Difficult decision

I need advice. I have gone thru the entire four-month process and am just days away from my sleeve surgery (just waiting for approval from the insurance company). However, I'm so worried by something that I am having trouble sleeping, unable to reach a decision.

I have two choices for my surgery: RNY or VSG. I also have two medical problems; one is an issue with the RNY & the other is an issue with the VSG.

I chose the VSG over the RNY for several reasons, the main two being I don't like the idea of having my intestines rearranged when the VSG works just as well & has less risks, and the other being because I have a back condition that causes me to take NSAIDs daily. I have a bulging disc & arthritis in my lower back, and also heel spurs. I take Naprelan 750mg every day and without it, walking and standing is very painful. This alone is enough reason to want the VSG over the RNY.

However, I also have severe acid reflux. I do not have heartburn symptoms. Instead, when I have a reflux attack, I can't stop clearing my throat; it will last about an hour and is very unpleasant. When I take Nexium daily, that goes away - not a problem. However, whenever I get a cold or have allergies, I get a cough that lasts 3-4 months; 4 doctors have now told me that the chronic cough is due to acid reflux (the acid irritates my trachea or something). I had an endoscopy and they diagnosed a hiatial hernia. Then I had an Upper GI and they found no hernia, just severe reflux, esophageal spasms & rapid gastric emptying. So I don't know if I have a hiatial hernia or not; the tests showed different results and I don't know which is right.

Here is my problem. My surgeon recommends the RNY for me, because of the reflux, which he says will probably get worse after a VSG. I pretty much decided against the RNY long ago because I don't want to give up my NSAIDs. The doctor says I can still take NSIADs after a bypass, just in smaller doses and infrequently, but that goes against everything I've read and I'm not comfortable with it. Besides, I need them daily and small doses don't help me. I know losing weight will help my back, but I don't know how much it will help, and I'm not willing to take the gamble and live in constant pain because I can't take my antiinflammatory meds. (Not to mention that my back is getting steadily worse.)

Which leaves me with the VSG, which is what I really want anyway. But I am very worried about the reflux. At this point, I don't know if I have a hiatial hernia. If I do, then the doc will repair it and it should be okay. But if I don't, am I condemning myself to a lifetime of chronic coughing (not to mention possible ulcers & esophagael cancer) due to uncontrolled reflux?

Has anyone else gotten conflicting information (endoscopy vs upper GI) about whether or not they had a hiatial hernia? If so, which test was right?

And if I don't have the hernia and go ahead with the sleeve surgery, what will happen with my reflux? Will it be permanent, or likely to go away when I lose weight? I don't mind taking meds the rest of my life, but I don't want this horrid cough forever. :-(

Sorry this is so long, but it's a life-changing decision I'm facing and wanted to be sure I told the whole story. Any help would be greatly appreciated!

I had a hiatal hernia repair at the same time as my vsg. I haven't had any reflux problems since surgery. I cough constantly also, when we go somewhere and I get separated from my family they tell me they can find me because they can here me coughing before they see me. Since surgery I have had bouts of coughing due to allergies. I also have severe arthritis in both my knees. I actually need two knee replacements so I take anti inflammatories also. I'm hoping vsg will prolong knee replacements for a while. I had vsg 8/18 and have had no problems at all, no pain and no nausea. Hope this helps. Good luck on your decision.

Penny

Thanks, How's your cough since the surgery? Any better? Worse?

I sure wish I new if I had the hiatial hernia or not. The endoscopy showed a small one, but the barium x-ray didn't show one. I would feel a lot better about having the VSG if I knew I had the hernia, because it's repairable during surgery. 

Cough hasn't gotten worse. Still have a cough, probably due to sinis drip. My hiatal hernia was large. The surgeon originally wanted to do the repair before the vsg then for what ever reason decided to do it at same time. Not sure how much of the cough was due to the hernia, guess to soon to tell, but I haven't had any reflux problems since the surgery and that's a good thing. It is scarry to wake up in the middle of the night choking on the acid coming up. I was hoping to ease your mind in case you have a hernia it hasn't made my recovery a problem. Wishing you the best.

Penny

 When you did the upper GI, did they make you move all kinds of directions, and bear down?  I had an upper GI when I was investigating the band, and no one said anything about a hiatal hernia.  But when I had it done this time, they rolled me this way and that, had me bear down, it was much different - and when I asked what they were seeing the Dr. told me a hiatal hernia.  

Which I did have and was repaired during my sleeve surgery.  I'm only a week out, not on any PPI's and not having any reflux.  I used to have it on and off for long stretches.  I did feel some one night and took some Tums and it hasn't come back.

All I can say is I had GERD before, totally controlled on 10mg Prilosec. I take the same dose now.. so no better no worse as far as I can tell.. I'll try to wean off sometime when I get closer to goal as I'm hoping it's weight related- no hernia here.

I have read some hernias are hard to spot as they only slide through occasionally or when swallowing.. but, I chose the VSG for many of the same reasons (NSAIDs), plus a few more. I would not want to even try the RNY. Worst case scenario, my drs said if I get intractable uncontrollable GERD, that I'd need a revision to a RNY.. 

I don't know if this helps but... I'm pre-op and I have reflux. I discussed this with my surgeon about it getting worse post-op. He said because of my age (24) I really don't want to be messing with all the hassle of RNY for the rest of my life and that VSG was the right procedure for me. I too am worried about having intestines moved around. I have heard too many stories about intestinal erosion later on in life to be comfortable with it.  He also said the reflux could be dealt with post-op via medication  should it get any worse. It's a small price to pay, IMO. Just know there are ways to deal with acid reflux and that it can be controlled. If Nexium is working for you now, I don't see why it wouldn't work for you post-op, too.

I hope this helps a little. Good luck making your decision. I know you will choose what's best for you in the long run. Go with your gut feeling on it.

 I am in your exact predicament! I was warned by both the PA and the NUT at my last app't.. that my Dr in all probability will refuse to do the VSG based on my Upper GI results. I do not want the RNY but I cannot keep doing what I'm doing. I have already paid my fees and have only a cardiac clearance before my final pre op app't. Please let me know what you decide. I only hope my Dr will give me a choice. (the PA said he will view the results..they were just reporting what he usually does with those that have severe reflux) I take aciphex daily and I thought it was handling all of my problems but the results show I also have inflammation. I wish I could be of help! Keep us posted!!! 

 this article is most interesting....


http://findarticles.com/p/articles/mi_hb4365/is_10_40/ai_n29 427826/

My dr said the only real way to diagnose a Hiatal hernia is to be in there and see it. Ive had 2 drs tell me I had one and 3 upper Gis that did not show it. When I had my VSG on Monday They repaired a severe Hiatal hernia. it has been instant relief from years of suffering with that thing some Drs wont fix it during a VSG, make sure yours will. I struggled with this decision for a while, but now Im sure I made the right choice, Do your research, make a educated decision, and decide whats best for you, Im happy with my sleeve Im 5 days out and feeling better everyday!!! GOOD LUCK to you