drtinsac journal - GERD/LPR - extremely long

Thanks Denise. I will remember the reminder to keep everything in perspective since I just had it done. I'd like to think that when I first had no symptoms after the surgery, there was minimal swelling, which will now increase and could change a lot of the symptoms. So I'll just hope that when all is said and done, I'll be back to where I was right after the surgery.

My at home diet so far has been Costco nutritional drink, and apple juice and apple sauce. No problems eating any of it.

Today, the most uncomfortable thing has been what feels like an air or gas bubble that seems to occur in my back/chest area a bit after I'm done eating something, and sometimes after I get up to walk around. I can feel it coming on. Luckily it's not terribly excruciating but I sure will be glad when its gone.

The sore throat has been around in various degrees today, throat lozenges are helping me with that. Tonight I am going to try some mashed potatoes for dinner.

Still no BM, but this morning was the first time since the surgery I passed any 'farts'. I think that means a BM is coming sometime.

Something interesting happened today that makes me reconsider some of the symptoms I have. I had some yogurt at around 3pm, then had some more for dinner around 6:30 along with some mashed potatoes.

During the day, I've been relaxing but have had the tongue burning and bitter taste thing going on pretty strong, frankly, just like before surgery.

After dinner, I noticed a strange sensation on my tongue, and I tried scraping my tongue against my front teeth. I checked it out in the mirror, and my tongue was completely coated with a white coating. I brushed my teeth and my tongue and rinsed out with grapefruit seed extract, tongue felt a bit nicer for a while.

Not sure if I put it in this long diary somewhere, but something very similar happened within a day or two of ever taking a PPI. I had a white coated tongue, and the bitter taste, the taste I had never had before taking the PPI.

I am still taking the PPI at this point at my doctor's orders. I have noticed that since the surgery, I haven't had any of the throat tightness (globus) that I experienced in the first place (long long ago) before I ever knew I had reflux.

So.. I am thinking that perhaps the tongue issue and sour taste, is a side effect I have to acid blockers (same bitter taste happened on zantac, which similarly helped my globus). I am curious whether when I stop the PPI in the near future, my throat will remain feeling good and my bitter taste and tongue symptom will disappear.

It is confusing, yet promising. It is a bummer to sit here having had surgery and still have the bitter taste and tongue symptoms that I had on PPIs, but since I only had those symptoms when on PPIs, I can't help but wonder if they'll cease when I stop my PPI.

Any input is welcomed. I think perhaps that when I first took PPI, the white tongue was caused by some disruption in the flora/fauna in my system which then caused the sour taste. When I tried ceasing the PPI after knowing it helped my throat tightness, the bitter taste went away but my throat became tight again.

Yes, this remains a very confusing condition..

This sentence gives me hope:

"Following this diet after surgery will help minimize problems swallowing and irritation of the esophagus that can be a result of swelling at your surgery site."

If the esophagus is irritated because of the swelling at the wrap, it makes perfect sense that my built in countermeasures are in overdrive.

2 weeks out now.

I think the sour taste is getting less, but it's still there. My throat feels decent.. it's hard to tell whether the throat irritation is from reflux, or from the salivation that goes along with the sour taste.

I had my follow-up appt. yesterday, everything went fine, the NP I saw cleared me to eat other things like ground beef, and even tomato based pasta sauces. My biggest challenge is consuming enough to feel strong without eating too much volume.. so I'm eating lots of rich foods-- corned beef hash, ice cream, clam chowder, and I discovered that I can comfortably eat Fiber One bars (kind of like a granola bar, with much more fiber) which is good because I think it can make me more regular.

Besides the sour taste.. I still have that uncomfortable gas bubble that comes up fairly predictably. After I'm done eating, and when I get up or change seated positions. Just in the past day or so, I think it's getting better, at least, less painful.

One more week of freedom then back to work 2/7.

Today is the 3 week mark.. I return to work tomorrow. The last 2-3 days have been tough in the morning, I am waking up with that familiar old throat tightness. But as best as I can tell, it's much less irritating than it was before the surgery.. maybe a 3/10 compared to 9/10. The feeling is like the throat is preparing to swallow, and once you swallow, that feeling returns soon, too soon to be normal.

Funny thing is, after a few hours in the morning, by about mid-morning or noon my throat feels much better, practically normal. Although it's hard to call it normal because there is still some bitter taste and excess saliva. Excess saliva itself can make the body prepare to swallow which results in that same tight throat feeling, but it turns into about a 1/10 in the after noon. Before surgery and before PPIs, the tightness would be there always, 8/10 or 9/10, so I definitely believe there has been a major benefit even 3 weeks out.

Regarding the sour taste.. it goes in and out, overall I'd say it's better than before the fundo where it was also basically constant. At least now it abates sometimes. In googling, I've found people who have the taste symptom 4-5 weeks out from surgery.. so again, there is hope there. Since it was one of my main symptoms before surgery, perhaps my anatomy is predisposed to it and therefore it may take longer to go away.

I emailed my NP to see if I could get a prescription for Protonix, which is what they gave me when I was in the hospital. It was a very small pill compared to my regular 20mg Omeprazole (which is a capsule containing beads of the medicine) which is the reason I requested it.

Tonight, I plan to take a Zantac (Ranitidine) a bit before bedtime. Since my throat symptoms are only in the morning, I am hoping the Zantac will keep acid from doing damage while I sleep.. and I'd also like to think that I'd be able to stop the Zantac cold-turkey since I will only be taking it once a day, thereby (as the plan goes) bypassing any rebound effect, or at least spreading that rebound effect across each day.

In case that doesn't work though, I'm thinking I should take a PPI again, as I've heard many people stay on PPI for a while after fundo.

I'm sure the PPI is not as effective if I break open the capsule and try to swallow all the beads.. but I'm also not sure if I can swallow a decent sized capsule like that whole.. anyone care to weigh in? So far, I have eaten a number of different foods including fried chicken breast, and I've yet to have any issues with anything getting stuck there. However I find that if i drink too fast, I feel it slowly working its way through. Weird.

Thanks GH, I read your journal and I'm glad to hear it's going well for you. I guess overall I am doing OK, and it's early, but I've had my doubts with this thing so far. The LINX just sounds so much simpler than all this fundo stuff.

I took a ranitidine 150mg a few minutes ago, it went down very easy, I didn't even feel it. I am thinking that I could probably take my PPI in a whole capsule form even if I can't get the Protonix. Hope my throat feels OK in the morning.

2/7/13 - first day at work, went well and I noticed that my throat symptoms and sour taste symptoms were better today than they were in the past (even on PPIs).

The ranitidine I took last night seemed to help.

I got a prescription for generic Pantoprazole (protonix) made by Kremers Urban, very small pill. I plan to take it around 5pm each day before eating at 5:30, that way it'll be extra strong when I'm sleeping.

Last time I started a PPI, I had a lot of white gunk (thrush) on my tongue within about a day. We'll see if that happens this time too.

I plan to stick with the PPI until my innerds are feeling better overall, then I'll ratchet them down. That should at least take acid out of the equation, and mean that any symptoms I'm having are from the wrap irritation and/or leftover irritation from when I had reflux .. in that case, protecting those areas from more acid is a good idea anyway. I am still having some abdominal discomfort and this weird hiccupy thing, which I'm sure is all related to how things are all twisted up inside.

My coworkers commented that I'd lost weight and fat, which I expected.. I think I am down about 8-10 lbs. Next Wednesday will be 4 weeks and I think then I will try to do some bodyweight exercises that don't strain my abdomen, like maybe stair climbing, just to stay in shape and keep my skinny legs from getting any worse.

Thanks Denise. I've been taking it 30-40 minutes before meals, which worked great for me when on Omeprazole.

My throat symptoms were pretty bad today, my 2nd day being on the generic protonix. Since I still have omeprazole, and I know it worked for me before surgery, I took one of those today. I felt it going down, followed by several sips of water it seemed to slip through with no issue.

What a confusing condition this is, as we all know. Part of my mind wants to "figure it out" and the other part knows that trying to do so can be non-acceptance in disguise.

To deal with it, I'm reminding myself that I'm obviously still healing and that if I try to compare one day, or one hour, to the next, things can get depressing.. and nothing gets solved. So as best I can I'll try to think of my recovery progressing (I hope) from week to week, and deal peacefully with the hour to hour or day to day symptoms.

Hi BG. Not sure if this will help you but here's an update :). Since having the fundo and given that the "reflux" didn't immediately stop, I've been re-thinking what was going on in my case.

My gastro doc had told me that the sour taste I was having was not reflux, it was my body generating saliva as a result of the reflux. I didn't believe it, and I figured that the actual reflux was what I was tasting. Looking back on it, given that the taste was pretty much always there, it doesn't make much sense that it was actual reflux.

At this point I have a new theory for my symptoms anyway. I think my throat symptoms were (and at the moment, still are on occasion) caused partially as the result of reflux itself and partially as a result of the body reacting to reflux down in the esophagus. Now that I shouldn't have any actual reflux (or very little), I believe I'm experiencing the exact same symptoms because that's how my esophagus reacts to irritation.. sour saliva generated so that I swallow, and a tightening UES to prevent acid coming up, and also making me swallow to keep it down.

So I am thinking that as swelling and irritation decreases, and as acid is kept at bay by the wrap and the fact that I'm on a PPI, that the inflammed tissue will heal and my symptoms will go away.

Maybe there is something different about people who experience heartburn and people who don't. I didn't, yet my body was really reacting to something and the inflammed tissue proves that there was something there to react to. The hypersensitivity treatments didn't help me. So here I sit, wrapped.

People who get LINX seem to report instant relief from heartburn, and compared to fundo, that is probably a result of less swelling/irritation (a much less invasive approach) plus the fact that the barrier is keeping reflux away. Fundo people have irritated wraps and often experience heartburn, pain, etc. for a while after the wrap. That may be a combination of the surgical irritation plus the fact that the anatomy isn't sealing as well as it would were it not swollen.

Not sure if any of that helps you, BG. I am certainly trying to be hopeful about my case.. I have seen improvement for sure, but at the moment I am certainly not feeling much relief. I do believe the battery of tests, from EGD to 24 hour PH, can really be useful.. though I don't understand how "normal" acid exposure (as they tell me I had) could have led to visually inflamed GEJ after many months of acid blocking.

One thing is for sure, I have been bummed to see people disappear from this site without follow-up on their cases.. and I wont be one of those, I'll keep updating this as I go, to hopefully wrap it all up.

This is my 2nd or 3rd day back on Omeprazole (I figure a PPI can only help) and it seems to have helped my throat in the morning. Though, around the 2nd week having been off PPIs, my throat seemed to be doing decent with no protection from acid.. so I'm hoping that ties in with the irritation/swelling making things temporarily worse.

I'll update again Wednesday at the 4 week mark.

Alright here is a 4 week update..

It's easiest to classify my current condition into "overall", which includes general wellbeing, moving around, bowel habits etc, and "reflux" related.

Overall, I am progressing nicely. I am feeling comfortable enough to walk my dogs again, and I'm walking a lot each day to and from work. I am eating most anything I want, even sandwiches with lots of chewing and small bites (I haven't tried any hard/sharp things like tortilla chips yet, and I'm not planning on rushing into it).

Reflux related, I might be slightly better than last week in that my throat feels a bit better (less tight). I still have sour taste and a tongue burning sensation. I'm still on my 20mg Omeprazole.

All in all, it's very similar to how I was before fundoplication when I was on PPI. One thing I have definitely noticed is different, is that now, after I eat, I do not have the throat tightness that used to come about after meals (even on a PPI). My ramblings above, and in other threads, basically boil down to the idea that post-fundoplication, a person can experience reflux symptoms even in the absence of reflux. I've read of more than one person who suddenly has a sour taste after fundoplication, that (I assume in some cases, I know in others) goes away eventually. The sour taste, if it's nearly constant like it is for me, is not actually reflux itself, but is a sour water brash which is the body's response to reflux. The body has other responses to reflux including throat tightening, which I used to have a major case of but seems fairly well gone at this point.

So overall I'm better, even reflux wise in that my throat does not get tighter after eating. I'm reminding myself that healing takes time. I read an article today specifically on gastro problems after fundoplication. Problems are very common in the first 3 months, but by the 3rd month, they have gone away in ~90%+ of people.

I'll stay on the PPI, as I figure it can't hurt, and it may help damage the acid-affected areas of my esophagus and throat. I recall back to the first week or two of recovery when my throat felt OK even when I was off PPI. That makes me think that my throat symptoms may not be reflux related anymore as since the fundo, I've had the throat symptoms both on and off PPIs. If the symptoms were wholly reflux related, then a PPI should completely stop them (as a PPI stopped them before my surgery). So I am a firm believer that the surgically affected areas of the esophagus and stomach continue to react to reflux that may not be there. It may also be "nerve" damage related to the extended exposure to reflux before the surgery.. in which case it could take some time but should go away now that reflux levels are decreased.

Hi drtinsac,

I think you're on to something there. Thank you for sharing your insights, as they are certain to be helpful to many who are recovering with some continued "symptoms". As I learned early on, pain can be interpreted in many ways that can create confusion regarding the source.

Think about that referred shoulder pain that is so universal after stomach surgery. Who'd have thought that irritation to the stomach could create that type of pain? It's also well known that the brain interprets esophageal pain as reflux, which confuses so many and leads them to believe that their surgery has failed.

Your attitude is outstanding, and your calm, patient acceptance of the recovery will go a long way in making it a better experience. It will also allow your body to maintain the energy to heal. You aren't diverting precious healing energy to be spent on stress and panic. You are surrendering to what is, and allowing it to run its course.

Thanks again for sharing your experiences and thoughts!
Happy healing,
Denise

Something I've been meaning to write here, is that I'm not sure if I can belch or not. Before I had the surgery, something I took for granted, was being able to open my mouth and release air from my stomach. I don't know how I learned to do it, or even realize that I was doing it, but I realize now that I can't do it (nothing is released) that I used to do it all the time. I'm now thinking it was something to do with my hiatal hernia, which was small, but has been fixed.

After surgery, I could make a little burp after each swallow. I do not know much about burps/belches, but it's very small. Before surgery, I could burp pretty loud, now I can only do those tiny burps after swallowing something.

Anyways, I've just been meaning to jot that down here, so there it is. :)