Paul is 3 Weeks Post-Nissen and in Need of Support

Dear Paul,

Welcome to the Healing Well Wrapped Club!

You are in the midst of the most difficult part of your recovery. I expect your surgeon didn't prepare you properly for what to expect, as they generally don't. You're not alone.

First of all, try to understand that these symptoms are part of your early stages of recovery. Keep in mind that your upper GI tract has undergone a significant revision. Although you have only 5 little incisions on the outside, you've been through MAJOR surgery on the inside, and it will take time and patience to heal.

This is going to take some TRUST. You are not always going to suffer from these symptoms. Your body is going through a lot of healing and adjustments, and symptoms like the ones you're describing are not uncommon.

Your stomach is not happy with you right now. It has been stretched and wrapped and stitched, and it's easy to understand why it isn't feeling too perky. Nausea is an indication that your stomach lining is irritated.

Please be sure to get anti-nausea medication from your doctor if you don't already have it. Retching/vomiting is very hard on your healing wrap. You should be taking medication for your nausea. Your surgeon would not want you retching right now. I am 6 plus year post-Nissen surgery, and I always keep anti-nausea drugs handy, in case I get a stomach bug. Even once healed, severe vomiting and retching can do damage to your wrap/repair. I has Zofran for milder nausea, and when I have an all-out stomach virus, I use Compazine suppositories, and they work great.

Your light-headedness/diarrhea symptoms are most likely a result of dumping syndrome, which is common during recovery from stomach surgery. Here is a link to information regarding anti-dumping diet information:

gicare.com/diets/anti-dumping-post-gastrectomy-diet/

You need to stop worrying, and work on trying to surrender to your recovery and follow its lead. This stage of recovery isn't forever. Three weeks in a very short time into a recovery that takes six months for most of the healing and a year for the rest. Don't panic.

Stick around this forum, as there are others who have been where you are now, are now very happy with their results. I know it's hard, but try to relax, and give your body the time it needs to heal. Stress and worry will not speed your recovery, and may even impede it.

You WILL get through this! Hang in there!
Denise

Paul,

Here is a long post that may help you out:

I had a toupet (270 degree wrap) done seven weeks ago. While it is not as restrictive as the full nissen (360 degree wrap), it did mess with my body a lot. I was unable to have a nissen wrap due to esophageal issues. I basically had pre-surgery reflux like symptoms up to five weeks. They have tapered off a lot in the past 10 days or so, but i am still take one 40mg Nexium per day. I fortunately did not suffer from nausea. Even now constipation is an issue that can go on for four or five days with no relief. Then the diarrhea.

Here is my take on the constipation/diarrhea cycle based on personal experience and research:

Nissens/topuet patients do not eat a lot of fiber now for a variety of reasons post surgery. Our diets are pretty low fiber. For me this has always been trouble. Multi-day constipation eventually leads to a very irritated colon which results in diarrhea. I know it well... Until I can start more fiber, I have been told to drink a lot of water, which I do any way, and take stool softeners daily. Most softeners are benign in side effects. No laxatives unless it is extreme as this can add irritation. This has helped, but the issue continues just not as severe.

I am not going to paint a picture that all will be fine as I do not know if even I will be 'cured'. I will say that I was initially quite disappointed with the surgery and depressed about it. Time off work, the cost of the surgery, follow up visit, etc and I still had the same symptoms - GERD and LPR. I let my surgeon know that I was very unhappy about the lack of pre-surgery information including an understanding of the symptoms that would continue. I found the lack of information across the board from physicians on symptoms which are common post surgery to be lacking and really unprofessional. If you look at my previous posts you can read some of my despair.

I visited my local gastroenterologist and GP and asked them about the symptoms. Here is what I discovered - as a reminder I am not a physician, just putting into words what research, talking to my local gastro/GP and emails/visit to my surgeon told me.

Most of GERD symptoms, but not all, are not really GERD but swelling and healing in nature. Unfortunately the symptom feels like GERD. I heard this here first, confirmed it with some doctors, and tested it myself by ramping up my Nexium to four times a day (two times more than prescribed) with no GERD relief several days in a row. I then took analgesics (Tylenol) at the maximum strength and felt some relief. Not very scientific, but it confirmed what I was told. I also learned that it can take up to 6 months for full healing depending on the damage to the esophagus and in my case lungs. Not only must the wound heal, but the cells that line the esophagus must heal which can take 3-6+ months. I have issues with my lungs called 'micro aspirations' which my local gastro said he has seen take 6-9 months to clear up. Did I know this before hand? No. This pissed me off and still does because I was entitled to know about all common, and these are common, post-surgical issues. Would I have gotten the surgery knowing this beforehand? Yes, but at least I would have been informed.

Things I have learned to alleviate some symptoms:

Eat small portions, eat often and eat slowly. You will hear this over and over. It sounds simple, it is not. I do not have little kids, but my wife and I eat dinner with our teenager every night. I found that while I could eat smaller and often, eating slowly was tough when talking at dinner. Cannot over emphasis the slow....

First five weeks - No food after 7:30pm. None, zip. I will drink water but that is it. Even if I work late and get home after 7:30pm, nothing to eat or GERD symptoms are almost guaranteed. Note that I have found that in the past week I can have a snack as late as 8:30pm with no real issues. I never normally ate after 7:00 or so before surgery either.

Learn what your body does not like. For me is/was greasy, dairy (except small portions of vanilla ice cream and a little cheese), chocolate candy in any form (bummer), acidic stuff (OJ, tomato sauce, etc), spicy stuff (double bummer), fried anything, chewy anything and anything that is overly sweet (tea, juice, cakes, etc). As I progress I am slowly adding this into my diet, but some are still problematic: chocolate, sweets and fried anything.

Learn when the symptoms are the worst and what preceded them. Big one for me. My worst GERD post-surgery symptoms were/are late in the afternoon and into the evening. It was not stress related, consistent symptoms regardless of stress for the day, or work related. Interestingly I found at first the symptoms were less at work not at home. I believe they are caused by what I ate, how I ate it and my activities in the afternoon. At work I close my office door, read news sites and articles and eat lunch. Calmly and slowly. I am usually in meetings in the afternoon which required me to sit in a chair and be upright. On the weekends I tended to eat faster and less healthy because I am working on hobbies, the yard, or hanging out with family. I also tend to slouch and recline a lot more on the weekend. For me, this has never been good for my GERD.

Sorry about the long post. While I am still waiting for the end, I do believe that the chances of success far outweigh the chances of failure. I know that there is a 20% chance that my toupet surgery will fail in the next 10-12 years and there is an even chance that I will be on PPIs forever. However, coughing due to GERD is almost gone, my sore throat is much better and the majority of the day I am symptom free. Each week does get incrementally better.

Consider what I have posted as I hope you do with all the information that you find. Keep in mind that very few of us will react the same way.

Best wishes...

Hi Paul,

I am concerned with the "severe retching". That in itself can cause the wrap to fail. Have you told your surgeon you're having this symptom? Of all the discomforts you are suffering this is the one that could actually do damage.

Please call your surgeon/GI doctor and let them know. They can prescribe stronger, more effective medication.

We are here for you, to provides support and encouragement!
Hang in there...it will get better!

Best wishes,
Denise