I've never posted here but I just got a laparoscopic Nissen fundoplication on 8/24 and figured I would share my experiences of the recovery so people like me can learn about
their options. I'll start from the beginning.
I'm 22, younger than most here it seems! I first noticed symptoms of GERD probably 3 years ago. It started as a mysterious pain in my left breast. I was worried about
my heart until I noticed that the pain corresponded to digestion. Before I knew it the pain had mostly moved up and to the center of my chest, and felt unlike any pain I had felt before. I learned what heartburn was, and found that most people managed it quite easily. I bought a 14-day course of omeprazole, and felt pretty good for the four months I was told it would work for. Symptoms started to come back, I took another 14-day course, and didn't have quite the same luck.
It was such a gradual transition, but before I knew it, I was having heartburn and other GERD symptoms all day every day. I started various PPIs and H2 blockers daily, twice daily, nothing seemed to have any effect. I massively restricted my diet but still suffered. I had found a few trigger foods (like soda), but by and large my symptoms did not correlate to what I ate (nor did they correlate to what popular literature will tell you causes heartburn). I got an endoscopy this past March and the doctor found severe inflammation at the esophageal junction as well as a hiatal hernia. Thankfully the biopsies showed nothing serious. He changed my meds to a new PPI/H2 combo and told me to come back in six weeks.
Well as I expected the new meds changed nothing, so he referred me to an expert laparoscopic surgeon who he told me could perform the Nissen. Based on my hiatal hernia, severe inflammation, and lack of response to medical intervention, the surgeon was happy to take my case, but wanted to perform some more tests. He asked that I discontinue all of my meds in order to get proper test results. I was fearful, knowing about
the dreaded PPI withdrawal reflux that is said to occur. Luckily, I never got it--in fact, I felt a little bit better than usual, and was starting to question whether I should really be trying to get such a major surgery. But then I thought about
how I still needed to chug Maalox to get through the day, and that the possibility of esophageal cancer would be hanging over me the rest of my life if I didn't do anything, and my confidence was restored.
I got an esophageal motility test, which determined that I had an incompetent LES. My surgeon described it as "brakes without brake pads." I got the 24-hour pH test, unfortunately on a rather good day and didn't quite meet the threshold score. This disappointed my surgeon; however, I still had a massive number of incidents of reflux over the 24 hours, even if they weren't very long. I had a video esophagram (barium swallow) as well, I guess to confirm that my swallowing was good enough to undergo surgery.
Due to the non-positive 24-hour pH, my surgeon said that he wanted me to be very confident that I understood all about
the risks and benefits and still desired the surgery, and to know that I could continue with meds for another year or two as an alternative. My heart sank, thinking about
my misery over the last couple of years, so I told him I was going to go for it. I got a call the next Monday from his office, they told me they had a date three weeks away. It was a bit scary hearing that it would be that close, but I had already done plenty of research and had been mentally preparing myself for a long recovery (although hoping it will be much shorter).
Well 8/24 was the day. The surgeon was two hours away, and my surgery was scheduled for 7:30am, so I had to leave at about
3am to get there in time for all of the prep. I ended up getting just 45 minutes of sleep. It all felt a bit surreal. I had been dealing with GERD day by day for so long (well of course 3 years is nothing compared to some of the people here), and now I felt like time had fast-forwarded me into this surgery. I got into my hospital gown, got IVed, kissed my girlfriend goodbye and then the drugs time travelled me about
I woke up in my hospital room feeling groggy and with a killer pain in my neck and shoulders. That day was a bit of a blur. They kept me just on IV fluids, no liquids to drink yet. I had mild pain and soreness in my abs behind the incisions but my neck was much worse, although the morphine controlled it well. They kept asking me to rate my pain on a 1-10 scale and I don't think it ever went above a 4 or 5, although I'm not sure the nurses believed that because they kept telling me I didn't need to act brave for them. My throat also got pretty sore. The anesthesia didn't leave me with any nausea. I thought that the morphine made me a bit nauseous once and asked for something like Zofran, but in retrospect it was probably just extreme hunger. I amazed myself with the amounts and frequency of my urinations, and it was annoying having to disconnect my calf squeezers and get out of bed every time to stand up and actually pee, but it made me be a bit more mobile so I suppose it was a good thing.
The night went pretty okay as well. I slept in fits, then would wake up and be unable to get comfortable for an hour or more. It was always a bit easier to fall asleep after my next dose of morphine, but I was restricted in how often I was allowed to get it. The nurses and doctors were pleased with my recovery though and I got my first clear liquids meal the next morning. I made sure to eat very slowly and certainly did not finish the tray, but it was nice to even get some water for the first time in 36 hours. Swallowing was no trouble, and I even made a few (small) burps. I watched some cheesy morning TV, eventually got my clear liquids meal, and my first dose of a liquid painkiller for which I would be getting a prescript
ion. By early afternoon, they saw that I had tolerated liquid foods and liquid medicine and decided I was ready to be discharged! My surgeon came by and told me that everything had gone great, I was a textbook case, and that he did the surgery in under an hour (both nissen and hiatal hernia repair). He told me I could progress straight to full liquids, and in three days I could start adding soft foods. These timetables seem a bit fast to me so I'm going to be a bit more conservative I think.
My girlfriend took me to a nearby hotel (we didn't want to be 2 hours away for my first night out of the hospital), and I got to say hello to my puppy! He's not even 4 months old so I think he was a bit confused about
being brought to a hotel and acted out a bit, but he was still able to warm my heart. I was moving pretty slowly but I felt pretty capable, stairs were no trouble. I had some juice and jello, as well as Gas-X to try to move the gas along through my system. I fell asleep around midnight, woke up at 6am thinking I felt nauseous, but then I realized it was just pressure from the gas, and I sat up until a bit of it passed. I managed to get a bit more shut eye and then we all drove back home.
Since being home I've been having juice, jello, broth, milk (soy and cow's), Ensure, and even some vanilla ice cream. I tried cream of wheat but I found it too bland to force down really. Everything's gone down well so far. I've been careful not to do too much in one sitting. Occasionally when in the past I would have burped, I'll do something involuntary reminiscent of a hiccup, and that does hurt a bit. I've noticed some sensation now and then down in my throat that reminds me much of heartburn; however, I am not concerned, as people here like to call the esophagus a dumb organ in terms of pain. I'm sure right now it has plenty of non-heartburn pain to report!
I've been fairly active (having a puppy kind of forces that). I've made sure not to lift objects over 5 pounds but it's likely I've exerted that much force in other ways, so I have to make sure to be more careful about
that. My incisions don't hurt really unless I touch them, and even then not so much. One of them looks a bit gross with some red stuff and bruising around it, but it's not getting worse and I've made sure I don't have a fever, so I don't think that it's infected. If it still looks like this in a couple days I might ask for some antibiotics. I still haven't gone number two yet, I suppose due to the pain meds (which I'm weaning myself off of), hopefully the stool softeners kick in soon.
All in all, it seems like I'm doing quite well compared to some cases, so hopefully it all continues this way. Even though I haven't made it fully around the bend yet, I'm optimistic and I hope my story encourages other people out there that there are options when PPIs do nothing. Don't resign yourself to a life of GERD!
I'll try to keep this updated if people are interested.
Post Edited (randybobandy) : 8/28/2011 12:48:15 PM (GMT-6)