Having heart, neck, breathing, symptoms? Exercise intolerance? Heat intolerance?

Hello fellow bandsters

I wanted to take a moment to review some facts about the vagus nerve and its impact on general health.  I was banded in 2010 and have had some success with weight loss when I am diligent with band rules.  However, over the past 2-3 years I have experienced some symptoms that when taken individually may not seem to be able to be put into a clinically clear picture, but when combined tell a completely different story.

As we know, the vagus nerve is compressed during gastric banding and because of that there is in increase of the feeling of satiety. (feeling fuller earlier)  The tighter the band, the more the compression.  This increases "vagal tone", which in and of it self is not a problem.  However, the more abnormal or higher the tone becomes, the more "symptoms" occur.  Because the vagus nerve is the "wanderer", and is responsible for motor or "activity" from structures in the throat/neck/voice to the heart to the stomach and intestines and even exerts a chemical influence on bladder function the symptoms of increased tone of the vagus nerve (which I will call Parasympathetic Excess or PE)  paint  wide swath of symptoms that often seem unrelated.

After being banded, I started to develop increasing episodes of "flutter" and "palpitations" in addition to atrial fibrillation.  Because obesity is a predisposing factor in atrial fibrillation, I attributed it to that.  As I lost weight and no longer snored like crazy, (sleep apnea is also attributable to atrial fibrillation) I thought that the episodes would lessen.  They did not.  In fact, they continued to increase in number and frequency, even tot he point of developing a first degree heart block in the absence of any cardiovascular disease. In short, I would like to list a few of the common symptoms that occur with PE- particularly increased vagal tone.

Increased chance of atrial fibrillation-which untreated or undetected can lead to stroke or death

Bradycardia (slow heart rate)

Exercise intolerance

Heat intolerance as sweat gland function is inhibited

Autonomic dysfunction including the symptoms of POTS- inability to regulate heart rate and blood pressure upon going from lying down/sitting to standing, exercise intolerance, etc.

Feeling of being choked/strangled and/or feeling uncomfortable with anything around the neck. (This is usually a sign of thyroid disease but in the absence of such disorders, consider the skeletal muscles in the neck/throat that are controlled by the vagus nerve.)  Part of my symptomatic picture was this tightness/constriction in the throat/neck that required that I place my head only in ONE position while sleeping, otherwise it would cause irritation and send me into atrial fibrillation.  After ruling out sleep apnea, and expensive testing, we came to this conclusion. 

Increased intestinal gas, problems with gastric motility, esophageal motility, GERD. The lower esophageal sphincter is innervated by the vagus nerve.  "Stuck" episodes cause swelling to this region and over time can cause issues.  Be sure to follow the rules of liquids after a "stuck" episode.  Dysfunction of the LES may be the cause of your GERD, not just a band too tight. (also many other reasons for GERD, so please do not misunderstand me)

There is a myriad of other symptoms that can be attributed to PE that may come from compression of the vagus nerve.  Having been in health care for  over 20 years, I have a great team of physicians that provide excellent resources.  However, my personal physician knew nothing about the vagus nerve being compressed by the band. (It required quite a bit of convincing, I am sorry to say) and even then, he was skeptical.  In fact my personal physician did not even KNOW that the vagus nerve when stimulated would/could cause atrial fibrillation.  He kept telling me it would only produce bradycardia. (slow heart rate) I had to actually provide references that explain that the vagus nerve will cause the lower chambers of the heart (ventricles) to slow down but cause the refractory period of the upper chambers (atria) to shorten making re-entry of abnormal electrical impulses, causing abnormal rhythms.  It also will cause a first degree heart block.

My ENT whom I consulted about the neck constriction had the same impression about the vagus and the heart.  Both were surprised that the vagus nerve could cause atrial fibrillation and had not considered PE as an initial reason for the breathing/throat symptoms. 

My cardiologist was also unfamiliar with the extent of PE.  Thankfully, he is open minded as well and was open to having me tested for PE and ANS dysfunction as a reason for my inability to stay out of atrial fibrillation and as a possible need to change medications from antiarrhythmics to anticholinergics.

Like many women, I am acutely aware of symptoms and changes in my body. I am pleased that I could put it all together as the symptoms alone would send me to (as they did) a family practitioner, and ENT, cardiologist and and a GI specialist.  None of which could put the entire picture together, as each had his/her own specialty.

I will be getting fluid removed from the band this upcoming week and hopefully it will alleviate some of my symptoms.  As a side note, I took benadryl which has anticholinergic properties (works to shut down the chemical effects) of the vagus (and other parasympathetic systems) and some of the symptoms were alleviated.  Respiratory and some cardiac symptoms have abated.  I can safely take benadryl in low doses.  I am not recommending it as a approach/treatment/etc. Merely stating that it is possible to alleviate some of the symptoms temporarily for me. 

I hope that this helps someone out there in Lap Band Land.  Medical treatment has become so very specialist oriented it becomes frustrating to bring symptoms of many organ systems together to come to a correct conclusion.  Some physicians are open to listening, others are not.  If you think that you may have a similar issue, I encourage you to gather your data and pursue it. 

I am not bashing the band.  I have been pleased for the most part with it.  However, as time goes on, the band will continue to constrict tighter from scar tissue and that MAY cause some symptoms that may be treated- such as letting out some fluid to reduce compression.   Hope this helps.

Ciao

Thank you for sharing this information. 

I had damage to my diaphragm and Vagus nerves from the band. In spite of band removal almost 10 years ago, I still have symptoms of the damage, such as occasional referred left shoulder pain, heat intolerance and excessive perspiration, and throat constriction. My surgeon was one who did not put any stock into my assertion that the Vagus nerves were being damaged (after I did my own massive amount of research because I couldn't find anyone who would help.) Way back in 2003 when I was banded, there was virtually no information about it at all. It was very depressing. 

It's important for people with bands to know this information, so I'm glad you shared it. And you did it in such a comprehensive way. Thank you! I hope that your health problems resolve fully. Best of luck. 

I developed a fib while my band was in and am still on medication for it even tho I had my band removed over a year ago. I've also noticed may people also develop gastroparesis a slow emptying of the stomach and a reduction in esophageal motility. Both happen very often and cause life long damage that can not be repaired. I find it very hard to believe none of these things were noticed in the earlier use of bands before they were put on the market for general use.

I, too, appreciate your sharing this information.  I'm always interested in increasing my knowledge.  Prior to surgery, I had GERD, A-Fib, and Sleep Apnea.  I no longer have Sleep Apnea but now have Sleep Maintenance Insomnia.  I, also, not longer have GERD.  I do occasionally upchuck, but that seems to happen if I eat to fast or to much.  I still have A-Fib, but believe it is permanent.  I, also, have low-blood pressure which causes me to sometimes get dizzy and weak in the arms/legs to the point where I've dropped drinks, and not being able to keep myself up (standing).