Links: Doctor's Post-Op Guidelines after Laparoscopic Nissen #Fundoplication

This is a list for those who have questions, and also to show the VAST differences in how different surgeons instruct their patients. My own doctor was fairly conservative in his instructions, which was consistent with my own reading of patient accounts. It seemed that the people that had the most issues many times ate too much - or the wrong things - too soon, or resumed activity - or strenuous activity - too soon. Anyway, you will see below that recommendations do vary widely, and since we are all different, the doctor who actually did the surgery, along with our own gradual experimentation will be our best guide :).

Since there are so many, I'm just listing 10 to provide the basic ideas. But if you search the web, you will find LOTS more.


from Winchester Surgeons, Winchester, TN

from Aaron S. Bransky, MD, Plano, TX

from Casco Bay Surgery
, Portland, Maine

from Surgical Specialist of Plano, Plano, TX

from The Crawford Clinic, Anniston, AL

from Surgical Associates, PC (multiple locations)

from Newton-Wellesley Surgeons, Inc., Newton, MA

from Oregon Surgical Specialists, Medford, OR

from Tampa Bay Surgical Group, Bradenton, FL

From Cedar Surgical, Tacoma, WA

7-Month Post-Op Update #fundoplication

First, I have been more careful with lifting/pushing since my June 15th entry, and have no more problems with that type of pain.

Second, my eating is going fine, still mainly pork that gets stuck, although I did have on incident of bread sticking. I still haven't tried my beloved raw cauliflower and broccoli, sooner or later I might but I got the sternest warnings about those from my surgeon, so I don't really want to try - yet.

Third, I've made these awful noises every so often since the surgery. I think they're awful anyway, my husband says it's not so bad...but on the Nissen Fundoplication group on Facebook there was a discussion of these sounds by some of the members; they described it like a seal barking (yeah, that's it!) and the conclusion is that it is caused by some sort of spasm in the esophagus. No word from them on iAdf it ever goes away, but I guess I will find that out on my own, given enough time.

Fourth, I am afraid to hope, but I think I MIGHT be burping! I don't know if that's good or bad, but I think I've burped a couple of times, not just the shallow burps from air in my esophagus before it ever reaches my wrap, but real burps. When it happens I'm not paying that much attention so that I can properly identify where it came from, but maybe...

Fifth, I bent over after eating one day, and felt this awful yet familiar feeling in my throat...it took a few seconds to recognize it as ACID! I was horrified, certain that my wrap was failing, and got myself pretty worked up. However, it hasn't happened since. Put together with what I just wrote, it would make sense that IF air is coming back up at times, it could bring a little bit of acid (which I know my stomach is still full of!) with it. But it doesn't seem to be a sign of wrap failure, since it only happened that once, a couple of weeks ago. I even tested my wrap by eating something and then laying down flat on my bed to fall asleep. Nothing. I'm good.

And happy :).

Quick Update - Pain from ???

All things great, except for occasional belly pain. It has felt like acid so I've continued taking Ranitidine (one of the meds I used pre-op) on the assumption that I still have lots of acid down there, it's just no longer coming up. However the last couple of days I've had some sharp pains around the area of my wrap that started soon after twisting my body as I tossed a large bucket of water up over a railing. I've really slowed down a lot since then, as doing too much adds more pain, just in case a stitch started to tear through or something. No reflux or even heartburn, but just the pain.

Last night the pain kept me awake much of the night. It felt like acid but I'd taken the Ranitidine at bedtime, but it also felt sharp in that same spot. Logically I'm thinking, "OK, so maybe there's a little tear from the other day, and when I lay down a little acid leaks into it and causes so much pain?" Not sure...I don't think I'm going to call the doc just yet, but rather I will go back to small meals, softer food, and not a whole lot of water-bucket-tossing, and see if things calm down. If they don't - or get worse - or I start refluxing again - I'll be calling the doc for sure! Loving this post-NF life and not willing to go back! :)

What Caused THAT?!?!?

Yesterday we had a potluck after church. Not sure what I ate, but whatever it was, I had the same pain - BAD pain - that I had when I had eaten 3 salads plus a big slab of raw onion a few months ago. AWFUL pain! I know I didn't eat that many raw veggies...there were probably some in the potato salad but not that much really - it was mostly potatoes! And actually I was fine throughout the meal, it was only when I ate the dessert (yes, I go off-plan for these monthly potlucks at church, I love tasting everyone else's culinary offerings!): a sliver of cherry-something-or-other, and a sliver of pumpkin pie with a dollop - ok, a generous dollop - ok a MOUND - of whipped cream. I've eaten whipped cream without issue, even though it is so full of air.

So really, I don't know. Simethicone didn't help, nothing did. We had to leave apruptly. I went to my room and found the most comfortable position that I could on the bed with my bean bag at the head, and sweated it out, finally falling asleep from exhaustion once it started to subside, the pain had taken so much out of me.

Wish I knew what caused it, so I could avoid it in the future!

Tomorrow, It Will Be 6 Months!

All is well. Still, the only thing I seem to choke on (unless I take a large swallow of something) is cooked pork. Do fine with beef and eat a lot of it. Do fine with bread (I make my own low carb loaves) and rice and other things that seem to cause choking in other folks with a wrap. Why pork? I still wonder about that...

Still haven't introduced raw broccoli or cauliflower even though I do fine with cole slaw, or the occasional carrot, salads of all kinds of greens, and raw onion (in moderation - too much will give me a SERIOUS bellyache!).

One change in the last month: I have started burping a little. I have always burped "shallow" burps, such as when I swallow an air bubble, it comes back up before it ever reaches my wrap. But just in the last week or so I have burped several times. They were small, and not the glorious belches of old - lol! - but nonetheless they brought relief from minor discomfort.

Which brings me to something else: I hope this isn't an indication that my wrap is losing integrity. I don't have heartburn or any reflux whatsoever, and I'm SO careful of my wrap...I probably worry too much :).

Still losing weight. Then again, still eating low carb and have increased my fats which has always caused weight loss for me. I'm about 50# down from my pre-surgery weight according to my own scale which never is the same as doctor's scales but should be close. Lost a pound last week, another 3# this week...and I hate what it is doing to my body but I told my surgeon I would lose weight so I'm sticking to it, being a woman of my word...

I'm drinking coffee again too! Did I mention that last month in my update? I know I've written that I LOVED coffee before the surgery, and it tasted awful to me for months afterward. Well it tastes great again :). This makes me happy. However, I have not gone back to my 6-7 big mugs of the stuff every day, and plan to have my cup in the morning and one after supper and that's it - decaf of course. And I still drink my decaf tea. And bottled water, and sugar-free drink mixes. I am drinking a lot more than I did before the surgery, I think - back then it was coffee or nothing. Now I am constantly drinking something or other. But only DECAF! And, of course, nothing carbonated.

And one last thing, which I have mentioned before but it is still the case that I have to take my 150 mg Ranitadine twice a day, or I get HORRIBLE belly pain. My stomach is undoubtedly still churning out way too much acid - just because it isn't shooting out like a volcano through my mouth and nose anymore doesn't mean it isn't there, I'm certain. If I miss a single dose, PAIN and lots of it! So I will continue with that as well. The only other cause of pain is heavy lifting, such as moving furniture. I thought that was just because I was post-op but just read on the Facebook NF group that this is common, sometimes even years after the surgery. That makes sense I suppose, if something causes pulling around the sutures or something.

All is well, most days I don't even think about my wrap anymore as everything comes second-nature to me now (chewing well, swallowing small amounts, not using the straw I'm given at restaurants or ordering pop, keeping a warm-almost-hot beverage nearby when eating cooked pork, etc.). Life is normal - a new normal, but normal nonetheless, and not so much changed from before as I had previously feared :).

That Darned Pork! (5-month post-op update)

Nothing really gets stuck that I eat anymore...except PORK! What is it about pork that it sticks?? I can eat any other kinds of meat, even beef brisket, but even the most tender pork roast gets stuck unless I give extra attention to chewing (very well) and swallowing (only the tiniest of amounts at a time)! I don't understand it. No problem with breads or rice, which other people have mentioned being problematic, although admittedly I eat very little of either since I'm a low carb eater. But pork...I just don't get it!

As far as belly pain or bloating, none of that unless I go crazy on raw greens and veggies. Which I occasionally do. But not often. If I take a simethecone first it helps.

Flatulence...nobody told me about that! I guess since I don't burp anymore, all that air has to go somewhere!

Acid...yeah, I'm guessing that my stomach is still churning it out. PPIs are so expensive, I can't afford to stay on them forever, but I take 150mg ranitidine morning and night and that seems to keep the acid levels down. Of course the acid isn't coming up anymore - the whole point of the surgery - but I can still feel it in my stomach, causing discomfort and burning, if I don't take something to keep it under control. Which the ranitidine does, and only costs about USD$4/month.

Altogether, it's all good :). Have adjusted to Life After a Wrap, and it isn't much different than life before a wrap. Except it's a lot better. A lot less painful. A lot more normal. A lot less hassle. Except for that darned pork...

4 Months Today!

That's when I had my life-changing surgery! The first of every month is a milestone for me, and a reminder of what my life used to be like...

Everything is going really well, so I just have a couple of things I just want to mention on this monthiversary :).

First, I'm still losing weight, although whether it is still from the surgery or whether it is from the low-carb/high-fat diet that I follow is hard to say. Due to my constant digestive issues pre-op I didn't adhere as closely to this healthy eating plan as I had the first few years I'd been on it (it will be 7 years tomorrow), and there were many times I was too ill to cook and I just ate whatever someone else made for me. But I do know that I had lost much of my passion for creating and serving wonderful "cheap'n'easy" low carb meals, when I was in so much pain it was hard to be passionate about anything. I was just trying to get through every day the best that I could. But my passion is back, I'm shopping and cooking myself once again, and that could be a reason for my continuing loss. I do know that the clothes I was wearing pre-surgery are now baggy on me, although I haven't stopped at the doctor's office for a weigh-in in a couple of months. But my health is more important to me than my weight, and I'm enjoying that a lot!

Second, I posted something on the nissen fundoplication group on Facebook a few days ago in response to someone else's post, and I felt I should copy/paste it here as well. Probably THE most important thing I had to do after my surgery was to relearn, and listen to, my body's signals. They were different than before, and in so doing I have had to relearn how to eat. Here is what I wrote (with minor changes to protect the other person's privacy):
"...from the first sip I took after my surgery I have been paying very close attention to my body's signals. The first few weeks were hard because the signals felt different than they did for the first 53 years of my life, but I'm getting used to it now. The 2nd thing I had to retrain myself to do was to stop eating at the first sign of fullness. After a lifetime of continuing to eat even after I was no longer hungry (just because I enjoyed it so much) it has been hard to do. I don't want to stretch or in any way threaten the integrity of my wrap, and risk having issues later that other people have had; that's the big picture, and it is always on my mind when I am tempted to eat more even after my belly tells me it has had enough. It is a matter of listening and obeying the signals I get...probably the thing that has been working best for me is to not do anything else (watch TV, engage in conversation, etc) but to think about my eating: chewing very well, swallowing only small bits at a time, concentrating on how it feels going down and how my stomach is accepting it and if it is done eating or not (even if I still want more!)..."

So all is well after 4 months! No digestive issues of any kind, not even a hint of heartburn, and life is good :).