What to expect one year after Nissen? A request for help.

about 11.5 months ago (March 31, 2016) I had a full Nissen fundo + hernia repair by a well-respected local surgeon who specializes in Nissen, Linx, and hernia repair. I'm a 41 year old female who has suffered from GERD for most of my 41 years. It worsened severely after a Norovirus-like event in my early 20's and due to a failure to respond consistently to a range of PPIs at a variety of weights, I decided to go for it.

I was not a candidate for Linx due to the size of my hernia and body weight. At the time, my BMI was all too close to 40 though I was in fairly good cardiovascular health and active. I did a fasting prep before surgery and lost ~ 12 lb and have now lost a total of ~34 lb. My BMI is closer etc 33-34 now.

My surgeon gave me a great idea of what to expect during, immediately after, and in the first 1-4 months following surgery. I had what I can only describe as an incredibly awesome recovery. My surgeon's PA went so far as to say that I would have to modulate my expectations for months 3-6 because I had an exceptionally easy surgery and early recover. My liver was not fatty and the surgery was described as textbook.

Fast-forward to month 10 or so, late this past January. One weekend I may have eaten some pizza crusts and been foolhardy about chewing; I cannot recall specifically the trigger. Around this time I began having:
*pain under my left rib cage (not under the sternum, but a bit lower and to the left). I'd imagine this is right where my wrap/stomach is? It is an intense aching with occasional pinching.
*mild to moderate nausea.
*very occasional heart palpitations
*occasional and very mild heartburn. (No sense of stomach matter being refluxed.)
* Sometimes, following the start of these episodes, mild increased sensitivity when swallowing.
(I want to note that I've been thoroughly checked by my primary care doctor and there's no fear of cardiac-related cause.)

It is now mid-March and I am on my third recurrence. Along with the ache I have the aforementioned "pinch", nausea...and I've been having bouts of pretty severe constipation. This is all in spite of a really-fairly-great diet with natural fiber, a fiber supplement, and plenty of water.

I can't help but feel really scared by all this, and I'm sure the anxiety is not helping. I had such an amazing result that it was like a new lease on life. I know my surgeon inspired "the fear of god" in me about my weight. Simply put, he said that staying at my former weight was not "if but when" the wrap would fail. I've not stopped losing weight and don't intend to stop now (I log all food every day and lose between .25 to 1.25 lb/week).

I simply can't find any reliable site or book for information on what to expect >1 year or so after Nissen. I have no idea whether these symptoms are normal. My surgeon did check me and felt my abdomen. She said that if I'm not having raging reflux and heartburn, and food occasionally goes down slowly to "calm down"; the surgery is either intact or not. This makes sense. The surgeon is a surgeon and just that; they are not super-gifted w/ hand-holding and aftercare.

I have made an appointment w/ my typical gastroenterologist. I wonder if anyone could direct me to a place to read about expectations. I also wonder if this pain under the left rib should be worrying me a lot, and whether the symptoms I have are simply my challenging myself too much w/ foods, not chewing well enough, gastritis or the like.

Thanks very much in advance for your help.

Thanks very much for the input. It's good to know. Everything seems relatively normal apart from the pain under my left ribs.

I do have Zoran from the surgeon which I take when it's really needed. I drink a lot of water and tend not to be too stressed. I am checking in w/ my gastroenterologist this Friday and that will be great in terms of checking on the left-side pain (the only symptom that seems really abnormal and hadn't occurred at all earlier in my recovery.)

Welcome Geekgirl, I'm glad that you are keeping in touch with your surgeon and GI Doctor. You had MAJOR surgery and healing goes slowly and gradually and still going on even at a year . The doctor told our family that having the procedure is not a license to go back and eat what you use to eat or want to eat . You should eat now how you should have eaten before the problem happened. You must now make proper eating your priority, still avoid trigger foods, chew, chew, chew is very important. No big bites or gulping like in a hurry. It helps to go back and eat soft, well cooked non-acidic fords when you are experiencing some problems-- do it for a week, then add Small firmer things back. If pizza crusts are bothersome--avoid, even its cheese and tomato topping. Don't get constipated as bearing down can cause discomfort for the hernia repair and wrap and push things up through the hiatus that was repaired. Please let us know if you are doing better and keep the weight loss going. Our surgeon said do not gain weight as it changes things anatomically inside after surgery. We wish you well. We all learn from others and know that we are not doctors.