Nissen is tommorrow/ pre-op information (NYC area)

Hi everyone, I rarely post here, but when preparing for my surgery I read this forum and I wanted to write about my experience to hopefully help anyone, like the information here helped me.

Background- I am a 28 yo female who has dealt with acid reflux for the past 12 years. I have a hiatal hernia. I began on prilosec and nexium and OTC meds, but for the past 7-8 years I have been taking 40mg omeprazole in the morning and pepcid complete at night. This usually takes care of all my heartburn. Without my meds I have 7-10heartburn pain (on a scale of 10 being the worst heartburn you could possibly imagine) 24 hours a day. Diet, tight clothes, sleeping upright, etc.- nothing made a difference. Otherwise I am pretty healthy.

Over the years I never did much research on surgery to fix this problem, I asked my gastroenterologist
very generally about surgery and he always just said it hasn't been around long enough so he doesn't feel 100% comfortable that it would be successful.

Getting engaged set this off for me- it gave me more of a timeline for getting pregnant. After discussing my problem with my OBGYN- she basically said I could not safely take my medicine for the first trimester (and honestly I wouldn't feel comfortable taking it at all during pregnancy). If I was pregnant and not taking meds I imagined I would be in immense pain for an extended period of time, not sleeping well, stressed out from the pain- all which I do not think it good to go through while pregnant if I can avoid it. Also, because I am young it is possible for me to be on this medicine for the next 60 years, which I also cannot imagine is good for me.

I got a second opinion from a new gastroenterologist- he said he recommended surgery, and said it would mean him losing business (me not seeing him regularly for years) but he didn't think it would be good for me to be on medicine for the rest of my life. This made me wonder about my old gastroenterologist's motives.

I came to this forum and found some doctors in my area that were recommended. I did a lot of research on many doctors and eventually narrowed it down to a few... The first doctor I looked into doesn't take insurance (ridiculous), the second doctor didn't take my insurance, then I found Dr. Rasa Zarnegar. Took my insurance, no lawsuits, good reviews, practices at NY Presbyterian (one of the better NYC hospitals). I met with him and was pleased and felt comfortable. He said I seemed like a good candidate, especially since I was young and acid reflux was my only symptom, but of course I had to do the pre-tests to make sure. He estimated he has done the procedure over 800 times, only had two wraps "undone" (they were uncommon circumstances), he said he follows all his patients and has had women become pregnant without incidence afterwards. He was prompt, patient and answered all my silly questions. I scheduled the pre tests and my surgery.

I figured I would go through my experiences with the pretests in case anyone was wondering:

1. Barium swallow- the hospital was great, was seen after 15 minutes, the doctor was nice, explained everything. Test was painless, took like 15-20 minutes (you just drink and eat things with barium and are x-rayed standing, laying and turning around. I didn't have heartburn that day oddly, but he said he could see my hernia and the acid reflux- I guess I was having asymptomatic heartburn. Side note: it is pretty cool to see the x-ray of yourself as you watch the drink go down.

2. manometry/ BRAVO test- The manometry I had done at the same time as the BRAVO while under general anesthesia. The wait was quick everyone was polite, helpful and made me feel comfortable. The process was similar to a regular endoscopy. The manometry was done first- I was put under while they inserted the tube, woken up just enough so I could take sips of water when they told me to, then put back under while they removed the tube. The part I was awake for was fine, strange, but not painful. I woke back up just enough to get a glance at the removed tube- and I'll just say it looked gross and I was so glad to be under anesthesia for the test. BRAVO- then they inserted the capsule to my esophagus- The insertion and immediately after was like a normal endoscopy, like I had been told. However by the time I got home I was experiencing pretty bad chest pain that I was not expecting. I basically felt the capsule in there, and it hurt a lot to swallow and every so often it felt like my esophagus was spasming, like it was being tied in a painful knot- painful enough that I would keel over grabbing my chest, almost enough pain to make me cry, and to consider spitting out my saliva since swallowing was so painful. I called the doctor because I was worried and they basically said this was normal (apparently I am the 1% this happens to). This went on for two days. I have not had a life full of pain and suffering (thankfully), but I have had surgery on my ear, all my wisdom teeth removed at once, etc. and this was easily the most pain I have ever been in. I think if I had been expecting it, that would have made it a little easier. Day 3 after the test I went back to work. Day 3 and 4 were uncomfortable but bearable. Days 4-9 were fine but I could still feel the capsule. After that it fell out and I am fine.

Very oddly to me after the capsule was implanted I had barely any heartburn (just that horrible chest/swallowing pain). I still had heartburn, but for me it went from unbearable I cannot live like this to probably 1/10th of that. Annoying, but much more bearable than before. For the next month after this test my heartburn is still better than before, but is slowly getting worse and worse. This made me wonder if I was doing the right thing- because the test had improved it (possibly temporarily)- I wondered is surgery was the right thing to do. (I have only had surgery once before and take it very seriously, especially this one as it is not for an immediately life threatening problem) I have not gone back on omeprazole since the test to be able to gauge my heartburn, but have taken tums and pepcid complete when it got too painful. At my follow up I learned that the capsule recorded asymptomatic acid reflux almost the entire time.


I just had my follow up and I learned- I am in the 95th percentile for acid reflux. My DeMeester Score (some heartburn rating) is triple that of your average person. My lower esophageal flap was not closed at all during the endoscopy. I do not have Barretts or anything precancerous in my esophagus. I do have polyps in my stomach. Dr. Zarnegar said it was most likely from being on PPIs for 12 years. This I am a little upset about just because I never knew this was a possible side effect of the medicine. My old gastroenterologist never mentioned it or checked my stomach for it during endoscopies. I might contact him about this. And after now doing some research about it, it teaches me I just have to be more well-read and do more research on meds. etc. I take. The doctor said they should go away when I am off PPIs, and I will have an endoscopy in a year to check on them.

I am happy in a way to find this information out- it helped me understand my pain more, and really made me realize I need this surgery and should not take medicine for decades...so my surgery is still on for Monday. I am trying to be mentally prepared (and prepared with soft foods/liquids available and plenty of reading material). Hopefully all goes well. I will come back eventually to tell my experience with the surgery.

Some other things in case anyone was wondering:

I have been very happy with my experiences with Dr. Zarnegar and NY Presbyterian the only "problems" that I have come across:
1. I was not prepared for the pain of the BRAVO test. I wish I had been prepared to take two days off of work, mentally prepared so I didn't think something was going terribly wrong and prepared with soft foods.
2. I was not given written after care instructions after the BRAVO- something I usually get after every endoscopy and really could have used after the BRAVO. I explained this to Zarnegar- just for his future reference, and it turns out because I scheduled my tests later than usual I wasn't given instructions when his patients normally get them, but he said he would talk to his staff about that.
3. I had to wait an hour an a half for my follow up appointment. I know this happens all the time at doctors and I have waited much longer at other doctors, but I think this was poor scheduling and annoying.

Again, all in all I am extremely happy with my care so far, but these are just some annoying points I possibly could have avoided had I known etc.

Also in case it can help anyone with their heartburn, some things I have learned over the years:

1. chewing gum alleviates my heartburn as well as some medicines (it probably helps me more than tums) obviously not a solution, but might help. I chew Orbits gum.
2. Some different brands of food exacerbate my heartburn. For example: I can have any artificial sugar while taking my medicine and not get heartburn- except for Splenda- it gives me HORRIBLE heartburn that no medicine can help. Same with Chock full o Nuts coffee (Other brands are fine for me, this one is not).

One last note- my mother came with me to the follow up (if you can, I recommend taking someone you trust to at least one appointment) she helped me think of questions to ask and she was please with Dr. Zarnegar (I trust her opinion she's dealt with hospitals and doctors for a long time)

Sorry this post is so long! I just know how helpful and reassuring (in a way) being informed can be!

Hi Peg, thanks for your note...I'm on day two now. I went home the night of the surgery. The worst of the pain I am feeling is gas I think. Sharp pains in my shoulders and chest. Drinking seems to make my gas worse- which I don't know if anyone has any tips for. I would like to have some broth, but its not worth it to me if it will make me hurt more. My abdomen feels sore and sensitive. The pain meds are working well and did not make me nauseated- which I was very worried about. I've been walking around a lot. I wish I could lay on my side or stomach- but this is probably not a good idea to try right?

Hi carolannie, so I'll cover as much as possible...

Going in to surgery was fine, woke up in recovery. I slept for a few hours, on pain meds, very tired and drained. I was able to drink some water and apple juice. They let me leave the hospital after I was drinking and going to the bathroom. I had surgery at about 9am and was home by 6:30pm. I probably could have stayed overnight if I wanted, but I'd rather be home. I hadn't picked up my pain meds yet, so the first night was pretty rough. I was up half the night, but got my pain meds first thing in the morning.

I was prescribed percoucet, the doctor told me to crush the pill to take it, but I was afraid of that based on things I heard and my previous experiences with pain meds. I was able to swallow it but it was very painful.

Day 2- laying around, in pain from gas (bad pain in shoulders and chest from the surgery). I only had apple juice, water and an ice pop this day. Drinking anything is painful because my stomach/chest seems to fill with air which becomes painful. I am walking (doc told me to walk a mile), but very slowly. Actually, most of it was pacing around the apartment- it felt better than sitting. My throat hurts a lot from the breathing tube, and my voice is strained.

Day 3- Walked some more, still have gas pains. Was able to sit in Starbucks for half an hour- oddly I feel very sore when I get up. Still having trouble drinking. I am taking small sips but it still hurts. This day I had juice, ice pop, broth, and soup. I also showered this day. All my movement is slow, my insides feel easily jostled. I am getting tired of laying and sitting on my back or upright.

BTW- days 1-5 I had family stay with me, not really necessary, especially after day 3- but it helped with walking the dog and distracting me.

Day 4- put actual clothes on, walked around town still very tired and not eating much. Sister bought me Ensure and it went down better than anything so far. This made me confident and I tried a soft food (noodles). The post-op instructions said I could. BAD IDEA. Horrible chest pain and regurgitated it. This scared me and I didn't try soft foods again until the one week mark.

Day 5-6- feeling a little better but drinking is still difficult/painful and slow-going. Up until now I've "eaten" the following: ice pops, ice cream, soup, broth, smoothies, Ensure, juice, yogurt. The saving grace is I have not been hungry since before the surgery. I eat because I know I have to. It is an effort to make sure I am drinking enough water. I've lost 10lbs in the first week. I can afford to lose this weight. Even if I really didn't want to lose any weight, it is really difficult to get any calories down. I probably had an average of 500 calories a day the first week. Day 6 I was down to 1 percoucet a day.

Day 7- was a turning point. I was able to eat (very watery) oatmeal and it felt triumphant. Before this, I was starting to get discouraged because drinking was still difficult. I have to eat it extremely slowly. The oatmeal and yogurt take me at least 20 minutes to eat each. Later this day I also have mashed potatoes. I also did laundry and drove today. Driving was a little difficult because I still felt like I didn't have all of my mobility back, but I only went on a short trip. I called the doc about my trouble drinking today, but they said it was normal. The nurse did seem a little surprised at how much weight I had lost though.

Day 7-9- I am actually eating soft foods, but to eat comfortably I have to eat very slowly and take very small bites. I am eating so slow, it gets annoying and almost seems like its not worth the effort. I am trying to sip water all day to get enough. A little more activity these days- long walks, short drive, laundry, walking to the store, but it is very tiring. I have lost 14 lbs by day 9. But I am up to about 1000 calories these days.

Some random information:

- swallowing the pills (and stool softners with the pain meds) was very difficult.
- in the beginning most of my pain/discomfort was gas and throat, now it is gas from eating/drinking (though not that painful, just a little uncomfortable)
- Incisions don't really hurt, they seem tender. I can't comfortably lay on my stomach yet. I could lay on my side by day 4.
- My post op instructions were very optimistic. I would not have rushed the soft foods if I could go back.
- I have 5 small incisions in a line across my abdomen above my belly button.
- I have regurgitated 3 times, once when I tried soft foods too soon, once when I took my meds and drank a lot of water, and once when I think I just ate mashed potatoes too fast. When this happens I get bad chest pain from gas, can't burp it away. Then I feel hot and my mouth fills with warm saliva like you get before you vomit. But the regurgitation doesn't feel like it comes from my stomach, it feels like it never went down. The third time I felt very sick, and started to get the waves (heaves?) in my stomach, but I didn't actually vomit.
- I have been able to burp since day 1, and it's very useful to relieve the pressure. I have been burping a lot.
-I am just worried about vomiting now...I have to talk to the doc about this during my follow up. I just know at some point in the future I will eventually have to vomit.

I hear a lot of people go back to work after week one. I think this might be possible, if I had a very relaxed, not physical job, but it would really be pushing it. I would recommend taking at least 2 weeks. (I am a teacher so I did the surgery during summer vacation)

I hope that was helpful carolannie and to anyone else!

Post Edited (Agordon) : 7/22/2015 11:53:15 AM (GMT-6)

Agordon thanks for sharing your journey! Wishing you a speedy recovery!

Hi agordon,
I'm following your recovery journal and hope you will continue posting your progress and/or set-backs. I am 25 days post-op and I'm not close to being strong enough to go back to work. I'm still on 'mushy' diet and even that has had its challenges. It's shocking to discover how I must now baby my stomach until it can handle regular food again. People who visit these boards need to know about our set-backs, as well so they can be prepared.

I'm probably older than you (68), but I'm in good health and still work as a custom interior painter. My surgery was June 30th and I'm taking all of July off as well as the first couple of weeks in August. Then I will go back part-time. I had a full Laprascopic Nissen Fundoplication performed by a cardio-thoracic surgeon. I still have a deep, throbbing chest pain that requires me to still take some narcotic pain meds, however, I have not had any acid reflux or heartburn and have been able to sleep flat in my bed and that's been great.

Take your time with the healing process as your insides will heal much slower than your outsides. Be prepared for set-backs if you get too frisky with foods or activities. I was warned about this and I still fell into that trap. In the first 10 days, I had set-backs as I went overboard as I was feeling good; boy did I pay for it! Be careful and patient; you are in good company.

Linda Sue:

Hope things are improving for you, I agree about taking your time in advancing your food intake. It's a painful less to learn. I missed two whole months of work and when I returned it was for 1/2 days the first week. I can't imagine how some people can go back to work after a week or two. I'm 54 and it was a struggle to work 1/2 days in the beginning.

Sharon