Managing GERD Longterm

As I’ve talked about several times, GERD is a fact of life after VSG surgery. I am averse to taking medications for the rest of my life, but it appears I’ll have no choice. I don’t mind taking supplements, I’ve done that for decades, but medications that alter my body make me uncomfortable. Even if I’d been told about the GERD (I WAS NOT), I’d still have gone for the surgery. The benefits far outweigh (ha! PUN!) the GERD.

That said, I’ve been on a quest to find the right balance of PPI and/or H2RA to manage the GERD with the smallest dose possible. In case you’re new or unsure about all these acronyms, here is a quick primer to bring you up to speed:

GERD – Gastroesophageal Reflux Disease
VSG – Vertical Sleeve Gastrectomy, often called gastric sleeve surgery (not an actual sleeve, refers to shape of stomach)
PPI – Proton Pump Inhibitor, a drug that binds with certain enzymes and prevents the pumps from producing acid in the stomach
H2RA – Histamine Receptor 2 Antagonist, an antihistamine that blocks acid production in the stomach
NAB – Nocturnal acid breakthrough
-zole drugs – any reflux drug that ends in -zole is a PPI class drug
-dine drugs – any reflux drug that ends in -dine is an H2RA class drug

There is a goodly amount of research and studies on both PPI and H2RA drugs, but there is still much unknown about long term use of them (paper HERE). Doctors tend to prescribe these drugs liberally, without taking into consideration their side effects and long term issues that will arise from taking them (paper on this HERE). I was not told a single thing about the PPI I was given, other than take it twice a day. That’s it. They also did not go into detail about other supplements a VSG patient should take for the rest of their lives. A passing mention was given to Vitamin B12, but no documentation was offered. The useless nutritionist never once mentioned Vit B12 supplementation, either.

Fortunately for any VSG patients reading this, you have ME to root through the reams of research and give you the info I’ve rounded up in a convenient blog post. :)

After finishing the initial month of Mexican omeprazole (Prilosec) in capsules, I switched to American omeprazole in tablets. I had already done the reading about the long term issues with omeprazole, such as calcium and magnesium blocking, which is very problematic. I tried switching to Zantac (ranitidine) twice a day and the side effects were horrible. I had ringing in my ears, constipation, diarrhea. I felt awful. And I still had some reflux. This lasted about two weeks, then I gave up and went back on omeprazole 20mg in the morning and famotidine 20mg (Pepcid) at night before bed. I spoke to the pharmacist about it and decided I’d split the difference (paper about PPI and H2RA HERE). I’ve been on this combo for about 2.5 months. The famotidine also gives me some buzzing in my ears, but milder than ranitidine. But it’s got to go.

Today I’ve been reading about using PPI and H2RA drugs together and mostly it’s a wash. There is little evidence that taking the H2RA at night will help with Nighttime Acid Breakthrough (NAB). It’s pretty much worked for me, but the last couple of weeks it has been less effective. Most of the studies I read indicated that taking a PPI twice a day is more effective in general than the combo.

I also read that Nexium (esomeprazole) is slightly more effective than Prilosec (omeprazole)(papers HERE and HERE) and the newer drugs Protonix (pantoprazole) and Aciphex (rabeprazole) are even better, but they are Rx and likely very expensive (Aciphex is $800/mo at retail and no insurance covers it, FYI). The good news is that Aciphex is available in generic, but there is a wide variety of quality amongst the manufacturers (more about that HERE). I will revisit trying them out if Nexium poops out on me in a few months. I’m betting it will, but I’ll save my $65 Dr visit for now. Article with comparisons HERE.

So I’ve decided to switch to Nexium 20mg once a day to see how the NAB is. (I ended up taking Nexium 20mg twice a day.) I hope I can keep the dosage to a minimum, although one study said that the dosage is irrelevant to the nasty side effects. Calcium and magnesium are blocked just the same with 20mg as 60mg+ (paper HERE). But hopefully the ear buzzing will cease when I discontinue the H2RA. (It did, mostly, but I still have light buzzing.)

To offset the calcium/magnesium issues, I take a cal/mag supplement as well as a D3 and Vit K2 supplement. D3 and K2 (NOT just K, but K2) help a lot with absorption of calcium and magnesium. I’ve listed details of what I take daily here.

I’ve found that taking Kyolic Kyo-Dophilus daily has helped with my gut issues. Taking PPIs and H2RAs wreaks havoc on your gut. Diarrhea, constipation or BOTH should be expected. Taking the gut flora caps seems to offset some of this. I recommend taking probiotics! Your gut is a mess after VSG. Between no food, antibiotics and taking 40mg of Prilosec a day, you pretty much kill off your gut flora. I wish I’d started the Kyo-Dophilus immediately after surgery, but of course, Drs (and apparently nutritionists) are not trained in supplements, so it was not mentioned. You should start this before and right after surgery. Get the yogurt with probiotics in it at the very least (Activia, I think it is).

My adventures in managing GERD after VSG have been informative if nothing else. I know more about how the stomach works that I ever did! I hope my blog posts are helping others who have gotten VSG and not been told all the facts. I know that Drs here AND in Mexico are extremely uninformed about the long term use of PPIs and how to supplement. I’ve spoken to people who’ve gotten VSG in both places and they have been told ZERO about what to take afterwards. Vitamin B12 supplementation is VITAL. So is calcium and magnesium! Not getting these vital nutrients can cause terrible side effects in the long term. B12 deficiency has been linked to dementia and of course calcium deficiency means osteoporosis. Magnesium imbalance can cause heart issues. So do your reading and TAKE YOUR SUPPLEMENTS. It is important to your long term health!

VSG and Reflux

Well, aside from not losing much weight, the truly sucky part of my sleeve recovery has begun. As I wrote about the other day, I decided to discontinue taking Prilosec because I didn’t like the long list of issues that can arise with long term use. I was expecting some acid rebound, so I had Pepcid, Tums and Zantac on hand.

I had a couple of days with no acid after I discoed the Prilosec. Then it hit me hard. I beat it back with Zantac and it was mostly OK (pain level 3-4) for a few days. THEN, day before yesterday, the acid started really hurting, like 7-8 with spikes to 9. I took Zantac and Pepcid, but didn’t get much sleep that night. Then yesterday the acid was terrible all day, despite the Zantac. I even took a Prilosec before dinner, to no effect. The pain kept me up most of the night last night. I took a Zantac around midnight when I got up and went to the couch to sit up for a while. I dunno about YOU, but I cannot sleep sitting up. So all together, yesterday I took Zantac, many tums, Prilosec and another Zantac. FINALLY at around 4-5am, the pain eased off and I slept a little. I moved to the bed around 7am and slept until 11am. No pain today, but my stomach feels weird. And I feel like little bitty RAT TURDS.

I took a Zantac this morning and I’ll take another before bed. Hopefully I’ll be able to sleep tonite.

I talked to Amy and she is still having reflux at 7 months. She takes Zantac twice a day and still wakes up with reflux every morning. Which tells me that I’ll probably have reflux for the rest of my life. Great. I never had any issues before VSG.

YES, I have buyers remorse. I have horrible reflux, I can’t eat anything, I can’t drink anything alcoholic (reflux and I can’t get drunk at all) and I’m very depressed that I’ve only lost 17# in TWO MONTHS. Overall, VSG has been mostly negatives for me.

I know intellectually that this is all just the Period Of Suck that everyone goes through, but it just doesn’t matter, I still feel crappy and depressed. Ugh.

I have a theory that the reflux (that is VERY common) with this surgery is partially due to the design of the sleeve itself. Let’s think about this. They make a narrow tube from the esophagus down to a pouch at the bottom. What do tubes do well? THEY SIPHON. I think sleeve patients get reflux because the tube siphons the stomach acid right up to the esophagus and VOILÀ! REFLUX. I hope someone who designs these bariatric surgeries reads this and will rethink the shape of the sleeve. Why not mimic the original shape of the stomach, just smaller?

Anyway, those are my thoughts on the HORRIBLE reflux that I and many other sleeve patients suffer with. Maybe in the future, they can do something about it by changing the shape of the sleeve. All I can say is that Prilosec forever is NOT the answer. Zantac is not much better, but it appears that I’ll have to take something for the foreseeable future. Which makes me SAD.