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Extreme acid reflux after surgery

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GERD & Acid Reflux
PPIs after Toupet Fundoplication
Had to have immediately after surgery - 50.0% - 1 votes
Tapered off after surgery - 0.0% - 0 votes
Needed no meds immediately after surgery - 50.0% - 1 votes
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Posted 6/21/2017 9:19 PM (GMT 0)
Hello everyone,

First, thank you for creating/maintaining this site. It is much more comforting to hear from actual patients who have undergone these procedures than from a pamphlet on WebMd.

I had a Toupet Fundoplication 7 days ago, and had the standard one-night hospital stay, followed by a liquid diet. I stayed pretty medicated (my prescribed meds) in order to sleep and heal. about 2 days ago, I started feeling like there was an extreme amount of acid in my chest, and in my mouth - exactly like it was at its worst before surgery.
A little back story: I am 37, and underweight for my height. I am currently under 110 pounds, and 5'7". I lost 25 pounds over the past 3 years from stress. My mom passed away, I lost my job, and started another extremely exhausting job, and got a divorce. I'm a teacher, and a single mom of 3 boys, so every day is a challenge. All the stress triggered the reflux, and not the greatest diet choices (it turns out you can't exist on coffee and wine). I started with the usual 20 mg dose of prilosec, which increased to 40, and finally 80 mgs (40 twice a day). One morning a couple of weeks ago, prior to the surgery, I literally woke up with unbearable reflux. I added 300 mgs of Zantac throughout the day, between the prilosec. I was also guzzling gaviscon, just to be able to stand eating anything at all.
I had already had a Barium swallow and endoscopy back in April, so I was formally diagnosed with GERD and esophageal damage (but no Barrett's, thank goodness), and was waiting until school was out for summer to have the surgery, because I knew it would be way too much to try to recover at work. I don't have any sick leave left. I rescheduled my surgery as soon as I could have it, which was last week. The first couple of days were typical, and I slept a lot. As I stated earlier, I started to feel the dreaded heartburn feeling, which rapidly intensified, and soon was in my mouth, as it had been before the surgery. I have been extremely careful with everything I have eaten, and I am still on the liquid diet. I called my doctor, and he told me that I should have stopped the ppi's and zantac immediately after surgery, because apparently, he is a wizard. (He really is a very skilled and reputable surgeon, but he is also aggressive in terms of not babying his patients in any way.) The nurse advised me, somewhat behind his back, that I am probably not able to cut them out cold turkey, given the dosage I had been on for so long.
I was devastated, and was trying so hard not to resort to meds after my history with them, and my surgeon assuring me that "95% of people never have to take meds again". However, I am in unbearable pain, and I'm sure the anxiety isn't helping. I am certainly not gaining any weight, and I don't even want to think about how much I may have lost. I am going back on my prilosec at half the dose, and will attempt to taper off very slowly from there. I tried carafate, but it is just not practical for me in terms of eating and spacing out medication. I take some pretty heavy psych meds for bipolar, and I cannot afford for that to get stirred up right now. I am a vocalist, and teach choir, so my voice is my livelihood.
I guess my question is, is this "normal", at all? Has anyone else experienced this? I am devastated to be back on meds, and still in so much acid pain.
Thank you in advance for reading my novel.

Post Edited (aaj98s) : 6/21/2017 3:25:45 PM (GMT-6)

Posted 6/22/2017 11:18 AM (GMT 0)
What you are experiencing is very common, and you may actually feel a lot worse before you get better (sorry). You are so early into your recovery, and I think you are expecting too much, too soon. And no, the anxiety is not helping, in fact, it's probably making your symptoms seem worse. Did your surgeon discuss what your recovery after surgery would be like? Initially most people lose weight, then eventually gain it back (most people, not all). You've just had major surgery and your recovery is not going to be quick or easy. In my situation, I didn't start to feel better until about 6 months post-surgery and my "new" self around 1 year. Everyone is different, but I missed two months of work. Three years after surgery, I still have foods that I stay away from and you won't necessarily have the ability to just eat what you want after you recover.
Posted 6/22/2017 7:12 PM (GMT 0)
Wow, okay. Thank you so much for your response. My doctor, who is very reputable in this area, drew me a brief diagram of the procedure, told me that I would be on a liquid diet for a week, and that was it. And then no antacids of any kind for life. I thought it over for two months before I decided to go through with the surgery, and I finally caved because I was so miserable. I don't know why I thought it would be so quick and easy. I had a partial hysterectomy 3 years ago, and then an emergency removal of one of my ovaries back in April, due to ovarian cysts and endometriosis, and I was off work for 5 weeks, which is very abnormal. I think I just have no immune system due to being worn down all the time, and not being able to eat certainly didn't help. Like I said, I waited until summer so I could rest and take my time recovering. I'm just surprised that it is this extreme. I called them today and told them about the pain in my left side. I don't think they will do anything, if they even could, but I thought it needed to be noted in my chart in case it is significant.
Posted 6/22/2017 7:15 PM (GMT 0)
Also, I think I may be perceiving damage to my esophagus as acid in my throat. I'm so paranoid about it that I panic over any kind of discomfort, and assume the whole thing didn't work, and I'm back to square one. From what I have read on here, it seems that the healing of my stomach lining and esophagus can take quite a while.
Posted 6/22/2017 7:45 PM (GMT 0)
You are absolutely right about your recovery taking time. The pain in your left side may be gas from the surgery. The remedy is walking, or taking an anti-gas medication (simethicone). If you weren't given a diet to follow, Google UPMC Post-Nissen diet, it is much more detailed than just a liquid diet for a week. You also may want to keep an anti-nausea medication on hand, just in case. You may have had an excellent surgeon, but he certainly didn't give you a good idea of what recovery would be like, and that happens a lot.
Posted 6/22/2017 9:21 PM (GMT 0)
I'll try to give a different perspective on this. But let's review what you wrote:

"I lost 25 pounds over the past 3 years from stress. My mom passed away, I lost my job, and started another extremely exhausting job, and got a divorce. I'm a teacher, and a single mom of 3 boys, so every day is a challenge. All the stress triggered the reflux, and not the greatest diet choices (it turns out you can't exist on coffee and wine)."

Many studies have tried to assign GERD to a variety of factors, like weight gain, smoking, hiatal hernia, etc. etc. and very very many have found a strong association between GERD and various psychological factors. One of the most cited papers on this topic (cited >100 times by other researchers, according to Google Scholar) was one that looked at the usually studied psychological states (like anxiety and depression), but also included a few other psychological states that are relevant for your situation.

The paper identified a correlation between 'vital exhaustion' and heartburn symptoms that was stronger than any other psychological factor that the researchers measured in their patients. Vital exhaustion is a very 'deep' kind of exhaustion where you feel 1) extremely exhausted and tired when you aren't doing work or taking stimulants (like caffeine), 2) more irritable and impatient, 3) more depressive symptoms, such as repeated feelings of hopelessness about something, or even generalized hopelessness, and 4) can cause abnormal heart rhythms and even lead to heart attack.

After 'vital exhaustion', 'high impact stressor' demonstrated the next highest correlation with heartburn symptoms. A 'high impact stressor' is something like a recent divorce or [traumatic] loss of a loved one. Comparatively, anxiety and depression were somewhat less associated with heartburn symptoms.

If you go to the typical site, you need to pay for a copy of the article, but the authors posted a free-to-obtain version of it here where you can download it: https://www.researchgate.net/publication/8521802_The_Effect_of_Life_Stress_on_Symptoms_of_Heartburn

Based on what you've written, it seems like the last few years of your life include both of these psychological states that have a strong correlation with worsening GERD. Now, perhaps these things aren't 100% responsible for your condition, but it is likely that they contribute to some degree. Thus, I would include strategies to handle these problems as part of your GERD treatment. You may not be able to escape this situation with meds and surgery alone. As good as their intentions may be, the posts of others are somewhat misleading. There are a good number of people that get the full or partial (like the Toupet) fundoplication and it does not improve their symptoms much or at all. I do not mean to imply that addressing the psychological concerns will do more than surgery, but you shouldn't rely on surgery completely, it just doesn't work in all cases.

However, its hard to call the assurance that 95% never take meds again after surgery anything other than lie. Studies I've read that track patients over the long term (such as a 10 year follow-up) show that 1/3 to 2/3 of patients have taken heartburn medications again post-fundoplication surgery.

Post Edited (EJohn) : 6/22/2017 5:22:16 PM (GMT-6)

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