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Myotomy and sleeve to bypass revision due to GERD



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I did my weekly weigh-in today and I've gained 2 lbs. Not real, stuck on the hips pounds because in order to gain 2 real pounds in a week I'd have to have eaten 1000 calories a day, every day, over my calorie expenditure, which I didn't do. What I did do is eat a lot of Asian recipes this week. All are high in sodium, so I suspect I'm holding on to some Water weight, but I wanted some strong flavors after yogurt, egg salad, and cottage cheese these past weeks. So I broke out the fish sauce, soy sauce, and made some quick cucumber pickles. Everything was delicious. I tried half a toasted English muffin, seemed to sit well. I haven't vomited at all, or dumped. Maybe I'll escape that. I am walking 5000+ steps a day and I will add some yoga and squats I think. I still feel like I'm wearing a corset, a tightness under the skin. It's odd but not painful. My incisions have all healed and the scab from the hole where the drain exited has finally fallen off. I still get some odd pains here and there, mostly around my belly button. I am taking a 750mg psyllium capsule each morning and have not had a problem with constipation despite falling short of my 64 oz Fluid goal a couple of days this week. And best of all, still no GERD, no regurgitation, and I started swallowing full size pills without a problem this week. I have a telephone appt with the surgeon's office on Friday and I hope I can stop taking omeprazole then.

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Weight this morning 136.4. I spoke to the surgeon's office on Friday and I still have to take omeprazole until they take a look at everything with an EGD in another six weeks. I still have no GERD. I can sleep flat again!

I ordered my operative record and discharge summary from the hospital records department and they emailed them to me for free. It was very interesting to read, I learned quite a lot that no one had told me. My bypass is 50 cm, so I am hoping I will not have too much malabsorption and no bile reflux. My sleeve/pouch is 6 cm long, I think my surgeon made it longer than usual because my sleeve was very narrow. Despite a bigger pouch I have had to start measuring my food because I can't eat as much with this pouch as I could with the full sleeve. I can comfortably eat about a cup. I want to be very careful not to stretch out the stoma. My sleeve used to be so sensitive, but with this RNY I haven't vomited at all. So far I'm pretty happy with this surgery.

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7 weeks post-op tomorrow, weight today 137.6, again I'm retaining Water. I stopped taking the psyllium capsules because I was having multiple loose BMs a day. Maybe constipation will not be an issue for me as it was with the sleeve. I am still tolerating all foods. I tried cauliflower rice this week. It tastes of nothing, not even cauliflower. I put some za'atar on it to give it some flavor but I think I have to add some cheese or condensed Soup or something. I hate throwing out food these days.

Got a call from the surgeon's office and I am scheduled for an EGD the first week in October to check that everything is okay and that's when I am supposed to be able to discontinue the PPI. I have had two instances of acid, or something that feels like acid, this week. Not nearly as horrible as before surgery, but distinctly there. If it happens again I will have to pay attention to whether it is precipitated by a particular food/drink/time of day/relation to meals.

I overate for the first time on Thursday. I picked up a bag of popcorn that someone left sitting on the counter, and it felt so light I figured there couldn't be much in it. So I mindlessly kept eating it while watching TV (usually I measure my food in measuring cups) until it became clear that I was full. Too full. Painfully full. The fullness feeling was not in my chest, where my stomach is, but in my upper abdomen, where the Roux limb is. Gosh it hurt for about two hours, and I tried to vomit but it was too far down to come up, so I just had to bear it. Prior to last night I had not felt full, but I wasn't hungry, either. I think that's the feeling I want. With the sleeve it was very clear when I was full, with the RNY my stomach doesn't let me know. I think that may be at least partly due to the fact that I told my surgeon I was concerned about losing too much weight and he made the pouch bigger than he normally would.

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On 8/16/2020 at 2:50 PM, Foxbins said:

7 weeks post-op tomorrow, weight today 137.6, again I'm retaining Water. I stopped taking the psyllium capsules because I was having multiple loose BMs a day. Maybe constipation will not be an issue for me as it was with the sleeve. I am still tolerating all foods. I tried cauliflower rice this week. It tastes of nothing, not even cauliflower. I put some za'atar on it to give it some flavor but I think I have to add some cheese or condensed Soup or something. I hate throwing out food these days.

Got a call from the surgeon's office and I am scheduled for an EGD the first week in October to check that everything is okay and that's when I am supposed to be able to discontinue the PPI. I have had two instances of acid, or something that feels like acid, this week. Not nearly as horrible as before surgery, but distinctly there. If it happens again I will have to pay attention to whether it is precipitated by a particular food/drink/time of day/relation to meals.

I overate for the first time on Thursday. I picked up a bag of popcorn that someone left sitting on the counter, and it felt so light I figured there couldn't be much in it. So I mindlessly kept eating it while watching TV (usually I measure my food in measuring cups) until it became clear that I was full. Too full. Painfully full. The fullness feeling was not in my chest, where my stomach is, but in my upper abdomen, where the Roux limb is. Gosh it hurt for about two hours, and I tried to vomit but it was too far down to come up, so I just had to bear it. Prior to last night I had not felt full, but I wasn't hungry, either. I think that's the feeling I want. With the sleeve it was very clear when I was full, with the RNY my stomach doesn't let me know. I think that may be at least partly due to the fact that I told my surgeon I was concerned about losing too much weight and he made the pouch bigger than he normally would.

I feel your pain on overeating and being sick for 2 hrs and not being able to vomit. ITS HORRIBLE !!

Glad you are doing well with your revision.

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135.8 this morning. My strategy to keep weight on by using full-fat dairy products won't work. Fat is what is giving me loose and frequent bowel movements, so I've changed my strategy and have upped the carbs, going with more fruit and veg and more whole grains like barley. I'm eating five or six times a day. I'm trying to understand the "full" feeling with this surgery because I won't always be able to measure my food. It's so different from the sleeve. The sleeve had a definite feeling of pressure inside, this is more subtle. It's a little more apparent if I eat Protein by itself, but I can't just eat protein.

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135.6 this morning. Cut back on fat and now bowel movements are less frequent and less liquid. However, I woke up last week 3 nights in a row with terrible reflux, but it was not acid. Antacids did not work to stop the burning, and I'm still on a PPI. I called the surgeon's office and they told me it's stomach juice (without acid, but still very irritating to the esophagus and stomach). I had been eating a snack before going to bed because my stomach growls and it's hard to fall asleep if I'm hungry, but the RN said that could be the cause and to stop eating 3 hours before bedtime. I did that and everything is fine now, no more reflux. Also I have noticed that if I am full my nose runs, so I'm trying to eat until I just start to feel it get watery.

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135.4 this morning. Really I don't want to eat crap, but I keep losing weight. I can tolerate sugar and moderate amounts of fat without spending a lot of time in the bathroom, but I'd rather eat Protein, vegetables, fruit, and dairy for calories than candy bars. Because I reflux stomach Fluid at night, I can't eat after 8 (if I plan on going to sleep at 11) and I've never been a Breakfast eater. That mean getting about 1500 calories in between 11 and 8. That's nine hours, at 166 calories an hour, complicated by the fact that I am not hungry at all. This is going to take some thought.

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Weight this morning 137.0, but not real. I couldn't walk this week due to wildfire smoke and I overdid the salt. I have figured out another contributor to my bowel movement miseries--dairy. All these weeks I've been eating so much dairy (I love dairy) and finally it hit me that I might have become lactose-intolerant. So I quit dairy except for a small amount of half&half in my morning coffee. Bingo! no more loose BMs, no more frequent BMs, no more gas and bloating. I experimented with Lactaid on Friday and Saturday and it seems to help, but doesn't totally prevent gas and bloating. So I guess now I'm buying lactose-free products.

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136.2 this morning. What a massive relief not to have runny bowel movements anymore, but I think I have to go back to taking the psyllium capsules because things are getting pretty dry. This surgery is so much trial and error, the sleeve was so much easier. Reflux is back, I am waking up in the middle of the night with heartburn. I'm documenting what I eat and when, trying to find out if there are trigger foods or other behaviors that cause it. It's awful, because I had this RNY (that I didn't want) specifically to get rid of GERD. Now I don't have acid but the remaining digestive juice in my stomach burns without the acid anyway, and antacids don't help because there's no acid to neutralize. Now that my stomach is under my sternum, I have to crank the head of the bed way up to keep the reflux down. I don't eat after 8 pm and go to bed at 11 and still have reflux, so I'm adjusting "no more food" to 7 pm and hoping that helps. I am not happy. My surgeon said that I have been "surgically optimized" and that he can't do anything else for me (not that I asked him to) so if this keeps up I guess it's back to the gastroenterologist.

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I'm a little more cheerful this week than I was last week. I am still waking up with heartburn but not eating after 8 (7 is too early, I can't sleep if I'm hungry) and more importantly, exercise, is helping a great deal. I think after having GERD all those years I am hypersensitive to any burning sensation in my stomach and anything moving up my esophagus, so I wake up easily when that happens. If I exercise I think I sleep more deeply and maybe I'm not quite so aware of those sensations. I do wake up with a slightly burning stomach most mornings, but a slug of Lactaid milk takes care of it. I kept a meal diary this past week and it also looks like chocolate may be a trigger. I had a slice of chocolate cake two days this week and both nights I woke up. The cake slices are gone now. I have my 3 month EGD on Thursday, wondering if it will show gastritis/esophagitis. Also wondering what my surgeon will say if it does.

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Thanks for sharing your journey. I am having the RNY with hernia repair in 2 weeks and I am nervous. It’s not something I want to have but due to extreme GERD my Dr thinks it’s necessary to prevent esophageal cancer. I’ve been happy with my sleeve, so don’t know what to expect from this new surgery. And I will be SUPER upset if I still have GERD post surgery!

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16 hours ago, MamT said:

Thanks for sharing your journey. I am having the RNY with hernia repair in 2 weeks and I am nervous. It’s not something I want to have but due to extreme GERD my Dr thinks it’s necessary to prevent esophageal cancer. I’ve been happy with my sleeve, so don’t know what to expect from this new surgery. And I will be SUPER upset if I still have GERD post surgery!

This surgery is way different than my sleeve. I don't really have anything I'd call restriction compared to restriction in my sleeve. On the plus side, I can eat things like Pasta and rice that I couldn't with the sleeve, and I can drink a lot of Water all at once without it backing up. The reflux thing is a PITA but I am so happy I'm not regurgitating every mouthful I think I'm okay with the tradeoff. Best wishes on your surgery, I know you will do fine. PM me with questions if you think I might be able to help.

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5 hours ago, Foxbins said:

This surgery is way different than my sleeve. I don't really have anything I'd call restriction compared to restriction in my sleeve. On the plus side, I can eat things like Pasta and rice that I couldn't with the sleeve, and I can drink a lot of Water all at once without it backing up. The reflux thing is a PITA but I am so happy I'm not regurgitating every mouthful I think I'm okay with the tradeoff. Best wishes on your surgery, I know you will do fine. PM me with questions if you think I might be able to help.

So you still have reflux and heartburn?

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2 hours ago, MamT said:

So you still have reflux and heartburn?

Yes, but the reflux doesn't have acid in it. My vagus nerve was cut and that has something to do with acid release in the stomach, so I don't have acid, but whatever is left in gastric juice after the acid is removed burns just like the acid did. I had my esophagus widened, too, because I had a stricture, and now the lower esophageal junction valve doesn't work any more, so it is easier for the reflux to come up. That was a risk I knew about going in to surgery. My surgeon swore I would not have acid reflux after surgery and technically he is correct, but I still have gastric juice reflux. I am still trying to figure out what causes my heartburn. Sometimes it's food related and I think the Iron I take also might cause it.

But I want to be clear, on a scale of 1-10, where I was and where I am now. Before surgery, I would have said my quality of life with GERD was about a 2. My reflux was not controlled at 3X the regular dose of omeprazole and I regurgitated everything I swallowed multiple times. I woke up numerous times a night with acid. Now I'd say I'm about a 7-8. There are many days when I don't have reflux or heartburn and I don't regurgitate anything anymore. I wake up one or two nights a week.

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21 hours ago, Foxbins said:

Yes, but the reflux doesn't have acid in it. My vagus nerve was cut and that has something to do with acid release in the stomach, so I don't have acid, but whatever is left in gastric juice after the acid is removed burns just like the acid did. I had my esophagus widened, too, because I had a stricture, and now the lower esophageal junction valve doesn't work any more, so it is easier for the reflux to come up. That was a risk I knew about going in to surgery. My surgeon swore I would not have acid reflux after surgery and technically he is correct, but I still have gastric juice reflux. I am still trying to figure out what causes my heartburn. Sometimes it's food related and I think the Iron I take also might cause it.

But I want to be clear, on a scale of 1-10, where I was and where I am now. Before surgery, I would have said my quality of life with GERD was about a 2. My reflux was not controlled at 3X the regular dose of omeprazole and I regurgitated everything I swallowed multiple times. I woke up numerous times a night with acid. Now I'd say I'm about a 7-8. There are many days when I don't have reflux or heartburn and I don't regurgitate anything anymore. I wake up one or two nights a week.

Thanks for explaining. My situation is extremely similar to yours and I’m just so nervous that the surgery won’t help.

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