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Would you allow surgery
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RetiredSeabee posted:
I am a very active tennis playing 73 year old with a moderate-sized hiatal hernia and relatively weak swollowing for related reasons. I have had the problem for 30+ years and with lots of antacids I have coped with it. Within the last five years the problem with reflux has increased and two years ago I had a difficulty swollowing. The Gastroenterologist dialated a stricture which relieved the problem. He also prescribed Nexium which relieved the acid problem but not the reflux. Last year I had a serious lung abscess which I attribute to the nighttime reflux spilling over into my respiratory tract. It took months of powerful antibiotics to heal. I have recently had the barium Xrays (during which the Radiologist could see the barium refluxing), Endopscopic exam, Esophagael Manometry and other tests. All of the Air Force Doctors recommend surgical repair and fundiplication. Surgery is scheduled for next month but I am now hesitant. As I said, I take Nexium which does a great job of reducing the acid. However, I still have reflux within minutes to an hour after I eat. My esophagus is constantly full but it is not very acidic. I have done all of the usual precautions--elevated bed, wedge pillow, moderate sized meals, etc. I frequently must intentionally regurgitate the contents of the esophagus prior to going to bed or at other times during the day when it becomes uncomfortably full...Sometimes I regurgitate multiple times in an evening if there is more reflux. I know that I am still digesting enough food to maintain my weight and I know that I can survive and live out my remaining years with the problem but I am tired of it. Would you do the surgery???
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Maxaira responded:
Given all of the circumstances that you describe, surgery certainly does sound like the way to go. May I just say this, however, I had this surgery thirty years ago and yes, for a number of years it was effective. But then about two years ago the reflux problem started and with a vengeance. I had the scope done, and the doctor admitted that the hernia was back and much larger than before. The reflux can be bad but if I keep the meals light; never eat after 7pm, use the wedge pillow AND prop up the bed there is a certain amount of control available. This does not eradicate the swallowing problem, but here again I have to be careful how fast I begin a mouthful as it too can be a nasty matter of regurgitation. There is no magic cure all. Certain life style changes may make a difference, but not all the time and certainly not permanently. In a few weeks I will be seventy [can't believe I said that!>, so it's just a matter of being wise in the way one carries on one's life. As to the surgery, well if I knew what it would bring in the days ahead, I probably would not have had it. Sometimes we are awfully slow to learn. Trust this helps.
 
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farmgirl76 responded:
Dear Retired Seabee - I don't want to be an alarmist; however, my sister at the age of 79, had a hiatal hernia that strangulated and burst. She had had difficulty swallowing for at least 30 years, and had several of the procedures you mentioned. Anyway, the doctors were slow in diagnosing the strangulation and then the bursting, and she became about 98% septic. Through some extreme and heroic measures taken by the doctors at the Sacred Heart Hospital in Pensacola (she was medivaced there from her little town in Florida), she managed to survive and thrive. When she arrived at the hospital in Pensacola, she had no pulse to speak of, but the excellent surgeon on call (Dr. Gill) performed what turned out to be miraculous surgery. The staff at the hospital was superb. She had 5 specialists attending her all of the time. She was in ICU for 13 weeks. To say what occurred was nothing short of a miracle would be an understatement. So, having said all of that and put the fear of God in you, my advice, after having sat with her in ICU for 13 weeks, is to go ahead with the surgery while things are still manageable. I don't know that you would want to have her experience. Although if you could get Dr. Gill at Sacred Heart Hospital in Pensacola to do it for you, that would be a good thing. Good luck to you in making your decision. Pray about it alot, and God will lead you to where you are to go. Sorry if I upset you -- didn't mean to do that; only wanted you to know of someone's experience when it was not left alone. She, unlike you, never had anyone recommend surgery. I don't know if she would have considered it or not -- but feel she probably would have.
 
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calgal37 replied to farmgirl76's response:
Farmgirl, are you sure you're speaking of a hiatal hernia and not another form or hernia, such as an abdominal hernia? The problems with a hiatal hernia encompass the stomach slipping upward into/above the diaphragm, or the possibility of developing a paraesophageal hernia - one in which the movement of the stomach is into the thoracic cavity.


I'm not sure a hiatal hernia can become 'strangled.'
 
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RetiredSeabee replied to calgal37's response:
She is right.... Like many of you, I have been reading most of the related literature and posts on the web. There are two types of hiatal hernias....sliding and fixed.....the fixed type is the most dangerous because the blood supply can be cut off and the part of the stomach above the diaphram can "die". (maybe "explode") I don't know which type I have but it seems to always be there above the diaphram.

I had a second Manometry this past Wednesday but this time they had all the hospital gastro clinic staff there. There were four Gastroenterologist, several interns and three techs. They did the second test because they didn't like the first one. They think they got false readings because when the catheter reached the curve of the hernia, it turned and doubled back on itself. That distorted the depth that the sensors measured. I won't get the analysis until sometime next week.
 
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Rlilyns responded:
I would advise the surgery. I am 64 and I had it a year ago at USC, My quality of life is 100% better. I was to the point that I couldnt eat or sleep. I got to a point that I vomited after I ate my food every time. Stomach bleeding and had a low blood count for 2 years & losing weight. It was the best decision for me. It takes awhile to heal and get your strength. I did have to have one dilation about 6 months later but this helped & I am great! It is a scarey decision but I had the best doctor at USC and felt confident. I had a very large hiatal hernia & half of my stomach was in it! Prayers for you!
 
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RetiredSeabee replied to Rlilyns's response:
I appreciate everybody's input and hope to receive more. However, as described in my original post, I don't really have the debilitating acid reflux that most of the discussions on the internet report. Most of my problem is the frequent refluxing of partially digested food into my esophagus. I don't have the breathing difficulties, hoarseness, coughing, etc. that most people have and Nexium controls the acid. I suspect that much of the food that refluxes is being retained in the upper part of the stomach that is above the diaphragm and only gets into the lower part by gravity flow......that may be "whacky" but that could account for the lack of acid. That is why I am having misgivings.


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