Update #2: Hiatal Hernia Confirmed, minimal esophageal damage, Bile Reflux, Reactive...

Had my upper GI this morning.  I have a medium sized hernia that will need surgery to repair.  There is minimum damage to the esophagus.  I have reactive hypoglycemia.  There's lots of bile in the stomach.  So, I have bile reflux not acid reflux.

This surgeon (not mine) stated that the hernia repair will not cure the bile reflux, only RNY.  However, because of the reactive hypoglycemia, he would not perform the RNY to cure the bile reflux because he believes the RH may become worse.  I would have to chose which to live with.  

Well, the bile reflux is a b*!ch!  I don't like the food sitting in my throat all night.  I don't like the acid in my throat all day.  Sleeping propped up is a pain.  I am in a catch 22--if I don't eat at bedtime, then I have less acid in my throat in the morning.  However, I have the RH symptoms of feeling weak and faint , high anxiety, etc.  I feel downright awful in the morning.

So, all my blood work came back OK with the exception of Vitamin D--its too high at 68 so my surgeon  told me to stop the supplements.  

Next stop:  Appointment with my surgeon.

I am off to Walt Disney World for my mother's birthday and Thanksgiving!!  Gotta have some fun through all of this because life really is good and I am truly grateful!

To address just a small part of your post, RNYers can almost always control RH with a proper diet. It's really not hard at all. I have no idea what can fix bile reflux, besides the revision.

Good luck at Mom's birthday!

Grim,

My thoughts exactly.  I am more than willing to watch my diet to deal with the RH rather than deal with the bile reflux.  I have read that RNY will reduce the bile--don't know about a cure but if I can have surgery to fix the hernia and rny to reduce  the bile at the same time, I'm great!  I told the surgeon I will not go for a third surgery if both can be done simultaneously.

 

The DS and the RNY both will reduce the likelihood of bile reflux, although the DS is better at it, statistically.  Any surgery that bypasses the duodenum has a tendency to fix bile reflux, because it moves the point of entry for the bile further from the stomach where it causes grief.  Definitely take a look at the DS too.  Either is an option, which I was told for my own bile reflux.

The hernia repair won't fix it because the pyloric valve may be week or under pressure.  Here is why if you are curious:

Eating a meal stimulates bile to flow into the duodenum - the duodenum is the curvy part of intestine right after the stomach.  The pyloric valve actually opens a teeny bit (like a few centimeters) to then let chyme (digested food) into the duodenum.  Sometimes if it does not close right, the bile will wash back into the stomach.  This isn't always problematic.  Sometimes though if the sphincter of your esophagus is damaged or weak it can creep up there, just like acid.

The interesting thing is that the stomach is very acidic and bile is actually alkaline and not acidic like the stomach - they are opposite environments.  In fact, the small intestine is basically (heh, chemistry pun) super alkaline (like a ph of 7-9) which helps to neutralize the hydrochloric acid of the stomach.  However, high alkaline substances are also prone to cause chemical burns just like stomach acid, which is why they can damage the delicate esophagus just as much (and sometimes more) than the stomach acid can.

A great example of another alkaline substance is lye.  Lots of people assume it is an acid, but it is actually a chemical base.  That is how caustic alkaline stuff can be!

Donna,

Thank you for responding.  I will definitely ask my surgeon about the RNY.  I can do one more surgery to fix the hernia and help relieve the bile. But I am unwilling to live with the bile.  It's just nasty!

Reactive Hypoglycemia can happen, but can also be controlled as Grim said. H.a.l.a. is a great source of knowledge on this. Search the posts and you will find lots of information...

NYMom222,

Thank you for the information.  I have started to search archived posts to see how others resolved similar situations.  

Hi. I am sorry you deal with that. 

If your diet is good - you should not get RH. 

What you describe - morning low blood sugars are Hypoglycemia. Not RH. There is a huge difference between those 2.  At one time I had both. 

Hypoglycemia can be caused by hormonal imbalances - cortisol- insulin- thyroid.  

RH is caused by diet. 

I will get RH if I eat too many sugars or carbs... But I no longer have hypoglycemia. 

You need to find a good - great - endocrinologist that deals with andrenal issues. Most of them deal with diabetics - and have no idea how to deal - treat endocrine issues. Been there - my first endo was an "educated moron". My second - she "gave me my life back".  At least it felt that way. 

Read on adrenal insufficiency- primary and secondary. 

App 3 years ago I was diagnosed with (mild) secondary adrenal insufficiency. My pituitary, that controls the adrenals, where not working as good as the needed. 

I was put on steroids - hydrocortisone, a replacement dosage.  As much as my body should make. 

Over last 3 years - my body is slowly recovering - I am still on a very small dosage - but during the last year - I was able to decrease the HC I have been taking. Again - we don't know why my Pituatary were not working right and why they are slowly recovering. 

Low cortisol leads to so many issue - including hypoglycemia, RH, digestion - gut motility issues, low BP - ortostatic hypotension, mineral imbalance (sodium, potasupium) inflamation.etc etc etc... The list goes on and on...

Steroids are viewed as "bad drugs" - but reality is that we can't function without them. If out body stop producing them (addison) we die. Die very quickly. 

When body still makes some - we end up with a lot of problems. 

 

Hypoglycemia or RH can also be caused by too much insulin - insulinoma. And depends on severiy of that - it can be from mild to severe. The first one - can be controlled by diet...to a point..the second - may require surgery - removal of part of a pancreas.  

Insulinoma needs invesigating - to make sure there are no tumors or cysts on pancreas. Tumors - can be begnin, but they can overpriduce insulin in response to foods higer in carbs. Or proteins. 

There is so much info about the very fine balance... 

This here - just scratch the surface. 

Btw - it took me 1.5 year to find a good endo and be seen by her (9 months waiting list) ...2 years to find the answers and feel better. 

 

I can always count on you providing great insight.  

I am now scheduled to see my surgeon regarding next steps.  I am reading everything I can regarding my situation/diagnosis.  The all day "bile mouth" is just intolerable.  I am eating 5-7 small meals daily and I must have one right before bedtime to feel normal in the morning.  I do feel better most days when I stick to the small meals plan.  

No one has been able to diagnose the chronic achiness I feel--feels like the flu aches but on a lesser scale.  I am always exhausted by the end of the day.

I will definitely print this and put in my WLS binder--I am keeping detailed notes of how I feel, how long it lasts and what I am eating each day along with suggestions/experiences of others.

I'm glad you are feeling better.

 

 

and for the record - I lost weight after I was put on steroids.  Because I no longer had to chase my low blood sugar- hypoglycemia. Because I had energy to exercise - simple walking before that would make my BS crash. Because I was able to limit what and how much I ate - without worrying about my BS crashing.. 

cortisol  and insulin are needed to regulate BS, when it gets too high - insulin lowers it, but when it gets too low - cortisol gets activated and helps to convert the glycogen into BS.  No cortisone - pr low cortisone - and we end up with low blood sugar- hypoglycemia. 

steroids control digestion and inflammation.  too much is not good - not enough - is no good. The back- joints pain and swelling...

I do hope you find a good doc to find out what's going on...