Posted 11/30/2010 10:15 AM (GMT -7)
I just wanted to stop by and let you know that I'm thinking of you today! I'm looking forward to hearing from you once you're feeling up to a visit to the forum. I don't know if it will be helpful at all, but I'll copy and paste my post-op journal that goes to (I believe) Day 19. It might give you a framework the will help you as you go through similar experiences. Every situation is different, but it might give you some valuable information. Hope so!
Wishing you a great surgery and quick recovery!
It's probably too much information, but here it is!
PS--Just in case you didn't hear this yet, have your husband pick up some liquid Motrin, or Tylenol, because you won't need the pain meds they give you for long, and you'll be switching to OTC pain relievers.
Nissen Fundoplication Surgery:
Hi all. Thanks for sharing your experiences on this forum! I am having surgery (provided my asthma allows it) on next Friday. I've read everything possible in the internet, and am going into this with eyes opened, but I'm glad to be moving forward. My asthma is just unbearable, and I have 3 doctors who are quite confident that ending GERD is the answer.
I've resisted for 4 years...since being hospitalized for an asthma attack set off by GERD. I've been nudged over and over by my doctors. I feel quite confident with my surgeon, who was recommended by my GI doc, and has checked out with other sources as well. He has excellent bedside manner.
rburnet, thanks for sharing your recovery experience. I'm a teacher, and am hoping that my recovery goes well enough that I can manage to go back to school in two weeks. Wish me luck!
If anybody has some advice for a fundo nubie, I'd greatly appreciate it. I'll let you know how I do.
Days 1 and 2:
Well, I'm on the other side! I had my surgery done yesterday morning at 9 AM. I had a hiatal hernia repair and laproscopic Nissen Fundoplication. My surgeon reported that things went well.
I did have one little complication. I have taken inhaled steroids for a long time for asthma, as well as having to take oral prednosone for about the past 10 days due to an asthma flare up. The doctor said that my tissue was very fragile as a result, so he took extra sutures in the hernia repair to ensure that it would hold.
Of course, I didn't know what to expect after waking up from surgery, and was pleasantly surprised. I had no nausea from the general anesthesia, my throat wasn't all that sore, and my lungs had handled the surgery well, with no asthma flare ups.
I had probably 3 doses of morphene through the day, before I switched to Lortab elixir. That worked very well, and is what I came home with.
My swallowing was a little spasmy at first, but got better as the day went on. I only had water all day, and a bit of chicken broth, and lemon ice at night.
Tips about the hospital stay:
Don't count on the nurses or dietary people to know what you should be eating and drinking.
Read lots about what to have and what to avoid.
I was greeted with a cup of water complete with straw. If I hadn't learned that straws are a no-no, I'd have gulped a lot of air into my stomach for no good reason.
I also had caffeinated tea on my dinner tray (which I switched out)
This morning I had a can of ginger ale and another straw. Also caffeinated coffee. (All no-nos)
I had to ask for a gas-X product (simethicone) to be ordered, and it was a bit of a challenge to get it when I wanted it.
I'm home now, which is a huge positive.
Honestly, I've had much worse experiences with actual GERD episodes that burned my esophagus so badly that I couldn't eat a bite. This (so far) has been more comfortable than that. I've just got to remember not to get too feisty, and let myself heal.
IN THE HOSPITAL:
Everything went very easily. Pre-op and post-op procedures were fine. Recovery was a pleasant surprise. I didn't know what to expect, because I'd never had general anesthesia.
Once back in the room I just dosed on and off with the morphine. I didn't have any adverse effects from that, either. My swallowing wasn't as good in the beginning...little sips. As time went on, my swallowing got quite normal (water only), but I tried to be careful not to overload my stomach.
The nurse switched me from morphine to Loritab, so I could see if it was effective, since that's what they'd send me home with. It worked fine.
Here I sit at the computer. I haven't had any pain meds since about 6 AM, so I'm feeling some discomfort.
Mainly in my left rib area...according to the resident, that's the port that gets the most activity and movement during the surgery.
I do have some of that famous left shoulder/collar bone are pain. They blame it on the co2 they pump into your gut so they can see what they're doing. It's uncomfortable, but bearable.
I had part of a soft scrambled egg, because I was really pretty hungry. It went down well, but I think my new valve is tired of working at the moment, and doesn't feel as good as it had when I didn't challenge it as much.
While I know I'm in for some ups and downs, I feel that this is a very "doable" process, and I'm very glad I went through with this. I know that there are a lot of hurdles to pass, and I won't know of its ultimate success for quite a while.
I had to do this, though. Although the percentage for the lap Nissen's effectiveness in curing things other than GERD is only about 70-80%, I had to try this procedure. My doctors were just maintaining me. They had nothing else to help me, and really wanted me to give this a try.
Just before leaving for the hospital I had a severe GERD episode, and of course I could take nothing for it. I immediately started coughing and wheezing, and it took an nebulizer treatment in the hospital to get my lungs to calm back down. IT WAS A MESSAGE TO ME; This surgery will help your asthma, and the GERD definitely is irritating your lungs.
I stupidly did something I shouldn't have just now. I bit into a Dulcolax "softgel" to see if it was chewable, and got actually swallowed the liquid. It was quite irritating to my throat. Hopefully I haven't done something that will screw me up! Oh well...don't make that mistake!
I'll keep you posted.
Well, I've made it through my third day post-op, and I'm still here! My stomach felt more comfortable today. I'm on oral prednosone (due to persistent, severe asthma), and have been on it about 13 days (IV in the hospital), and that is very tough on the stomach. Because of that, I gave up the hydrocodone pain meds, and switched to extra strength liquid Tylenol (chosen because it's the easiest on the stomach). I use ice for the surgical pain. My left rib area is the most painful location, and I'm keeping ice on that most of the time. I'd rather deal with some pain, than an upset stomach right now.
By the way...my family doctor did call in a nausea script (suppositories) for me to have on hand. He understood that peace of mind is important at this time.
This morning, I don't know what I was thinking, (I guess I wasn't thinking)--I swallowed two 10mg prednosone tablets whole. They seemed to go down okay, but I won't do that again. I'll cut them into smaller chunks tomorrow.
So far, my swallowing is pretty good. I handle liquids just fine. My doctor sent me home to a soft diet, and I seem to be doing pretty well with it. Before my surgery I made up some fresh frozen squash, applesauce, and homemade chicken broth. Today I made whipped potatoes, and topped them with some locally made low fat turkey gravy. I also had some squash. A Thanksgiving dinner minus the turkey! I don't eat much, though...a quarter cup total. I don't want to challenge my stomach. I just eat tiny meals whenever I feel like it.
I slept from midnight to 6 AM last night...so that was good.
I have been trying to walk around the house as much as possible. At the hospital I walked a lot. A night nurse told me to walk whenever I got up to go to the bathroom. She said that was the trick to getting the gas to move out of the body. I still have some shoulder pain, but it seems to have subsided a bit. It's just a dull discomfort...not excruciating at this point.
Overall, I'd say..so far, so good. I was prepared for anything. I've had more torturous episodes with my uncontrolled GERD/gastritis that was caused by intolerable antibiotics.
I do have some phelgm in my lungs that I'm coughing up. I'm assuming this is not just limited to asthma patients post op. I'm assuming that many people experience the need to cough up some gunk. Am I right? I'd like to hear your experience.
Hope this record of my post surgical journey helps someone else who is struggling with their own decision to take the surgical route.
Best wishes to all.
Every day is an adventure. Still, to all those people out there who are fearful of this surgery (as I was)--in my experience, Days 1-4 have been much better than I had hoped. FYI--To help with others who are trying to relate to this experience...I'm a nearly 57 year old female. I don't think I'd mentioned that.
A few things that I'm noticing (and would appreciate experienced members to comment on):
1. Lung Issues
As I've shared, I have asthma issues, so my lungs are more problematic than in other cases. Do other (non asthmatic) recovering patients experience mucous in their lungs as well?
I made the mistake of trying the Unisom Melts, and they worked great in getting me to drift off to sleep again, but I ended up paying for a few extra hours of sleep with dried out mucous in my lungs, and a wheeze that won't quit. So--to anyone reading this who has asthma, I would recommend against the Unisom. (They're just Benadryl--which is an antihistimine/drying agent, that makes you sleepy) Lucky non-asthmatics, it works great for snoozing, and is definitely non habit forming.
I've been coughing way too much today, which hurts and worries me a bit. I'm also tapering off prednosone, so that could be part of the problem as well. I've emailed my doctor for advice. I'm sure this too will pass. Just one of those little bumps in the road.
My surgeon told me that I wouldn't be able to burp, but burps are slipping out here and there. I'm not purposely burping, but every so often a burp is allowed--which is actually very nice, since it allows the bloating to dissipate.
The surgeon (another in the practice) who discharged me, said that I MAY be able to burp. I guess he was right!
Do I need to worry that because I can burp it will mean that reflux will also be allowed to pass out of the stomach? The resident said that the flap can allow a bit of air to escape without letting stomach contents out.
What has been the experience of others who've been through this? Are burps okay?
3. Wrap swelling over the first two weeks.
I noticed today that "lump" feeling--the feeling that I'm swallowing a big gulp of air--when I swallow food. I figure it's the beginning of the swelling, and expect that it will probably become progressively more challenging to get things swallowed, until the swelling begins to subside. So far, though, swallowing has been fairly easy. Better than I had hoped. Very "do-able", and much less scary than I expected.
Is it common to have this experience? Do the wraps always swell?
I'm determined to go with the flow of the recovery process. I wish my lungs weren't giving me fits, but oh well...that's why I'm here to begin with. The surgery isn't a magic wand! It's so important to maintain a positive attitude, and be patient, patient, patient!
Anyway...in case it helps anyone, I'm sharing my experience. If anyone has anything to add, or can help me through some of these issues, I'd appreciate it! Best wishes to all!
Another day, another adventure.
I went to the doc today regarding my lung issues. I'm back on an antibiotic for a suspected lung infection--I was being treated for one before surgery, and I guess it didn't totally resolve. I never really got a full course of antibiotics. I'm also continuing on 20mg prednosone twice a day to protect my lungs as well.
Because of those meds, my doctor put me back on Protonix for a while, to protect my stomach, which is very sensitive.
I knew this was coming, but it's not too much fun. I've got that lump in my throat that doesn't want to cooperate in getting food to my stomach. No complaints, though. I knew this was coming before I made the decision to go forward. I was a lucky one. After the surgery, and before the swelling, I had no difficulty at all, swallowing liquids or soft foods. Now it's definitely a challenge.
It will probably get worse before it gets better. I am determined to go with the flow. This too will pass.
AND IT DID
When I eat, I feel like I'm getting (non-painful) throat spasms, as things move at the unmovable wrap.
When I drink or eat, and start having spasms, etc., my mouth begins making huge amounts of thick, "mucousy" saliva. I can't even stand to swallow it. It only happens during eating or drinking, and subsides shortly afterward. Has anyone experienced that?
I haven't used pain meds in 3 days (even Tylenol)...I've been icing. The only incision that hurt is in the left rib area. OUCH. Ice takes care of it. Actually, lately it hasn't even hurt enough to ice. Coughing does flare it up.
I've been walking for 10-15 minute intervals on my treadmill...all day long. A nurse told me to walk whenever I get up to go to the bathroom, so I try to follow that advice. I had a blood clot after my last surgery, so it's important to keep my legs moving...it's also good for my lungs. I also think it has help my shoulder/neck referred pain/loose gas pain.
FEELING REMARKABLY GOOD
I'm amazed at how quickly you can bounce back from laprascopic surgery. Nobody should fear the surgical pain aspect of this surgery.
Just a quick update:
1. VISIT TO SURGEON
All was well with incisions. He assured me that I don't have to worry about healing on prednosone. I'll heal. He's not worried that the tissue/sutures won't hold through coughing. He put extra sutures in the hernia repair (it was a small hernia). He's confident that all is fine with the repairs.
BURPS--he thinks I'm fortunate that burps are escaping, and that it's very normal, and a bonus for me. Burping does not mean reflux.
From my perspective, burps have been a lifesaver. When my stomach starts feeling bloated (after drinking or eating), the pressure shifts around, until a little bit of air escapes. This may repeat several times. I don't "belch"...the burps just happen on their own.
SWELLING OF WRAP--My surgeon reinforced the fact that the wrap will continue to swell over the next two weeks. He said I could eat anything I can manage--things that can be chewed thoroughly. He said that if the wrap makes it hard to get food through, (being sure to take small bites), just sip water/tea until it goes down. It will get through.
Surrender to the recovery process...it makes it lots easier.
I'll be going back for a follow up with him in a month.
I do have some fluid in my lungs. Hopefully the antibiotic I'm taking will take care of any residual infection from my pre-surgery lung issue.
Patience is a virtue!
I did have a bout of loose stool/diarrhea...I have a tendency to react to GI issues (even my endoscopy) with that problem. Also, being on the antibiotic...
3. OUT TO DINNER
Before coming home, we stopped at Friendly's for supper. I ordered a cup of decaf tea and a bowl of clam chowder. I just worked around the clams and enjoyed the broth, potatoes, and vegetables. Of course I didn't eat a whole bowl. I get stuffed before I eat much. I was also able to eat saltines...they chew up to total mush. YUM. It was a treat to have crackers and soup ! I brought the rest of my soup home to enjoy later.
All in All...
I'm keeping active...walk daily on my treadmill--10-15 minutes at a time...no incline...1.9mph. SLOW. It feels great, though.
Things going as well as to be expected...I was prepared for pretty much anything.
First of all...to anyone who is agonizing over this surgery, stop. It is nothing to be afraid of, provided that you do your homework, take the required tests, and find an experienced surgeon.
I was very frightened, and struggled against the decision for four years. Granted, at 13 days, the jury is still out as to it's effectiveness in my case, but I can speak to the surgical experience.
I was ready to be tortured in recovery. I expected my stomach to shut down, and that I may not be able to swallow anything but liquids, and that I would have unbearable bloating and gas. I didn't know what to expect, and prepared myself for a horrific experience.
This fear was totally unwarranted. Once the anesthesia wore off, I had no trouble swallowing liquids. I went home after just one night in the hospital, on a soft diet. Within 6 days post surgery the surgeon told me I could eat anything that could be chewed thoroughly--warning me against sandwiches/bread/steak.
I have had a few moments of swallowing spasms during the 9-13 days post op, but very few. Actually Days 4-5 seem to have been my most difficult hurdle, swallowing-wise.
Throughout this time, I was having difficulty with my lungs, and coughing did hurt the incision at my left rib area. Over time, that incision has healed, and although I still have some coughing (better, but still mucous to raise), my rib area is much more comfortable. I don't even need to ice any more, and can just hold my arm there when I cough. Much improved on that front.
I'm now walking on my treadmill--no incline--2.5mph. I truly believe that my emphasis on walking and getting up and around right after surgery has made a huge difference with the shoulder/neck pain gas issue. It has resolved quite quickly, and is only occasionally felt--and then, very mildly. I would recommend getting right up and walking as much as possible throughout the recovery process.
I'm feeling much better--stronger--more comfortable, and I have lots more energy at this point.
I'm noticing that my stomach is beginning to accept more food without feeling so bloated and uncomfortable. I'm not getting as much gas, either. My surgeon said I wouldn't be able to burp, but my stomach does burp. I've never been one to force burps, and I don't now. My stomach burps itself whenever necessary, which really reduces the gas issues.
I took two weeks off from work (I'm a second grade teacher) after surgery. I've got enough sick time available that it wasn't a problem. I'm going to start back to work next week--mornings only--to give myself a chance to regain my strength before going full force. My family doctor, who is following my lung recovery, is very conservative in that way, and wants me to take it easy so as not to relapse.
My lungs are still far from perfect, but they're already better than they were pre-surgery. Also, everyone who sees me comments on the fact that my voice sounds so much better--I was very, very hoarse before the surgery.
I'll check in again as my recovery continues. Hopefully those who are seeking the information they need to make an informed decision will find these posts helpful.
Once again, I'd like to begin by reassuring those people who are searching these forums for information as they try to decide whether or not to go forward with a Nissen Fundoplication surgery. I know how hard it is to find positive comments on the web. I found so many negative blogs and forums that I waited way too long to make the decision to go forward with the surgery.
This surgery isn't as difficult to recover from as I had expected. I've posted earlier reports, so I won't repeat that here.
1. For those who want to avoid or alleviate shoulder pain (due to gas forced into body during surgery)--walk,walk, walk. Mine improved greatly with walking. In fact, when I went a couple days without walking as much, the pain came back. Once I went back to walking a lot, it went away again. The more you walk, the less pain you'll have.
2. Rib/incision pain subsided by the end of the second week--I didn't even need to ice. I think it would have healed more quickly if I hadn't been coughing so much. (I had a lung infection that started before surgery.)
3. By day 15 or 16, my stomach began accepting more food. (Not a lot, mind you...but still more than before.) Be careful not to overdo it, though. You'll be sorry if you stuff your stomach. Several small meals are better than one larger one.
4. Bready foods--even when chewed well--still seem to challenge the wrap.
5. I was able to eat stew cooked in the crock pot (for hours). Even the meat was able to be chewed to liquid form. If you can handle soft foods, you can (carefully) experiment with the slow cooker.
6. Creamy Chicken Gnocchi soup at Olive Garden is a great choice. Actually small bites/careful chewing--opens up a lot of options. Just don't swallow anything that you can't chew to a liquid/mush.
7. My doctor put me on Carafate to counteract stomach problems/acid/wrap irritation. It coats my stomach really well. I take it 4 times a day--1 hour before/2-3 hours after meals. I put the pill in a little medicine cup and add a bit of water to make a slurry that I can drink easily. It did work well to counteract the wrap irritation that was waking me up in the early morning (3AM and on).
8. Expect some irritation feelings around the wrap site. Expect some resistance at the wrap site. It's normal. Things get better, though. Just don't get too frisky with your eating. Your appetite gets better before your stomach can handle a lot. I found that when I became too frisky/eating too much, eating things that might be a bit too chewy, I paid dearly, with more wrap irritation, and stomach problems.
When that happened I backed off and started measuring my meals--a half to 2/3 of a cup is about all I can tolerate comfortably.
9. I've lost about 14 pounds, which I'm glad about. I can lose a little more without a problem. If I start losing more than I want to, I'll just pick my nutrition intake with some snacks in between meals.
10. I still have a persistent lung infection, and am now on injected antibiotics to get rid of it. I can't take antibiotics orally (except amoxicillin) without getting gastritis, which I don't need now. So I'll be going to the doc daily for some (ouchy) shots. I just want to get my lungs cleared. My asthma is the best it's been in years. So far so good there. My lung problem is the reason I finally had the surgery, and so far so good...once I get over the infection. I'm off prednosone as of tomorrow, so that's a happy development.
Hopefully this little journal helps someone who's looking for information and trying to imagine what the recovery will be like. It has been so much better that I had ever dreamed.
This is a great forum. There are many supportive and experienced members who will help you through.
Best of luck to anyone considering/or is scheduled for surgery.
Nissen Surgery Failures: My Thoughts:
Yes, there are many very disturbing stories all over the internet--enough to scare anyone away from this procedure. I spent four years searching the web, looking for information to help me make an informed decision. The internet sources I searched out provided me with an overabundance of reasons not to go ahead with a surgical fix.
It is clear that pre-testing is crucial to ensuring that a patient will be helped by this surgery. Motility tests (manometry--tests the strength and effectiveness of your swallowing muscles, as well as the strength of the LES valve.), 24hr PH Monitor, Barium Swallow, and perhaps a stomach emptying study, are all tests that can spot problems that could complicate this surgery.
Choosing a skilled and experienced surgeon is also critical. A surgeon who does an overly tight wrap can create swallowing problems--especially in someone who has slipped through the testing cracks, and has a swallowing problem to begin with. Careful selection of a good candidate is most important. Don't rush your way towards surgery. Go to a good GI doc, and thoroughly explore all your options. Once you have a trusted specialist, it's likely that he/she will be able to recommend a surgeon who is skilled in the procedure. Then check that surgeon's credentials further.
Make an appointment with one or more surgeons...ask lots of questions. Just because you meet with someone doesn't mean you have to go through with surgery. My family doctor recommend a surgeon, and I met with him/had tests done/was told I was a good candidate for the surgery. I was not ready to make that decision, so I went back to my GI doc, who looked at the results of the tests the other surgeon did, and ordered an additional test. After testing was done and we discussed the results, he suggested that I just go and talk to the surgeon...no rush...just discuss the procedure, and start to think about what I wanted to do. I ended up meeting with his recommended surgeon twice, and made the decision to go through with the surgery.
Keep in mind that many, many people have a Nissen Fundoplication and never enter any comments in a forum online. It's more likely that people who had bad outcomes will search the web for reasons for their suffering. Many, many successful surgeries happen, and you just don't hear about them. The more problems a person has with the outcome, the more likely you'll hear about his/her poor results.
It is too early for me to know if I'll be in the ranks of the successful, or unsuccessful procedures. I understand that I can not speak with any authority in that regard.
I do know that as an open procedure, this is a 50 year old surgical method, so it must have helped many people for it to have lasted this long.
Laproscopic Nissen Fundoplication has been around a much shorter time (approx. 10 years, I believe, but I may be off on that number). From what I've read, the move to laproscopic Nissens has been beneficial, in that fewer surgeons are qualified for to do non-invasive procedures, and it creates a situation where a few surgeons get lots more Nissen surgeries--which provides ample opportunites for developing skills necessary for successful outcomes.
So yes...it seems that there is a disproportionally large number of Nissen failure when you read forums such as these. If you go to surgical sites, though...read medical journal entries, you will find that the success rate is quite high. That doesn't solve the problem for people who have had poor outcomes, but it should create more confidence in someone making the decision to have this life-changing surgery.
Don't let scary stories make up your mind for you. Do the work to find out if this procedure is right for you. Then make an informed decision and go with it. Best wishes to anyone trying to make this difficult decision.
Also...good luck to those who are struggling with surgeries that didn't work out the way you had hoped. I hope you all find solutions to your medical problems.
Thanks again to everyone who shares their experience and hope on this forum. It has made a big difference to a lot of people.