fundoplication [Heart Medication]

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From: ksmith005 on 10 Nov 2006 00:37

Hello-

I have been suffering from gerd for over a year. None of the PPI's or
even the Stretta procedure have been of any any benefit. My GI doctor
has given me a referral to a surgeon for a fundoplication. At my
appointment today he was very short and curt, as I have found many
specialists to be, so he left me with a pamphlet and lots of questions.
Has anyone gone through this before? If so, would you be able to
answer these questions?

1) What is the long-term effectiveness of this procedure? I am 24 --
will this be a 30-40 year solution?
2) What are the side effects?
3) What qualities do I look for in a surgeon? I don't necessarily
want to blindly go with the one my doctor recommended.
4) Can the stretta procedure be repeated?
5) Besides a fundoplication, what other options do I have?
6) Is there any treatment for alkaline reflux --
medications/foods/herbs/anything that supress alkaline stomach contents
in the same way as PPI's do acid?

Kind of afraid to have the surgery since I had such a miserable
experience with the Stretta procedure, which supposedly has less side
effects than the fundoplication. But I cannot live like this much
longer so don't really know where to turn...

---Kevin

From: Howard McCollister on 10 Nov 2006 07:27

From: Blocks to Books on 10 Nov 2006 11:04

<ksmith005(a)gmail.com> wrote in message
news:1163137026.181053.180400(a)i42g2000cwa.googlegroups.com...
> Hello-
>
> I have been suffering from gerd for over a year. None of the PPI's or
> even the Stretta procedure have been of any any benefit. My GI doctor
> has given me a referral to a surgeon for a fundoplication. At my
> appointment today he was very short and curt, as I have found many
> specialists to be, so he left me with a pamphlet and lots of questions.
> Has anyone gone through this before? If so, would you be able to
> answer these questions?
>
> 1) What is the long-term effectiveness of this procedure? I am 24 --
> will this be a 30-40 year solution?
> 2) What are the side effects?
> 3) What qualities do I look for in a surgeon? I don't necessarily
> want to blindly go with the one my doctor recommended.
> 4) Can the stretta procedure be repeated?
> 5) Besides a fundoplication, what other options do I have?
> 6) Is there any treatment for alkaline reflux --
> medications/foods/herbs/anything that supress alkaline stomach contents
> in the same way as PPI's do acid?
>
> Kind of afraid to have the surgery since I had such a miserable
> experience with the Stretta procedure, which supposedly has less side
> effects than the fundoplication. But I cannot live like this much
> longer so don't really know where to turn...
>
> ---Kevin

The only thing I recently learned to do to help change the PH of my reflux
to a more acid ph is to eat small amounts of foods with acid in them at
mealtimes, such as oranges, tomatoes, vinegar, pickled beets, etc. I
recently had a bravo study done and I could see the actual ph results coming
up my esophagus for two days so I could see the results of eating different
kinds of foods on the PH values of the reflux. I learned it's like making a
mixture in chemistry class - acids and bases can actually neutralize each
other in the correct proportions. My reflux has recently in the past few
months apparently become fairly neutral rather than heavily acid or
alkaline - if the PH study is accurate. It's only when I take an acid
suppressor of some kind that it becomes more alkaline. If I eat foods with
acid in them then it becomes more acid. I've eaten a very strict
anti-reflux diet for many years and I think it has helped for my reflux to
become more neutral and now I think perhaps the acid and alkaline components
of the reflux are neutralizing each other out apparently. Instead of having
the constant sore throats, sores in the throat and tickle in the throat and
dry cough I used to have I now have a lot of mucous and needing to try to
cough the mucous up. An ENT just checked my larynx yesterday with a small
scope and said the back of my larynx is very calloused from reflux
irritation over the years. He wants me to try taking pepsid type of drugs
every night for 3 weeks and have him check it again. I don't know if I can
tolerate that but I'm going to try to see if it makes any difference. It
might make me go back to the symptoms I had before my reflux become more
neutral. I might lose some of the mucous and gain heartburn, sores in my
throat and dry coughing. I already feel a slight bit of heartburn today
after taking it last night.

If you go on the NDO Plicator website, they have a section where you can
find physicians that do the plicator procedure. There were two in my large
city. I contacted the NDO company with a question about the procedure for
someone like myself who does a lot of heavy lifting all the time. They said
they wouldn't recommend me as a candidate for Plicator at this time unless I
stopped doing the lifting. It does seem like a good procedure for someone
who would want to avoid or postpone doing a fundoplication.

I don't know if the procedure has been done long enough to have good long
term studies. Sometimes the studies come out good for a few years and then
they find problems later on. If you want to check it out, I think their
website is www.ndomedical.com.

Did your Stretta procedure make you worse, or just no better? I was
considering it but now I'm not so sure. If it could help cut down on the
amount of the reflux that comes out of my stomach I would want to do it. If
it just ablated the nerves in my esophageal sphincter muscle, then I
wouldn't want to risk it at this time. -Blocks

From: Blocks to Books on 10 Nov 2006 13:07

"Blocks to Books" <news(a)blockstobooks.com> wrote in message
news:uq15h.39117$3y3.496(a)newsfe07.phx...
>
> <ksmith005(a)gmail.com> wrote in message
> news:1163137026.181053.180400(a)i42g2000cwa.googlegroups.com...
>> Hello-
>>
>> I have been suffering from gerd for over a year. None of the PPI's or
>> even the Stretta procedure have been of any any benefit. My GI doctor
>> has given me a referral to a surgeon for a fundoplication. At my
>> appointment today he was very short and curt, as I have found many
>> specialists to be, so he left me with a pamphlet and lots of questions.
>> Has anyone gone through this before? If so, would you be able to
>> answer these questions?
>>
>> 1) What is the long-term effectiveness of this procedure? I am 24 --
>> will this be a 30-40 year solution?
>> 2) What are the side effects?
>> 3) What qualities do I look for in a surgeon? I don't necessarily
>> want to blindly go with the one my doctor recommended.
>> 4) Can the stretta procedure be repeated?
>> 5) Besides a fundoplication, what other options do I have?
>> 6) Is there any treatment for alkaline reflux --
>> medications/foods/herbs/anything that supress alkaline stomach contents
>> in the same way as PPI's do acid?
>>
>> Kind of afraid to have the surgery since I had such a miserable
>> experience with the Stretta procedure, which supposedly has less side
>> effects than the fundoplication. But I cannot live like this much
>> longer so don't really know where to turn...
>>
>> ---Kevin
>
> The only thing I recently learned to do to help change the PH of my reflux
> to a more acid ph is to eat small amounts of foods with acid in them at
> mealtimes, such as oranges, tomatoes, vinegar, pickled beets, etc. I
> recently had a bravo study done and I could see the actual ph results
> coming up my esophagus for two days so I could see the results of eating
> different kinds of foods on the PH values of the reflux. I learned it's
> like making a mixture in chemistry class - acids and bases can actually
> neutralize each other in the correct proportions. My reflux has recently
> in the past few months apparently become fairly neutral rather than
> heavily acid or alkaline - if the PH study is accurate. It's only when I
> take an acid suppressor of some kind that it becomes more alkaline. If I
> eat foods with acid in them then it becomes more acid. I've eaten a very
> strict anti-reflux diet for many years and I think it has helped for my
> reflux to become more neutral and now I think perhaps the acid and
> alkaline components of the reflux are neutralizing each other out
> apparently. Instead of having the constant sore throats, sores in the
> throat and tickle in the throat and dry cough I used to have I now have a
> lot of mucous and needing to try to cough the mucous up. An ENT just
> checked my larynx yesterday with a small scope and said the back of my
> larynx is very calloused from reflux irritation over the years. He wants
> me to try taking pepsid type of drugs every night for 3 weeks and have him
> check it again. I don't know if I can tolerate that but I'm going to try
> to see if it makes any difference. It might make me go back to the
> symptoms I had before my reflux become more neutral. I might lose some of
> the mucous and gain heartburn, sores in my throat and dry coughing. I
> already feel a slight bit of heartburn today after taking it last night.
>
> If you go on the NDO Plicator website, they have a section where you can
> find physicians that do the plicator procedure. There were two in my
> large city. I contacted the NDO company with a question about the
> procedure for someone like myself who does a lot of heavy lifting all the
> time. They said they wouldn't recommend me as a candidate for Plicator at
> this time unless I stopped doing the lifting. It does seem like a good
> procedure for someone who would want to avoid or postpone doing a
> fundoplication.
>
> I don't know if the procedure has been done long enough to have good long
> term studies. Sometimes the studies come out good for a few years and then
> they find problems later on. If you want to check it out, I think their
> website is www.ndomedical.com.
>
> Did your Stretta procedure make you worse, or just no better? I was
> considering it but now I'm not so sure. If it could help cut down on the
> amount of the reflux that comes out of my stomach I would want to do it.
> If it just ablated the nerves in my esophageal sphincter muscle, then I
> wouldn't want to risk it at this time. -Blocks

Sorry - the correct address for Plicator is www.ndosurgical.com. -Blocks

From: ksmith005 on 12 Nov 2006 00:17

Thanks Howard. How many fundoplications do you think would qualify a
surgeon as experienced? What other questions besides this would best
help me gague his experience?

Blocks -- Thanks for the advice. My bravo didn't have a real-time
display so I wasn't able to experiment. The Stretta definitely changed
the nature of my symptoms, but it didn't really do anything to help.
Before the procedure, my chief complaint was a constant sore throat,
which was very painful. After the procedure I now swallow lots of air
whenever I eat or drink anything. Plus, even the slightest pressure on
my stomach will now force food or air into my esophagus. Walking,
slightly stooping, or even straining to have a normal bowel movement
will do the trick. My throat isn't as sore, but I now have this cough,
and it always feels like food is stuck right under my UES. It's been
4 1/2 months since my procedure, and the only real conclusion I can
draw is that life is pretty miserable..

Howard McCollister wrote:
> <ksmith005(a)gmail.com> wrote in message
> news:1163137026.181053.180400(a)i42g2000cwa.googlegroups.com...
> > Hello-
> >
> > I have been suffering from gerd for over a year. None of the PPI's or
> > even the Stretta procedure have been of any any benefit. My GI doctor
> > has given me a referral to a surgeon for a fundoplication. At my
> > appointment today he was very short and curt, as I have found many
> > specialists to be, so he left me with a pamphlet and lots of questions.
> > Has anyone gone through this before? If so, would you be able to
> > answer these questions?
> >
> > 1) What is the long-term effectiveness of this procedure? I am 24 --
> > will this be a 30-40 year solution?
> > 2) What are the side effects?
> > 3) What qualities do I look for in a surgeon? I don't necessarily
> > want to blindly go with the one my doctor recommended.
> > 4) Can the stretta procedure be repeated?
> > 5) Besides a fundoplication, what other options do I have?
> > 6) Is there any treatment for alkaline reflux --
> > medications/foods/herbs/anything that supress alkaline stomach contents
> > in the same way as PPI's do acid?
> >
> > Kind of afraid to have the surgery since I had such a miserable
> > experience with the Stretta procedure, which supposedly has less side
> > effects than the fundoplication. But I cannot live like this much
> > longer so don't really know where to turn...
> >
>
> Fundoplication is very skill-dependant. Its long term success and degree of
> postop side effects are in large part determined by the abilities and
> experience of the surgeon doing it.
>
> Long term effectiveness is about 85%, although this is likely to be better
> in the hands of a surgeon who has done many. One cause of failure is
> slippage of the wrap, and this depends largely on the surgeon's
> understanding of what constitutes esophageal shortening and his ability to
> address that problem. The other cause of failure is loosening of the wrap,
> and this is inevitable to some extent. It can be ameliorated by creating a
> fundoplication of the proper length and proper location on the stomach.
>
> Side effects are primarily bloating due to decreased ability to belch, and
> inability to vomit afterwards. There is often some noticable difficulty
> swallowing at first, but this will decrease usually, over several weeks post
> op.
>
> You need to find a surgeon that you are comfortable with, and that has a lot
> of experience in laparoscopic surgery and esophageal problems. If you're not
> getting your questions answered to your satisfaction, you need to look for
> another surgeon.
>
> The Stretta procedure can be repeated.
>
> Besides fundoplication and Stretta, the only other viable option is the new
> NDO plicator. This is very new, but looks promising. It's not commonly
> available yet.
>
> No other good treatment for reflux, especially alkaline reflux.
>
> HMc

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