How can you tell if Nissen is too loose?

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StephanieJean
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Date Joined Jun 2013
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   Posted 9/26/2013 7:52 AM (GMT -6)   
Before I even start writing about my concerns I want to say that I am probably just freaking myself out over nothing and I need to calm down. So if you feel like that is what is going on, feel free to tell me :)

My Nissen fundo was 7 weeks ago for those not familiar with my story. I was excited initially because I had very few problems eating solid food after the 3 week mark and now I have little to no problems eating meat and bread even, although I will say I am careful with how much I chew and how big my bites are.

I am able to burp, I cant if I try, but they are but it started with being able to after drinking liquids, now little burps will slip out even when I have not drank anything. This is great for the bloating which has really decreased, in part because I have changed my diet and I think I am swallowing less air post surgery.

I can not get it out of my head though that I shouldn't be able to eat so easily and burp this soon after surgery. I know it is natural to worry that I went through all this and its going to fail, I mean, with all my health problems I am a bit of a pessimist, but should I get tested just in case or should I give it more time?

The reason I worry is because I had silent reflux, I did not realize that for years my regurgitation was damaging my esophagus because I did not experience any typical heartburn pain. It was only after years that my larynx burnt up with stomach acid so much I got a sore throat and subsequent tests found I was refluxing constantly all day long and needed surgery to fix it. I am just worried that I wont be able to feel it if I am refluxing. (I also now have allergies and post nasal drip and dry air are making my throat sore freaking me out even more)

I have an appointment with my Gastro in two weeks. I will obviously talk with them about it, as well as my surgeron, but I guess in the mean time I just need a little reassurance or honesty if I am stressed out and don't need to be. Should I ask for another PH test or barium swallow?

Albez
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Date Joined Jan 2013
Total Posts : 103
   Posted 9/26/2013 8:06 AM (GMT -6)   
I sometimes wonder if my wrap is too loose as I still feel like I'm refluxing but I haven't even past peak swelling yet so need to be more patient. I can burp also, mostly if I drink too fast. Ask your doctor for a pH test to double check, perhaps he will arrange one anyway if you tell him your fears.

StephanieJean
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Date Joined Jun 2013
Total Posts : 500
   Posted 9/26/2013 8:15 AM (GMT -6)   
When I had my followup with my surgeon, he told me that I was not actually burping, but it was gas trapped in my esophagus. That made sense, because it would happen when I would drink, but this morning I did have anything to drink and I had to small belches that I could tell actually game from my stomach.

I think I will ask for the PH test, as much as I dont want to have to do it again, I think I might drive myself crazy with the what-ifs.

I just worry I will have to do this all over again and then maybe end up with a wrap that is too tight...

Albez
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Date Joined Jan 2013
Total Posts : 103
   Posted 9/26/2013 8:26 AM (GMT -6)   
Yeah, as much I hate that pH test I would do it again if it meant putting my mind to rest. Was your score on the pH test high the first time round? I'm not sure I would want to go through this surgery again though, not unless I had definitive proof the wrap wasn't working and needed tightening.

StephanieJean
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Date Joined Jun 2013
Total Posts : 500
   Posted 9/26/2013 8:31 AM (GMT -6)   
I can't find my paperwork from my test, I think it is at home somewhere, but I had something like 49 acid reflux occurances and 44 non acid reflux occurrances during the day with the longest lasting something like 128 minutes. I only had 1 reflux episode at night, so most of it was during the day. I used to be able to feel my stomach squeeze the reflux up before the surgery, and my stomach still does that squeezy spasm thing, but my wrap seems to stop it and as time goes on, it is doing it less and less.

I honestly think that my wrap is working...I am just worried that as time goes on it will loosen up more and more.

Do you think a barium swallow would be more appropriate right now than a PH test?
29 Years old/Nissen Fundo (Loose Floppy) on 8/9/2013
No more reflux!

lajenner
Regular Member


Date Joined Jul 2013
Total Posts : 349
   Posted 9/26/2013 8:38 AM (GMT -6)   
I have not idea about the size of the wrap, but did your surgeon use a boujie? It's a tube they put down your throat into the stomach to measure the exact size for the wrap.

I also wonder if some of us can eat easier because maybe our esophagus was working well prior to the surgery, as measured by manometry. The surgeon said my esophagus was working normally, just hiatal hernia was so large causing problems.

Even a peak swelling (day 16 for me), I can eat anything that I have tried so far. I had crackers with peanut butter last night and had no problem with that, although I did take my time and pay attention to my bites and swallowing.

I fixed steak for my husband last night and I was tempted to try a bite, but I figured I better not push my luck and went for the crackers instead.

StephanieJean
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Date Joined Jun 2013
Total Posts : 500
   Posted 9/26/2013 8:46 AM (GMT -6)   
Hey there lajenner, I was hoping you would chime in.

I had a loose floppy, so my surgeon did use a bougie and I had perfect esophageal and stomach motility too. My hernia was really small as well, but it was enough to cause horrible reflux.

I also used ibuprofen round the clock and I think my swelling went down really fast because of that.
I stopped taking it though recently because I don't need it anymore. My peak swelling was at week 2, week three was a LOT better for me. I can still feel things moving past my wrap when I eat, especially crackers and bread and stuff like that.

I just have a lot of anxiety today over this for some reason. Maybe it is something as silly as being at the end of my swelling now and things being normal?
Its hard to know what normal is after this kind of surgery?!

lajenner
Regular Member


Date Joined Jul 2013
Total Posts : 349
   Posted 9/26/2013 9:52 AM (GMT -6)   
I agree, we have not idea what our new 'normal' will be. I had those same feelings about maybe it's too loose, maybe that's why I can eat so many different things. Thankfully, our surgeons used the tools necessary in insure it's right. :) Mine was also a floppy wrap.

StephanieJean
Veteran Member


Date Joined Jun 2013
Total Posts : 500
   Posted 9/26/2013 9:57 AM (GMT -6)   
Well, it makes me feel more normal that you feel the same way as me. Perhaps our wrap is just different enough that it makes us feel abnormal when we read about everyone elses experiences.
I am curious about how you will feel when you are a month out. I know I felt totally different at 4-5 weeks.
different in a good way, aside from the anxiety that my wrap is too loose. :)

Albez
Regular Member


Date Joined Jan 2013
Total Posts : 103
   Posted 9/26/2013 10:14 AM (GMT -6)   
Your pH test result was worse than mine. I only had 36 reflux and 26 acidic. My manometry was normal which is why I have no problems with swallowing. My barium swallow was also normal as was all the other tests I had.

Before the surgery I could eat quite fast and used to finish my meal before my family. I had two eggs scrambled today, my first soft food, and it took about 15 mins for me to finish them off. I had no problems with them getting stuck though.

I think like you I have had a floppy wrap but because we have no problem with esophageal motility it makes it easier to eat and in turn makes us question the wrap. We have a lot of healing still to do and its easy to get anxious with the recovery process. I for one still get a bit paranoid that it was my diabetes causing all the symptoms but then I wake up each morning feeling better and without feeling all that horrible reflux and nausea. I can also get a good nights sleep which was almost impossible before the surgery.

StephanieJean
Veteran Member


Date Joined Jun 2013
Total Posts : 500
   Posted 9/26/2013 10:25 AM (GMT -6)   
Thanks Albez. I bet you did have the floppy. I think they like to do that with those who have good motility.

I remember in the beginning, the one thing that really was difficult for me was applesauce and thick pureed foods. I had less difficulty with firmer things like chicken chunks. I think that might be because my esophagus had an easier time moving it past my wrap.

I have been following your progress . I am glad that you are feeling the positive results of the surgery now. There were times I wondered why the heck I did this to myself, but now I feel like I made the right decision (aside from some irrational anxiety over how loose my wrap is today)

I just keep repeating myself today "its ok to burp, its ok to burp" ha!

TonyG
Regular Member


Date Joined Apr 2013
Total Posts : 254
   Posted 9/26/2013 11:44 AM (GMT -6)   
Hiya SJ,

My wrap was a floppy Nissen as well, using a size 56 bougie. I, too, was surprised at how easy it was to eat so soon after my surgery. By about week 4, my diet was back to normal (except peanut butter, which still has a hard time getting down). I can't burp at all and when I have a little bit escape, it doesn't feel like a burp but more like trapped air as food was trying to make it's way down. Let your doctors be your doctors and let them decide what tests, if any, you need again. In short....RELAX! And yes, it IS okay to burp!! Just keep thinking, "some people heal faster than others and everyone is different". I wish I could! :)

-TonyG-
-TonyG-
Nissen Fundoplication April 30, 2013
Pain-Free, Reflux-Free, Sleeping on my back!

StephanieJean
Veteran Member


Date Joined Jun 2013
Total Posts : 500
   Posted 9/26/2013 1:37 PM (GMT -6)   
Thanks TonyG, you are a good voice of reason.
I will try to keep my cool until Oct. 8th when I can talk to my gastro.
29 Years old/Nissen Fundo (Loose Floppy) on 8/9/2013
No more reflux!

Ian Victor
Regular Member


Date Joined May 2013
Total Posts : 214
   Posted 9/26/2013 4:23 PM (GMT -6)   
You may recall that not long ago I posted a specific question about burping. One can have a successful wrap and still be able to burp. My surgeon was very clear that he gave me "a nice loose wrap."--- his exact words. Burping is a normal bodily function and many people burp freely, but do not have reflux. I think that you'll be okay. Surgeons have discovered (over the past decade or so) that the Nissen wrap doesn't have to be as tight as previously believed-- yet is can still be equally effective.

Ian

StephanieJean
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Date Joined Jun 2013
Total Posts : 500
   Posted 9/26/2013 7:44 PM (GMT -6)   
Thanks for checking in on me Ian. I obviously am working through some health anxiety issues and even when I know I am jumping the gun and not being rational my fears kind of take over and control me. I took a Xanax and I am hoping tomorrow it will stop.

My surgeon told me exactly what yours did and I trust him and it's good to be reassured on here when I am in a panic. Thank you for that.

I also did call my surgeon today because I felt like if it was important enough to me to post on here about it and I really should be talking to them too. The nurse was nice and said she felt like I was probably lucky to be able to eat so freely and release air from my stomach but she would let the surgeon know I was worried and they will call me by next Tuesday.

Thanks everyone for letting me panic a bit in a safe place but I will let you know what my surgeon says when he calls.
29 Years old/Nissen Fundo (Loose Floppy) on 8/9/2013
No more reflux!

opnwhl4
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Date Joined Dec 2008
Total Posts : 4961
   Posted 9/27/2013 9:37 AM (GMT -6)   
SJ-

You are over thinking things way too much. Th purpose of designing the floppy wrap was to ease the post nissen dysphagia. It works! The wrap still functions great because as you add food and drink to your stomach the pressure builds and this tightens the wrap at the LES.

No you won't be able to truly belch as before, but your stomach can burp a little. Yes most can be from your esophagus, but some does come from the stomach.

All people reflux some, they have to in order for food to get into and excess air/gas to escape. The nissen doesn't stop ALL reflux it brings us back to "normal" reflux.

I have had many EGDs after my 2 floppy nissens and things are great inside. I can swallow air and make a burp somewhat like I did before my nissen.

Having a PH study done now would be a waste since your wrap will still heal and settle in. Now if you want one I would wait until the year mark. That would be a better time to tell how it's working.

You are one of the luckier ones to have an easier recovery, welcome that.

If you are set on checking the function of your wrap, a barium swallow would be the better way to go right now. It will show what everything is doing as it goes down and if anything bounces back up. Yes you can see the barium bounce back up from your stomach if the LES is way too loose. I always got a kick out of watching what the barium did.

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn, Kidney disease

Nissen 6/06 and 5/09
#3 8/24/11

StephanieJean
Veteran Member


Date Joined Jun 2013
Total Posts : 500
   Posted 9/27/2013 9:43 AM (GMT -6)   
Thank you Bill, You are right.
I was just having some overwhelming anxiety yesterday about my surgery and healing and today I am feeling better about it.
I feel so stupid being worked up about having "good" side effects. I think I just needed some reassurance that I am ok, here and from my doctor. Like I said today I am feeling better, but maybe one day someone else will be feeling the way I feel about their loose floppy and this thread can reassure them as well.

Thank you all for talking things over with me.

StephanieJean
Veteran Member


Date Joined Jun 2013
Total Posts : 500
   Posted 9/27/2013 10:01 AM (GMT -6)   
Ok FYI before I end this crazy thread.
My wonderful patient surgeon called me just now and told me that he deliberately made my wrap nice and loose and that I am healing really really well and he couldn't have expected a better outcome for me.
If, after awhile, because I am still healing, I feel like I am concerned about my wrap he would be happy to talk to me about tests to prove that its working, but I should just feel lucky right now to have so few problems.

silly me.

Ian Victor
Regular Member


Date Joined May 2013
Total Posts : 214
   Posted 9/27/2013 3:09 PM (GMT -6)   
SJ-- I can appreciate your anxiety. I have had all kinds of pre- and post-surgery concerns and worries. I just keep coming back to this forum for a reality check and support. I can burp a little, but nothing like before my surgery. This is important to me because I'm still awaiting the go ahead to drink carbonated drinks.
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