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Nausea/vomiting-post esophagectomy
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Nausea/vomiting-post esophagectomy

I apologize first for the length of this post.

My fiance had an esophagectomy in October 2007 (Ivor-Lewis) due to high grade displaysia.  The vagus nerve was removed as were both “flaps” (sphincters?) at top and bottom of stomach, which was pulled up to make the reconnection.  All biopsies showed NO cancer.

He had many complications after the surgery, including three bouts of pneumonia, two of which were followed by c. diff, and one which was caused by aspiration.  He was actually in a coma for approx. 14 hours.  He spent two months in the hospital and one month in a rehabilitation center.  Even when he came home, he truly wasn’t ready to be home.

Approx. March 2008, he began vomiting regularly.  Mostly this does not consist of food—just foamy clear/white, thick phlegm (?).  It seems to be “triggered” by eating, but when he gets going, it takes a very long time for him to stop again.  He has made several visits to his regular physician, several visits to the emergency room.  

His surgeon dilated him 1.5 cm several weeks ago.  He said he didn’t believe the small amount of narrowing that was present was the cause of his gagging/vomiting.  

He has now been in the hospital for 11 days.  He was taking a large amount of medications (Albuterol, Atrovent, QVAR, Norvasc, Cozaar, Lopressor, Hydralazine, Plavix, Lisinopril, Lipitol, Elavil, Wellbutrin, Duragesic patch, Glucophage, Reglan, Klonopin, a multi vitamin and iron.  They doctor(s) have removed some medications and added some medications.  

As of this morning, his list of medications was: Duragesic patch, Norvasc, Wellbutrin, Klonopin, Cozaar, Toprol, Protonix, Zofran, Albuterol, Atrovent.  

Fortunately, they have determined that he does not need the Glucophage at this time.  His regular doctor had told him well before the surgery if he lost weight, this might be the case.  Prior to surgery his weight was 236 pounds.  He now weighs 150 pounds.  

The Duragesic patch was removed a short time ago, but we don’t know if this is the problem.

I guess the question at this point is where should be looking to go from here if this is not medication-related?  One of his doctors (a fill-in doctor) even told him that it’s possible for the vagus nerve to grow back…is this true?  If so, what can be done about this?  

The kicker to this entire story is that his regular doctor is currently in the hospital and has been for the past 10 days!  So he is not even getting “treated” by his regular doctor, but his substitute.  Over the holiday weekend, it was the substitute for his substitute.  To say this is frustrating is an understatement.  And quite frankly, I am really scared watching his weight continue to plummet, as well as his spirits, and knowing he is not getting enough nutrition.

PLEASE HELP.

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Avatar_n_tn
Have his doctors mentioned liquid magace (appetite enhancer) and/or reglan (helps with vegus nerve damage)?  My husband is on both for loss of appetite, nausea, vomiting etc.  At this point we're not sure which one in helping the most.  But, his appetite is back and he doesn't have any nausea.
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Avatar_n_tn
Hi, mysay.  Thank you for your post.  We finally got to the bottom of things!  After the 12-day stay in the hospital, where they tried changing and/or removing different medications and perforemed an upper G.I., we were ultimately told by the docotor filling in for his regular physician to, "Go home and learn how to deal with it" [the throwing up].  OMG!  

After yet more time throwing up, we decided it was time to contact his original gastroenterologist.  We had an appointment within two days and an endoscopy done within a week.

It runs out that: (1) he had an ulcer and severe irritation at the juncture where the stomach and esophagus were joined, which also had food particles stuck in it; and (2) he had acid reflux (which we were told by his surgeon was not possible after the esophagectomy!!!!!!).  The G.I. doctor dilated him and immediately put him on Prevacid (solutab) 2x/day.  He has had to go back twice for more dilations, but each time, he has gotten longer periods out of them.

He was finally able to get into and complete his physical therapy, but he is still not half the person (literally) he was before the surgery.  He has only regained about 5 pounds of the almost 110 he lost.  

It's been just over a year, and he still says he would NEVER have this surgery again, and I agree.  If anyone said they were going to have it, we would give them the sneakers and tell them to RUN, RUN, RUN.  Take your chances at getting the cancer.  This man's life has been truly ruined by this surgery (including the fact that his lungs were permanently damaged from the aspiration...but they don't tell you the full ramifications of aspirating going into the surgery either).

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Avatar_m_tn
Had esophagetomy 8 weeks ago due to cancer. I am having problems with dry cough, dumping and vomiting and have lost 40 lbs in 8 weeks with more to go I'm sure. However, I suggest if you are diagnosed as I was you HAVE the surgery regardless of post surgical issues. Due to my surgery I will live past the 18 months they gave me as my PET shows no cancer

Sorry to hear of all the problems you guys are having but for me and others Death is the result if nothing done and that is guranteed.
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Avatar_f_tn
My husband had an esophagectomy and stomach resection in January 2011 after completing radiation and chemo for a stage 2 carcinoma.....it worked he is cancer free as of Feb 2012 we will continue to follow...our issue..he's coughing uncontrollably and as a result vomiting he has lost a considerable amount of weight...he weighs around 123 lbs and is 5'7"....yes a virtual skeleton.....his doc says reflux apriation yet his recent egd says everything is fine so does his recent cat scan.....several xrays says lungs are clear...been to his pcp (referred us to pulmonary specialist) waiting for appt....when he got worse called pcp who referred him to his gastro to find out why he was vomiting.  spoke with gastro and then ended up in ER dehydrated and sick..they gave him fluids actually listened to us and decided it was most likely whooping cough as there were several cases in the area and his symptoms fit....gave us a script for 5 days of meds and said to follow up with his pcp (who really hasn't been much help) with no insurance we don't have much choice....he's lost soo much weight now I can barely get him to eat..... it's a nightmare as we leave on a 1500+ mile trip to move home near family......anyone else have any suggestions the meds worked while he had them but now he's coughing and throwing up again...his pcp treats him like he's just trying to get narcotics..please, really....no insurance means treatment at the ER or going back to the pcp who doesn't care.....prayers appreciated and suggestions welcomed....he's young to have this they tell us age 48....we have 2 teenage daughters...it's hard seeing him go through all of this I don't know what more I can do...
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Avatar_f_tn
KayJay, we've had 2 cases similar to what your husband is experiencing and found that both had some form of food intolerance. When the 'offending substance' was removed from the diet all discomfort was relieved. I know one was due to dairy, but don't remember what the other person had. Apparently neither had overt food issues before the surgery.
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Avatar_m_tn
My husband had an esophagectomy 3 yrs ago and is still suffering from severe nausea, every day after every meal..... you may want to try:  zofran (sublingual) for nausea/vomiting....... ginger (bought at grocery store near spices) suck on several pieces..... these did not help my husband, but you may want to try them.

If you are interested I found an esophageal cancer online community at ****.***  I just now signed up so I am hopeful at this point.  I wish you and your husband the best of life.

~Colleen~
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Avatar_f_tn
My hubby had the op - and is still suffering and trying to cope - and if  he hadn't he wouldn't be here now - horrible op I agree, but do you want to live?? - Hope all ok now x
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Avatar_n_tn
My father had the surgery, I take care of him daily. he would of died had he not followed through with the surgery. I would of lost my daddy. But it is true, he is having all sorts of complications, including the coughing, nausea, and the major fear is ACID REFLUX!!! the doctor claimed we shouldn't have that anymore so get off the prilosec. Besides getting used to eating and living again, he seemed to be responding to the surgery very well. Till the acid reflux began and the coughing, we were afraid that he was going to get fluid in his lungs. anyways i guess my main question and concern is what does it mean for him to have acid reflux again, even if the doctor said he shouldn't after the surgery?? im confused and so is he. I don't want anything to happen to him.... any ideas or similiar situations?
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Avatar_f_tn
Royalb23, I'm not sure how your doc could say your father wouldn't have acid reflux considering the upper sphincter is probably gone no matter where the stomach was placed - above the sternum or sub-sternal. The people I've worked with who have had this operation are routinely placed on PPIs and told to stay on them. If you think about how a normal stomach compartmentalizes and sequesters the acid within the stomach because of an upper and lower sphincter, and the acid is quickly neutralized as it is released into the small intestine by specialized cells and glands, it makes sense that if one or the two sphincters are removed there's either going to be acid released into the small intestine, or it's possible that acid could be moved into what's left of the esophagus (upward) with positional changes (if the upper sphincter is gone).

Go back and discuss it with the doctor. And in addition, consider making sure your dad is upright after eating, and when sleeping he may want to be in a slightly head/chest-elevated position.
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