Post-Nissen, need support

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scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 9/11/2010 7:44 AM (GMT -6)   
First of all, thank you for the forum. When I was researching Nissen vs TIFF this board was a huge help. I felt very prepared for what would and might happen, and my surgery (8/24), as well as the week after surgery were a ringing success. I'm off the PPIs.

I am writing because I am becoming very stressed, panicky because I have been having GERD symptoms on and off, ever since going on the soft diet (while I was on the liquids & full liquids and immediately after the surgery I felt amazing, no GERD. Physically I feel good, no gas problems, pain is gone, I can take my full breath, painful hiccups are gone). Now, panicking is my usual reaction as I had GERD for 4 years, struggled, it was very emotional, especially since I am a singer and most of my symptoms were in my throat. I am not used to waiting as I've been told by my doctors. My main panic is that I basically have to act like I have reflux: modified diet, no acid and acid causing foods, I can't sing if I feel anything in my throat, I can't recline after eating. Since 8/24 I've only sang 3 times (which doesn't a career make). The first time I sang it was incredible, as were parts of the second time I sang, but as my throat has become irritated, sore, hoarse, and feeling like there's something in my throat. (I beg of you not to say it can be something else with my singing. I know my GERD symptoms like a hawk.)

However I am confused by what my GI doc & my surgeon say. My surgeon--who is warm & chief of surgery in an major NYC hospital, very confident in his work-- says this should last forever, I should never have any drugs, and he was concerned that I was "happy" with the procedure, despite my telling him of the throat symptoms. He says there's no way it's reflux because of the wrap. But I know my body. His NP says everyone is different when you can tolerate certain foods. To be gradual. MY GI doc says look, you're only 2 weeks out, that full recovery can take 12 weeks, that I should be careful and am in recovery for 6-8 weeks; he says that scarrification of the wrap has to happen, that the GI system is a dynamic system that needs to adjust. They both say do not worry, to give it time. I also read somewhere that my symptoms, "Indirect symptoms take weeks to months to improve."

My surgeon had me thinking that I would be fixed in 2 weeks, so I am having a hard time accepting and waiting longer. This is an entirely new system of diet, of mind, of singing, and it is really stressing me out. It is very hard to have these symptoms and not have my usual PPIs to take. Meditation, exercise, I know what I have to do.

So please tell me it can get better with time. Help me wait. Please tell me the success stories of waiting, of how much better you felt in a couple months compared with the first few weeks.

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 9/11/2010 8:03 AM (GMT -6)   
Your doctor was right, it does take time to fully recover. Since you had throat issues before surgery it will take a couple of months before your throat is healed fully.
You are still swollen inside, think egg beater's happened.
At two weeks I was still on semi-liquids. If I has a soft food it was soupy-like.
Eventually, you will be able to eat normal again, just chew very well right now.

I'm 9 months out and everything is great. Everything's back to normal. I was feeling good by the end of the second month. I'm a singer, too. My voice came back around the middle of second month.

Just be patient and don't rush it. :)
Joy

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 9/11/2010 9:54 AM (GMT -6)   
scazzasofija.
Try to relax. You're just at the very beginning stages of healing. Your surgeon shouldn't have made you think that damage that was caused by years of reflux could be completely healed in just two weeks. You may have been able to sing, and not be able to now, but that does not mean that you never will.

I had severe, uncontrolled asthma, and had the surgery to try to get it under control. It took a full two and a half months for it to heal, and I'm sure it was still healing for weeks thereafter.

I don't know if your GI Doc said anything about the fact that it takes time for your wrap to heal, become less swollen, and settle into place. My surgeon said anything can happen during the first weeks of healing, and that there may well be a bit of reflux occurring, in spite of your wrap. If it is swollen and not totally healed (and it's not--remember Joy's egg beater analogy), you can be getting some reflux, regardless of what your doctors say. (You know your body, as you said.) This is not at all uncommon, and does not mean that your wrap has failed, and that you will never sing again.

Give your body a break, and let it heal. Don't try to rush your recovery, because if you do it will only cause frustration.

Personally, I see no reason why you can't go on PPI's during the healing process. Many, many people continue taking them until they are fully healed. If you think they would be helpful, why not discuss it with your GI doc?

Above all, don't panic and think this is the end of your singing career, and that you had the surgery for nothing. That is not the case. If you read posts from others who have had the surgery, you will find that it takes months for the healing and recovery to occur. Give yourself time, and don't try to rush things.

I'm no expert on voice (although I have my own struggle with mine--exacerbated by severe allergies), but it seems to me that if you were beginning to heal, then used it too soon, you could have created your own hoarseness, rather than it being reflux-oriented. I know that when my voice seems better, then I overuse it, I can be back to hoarseness.

You might want to check with an ENT about that aspect of your recovery.

Anyway, welcome to the Wrapped Club. You're in the right place! People here have been there and done that, and have stayed around to help others through the same things.
Take care, rest, and recover.
We're with you!
Denise

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 9/11/2010 10:02 AM (GMT -6)   
One more thing, scazzasofija...
As far as eating goes...the main thing at this stage is to eat only things that can be chewed to a liquid. Irritating foods (spicy and such) might be held off, as your esophagus is likely recovering from a very irritating procedure, and those foods, as they sit at the bottom of the esophagus waiting to be let through your newly created (and likely still swollen) wrap, can create their own irritation. Actually any food, if sitting at the bottom of the esophagus, can create the feeling of reflux. The esophagus is a dumb organ, and can interpret any pain as reflux.

Try drinking water after eating, to wash any remaining food into your stomach. Stay away from sticky things like bread (toasted is fine) and things that are hard to chew completely, like steak. Take small bites and chew your food thoroughly.

Most of all don't despair! You just had a major revision of your upper GI tract. It will take time.
Give yourself that time...it will be worth it in the end!
Denise

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 9/11/2010 11:17 AM (GMT -6)   
Thank you for your replies. Couchtater it's good to hear from a singer, and that it took until the second month. Dencha thank you for this: "My surgeon said anything can happen during the first weeks of healing, and that there may well be a bit of reflux occurring, in spite of your wrap. …you can be getting some reflux, regardless of what your doctors say…. This is not at all uncommon, and does not mean that your wrap has failed, and that you will never sing again."

This is my first surgery ever, so the idea that it would months to heal when I feel fine (other than the GERD) is mindboggling. I have to get used to it though. Perhaps I should ask my GI doc about PPIs while I'm healing. Though they weren't really effective for me, I'll have to think about it. I am rushing it, I shouldn't despair or lose hope even though I am getting reflux now.

As for using it too soon, I mentioned that my first practice was incredible, and got progressively worse as the reflux would happen in the subsequent 2 practices. Thank you for your kind words though. I'm not feeling pain. These are the symptoms that I've gotten to know well over 4 years.

Today the reflux is just feeling awful, but I'm sure my stress is a big part of that.

So good to know that this is all part of the process. I'll be keeping your words close, thank you.

"Give yourself that time...it will be worth it in the end!" Yay!

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 9/11/2010 7:12 PM (GMT -6)   
Yay is right!

Laproscopic surgery is deceiving. You have tiny incisions, and recover quickly on the outside. At the same time, your insides have been stirred up, and your upper GI tract has undergone a major revision. It will definitely take time for it to heal and settle into place.

Some people have very tight repairs, and can have difficulty swallowing, but no reflux whatsoever. Those of us who had looser wraps can experience some reflux during healing, and occasionally after everything settles into place. At the same time we don't have as many of the negative side effects like bloating and swallowing issues. It's a delicate balance that the surgeon tries to reach...tight enough to ensure no reflux, and loose enough to allow easy swallowing and fewer bloating issues.

You are not even a month post op. You've got lots of healing still to do. It's hard not to want to rush your recovery, but it just takes time. Relax, keep occupied, think positive thoughts, and heal.

Glad you're here with us. Keep the faith. It will happen!
Take care,
Denise

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 9/12/2010 8:30 AM (GMT -6)   
I'm very thankful for you guys. Last night was really hard because the reflux is getting worse: I am now hoarse all day and have heartburn all day. I didn't want to eat anything yesterday (not good) for fear of the reflux. I was afraid of damaging my esophagus with 6 weeks of heartburn and stressed that my doctors wouldn't understand and let me take PPIs. I also scheduled a lesson for Monday a week ago and don't know what my body will be like. So I took one of my old Protonix and woke up feeling mostly better. I can't decide if I should just use it occasionally or daily for the next 6 weeks. I'm also stressed about having to have these frustrating conversations with my doctors. But still, having PPIs as an option is an improvement, I meditated, and I didn't have a meltdown.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 9/12/2010 9:06 AM (GMT -6)   
It makes total sense to use the PPI's for a while, while you are healing. It's a common practice, and I'm certain that your doctors would not disagree.

You definitely should eat. Not eating could stir things up in its own way, irritating your stomach as it waits to be fed!

You will heal. You will get better. It take some time, so try to give it the time your revised GI tract need to settle into place and recover.

Hang in there...things will get better.
Denise

rummaan
Regular Member


Date Joined Mar 2010
Total Posts : 92
   Posted 9/19/2010 9:43 PM (GMT -6)   
Scazzasofja,
I had a surgery on Aug 7 and I'm still going through tough recovery. The worst part is nausea in the mornings, just like it was before surgery. It usually goes away by afternoon, be it is exhausting. I also have throat symptoms - dry throat, hoarseness, ball in the throat. Swallowing is okay and gas is not too bothersome. The worst part is feeling pre-surgery symptoms and thinking "oh my God, the surgery didn't work". I tried to drop my evening dose of PPIs for two last weeks and I feel awful in the mornings. The pain and nausea wake me up at 4 am. I also thought the surgery is going to help right away. I saw my surgeon yesterday and he was very positive about my surgery. He said the I had a huge amount of inflammation in the esophagus, it was actually going through the walls and had some adhesions on the outside, called transmural inflammation. He said only people whose main problem is acid regurgitation feel immediate relief after surgery. But not hose who have long standing inflammation. It may take up to a year to feel good. He said I could continue with the PPIs if I wanted to, but he also said I could just tough it out with Zantac and antacids. Up to me. I think I'm gonna start taking them again tonight. I can't work without sleeping. I also was eating solid foods since two-three weeks ago and that aggravated the wrap too. So I'm gonna back down to the liquids and mash. Hang in there, everybody says that's how it goes, so let's give it time. I'm pessimistic about the whole outcome when I feel bad, but have glimpses of hope when I feel better.

mam1298
Regular Member


Date Joined Mar 2010
Total Posts : 81
   Posted 9/20/2010 5:33 AM (GMT -6)   
Scazzasofja, I had my surgery 3/1/2010 and it took a LONG time to feel normal again. I can remember being where you are and many others who are in the early stages of recovery.

I thought there wouldn't come a day when I would feel normal and able to eat normally again but it did come.

If you search back to my postings you can see how terrible I was doing and how depressed I was that I had it done.

I am doing well today, back to normal and eating what I want with no side effects. The only problem I have and that is because my DR told me the esophagus is a dumb organ is that it goes into a spasm sometimes. This happens when I take too big of a bite of food and I don't chew it well enough or if I drink while I am eating. I've learned that lesson now since I would get the choking feeling and have to throw up immediately. I can no longer throw up food but I will get saliva that has to come up and then I am ok and I can go back to eating. Sounds gross I know.

So be kind to yourself as this was a major operation. I had numerous side effects from the swelling inside to the left arm pain and also heart burn feeling. Tums works for me now but under my circumstances of just losing my Mother, I have been taking prescription meds when needed.

Good luck and keep posting here and reading what others have posted as this forum was my saving Grace.
Nissen Fundaplication 3/1/2010 (full wrap)
Hiatal Hernia 3/1/2010
Thyroid Removal 1990

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 9/23/2010 11:15 AM (GMT -6)   
Thank you both for your posts. I haven't suffered from any esophagus inflammation, but regardless I'm trying to hang in there despite the unpredictable reflux symptoms. Trying not to worry that your doctor said that only those w/o esophagus symptoms are healed immediately, which sounds like me.

I've gone back to Protonix 1/day and that helps some. Yesterday wasn't a good day since I thought I could handle a lot of acid causing activities all at once, then at night had reflux in my throat. I had exercised, sang, then decided to try tomatoes. I had to keep eating yesterday as my weight had dropped 3lbs below what's acceptable to me so my stomach didn't get a break. Today I'm recovering from that. Not being able to eat my favorite foods is a bit depressing as food is a huge part of my life, fun, inspiration as a cook & big eater (FYI I'm naturally skinny, obesity is not a problem for me when I say this, keeping weight ON is the challenge). I definitely miss my veggies, roughage & tomatoes. I'm seriously hoping my surgeon did not make this wrap too loose. But trying not to think about that.

BTW my lesson went really well. My teacher said I was at a completely new level and after one aria my coach commented that I could sing that in any first rate opera house. yeah I'm still healing so I can't expect to sing like that all the time... yet.

Sirkit
Regular Member


Date Joined Jul 2009
Total Posts : 61
   Posted 9/23/2010 2:50 PM (GMT -6)   
Hi!
I didn't have any esophageal issues pre-surgery (I was super cautious and took gaviscon regularly to make sure I didn't have problems that way) and I still had post-op heartburn. I'm now on the tail end of week 5 for healing and things are going much better.

about two weeks ago I was lamenting that the wrap seemed like it made things worse rather than better and that the reflux was terrible! After some healing time... no reflux. Drank a couple of glasses of wine last night... no reflux. Slept flat and without Gaviscon... no reflux :)

Hang in there, it sounds like you're getting to do some of the things you like doing and I'm sure your wrap is just perfect! Try to go easy on your tummy and don't give it any reasons to be mad at you, it'll come around.

I'm naturally skinny too (body fat just below 8%)! My surgeon called me the best candidate he had seen in years and here I was one failed surgery and a slow second recovery. LOL! Sometimes you can just never tell.

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 9/24/2010 8:55 PM (GMT -6)   
Hi scazzasofija,
Glad to hear your singing voice is in good form! Try not to worry about symptoms at this stage of the game. You're just a month into recovery...you've got a long way to go. Your insides haven't healed yet, and still have some settling in to do.
Try to be patient and don't stress. It will come...
Take care,
Denise

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 9/28/2010 2:16 PM (GMT -6)   
Thanks Denise. That was just one day and today my practice went horrible and nothing was working. My mind goes right to the surgery but I'm pretty sure my cords are swollen from PMS. So your advice always means a lot to me. I keep remembering Joy saying her voice came back in the middle of the second month. I miss singing regularly so much. Patience patience, with your support I will be. "It will be worth it in the end."

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 10/8/2010 9:06 AM (GMT -6)   
So I'm back with more complaints. confused It's the middle of the second month now. Some things in my singing are better, though inconsistent is the best thing I can say about it. The worst is that I feel like my reflux symptoms are getting worse, not better. I've been back on the PPIs, but I feel like they're helping less than they did a month ago. Before the surgery the PPIs took a couple months to get to full strength, and where they were working like a charm to manage the reflux before, now they're helping less. Last night I took a PPI after feeling some heartburn, but I'd also been taking it regularly, and I thought it would help. This morning I woke up with a burning throat and esophagus. I can imagine and also feel that the wrap has stretched; I certainly don't feel anything going through it anymore, no spasms, nothing gets stuck, and I don't have to be careful about chewing my food, everything goes down easily. That last scares me since I was told I was supposed to chew my food well for the rest of my life, that food shouldn't be going down this easily.

That first singing practice a couple weeks after my surgery when the wrap was still tight, I could feel the tightness keeping my chest and throat completely clear. It certainly got worse in the next few days, and now I'm more active which could be harder on the healing. While I've sang well on occasion since, it hasn't felt like that, and it feels like it could be getting worse. Due to deadlines I have to record this weekend, so I'm on voice rest, going back to soft & bland foods, and drinking lots of ginger. I've already turned in applications with old bunk recordings so I have to record asap. I don't stress about the reflux anymore, but I'm certainly observing, curious and confused. While I can only judge after 2 or 3 months, I am starting to think the wrap is too loose.

Thank you al for all your encouragement! sad

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 10/8/2010 9:13 AM (GMT -6)   
You can ask your doctor to do a barium swallow to see if it's refluxing.
Joy

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 10/8/2010 9:46 AM (GMT -6)   
Hi Joy,

From what the other posters said, I understand that having reflux at this point is common. I am having reflux, there's no doubt about it. Why do I want to see if it's refluxing? Are you saying that reflux at this point is something the doctors should see for some next step? It's not too soon? I thought it takes 3 months before this kind of questioning starts.

Thanks!

couchtater
Elite Member


Date Joined Jul 2009
Total Posts : 14475
   Posted 10/8/2010 2:27 PM (GMT -6)   
Some people have worried this soon and to calm their fears they get a second swallow done just to be sure.
My coughing didn't fully stop until 3 months, but then I had caught pnuemonia that 2nd month. So I'm not totally sure when my issues had calmed down.
Give a few more weeks on gerd diet and see what happens.
Joy

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 11/2/2010 7:07 PM (GMT -6)   
Hello everyone,

I wanted to give you guys an update on the symptoms I've been having ever since going on soft foods back in September. Things have been the same with the reflux, heartburn, hoarseness, even getting worse as I haven't had a good singing day in weeks. I've been really strict (staying hydrated, no acid, no roughage, no fats, sleeping elevated, taking meds) and nothing has helped. Last week was tough as my symptoms were at their worst and so a very important audition wasn't adequate. I saw my surgeon that week and they said this was definitely not normal, they thought it was possibly bile reflux and scheduled me for a barium swallow study which I had this morning. Sooooo the results: the wrap is in tact, I don't have anything coming up from my stomach, yay! No popped stitch, no leakage, seems like no bile reflux, no need for a second surgery which was lingering in my mind a bit.

But I did get confirmation of my symptoms, it's not nothing, not all in my head. There's "stasis" in my lower esophagus, meaning not everything is going through the wrap and then the food is refluxing back up from there. Because of my severe symptoms I'm going to have an endoscopy with "dilation" to stretch the wrap so things pass more smoothly. This definitely explains why I've been having constant heartburn which I never had before with all the stuff sitting there, why my symptoms were so unresponsive since this isn't something I can really treat by being strict, why drugs were inconsistent in helping, etc. I took your advice and had been drinking lots after eating, trying to flush it out, but this stuff won't flush. I never would have just thought this was the culprit since I don't get spasms, no pain, eating goes very well.

So, in case any of you are still interested, there it is. I'm trying to get my dilation asap as this is my final year I can compete in the Met Auditions, and that's in 2 weeks! I'm so excited I could have my voice back!

sleepless77
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 11/3/2010 4:12 AM (GMT -6)   
I wish you all the best with your recovery, sounds like you are on a right pass.

I am also in NYC and now researching the Nissen Surgery and doctors. Could you please give me some recommendations? The name of your surgeon if it possible or which Hospital did you have it at? Sorry I am asking like this but your email is not available.

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 11/3/2010 9:15 AM (GMT -6)   
Feel free to email me: aanon44 at gmail.com

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 11/3/2010 9:31 AM (GMT -6)   
From my GI, the doctors who were recommended to me in order of preference, though all extremely accomplished and talented:

Dr. Michael Edye http://www.mountsinai.org/profiles/michael-edye
Dr. Marc Bessler 212-305-9506
Dr. Paresh Shah-Lenox Hill Hospital- Ph:(212) 434-3285
Dr. Martin Karpeh- Beth Israel- Ph: (212) 420-4041

I hope that helps you. My insurance determined who I went to. If you have more financial options, that will be great in finding a relationship with a surgeon who works for you. I went to a surgeon after I completely ran out of options and did extensive testing. If you have more questions about my specific surgeon, I'll be happy to tell you via email.

Post Edited (scazzasofija) : 11/3/2010 9:52:51 AM (GMT-6)


sleepless77
New Member


Date Joined Oct 2010
Total Posts : 6
   Posted 11/3/2010 5:00 PM (GMT -6)   
Dear Scazzasofia,

Thank you so very much! It will help me tremendously. I guess I was searching in the right directions, Marc Bessler and Paresh Shah names were mentioned to me already!

But, of course my insurance will have the last word.

And the best of luck with your procedure and your Met Auditions (wow). Go get them!

dencha
Forum Moderator


Date Joined Feb 2009
Total Posts : 7181
   Posted 11/3/2010 9:15 PM (GMT -6)   
Hi scazzasofija,
I'm so glad that you've gotten good news. I truly hope you can get things straightened around and healed in time for your audition! That IS really impressive!

I had a barium swallow and there was a similar finding...a small amount of barium was retained in the esophagus, and air from my stomach moved it up and down my esophagus. Your story made me think. Like you, my wrap and hernia repair appeared intact.

Also, while I don't seem to have trouble eating, I do notice that if I drink a lot of water, I can feel it building up in my esophagus, then it gradually drains into my stomach.

Your experience has made me wonder if my symptoms are caused by the same thing. I'm going to visit a surgeon on Tuesday, to see if he thinks I need a redo. I suspect he may not find anything to fix. My problem is mainly asthma made worse by reflux. Food retained in the esophagus would be enough to get it going as well. My voice is also affected.

We shall see...

Good luck with your endoscopy and dilation. I hope you get your voice back very soon!
Take care,
Denise

scazzasofija
New Member


Date Joined Sep 2010
Total Posts : 16
   Posted 11/5/2010 7:13 PM (GMT -6)   
Denise,

I had the procedure today and I'm feeling a bit sore, trying not to fear that it went too far--we shall see how things go. I wanted to mention that when I consulted with my GI doc who actually did the procedure, because I wasn't having trouble swallowing he didn't necessarily consider it conclusive. He had his doubts, and so I did as well (all night last night, so I'm exhausted). My symptoms had been better this week, still inconsistent though, and especially the last 2 days I've been feeling ok. He said he would give it more time, and if it weren't for the competition and my months of misery & confusion, I think I would have. I didn't feel good about changing course the night before and my surgeon felt the procedure was the right course and the wrap would be fine. I'm just saying there was debate.

Your voice is affected, heartburn too? My GI doc said a good test to see if it's refluxing would be an impedance probe (but god those things suck). I think you're good to ask your doctor, and I'd say give your GI a call and talk it over with them too.

Thank you for all your support, let me know if I can do anything.

S
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