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Myotomy and sleeve to bypass revision due to GERD



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I had my sleeve done in 2011, reached my goal weight of 138, and have maintained it since. I developed GERD about two years after the sleeve surgery. I've been on omeprazole since, the max dosage the past two years. GERD gave me an esophageal stricture which causes food and liquids to regurgitate back into my mouth after swallowing. It's truly gross to have to repeatedly reswallow the same mouthful of food. Sometimes things get stuck and I have to vomit them up. I've had a couple of endoscopies, a BRAVO study, and esophageal manometry. The manometry shows I have achalasia (impaired swallowing) too, not surprising when you only have a 12.5 mm wide esophagus. It was dilated during an endoscopy, but shrank back down fairly quickly. My surgeon wants to do a Heller myotomy to fix the stricture but a common side effect of myotomy is GERD. So he has to do something about the GERD, too, and that has to be some kind of bypass. Since I'm at goal weight with a BMI of 21, I don't have much spare poundage to lose. Plus I'm 65 and don't want to end up one of those "frail elderly" people who can't carry groceries or walk very far. I am hoping that my surgeon will make the very shortest bypass limb he can.

Approval came a week after submission so I'm scheduled for June 29. No preop diet required. It's all happening a little fast and I'm a little freaked out. I think I've forgotten all the food stages :-). Support would be appreciated.

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if you're at a normal BMI, you may not lose any more weight. People who are still pretty far from goal typically do with a revision (although not as quickly as with a virgin surgery), but if you're at a normal weight, then you may not. Just follow your surgeon's guidelines and you should be fine..

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Yeah, what catwoman7 said, hopefully this will give you relief from your swallowing issues but allow you to maintain your weight without losing more. Good luck!

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She is right. I had the revision done a few weeks ago and I could eat more calories if I wanted or needed to. I am doing 700 no problems. There is no restriction for me like with the sleeve so all liquids and full liquids and even some soft foods just slide right on through. It is really weird ! I can see how people could gain so easily with this if they just ate slider foods.

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Thank you all for the reassurance. I picked my surgeon because he's the expert in this area for complex foregut problems. He's not really a people person. I'm hoping that post-op, the dietician can help.

I am just worrying that I will go through all this and 1) still have reflux and 2) will have malabsorption issues and lose too much. I lost five pounds over a weekend in December when I had the flu and couldn't keep anything down.

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I had my revision done on 6/29. There were a few little hiccups--after surgery I couldn't pee, so I needed a catheter, and I lost quite a lot of blood and needed 2 units of packed red blood cells transfused, which upped my hemoglobin level enough to where I'm anemic now but not fainting when I stand up. It was a long surgery, as I had three procedures done--a myotomy to fix the esophageal stricture I got from GERD, a hernia repair, and the RNY. I was originally supposed to come home on July 1, but my drain was still bloody and filling quickly, so I stayed until this afternoon, 7/3. I still have the drain, it's supposed to come out Monday. I have had two episodes of "heartburn" but neither were in my new stomach, but in the intestine, because the burning is above my bellybutton but below my rib cage. My stomach is much higher up and has not hurt at all. I cannot tell you how happy I am that I am not regurgitating everything I swallow and that I can sleep through the night without acid crawling up into my mouth. My nurse was quite concerned when I finished an 11 oz. Protein Shake in fifteen minutes, but the surgeon told her it was fine as long as I could tolerate swallowing things that fast. Because I'm at goal and don't want to lose any more weight, he also said for the next two weeks I could eat anything I could pour, but to be careful of sugar and fat content in case I dump. This brought back memories of a Saturday Night Live sketch called "Bass-O-Matic" (it's on YouTube, it's a hoot) but blending a whole fish is not on the menu. I have not had much pain, mostly gas because he had to operate so high up in the chest he put a lot of gas in. I came out of surgery with both eyes swollen shut because the gas seeped into my face, but it is mostly gone now. Now it looks like I have bags under my eyes. I loved my sleeve and tried everything to keep it but the GERD was just too bad. Hoping I come to love the bypass too.

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3 hours ago, Foxbins said:

I had my revision done on 6/29. There were a few little hiccups--after surgery I couldn't pee, so I needed a catheter, and I lost quite a lot of blood and needed 2 units of packed red blood cells transfused, which upped my hemoglobin level enough to where I'm anemic now but not fainting when I stand up. It was a long surgery, as I had three procedures done--a myotomy to fix the esophageal stricture I got from GERD, a hernia repair, and the RNY. I was originally supposed to come home on July 1, but my drain was still bloody and filling quickly, so I stayed until this afternoon, 7/3. I still have the drain, it's supposed to come out Monday. I have had two episodes of "heartburn" but neither were in my new stomach, but in the intestine, because the burning is above my bellybutton but below my rib cage. My stomach is much higher up and has not hurt at all. I cannot tell you how happy I am that I am not regurgitating everything I swallow and that I can sleep through the night without acid crawling up into my mouth. My nurse was quite concerned when I finished an 11 oz. Protein Shake in fifteen minutes, but the surgeon told her it was fine as long as I could tolerate swallowing things that fast. Because I'm at goal and don't want to lose any more weight, he also said for the next two weeks I could eat anything I could pour, but to be careful of sugar and fat content in case I dump. This brought back memories of a Saturday Night Live sketch called "Bass-O-Matic" (it's on YouTube, it's a hoot) but blending a whole fish is not on the menu. I have not had much pain, mostly gas because he had to operate so high up in the chest he put a lot of gas in. I came out of surgery with both eyes swollen shut because the gas seeped into my face, but it is mostly gone now. Now it looks like I have bags under my eyes. I loved my sleeve and tried everything to keep it but the GERD was just too bad. Hoping I come to love the bypass too.

Glad you are home and doing well.

Its crazy being able to drink like that after surgery. I was able to do that as well. There are plenty of things you will be able to get down without making you lose that much weight. You will be surprised of how easy I am sure. Be very careful dumping is horrible !

I loved my sleeve too and miss it. Hoping someday I will feel better about this bypass, lol.

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Well, I just got home from the ER. I was standing at the sink, fixing the cat's food, when I felt dizzy and weak and sweaty. The ER said I'm dehydrated but I swear I drank 64+ oz of Fluid on Saturday--14 oz Soup, 28 oz Protein Shakes, 32 oz crystal light, and a glass of skim milk. I wonder if I had a little dump episode--for Breakfast I had half a Protein Shake topped up with some of that Fairlife milk. Neither one should cause dumping but who knows? I think getting used to my new insides is going to be all trial and error. Anyway, I'm supposed to get my drain out tomorrow, It's still putting out 40 cc of bloody fluid every 12 hours so I am going to ask about a scan to look for a bleeder, but who knows if I'll get one. Part of me thinks that if everything is okay my surgeon should have pulled the drain on Friday when he discharged me home, but he didn't, leading me to think that he was hoping for a decrease in the volume over the weekend, which isn't happening.

Still no reflux and I am so frigging happy not to be regurgitating everything I swallow I can't even say. What a relief.

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8 minutes ago, Foxbins said:

. I wonder if I had a little dump episode--for Breakfast I had half a Protein Shake topped up with some of that Fairlife milk. Neither one should cause dumping but who knows?

those normally wouldn't cause dumping. Maybe lactose intolerance? That's not uncommon after WLS. Or maybe you just drank it too fast ...or your stomach is just weirding out...or ????

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I saw my surgeon yesterday and because the drain is still putting out so much bloody liquid, he left it in. The ER did labs on Sunday and my hemoglobin looks good. The surgeon wonders if I didn't have a big clot inside that has been dissolving over the past week and causing the blood in the drain. He didn't sound terribly sure that was the cause, but just threw it out there as a possibility. I go back on Thursday for another drain check. Drain volume has been decreasing and I'm hoping it will continue. Eating and drinking are fine. Liking my blenderizied Soups because they aren't sweet and I'm tolerating them well.

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The drain was removed today, the output was down to about 30cc in 24 hours. When they removed the drain from my sleeve surgery, there was this sort of funny slithery sensation inside. Today I felt nothing. The stab incisions, covered in glue, are starting to itch and I'll be happy when the glue is gone. Some is flaking already. I weighed in at 140.7, I'm happy I haven't lost, but I think I still have a lot of Fluid in me. My abdomen is pretty swollen and has turned green, yellow, and purple from the bruising.

I'm getting sick of the Protein Drinks and I've started cutting them with skim milk. It makes them less sweet.

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I weighed myself on Sunday--137 lbs. My lowest weight after the sleeve was 132 and I'd really like not to go below that with the bypass. I have been trying to get the chewable bariatric Vitamins down (BariSlim with 45mg iron) but they just seem to irritate my intestines and they make my poop orange, which is weird to see. The nutritionist at the hospital suggested Flintstones but Amazon reviews say the formula has changed and there isn't enough Iron, even at a double dose. I have almost a full bottle of costco Mature Multi Vitamins that I was taking before the bypass and tolerated well and I can cut the tablets in half to make them easier to swallow. I'm thinking if I take 2x the dose, and supplement with the Feosol iron and the sublingual B12 I was taking with the sleeve, that should be adequate supplementation. I have to contact my endocrinologist about Calcium, my levels were high last December and he cut the dosage to 500mg/day.

No reflux, no dumping (but haven't challenged myself) no regurgitation. Walking a mile a day. Sometimes have to take a nap in the afternoon but not always.

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Because I was at goal and having the revision because of intractable GERD, the dietary instructions for RNY really don't apply to me. The texture progression does, liquid to pureed to soft to regular food, but the caloric advice doesn't. So I scouted around on the web. Gastrectomy and intestinal rerouting has been done a long time for GI cancers. There is a surgery called a Billroth II that is almost the same as RNY so I have been following dietary guidelines for them--whole milk and full fat yogurt, mashed potatoes with small amounts of butter, basically avoiding low-fat and low-sugar options without taking in so much fat and sugar that I might dump. We'll see how it works, I only weigh myself once a week and there are a few more days to go.

Last night I woke up at 2 am and had to pee. When I got back in bed, my abdomen, inside and out, ached and throbbed. I have no idea what happened, maybe I twisted getting out of bed. I tried to deep breathe enough to relax and go back to sleep but couldn't. I ended up taking half an oxycodone (2.5 mg). Tylenol probably would have worked but it was in the bathroom and the oxycodone was in the drawer of the nightstand. First painkiller of any kind I've taken since July 5.

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I'm noticing that my recovery is kind of a plateau and then an improvement. I'll go a couple of days feeling okay, and then wake up one morning and feel noticeably stronger. I'm walking 2500 steps a day and intend to increase by 500 each week until I'm at 6000. I think I will start lifting some 8 lbs weights for my arms and start doing some squats too.

At this stage of my food plan, I have no restriction or feelings of fullness, so I have been looking for a signal so I don't overeat. I think I have found it--twice I have felt a dull pain in my right shoulder while eating. I've decided to pay attention to it.

The glue over my incisions balled up and rolled off in the shower a couple of days ago except for the largest incision next to my bellybutton, and there is still a scab where my drain was. There are also some bumps under my incisions but I remember them from my sleeve surgery and know that they go away. At this point, the biggest issue I have is that while sleeping, my mouth is wide open and I wake up with a dry mouth unlike anything I've ever experienced. I'm fine during the day, and I don't understand why I've apparently stopped breathing through my nose at night. It's annoying and uncomfortable. I am hoping it resolves on its own soon.

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Three weeks since I came home. I have been hurting since Tuesday. Not "give me narcotics" hurting, but enough to be taking regular doses of Tylenol. My insides feel tight, like I'm wearing a corset under my skin, and every once in a while there is a little stabby pain. Mostly I don't notice it when I'm awake but when I try to sleep it interferes. I'm not vomiting, nauseated, constipated, dehydrated, or unable to pass gas so I'm pretty sure everything is okay inside and I'm just feeling things healing, probably some adhesion formation too. In contrast to the sleeve, this surgery feels like my insides were rearranged.

So far I've been able to eat anything I've tried, I had some boiled rice and some ground pork with hoisin sauce, some Peanut Butter, some chicken salad, all good. I might try some oatmeal soon. I lost another pound last week but as I add more calories back I think I will be okay. I'm still waking up with a dry mouth but not as bad as it was.

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