Thursday, January 15, 2015

Nissen Fundoplication One Year Later

I am sharing my experience after having Nissen Fundoplication surgery one year ago in hopes it might help someone.  I had my surgery on January 17, 2014, at Sparrow Hospital with Dr. Jeffrey Deppen. I had both acid reflux (GERD) and a hiatal hernia.

Preparation: Dr. Deppen had ordered me to take a swallow test which can only be done in Michigan at the University of Michigan Hospital. The results of that were that I did have a slight restriction on my swallowing analysis so during the surgery they would not be tightening the spinchter valve between my stomach and esophagus as much as they do for the typical person.

Surgery: The surgery went fine and the physician did more work than anticipated because my hiatal hernia was larger than advertised in the preliminary tests. They were able to do the surgery with the laparoscopic method, which is the easiest for recovery.

Recovery: I spent two days at Sparrow Hospital after surgery. After I came home I was off work for a week and then returned for 30 hours (3/4 time) the second week after surgery. One of the hardest things was the limited amount of things I could eat for several weeks. I developed stomach aches when eating soy drinks or milk shakes, so I had to limit those drinks, which I had expected to be an important part of my diet.

Positive Effects: Here are some of the positive effects that I have noticed after one year.
  • Acid-Reflux No More. I have taken zero antacids in the year since my surgery and have absolutely no heart burn ever. I also don't wake up in the middle of the night chocking on reflux.
  • Coughing Disappeared. For decades going back to my teens, I have had unexplained coughing, especially after eating. I have had numerous tests to rule out things like TB, but there never was any answer. What led me to get a endoscopy was more severe dry coughing and gagging in the mornings. After the surgery my chronic coughing ended.  
  • Not Vomiting. Vomiting is much harder to do after this surgery. I think most of the times I had this problem prior to the surgery it was from coughing too much, and that no longer happens.
Negative Effects: Here are some of the less than ideal effects that I have faced after one year.
  • Weight Loss. I have lost about 35 pounds give or take a few pounds. Some people may see this as a positive effect but for me that was 20% of my body weight. After a year it is clear that my weight is not coming back to what it was before surgery, as my weight records over past six months show I'm consistently around 130 pounds, give or take a few pounds. I've started the gradual process of getting a new wardrobe of clothes that are smaller and fit better.  
  • Stomach Aches/Nausea. I find that I'm just not able to eat as much as I did before surgery.  If I do eat too much quantity of food I develop a stomach ache that is more severe than I ever had before the surgery. I also have to watch the amount of dairy, soy, and processed food I eat.
Lifestyle Changes:
  • Diet. I'm trying to keep a modified Paleo Diet of unprocessed food. This is harder than one thinks but really does help. I've found if I avoid soy drinks, dairy, and overeating I get along much better.
  • Zofran. After the type of surgery I had it is more difficult to actually vomit and doing so could put the surgical corrections at risk, so I keep with me at all times an anti-nausea 8mg tablet of Ondansetron (generic for Zofran) to take as needed every 8 hours. I only take once per day at the most and can go several days without having to take one. When I feel a severe stomach ache or nausea I take one of those. The medicine seems to still work for me after a year and does not seem to cause me any problems. My goal is to keep a closer reign on my diet and rarely have to rely on Zofran to feel better.
Cancer Prevention: The above are real effects I can measure and feel but it has been brought to my attention that a silent effect of this surgery could be the reduced risk of esophageal cancer. Esophageal cancer can develop when a hiatal hernia turns into Barret's Esophagus. Esophageal cancer is on the rise despite people taking more antacids. Could it be that the antacids cover up symptoms but never eliminate the underlying condition that causes cancer. In fact, when I told my periodontist that I had the Nissen surgery he said, "Well you won't have to worry about esophageal cancer now."

I would recommend this surgery for those with both GERD and a hiatal hernia.  It is not without its effects but a year later it has seemed to be worth it for me.