Re: Re: Violent digestive upsets after HM surgery

[Guest guest]

This is an interesting question.  I will relate my personal experience and

perhaps others can chime in on this topic also.  Long story short, after my

surgery I was elated that I could swallow and thought the world was my

oyster!!!  I quickly found that my stomach could not handle all these food

items at once and wound up with heavy cramping pains nausea and diarrhea almost

all the time.  Many call this dumping syndrome I think.  My stomach was

extremely sensitive, some of the offenders were things like fried foods, salads,

fresh fruit or to many veggies.  Sometimes it had no rhyme or reason and other

times I could eat and I would feel okay, but I did find that small portions at

each meal helped alot. 

 

I ran this by my doctor, her best advice was to drink more water each day, to

avoid constipation and learn to eat smaller meals.  She felt that over time I

might adjust, which I have gotten better, but I still battle it at least 4-5

days per month where I am miserable and in pain.  I guess this is the new me. 

I still am glad that I can swallow, my situation is like IBS??  My regular doc

has given me some anti cramping meds to help when it gets bad. 

 

I will say that the first 6 months after surgery was the worst for me.  Please

have your SO try watching what triggers and avoid fatty foods or just eat small

portions at each meal.  Wish I had more info, hope this helps. 

 

Julee in Oregon. 

________________________________

From: shimonwimon <@...>

achalasia

Sent: Monday, April 16, 2012 11:38 AM

Subject: Re: Violent digestive upsets after HM surgery

 

One more detail I forgot: both times she ran a bit of a fever for a day or two.

We initially suspected food poisoning, but after the second episode that seems

unlikely. Thanks for any thoughts.

>

> Looking for some insight or advice from the HM veterans here.

>

> My SO is six weeks out from her HM with Toupet wrap. She can eat now, and so

far no symptoms of reflux, which is great. But twice now (last night and a week

ago) she's suffered violent stomach upsets, with major pain in the stomach

area, intense belching, and nausea.

>

> The first time, she was terrified, since she's never experienced anything like

this before. She had difficulty vomiting, which I understand can happen after a

wrap, and that didn't help.

>

> I reached the surgeon covering for her doc, who did not see any red flags

requiring a trip to the ER. She said at five weeks out from surgery, it was

highly unlikely it was a surgical problem. Good call, since she did recover over

the next few days.

>

> But the abdominal pain (seemingly right below the surgery site, across the top

area of her stomach) continued, though it has slowly abated since the crisis.

>

> Than again last night she had another major painful upset with the same

pattern. It is improved today, but she's still pretty sick.

>

> Both times, the upsets occurred at night, after restaurant meals at lunchtime

that she perhaps should not have eaten. Previously, maybe such meals would have

precipitated a mild problem, but nothing like this.

>

> I've begged her to call her surgeon, which she says she will when she feels

well enough to talk with him. In the meantime, I wonder if any of this sounds

familiar to other people who had HM's.

>

> I wonder if the residual abdominal pain could be from her diaphragm after all

the violent attempts to vomit the last time. I also wonder if the Toupet wrap

could somehow be promoting these upsets. She had a first-rate surgeon who has

done hundreds of these procedures with great success, so I don't suspect a

surgical error.

>

> Thanks for any thoughts. I will also post back after she speaks with her

surgeon.

>

[Guest guest]

I've had this problem for years. I just finally learned that I need to keep

everything flowing and avoid constipation. Doing that also improves my ability

to swallow. Not do that can close my esophagus up totally.

Re: Violent digestive upsets after HM surgery

One more detail I forgot: both times she ran a bit of a fever for a day or two.

We initially suspected food poisoning, but after the second episode that seems

unlikely. Thanks for any thoughts.

>

> Looking for some insight or advice from the HM veterans here.

>

> My SO is six weeks out from her HM with Toupet wrap. She can eat now, and so

far no symptoms of reflux, which is great. But twice now (last night and a week

ago) she's suffered violent stomach upsets, with major pain in the stomach area,

intense belching, and nausea.

>

> The first time, she was terrified, since she's never experienced anything like

this before. She had difficulty vomiting, which I understand can happen after a

wrap, and that didn't help.

>

> I reached the surgeon covering for her doc, who did not see any red flags

requiring a trip to the ER. She said at five weeks out from surgery, it was

highly unlikely it was a surgical problem. Good call, since she did recover over

the next few days.

>

> But the abdominal pain (seemingly right below the surgery site, across the top

area of her stomach) continued, though it has slowly abated since the crisis.

>

> Than again last night she had another major painful upset with the same

pattern. It is improved today, but she's still pretty sick.

>

> Both times, the upsets occurred at night, after restaurant meals at lunchtime

that she perhaps should not have eaten. Previously, maybe such meals would have

precipitated a mild problem, but nothing like this.

>

> I've begged her to call her surgeon, which she says she will when she feels

well enough to talk with him. In the meantime, I wonder if any of this sounds

familiar to other people who had HM's.

>

> I wonder if the residual abdominal pain could be from her diaphragm after all

the violent attempts to vomit the last time. I also wonder if the Toupet wrap

could somehow be promoting these upsets. She had a first-rate surgeon who has

done hundreds of these procedures with great success, so I don't suspect a

surgical error.

>

> Thanks for any thoughts. I will also post back after she speaks with her

surgeon.

>

[Guest guest]

shimonwimon wrote:

>

> I was surprised to hear him say that even with a Toupet wrap she

> should be able to vomit, based on some experiences I've read here.

>

I don't think it should be so surprising. Lets consider vomiting without

a wrap for a moment. Vomiting does not happen in one step. It happens in

stages. Those funny feeling you get right before you vomit are partly

the body getting ready. Muscles begin to relax or contract in

preparation, salvation increase to protect the teeth, and

retroperistalsis begins. One of the last stages before vomiting is

retching. Sometimes retching goes right into vomiting and you don't

really notice the retching stage. But sometimes, even in people that

don't have achalasia one may retch a number of times before vomiting and

the sequence may even end after retching without ever proceeding to

vomiting. If things don't go just right the sequence may fail before

vomiting. That can happen without a wrap. It happens to some people with

achalasia before having a myotomy or wrap. Most of my adult life before

the myotomy I rarely reached the stage of vomiting. Probably the tight

LES had something to do with that. But we also have a gastroesophageal

junction and lower esophagus that are dysfunctional even if the LES is

open. The good new there is that retroperistalsis does not have to

happen in the esophagus. Even so the muscles in the esophagus may not be

cooperating with the sequence. There could be spasms blocking the

esophagus. Also the Upper Esophageal Sphincter (UES) needs to relax and

there can be a dysfunction of the UES with achalasia. It would not

surprise me to hear from a person with a myotomy without a wrap having a

bad day trying to vomit. But add a wrap and it is one more thing to get

in the way. The stronger the wrap the more it can get in the way. We are

all different though and of those with the same wrap some will have

problems vomiting and others will not.

I have the Toupet wrap and I usually have a hard time vomiting even

though I also have gastric reflux. Usually I retch a lot and only bring

up a little, just a spit now and then but mostly just retching. You will

find there are others in this group that only had a Dor wrap and have

trouble vomiting. Yet others with either that have no problems vomiting.

I suspect that some with problems don't have consistent problems every

time, just as sometime it is easier to eat than at other times.

> He asked her to get a barium swallow test to make sure nothing has

> herniated. I'm not wild about the additional exposure to medical

> radiation and contrast medium ...

If you are familiar with hiatal hernias then the one you are probably

most familiar with is unlikely to be one would get after having a Toupet

wrap. It is unlikely that the wrap could have been completely pushed up

through the hiatus. More likely would be a paraesophageal hernia or one

involving intestines.

Newer X-ray machines use a small fraction of the radiation that the

older ones did. I wouldn't want to sit under one just for the fun of it

but the risks of having one may be much better than the risks from not

having one.

notan

[Guest guest]

shimonwimon wrote:

>

> > > I was surprised to hear him say that even with a Toupet wrap she

> > > should be able to vomit, based on some experiences I've read here.

> > >

> >

> > I don't think it should be so surprising.

>

I believe I wrote that thinking the doctor was surprised to hear about

people having problems vomiting. Anyway, that line should read something

like, I don't think it should be so surprising that some people have a

problem vomiting.

>

> As you may know, some scientists believe that low level radiation can

> actually be *benefecial* via hormesis. Here is one example:

>

Yes, there is a variation on that theme I like and I have used the logic

here a few times. It is kind of a what doesn't kill you makes you

stronger kind of thing but not that crude. A little sun light is

healthy, too much can cause burns and even be fatal. If you don't get

any sun light it is even worse for you when you do get over exposed.

Using sun screens everyday and then forgetting them when going on an

outing in the sun may be worse than never using sun screens. I think a

lot of things are like that. Oxidative stress and free radicals may be

that way. I think the body has ways of healing the damage from them but

if you could prevent the damage altogether then on a following event

where you underwent a intense oxidative stress the body may not be as

able to heal it because the ability to do so has atrophied.

> ... For myself, I decline all medical radiation unless the " pre-test

> probability " of finding something, in the terms of Bayesian

> statistics, is pretty high. Never to just " rule out " very unlikely

> possibilities.

>

Make sense to me. You will like this: a new study found an association

of brain tumors and dental X-rays. The risk is low so it probably is not

a big deal. But even if the probability was higher there is a problem

with the study. The increase was found in people who had X-rays as

children. Many of the people in the study were children decades ago when

the X-ray equipment was different. They have been pulling different arms

on the bandit over the years but want to predict what the risks are with

the bandit arm being pulled today.

http://www.webmd.com/brain/news/20120410/dental-x-rays-linked-brain-tumors

> In addition to avoiding the exposure, I'm always afraid of incidental

> findings leading to fear, labeling, and maybe a cascade of risky tests

> and procedures. It is always a judgment call, and not everyone makes

> the same judgement.

>

Right, CTs and MRIs are major fishing trips for things to drive you

nuts. I now know that I have a bump on my kidney that was the start of

an extra lobe, masses on my adrenal glands and cysts in my kidneys. None

of that information is very useful but it cost the insurance company

plenty to get it and so the doctors could figure out that it didn't mean

much. And at the equivalent of hundreds of chest X-rays per CT I have

now had enough radiation to do chest X-rays on everyone in a town.

notan