Re: Violent digestive upsets after HM surgery

[Guest guest]

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:

>

> 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.

>

If it were me I would just assume I got a stomach bug twice or something

of the sort. I also have a Toupet wrap. It is more likely to make

vomiting difficult than the Dor wrap because it is more complete than

the Dor, 270 degrees instead of 180. The forces from retching can cause

problems. After a night of retching I feel like I was hit by a buss and

it hurts to breath or laugh. It is also possible to push part of the

stomach up through the hiatus of the diaphragm and cause a hiatal

hernia. I did that in the hospital after my HM surgery. After a HM heals

the wrap and adhesions may help prevent hiatal hernias. You can't rule

one out though. Still, if it was me I wouldn't assume it was anything to

worry about unless it continues. You could call her doctor and ask if he

thinks it is worth looking into.

notan

[Guest guest]

Got to say nope. Have a mild tummy upset from time to time, for which I take a

PPI. On a *daily* basis, I take both diegestive enzymes and magnesium -- both

designed to keep things moving naturally, and they do. I didn't take the

enzymes before the Heller, as not enough was getting through to worry about. I

started after, because I figured my tummy was *way* out of practice, lol! The

need we have for extra water throws the *natural* digestive system outta wack.

I figure anything I can do to help it is all to the good. But I'm also with

Notan: fevers are caused by infection.

Hope this helps, a bit.

>

> 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]

Update, after my SO spoke with her surgeon:

He was concerned; he didn't think she should be having these violent digestive

episodes. He also said she should be able to vomit since he only did a partial

wrap.

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, but I guess it's worth it to make sure there is no surgical problem. I

wasn't on the phone call or I would have asked if an endoscopy could provide the

needed information. Perhaps he wants to see the " functional " swallow test and

watch where the barium fluid actually goes, whereas some hernias might not be

seen through an endoscope, but I'm only speculating.

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 had thought that some

people with these, or other kinds of partial wraps, do find themselves unable to

vomit. He is extremely experienced with these procedures, and a top academic

surgeon, so it is interesting.

I will update the group again after her test.

Thanks to everyone who shared their thoughts and experiences--it helps a lot.

This has been a big setback for her. She's afraid to eat again, even now that

she can swallow the food. Her fear is understandable to me: she was in so much

pain during these episodes that even the narcotic they gave her for

post-surgical pain (which she never used) didn't help. The first time, we nearly

rushed to the ER to rule out a heart attack.

>

> 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 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 was only surprised because my impression is that he was saying that his

patients treated this way can vomit just fine—so that's why he thought her

inability to vomit was abnormal. Yet I know that post-HM people, with whatever

kind of wrap, do sometimes have trouble vomiting. I will know more about this

after we meet with him in a few weeks after her barium swallow. I could have

misunderstood since I got this secondhand.

> 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.

As far as I can tell, despite strong opinions on both sides, no one can really

know the long-term effects of low-level medical radiation. The only real data

still comes from Hiroshima and Nagasaki, and that was not low-level exposure.

How to extrapolate from one to the other is far from clear.

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

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

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2889503/?tool=pubmed

I agree with you that in the case of my SO, the benefit of maybe figuring out

why she is suffering so seems to outweigh the potential, but unknown, risks of

the radiation. 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. 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.

> >

> > 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]

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

people having problems vomiting.

Notan, I am curious now and will ask the surgeon when we see him after the

barium swallow study. After hundreds of HM's with wraps, has he had patients who

lost the ability to vomit freely? If not, I will have to wonder if he is doing

something different than other surgeons. But as I said I could have

misunderstood what my SO relayed from him.

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

here a few times.

Hormesis is indeed a fascinating idea. As you may know, some scientists think

that even the health benefits of vegetables (to the extent they really exist,

which is basically still unclear in itself) are due to hormesis. The plants have

evolved toxins against us because they don't want to be eaten, particularly

their babies—e.g., grains, which are seeds. Low dose exposure to those toxins

provides a stimulus for us to become stronger to defend ourselves. So maybe they

are good for us because they are bad for us. Fruits are a different story: the

plant wants us to eat those so we can poop out their baby seeds, complete with

fertilizer, somewhere else and continue their cycle of life.

The problem is that only after very careful research can we say if any given

" stress " is beneficial via hormesis or just debilitating via the stress. With

low-level radiation and many other things I don't know that the jury is anywhere

near in yet.

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

Speaking of which, and bringing us back on the topic of this group, did you see

this, about a new way to screen for esophageal cancer?

http://uk.reuters.com/article/2012/04/20/uk-usa-cancer-screening-idUKBRE83J0K020\

120420?feedType=RSS & feedName=GCA-GoogleNewsUK

I am a big fan of Dr. Gilbert Welch's work, and I suspect he is right about

this. I have to doubt if such screening is a good idea even for an achalasian

with acid reflux. Without long-term studies I don't know how one could be

confident it is, given the inevitable huge number of scares and false positives

with this very rare cancer. A very few may benefit, some will be harmed, many

will be terrified and turned into lifelong patients, " sick " people instead of

well ones. Is it worth it?

When the same question is asked by open minded people about more common cancers,

even standard things like colonoscopy and mammography look pretty questionable.

So do cholesterol screening, EKG's, ultrasounds in pregnancy, fetal heart

monitors, and much else that doctors do routinely to well people. Dr. Welch and

Dr. Nortin Hadler have written the best stuff on these questions I've seen.

After learning about all this I look cross-eyed at everything now. Aren't you

glad you are not my doctor?

> >

> > > > 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

>

>

>

>

>

>

>

>

[Guest guest]

We saw my SO's surgeon today. Her barium swallow study was excellent, showing

clearly the 20mm wide open area at her LES the surgeon made eight weeks ago. He

did not have an explanation for her two violent stomach upsets, but he does not

think anything major is wrong. With any luck, they won't recur.

I asked him about her inability to vomit during these episodes. He said that her

wrap was only partial (Toupet), she should be able to vomit. The pressure

generated by the attempt to vomit should be able to push open the partial wrap.

He said only people with full (Nissen) wraps should be unable to vomit. His

patients with partial wraps, he said, have not had difficulty vomiting.

This is a bit of a mystery to me since so many people here with partial wraps do

have trouble vomiting. He is an exceptional surgeon, so perhaps he does things

differently. I don't really have an explanation for the discrepancy, but it is

interesting. We will see over time if my SO can in fact vomit when she needs to.

> > >

> > > > > 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

> >

> >

> >

> >

> >

> >

> >

> >