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Old 06-09-2011, 08:27 AM   #1
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Manometry - is it horrible? Is it required for Nissen Fundoplication?

My gastroenterologist referred me to a general surgeon b/c he wants me to have surgery to repair my hiatal hernia (Ive had it since 2002). I had a horrific experience with this surgeon, his bedside manor was just AWFUL. I understand that some surgeons are not the most charismatic people in the world, but this guy was rude. So rude, in fact, that I cried for a few minutes once I got in my car. He told me that I would have to have a manometry test done and that I would "hate it because it is VERY uncomfortable." He said they stick a tube down my throat & I would be miserable. He said I absolutely have to get that done before my nissen fundoplication. Is this true? Or is he just giving me the run around? He was so rude, I couldn't tell. I have had multiple barium swallow tests, scopes, etc. over the years. Just wondering if this really required? And, is it as horrible as he made it seem?

 
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Old 06-09-2011, 09:27 AM   #2
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Re: Manometry - is it horrible? Is it required for Nissen Fundoplication?

Yes, you need to have the pressure measured. If your pressure is too low, the Nissen is much more likely to cause serious swallowing problems.

I haven't had mine yet, but generally you're sedated, and I can't imagine it would be worse than any other endoscopy. Ask the place doing the test whether you'll be sedated.

It's possible that the barium swallow test might provide the necessary info, but if your surgeon insist on the manometry, that's what you need. The last thing ANY surgeon wants is to operate on someone who's a bad candidate.

Check into this guy's reputation, and decide whether his skills are good enough to make you overlook his unkindness.

 
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Old 06-09-2011, 07:49 PM   #3
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Re: Manometry - is it horrible? Is it required for Nissen Fundoplication?

I had a Nissen Fundoplication in 2008. I had a couple barium swallows/ esophagram's and a couple manometry tests done over the years.

Please make sure you are confident in your surgeon. If not, you might seek out a second opinion to do your surgery. Make sure to ask how many of these procedures he has done before.

Yes, you do need to have a Manometry. No it is not horrible. If you don't have good esophageal motility, the Nissen Fundoplication will cause you many problems with swallowing and you wouldn't be a good candidate for the surgery.

If you search through some of my posts through the years, you will see descriptions of what I experienced. Basically, they have you sit in a chair next to the Manometry machine. The technician will numb the nostril of your choice and the back of your throat. The spray they use in your throat tastes across between gasoline and banana--it goes away quickly. They will give you a couple minutes for the numbing to take effect. They will give you a glass of water with a straw. Then, they will take a probe that is attached to the machine and place it up your nostril and down your throat. They will walk you through this process and have you swallowing water as they guide the probe so it is kind of like you are "swallowing" the probe. If you focus on the swallowing, it isn't too bad. Just don't think about gagging or try to fight the probe, that can make the experience worse. If you focus on the swallowing, you will be just fine. As they guide the probe down your esophagus, they will have you take swallows of the water periodically to help get good measures of the pressure in your esophagus. They will also be measuring the pressure of your lower esophageal sphincter as well. Once they are done, they just pull the probe out. It doesn't hurt and only takes a couple seconds. The entire procedure should be done in about 10-15 minutes or so if you have a good technician.

I have never heard of sedation with a Manometry. I would think that it would keep you from getting good results since you wouldn't be getting readings as you swallow.

Have you had a pH probe or Bravo test done? My insurance required that as well before I could be approved for surgery.

Let me know if you have any further questions on the test or the surgery. I'm happy to share my experiences to help others learn through my experience.

Good luck and stay strong.
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Old 06-09-2011, 09:56 PM   #4
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Re: Manometry - is it horrible? Is it required for Nissen Fundoplication?

Huh. That's interesting. I apparently misunderstood my doctor's explanation of those tests, which I'll be having soon.

Still, manometry needs doing. I've been browsing the medical literature, reading all the Nissen studies I can get my hands on. The most common long-term complication is swallowing problems, and quite a few studies stressed that people with motility problems were more likely by far to suffer that complication.

 
Old 06-09-2011, 11:27 PM   #5
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Re: Manometry - is it horrible? Is it required for Nissen Fundoplication?

***** had a good explaination of a Manometry.

www.*****.com/heartburn-gerd/guide/esophageal-manometry


After you have a Nissen Fundoplication, you will always have to be careful with swallowing, even if everything goes as planned. Food can get "stuck" above the wrap and it can be uncomfortable. When that happens, the food will eventually go down. It is a bit disconcerting, but breathing is OK so it just needs time to work its way down. I just need to make sure I cut up my food in small enough pieces. It took me months after surgery before I could eat meat or bread. To this day, I still have trouble with angel food cake since it doesn't break down well when chewed. For the most part I'm good if I don't make any foolish decisions in my eating though.

Honestly, my breathing issues were so bad from my acid reflux that I'd make the same decision to have the surgery again. To me, being able to breathe far outweighed the possibility of other side effects.
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Old 06-10-2011, 05:27 AM   #6
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Re: Manometry - is it horrible? Is it required for Nissen Fundoplication?

Thank you both for reassuring me. I really appreciate it. If you say its not that bad, then I believe you Ive had something similar done before at an allergist, they numbed my nostril and throat & placed a tube down my throat, to get a good view of my vocal cords (they thought I had a paralyzed vocal cord). It wasn't the best experience, but it also wasn't "terrible," so if it is similar to that, I'll be ok. And if it's what I have to do in order to get the surgery, I'm willing!
Mountainreader - yes, I've had the 48 hour Bravo capsule test & a barium swallow. I was also told something about a gastric dumping study? Ive done research on that & it doesnt seem so bad. And I completely agree with you, I only want someone performing a surgery on me if I feel comfortable with them. This guy seemed like he didn't care at all, he just wanted a paycheck. And my breathing problems have gotten terrible, that's actually what has led me to this point. What were your breathing problems, and have they improved since your surgery?
I called my doctor and asked him to refer me to another surgeon, and I meet with him on Monday. So, we'll see how it goes. Hopefully better than my last appointment!

 
Old 06-10-2011, 07:52 PM   #7
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Re: Manometry - is it horrible? Is it required for Nissen Fundoplication?

Hi Cards,

The Manometry is a bit worst than that one at the ENT, but not a whole lot. If you can handle that, you should be fine.

I have GERD and LPR. My worst reflux symptom has been a chronic cough. At times, it gets so bad that I can't catch my breath. When I flare, I typically go about 4 months straight with not being able to get a good breath and with constant coughing. It isn't a gentle cough either. It is a loud rough cough. The acid irritates my lungs and throat. What hits my lungs irritates them and ends up flaring my asthma. Ironically, with all the coughing, it squeezes the stomach and causes more acid to come up and irritate my lungs and throat. It becomes a viscious cycle.

I end up on multiple reflux meds, asthma meds, cough meds, muscle relaxers, tricyclic anti-depressants, etc... just for the acid reflux trying to get my symptoms under control. At one point before surgery, I was on 12 prescriptions and things still weren't under control. (This was on top of diet and lifestyle changes.)

I had a couple pH tests, endoscopies, manometries, ENT scopes, Modified Barium Swallow/ Esophagrams, blood work, etc... Basically my acid reflux went from severe to extremely severe and the manometry showed my LES wasn't functioning properly. It was actually my Pulmonologist was the one who recommended the surgery to help with my asthma/breathing problems/cough. I got second opinions from my GI doc, ENT and PCP who all agreed that it was the appropriate next step. (Personally, I think they were all tired of seeing me with so many office visits when I was struggling for months on end. ) They all recommended the same surgeon as well and said that is who they would personally go to. The surgeon was pretty text-book when I went to him and I felt comfortable. I did have a recommendation to go to a local university GI doc for another opinion, but I was so far into the process and so miserable at the time that I decided to go with the docs I'd already been to.

My Modified Barium swallow actually showed the acid hitting my lungs. What made me really agressively persue the surgery was an incident that scared me to death. I was on the highway driving to work and all the sudden couldn't get a good breath. My inhaler didn't help at all. By the time I got to the emergency doc, I was lightheaded, numb, my fingernails and lips were purple and tingling and I started hyperventilating because I couldn't get a breath. I was moments from passing out from lack of oxygen. Fortunately, I was able to get emergency treatment.... what would happen if it happened again and I couldn't get to treatment so fast? When this attack hit I was on the 12 meds at the time already and I was diligent about following the instructions of my doctors in treating myself.

From the moment I woke up from surgery, my cough disappeared. It was that effective for me. Unfortunately, last July my cough returned. I had an upper LES pH test done last fall that measures gaseous acid and it was found that I still have acid coming up into my throat almost 50% of the day even when I'm "symptom free". (On the day of the test I was actually feeling pretty good.) I would have the surgery again in a heartbeat because it has been effective, but it is not an absolute solution. The surgery tightens things to keep less acid from coming back up, but because they have to leave it loose enough for food to go down, it also will allow for acid to come up sometimes. From what my doctors have said, I appear to be pretty abnormal in the severity of my reflux. My PCP said I was the worst patient that had ever come through the clinic, my Pulmonologist said my results were very "impressive" and my ENT said I was doing 'everything right' but that my reflux was still severe. I can only imagine how bad off I'd be now if I hadn't had the surgery. On my visit with my Pulmonologist following surgery he indicated he fully expected to see me as a hospital patient in bad condition as severe as things were. He said if I hadn't been aggressive in my own treatment things would have been even more life-threatening.

Currently, I haven't needed my asthma inhaler since last October and I just went off all my asthma daily meds. I credit part of that to the surgery.

One thing I should note is that I never went off of PPI's at all per my GI doc. I'm currently on Dexilant with Pepcid or Gaviscon for supplementation. I appear to have things under control now though which wasn't the case prior to surgery. Most people who have surgery are able to go off of the PPI's though.

I know that was a long rambling answer, but I was in such bad shape prior to surgery that I'm pretty passionate about treatments now.

I hope you find something in my answer that helps.

Good luck on your appointment Monday.

MountainReader
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Last edited by MountainReader; 06-10-2011 at 07:53 PM.

 
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