My name is Mike, and I had the Nissan Fundoplication surgery done on April 21, 1999. My history and background follows. My age at date of surgery was 44. My physical condition was excellent, albeit slightly overweight (by about 15 pounds). I am an avid weight lifter and also do regular cardio workouts (3 x a week) for the past 8-9 years. Genetics seems to insist that pretty much everyone in my family is overweight to some degree, regardless of the level of exercise or diet.

Approximately 11 years ago I was having some severe stomach problems, heartburn, reflux, etc. I thought I had an ulcer. I was in a very high stress position as a CPA with a large international CPA firm. At the time my medical coverage was with an HMO (Kaiser-Permanente). They conducted an upper GI (not lower). Diagnosis was a hiatel hernia. They prescribed Tagamet - which I continued to take off and on for the next 10 years. There were periods of time when I had no symptoms or problems - so I didn't take Tagamet. Not sure wwhhy I had periods of no problems. Could have been related to stress levels. I left the public accounting field shortly after this diagnosis (the diagnosis had nothing to do with my career/job change). For the past 10 years I have owned my own businesses - in the franchising field for 6 years, and a telecommunications consulting firm for the past 4 years. Naturally, there have been some very stressful times!

About 3 -4 years ago my "heartburn" attacks started getting much more severe. I call them "attacks" as they were literally like having a heart attack. Usually occurred at night, after I had been asleep for a couple hours. I would wake up gasping for breath, unable to breath or talk without gagging and coughing. Acid and bile in my throat. Cold sweats, extremely intense pain from stomach to throat. As if someone had taken a knife and gutted me. Nothing could provide immediate relief. I usually would try to take some tagamet, chew tums or drink a bottle of pepto-bismal, but regardless of what I did, the attack would remain for at least an two - three hours. I would have to remain standing or seated and try to breath and "survive" until it subsided. Basically, I was having extremely severe acid reflux.

Despite these attacks, I just lived with it. I didn't go to the doctor for these symptoms, other than to ask my new doctor for prescription renewals for Tagamet. I had left the HMO in 1991, and was now (and still am) with a PPO plan with Blue Cross. My new doctor simply accepted the diagnosis of the HMO and didn't investigate further (big mistake). If I had gone to a Gastroenterologist specialst years ago, we probably would have caught this problem before it progressed to the stage it is in now (Barrets Esophagus - discussed later).

While there was no consistency in when these attacks would occur, it was generally clear that eating a large, rich meal late at night, along with too much wine & spirits, and going to bed shortly afterward, was a recipe for disaster. What was baffling was this did not always cause a problem. In fact, sometimes I would have an attack even though I only had a light, bland dinner, and allowed adequate time for digestion before going to bed.

In October of 1998, things got much worse. I had several extremely bad attacks - the last one I seriously thought I was going to die. My wife was ready to call 911. This time I was scared. I could actually feel the damage to my esophagus and vocal chords. My throat was sore and my speaking was hoarse for a week. I knew something was terribly wrong - so I finally made an appointment with a gastroenterologist.

I went to the most highly regarded Gastroenterologist here in Sacramento. Dr. Arensen. We discussed my history, symptons, severity of attacks, etc. He very bluntly told me that I should have seen a specialist 8 years earlier. He didn't like what he was hearing, and he was very concerned that I may have a serious problem. He also wasn't pleased that my regular doc hadn't done more investigating. He immediately put me on Prevosid 1x a day. It didn't seem to do much help.

Dr. Arensen scheduled me for several tests, the most important one was an endoscopy - which he performed about 3 weeks later. This is not necessarily a difficult procedure. They put you "almost" under. In fact, I really don't remember it. He didn't like what he saw in my esophagus, and he also didn't like what he saw in my throat/vocal chords. He sent me to a Throat specialist to have my vocal chords checked out. Other tests included a barium enema (yuck-oo), and sigmoidoscopy (sp??), another unpleasant procedure.

The endoscopy revealed that I had Barrets Esophagus. This is a pre cancerous disease caused by severe acid reflux. The lining and cell structure of the esophagus has changed - which is not good. Basically, the stomach is the only organ in your body designed to contain the extremely caustic stomach acid. Apparently this acid is as caustic as battery acid, and can burn a hole in your skin if it were placed there. Your esophagus is not designed to have acid in it. As a result, over time it will try to protect itself by mutating its cells to withstand the acid. This is the first step towards cancer. He indicated that I was a prime candidate for the Nissan Fundoplication surgery. The general consensus is that with Barrets, you're chances of getting esophogul cancer are about 10 -15% higher than normal. This was all caused by a non-functioning sphincter valve, the valve that allows food to pass from your esophagus to your stomach, but is not supposed to allow the contents to come back up. Mine was not doing it's job.

The throat specialist also gave me a jolt. She determined that the acid had been refluxing all the way to my vocal chords and had caused damage there also. She indicated that this could eventually cause throat/vocal chord cancer. I don't need to tell you how freaked out I was becoming. Like I said earlier, I am in excellent physical shape, and generally eat a healthy diet and take pretty good care of myself. When I told her the Prevosid wasn't doing much, she changed me to Prilosec, 2x a day (breakfast & dinner). This helped control the acid, but I still had reflux. Nothing can stop the reflux if your sphincter valve is defective.

Naturally, I began my investigation into Barrets disease, fundoplication surgery, etc. The internet was an excellent resource and I was able to gather a tremendous wealth of knowledge on the clinical and technical elements of these things. What I couldn't get much of was actual patient feedback - like you are reading here. I found that reading actual patient stories, and corresponding with people who went through this, was the best source of information and reassurance.

After extensive research, and several "2nd opinions", I concluded that surgery was the most intelligent option for me, for the following reasons:
(1) There is no history of long-term use of these new drugs - prilosec or prevosid. These are relatively new drugs, and there is some uncertainty about side effects or problems from long term use. Without the surgery, I would have to take these drugs for the rest of my life. I didn't want to be a guinea pig for the drug companies. (2) If I stayed with the medications, I would forever have to be concerned about what I eat and drink, keep the head of my bed elevated, etc.. I enjoy life, fine foods and wine too much to give that up at the "young" age of 44. Surgery (if successful) would enable me to lead a normal life, and eat & drink what I want. (3) The fundoplication surgery has had very good success, and done laproscopically, it would not leave huge scars on my torso.

So, on to the next step - investigate surgeons. I was prepared to go anywhere in the country for the best, most experienced surgeon. I corresponded with surgeons on the East coast as well as out here (West coast - California). Turns out, the surgeon my Gastroenterologist recommended - Dr. Steven Patchings, is one of the best and most experienced in the country. He has performed this surgery over 450 times, has studied in Belgium with the doctor who originally developed the fundoplication procedure, and he has a higher success rate than the national average for this surgery. His rate is 96%. And, he is located here in Sacramento. I met with him and was very impressed. As a Christian, I believe I was purposely led this surgeon.

Dr. Patchings ordered several tests before he would do the surgery. These included esophagul motility & gall bladder tests. The worst for me was the esophogul motility. While you are wide awake (they cannot dope you up for this), they inject a nasty tasting gel substance into your nostrils - filling them entirely. This helps numb out and lubricate your nasal passage. They then insert a long tube, about 3/16" in diameter, into one of your nostrils and snake it all the way down to your stomach. It is REALLY an unpleasant and uncomfortable procedure. It goes on for about 45 minutes, and they continue to move it up and down as they take measurements. You are also asked to swallow gulps of water - which is a little painful as this hose is down your throat and in the way of being able to swallow. Very strange procedure.

End result of these tests - they determined the strength of my esophogus, which tells the surgeon how tight to make the fundoplication wrap. Also, they determined that my gall bladder wasn't in the greatest shape, so they will pull that out at the same time as the fundoplication. Apparently it's not unusual for people with this acid reflux problem to have a bad gall bladder. Dr. Patchings indicated that he would prefer to get everything fixed at once, as it is not a good idea to go thru the fundo surgery and 6 months later have pains from the gall bladder and have to come back into surgery for that. I agreed.

Surgery was on Wednesday, April 21, 1999, at Sutter General Hospital in Sacramento, CA. I checked in at 10:30 a.m. on Wednesday. Due to another surgery taking longer than expected, I didn't go into the operating room until about 3:00 p.m. Much too long to be hanging around in a hospital bed in one of those silly gowns. I'd recommend trying to get your surgery scheduled for the first one of the day.

My surgery took a lot longer than expected. 3 1/2 hours. They did 3 things - fixed my hiatel hernia, took out my gall bladder, and did the Nissan Fundoplication. They ran into difficulties due to the location of those extra 15 pounds I was carrying. That excess fat was right where they had to operate, so it took them a long time to work around everything. What my surgeon said was that he took his time, went very slowly to make sure he did as thorough a job as he possibly could (good decision!!). But, they still had to beat me up pretty good to get to the stomach and esophagus. I would feel the impact of this later.

Back in my room by about 8:00 p.m.. Don't remember much for the next few hours - I was pretty out of it. During the night, I started having some pain, and gladly accepted the pain shots (morphine thru the IV line). I can see how people get addicted to that stuff! Really takes care of the pain and makes you feel really happy!!

Also, at some point in the middle of the night, I got restless and had the nurse help me out of bed and I walked the hall a little (very little, but it felt good to get out of bed). By morning, I was much more alert, and getting out of bed and taking little walks on my own. I was also drinking water, and had a little jello and yogurt for breakfast. Very little. I wasn't that hungry. My surgeon had stopped by very early to see how I was doing. All things considered, I was doing very well.

By noon on Thursday, I was ready to get out of there. Still had a fair amount of pain. I had stopped the morphine injections, as I wanted to clear my head so I could determine if I could check myself out and go home. I was not impressed with the nursing care, and felt that I could do better at home. My wife was prepared to stay at home with me the rest of the week - so I decided it was time to go. I was ready to leave at noon, but it took until 4:00 for the hospital to do whatever they needed to do to check me out. Thus, within 24 hours of surgery, I was on my way home. I was given a prescription for pain medication (vicodan), which I ended up using it all.

Over the next few days I felt a fair amount of pain. But, each day seemed to get better. I gradually increased my walks. Food intake was limited to very soft stuff, like jello, pudding, liquid Ensure and Slim Fast, etc. I went to my office a week later for a half-day. By Friday (9 days after surgery) I was back full-time. 14 days after surgery I went to the gym for a light workout. Although I went very light on the weights, and only did 30 minutes (2- 15 minute sets) of walking on the treadmill, I probably pushed it too much. I was hurtin that night.

Had my first post-op meeting with the surgeon after 2 weeks. He was very pleased with my progress. I have 6 very small incisions on my belly. 5 are about 1/2" long or less, one is about 1". They will pretty much be unnoticeable once they all heal up and the hair on my torso grows back.

It is now exactly 3 weeks from surgery. I'm still not back to normal eating, but each day I progress further. I've lost about 12 pounds - which is great. I'm going to stay on this program regardless of my swallowing abilities until I lose another 5 - 8 pounds. My appetite is definitely less than before, and I get full very quickly. I hope to maintain this level indefinitely so I can keep the weight off. I am able to eat some solid things, I just have to make sure I take small bites, chew it up really well, and pay attention as I swallow. Before, I used to gobble down my food (which wasn't good). Now, I eat very slowly and consciously. Takes me 2 -3 times as long to eat something, which also helps me feel full sooner. No breads, muffins, or doughy things. They still get stuck and it can be pretty painful. Otherwise, my life is back to normal. I'm back at the office full-time, doing my normal things around the house, etc. Not back to the gym yet. After the last visit, I decided to wait until the 4th week. Give everything inside plenty of time to heal up.

I have a lot of gurgling and gas in my stomach and intestines. The gas is not uncommon from what I understand. Causes some farting - but it's controllable. Not sure about the gurgling. It's pretty constant - especially at night. I will be asking my surgeon when I go back for my next visit (4 weeks) if it hasn't let up. A lot of people are not able to belch after this surgery. I seem to be able to belch a little. But, I've also avoided foods or beverages that might cause belching (like soda's).

It will be a few weeks before I can really judge the success of the surgery. Keep in mind, if you have Barrets, this surgery will not fix it. At this time, there is no way to reverse the damaged Barrets cells. This surgery will only prevent further damage as well as allow you to lead a more normal life. I will be going back for an endoscopy annually for the rest of my life to be monitored to make sure the Barrets doesn't progress to cancer. There is a new photo-laser surgerical technigue that is in an experimental stage that may allow the surgeon to zap out the damaged Barrets cells. This would significantly improve the cancer odds. My surgeon, Dr. Patchings, is staying on top of this and feels it will be perfected in a couple years, and I would be a prime candidate for it at that time. I pray for this.

Some suggestions & recommendations to anyone going through this:
(1) If you are having any acid reflux or severe heartburn problems, see a good gastroenterologist right away!

(2) Get an endoscopy done, and make sure they take plenty of biopsies

(3) If surgery is recommended, find a surgeon who has plenty of experience doing fundoplications. It is important that the surgeon is extremely experienced and has expertise in this type of surgery. It is not a typical procedure, so there are not a lot of heavily experienced surgeons. You want the best!

(4) Research, investigate and learn as much as you can. It will make a difference in your comfort level and recovery. You need to be a well informed patient - especially in todays medical environment. There are a ton of web sites that will help. Just search key words such as esophagus, fundoplication, barrets, acid reflux, GERD, etc...

(5) Don't be afraid of having this surgery - but make sure you have gotten a 2nd opinion from a qualified gastro. And, I can't stress it enough, make sure you get a surgeon who is well qualified and has lots of experience with this surgery (has done at least 200 fundoplications).

(6) Communicate with others who have gone thru it.

Best of luck to you. Feel free to e-mail me with any questions.

Mike E.