It's Been a Rough Day

[ouroborous 519]

Well, today was surprisingly tough. I've been dealing with the after effects of last night's acid extravaganza all day long, literally.

My throat constantly wants to get sore and swell up. Fortunately I've discovered that hot tea soothes the soreness and I can pretty much drink as much chamomile tea (and Splenda) as I want. I took the advice of the MA who I spoke with on the phone, and at around 8:30 pm I took another 40 mg of omeprazole. That makes 80 mg for the day; that seems really high, but my acid is just out of control.

(TMI coming up, sorry...)

On top of that, my intestines have been in an utter uproar. I was having sharp pains in my side (and, being a hypochondriac, my first thought was "aggh! gall bladder!") but it was just gas. Still alarming and painful. My BM's (I've had 3 today) have ranged from full and healthy to... not so healthy. No blood in my stool, thank goodness, but I've been pooping so much acid that my bottom is raw and bloody. It seems like everything I take in causes my stomach to roil and causes gas and stuff. First I thought maybe I was getting lactose intolerant because my last gas outburst happened when I was drinking my evening Protein shake, but my next one happened when I was sipping Water after my omeprazole.

What I think happened is:

1. My acid has been barely controlled for a while. I've noticed that it's been building up, and I think I have to work with the doc to really control it.
   
2. I've been eating too aggressively and too much; even though I'm cleared for "puree" foods and my handout from my surgical center says that mashed potatoes and melted cheese count as "puree," it felt ... too much when I ate it last night. I think it got stuck or irritated my sleeve or something. I didn't puke, thank goodness.
   
3. Last night I had an apnea attack that triggered a LOT of stomach acid to come back up -- I woke up gagging on acid. I think that burned the hell out of my throat and caused it to be swollen all day.
   
4. On top of that, the acid has been going out the other end, and it's been wreaking havoc on my digestive system -- causing my guts to be in an uproar, giving me gas, etc.
   

I think it's a sort of "perfect storm."

Here's how I'm going to address it:

• I'm going to really step up the omeprazole. I don't know what the maximum safe dose is, but while I'm healing, I'm more worried about the effects of the acid than I am of the PPI's. The omeprazole is not an instant fix, but it does seem to help long-term.
  
• I'm going to REALLY dial back on the food -- portion sizes are going to get smaller, I'm going to eat slower, and I'm going to go back to mostly liquid or super-runny food. I just don't feel like my sleeve is ready for heavier food yet, and it's sort of telling me that.
  
• I'm going to be drinking a CRAP-ton of hot tea. It seems to really help with the reflux, and it's the one thing in the mix that I'm not worried about the side effects of!
  

I think what really blew me away was that last week was such a breeze! I had one minor incident of acid reflux (which upping the omeprazole seemed to help), but no real intestinal pain or anything. I was even sleeping better. And then BAM, last night and today was really rough!

I'm not looking for sympathy, just relating my experiences so you other new sleevers can be prepared for it. At least I don't think I've done any permanent harm to myself (I'm not vomiting or in unbearable pain, nothing's bleeding, I've still managed to get all my Water, Vitamins, and Protein today). I think that just basically I went too fast.

Lesson learned!

[wannalise 15]

Super great that you are listening to your body and tweaking what you can. I did not and still don't do great with mashed potatoes. It is like they become lodged and that feeling is like internal claustrophobia mixed with pain! I hate it. I don't know if this is universal advice but my surgeon talked about any time your sleeve becomes irritated (ex through vomiting) that you should really step back for 6-12 hours and just drink fluids until the inflamation goes down. I don't know if that is a possiblity but it may help things feel a little better. Keep posting and good luck! Sorry its been a rough one.

[ouroborous 519]

Super great that you are listening to your body and tweaking what you can. I did not and still don't do great with mashed potatoes. It is like they become lodged and that feeling is like internal claustrophobia mixed with pain! I hate it. I don't know if this is universal advice but my surgeon talked about any time your sleeve becomes irritated (ex through vomiting) that you should really step back for 6-12 hours and just drink fluids until the inflamation goes down. I don't know if that is a possiblity but it may help things feel a little better. Keep posting and good luck! Sorry its been a rough one.

Yeah, the weird thing is that I didn't really have any pain with the mashed potatoes. They just felt a little bit... heavy, and kinda got stuck. But I DO think I may have irritated my sleeve a little bit (which might explain all the acid), so I'm going back to just liquids and such for a while.

Also, I just read that chamomile tea in high doses can actually cause stomach upset and cramps, so I may have been bringing some of this on myself. Maybe I'll just drink hot Water?

[deletedsally 8]

Just another thing to consider...it seems a lot of Protein shakes are chocolate, and this can really make problems with reflux worse. I pasted a clip from one research study:

"The researchers found that chocolate significantly increased the number of reflux events and the acid exposure time in the esophagus for the seven patients. "We found that the chocolate causes a large amount of serotonin to be released from the cells in the intestines," says Wei Ming Sun, Ph.D., research scientist, U-M Department of Internal Medicine. "The serotonin causes the lower esophageal sphincter to relax. The relaxation means the 'door' between the esophagus and stomach is opened and acid is allowed to flow back up to the esophagus."

I had a lot of digestive distress (cramping, intermittent diarrhea) when I was on my preop diet and using various Protein supplements that contained whey protein concentrate. When I switched to the powders?utm_source=BariatricPal&utm_medium=Affiliate&utm_campaign=CommentLink" target="_ad" data-id="1" >unjury unflavored, which is pure whey protein isolate (with no other ingredients) and ditched all the additives my GI problems cleared up immediately.

[ouroborous 519]

Well, the good news is that I didn't have any significant reflux last night.

[ouroborous 519]

Just another thing to consider...it seems a lot of Protein shakes are chocolate, and this can really make problems with reflux worse. I pasted a clip from one research study:

"The researchers found that chocolate significantly increased the number of reflux events and the acid exposure time in the esophagus for the seven patients. "We found that the chocolate causes a large amount of serotonin to be released from the cells in the intestines," says Wei Ming Sun, Ph.D., research scientist, U-M Department of Internal Medicine. "The serotonin causes the lower esophageal sphincter to relax. The relaxation means the 'door' between the esophagus and stomach is opened and acid is allowed to flow back up to the esophagus."

I had a lot of digestive distress (cramping, intermittent diarrhea) when I was on my preop diet and using various Protein supplements that contained whey protein concentrate. When I switched to the unjury unflavored, which is pure whey protein isolate (with no other ingredients) and ditched all the additives my GI problems cleared up immediately.

That's good advice, but I'm 99% convinced that it was just the lingering side effects of an acid "dump" triggered by Not Respecting the Sleeve.

If smaller, slower portions and smoother food don't fix it (along with being regular with my omeprazole), I'll definitely try switching things up.

[ouroborous 519]

...another rough night, up most of the night with acid reflux and a swollen throat (that felt like it was closing up). I took more drugs than I care to mention.

I finally turned the corner after I took some liquid Tylenol (I dunno, maybe it helped the swelling go down?) and forced myself to use my wedge pillow. The wedge pillow definitely helps a lot with preventing more reflux (although obviously it does nothing if I'm already raw and swollen). The problem is it's too tall; it's got a 12" rise and I feel like I'm sitting up, not lying down, and have a hard time getting comfortable. I've ordered another one from Amazon that got rave reviews from folks with reflux, and it's only got a 7" rise. Hopefully I can begin regularly sleeping on that one and "heal" my reflux.

It's still a major pain trying to juggle all these meds and treatments -- omeprazole, Carafate, Mylanta, hot tea, heating pad... They all have their own limitations and restrictions, none seems to be 100% effective.

I just can't wait until I'm out of this burning, choking acid phase. It's really for the birds. When I'm not troubled by acid, I feel great! And I'm losing weight fast. It's just that when the reflux flares up I'm MISERABLE and panicky and can't sleep.

[lmmore 0]

Be careful about not taking too much omeprazole. Just because you're allowed to go into another food stage, doesn't mean you should be eating everything. They tell you to try one thing at a time to see how you tolerate it. Why are you eating this stuff when you have been having acid problems? Go back to square one. Get your tummy stabilized. and they slowly add food. but mash potatoes? They are heavy in the stomach. I think you are right. you have irritated your sleeve. Let it heal. And call your doctor before taking more omeprazole. Also, I have found the CPAP has not always been my freind after this surgery. Check with you doctor to make sure it isn't contributing to your reflux. Good luck.

[ouroborous 519]

Well my doc's assistant told me to take 80mg/day for now. I figure that for the short term that's not too big of a risk. The Carafate doesn't seem to do much, but the doc says it helps protect the tissues from the acid, so I'm trying to take it to prevent the reflux from damaging my esophagus or sleeve/stomach lining.

Yeah, I'm staying away from heavy food for a little while, but I can't skip the CPAP. I don't sleep at all with it. The question is what is the right pressure; I think it's a little high right now since I wake up with MAJOR dry mouth (when I sleep), but the problem is that if I lower the pressure, I wake up with apnea attacks. And my apnea attacks seem to trigger reflux attacks, so...

It's a pain. I keep trying to remind myself that this is only a phase in my healing, and it will pass... but when it's 4am and I can't get any sleep and I'm scared that it's going to be like this forever, it's hard to be all calm and optimistic and zen-like about it.

[wannalise 15]

My first couple weeks post op where really difficult. Different issues than you are having, but none the less frustrating. At six weeks out, I really do feel so good. Its super fun right now and you'll get here. A week ago I was walking a decent distance which used to hurt my feet (fractured them in the past d/t weight) and I realized my feet felt no pain at all. You really are gonna make it, you are going to have little victories that outweigh these difficulties. Keep posting and vent as you need. Hopefully you will find the right mix of meds, and other treatments. Hang in there!

[deletedsally 8]

We don't usually think about how important good sleep is to our ability to feel decent and function normally until something happens that deprives us of that sleep. About 1.5 years ago, I had a 3 month period where I would wake up having palpitations any time I tried to sleep. (No cardiac issues, and the cardiologist suspected that the palpitations were the result of too much synthroid or my oxygen level dropping due to sleep apnea). Anyway, what I'm getting at is that I've never been so anxious and miserable in my life. I tried every sleeping postion imaginable, including sitting in a chair. It was horrible!

I'm sorry you are having this trouble. Hopefully, medication will help in the short-term and this phase in your recovery will pass quickly. Even though it doesn't help you feel better now, I think you can be confident that as you continue to lose weight, the sleep apnea and the reflux will both be less of a problem, and you will be sleeping much better! For now, just do your best to relax and take care of your sleeve!

Edited May 20, 2010 by katt

[ouroborous 519]

Yeah, the regular sleep deprivation is probably the worst part of all of this. I could deal with the reflux if it wasn't keeping me up at night.

[lmmore 0]

Didn't mean to sound harsh. Are you taking alot of meds. I do, and they can cause heartburn for me. I space them out during the day (a logistics nightmare, since some are once, twice or three times a day). The reason 80 mg sounds high to me.....is I take 20 mg. I'm curious did you have heartburn before surgery, or only after? I had it before, and my doctor started me on daily Prilosec before surgery to make sure i did not have any problems, or he wasn't going to do the surgery. Also, since you've lost 26 lbs, can you lower your cPAP just a little without it causing you dry mouth? Like I said, I have been having problems with CPAP since surgery. I seem to do okay with using it every third night. I am hoping the more weight I lose, that the less I will need it. But I understand where you are coming from. There is also a psychological aspect to it. I used to feel like I was going to croak if I didnt' use it. I was afraid not to use it. Anyway, I hope you find ways to help your situation. Les