Surgeon recommeds RNY in efforts to resolve my non-acid "Silent GERD"...

Hello All!

I have an unique situation in which my surgeon is recommending Gastric Bypass due to a medical condition that abruptly occurred for me this past January – days prior of turning 50. It all started during an episode of bronchitis which I get yearly. New symptoms were acute – after 5 visits with urgent care in January, a Physical in February prompting an ENT Consult to perform a 24-hour Esophageal PH test/monitoring for Acid and Non- Acid reflux. The final results supported what I figured I was experiencing – being “Silent GERD”! Not the typical acid producing- heartburn GERD – but Silent GERD. Even taking 40 mg /twice daily of Omeprazole for a month and during the 24- hr PH test – I was off the charts for “non-acid” Reflux occurring – 100 times per that 24 hour (ones on medication at time of testing should not experience reflux higher then 40)!

Omeprazole is a great medication for the Acid GERD symptoms, but will never completely resolve Non-Acid Silent GERD issues. Next I was off to a surgeon consult; I knew I would need surgery – likely the Nissan Fundoplication (procedure which uses your top portion of stomach to wrap around you Lower Esophageal sphincter) Yikes!! BUT, during my consult and surgeon’s review of my history prior to my appt – he indicated the Nissen Fundoplication is about 40% successful in people who are obese due to the wrap failing by coming undone. Surgeon suggested the best option would be the Gastric Bypass –RNY as it would completely eliminate my Silent GERD…. and my sleep apnea and weight loss as added BONUS – then asking if I ever considered weight loss surgery?

Wow – I found myself having a lot to think about since that 4/30/15 visit with the surgeon. My Insurance denied it initially mid-May; and as my surgeon promised he would appeal the denial for me. Recently, found out it has been approved on June 19. Next steps I’m not sure about as contact hasn’t been made yet since the approval. I haven’t done any of the preliminary nutrition counseling, psychological etc, appts.

So ---- my question is: has anyone else had the RNY performed due to a ‘medical condition’ such as Silent GERD? I have been lurking a lot here on this site and appreciate all the valuable insight/guidance/support for weight loss surgery options shared by successful losers =)

I feel I would be crazy NOT to go forward with the RNY since surgery is required for me to resolve this Silent GERD – and the Nissen Fundoplication isn’t an option for me. I am 223 at 5 foot 2.

It’s a huge decision to make and potential risks as you all know – I have struggled with my weigh for a good 30 years when I was about 160 pounds creeping to 190 after second child born 17 years ago to my weight now (223) with a very sedentary job of a Medical Coder!

Thoughts?

My reflux wasn't as bad as yours but I haven't had any issues after RNY. I would suggest you look at all of the aftercare you will need after surgery. Things such as eating X number of protein a day and vitamins 4x a day and also no eating and drinking together. These are lifelong commitments. 

I had SEVERE GERD caused by an old weight loss surgery (VBG) that failed, mechanically.  I was diagnosed with Barrett's Esophagus and had 6 tumors removed from my esophagus.  I was on 180 mg of Prilosec with NO improvement in my reflux.  I had to sleep on an incline and I still had stomach contents on my pillow every morning.  There was no barrier left (it had eroded away from 25 years of acid) to keep the  stomach stuff contained. I had a revision to RNY and have not had one reflux episode since.  I woke up from surgery cured.

I lost all my excess weight and am currently 15 pounds below goal (I'm 5 years out from my revision).  I will caution you that the reflux can return if you regain weight and don't follow the RNY food plan and rules.  You have to be compliant for it to work long term.

I'm sure I would have developed cancer of the esophagus without RNY.

To be perfectly frank, at 5'2" and 223 lbs you are morbidly obese with a BMI of slightly over 40.  I would get the surgery even without the co-morbidity of the silent GERD.  

While it is a huge decision with potential risks, it seems to me that your risks are far greater not having the surgery.  

Do keep in mind that it isn't worth taking the risk, however, if you are not fully committed to keeping up the necessary plan and lifestyle changes after surgery.  

I wish you nothing but success!

Edited to add -- I realized after posting that my first statement might have appeared harsh -- and please know that I am just very honest.  I came from a point of SUPER morbidly obese with a 57 BMI.  It's pretty bad when "morbidly" and "obese" are enough of a description for my weight   -- so, I hope my opinion was taken as honest rather than meant to be mean.

I would have it done in a heartbeat.  The risk of esophageal cancer - in my opinion - far outweighs the lifestyle changes that you'll need to make in order to be successful with RNY.  

Wishing you all the best!  

I too had "silent GERD" (never had heartburn but a lot of nausea and significant esophageal damage seen on an endoscopy), and my 24-hr pH monitor also showed a lot of non-acid reflux in addition. I was already looking into WLS surgery at the time, but the severity of my GERD is what convinced me to go with the RNY over the sleeve. If I were you, I'd do it in a heartbeat. You may even have an easier time than the rest of us getting approved by your insurance since morbid obesity might not be listed as the primary diagnosis when the procedure is billed.

RNY has a much better success rate at resolving GERD in the obese than any other surgeries specifically for GERD, for exactly the reasons you mentioned. I did a lot of research on this and my surgeon before surgery, and found he'd authored a bunch of articles about it. You sound like you've already educated yourself very well on your condition, but if you want, try searching Google Scholar for GERD-related articles by Kevin Reavis (or KM Reavis). I found a bunch of good stuff (and it made me feel more confident in my surgeon to know he wrote them!) Good luck to you!

Thank you all who have responded  - I appreciate them all.  I did make a call today to surgeon's office to speak to his nurse since I haven't heard anything since learning that I was now approved after the appeal process on June 19.  I work for this insurance company and being proactive have my per-authorization number for the approved RNY.  The surgeon's office wasn't aware of the recent approval - thinking perhaps the approval letter fell through the cracks.

I will do this RNY surgery in the near future - a turning of events may occur next week when I find out I'm offered a new job! If that occurs and I accept - plans are to pick up my husband's insurance stay with the same insurance company for an easy round two of approval AGAIN but this time under his insurance vs mine due to possible job change.  With a potential job offer - I will share with them my need for a surgery soon which involves a good 2 week recovery time.   How the heck do you pull that off, esp the job being offered is a one-woman medical coding position??  - and I already need to be out of work for two weeks ??  - or do I inform them and put off the surgery until Jan 2016??  

Nurse said today since I have a medical condition that requires RNY to resolve my symptoms - I may find a date of late August being offered. For me accepting a new job - I hope to be offered next week -- I feel the earliest I could consider this surgery as a new employee is October 2015.   Please me reminded I haven't even met with a Nutritionist - or psychologist etc yet -- but with my medical issue they want to get that RNY surgery scheduled.  She plans to touch base with surgeon on my concerns - and I will follow-up with her week of July 14 once I know if I have a new job or not. 

I will continue to research and research and more research -- I'm aware of the vitamins for life; but didn't know one finds themselves taking them 4 times a day.  Also I have attended a support WLS group that is part of the U-Wisconsin Hsp Bariatric department. Nice size group of about 40 who showed at the June meeting - next one is July 14 and I will attend again=)

Thanks!   and I will return with updates.

Yes, we need vitamins 4 times a day (sometimes 5). The problem is that we need 1500-2000mg of calcium citrate daily, but we can only take 500mg at a time, so that is three doses, and calcium and iron cannot be taken together, so the iron is a 4th dose.  Then you fit in the other vitamins (multivitamins, Vit D, B12, sometimes a B complex, etc.) into one of those 4 times.

Having surgery right after taking a new job can be very tricky, especially in a situation where there isn't anyone to help cover your responsibilities.  I would find out whether your insurance requires a 3-month or 6-month pre-op diet (some do and some don't).  If it is going to be 6 months, that gives you some time on the new job before you would have to be out.  

Most people can have lap surgery and go back to work at a sedentary job after 2 weeks, but you should be prepared for the possibility of complications that might require you to be off work another week, maybe two.

Good luck!

Lora

Get the surgery ASAP.  Every day you risk your GERD turning into esophageal cancer, something two family members of mine died from.  I had RNY to fix my GERD and reflux and woke up cured as well.  I no longer aspirate acid in the middle of the night   I understand you have a job thing going on, but keep in mind that insurance is not the same from company to company.  I realize you and your husband have the same carrier, but his company may have exclusions or certain hoops they will expect you to go through.  It might not be an easy 2nd approval.  Just check that out before you make any changes.  

That said, congratz on catching the silent gerd and on the approval for the surgery!  Both are super important!  Hopefully you can have the surgery soon and be on the road to recovery shortly.