My recovery from Acid
Reflux Surgery following Linx ring implant
Surgery performed by
Dr Daniel Smith, Mayo Clinic, Jacksonville, Fl.
by Joe Mehaffey
-- Rev 8 January 15, 2014
For
about 40 years, I have had problems with Acid Reflux. For me, this caused
problems mostly at night when I lay down. If I had eaten a normal meal
less than about 5 to 6 hours before I went to bed, during the night my mouth
would be bathed in acid and I would awake with a sore throat and
hoarseness. If the amount of reflux were large, it would get into my
sinuses and cause many sinus problems and infections. I think I have had
every antacid and drug treatment known to man for the condition, but a
"cure" was not forthcoming. The problems got more and more
frequent and troublesome in recent years, and so I went to a number of doctors
who recommended the Nissen fundoplication surgery in 2010. I am an
Engineer and when I looked at the Nissen surgery and discovered it gave about a
70+ percent satisfaction rate and was not reversible, I decided to look at
alternative surgeries. A number were available but all seemed to have
problems. Then I read about the new experimental Linx Magnetic Ring
surgery. The Linx device had a reported 90+ percent patient satisfaction
rate and in the three years since 2007 when human implant experiments
started, no serious problems had occurred. It looked to me like the Linx
Ring device got "right to the seat of the problem" and provided the
extra pressure needed to keep the lower esophageal sphincter closed when a
person was relaxed and lying down. In addition, if problems with the
surgery or the device occurred, the Linx device could be removed without
problems. The only major negative I found was that ordinary MRI scans
cannot be used on a patient with a Linx implant. My consultants
concluded that this was not a huge price to pay since other scan techniques
could suffice in most cases and the Linx device could be removed should an MRI
be essential. Also, experiments are being run using lower flux MRI scans
on people with the Linx. So.. I then made my decision to get the
Linx surgery.
The
story is involved, but, in the end, I waited until one year after the FDA
approved the device and the surgeons got a good deal of experience before I
seriously set out to get the job done. I wanted a surgeon VERY
experienced in installing these devices and such were hard to find in
2013. I went to see one well known surgeon in California who had a
good reputation for Linx Surgery. Unfortunately, my reflux
was mostly during sleep and his ironclad Demeester criteria requiring at
minimum 30 or 50 reflux events per day to even be considered to HAVE Acid
Reflux Disease and qualify for the surgery precluded my surgery at that Medical
Center. This in spite of my demonstrated symptoms and
recommendations from four other doctors!
I then learned that Dr. Daniel Smith of Mayo Clinic Jacksonville
Florida had done about 50 Linx Surgeries and so I consulted with him.
After some additional testing to ensure I qualified and would benefit from the
surgery, my appointment was set up for November 6, 2013. The surgery went
VERY smoothly and to say that I am absolutely delighted with the results is the
wildest UNDERstatement! I think mine was about Dr. Smith's Linx Surgery
number 73 or so.
But how was the recovery you ask?
I
have not found many reviews from patients about how their recovery went
following a Linx magnetic ring implant surgery. Here is how it went for
me. I kept a written log of my recovery process. Of course, other
people's recovery will differ.
The Day of Surgery
1)
My surgery with Dr. Daniel Smith started about 7AM on Thursday
morning, November 7.. Preparations took about a half hour and the
surgery itself about 45 minutes.
2)
I started to wake at about 11AM and I was pretty sore in spots
and gratefully accepted a shot of pain killer when offered at about 11:20am.
3)
I was still recovering from the anesthesia at about noon.
4)
The nurses came in and offered me lunch. I had a glass
of apple juice and some crackers. Swallowing was slightly difficult, but
not painful and not a serious problem either. The staff had emphasized
the importance of quickly eating after surgery so the magnetic ring could
begin to operate in its new environment without delay.
5)
I then took a nap.
6)
By about 2:30PM, I was fully awake and I was asked if I
would like something else to eat. I was hungry and ordered a glass of
iced tea, a bowl of bean soup and a tuna salad sandwich. When it
came, I ate all of it without much problem. A couple of bites took two
swallows but I had no real problems swallowing the food. There was little
or no pain in swallowing. Overall, I was in little to no pain after
the pain shot at 11:20AM.
7)
At 4:30pm, the nurses got me up to take a walk..
They suggested I take a good walk to help my recovery. I walked six times
around the circular hallway which is about a mile over a period of about 30
minutes. No speed demon here!.
8)
At about 5:30pm, I checked out of the hospital and went back
to my hotel for the evening. I was tired, but not in pain. I took a
Tylenol tablet and went to bed. In the evening, I got up out of bed
and felt nauseated so I took one of the nausea tablets furnished and within a
few minutes, I was OK. I took another couple of Tylenol tablets about 9pm
and went to bed and slept for 10 hours. During the night, I took no
reflux medications and I had no sign of reflux over night or in the
morning. This (for me) was a historic event!
Week 1: Day 1 following surgery
9)
I got up about 7am on the Friday after surgery and went to an
exit exam with Dr Smith and was fine. I had a breakfast of a couple of
eggs, large bowl of oatmeal and coffee. After that my wife drove us
back to Atlanta from Jacksonville. I took a couple of Tylenol tablets
after breakfast to help with pain and soreness around and behind the incision
sites in my chest..
10) We
had lunch at Cracker Barrel Restaurant where I had a glass of iced tea and the
meatloaf lunch, turnip greens, mashed potatoes and gravy and a roll and corn
bread. Yum! Absolutely no problem swallowing and at this point, I
am no longer “thinking about” if the coming swallow is going to be
uncomfortable or not. I took another Tylenol tablet after lunch.
11) We
arrived at home about 6pm.. I decided to check out the repair and we went
to the Varsity where I got a chili dog with cole slaw and a frosted
orange. Then I went home and went to bed about 9PM. (This
would have caused a very painful reflux episode before the surgery.) Just
to be on the super cautious side, I did take a 150mg tagamet tablet before
going to bed. But no other antacids. Two more Tylenol tablets after
supper for the incision discomfort. If I sit or stand normally, I have no
pain. But If I cough, it hurts a lot. Hopefully this will be better
tomorrow. No BM yet.
12) Doctor
Smith told me that I should expect the pain and perhaps the swallowing
difficulties to increase over the first week and then subside due to swelling
in the disturbed area above the stomach. It is Friday Evening now and at
bedtime, I am noticing some increasing pain and discomfort if I cough.
But still MUCH less overall discomfort than I was expecting. And no
pain or discomfort at all when I swallow. No pain when I lie quietly in
bed or sit.
Day 2 following surgery
13) Saturday
Morning. There were no signs of any acid reflux overnight. I still have
significant soreness in my chest and it hurts if I have to cough. But the
soreness has improved. I had a nice breakfast of pancakes, bacon,
eggs and coffee at iHop. No swallowing problems and I can say that
now I have gotten over thinking about swallowing as I eat. I took an
afternoon nap I took a long walk in the woods this afternoon and all felt
fine. The chest pain/soreness has gotten better as the day has
progressed. Supper of soup and salad was unremarkable.
14) Sunday
Morning: No signs of any acid reflux overnight. My chest pain from
the incisions is dramatically better this morning. We will be off this
morning to the Old Hickory House for my favorite Sunday brunch of country fried
steak, eggs and grits! The laxative is working and the bowels are the
last function to go back to normal. I think the worst is over now.
I will be able to start driving again today. No lifting over 10 pounds
for 30 days.
15) Monday:
All going fine. No problems with Mexican Lunch with light
seasoning. At supper I did notice minor swallowing problem but sipping
Iced Tea for a few minutes sorted it out. There was zero reflux overnight
as expected.
16) Tuesday:
Minor swallowing problems at breakfast. Again, sipping liquid for a few
minutes was the solution. Such swallowing problems were said by Dr. Smith
to be expected due to the healing process, but should disappear by the end of
about two weeks following surgery. There was zero reflux overnight as
expected. One of my employees told me today that my Hoarseness was fading
away. I hope he is right! I have been hoarse continuously for many
years. Perhaps giving your vocal cords a nightly bath in stomach juices
is not all that good for them.
17) Wednesday/Thursday: Nothing new. No reflux during sleep. All pain has now dissipated in my chest/incision area. A little problem on Thursday drinking a glass of iced tea. Caused spasm in swallowing.
Week 2 following surgery (November 15)
18) Friday: All going
nicely. The spasm when I drink iced tea or a coke with ice is still with
me today. Other than that, no problems at all. No Acid reflux
anytime.
19) Saturday/Sunday: All
fine.. I still have spasm when I drink iced drinks, but Dr. Smith says
that too will pass. Room temp or warm drinks are no problem to
drink. No acid reflux problems at all. :)
20) Monday: All fine. Cold
drinks such as Iced Tea are OK to drink today. I am eating anything I
want. I have no acid reflux when sleeping or awake. There is no
pain when I eat or swallow. My sinus drainage has improved very slowly
over the last week, but this may have been from the weather change
to cold weather. In any case, I now consider myself completely recovered
from the Linx Surgery and without any residual Acid Reflux symptoms to worry
about. I still have a little problem when I start to swallow
something cold, but this is getting better.
21) Tuesday/Wednesday/Thursday: All fine. Had a few moments of difficulty swallowing cold food, but after a minute, the spasm went away each time and did not return for that meal.
Week 3 following surgery (November 22)
22) Friday/Saturday: All
fine.. No more problems swallowing. No Acid Reflux! My
hoarseness is just about gone. I am quite pleased with the outcome and
the very comfortable and speedy recovery!
23) Sunday: I spoke too soon. Sunday, I had a problem swallowing for a few minutes at lunch. After 5 minutes I ate the rest of the meal without problem. All else fine.
24) Monday/Tuesday: No problems, All OK.
25) Wednesday: At Dinner, I had a problem swallowing for a couple of minutes and then went on to eat the evening meal with no problems.
Week 4 following Surgery (November 29)
26) Thursday/Friday: All OK.
27) Saturday: I had a 5 minute "spasm" at lunch.. I waited about 10 minutes and then the meal went down with no further problems. Note: The "spasms" are not painful, but it just feels like my esophogus is "cramped". The food that causes the cramp always goes down BEFORE the start of the cramp. No food comes back up unless I try to eat a bite while the cramp is in progress. Still.. I consider this swallow problem extremely minor compared with getting rid of my Acid Reflux 100%!
28) Sunday/Monday/Tuesday: No problems and no reflux.
29) Wednesday: I had a "spasm" today at lunch. I waited about 10 minutes and it did not immediately go away. I took my food home and by the time I got home, the spasm was gone and I ate the rest of the "veggie plate" without any further problem. No reflux at all to report.
30) During December, I had, approximately two or three times a week, problems swollowing food after the first bite at a meal. This "can't swallow" problem usually lasted from one to two minutes before "fading away" and allowing me to continue eating. One just one occasion, the problem took about 30 minutes to resolve. Once the problem resolved itself, the "can't swallow" sensation completely went away and I could eat the rest of the meal without further complication.
31)
In January, I have had zero swallowing or other problems. I
seem to be "cured" of my reflux and without further problems. I
DO notice that if I eat spicy food, tomatoes, or other acid
producing meals, I get a bit of a "tummy ache". I then take
a tagamet and a gaviscon tablet and the problem disappears.
But even during or following these situations, I have zero acid
reflux.
So..
I am apparently completely over my acid reflux for the first time in
maybe 30 years. Does it feel good? YOU BET!
Notes:
a)
There were times early on, when I wished I could take the codeine pain
killers, but due to my allergy to codeine, I did not.. But the three or
four Tylenol a day did keep me pretty comfortable the first two days and then
two on the third day. I intend for Saturday to be the end of painkillers
for this surgery. I speculate that NOT having the strong pain killer
perhaps made any swallowing problem less severe than it might have been.
b)
Riding home in the car for 6 hours with a stop for walking
about for 10 minutes every hour was no problem at all.
c)
The worst pain I had was around the incision sites and in my
chest area behind the incisions. And that was not “awful”.
I really
never had any pain when swallowing right from the first. Even
during the times when I was momentarily unable to swallow, there
was no "pain". The swallow function simply would not work.
d) The Linx device
supposedly does not preclude belching or vomiting, both of which are problems
for the Nissen procedure. Formerly, I belched many times a day.
However, since I had the implant, I have belched exactly once.
However... I will mention that the gas DOES exit elsewhere.