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Old 04-21-2011, 01:17 PM   #1
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Hiatal hernia & breathing problems - does surgery help????

Hi everyone. I am SO glad that I found this discussion board. I need some questions answered, and if any of you can help, I would greatly appreciate it. I have had a hiatal hernia for about 8 years now & I have taken Nexium every since the day that I was diagnosed (8 years ago). I finally got diagnosed after I was experiencing horrible acid reflux & went through many tests, including scopes & barium xrays. The Nexium worked for the first few years to control my acid reflux, but I have always experienced nausea & constipation off and on, depending on what I eat, you know? I just figured this was something I had to deal with. I am a very healthy eater -no greasy foods. I eat 4-6 small meals daily. I go for a checkup with my gastroenterologist every year. I always discussed my symptoms & he would basically tell me that I should try to live with the symptoms & if they get worse, to let him know. I feel as though over the last couple years, my symptoms are getting MUCH worse. I experience upper back pain, upper abdominal pressure (it feels as though someone is standing on my upper abdomen), my acid reflux is worse even when I take my nexium daily and the worst symptom of all is my breathing. I cannot breath normally, and this is hard for someone who is very active like me (I perform in triathalons regularly). I feel like I have shallow breathing & when I try to catch a solid, deep breath, I usually can't. I feel as though every couple minutes I try to breath deeply & it gets cut off. I have to basically sit up really straight & raise my shoulders up to breath in deep, and sometimes I get a satisfying breath, but usually not. I went for a checkup with my gasteroenterologist yesterday, for the first time in 2 years & told him of all my symptoms. He told me that he would put me on a new medication, and if my symptoms do not improve, I could have hiatal hernia repair surgery. He gave me Dexilant. I took it this morning & my symptoms feel even worse today. My question is this -could my hernia have grown larger over the years & is causing new symptoms? Has anyone had breathing problems b/c of their hiatal hernia? And, did the surgery help with the breathing problems? I'm a little hesitant to have the surgery b/c of all of the horror stories I have heard, but then again, I want to give it a try b/c I am miserable! I can't breathe!

 
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Old 04-26-2011, 05:42 AM   #2
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Re: Hiatal hernia & breathing problems - does surgery help????

You sound just like me. I've had Acid Reflux for over 10 years plus a hiatal hernia. In that time I've had so many issues with my breathing.I've had all sorts of tests (upper Gi, Bronchoscopy, Asthma tests including methacholine challenge, endoscope and many more), and my ENT told me that it comes from swelling in my throat and at the top of my esophagus as a direct result of the LPR.

I've taken nearly every PPI under the sun (currently taking Dexilant), and they all work for a little while then quit. One thing I did notice on my upper GI was food and liquid tends to sit in my esophagus before moving down to my stomach and I have to drink a lot to make anything go down. Not sure if this interferes with breathing or not, but I will ask my doc the next time I go.

Have they done a laryngoscope on you to see if you have any swelling in your throat and around your esophageal opening that could hinder your breathing?

 
Old 04-26-2011, 12:24 PM   #3
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Re: Hiatal hernia & breathing problems - does surgery help????

I'm sorry for your trouble, I know how annoying it can be. We've both been dealing with these issues for far too long unfortunately I had a laryngoscope done at an allergist and he told me that I had a paralyzed vocal cord. Whatever that means! I've had several tests on my lungs, been to lung specialists and allergists. All they can tell me is that I am slightly allergic to pollen. When I saw my gasteroenterologist last week, he told me that the hernia is most likely pressing on my diaphragm, making it difficult for me to breathe. He put me on Dexilant, but I called him a couple days late b/c it was not working at all. He then put me on Aciphex. I called him yesterday morning to let him know that it is not working. He told me to continue to take Aciphex once a day. Along with another liquid medicine (which he phoned in to my pharmacy for me, I will pick it up tonight) 4 times a day!!! 4 TIMES!! Sheesh. So, my follow up appointment is May 18th, I think I will discuss surgery with him then. I just can't live like this anymore. Have you thought about surgery, Indianmist?

 
Old 04-26-2011, 04:29 PM   #4
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Re: Hiatal hernia & breathing problems - does surgery help????

Hey Cards,

Yes, I've thought about surgery and discussed it with my doctor, but he wants me to try losing some weight first to see if that helps. Plus my throat gets so swollen, that it's also a huge factor in my breathing issues. The last time I had an upper GI ( which was sometime last year) the hernia had shrunken in size; at least it went from medium size to small, so i'm hoping with a bit more weight off it will go away completely.

 
Old 04-26-2011, 05:41 PM   #5
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Re: Hiatal hernia & breathing problems - does surgery help????

I had a Nissen Fundoplication in 2008. The procedure resulted in my hiatal hernia being "fixed". I'm still dealing with LPR/GERD symptoms, but I'd still try the surgery again in a heartbeat. I think it really depends on the severity of your symptoms, how effective medications and lifestyle changes are and how much the symptoms are affecting your quality of life. Any surgery is a serious thing.

In my case, my LES had become extremely weak. I wasn't as concerned about the hiatal hernia as it was a sliding one. My problem was that the acid was constantly irritating my lungs as well as my throat and causing some extreme breathing problems. I'd made the lifestyle changes years before and continued to follow them and I'd tried all the PPI's on the market and they were no longer working for me. Being able to breathe outweighed any other concerns I had when considering the surgery.

For me, it was a good decision.
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Old 04-26-2011, 05:50 PM   #6
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Re: Hiatal hernia & breathing problems - does surgery help????

MountainReader,

If you don't mind me asking, when you took the PFTs, did they show diminished lung capacity and impared lung function? Mine show nothing that would point to Asthma, although I wish it did, as it would explain so much of what's going on.

 
Old 04-26-2011, 10:21 PM   #7
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Re: Hiatal hernia & breathing problems - does surgery help????

Feel free to ask. I love that these boards are here to help each other. I wish I'd found them years sooner.

I've had PFT's yearly for about 4-5 years now. All have come back normal. Of course, by the time I get a Pulmonology appointment, then get my PFT's scheduled, I've never had them done when I'm at my worst. What a difference a few months makes sometimes in the flow of things.

It was actually my Pulmonologist who helped me figure out how much the acid reflux was affecting me. He spent about 45 minutes with me on my first visit several years ago and pretty much diagnosed it just from all the questions he asked. He was also the first to order a Modified Barium Swallow and Esophagram. The Barium Swallow showed the acid coming up and showed it hitting my lungs and coming up past my throat.

I also had 2 24 hr pH tests and 2 Manometries a couple years apart. During that time I went from severe to extremely severe with my results. By the time I had the second one, I'd tried all the PPI's on the market. At first, they helped, but as my symptoms got worse over the years, a couple helpedonly a bit, but the rest didn't do anything for me. None resolved my symptoms completely anymore. One even caused me permanant digestive issues the side effects were so bad. The Manometry showed my LES wasn't working like it should. I've had several EGD's that have all come back normal. Chest x-rays were also normal.

In my case, I actually do have environmentally and possiblly allergy triggered asthma. When flares of symptoms kick in, I don't always know if it is just asthma or acid triggered asthma. With the acid though, it irritates my throat causing chronic coughing. The coughing causes my stomach to squeeze and resulted in more acid coming up which ended up irritating my lungs and sometimes being aspirated into my lungs in addition to irritating my throat more. I'd end up coughing from the lung irritation and from the irritated throat. It becomes a viscious cycle. I was on the PPI's twice a day and supplementing with OTC reflux meds, eating a restricted diet, sleeping on an incline, taking lots of asthma meds and steroids, etc... Still I was coughing. My last straw was an incident that led to needing emergency care. I was just moments from totally passing out from lack of oxygen when I actually got to care. I was scared for my life. My asthma meds just couldn't keep up with the acid irritation. I knew then that surgery was the right option to me.

On my follow-up appointment with my Pulmonologist after surgery, he told me he had come from the bedside of a patient in the hospital in serious condition who was in a similar situation to me. He said if I hadn't been as proactive in my own care as I had been, that could have easily been me. Until then, I had no idea acid reflux could be so serious for some people.

I even had 4 of my specialists and an anesthesiologist recommend the surgeon who did the surgery so that made my decision even easier.

By the way, I coordinate my own care with multiple doctors. I have my primary care doc, a Gastroenterologist, a Pulmonologist and an ENT/Allergist. Crazy how something as common as acid reflux crosses so many areas. The stomach and digestive issues, the lung issues, the throat issues, the quality of life issues.

Please feel free to ask more questions if there is something I didn't touch on.
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Last edited by MountainReader; 04-26-2011 at 10:25 PM.

 
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Old 04-26-2011, 11:45 PM   #8
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Re: Hiatal hernia & breathing problems - does surgery help????

MountainReader,

Thanks for answering my question! Did they give you a methacholine challenge as well? When I had my tests done, I literally thought I would die during the test. The methacholine irritated my throat in the same way that acid does and I started having the same symptoms while testing, so I was sure something would show up, but nothing except over inflated lungs. I know that can be a sign of Asthma but the doctor told me that it can also be caused from breathing in deeply.

Never had low pulse ox during any of these episodes, although sometimes ny levels will get low while sleeping.

I'm going to ask my doctor about PH testing and the modified Barium swallow. My symptoms are worse when my throat is swollen like now. It's very sore and feel as though it going to close up on me.

I must add this breathing issue came about after my gallbladder removal, before then if I had any shortness of breath it went away within minutes, after surgery the shortness of breath is all day everyday.

Is your breathing any better after surgery? How are you feeling now?

 
Old 04-27-2011, 07:49 PM   #9
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Re: Hiatal hernia & breathing problems - does surgery help????

I had my asthma diagnosis a couple years before my acid reflux diagnosis. My most recent PFT's have been just the regular testing with the albuterol, not the challenge testing.

When my reflux is flaring, I can't even breathe in for the doctor to listen to my lungs without it setting off a bad coughing fit.

Even when I'm coughing almost constantly and can't catch a good breath, my pulse ox is typically pretty normal. I had nighttime pulse ox monitoring 3 months apart this last year. Ironically, the first one came back normal while the second one didn't.

I noticed an immediate difference after surgery. Typically the Nissen Fundoplication has higher success rate for people with breathing problem symptoms.

Unfortunately, while testing shows my surgery is holding intact, my problems returned this year. Turns out I have a high amount of gaseous acid coming up during the majority of the day and that is what causes my irritation. While I swing from keeping the symptoms under control to flaring for months at a time, I would repeat the NF in a heartbeat. I would be so much worse at this point without it.

My last reflux "flare" was from July-September of last year. I've done well since then. I was extremely careful with my asthma this winter and wore a mask outside all winter. I got made fun of, but I was bound and determined not to allow the reflux-asthma cycle to start back up. I still get some breakthrough symptoms, but I've been able to keep them under control with my Dexilant and adding some OTC reflux meds.

I do want to clarify that my case is unusual on the extreme side. I have 4 doctors who all basically say the same. My PCP even told me I had the worst case that has ever come through their entire clinic.
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Old 04-28-2011, 04:31 AM   #10
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Re: Hiatal hernia & breathing problems - does surgery help????

I have exactly the same issue. My Dr sent me for a sleep apnea test No sleep apnea

i think it is from the meds I am on prilosec for 3 years and my breathing is bad especially at night. I am going next week for a breathing study ordered by my pulmonologist. These acid reducers are terrible but they are all they have to reduce the acid. I have trie dto wean myself off them. I feel worse!!!

 
Old 04-28-2011, 06:15 PM   #11
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Re: Hiatal hernia & breathing problems - does surgery help????

Mountain Reader,

I pray you can get your asthma and reflux under control. I know it must be extremely difficult to deal with both on a daily basis. I know of one thing that contributes to my symptoms. chronically low potassium and magnesium levels; they stay low despite eating mag and potassium rich foods, so now they are trying to find out what's causing it.
When those levels are low my breathing is always worse.

I will ask my doctor about the modified barium swallow and the EDG. I hope that I won't need surgery, but the way things are going, I might end up with it.

When I think back on my mom and her chronic pneumonia, I'm more than certain it was her acid reflux causing it, so now I get a shot every 5 years to prevent that. everyone in my family suffers from reflux, so I think it's more than likely some hereditary LES/UES weakness.

I hope you are feeling better today!

 
Old 04-28-2011, 06:19 PM   #12
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Re: Hiatal hernia & breathing problems - does surgery help????

Hi bigred,

I have sleep apnea, but can wear my mask they way they want me too because the acid ruined the inside of my sinuses to such a degree, that I now need surgery to fix them.

Yeah, those PPI's are terrible; I rarely take mine anymore but I'm going to try the Pepcid AC, because it helped me before.

Maybe the PFTs will tell them something. Good luck!

 
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