Ugh... yeah, I have a 4 cm hernia. Horrible to live with. They do nissens all over the place, just be sure to have an doctor who's done a ton of them before, and a thoracic surgeon will be better than a general surgeon. Good luck!

I don't know what size large hiatal hernia is is a 4 cm considered large? My friend told me to go to NYC but I don't know any doctors
there. What a problem, I really don't want surgery, but I can't live like this being so weak....I know this is a difficult
surgery and I don't want to suffer for the rest of my life after surgery

Mayo did call it "large" in all of my imaging from the past year.

The only medical center I know about in NYC is Mount Sinai, and it's pretty large and well-known.

If it's any help, I've also had my gallbladder removed (age 40) and had my appendix removed in 1991 with a four-inch incision (age 19), and this fundoplication surgery was *much* easier on me than those two were.

The biggest plus is that the surgery allowed me to stop taking all of those proton pump inhibitor drugs. These drugs were NOT intended to be used long-term -- I think no more than 14 days or so. And here's a very important fact to know... even if you don't have genetic polymorphisms like I do, drugs like Nexium (esomeprazole) inhibit the liver enzyme that your body uses to metabolize all medications that are also metabolized via that enzyme. It basically slows down the your body's ability to get that drug out of your system. Nexium actually inhibits the enzyme that it itself needs to be metabolized. And if you are on any other medications that are also metabolized by that enzyme, it slows down the metabolization of those meds, too.

Unfortunately, the overwhelming majority of doctors out there have such a rudimentary understanding of this system (called cytochrome P450), that they have no clue about the ramifications of long-term use of certain drugs like this. Frankly, I'm *stunned* by how little doctors know about this system of the body and how each drug they add or remove from a patient's regimen can morph how the patient's entire drug metabolization methodology.

I've been using PPI's for years and years, that's probably why my gastroenterologist told me to get a bone density test and it was
discovered I have osteoporosis. May I ask what is polymorphisms? I'm taking an iron pill for this weakness, B12, my Vit. D for the osteoporosis and calcium. I'm not feeling any better though, that's why I'm so scared that he will tell me I'm losing blood. The dr. doesn't even know how I'm feeling right now, all this weakness. I agree I am very surprised doctors don't realize how pills have bad side effects for some people.

I just saw your question regarding polymorphisms.

Mayo figured out that I have multiple cytochrome P450 liver enzyme drug metabolization polymorphisms. P450 is a huge system in our bodies that does different things. Part of it is in the liver and consists of a bunch of enzymes that help us metabolize medications, hormones, and toxins. Mayo figured out that a bunch of my enzymes are polymorphic, meaning they are mutated, causing me to improperly-metabolize many medications, which I had been taking for years. One of these medications was Nexium and its generic equivalents. The thing is, even if you don't have polymorphisms like I do, you can still be negatively affected because many drugs inhibit these enzymes from working properly. Nexium even inhibits the very enzyme that it itself needs to be metabolized, so if you take it for a super-long time, which for me was 12+ years, it can make you sick, like it did me.

Can you suggest a thoracic surgeon from Mayo Clinic that does Nissen Fundoplication. Its time I start doing something about this
hiatal hernia. But I don't know of any doctors that do this surgery near my home. Any help from you would be so greatly
appreciated.

I believe what you want is a thoracic surgeon.

Have you been to Mayo before? They will likely want you to meet with a GI doctor first, and they will then order testing and maybe some labs. You usually don't get to choose which doctor you get, but that's okay because they are all great.

I see Dr. Jeffrey Alexander in GI. He then finds a thoracic surgeon. My thoracic surgeon is Dr. Francis Nichols.

I first met Dr. Alexander in January 2016.

I had a follow-up with him in August, and at that time he said that I was now a candidate for the surgery because I had lost some weight, was healthier, and they had also learned that I cannot take PPIs due to genetic issues. He asked if I could stay a week longer to do the testing and have a subsequent follow-up with him and the surgeon because I lucked out and another patient had just cancelled all of these same appointments I needed.

At the follow-up, I met with him again, and then he pulled a thoracic surgery PA and Dr. Nichols into the room. We talked everything over, and Dr. Nichols then pulled his schedule/calendar up on the computer screen and we picked a surgery date.

No, I have never been to the Mayo Clinic<br>I hope what you say is true, that they are all great<br>Don't need any mistakes or problems at my age, I'm 75yrs. old<br>This hiatal hernia never ever bothered me only having the heartburn<br>Its only been bothering me on and off for the last year. I get very weak<br>and no energy, I think I'm losing blood, so my gastroenterologist wants<br>me to have a colonoscopy which I haven't done either. <br>Not crazy about the prepping for it.<br><br>Do the doctors mention to lose weight, before surgery? I've been trying for years without success.<br>How are you feeling now? Are you happy you went thru with it?<br><br>Let me know, thanks so much for the information<br>Regards,<br><br>Caress<br><br><br>--------------------------------------------<br>On Wed, 2/15/17, Mayo Clinic Connect wrote:<br><br> Subject: @kdubois replied to I'm scheduled for Nissen Fundoplication surgery @ Mayo next Tuesday...<br> To: barpet63@yahoo.com<br> Date: Wednesday, February 15, 2017, 12:49 PM<br> <br> .<br> Mayo<br> Clinic<br> ConnectReply<br> by @kdubois<br> in Digestive<br> Health on Wed, Feb 15<br> <br> Reply<br> I believe what you want is a thoracic surgeon. <br> <br> <br> <br> Have you been to Mayo before? They will likely want you to<br> meet with a GI doctor first, and they will then order<br> testing and maybe some labs. You usually don't get to<br> choose which doctor you get, but that's okay because<br> they are all great. <br> <br> <br> <br> I see Dr. Jeffrey Alexander in GI. He then finds a thoracic<br> surgeon. My thoracic surgeon is Dr. Francis Nichols. <br> <br> <br> <br> I first met Dr. Alexander in January 2016. <br> <br> <br> <br> I had a follow-up with him in August, and at that time he<br> said that I was now a candidate for the surgery because I<br> had lost some weight, was healthier, and they had also<br> learned that I cannot take PPIs due to genetic issues. He<br> asked if I could stay a week longer to do the testing and<br> have a subsequent follow-up with him and the surgeon because<br> I lucked out and another patient had just cancelled all of<br> these same appointments I needed. <br> <br> <br> <br> At the follow-up, I met with him again, and then he pulled a<br> thoracic surgery PA and Dr. Nichols into the room. We talked<br> everything over, and Dr. Nichols then pulled his<br> schedule/calendar up on the computer screen and we picked a<br> surgery date.<br> VIEW<br> & REPLY or reply to this email to respond.Unsubscribe<br> from this discussion thread.<br> Notification preferences can be set in your Account<br> Settings<br> <br> <br> <br>

I've had excellent doctors in all of the specialties I've seen there... GI/Hepatology, Endocrine, Sleep, Nephrology, Pulmonary, Neurology, and NeuroPsychology. (Hmmm... I think that's all of them.) Doctors at Mayo don't strictly stick to 20 minutes and then kick you out the door like they do elsewhere in the country. They spend as long as you need with them. I've even had Mayo doctors chat with me and walk me to the elevator, and I've had Mayo doctors hug me after giving me good news. These are truly nice people.

As part of the pre-surgery testing, they will most likely have you do a manometry and then an esophagram if they want to further-test your esophagus after the manometry. You will need to go off of any PPI and H2 Antagonist medications, and then they will most likely want you to have an endoscopy (I think). They are checking to see what level of esophageal burn you will have from the hernia and not taking the medications. I've had them all performed there, and I've also had a colonoscopy there. Instead of prescription stuff for the prep, there is a prep that I do that uses Dulcolax and Miralax. You can google it and then ask your doctor before the colonoscopy if they feel this is a viable alternative. It's much more tolerable when it comes to having to taste it.

Many surgeons won't perform many types of surgeries if people are heavy because the weight can negatively-affect the outcome. In January 2016, I weighed in at Mayo at 198 pounds. After they figured out that I don't properly-metabolize certain medications later in the year, I was weaned off of them, and I lost ~50 pounds by the time I went back to Mayo in August.

I cannot even tell you how glad I am that I had this surgery. I wish I had done it years sooner!

Good Morning kdubois: I'm re-reading your post about Nexium, I have a feeling I kinda have that sort of problem with Prevacid. A lot of times when I take Prevacid, hrs. later I may feel a little heartburn, I don't know if that's from what I eat, or the problem you were talking about enzymes being polymorpbhic, I'm just guessing, don't really know. Did you ever think to go to the Florida Mayo Clinic? I was thinking about it because its closer. Let me know, again thanks for all the detailed information which I needed to make a decision about this hiatal hernia. Were you ever a nurse?