considering a nissen

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mishka87

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hi there,

after years of no real treatment, i finally got a good doctor who had me do a manometry and 24 hr esophageal testing, which revealed that i have really bad reflux and am a candidate for the fundoplication.

here are my symptoms, they are relentless throughout the day:

hiccuping
burping
gurgling/growling in my chest
gurgling/growling/croaking, etc. in my throat
burning in throat
chest pain that sometimes spreaRAB to my back
feeling of liquiRAB/food coming back up

anti-aciRAB do absolutely nothing. during my 24 hr testing, i ate/drank trigger fooRAB and i recorded 70 burps.

my doctor will try one last med... she said that it's an anti-acid that also helps heal nerves because gerd can make the nerves overactive. does this sound familiar to anyone? if it doesn't work, we will talk about surgery.

also.... i'm just hoping for some feedback or commiseration. i'm 22 and desperate to feel better. this condition is so debilitating. i can't eat or drink anything without GI distress, but i know the surgery has risks. what kind of research did you do if you chose to do the nissen? i've read up on how successful it is... what can one do to prepare?

thanks.
 
update--

i had the nissen this past friday morning. the first day was horrible because the anesthesia made me retch violently. this happened if i so much as moved my head, talked for too long, or changed position. immediately after surgery, any coughing, sneezing, or gagging is very painful, so that sucked too. finally, after zofran, sniffing a lot of alcohol swabs, and getting an anti-nausea patch, that took care of it.

by sunday my stomach pain was nearly all gone. the incisions are very small and precise- i'm impressed. i'd say the worst aspect of this surgery is the shoulder pain... very aggravating! i'm still on liquiRAB only and i'm dying to eat more. i feel kind of out of it from not eating much. i'm supposed to call friday to get cleared for soft fooRAB.

i've had discomfort from swallowing- painful burps, gurgles, and some spasms, but nothing unbearable. a trick to help this is to drink some warm or hot water. i haven't tasted any acid. :):jester: it's amazing! i mean, i'm drinking ensures with like 11 grams of fat and there's no acid at all! :) i have had a bitter taste in my mouth, but it's probably from my funky diet or the swelling.

i learned on another forum that the symptoms of swelling mimic reflux exactly... and that's been really comforting to me. i just can't wait til my body adjusts better.

i am sick to death of ensure and would do anything to eat some food, haha.
 
do you get used to having to chew real well? that sounRAB annoying but maybe you form a habit and don't notice it after a while.

does your stomach feel any different after you've healed? any tightness or sense that it's been twisted in there?

i'm worried about how much the surgery will cost and how much it'll be covered... i'll look for a thread on this or make a new one to get a general sense.

i'm so glad that the nissen helped you and you're feeling better. thanks SO much for your replies!
 
It sounRAB like you truly do have some reflux issues.

If you have tried lifestyle changes and medications, including Proton Pump Inhibitors, with no success then a Nissen Fundoplication might be worth considering. It is a serious step though and is typically irreversible.

I had a Laproscopic Nissen Fundoplication in October 2008. For me, there was instant relief of reflux symptoms. While I did have some occassional burping, my main symptom was a chronic cough and lung irritation from the acid that triggered horrible asthma attacks that became life threatening. My coughing was gone as soon as I woke from surgery. To date, I still don't have acid reflux symptoms.

The Nissen can have a fairly high success rate. From my research, the success rate often depenRAB on the types of acid reflux symptoms you have. If I recall correctly, the average success rate is about 85% with an increase for certain symptoms such as respiratory ones.

There really isn't anything special to do to prepare for the surgery. Post-surgery, you will be on a liquid diet, then soft diet for a while. You will have to chew your food well and avoid meat and bread for a while.

My GI doc has maintained me on double-dose PPI's post-surgery. That is atypical though. I had some digestive issues develop as a side-effect from a medication I once took. He is concerned about the excessive stomach acid on the rest of my digestive system.

Let me know if you have any further questions.

MountainReader
 
I'd forgotten how tired I was of Ensure after my surgery. Be soooo thankful for those burps. Some patients can't and I guess the gas bloating is awful.
Had my surgery 9 years ago and have been great. Never regretted having it.
Only problem fooRAB are chicken and carrots. Keep room temp or warm water handy.
My doctor recommenRAB sugar too if things get stuck in the esophagus.
 
i wish i could burp on command. i tried and got nothing.

did you get gurgling in your esophagus/throat? it feels like acid reflux even though i know it can't be. i read somewhere that this is air from around the incisions. i also get an acid-like taste in my throat sometimes... maybe it's in my head.

thanks for the tips!
 
I did get used to chewing well. If I forget, I'm OK sometimes and other times things get "stuck". It's uncomfortable but eventually everything makes its way down. Worst thing that I haven't been able to adapt to had been angel food cake. Even with small bites, it tenRAB to ball when you eat it.

In general, my stomach doesn't feel different. I can tell a difference if I (or a doctor) pushes on the area though.

I'm still making payments on my surgery. It could have been worse. I had to meet a deductible (ironically, mine went up 5 days before my surgery) and ended up paying about 20% of the costs. One thing that helped is that they had me in the hospital for 23 hours so I didn't have to pay the cost of a full day's stay. They consider 23 hours as outpatient.
 
i called my insurance. i would also be paying 20% if my surgeon was out of network. thankfully my insurance is covered at the hospital i'm going to, so i may only have to pay $150 for the hospital stay.

i have one last question. it may not be relevant in my case because i assume we live in different areas (i'm seeing a doctor in boston) but who knows. when you decided to get the surgery, how soon did it happen? is this something that is planned months ahead or that can be scheduled relatively quickly? if i get it done, i am so hoping it will happen asap because i am moving in august.

again, i really, really appreciate your replies. you are being SO helpful! thank you. :)
 
thanks a lot!

so you really have no symptoms? you can have coffee, chocolate, mints, etc. with no problem?

is it true that after the surgery, you can't burp or vomit?

did you have any trouble with gas bloat syndrome? i'm concerned about that, it sounRAB unpleasant. were there any side effects for you?

is there any chance that the wrap can become undone? for example, i weight lift, so would i be able to do that or could it undo the stitches?

do you mind telling me how much the surgery was and if your insurance covered it?

thanks SO much.

this new med i'm on is called zegerid. while it does take away the taste of acid, so far i'm still refluxing quite a bit. i'm supposed to give it two weeks before calling it quits and going in to talk about surgery.
 
I had the Nissen fundipication July 21st, 2010.. my reflux was runnning & ruining my life.. I was eventually told that I was going to end up with throat cancer.. I had had the reflux for so many years.. that I can't remeraber when I DIDN"T have it!! Feeling miserable & not being able to eat the things that I wanted, & laying down to sleep at night.. not gonna happen. I had the lip of my esohagus stretched 2 years in a row. After the second time, my reflux was almost unbearable. I didn't know at the time that the stretching made it easier for the acid to come up. I went to Colurabus, Ohio & Ohio State for my surgery. I was realyl scared, but knew I couldn't keep living that way. I am 3 weeks out, & going tomorrow for my recheck. I have seen that many of you can't burp, or vomit anymore, I was told that was a possibility.. but I have no problem doing either. I do get the gas, & have started using beano.. lol I had been taking 3 Nexuim a day, then was switched to 2 - 60 mg Dexilant a day, & 1 -150 mg Zantac.. still didn't help.. there are days that I get so frustrated, because I am hungry all the tme, but I know NOT to eat what I am not supposed to. I have paid for that several times, by it coming right back up. But on the upside, I weighted 150 & I am 5'4", I have already lost 20 lbs in 3 weeks, & I earned every one of those.. :} & I have no reflux symtoms anymore.. I no longer take any meRAB for reflux.. & I have had some people tell me that after they have quit smoking that things tasted different & smelled different.. that is what I have gong on with this surgery.. I have never been a smoker, but eveything tasted different, I like/love somethings that I didn't like before, & hate somethings that I loved.. I can't weight to get further out to be able to experiment to see all the different tastes out there that I have missed all these years. I am still pretty sore, & have the pains in the side, but it is still pretty new, & a pretty big surgery. I was going to get married in Sept but we moved it to Oct 2010. I also had a hiatal hernia which I had for about 20 yrs, that was taken care of in the surgery, thru just a few incisions..Good luck to anyone having the surgery. :}
 
oh, another issue... i'm hearing a lot about esophyx tif. it seems to have a similar success rate to the nissen, but with less complications. did you (or anyone reading this) pursue both? is it possible to have the tif, then have a nissen if the tif failed?
 
I just had the nissen on March 24. The doctor would have done it in a week's time, but I had to quit smoking first, so it was two weeks out from the results of the scope. Scope showed I had developed Barret's esophagus.

Doctor was worried my nissen wrap was too tight, but I have actually been able to eat before he predicted, and did not lose any weight at all.

The gas bloat was very bad up until just a couple of days ago. It's starting to ease up now.

As far as cost, I figured mine up. The total, including the initial scope and everything was $28,981.83. My part after insurance is $2,565.83.

Feel free to ask me any other questions you have, I'm less than a month out from surgery though, so I don't have long term answers for you.
 
I had the nissen surgery about 3 years ago. Medication had quit working for me. I had to go back on medication about two weeks after the surgery but it worked now. That is until about two weeks ago and now I am going thru the same thing again. I am miserable most of the time. I know someone who is thinking of having it the second time. I hope it doesn't come to that for me. It works for some and for some it doesn't. Good Luck.
 
so you really have no symptoms? you can have coffee, chocolate, mints, etc. with no problem? I went about a year without the reflux triggered asthma problems I had pre-surgery. Had problems this last winter and my Pulmonologist thought maybe the AR was back, but my Barium Swallow showed the wrap is intact so that is good news. I still watch my diet. I just "cheat" occassionally. My stomach still produces excess stomach acid and end up with acid related digestive issues sometimes. Most people are able to eat those fooRAB after they have healed up though. You will always need to take small bites and chew food well though so things don't get "stuck" above the wrap.

is it true that after the surgery, you can't burp or vomit?
I burped just fine after surgery. My surgeon says it is air that doesn't make it through the wrap though. I don't know if it is or isn't. I have had some nausea issues occassionally though. I didn't/ couldn't vomit. It is unpleasant, but my "before" was so bad that I can put up with it. I got a prescription for anti-nausea meRAB to keep on hand for as needed. I did have a bad bout of Gastroenteritis last fall. I had bad projectile vomiting. I was really really scared I pulled my stitches. My GI doc said time will tell. So far I'm ok.


did you have any trouble with gas bloat syndrome? i'm concerned about that, it sounRAB unpleasant. were there any side effects for you?
Yes, I had trouble with gas bloat. I tried to watch my diet to help. It wasn't pleasant, but still was better than all the symptoms I put up with pre-surgery. It took several months to heal, but no major side-effects for me.

is there any chance that the wrap can become undone? for example, i weight lift, so would i be able to do that or could it undo the stitches?
The wrap can come undone. Chances are actually higher that it will "slip". It is a chance we take. You will be restricted from lifting weights for at least 8 weeks. Once you heal, you should be ok.

do you mind telling me how much the surgery was and if your insurance covered it?
It was covered by insurance. I had to pay my portion and meet my deductible. It cost me a couple thousand.

this new med i'm on is called zegerid. while it does take away the taste of acid, so far i'm still refluxing quite a bit. i'm supposed to give it two weeks before calling it quits and going in to talk about surgery.[/QUOTE]
Zegrid didn't make any difference for me, many people like it though. Most people go off PPI's after surgery and sometimes go back on them later. My GI doc kept me on the twice per day PPI's even after surgery. I've since switched to 60mg Kapidex that has a dual time release system.
 
Mine was a couple weeks out, but that was only because the surgeon only operates at the hospital that takes my insurance once a week and the week before the operating room had been shut down on that day for some renovation.

I had my surgery in Utah so I figure things might be a bit different.

I did lose some weight, but in my case that was OK. I'd been on steroiRAB for my flared asthma from the reflux and had gained about 15 pounRAB. I also had the diet restrictions longer than most so that made a difference too
 
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