Posted 6/6/2017 11:13 PM (GMT 0)
Hey all, I just wanted to share my recent fundoplication experience. I will give updates in the form of a weekly summary, and will commit to do this for at least 12 weeks (I was personally disappointed that most other journals on here only lasted ~10-14 days, especially in cases where someone had complications or recurrence of symptoms and then just stopped posting). Before I get started, I wanted to share my history with GERD:
EARLY HISTORY OF SYMPTOMS:
I've had frequent indigestion since I was 7 years old. After a few years of this, I gained the ability to recall food from the stomach back into my mouth voluntarily. My first symptoms of acid reflux began when I was ~11-12 from too much Coca-Cola. The symptoms became more frequent when I was 19 years old, probably because I was smoking and drinking a lot of caffeine. By age 21, I started having reflux most days of the week, and began to take the reflux more seriously - I cut out smoking and limited my caffeine intake. At age 22, I began having moderate, right-sided abdominal pain that, after several rounds of tests, no one has ever been able to give me a diagnosis for. My reflux just continued to get worse over time (I am currently 28).
ATTEMPTED REMEDIES:
I started taking PPIs around ~20 years old, and have tried omeprazole, nexium, aciphex, prevacid, dexilant, etc. I've also tried almost every other remedy I've ever read about, including a gluten-free diet for 3 months, a lactose-free diet for 1 month, adherence to the FODMAP diet for 3 months, apple-cider vinegar, licorice root, digestive enzymes, probiotics, Betaine HCL with Pepsin (out of all the 'home remedies', this one actually seemed to work somewhat, but only for a few months), a very low carb diet, and a slew of other things that are probably less significant (like drinking prune juice to keep my GI system moving) or sound uneducated (like avoiding fluoridated water and toothpaste for months). I even went to a chiropractor that claimed to specialize in this sort of thing and used techniques to push the hernia down for 5-6 weeks (this didn't cause any noticeable improvement).
RECENT HISTORY AND DECISION TO GET SURGERY:
Around age 24-25, the reflux was so bad that it became life-altering. I became less social, much more irritable, and depressed. I was never overweight, but from 24-28 years old, I managed to lose 35 pounds (at some point, I was a 6'1" male at 140 lbs) due to chronic pain and being affected so severely by most food categories. I've started to develop other issues resulting from GERD as well, such as difficulty breathing and have had a few 'asthma attacks' already where I am unable to talk for up to a minute or more.
So why did I wait so long to get surgery? The idea of getting surgery bounced around in my head since 2012 when it was originally suggested to me, but I delayed this because I was convinced that it was a modern problem (which arguably it is) and that I could figure it out by eliminating some 'secret modern trigger' - but none of the remedies I tried ever fully resolved my GERD. I am now somewhat regretful of my prior hesitation to head into surgery. In Oct 2016, I told my GI specialist I was ready to move forward with surgery. However, I had to undergo a series of tests before seeing the surgeon (most were a repeat of prior tests, some were new), and on May 04th 2017, I finally had my fundoplication procedure.
THE PROCEDURE:
My procedure was performed by one of the more skilled GI surgeons in the U.S.. He is currently a chief surgeon at a major medical institution in Atlanta, has pioneered some laparoscopic GI surgeries, and has performed the fundoplication procedure several hundred times - he is the surgeon that does most of the fundoplication re-do's in the area, which really tells you something. I was told that I'd be getting the Nissen wrap (full, 360 degree wrap), but during the procedure, they decided to go with the Toupet (270 degree wrap) because they thought I wouldn't be able to swallow with the full Nissen wrap. Also, during the procedure, the CO2 they used to fill my stomach escaped somehow and went all over my body, causing my skin to look and feel like bubble wrap - a condition called subcutaneous emphysema.
INITIAL RECOVERY:
I remember being very emotional after waking up from anesthesia for ~30 minutes (probably due to the drugs?). I was in a moderate amount of pain, mostly around my throat and stomach area, and had a difficult time moving around (even turning in bed). My first big challenge was to get up and urinate. If I couldn't do this within a few hours, they were going to have to give me a catheter. Fortunately, I was able to go after struggling for an hour or two. I tried food for the first time a few hours later (broth and jello), and with only some minor difficulty, I was able to get the food down. I've never had any difficulty burping since the beginning, and my only experience with nausea was for a brief period in the evening after surgery.
My doctor said that I should follow an all-liquid diet for the first 2 weeks, followed by a soft foods diet for the second 2 weeks, after which, I could eat anything I could handle. Prior to surgery, I was taking Dexilant 60mg and was told to wean off of it after the first week or so.
WEEK 1:
I drove home with my girlfriend ~24 hours after surgery, and it was a big help to have her around to assist me. I mostly laid/sat down and got up only out of necessity. I had enough physical discomfort from the surgery and was taking hydrocodone-acetaminophen 3-4 times a day, which caused me to sleep most of the time. My diet consisted mostly of beef broth, vanilla ice cream, Ensure protein shakes, jello, pudding, and tomato soup. I had no problem swallowing the thinner foods (like broth), but had minor difficulty with thicker substances, like pudding, which could be alleviated with 1-2 sips of water. In this first week, I still felt the sensation of reflux, especially at night and when lying down.
WEEK 2:
I continued with the same diet I had in week 1, with the addition of Oreo shakes from Baskin Robbins. My physical discomfort stopped after day 10 and I discontinued all pain medication. On day 12, I was able to return to work (a job where I mostly just sit at a computer). Depending on the day, it felt as if my reflux symptoms had subsided 50-90% (compared to pre-surgery), but were not completely gone. I tried to wean myself off the Dexilant by skipping a dose, but it caused my GERD symptoms to become much more severe, so I returned to taking it daily. I wasn't really having much trouble swallowing at all, even with thicker items like milkshakes and pudding. At the end of week 2, I also started taking 30-60 minute walk here and there.
WEEK 3:
I mostly continued with the same diet as in week 1 and 2, with some small allowances (like soups with soft meat and vegetables). Attempting to eat some peanut butter on a spoon caused some severe swallowing pain that lasted for a minute or two, so I put peanut butter on the black list for now. During this week, my GERD related symptoms had improved, and I had 1 or 2 days without any symptoms at all (probably the first time in years).
WEEK 4:
At week 4, I was having no difficulty swallowing at all, with any type of food I ate. To be cautious, my diet remained fairly unchanged. I tried to wean myself off the Dexilant again by supplementing my 'off days' with 15mg of over-the-counter Prevacid. After a few days of this, my reflux became much more severe, so decided to continue taking the Dexilant daily. This is a small detail that perhaps isn't important, but I wanted to include it - On day 27, I played catch with a frisbee since it was a low intensity form of exercise, but when I went to reach up for it above my head, I felt a pop in my chest that caused me to contract in pain briefly. I tried to take it a little bit easier, but it happened a second time, so we stopped throwing the frisbee around and went home. Maybe it was a coincidence, or maybe it was because I had only taken 15mg of prevacid earlier that day, but all my reflux symptoms came back entirely. For the end of week 4, there was no reduction in my GERD symptoms compared to pre-op, and it's possible that they were even a bit worse.
WEEK 5:
As I write this, I am mostly through week 5. Strangely, I see marks on my chest from the 5 incisions they made, but that's the only noticeable difference in my condition at this point (compared to pre-op). I have no complications from the surgery (e.g., difficulty swallowing, nausea, difficulty burping, etc.), and my GERD symptoms are back to the way there were before surgery. I am sticking almost entirely to a liquid/soft-foods diet and am taking the Dexilant daily. Due to the reflux pain and my inability to sleep at night, I took a few more days off of work. I am going to the surgeon tomorrow for a follow-up appointment and will relay my experiences to him.
THOUGHTS AT THIS TIME:
I've seen many posts mentioning that 'anything is possible in the first few months', or that the 'esophagus is a dumb organ and will interpret other kinds of pain as reflux pain', but I admittedly very dismayed and unhopeful right now. I am fairly confident that the pain is actually reflux, since some small amount of liquid/material actually goes into my throat or mouth, and because it is worse after eating certain things or after lying down.
I am a little paranoid that my wrap came undone or herniated while playing catch with a frisbee, but at the same time, it seems highly unlikely that this could happen simply from me putting my hands up in the air to reach for a frisbee, but it did really seem like the 'turning point' for my symptoms returning. I will see how it goes and see what the surgeon has to say tomorrow when we meet, but am currently feeling defeated. I will try to remain optimistic, and like I promised, I will provide weekly updates, rain or shine, for at least the first 12 weeks.