A medical question for physicians, PAs, RNPs, and whomever

Discussion in 'Et Cetera, Et Cetera' started by Dave NoCal, Apr 14, 2008.

  1. Dave NoCal

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    Dear folks,
    This may be kind of out of place but I know there are a number of medical personnel who post here and I am interested in their perspectives. No, I'm not asking for medical advice and, yes, I have an appointment with a gastroenterologist whom I know on the 22nd.
    Here's the story. I've been having constant right side abdominal pain and other GI symptoms most of the time for about a year. Also, about a year ago I spoke with my PCP about having a sensation of breathlessness. I've had x-rays, a CT, an echocardiogram and recently, an upper GI follow-through. All the findings have been basically negative although the echo showed mild regurgitation in three valves. Both my PCP and a cardiologist said that the amount of regurgitation is not sufficient to cause symptoms. I have thought that my abdominal symptoms have been due to adhesions from two previous abdominal surgeries and that I need to do more cardio to improve my breathing. I previously had similar GI symptoms, after a laparascopic Nissen fundoplication (anti-reflux surgery) which were relieved entirely for five years by a lysis of adhesions. Despite my history of adhesions, which tend to recur and my history of having similar symptoms relieved by lysis of adhesions, no one has been willing to take a look, absents some clear radiographic findings (which, of course won't reveal adhesions unless there is an acute obstruction).
    However, the recent upper GI follow through did reveal that I have a "large" hiatal hernia and that the terminal ileum "is of usual appearance." This is where it might start to get a bit interesting. in 2000, when I was getting my workup that eventually led to the lysis of adhesions, I had two different upper GI tests involving contrast (barium?) and two different radiologists described the cecum as "higher than normal in the right upper quadrant" and "just above the level of the right iliac crest." Is sounds like it has been visualized in at least two, and possibly three, different locations. It's not supposed to do that as normal anatomy has it attached to the abdominal wall. I'm wondering whether, reviewd in series, these studies reveal a mobile cecum, which could further explain my symptoms which closely match those of mobile cecum syndrome.
    So, no one has been willing to go in after adhesions (and I understand that surgery CAUSES adhesions although I had a good result before) and I remain uncomfortable and inconvenienced most of the time. However, breathlessness and swallowing problems (which I also have if I eat other than slowly) are symptoms of hiatial hernia that often justify surgical intervention as might a mobile cecum. I don't WANT surgery but do want to be able to exercise vigorously and not have to be constantly running to the bathroom. All of this adds up to an exercise problem, a hygiene problem, a pain problem, an outdoor activities problem, and a travel problem. I'm almost fifty-eight and did not suddenly develop IBS (I'm bored and stumped).
    I'll stop except to pose my questions which are: What does this sound like and how likely is it that surgery is in my near future? Thanks.
    Dave
     
  2. Industrialsize

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    I'm only a Registered Nurse but it sounds like your hiatal hernia may be causing your current symptoms.........if you do have a surgicla repair, I would explore having it done as a Laporoscopic procedure rather than an "open" procedure;

    [SIZE=2ex]
    [FONT=Verdana, Arial, Helvetica, sans-serif]Laparoscopic Hiatal Hernia Repair
    [FONT=Verdana, Arial, Helvetica, sans-serif]The majority of hernias involve the intestine slipping through a weakness or tear in the abdominal wall. Hiatal hernias, however, involve a portion of the stomach, which is forced into the chest cavity through an opening in the diaphragm — the sheet of muscle that separates the chest from the abdomen — where the esophagus normally passes through to join the stomach.[/FONT]​
    [FONT=Verdana, Arial, Helvetica, sans-serif]There are two types of hiatal hernias. The more common sliding hiatial hernia occurs when the esophagus and stomach both slide upward and the top of the stomach protrudes through the diaphragm into the chest. The paraesophageal hiatal hernia occurs when the top of the stomach moves up alongside the esophagus and both protrude through the opening in the diaphragm. The cause of hiatal hernias is not fully known, but they may be the result of a weakening of the supporting tissue. Increasing age, obesity and smoking seem to be contributing risk factors. Typical symptoms can include chest pain, heartburn and acid reflux, shortness of breath or nausea, but sometimes hiatal hernias have no symptoms at all.[/FONT]​
    [FONT=Verdana, Arial, Helvetica, sans-serif]While symptoms may be treated with medication, surgical repair is often the preferred course of action. Left unrepaired, hiatal hernias can develop life-threatening complications, such as stomach obstructions, bleeding, strangulation or perforation.[/FONT]​
    [FONT=Verdana, Arial, Helvetica, sans-serif]At Union Memorial, our specialists usually repair hiatal hernias laparoscopically, using only a few small incisions instead of a major incision required by traditional abdominal surgery. This minimally invasive procedure is more complex and requires more specialized skills, but it is much less painful, and the laparoscopic approach dramatically shortens recovery. Most patients resume their normal activities within two weeks, and the risk of recurrence is no greater than with the open surgical method.[/FONT]​
    [FONT=Verdana, Arial, Helvetica, sans-serif]What are the advantages of minimally invasive hiatal hernia repair?
    • Less trauma to the muscles and other tissue; 5 small incisions the size of a buttonhole instead of an 8 to 10 inch incision
    • Fewer complications such as bleeding and infection
    • Shorter hospital stays; usually 1 night for sliding hernia and 1 to 2 nights for paraesophageal hernia instead of 5 to 7 nights for standard open surgery
    • Faster, less painful recovery; return to normal activity in 2 weeks instead of 6 weeks with open surgery
    [/FONT]​
    [/SIZE][/FONT]
     
  3. Dave NoCal

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    Indy,
    Thanks. I tend to be a bit obsessive in studying medical things due to having had some disappointing experiences in the past. Recent long term follow-up studies have suggested that laparascopic hiatal hernia repairs relapse quite a bit more frequently compared to open repairs, over the years (Can't cite at the moment as I'm headed to work). Also, a repair would involve re-doing the Nissen. This two step process is commonly done laprascopically, also. If surgery happens, I would really like for the fixation of the cecum to be evaluated and for any problematic adhesions to be taken care of. I am REALLY TIRED of all of this and want whatever holds the best hope of fixing it and it staying fixed.
    This is also a worry problem in that I have the knack for not looking, or feeling, as sick as I am. I pulled a bicep tendon head loose from the shoulder and failed to notice. The doctor who previously lysed the adhesions commented that he was amazed I was not much sicker. Once, after getting my thyroid iradiated, I went profoundly hypothyroid earlier than expected and didn't feel too good at work. Labs revealed a CPK of 4600 and I was in renal failure. And here I was at work. I have a fear of developing torsion and not feeling ill enough to seek help and/or not being emphatic enough to be taken seriously (I'm pretty low-keyed and logical).
    Dave
     
  4. D_Gunther Snotpole

    D_Gunther Snotpole Account Disabled

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    Wouldn't torsion leave you profoundly ill and within days, at death's door?
    You couldn't even eat.
     
  5. D_Vita_Mee_Tavegamin

    D_Vita_Mee_Tavegamin Account Disabled

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    The twisting of the cecum on itself is reffered to as a volvulus and may be what you are reffering to by torsion.

    I agree numerous studies have shown that Lap Hiatal hernia repairs, and Lap nissens have increased failure rates when compared to open repairs. But pair this with being a known adhesion former and you probably have many adhesions already an open procedure may be technically the better option .

    Please feel free to email if you have more general questions.
     
  6. simcha

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    Dave_NoCal

    I have no clue what it is and I'm not a medical professional. I just wish you luck and I'll be sending positive energy your way (thoughts and prayers).
     
  7. Dave NoCal

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    Thanks guys. Rubi, it's my understanding that torsion/volvulus can be on a continuum of severity and, sometimes, intermittent. Therefore, people can be episodically and/or non-acutely symptomatic (which could change at any time) hence my worry. J. marose, thanks for your offer to e-mail (PM?). It's late and I will do that tomorrow. Simcha, despite our disagreements, you are a good guy.
    Dave
     
  8. Dave NoCal

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    Anyone else?
    Dave
     
  9. D_Vita_Mee_Tavegamin

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    How are you doing Dave?
     
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