Stop Heartburn: Fix that Hiatal Hernia

Stock photo of a doctorThis is the icky post, but I’m going to be offline for a few days and I’d rather use this last window of opportunity to say something that I’ve been wanting to say for a long time.

If you live in the United States or any place where you have been inundated by Nexium commercials, you have probably (like me) begun to tune out the “If you have heartburn 2-3 times per week, see your doctor” message. For the longest time, I thought those commercials were just trying to scare people into asking for Nexium.

While that may be a great marketing ploy, the truth is that the message is right on the money. I’ve learned that the hard way, although my condition has been diagnosed in time that I have an option many people miss out on.

I told my brother, after I was diagnosed, that if he’s having heartburn he needs to see a doctor. I thought heartburn and acid reflux disease were just normal, mild conditions that everyone experienced and there was nothing you could do about them. I was wrong. Worse, these conditions can reach a point where you have some serious medical problems.

I’ve experienced occasional heartburn since I was a kid. Never thought much about it. I used to drink a glass of milk and that solved the problem. About 9 years ago I had chronic heartburn that was so bad I woke up in the middle of the night and threw up several times a week (I told you this would get icky). My doctor concluded I had an ulcer and he put me on Cimetidine for a few weeks. The heartburn and the vomiting stopped after a few weeks.

A few years ago, I went out to mow the grass in New Mexico. I’d lived there for several years, and everyone told me that Albuquerque was the allergy capital of the world. I never seemed to have an allergy problem, so I figured I was lucky. Well, that day I spent about 20 minutes cutting grass and weeds in the front yard and then went into an allergy attack that lasted 12 hours. I finally took an antihistamine and went to bed for two days. Antihistamines knock me out and I rarely, rarely take them.

When I woke up two days later, I could barely walk. I was so dizzy I could barely stand up. That was my first experience with Vertigo, which lasted for about a month. My doctor put me on antivert (a standard antihistamine that doesn’t cause drowsiness). The dizziness gradually went away. I remember laying on the examining table in the doctor’s office, watching the ceiling writhe like it was alive with millions of white worms. He was writing a prescription for me and he said, “You can get up now.”

“I’ve tried twice,” I replied. He came over and helped me up. I wasn’t allowed to drive a car or operate lawn mowers or do much of anything for several weeks.

After I moved to Houston my allergy problems went away. But I took a job with a company that operates a refrigerated environment. During the course of 2-1/2 years I got sick a couple of times but struggled back to health. My doctor here in Houston treated me for a couple of oddball things where the medicines sometimes made me walk into walls. We switched medicines and I moved on.

A little over 2 years ago I caught a cold while working in the refrigerated environment without adequate clothing. The cold turned into bronchitis, the bronchitis turned into pneumonia. By the time my doctor had the pneumonia under control, I was having a massive Vertigo attack. This one lasted for 2 months, and I barely remember a few minutes here and there from that time frame.

The Vertigo was so bad I was referred to an Ear-Nose-Throat specialist who ordered some minor tests, determined he couldn’t find what was wrong, and he wanted to start doing massive tests like CAT scans (he still wants to). Well, I left that job and ended up back in Florida without insurance for a while, so I was careful not to do things that might trigger Vertigo attacks. One of the neat things about Vertigo is that you can wake up in the morning, completely incapable of standing up, crawl into the bathroom, throw up, and Voila! You can stand and move about.

Vomiting is one of the body’s ways of adjusting itself. The doctors don’t really explain how it works (maybe they don’t really know), but they all say, “If you feel a lot better after you vomit, why complain?”

Well, isn’t modern medical science wonderful?

Somewhere in my Floridian stay I started hitting antacids. Not much, but every few days I found myself with a case of heartburn and I started keeping antacids close to hand.

In late 2004 I moved back to Texas. The heartburn got worse. I eventually decided to just keep a bottle of antacids in my car and one at home. I was chewing antacids every two hours. Thought nothing of it because the heartburn went away. Just before it came back.

Well, last March I took a little trip up to Dallas and I got sick again. Cold turned into Bronchitis, Bronchitis turned into Vertigo. This lasted about two weeks because this time I was on to that trick. I sucked down every antihistamine and decongestant my body could tolerate.

Also, the ENT had told me to take a daily dose of B-100 vitamins. His treatment (which is not a cure) reduces the recovery time from a Vertigo attack to about two weeks. I can almost live with two weeks’ impairment. Almost.

The months moved on and my doctor started hinting it was that time in my life where I should do a certain uncomfortable test. “Look,” he said. “I’m a man, too. I hate this test. I’ve gone through it. But I don’t want to let anything go wrong down there that’s going to kill me. Do you really think that ignoring part of your body is going to keep you healthy?”

Okay, he was almost persuasive. We agreed that because I was eating antacids like candy that he would check out everything at once. Only, for reasons I forget, I couldn’t schedule the test last Fall as we planned. Well, what the heck? I didn’t want to take the test anyway.

But I got sick again this February. These colds-turn-into-bronchitis situations were getting old. Three years in a row around February or March I’ve gone through the same crap. This time my doctor gave me some powerful stuff that not only killed the bronchitis, he told me to start taking Claritin and a decongestant. “Don’t worry about what the dosages say,” he advised me. “I’m your doctor and I’m telling you to take THIS much stuff to get the gunk out of your system. And when do you want to do your tests?”

Okay, I let him scope me. The good news is that I’m healthy down there — no problems. But he then picked up a cardboard flipover illustration. “Have you ever heard of Acid Reflux Disease?” he asked me.

“Sure, I’ve seen the Nexium commercials. They drive me nuts.”

“Well, I’m not ever trusting you again,” he added. “And here’s why.”

He flipped the cardboard thingee open and said, “This is phase 1. This is phase 2. This is phase 3.” With each phase, you see more damage in the esophagus. There are only 4 phases. “This is you,” he concluded, flipping to phase 4. He held up a picture of my esophagus and compared it to the flip chart. If anything, I looked worse than phase 4.

“Most people in your condition would be screaming for narcotics,” the doctor continued. “You? You just pop some antacids and move on.” He rolled his eyes.

“Fortunately,” he added, “We got in there in time. I can fix you, but you have to make some decisions.”

Well, the ulcers were easily healed. He put me on Prevacid and I didn’t have to touch my antacids again. I almost donated them to charity, but I’ve been with them for so long there was a slight sentimental attachment to them — or maybe just some quiet paranoia.

But the reason why I have Acid Reflux Disease is that the aperture at the bottom of my esophagus (my food pipe) stays open. I have a hiatal hernia. Part of my stomach comes up through that hole every time I breathe. Worse, at night, when I’m laying down, fluid comes up and gets into my lungs. That’s why every little cold turns into bronchitis and pneumonia.

One of the most uncomfortable symptoms of this condition is that you cannot sleep. You’re constantly throwing up, or gurgling up. When I can drift off to sleep, I’m good for about two hours. Then I wake up choking and hacking and I have to sit up for an hour while my stomach settles. This happens even with the Prevacid. Of course, I sleep with more than one pillow. The more you elevate your head, the better. But that doesn’t fix the problem.

My doctor says I’m lucky because I have no scar tissue in my esophagus. If there were scar tissue, I would have to live with this for the rest of my life. But we diagnosed it in time and I’ve elected to have a laparoscopy, which is a relatively new surgical procedure. The surgeon will use microtools guided by little cameras to go in and tie off my esophagus. The really inconvenient part of the procedure is that I’ll be on a liquid diet for a few days.

I’m not looking forward to that, but my doctor and the surgeon assure me that I won’t need the Prevacid or antacids any more. I’ll be able to sleep normally. I won’t have to be afraid of getting a cold. Who knows? Maybe there is some connection to the Vertigo.

But there was one little catch. They wanted me to take a “motility test”. What was that? A nurse sticks a tube up your nose, snakes it down your throat, and then asks you to swallow. The tube has some gizmo in it that gauges your ability to swallow. There is no point in performing a laparoscopy if you don’t have the strength to force food down your newly closed esophagal aperture.

I was kind of put off by the description of the test, but I went ahead and tried to do it. I say, I tried to do it. I choked and gagged so much the nurse kept saying, “Do you want me to take it out?”

“I just want to get through this,” I insisted. “I don’t ever want to do this again.” Against my pleas she pulled it out. I was in so much pain tears were streaming down my face. I was sore for several days afterward.

So, my doctor conferred with the surgeon, the surgeon conferred with my doctor, they all said, “Maybe you should see an ENT.”

Conveniently, I knew one. My doctor agreed to refer me back to him. The ENT gave me the, “I’m not going to lie to you. I need lots of data before I can figure out what’s wrong. So it’s up to you how much we learn” speech.

He ended up having one of his assistants try to stick a tube up my nose. It didn’t go any better than the first time.

Well, by this point I’d scheduled the surgery but couldn’t get cleared for it. I called the surgeon and said, “I really don’t want any tubes up my nose.” My doctor warned me he might not approve the surgery.

“What’s the worst case scenario?” I asked.

My doctor shrugged. “Worst case? It doesn’t work.”

“Yeah, but what does that mean? What happens when you try to eat?”

“Oh, well, the food has to go somewhere. If you cannot swallow, it comes back up.”

I breathed a huge sigh of relief. “I can live with throwing up,” I said, feeling like a Bulimia victim. “I just don’t want you to say ‘Well, you could die.’ I’ll sue you if you kill me.”

He laughed. “You won’t die. If the surgery doesn’t work, they just undo it. But the purpose of the test is to see if they can do it safely. 1% of people are not candidates for the surgery.”

He proceeded to tell me in graphic detail about how many of his patients fall into the 1%. I’ll spare you the details, except to say that some of his patients are not out of their teenage years and they have to take Prevacid or a similar medicine for the rest of their lives. Children can have hiatal hernias, and if they go untreated the scar tissue develops and then they cannot have the surgery.

Meanwhile, back at the surgeon’s office, he just shrugs off the lack of a motility test. “It would be better if we could do it,” he said. “But I’ll just assume you failed it.”

“So I don’t get to have the surgery?”

“No, I’ll do the procedure, but I won’t do a full 360 degree wrap. I’ll just do a partial wrap. You’ll be able to swallow.”

Now they tell me….

Look, I don’t know how many people have chronic heartburn, but I know what you’re going through. If you think the Nexium commercials are just trying to make you paranoid, think again. When left untreated, Acid Reflux Disease can cause lesions that turn cancerous. And other things happen, too. Eventually, you become too old for any kind of surgery. And the impact on your quality of life is tremendous. Do you really want to wake up choking in your sleep every night?

I don’t.

So I’m going for the surgery. As far as the Vertigo is concerned, there may or may not be a connection. Doctors have lots of theories about Vertigo. I just know that if I can diminish the chances of developing bronchitis, I probably won’t have to suffer another massive Vertigo attack. I’m tired of losing weeks and months out of my life.

And that’s all for now.

Recovery time from the laparoscopy takes up to a week. I may be able to return to work before the end of next week. I picked Memorial Day weekend for the surgery because I wanted as little disruption to my life as possible. I’ll try to start blogging again around Monday.

Have a great weekend.

And those of you who know where I’ll be, remember to call me Friday evening like you promised. I’ll be going stir crazy about then.

I can only imagine what I’ll be like come Sunday evening….

The following comments were left on the original post.

Anonymous said…

I found your blog very helpful. My sister has the same symptoms as you including Vertigo. She often gets itchy swollen eyes on top of her heartburns…

Has the surgery helped alleviate the symptoms?

Thank you.

Michael Martinez said…

Yes, I had the surgery. The Vertigo was probably only worsened by the fact I got sick so easily. Anyway, I sleep much better now and don’t have all the heartburn and related problems. The recovery has been a little slower than I hoped. My energy levels are down and I feel a lot of pain and discomfort. My doctor says average recovery times vary, but take up to six months.

Anonymous said…

I have acid reflux and vertigo among other things like restless leg syndrome, eye issues, shortness of breath, etc. I’ve seen specialists and they all ran tests and couldn’t tell me what’s exactly causing them.

I tried acupuncture for the heck of it, and I couldn’t believe the results. Literally, shortly after the treatment, blurred vision went away. I lived with them for so long that I had blurry vision. Fatigue got better, I can sleep through the night without my leg cramps waking me up. Acid reflux hasn’t gone away totally but is much better than it was.

Vertigo also went away.

They told me that everything is related to liver energy being out of balance.

I would try acupuncture before surgery…

Michael Martinez said…

I believe acupuncture is a beneficial treatment system because, as I understand it, the process triggers physiological responses in the body. Western medical science confers only a grudging acknowledgement that something seems to happen with acupuncture, but hasn’t really endorsed formal study of acupuncture’s effects.

Nonetheless, acid reflux disease is itself more a symptom, in my opinion, of a deeper problem. It may have more than one cause, or so I was told by a couple of doctors.

If your acid reflux continues and you have not had an endoscopic examination, you should get one. You don’t mention what sorts of tests the doctors ran, but if they haven’t scoped you, they haven’t had an opportunity to rule out some very serious issues.

Esophageal cancer is a very real consequence of continuous untreated acid reflux disease. I would be very reluctant to leave my future in the hands of an acupuncturist, given that type of risk.