How did you convince your Dr. of surgery?

I was in a similar situation.  I had breakthrough reflux on 40mg Protonix twice a day and 300mg Ranitidine at bedtime.  That, however wasn't the worst of it...I had GERD induced asthma that was out of control. 

I did not have Barretts.  Not even esophageal inflammation when my endososcopies were done.  When I had the 24hr PH monitor test I tested 4 the first time and 14.6 or so the second time.  The 4 number was crazy.  I was in agony without the PPI, and had lots of pain the day of the test. 

My PCP sent me to the GI, and he was the one who was pushing for surgery.  Both he and my asthma doc were convinced that even a little reflux was creating havoc with my lungs.

This went on for over 4 years.  Finally, my PCP threw up his hands, and bypassed the GI doc...referring me to a thorasic surgeon himself.  I saw him, was tested, the surgeon said I was a good candidate and that I should schedule a surgery.

Knowing what I know about how important the most experienced Nissen surgeon is, I went back to my GI doc.  That was when he gave me the PH test and the results were 14.6.

FINALLY, after many doctors notes from my asthma doctor and PCP, my GI doc said, "Well, I suppose a couple good reflux episodes a day could cause trouble with your lungs.  You could either treat your reflux with medication, or I could make you an appointment to talk to a surgeon."

The surgeon, after considering the referrals of my asthma and PCP agreed to do the surgery (although he said, "I have some concern about the 14.6 DeMeester score, but I trust your other doctors who know you better...") agreed to do the surgery.  Note:  I'd already had an endoscopy, PH monitor, manometry, stomach emptying test...the whole gambut)

I scheduled the surgery for three weeks later.  The rest is history.

If you can get your PCP on your side, it could help. 

Have you considered getting your PCP to refer you to the best Nissen surgeon directly?  Then the surgeon could do your testing and determine whether or not he/she thinks you would benefit from the surgery.  In the end, that's what you'll have to do...the surgeon will either look at your recent tests, or do his own.  Half the battle is selecting a great Nissen surgeon, but the other half is allowing that skilled surgeon to determine whether or not he thinks it will solve your problems or create more.

Once I got the GI doc out of the way, things were a lot easier.

Good luck.  I do think that if you put pressure on it will help. 

Hope it all works out for you!

Denise

I was the one with the 4 and 14 DeMeester (yes, Johnson-DeMeester is the same thing).  I actually was told that "normal" is anything under 14, so 14 is borderline.  You are right that a DeMeester of 50 is high.  If I'd had those results I wouldn't have had to wait so long for surgery.

Keep in mind that your surgeon wants to avoid the situation where a patient has the surgery and symptoms remain the same or get worse.  That explains the hesitation.  Still, you should have a right to override that decision if you are suffering and can express that suffering.  Listen to what they have to say, and insist that they listen to you as well.

I wish you good luck!

Denise

What are your symptoms?  I assume your're atypical...none of the regurge of acid and food into your mouth, etc.  I am also atypical.  I've never been diagnosed as LPR, but I had all the symptoms.  While I had some heartburn that was painful, I never had regurge, and I know that I was having a lot of silent GERD. 

My most bothersome and unhealthy symptoms, as I've often shared, were lung related.  Of course, I also had a lot of throat phlem, but asthma was the dangerous health issue that I faced.

Like you, I finally decided I had to give surgery a try...if it didn't work, then I could rule it out.  I guess for atypical symptoms the success rate is from 50%-75%.  My suspicion is that because they can't make the wrap so tight that food will have difficult passing through, there is always a possibility that a tiny amount of acid could get through.  Those of us with atypical symptoms tend to react to a lot less acid.  Nobody as told me that this is the reason, but it seems logical. 

I did not have Barretts, and although I would sometimes get esophagitis (Mainly when I had gastritis), I was not one of those great surgical subjects that they prefer to work on.

It took two and a half month, but my lungs did clear, and they've been better ever since.  Because my lungs are so sensitive and I went through so much, my PCP and asthma doctors want me to take precautions anyway, so I continue to take 40mg Protonix before dinner, and I still sleep with an elevated bed.  I probably don't need to do these things, but I go along with their wishes, because my experience was so bad post-Nissen and my lungs are so sensitive that I certainly don't want to take any chances.

Still, prior to my Nissen I had extremely unhealthy lungs, was hospitalized on occasion, took far too high a dose of  inhaled steroid with far too little results.  I went from 4 puffs of 230mcg Flovent twice a day, plus Serevent twice a day, (and intermittent oral steroids) to taking 2 puffs 115/21 Advair twice a day. That's going form 2,020mcg of inhaled steroids a day to 460mcg a day.  I'd say the surgery worked!  Plus, before the surgery I was taking several nebulizer treatments daily.  Because of all those steroids I developed adrenal insufficiency.  I just wish my GI doc had been more cooperative and I'd had the surgery before the steroids damaged me permanently. 

So...my lungs are better, I experience no reflux, and I consider the surgery a big success.  I do have allergy-induced asthma, but at the moment my lungs are clear and my peak flow is great.  I couldn't have said that before the surgery.

I wish you lots of luck in finding someone who is willing to help you.

Don't give up!  I just wish I'd been more assertive during those four years of horror.  I hadn't found this site, and a lot of what's written on the internet regarding Nissens is very scary.  I found people here who were positive and realistic about the surgery.  It was a blessing, and helped me get the courage to go forward with the surgery, and recovery.

Hang in there!

Denise

I was always fine on my endoscopies, too.  I would say that the PPI's didn't work for me either.  I was on 40mg Protonix twice a day and 300mg Ranitidine at night, and I still had breakthrough heartburn symptoms, and as I said, had enough GERD and Silent GERD to create havoc with my lungs.

Good luck,

Denise