Gerdhater Linx Journal

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gerd_hater
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Date Joined Oct 2012
Total Posts : 322
   Posted 1/29/2013 11:53 PM (GMT -6)   
Jan 29 2013
Day -1


Met Dr. Lipham today for pre-op consult. Seemed a reasonable guy.
Things of note
(1) Eat properly and exercise the Linx after surgery
(2) MRI testing definitely on the list for Torax
(3) They measure intraoperative Gastric yield pressure pre and post Linx. This is how they ascertain whether Linx is actually adding pressure to the sphincter during the surgery. He said he would share that data with me after the surgery. Apparently they make sure at least 15 mmHg of pressure is added on after Linx.
(4) When I asked him about Endostim, he said that their data was pretty impressive as well - always a plus when surgeons are open to devices they haven't themselves invented...
(5) Post explantation risks are minimal according to him
(6) Dysphagia peaks 6 weeks post Linx
(7) 700 Linx worldwide, Italy itself 120
(8) Mentioned a new paper on respiratory symptoms being improved after Linx
(9) No correlation between DeMeester score and Linx effectiveness according to him - mentioned a couple cases of 100+ demeester score - only hernia and other complications like stricture/barrett's are difficult..
(10) Procedure time down to 20 mins he said - though I think it is only the Linx part - not opening and closing..
(11) Hospital stay of < 23 hrs - my insurance has no approvals required as long as it is less than 23 hrs stay.

All in all, I feel I am in good hands. Not sure about the staff yet, will know when I meet them tmw.

Also did a round up of Santa Monica Pier and Third Street Promenade today after flying in yesterday from New York.
Hoping for the best.

GH

Gastricman
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Date Joined Jan 2013
Total Posts : 294
   Posted 1/30/2013 8:21 AM (GMT -6)   
Hi gerd_hater,
 
Finally.
 
I guess by the time you read this your LINX surgery will be over! turn
 
What kind of diet do you have to be on and for how long?
 
Some questions for you regarding your pre-op visit - your list (1-11) has some great information, thanks.
 
The intraoperative Gastric yield pressure both pre and post LINX is of interest to me. From what I have been told about the NF or LINX is that when you are put under general anesthesia, the manometry readings are inaccurate. Your comment appears to contradict this. Are you sure?
 
How can there be no correlation between the DeMeester score and the effectiveness of the LINX?
Shouldn't the score go down? This confuses me a bit.
 
Also, how many LINX procedures have been done in the USA to date, especially by Dr. Lipham?
Could you perhaps ask him if he (or other MD) is training anyone for NYC where we both live?
 
I know, many questions!
 
Please write back in detail when you feel up to it. I wish you the very best. smilewinkgrin
 
Gastricman
 

Post Edited (Gastricman) : 1/30/2013 6:50:26 AM (GMT-7)


gerd_hater
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Date Joined Oct 2012
Total Posts : 322
   Posted 1/30/2013 10:50 AM (GMT -6)   
Thanks for the wishes. An hour to go before I leave for the OT.

Gastric yield pressures are I THINK collected by actually inflating (with water or gas I don't know) the stomach unlike manometry. I am not sure if that is affected by anesthesia.

No correlation between DeMeester score PRIOR to Linx and whether Linx works is what I meant.
He defines "moderate" Gerd as +ve Demeester, no stricture, no hernia, no Barretts, no esophageal ulceration etc. Within moderate Gerd, no correlation between PRIOR DeMeester score and Linx success was what he told me. (Of course, assuming that your DM score is high enough).

I don't know how many he has done yet or if anyone is being trained in NYC - will ask him when I get out.

Regards
GH

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 1/31/2013 8:06 AM (GMT -6)   
Jan 30 2013
Day 0


Unremarkable day of surgery. The usual check-in, register etc. Was taken in sometime around 12 and woke up around 4.

After checking that I could walk/talk/pee, they recommended that I get discharged. By 5:30 I was out.

Painkillers: 4 times daily separated by 6 hrs, for day 1 and day 2. Thereafter, as necessary. Had pain in the shoulder blades sometime around 11 PM and painkiller took it away.

No remarkable side effects. No major pain or dysphagia or bloating. Ate a fruit bowl, a banana, a couple of sips of soup and water. Was able to belch without issue. Swallowing my usual Nexium pills was no issue as well.

Still on Nexium, will slowly taper it over the month although I am undecided if I want to continue Nexium for 6 months. The doctor did advise me to taper instead of stopping suddenly which I think is really good advice.

As of now, not sure if I am refluxing or not but I did not seem to notice the usual regurgitation.

Not much feeling of the Linx unless I gulp down water and then I can feel some slight pain at the GE junction where the Linx should be.

Will meet Dr. Lipham for followup when I will be able to know things in more detail. We had only a brief conversation after I woke up very groggy.

All in all, no big side effects from surgery yet - no signs of failure or success either.

Regards
GH

Post Edited (gerd_hater) : 1/31/2013 6:19:03 AM (GMT-7)


Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 1/31/2013 9:01 AM (GMT -6)   
Hi gerd_hater,
 
I (we) have been eagerly awaiting your post. Glad everything went well for you!
I'm somewhat surprised that they didn't keep you for longer. When you are ready you can tell us all about it.
 
How long are you going to be in Los Angeles and what is the protocol for follow up?
Please don't forget about asking Dr. Lipham about LINX MD's in NYC.
 
By the way, welcome to the LINX club (though i'm not in it just yet!)
 
Gastricman :-)
 
P.S. I think that getting off the Nexium in the next few weeks is a smart move. Then you will know.

Post Edited (Gastricman) : 1/31/2013 7:31:29 AM (GMT-7)


gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 1/31/2013 9:42 AM (GMT -6)   
Gastricman,

Well, I feel normal except for the shoulder blade pain - may be because of the pain killers. I can walk just fine, bending hurts a little, but otherwise, I wouldn't know I just had abdominal surgery. No bloating at all.

I will try to ask, but you can also write to Dr. Lipham with any questions you have.

Follow up, I am not sure. I don't think there are any convenient answers and at this point I don't even have a PCP nor a GI !

GH

Post Edited (gerd_hater) : 1/31/2013 9:12:41 AM (GMT-7)


Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 1/31/2013 1:47 PM (GMT -6)   
Hi GH,

I think that the Shoulder Pain is from the CO2 left over during the Laparoscopic LINX implant.
It should go away soon. Denise (dencha) and others know quite a bit about this.

I found this from eHow...

"Take a short walk to help gas move through your digestive tract and reduce the resulting pain. Walking also helps your body to absorb excess gas remaining after surgery. Short walks around your home are sufficient. Strenuous exercise and lengthy walks are not advised."

Also, FWIW...
 
"The diaphragm and the shoulder is connected to the abdomen and other organs via the
phrenic nerve
. The phrenic nerve arises from the cervical spine roots on the neck, at the 3rd, 4th and 5th position. Carbon dioxide exerts tremendous pressure on the phrenic nerve due to which a sharp pain is felt in the shoulder and its surrounding region."
 
Hang in there.

Gastricman :-)

Post Edited (Gastricman) : 1/31/2013 11:52:57 AM (GMT-7)


NoDoubtLove
Regular Member


Date Joined Oct 2012
Total Posts : 359
   Posted 1/31/2013 2:46 PM (GMT -6)   
YAY!! I'm glad you finally got it done! The shoulder/back pain from the CO2 is uncomfortable and NOT fun! Walking helps it, although you probably don't feel like walking just yet!

I'm surprised to see you say "I wouldn't know I just had abdominal surgery"! Maybe because of the pain killers? I felt like I did a billion situps or something lol just very very sore.

I'm really happy for you, I'm loving LINX so far. Yes there are hurdles but the fact that I have had zero heartburn (and not on PPIs) is amazing! Keep us updated!
GERD - LINX January 15, 2013

BEACH-GIRL
Regular Member


Date Joined May 2012
Total Posts : 467
   Posted 1/31/2013 5:18 PM (GMT -6)   
GH,

Glad you are doing ok. Please keep us posted on your progress.

NDL,

What is your thread again?

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 1/31/2013 8:56 PM (GMT -6)   

Jan 31 2013
Day 1


The dreaded shoulder pain attacked me a few times during the day. Only on the right side and it is horrible at its peak, but settles down with lying down. Noticed that the neck was stiff and paining a little as well. Took a reasonably long walk in the sun ! (Glad I came to Sunny LA!) Pain killer did not make much of a difference.

Linx becoming more noticeable in that I can feel slow down of food as it goes in. Still, I can swallow decent sized bites without chewing. I had a big lunch too and did not notice much come up. I can also *feel* the Linx with deep breaths.

For years, my reflux would occur along with sharp anti-peristalsis wave of the esophagus right after eating.. Today I noticed that the sharp wave was extra sharp or probably made to feel so by the Linx. It was uncomfortable to say the least. But I *think* nothing came up. I am reserving judgment until I've seen a few more days. Hopefully the wrong wave settles down in time.

No change in breathing yet. Feeling a little bloat today - may be related to the beans I had and did not manage a Bowel Movement so far. #1 starts with some difficulty as well.

Meeting the doctor for follow up tomorrow, hopefully I know what's gone on inside.

GH

shrtcak81
Regular Member


Date Joined Jan 2013
Total Posts : 165
   Posted 2/1/2013 12:05 AM (GMT -6)   
GH - Yay, so happy that you have finally had the LINX surgery! Good for you. I'm sure you have great days ahead. I too am hoping to get the Linx once I have all of my testing done. I'm going to UCLA (I live in Vegas) to get the tests done. I asked the doctor there about surgery, particularly the Linx and he said no one there does that surgery yet, but he would send me to USC where I believe Dr. Lipham if i'm interested in the Linx. So I may be one of his patients soon:)

Congrats and keep us updated!

NoDoubtLove
Regular Member


Date Joined Oct 2012
Total Posts : 359
   Posted 2/1/2013 9:20 AM (GMT -6)   
GH -
I could feel the LINX with deep breathes too or even when I woke up in the morning and would get out of bed... but that is gone now, so don't worry too much :)

I wouldn't eat anything that you know will bloat, like beans or broccoli. Mainly because of the whole bowel movement situation. The anesthesia and pain killers cause major issues not being able to move the bowels. I'd highly highly recommend to take a stool softener a few times a day. I didn't and ended up having to take a laxative and that was AWFUL!!!

Enjoy LA while you are there and know you're on a better road... there are speed bumps during healing but it should get better!!
GERD - LINX January 15, 2013

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 2/1/2013 9:38 AM (GMT -6)   
NDL,

Thanks for the suggestions. I'd be happy to not feel the Linx at all ! My major complaints so far have been the terrible shoulder pains and the sharp anti-peristaltic waves or hiccups right after eating. The hiccups really hurt at the area of the Linx.

I just got up and was wondering if I should take some Colace since I haven't had any BM so far, not even close. And I've been eating fairly big portions ! How often should I take it, any recommendations ?

Definitely noticing the Linx more today both in slow movement of food / big pills going down and when trying to belch. On the plus side, I have stopped taking Nexium in the evening and haven't felt any hot vapors so far..

GH

Post Edited (gerd_hater) : 2/1/2013 7:41:00 AM (GMT-7)


Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 2/1/2013 11:21 AM (GMT -6)   
Hi gerd_hater,
 
I have been closely monitoring the thread ;)
 
I recommend Colace (generic is Docusate Sodium) - please check with your MD first to see if OK.
 
"Stool softeners moisten the stool and prevent dehydration. These laxatives are often recommended after childbirth or surgery. Brand names include Colace and Surfak. These products are suggested for people who should avoid straining in order to pass a bowel movement. The prolonged use of this class of drugs may result in an electrolyte imbalance." I also think that eating gassy foods as this point is not the best thing for digestion!
 
How would you rate your reflux symptoms at this point in time, as compared to not having the surgery?
 
Let us know how the follow-up goes with Dr. Lipham and if the shoulder pain is diminishing.
 
Hang in there.
 
Gastricman

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 2/1/2013 11:24 AM (GMT -6)   
Gastricman,

I will post the rating after a couple of weeks. So far, so good, but I have to feel comfortable with the Linx "in" and eat normal sized portions before I can post sustained symptom relief.

GH.

charlieboy
Regular Member


Date Joined Jan 2013
Total Posts : 37
   Posted 2/1/2013 5:49 PM (GMT -6)   
GH Many Congratulations and welcome to the club. I had severe pain in the right shoulder for 3 days. I was told by my doctor to try peppermint tea and it worked after 3 days it just went. The bloating was gone after a week but I had to wait 6 days for a bowel movement so as NDL says, take some lacutose now. Keep positive and good luck with the recovery

dany1982
Regular Member


Date Joined Jan 2012
Total Posts : 158
   Posted 2/1/2013 5:57 PM (GMT -6)   
For me the best aftersurgery for constipation are glicerin suppositories, look them up :)

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 2/2/2013 2:20 AM (GMT -6)   

Day 2
Feb 1 2013


Met Dr. Lipham for follow up before flying back to NYC Saturday.
- No hernia noted during surgery
- Esophagus was 12 mm diameter apparently before surgery at the LES which was "very loose" and it needed to be around 7 mm which he said they got to
- Post Linx intraoperative manometry showed pressure of around 24 mmHg according to him
- He is visiting the east coast some time in April to train surgeons in Linx and expects some one in NYC to be ready to do the procedure by June
- Suggested 3 months for lungs to show improvement
- Told me to expect dysphagia starting next week peaking at week 6

Shoulder pain not as acute today. But horrible day with the hiccups - they really hurt. I went on a bus trip around Beverly hills and Hollywood hills and sitting in the bus for long (1 hr) did bring up some reflux and it was very uncomfortable both feeling the Linx and some reflux at the same time. A heavy dinner complete with a big milkshake was well tolerated with minimal reflux though. I need to observe better before drawing strong conclusions because I fail to notice some of the less severe instances of reflux as I've become conditioned to ignore them over the years !
I was sipping milkshake from a straw and I did not seem to get bloated. I guess I can belch just fine then !

I am thinking that the Linx does indeed get overwhelmed initially after eating, possibly because of hiccup and it holds the reflux in otherwise. I can certainly feel something pressing from the stomach and the Linx stopping it. With sleeping though, I think it is definitely helping because I seem to be waking up for shoulder pain instead of gasping for air.

Stopped painkillers today - hoping there won't be any attacks. Resisted taking any Colace or Laxatives so far.

JPT,
Thanks and good to have you back! Strangely, I can tolerate rice just fine so far - At worst things go down the esophagus in slow motion, but they don't seem to back up (hope to not jinx it).

Overall, I am happy so far - it seems to be working reasonably so far and I suspect as things settle down, it will get better. If lungs regenerate and I can breathe normally, I will be on top of the world !

GH

Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 2/2/2013 2:15 PM (GMT -6)   
Hi GH,
 
Glad the the shoulder pain is dissapating. The hiccups are a bit of a concern though.
I wonder if anyone else has had this issue with the LINX? Is there any medicine for it?
 
BTW can you please clarify this when you have a chance...
 
"Esophagus was 12 mm diameter apparently before surgery at the LES which was "very loose" and it needed to be around 7 mm which he said they got to."
 
Thanks for the heads-up on Dr. Lipham coming to the east coast and helping out, hopefully in NYC!
 
Have a safe flight back - try to sleep a bit.
 
Regards,
 
Gastricman
 
 
 

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 2/2/2013 2:38 PM (GMT -6)   
Gastric man,
I did not press him on the diameter thing. I assumed it was just that my les was wide open. On endoscopy you expect the les to wrap tightly around the scope but mine had a BIG gap. That basically could have contributed to the expanded diameter. I did have a question around whether this means the linx now constricts the les. I should write to him at some point. For now I am not too worried since it won't change much about the future :-)

The hiccups are not unusual. I have had bad hiccups ever since I had gerd. Just they hurt with the linx. I wouldn't read too much into it yet.

Remember that the Linx may still be worth a shot even if you have only a 50% chance of success. I wouldn't undervalue a normal and intact anatomy.

GH

NoDoubtLove
Regular Member


Date Joined Oct 2012
Total Posts : 359
   Posted 2/2/2013 9:17 PM (GMT -6)   
I drink a ton of water daily, I have some coffee in the morning and the rest of the day is water. I would guess at least 10 glasses of water (I have to pee all the time from it LOL) and I still was very backed up from the anesthesia and pain killers. When I took the stool softener I started out with 1 50mg then took another one 6 hours later. The next day I took two and then that night I took two more. The next day I was still backed up so I took two more. Finally that next day things went well. I waited too long thinking things would work fine on their own lol.

I've had a few random hiccups here and there, one at a time and they feel a bit uncomfortable. I think if I had a few in a row I'd be pretty annoyed! Good luck with that :(

You sound like you are moving around better than I did! I am so out of shape I think surgery kicked my butt lol. I wish you a speedy recovery and hope this takes care of your issues!!
GERD - LINX January 15, 2013

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 2/3/2013 10:06 AM (GMT -6)   

Day 3
Feb 2 2013


Moving around is no problem right now. The incisions don't bother me unless I try to bend.

Got back to NYC after a surprisingly short flight from LA (just 5 hrs!) No problems sitting in the flight or getting back home.

As for reflux, I did notice the occasional reflux but my instinct is that it is well within normal. Typically this tends to happen right after eating when stomach is distended and along with a hiccup.

Best part so far, I have been able to sleep ! Still using the wedge pillow but I seem to be able to sleep the whole night and when I wake up I don't feel short of breath :) So, something is working.

Managed a BM without any Colace/Laxative. It wasn't as bad as I thought it might be. Of course, I had been walking a fair distance from day 1.

Shoulder pain is very occasional now.

The chronic sore throat still persisting however. Might take a while before I notice improvements.

Food is definitely slowing down across the Linx and does pain a little bit on the way down.

GH

Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 2/3/2013 4:11 PM (GMT -6)   
Hi GH,
 
Welcome home! smilewinkgrin
 
Tell me (us) a bit more about the problems swallowing across the Linx. Will it get better in a short period of time?
What about follow-up in NYC?
 
Best,
 
Gastricman

gerd_hater
Regular Member


Date Joined Oct 2012
Total Posts : 322
   Posted 2/3/2013 11:35 PM (GMT -6)   
Gastricman,

Swallowing is just slow, not particularly painful or anything, just slow. You want everything to go down before initiating another swallow, so you do not want to eat fast. Thats about it.

If this solves all my gerd/lpr problems and doesn't get one bit better, I will probably still take it. It is expected to get better, however.

GH

Gastricman
Regular Member


Date Joined Jan 2013
Total Posts : 294
   Posted 2/5/2013 10:42 AM (GMT -6)   
GH,

How are you doing?

Gastricman
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