Asthma attacks with GERD/LPR

I was an asthma sufferer and GERD made my conditon much, much worse.  During one episode I ended up in the hospital for a week on IV steroids.  Lung effects are an atypical symptom of GERD, and that's why my GI doc didn't push me toward surgery sooner.  My DeMeester (PH monitor) scores were never high, which is usually the thing that sends you to the surgeon. 

By the time my GI doc finally decided to give me the surgical option (with no promises, and unenthusiastically) my lungs were in horrible shape and I was doing nebulizer treatments daily.  My PCP finally sent me to a surgeon himself, which pushed the issue with my GI Doc as well.

Anyway, since my Nissen (although I do have allergic asthma symptoms during pollen season) I haven't used my nebulizer even once (for nearly 4 years) and am on much lower doses (a fraction) of my pre-Nissen inhaled steroid levels.

I still take a PPI before dinner because my asthma doc wants me to, and sleep with the head of my bed elevated.  Nissen surgery doesn't bring reflux to zero...or you couldn't swallow.  It just brings them down to normal levels--the type everyone who doesn't have GERD experiences.  The PPI is just to be safe, as an asthmatic has very reactive lungs. (I took PPIs before breakfast and dinner, as well as 300mg Ranitidine at bedtime before my Nissen, and my lungs were still a disaster.)

It's a big decision, but I, for one, have had a great exerience and excellent result from the Nissen surgery.

Good luck!

Denise

Honestly, there is nothing about the post-Nissen condition that bothers me much at all.  I'll try to  

• I wish that it brought reflux to zero (although my reflux episodes is pretty close to zero) however I am really fond of eating, so I guess I wouldn't want a wrap that was any tighter.  Because I have asthma, my asthma doc is always suspicious of GERD being the culprit for any allergy issue I have, but that's life.  I'm confident that it's not, and I know my body well.

• If I chug water it can get held up a bit at the wrap site, but it drains down pretty quickly.  If I'm walking fast on the treadmill and I take a drink, this can be a problem because it can splash up into windpipe and make me cough.  I've found that if I tilt my head down when I drink and take smaller sips (or slow down a bit) it works fine.

• I have (and had prior to my surgery) a reactive stomach.  It's very sensitve.  Since my wrap is created out of that reactive stomach, my wrap can get irritated by eating a lot of things that are rough (like large salads, raw carrots and celery, certain hard liquor drinks, etc.)  When that happens my wrap can be a little uncomfortable for a few days. I always keep Carafate suspension on hand to coat my stomach and help it heal.  This happens only occasionally. 

(I can tell you that prior to my surgery, this situation was far, far worse.  I would get gastritis which increased my reflux, and it would turn into esophagitis as well.  In addition my asthma would flare badly.  It would take at least 3 months to heal it all, and I'd lose 20 pounds before it was through.  This occurred at least 2-3 times a year.  Once I even landed in the hospital after taking an antibiotic that flared my stomach and GERD.  This has not happened since my surgery. Hooray!)

• For about a year and a couple months post op I had some dumping syndrome, although without the side-effect hypoglycemic symptoms.  I'd just hear gurgling in my stomach and I'd know that a dumping episode was on its way.  It only happened occasionally and seemed streaky.  I figured I'd always have to deal with it, and was fine with it, because the surgery had helped me so much.  However, sometime in the second year I realized it wasn't happening any more.

• I have to eat more slowly and chew more carefully.  There has been an unnatural barrier between my esophagus and stomach, and I need to be more careful to ensure I don't get anything stuck.  It's really not a big problem at all.  It's better to eat slowly and chew your food thoroughly anyway!

• I can't take giant pill anymore. I take liquid calcium, and more of smaller dose pills...3 400mg Vitamin D rather than a 1,000mg capsule.  Capsules work better than pills as they're smooth, and if they're huge I can open them and put them in some applesauce.  Again, this is no big deal for me.  I think some are able to take big pills...I can't.

• The last time I drank champagne I found out that its carbonation is too aggressive for me.  I got very bloated on two glasses. I have no trouble with beer (even draft beer) and can have a soda or two without a problem. 

There you go...all my side effects.  I guess it depends on how much you're suffering whether or not they're worth it.  I never complain.  I'm so glad I've got my life back.  I was very sick, and spent so much time on nebulizer treaments, lung PT (postural drainage), and coughing junk out of my lungs, I'd be happy to deal with a lot more difficult side effects than these!  I'm a happy Nissen Camper!

Good luck! 

Denise

Dumping generally resolves during healing.  People who have stomach surgery (including gastric bypass) tend to have the problem as they recover and their system adjusts to the changes.  There are dietary ways to help avoid the problem. Sweets tend to exacerbate the problem. Here's a link:

http://uvahealth.com/services/digestive-health-1/images-and-docs/dumping-syndrome.pdf/view

As I recall I'd get it a couple times in one week, then not again for a week or a few weeks, and it would crop up again for an episode.  As my healing progressed it became more and more rare...once a month...once every two months.  Sometimes it was just one day, sometimes two.  I never had it for an extended time.  I'm positive it was eating related.  I have that sensitive stomach I told you about, and whenever my wrap got irritated it seemed to happen.

In my case I'd get the gurgling and I'd know that dumping was coming, but I didn't have to use the bathroom immediately.  Also, I'd go a couple times in the morning and it wouldn't bother me again all day.  For me the loud gurgling was a bigger issue than the actual dumping!(When I was at a meeting once, people were offering me their snacks, because they thought I must be starving! LOL)

As far as the pills go...no, I don't choke.  They just get stuck at the wrap site and feel uncomfortable.  It's very irritating to have medication sit there and melt, or scrape through my wrap.  For that reason, I cut or crush large pills, empty large capsules into applesauce, go for smaller versions (for example, my allergy pills...Allegra is large, Xyzal is tiny, so I made the switch.  Not a big deal.)

I've never had any choking issues with the wrap.  During healing, when it's swollen, and something's not chewed well, food can get stuck and cause some spasms and discomfort.  Warm tea or non-iced water works well.  It's never choking.  Just discomfort for a few moments. The main thing is not to panic, and to take some sips to help it through.  Some people panic and try to cough it up like a cat coughs up a hairball, but unless it a huge piece of unchewed steak or something (which is a no-no during the first 8 weeks or so, and could cause problems any time...small bites and chew, chew, chew...I'm sure you've heard that more than a few times around here!)

Any other questions?

Glad to answer them.

Good luck with your search for answers!

Denise

Sorry, but I honestly don't know what my spirometry levels are.  Yes, I get them regularly when I see my asthma doc, but am more focused on how they are vs. previous testing.  Everyone's baseline is different.

I can often feel breathless and still have a fine spirometry result.  Now THAT'S frustrating. 

I do have a peak flow meter, which I use AM and PM and record what meds I've taken and how I'm doing that day.  It's a great thing to have in hand when visiting my doctor. It's easy to see trends...when things get worse, and better.  I have a great log that I use to keep track of everything, and even make note of different things that are happening (stomach problem, outside all day, etc.) to see if whatever I'm doing is creating any difference in the outcome.

You might consider that option!  Try not to get yourself all nervous and worried...stress is well known to make asthma worse!

Good luck!

Denise

You can buy a peak flow meter, and many insurance companies cover the cost.  If you have your own, you can have control over discovering whether your condition improves or declines.

Does this chart help?

http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=10058

Here's another document with great information:

http://www.ccjm.org/content/70/10/866.full.pdf

As I said, what's important in my case, and to my doctor, is the comparison to MY normal.  I guess it might be because have a long history of asthma and great records from nearly 20 years of seeing asthma specialists.

Take care,

Denise

Yes, I have experienced better results since my Nissen.  I must say that I didn't see immediate improvement.  It took some time for healing to occur.  I saw a marked improvement at about two and a half months post-op.

The cancer risk calculator is very interesting.  Thanks for sharing.

Take care,

Denise