Reflux Update

Saw my surgeon today, had the upper gi in the office, looks great. My esophagus empties very fast, which my surgeon said was good, I watched the contrast go all the way through and into the duodenum, no problems. No reflux. As I was describing more of what was happening to my surgeon, he said that was bile and changing my PPI wouldn’t help that. Bile comes from the small intestine and he showed me on the screen where it was. Bile. Ew.

Anyway, he changed my daily Reglan from 5pm to just before bed to see if that doesn’t help. All the heartburn makes so much more sense now, though. Doing some reading up on it and I learned a few things. Bile is alkaline, stomach acid is, well, acid. The alkaline from the bile causes the stomach to secrete more acid. I noticed when I have the worst heartburn is the two days or so following the episodes with the bile reflux.  Also, the bile when it’s mixed with the stomach acid can actually go up the esophagus. Bile by itself probably wouldn’t be able to make it that far.

So learned something new today. Saw my pretty sleeve (even if I had to drink some nasty stuff to see it). My surgeon is very pleased with my weight loss so far. I told him I sometimes feel like a slow loser and he reminded me it’s not a race.

Reflux

Prior to my VSG, I suffered from pretty constant gastroesophageal reflux (and, consequently, had GERD). I took Prilosec and that seemed to control the reflux pretty well, though I still had frequent heartburn. At least I didn’t have too many problems with the reflux irritating my esophagus. As it turned out, I had a hiatal hernia my surgeon repaired during my sleeve surgery. Post surgery I had some minor issues with reflux and heartburn like many VSG patients seem to do. Upping my Prilosec to twice a day and occasionally supplementing with Zantac, plus raising the head of my bead slightly seemed to keep it under control. I don’t eat a minimum of 90 minutes before going to bed (but try to keep that closer to three hours). My surgeon also put me on Reglan once a day. I had occasional heartburn but not much reflux to report at all. Until recently.

At least four times during the past two weeks, I have woken up literally gasping for breath (like I would sometimes do when my sleep apnea was the worst). Only, instead of it being apnea, I would be literally choking on stomach bile. It would literally taste like I had just vomited and I would be coughing/spitting up bright, almost neon, yellow ‘stuff’. It would also leave me with a very raw throat (again as if I had vomited) and lingering pain in my breastbone from heartburn.

After my most recent bout with this, I called my surgeon’s office. I was hoping they would put me on a different PPI since maybe the Prilosec was not working for me any longer. I talked with my surgeon’s PA since he was in surgery and she wants me to come in Thursday, when the surgeon is in the office, for an upper GI.  Her thoughts were I should not be still having problems with reflux at this stage and maybe they should check for a stricture.  I don’t think I have any symptoms beyond the admittedly occasional reflux (unless 4 times in two weeks is counted as more than occasional) but, I don’t mind being checked.

More than anything, I’m looking for relief from the reflux. It’s a horrible way to wake up and I’ve been paranoid about sleeping now because of it. The excess acid has been bad, too, because it makes me feel like I’m hungry even when I’m not. Stomach acid mimics the symptoms of hunger and I’m so RARELY ever hungry these days. The problem with this acid issue is I am constantly starving now (which is so not normal and makes me wonder how much of my crushing hunger/starvation pre-surgery was due to out of control stomach acid) and feel like I’m constantly eating, which is putting me over my calorie count for the day, if not my carb count. Hopefully, they’ll have a solution for me on Thursday.

Heartburn

The past couple days have been really rough with heartburn. I’m a little over a month out (my surgery was August 18) and had not been having any issues with heartburn or reflux. Pre-surgery, I suffered from Gastroesophageal reflux disease (aka GERD) and my reflux was awful. I had a small hiatal hernia my surgeon repaired when he did my sleeve and it really seemed to help. I continued to take Prilosec OTC every morning and was doing fantastic. Two days ago, I was woken up in the middle of the night with the most horrible reflux and feeling like my esophagus was on fire.

Thank goodness for the ultra powerful strength cherry flavored Maalox. I don’t know if it actually coats the esophagus or not, but it feels like it does. It soothed the burning and helped clear out some of the extra acid. I’m taking my Prilosec twice a day now, once in the morning and once before bed. Yesterday was a little better. Last night was better still.

I hope this settles down soon. I’ve heard some post sleeve patients were able to get rid of the PPI (protein pump inhibitor, Prilosec is one) at some point post surgery.