, I would attend morning practice, school, afternoon practice, and would have my first meal at dinner. Anything to avoid sickness. My doctors never seemed concerned, and most blamed my nausea on hormones since I was a teenager.

At 20, I experienced my first severe GERD attack. I awoke in the middle of the night with severe chest pains, trouble breathing, racing heart, and a horrible taste in my mouth. Vomiting soon followed and I was able to go back to sleep. This happened about once per week for the final two years of college. I also experienced daily reflux when I was in the pool swimming. It felt like I had phlegm coming up the whole time and I was always clearing my throat.

After college graduation, my stomach really started getting worse. I began vomiting blood, and didn't tell anyone because I was so afraid that it was something serious. At the time I was starting credential school and student teaching, so I had no health insurance. I self-medicated with Prilosec and the vomiting improved again, so I didn't worry about it. (Looking back I can't believe I waited so long to see a specialist!) I also started modifying my diet to make sure that it wasn't a specific type of food causing my symptoms. I was gluten-free (strict) for three years, dairy-free for one year, and even vegan for a few months.

Finally, in October 2013, I gave in and made an appointment with a gastroenterologist. By this time, I was having all sorts of pain, from burning to stabbing, GERD attacks three to five nights per week, and having blood in my stool and vomit. The GI doctor quickly scheduled me for an endoscopy and told me he thought I had GERD.

My first endoscopy confirmed the GERD diagnosis. Thankfully, I did not have Barrett's but did have several ulcers in my esophagus and stomach. I was started on PPI therapy (Prilosec 20 mg 2x daily) and put on a modified GERD diet. Things started to slowly improve but I still felt nauseated most days and was having constant reflux (although it was no longer acidic). My asthma was difficult to control and I would still have breakthrough attacks once a week at night. The two days after an attack were awful and I would struggle with asthma and pain several days per week.

Six months after my diagnosis I came back for another endoscopy. My esophagitis had improved from Grade 4 to Grade 3, but was still present. I also still had several erosions in the stomach lining and esophagus, as well as gastritis that hadn't improved. My doctor changed my PPI to Protonix. I didn't notice any improvement in symptoms.

I ended up in GI urgent care a few more times before my doctor mentioned the possibility of surgery. I decided to pursue this route since my quality of life was suffering severely and I was only 29. The idea of having children and a normal life seemed so far out of reach because my health was so poor. I made an appointment with a surgeon and never looked back.

Preparing for surgery was scary for me as I didn't know what to expect. I had already had two endoscopies, a CT scan, and an ultrasound of my abdomen. The surgeon wanted me to do an upper GI series/Barium swallow and a motility study. I did the Barium swallow and it was easy and not scary at all. Kind of fun riding on the xray bed! It confirmed my GERD diagnosis and showed a medium paraesophageal hernia (4 cm) and reflux.

I made the appointment for the motility study. Being in the San Diego area, the only place to go is UCSD, so I went and had the study done there. It was extremely challenging and uncomfortable, but not painful. I struggled with the tube once it was placed. The placement was the part I was most afraid of, and that wasn't bad at all. The nurse was great and very friendly and prepared me well. However, the test did not go well. My nose was bleeding, running into my throat, and making it really difficult to not swallow during the test. My test showed signs of swallowing issues, but overall I showed 80% motility success. During this appointment, my nurse asked me who my surgeon was. I told her and she suggested that I see Dr. Santiago Horgan at UCSD. She said he was amazing and that the majority of the patients she saw were sent by him.

I decided to change surgeons after my surgeon told me a few alarming statistics about his patients. I saw Dr. Horgan and he was great. Very up front and blunt. He is extremely experienced, and does 10-25 Nissens per week. However, he wanted me to retake more tests. I had another upper GI test, another endoscopy, and a 48 hour pH monitoring Bravo test. The Bravo test was much easier than I expected. No pain from placement, no annoying feeling of having something in my throat, and it came off after 4 days. It was actually really great seeing how severe my acid reflux was. For some reason, it felt like affirmation that I wasn't just crazy or overly sensitive to pain. This was a real issue that needed to be taken care of. My Demeester scores were 69 day 1 and 114 day 2.

Dr. Horgan is also known for being extremely strict with his patients as far as diet goes. I was still having such bad symptoms that when he approved me for surgery, his closest date was 4 weeks out. He put me on a liquid diet for four weeks prior to surgery to help prepare my stomach, liver, esophagus, and bowels for the surgery. Surprisingly, I felt the best I have in years while on all liquids. The month passed quickly and it came time for surgery.

I had my surgery (Paraesophageal hernia repair with Nissen Fundoplication) on March 24th. It has been ten days and I feel amazing. My next post will be all about the recovery process.

I also really want to thank Denise, Bill, and all of the other posters who put up their recovery process and journals. I have spent at least a year reading every post and researching the surgery. I am so thankful to you all and feel like I know you, despite never having responded or posted before. Your encouragement led me to get the surgery, and I am so thankful.
Posted 4/8/2015 11:20 PM (GMT 0)
Part 2: Recovery!

Okay so my surgery was done on March 24th at UCSD hospital in La Jolla. The surgery took 75 minutes, and according to Dr. Horgan, everything went as planned. During surgery, he found a liver nodule and removed it for biopsy (it was benign).

After surgery, I woke up in the PACU with no pain. I remember talking a LOT to my nurses, and probably making no sense! I needed to urinate so one of the nurses brought me a bedpan. I remember being excited that they hadn't inserted a catheter. I was also surprised and happy that there was no NG tube in place. My blood pressure and heart rate shot up during surgery so the nurses wouldn't let my family back until they were stabilized. I was in and out on pain meds (Fentanyl and Tramadol) and very comfortable but aware that I shouldn't move too much or flex my abs.

Two hours later my family was allowed in and I woke up a little more. The nurses brought me ice chips to try as I was really thirsty. I was so scared to try my first swallow of the ice liquid but it went down well. No spasms or pain. For the first time I could remember, no liquid came up either! I was so happy to have zero reflux. Four hours after surgery I was able to get out of bed (with some help) and use the restroom. I noticed that sitting down on the toilet took concentration. I had to try not to use my stomach muscles. I am so thankful for all the years of swimming and water polo- my legs are strong which made it much easier!

Eight hours after surgery my vitals were finally stabilized and I was moved to a private room. So nice- I kept calling it my hotel room on accident. I had a bed, my own bathroom, and a couch/window seat for my husband to sleep on. The nurses switched me to morphine and Tylenol via my iv, which took away pain so I could sleep for 3 hours at a time. Thankfully I had my Bose noise cancelling headphones (best purchase ever) so I slept like a rock. At this point, ice packs on my abdomen and shoulders helped immensely with incision pain and referred pain.

I was careful to get up as much as possible and walk, walk, walk. Every time I used the bathroom, I would ask a nurse to unhook my iv so I could walk the halls. I started with 10 minute walks, and quickly progressed to 30 minutes.

Day 2:

In the morning the nurses tried to change my pain meds to liquid Lortab. I quickly learned that this was not strong enough and that I needed more relief. I wasn't able to take deep enough breaths while on the Lortab and started getting some chest congestion. They put me back on Morphine and Tylenol and I was able to breath deeply again. My surgeon came at 5 am for a visit and to tell me that everything went great. He reminded me to breath into my incentive spirometer (HATE that thing) and checked my incisions. Because I was swallowing clear liquids with no issues, he approved me for full liquids for breakfast.

Breakfast was crazy. I couldn't believe how much they wanted me to drink. I was able to drink a pint of milk and felt stuffed to the brim. I saved the cranberry juice for later. No issues swallowing but I was very careful to take small sips and to let the milk warm up in my mouth before swallowing (thanks Denise for the tips!).

For lunch I had another pint of milk and some apple juice. No issues swallowing. Little pain from not being able to burp at all. Walking helped a ton with the gas issues. The CO2 gas was a weird feeling. My stomach was bloated and I looked 6 months pregnant. My shoulders hurt but not like I thought they would. Ice packs really helped with that pain.

Because I was still having trouble managing my pain with oral pain meds, the doctors wanted to keep me a second night. They tried liquid Oxycodone and Liquid Tylenol (which is basically Lortab) and for whatever reason, taking them separately worked wonders on my pain. The Oxycodone gave me full relief and lasted for three hours. I was released at 11 pm. The drive home was no fun. We live about 45 miles north of La Jolla and I felt every bump and dip in the road. I used a pillow to stabilize my abdomen while we drove. That seemed to help. We had to stop at CVS to pick up my pain meds since the hospital pharmacy was already closed when I was released. Then we were finally home. I slept in the guest bed alone since we have two small dogs that sleep with us and love to cuddle/walk on me at night. My husband was amazing and set me up with ice packs, extra pillows, and all my meds. Woke up every 4 hours to take meds and slept okay.

Post Edited (Heather H) : 4/8/2015 6:15:28 PM (GMT-6)

Posted 4/8/2015 11:34 PM (GMT 0)
Day 3:

Woke up early (6am) to move down to the couch since my husband had to go to work. My sister came over and spent the day with me. We set up the couch with blankets and pillows and a tv tray with all my meds, water, and my spirometer for breathing. My husband also put up two baby gates to block the dogs from jumping on me while I slept. We rented one of those lift chairs, but I found it uncomfortable to lay on my back the first week, so it wasn't very useful.

A couple of tips from recovery:

Laying on my right side was most comfortable to me. All five of my incisions were done on the left side of my body (from my POV). My right hip started getting sore from sleeping this way.

When getting up, use your arms to push yourself up, not your abs. This helped a ton and I was able to get up as needed with minimal pain.

Walk, walk, walk. The gas pain was uncomfortable and walking was the only thing that helped me. I did laps in the house (we have a tiny house too!) until gas would move. 10-15 minutes of slow walking every hour.

Stay hydrated. I asked my sister and my husband to prompt me to drink if they didn't see me drinking. I didn't want to eat or drink the first few days, and day 3 I let myself get dehydrated. Not smart. I got a low grade fever, the chills, a headache, and felt nauseated for the first time. One full cup of cranberry juice and I was much better. It is hard to drink and you will feel very full, but it will actually help your body recover faster. After this, I made sure to get plenty of liquids.

Ask for an anti-nausea medicine. Day 3 my surgeon called to check in on me, and my sister told him I was nauseated and needed Zofran. He was great and called it in. My pharmacy delivers (awesome, right?) and brought it to the house an hour later. One Zofran would stop my nausea and allow me to take pain meds without discomfort.

Buy wet wipes for the bathroom. Enough said. Even though my surgeon said I could shower right away, I did not feel good enough to shower. The wipes made me feel less disgusting. I also used them to clean some of the orange stains off of my belly (Iodine maybe? Who knows.).

Stock up on liquids before surgery. I was fully stocked since I had been on a full liquid diet for 4 weeks already. I found that cranberry juice, apple juice, milk, vanilla pudding, and peach yogurt were the best (I ate around the peaches). I could only eat 1-2 bites at a time at first without feeling full. That improved quickly.

That's it for day 3! Lots of naps and a better night of sleep each night. Still used the ice packs on my abdomen and shoulders that night.
Posted 4/9/2015 12:14 AM (GMT 0)
Day 4:

Woke up early and moved to couch. Walked for about 20 minutes before sitting down and drinking some water. Still taking Oxycodone and liquid Tylenol at this point.

My sister came over and we went out for a walk this morning. My first time out in the sunshine since surgery. It's weird how the days pass quickly when you are at home recovering. Probably because I am out of it on meds half the day! We were able to go about 3 blocks. Also happened to run into a friend. So embarassing- I was wearing pjs and slippers and looked crazy. Oh well smilewinkgrin

Still not able to eat much. Lost about 4 pounds by this point, which isn't too bad for eating basically nothing for 4 days.

Spent the day watching Netflix movies, napping, cuddling my dogs, and trying not to laugh too much (laughing hurts bad!). Still very low energy, but starting to feel great.

I should mention- I had zero heartburn or reflux after surgery. It was like a magic cure. My surgeon told me to stay on my PPIs for a month but I totally forgot for three days and since I've had no heartburn, I'm not going to start again. We'll see...

Day 5:

My first day alone. My husband worked until 2 pm and my sister was busy so I hung out at home alone. It wasn't bad at all. Walked about 6 blocks today, took my first shower, combed my hair (which was awful. It's really long and hadn't been combed since the surgery), ate my first whole pudding cup today! Only took one dose of Oxycodone today. Tylenol seems to be controlling the pain for the most part.

Still can't lay on my left side. Sticking to the right side and my back for now.

No issues with swallowing yet. My surgeon advised my to do full liquids for two whole weeks before trying soft foods. Man vanilla pudding cups and peach yogurt are delicious!

Day 6:

Not much has changed. Pain is getting better every day. I am not using pain meds much anymore. Mainly at night to sleep. Tylenol still helping.

I also should mention that Day 6 was my first bowel movement. I was plugged up from the surgery and pain meds. Had been taking Colace since the hospital but still no movement. I took 4 TBSP of Milk of Magnesia and finally went. It was not fun since things were backed up. A combination of hard stool and diarrhea. Yuck. Sorry for the TMI but I was so scared of that before surgery so I figured I should share for someone else who might be worried.

Day 7: Feeling so much better!

My appetite has returned! I am finally craving food and looking forward to eating. I have still been just on liquids but so far no swallowing issues. A little discomfort from gas and wanting to burp but not being able to. I am careful not to try to burp. That hurts and it doesn't work.

The first few days after surgery I was only able to eat about 200 calories a day. Yikes. I am down 10 pounds in one week so I am going to try to eat more high calorie foods/drinks. I am up to about 400 now and the weight loss has slowed. I tried Cream of Wheat tonight, made with milk and maple syrup. I about died from how delicious it was. My first food in over a month. SO GOOD. I could only eat about 1/3 of a cup. Will finish it for breakfast tomorrow!

Pain levels are steadily declining. My incisions don't hurt anymore, with the exception of the one on my left rib. Yowza! That must be the port that got the most action. It is the most bruised.

So far no fluid has come out of the incisions. Mine are glued on top of dissolving stitches. Some bruising around the incisions but nothing bad.

I am so happy I chose to get the surgery. I am already feeling amazing and know it's going to keep getting better. Virtually no asthma since my surgery, which is nuts.

Day 8:

My sister came over and we decided to run an errand today. We went to the pharmacy to pick up more liquid Tylenol and a prescription. I cannot believe how much better I feel already. It is hard to remember that I just had surgery a week ago.

Still used the pillow when riding in the car. Can't drive until I see the surgeon Thursday, but my sister drove us around.

Had some frozen yogurt today for lunch and it was so good. Cinnamon coconut flavor. So delicious! Had about 1/2 cup with no swallowing issues. Still a little discomfort from gas while I eat/right after eating.

After lunch we went to see a friend at her work. Stayed about an hour and talked about surgery (she has an autoimmune disease and has had 13 surgeries so she gave me great advice). Started getting tired and decided to go for a short walk before heading home.

We walked around the sports park (there's a nice walking trail there) for about a mile before my rib really started hurting. My back muscles are compensating for all the ab weakness so my back gets really sore too.

Came home with a lot of rib and back pain. Some spasms in the back so I took some Tylenol and laid on a heating pad for a while. All better.

Ate thinned out mashed potatoes for dinner. Went down well.

Day 9: Pretty much same as day 8 but with less pain. Pain improves daily. Still waking up in middle of night to take Tylenol. I am sleeping well though.

Day 10:

Had my first post-op appointment with my surgeon today. He said my incisions look great. I told him how great I am feeling and gave out thank you cards to the staff, him, the fellow who assisted in my surgery. I am so thankful for UCSD. Everyone there has been amazing. Kind, professional, knowledgeable. They answered all of my questions and never rushed me out the door. So thankful for them!

We also went back to the hospital to deliver thank you cards and cookies to the nurses in the PACU and the nurses in 2 West- the unit I stayed in. It was great to say thank you. They were excited to see how much better I was doing. I don't think they get to see patients after recovery too often.

I had a muscle milk today for lunch. Pretty nasty but full of protein. Probably better than my vanilla pudding tongue

After the appointment we went to Ikea to walk around. Started having some pain after about an hour. Leaned on the cart and had some frozen yogurt before heading home. Driving in the car is okay now. No more pain from that.

Day 11:

I drove again for the first time today. about 30 miles up North to visit a friend who is in town for Easter. We sat around and talked and had a great time. Drove home with very little discomfort. Only taking Tylenol now as needed (usually at night if I wake up).

Day 12 to now:

I am feeling better and better each day. My walks are up to normal pace and going about 4 miles again. Still can't jog or swim but I am starting to feel like myself. I am so excited to see what exercising is like without constant reflux. I really have to remind myself not to push my body. My doctor said no serious exercise until 6 week check up, which is May 4th. I might go nuts before then!

I am so thankful that I took 3 full weeks off of work. I am a high school teacher and work long hours. I find myself still getting tired around 3 pm and needing to go to bed early. I go back Monday and I should be ready by then.

My brain is working so much better now that I am not on PPIs. I feel like that was the worst side effect: brain fog. I feel more like myself again.

Also no asthma since surgery. I'm so thankful and even a little hopeful that my asthma is cured. We will see!

Zero reflux since surgery. I am beyond thankful for that. I told my surgeon that he gave me the gift of health. I cannot believe how amazing I feel just a few weeks out. I have to remind myself to take it easy and that I am still healing!

I am eating soft foods now and haven't had any major issues. I chew everything to liquid and make sure to take very small bites. I can eat about 1 cup of food at a time, which is normal for me. Still no meat or bread (I will try those week 7). I have had a few instances where things go past the wrap slowly. It is uncomfortable and feels almost like when you need to burp but can't. I get hiccups then and drink a bit of water.

Hiccups and sneezing are not painful by the way at this point. Thankfully I didn't have either until yesterday so I didn't go through any pain immediately after surgery from that. Whew! I was dreading that at first.

Bowels are back to normal with no meds needed. Nice feeling.

Laporoscopic surgery was a great experience for me. I was so worried that I put it off for years and now I feel so silly for being afraid. I am so thankful for all the encouragement I received on this site and for all of you who shared your Nissen experiences.

I am hopeful for the future and hope to update you all with great news when it has been a few more months. If you are thinking about getting wrapped, find a great surgeon and do it. I think having a great surgeon who is very experienced makes all the difference. UCSD was amazing so if any of you live in California, call Dr. Horgan.

Happy healing everyone!

Heather
Posted 4/9/2015 4:07 PM (GMT 0)
WOW, Heather,
THANK YOU for posting your journal. You give me such HOPE! I'm following several on this site and reading journals, such as Sweetie UK who had her surgery on March 12th and is doing fantastic as well as many others.

I'm going for, hopefully, the last test needed (pH manometry) before meeting with surgeon to see if I can have surgery. 6 years of suffering! If I can do half as well as you, I will be forever grateful.

I'll be watching your recovery and am rooting for you to be fully recovered SOON.
Posted 4/9/2015 8:39 PM (GMT 0)
Thanks Heather h for responding, even though I didn't post my reply in the proper location !!! Still learning how to post on forums!!!! I'm so glad to hear your dad has done so well. I think i just need to hear positive long term results to help me go through with the surgery. I'm pretty much at the point that I don't have much choice. I've tried several times to get off ppis and use h2 blockers and gaviscon to get by but it just isn't working. i do like to read all of the posts about the recovery process, thanks again!!!
Posted 9/11/2016 7:11 AM (GMT 0)
Hi everyone! I thought I would write a quick update since it has been a year and a half since my surgery. It was a great success- I have had zero heartburn since the surgery. Happy to report that I have not taken any type of antacid or stomach medication since March 2015.

No long term complications as of yet. I am back to regular exercise and have been lifting weights, doing sit ups, and all sorts of other things I worried would put stress on my wrap.

My asthma is completely gone and I haven't taken a breathing treatment or my inhaler since the day before my surgery.

If I could go back, I would have gotten the surgery ten years earlier! It was the best decision I've ever made and I am so thankful everyday to have gotten my quality of life back. I feel better at 31 than I did at 15 and am so thankful for each day of health.

If you have any questions please feel free to send me a pm.

Take care and I hope you all are encouraged that things can get better. Keep advocating for yourself and seeking help from good doctors. I had all but given up on living a normal life until my surgery.

All the best,

Heather
Posted 9/11/2016 7:41 AM (GMT 0)
Thanks for posting all of this and keeping us updated. I too had stomach problems as a kid and I've had really bad heartburn since the end of my teens. Between 22-25, I started seeing a GI specialist. He kept forgetting I had GERD and would ask me 'how my IBS is going'. They did all the tests and put me on heavy PPIs, but the problem continued to get worse.. When those didn't work, we started heading towards the surgery option. He set me up with a surgeon who only did the surgery 7 or so times, or so her office staff told me when I inquired about it. I decided to bail and haven't been to the doctor in a few years now.

My experience and the whole process of treating GERD and our lack of knowledge regarding this condition has made me feel negatively about the medical community. I decided to take it upon myself and committed to extreme dietary changes - for instance, just eating kale, greek yogurt, sunflower seeds, pumpkin seeds, cucumber, bananas, pistachios, no alcohol etc. etc.... but it just keeps getting worse. It continues to take my life away in various ways more and more. The reflux is so bad it's giving me asthma and ruining my teeth, and it makes me nervous to go to the dentist. I'm almost 28 now and am starting to feel like I need to go find a new GI doctor and just get the surgery over with. Your post was inspiring because I saw so many similarities. I'm glad you've gotten relief for the past 1.5 years.

Post Edited (EJohn) : 9/11/2016 1:45:26 AM (GMT-6)

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