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

Well Hala,

Your definently not alone with adrenal problems. Living that hell myself except come to find out I have congenital adrenal hyperplasia (which was the cause of my obesity since childhood). Cept now my adrenals are failing cause its gone this long without treatment. My thyroid and pituitary are just fine. I am off to see a major specialist next month and luckily one of the top in the nation for CAH.

As I say I truely dont wish this on anyone. It sucks how it nearly zaps the life out of you. Ive had 3 adrenal crisis, mild insufficancy would be welcome but Im not that lucky. We just have to find out which CAH varient I have cause I still produce cortisol but not much. And have salt wasting too.

First of all, I am sorry you are going through all these struggles!  I just wanted to encourage you, I had bile reflux and just tried elevating the mattress about 3 or 4 inches.  I eat earlier and just have a Danon ThripleZero greek yogurt if I am hungry late in the evening.  It is protein and it isn't heavy on my stomach.  It seems to help.  I can't sleep if I'm hungry. These two things helped a lot.  God bless your journey!

Josannee,

Thanks for the suggestions.  I have a wedge pillow which helps.  I had a  bile attack about 2:30 am this morning.  I had to get out of bed and have a drink and change my PJ's 

Eating early would help but then I am a hot mess in the morning.  I need to eat right before bedtime to keep my blood sugar level.  

At this point, I am just trying to stay comfortable.

Thanks again for responding.  

The question that I would have for the surgeon is what happens within the remnant stomach if I am still having bile reflux into it? Assuming that the current problem is associated with a weak or leaky pyloris, how does the RNY fix this, other than resolving the symptoms of reflux into the esophagus? What are the long term consequences of continued bile reflux into the remnant stomach, and without the ability to do an EGD on it, how does one monitor it?

The Billroth II style of gastrectomy, upon which the RNY is based, does have some predisposition toward bile reflux on its own, as the stomach access is moved downstream of the bile ducts and the pyloric valve is removed, though it generally is mitigated by surgical technique and choice of limb lengths. So, there is some small risk that the bile reflux can reappear, though from a different direction. It would likely solve the problem, at least symptomatically, though it's hard to really consider it to be a "cure" on the order of what the DS would provide.

Donna has a good point about the DS, as that is the most certain fix for the problem - it moves the stomach access many feet away from the bile ducts. In the DS, the bile along with the pancreatic enzymes flow through several feet of blind intestine to the common channel where they are introduced to the food flow; from there the bile would have to counterflow several feet up the food channel to reach the stomach to cause a problem.

As you are investigating your conflicting problems (this is what makes us "interesting" patients!) you may want to consult with Dr. Ara Keshisian in Glendale, as he would be your local DS expert (even if he is affiliated with that "other" school across town!)

Good luck in working this through - these conflicting problems can be the toughest to solve,

Thank you for the recommendation regarding Dr. Keshisian.  I am investigating my options and researching what would be best for me.  I know I can control the RH via diet.  

I am only planning one more surgery if possible to fix the hernia and correct the bile reflux.  Appointment #2 with the surgeon is next month.

Dr. Keshishian is one of the very best. If I needed a complicated revision, he is one of the 2 or 3 I would go see.