HELP - Continuous nausea/vomiting after Ivor Lewis method esophagogastrectomy

Welcome Wrlias-

It’s good to hear that your dad had a successful surgery, but now he must adjust to a new way of eating and sleeping.  This is a small price to pay for a successful surgery in which the cancer has been totally eradicated, believe me.  However, for newbies, this is all new.  You will constantly wonder, is this normal when you have something new come up. 

You are explaining a somewhat common symptom that post-esophagectomy patients endure for a number of months.  My husband experienced a real problem commonly referred to as “dumping.”  Believe me, it’s best to be close to bathroom facilities after an esophagectomy, regardless of the type of surgery.  Below my name I will give you a reference which our surgeon, Dr. James D. Luketich at the University Of Pittsburgh Medical Center gave to my husband.  You will be happy to know that my husband is now in his 14^th year of survival of Esophageal Cancer, Stage III  (T3N1M0).  My husband never had a problem with vomiting, but he did have problems with controlling his bowels.  We are sure it came from damage to the Vagus nerve.  I’m wondering if your surgeon explained that this might be a normal unpleasant experience for your dad until he developed a coping pattern.  I would hope that in due time, with changes in Dad’s dietary habits, that he will get back to having a normal routine and that the diarrhea will subside.

Understand that I am speaking as a caregiver for my husband, William.  I don’t know how much information your dad has been given about “after effects” of having an Esophagectomy.  But many here, and probably most, have gone through the “dumping” period early after surgery.  This usually subsides with time. 

Now I will say that I hope your Dad is having some form of regular hydration from his doctor until the problem is under control.  As for nausea, we found it best to take the anti-nausea medicine first thing in the morning, upon awakening, and before breakfast.  It works best as a preventative measure not to wait until one gets nauseous to take the medication.

As a matter of fact, at the last EC support meeting, our local Thoracic surgeon had a question and answer session.  This very question was asked about nausea, vomiting and diarrhea.  She explained that during the surgery, the Vagus nerve would have to be cut.  When we read about the Vagus nerve, we see that it controls the muscles to the stomach.  And most often, until the new patient has made readjustments to the type of food, the amount of food, etc. that they ingest on a timely basis, they will most likely have these problems. It’s considered a common occurrence among post-esophagectomy patients.

Dr. Tann stated that often they will use Botox to help with the problem of the stomach not emptying properly.  Using an instrument through a small incision, botulinum toxin (such as Botox) can be injected into the pylorus, the valve that leads from the stomach to the small intestine. This can relax the valve, keeping it open for a longer period of time to allow the stomach to empty.

 I will tell you that the “dumping” improved and eventually subsided for my husband.  He didn’t have any medications to control it.  It remedied itself in time.  He lost 60# during the first 9 months before his weight settled in.  Of course, he was overweight at 275# and now stays in a range of 205 to 215.  He eats several times a day.  The types of food he eats will make a difference in the “elimination process” as well.  And it’s best to not drink with meals.  Liquids are best drunk between meals, either an hour before or an hour after.  And believe me, it seems that at the first all Dad will be doing is eating or going to the bathroom.  But there are excellent suggestions from the UPMC link to control problems with the diet.  I would suggest you print this out for your dad.

Hoping that if your Dad didn’t know these things already, it may just solve his problem.  Others will answer you as well to let you know how they dealt with these kinds of symptoms after their surgeries, regardless of whether it was Open, Transhiatal, or Minimally Invasive.  All the patients will experience the same “readjustment” problems.  “Nerve wracking you bet, but tolerated because they are so happy to be ALIVE!  So I hope this problem ceases to be with time, and that Dad has no recurrence.  That’s the ideal we all pray for.

Loretta

Wife of William, totally laparoscopic Esophagectomy @ UPMC on May 17, 2003 for EC Stage III (T3N1M0) by Dr. James D. Luketich, pioneer of the Ivor Lewis Minimally Invasive Esophagectomy MIE)

 Helpful references below:

1.   http://www.upmc.com/patients-visitors/education/nutrition/pages/esophagectomy.aspx

UPMC Content 2""" "Diet After an Esophagectomy

An esophagectomy (ee-soff-uh-JEK-tuh-mee) is surgery to remove the esophagus. After this type of surgery, it is common to have some problems eating for a few months.

What can I expect after surgery?

For the first few months after surgery, you may have problems such as:

Weight loss ...Dumping syndrome (nausea, diarrhea, abdominal cramping, light-headedness)...Excess gas...Trouble swallowing

• Your diet plan after surgery is designed to lessen your discomfort and allow you to enjoy eating.

  What type of diet will I have?

  You will have several types of diet. Your diet will change slowly based on your rate of recovery and how well you can tolerate food. The amount of liquids that you are permitted to have at one time will vary based on your doctor's recommendation. In general, your diet plan will advance as follows:

• 1.   Clear liquid diet, for the first few days after surgery...        2.     Full liquid diet...        3.     Soft diet

Each person tolerates food in a different way. Your doctor will advance your diet plan based upon your progress after surgery. 

How can I help myself?

Follow the tips below to make eating more comfortable and enjoyable.

To reduce discomfort

• Eat small, frequent meals (6 to 8 per day). This helps you get all the nutrients you need.

• Take small bites and chew your food well. This helps you to swallow and to digest your food.

• Drink most of your liquids between meals. Limit liquids with meals to ½ cup (4 ounces). Limit liquids with snacks to 1 cup (8 ounces).

• If you eat sweets, eat them at the end of your meal. Sweets are digested more quickly than other foods. Eating sweets first could lead to low blood sugar or hypoglycemia.

• Choose foods that are soft and moist because they can be easier to digest. Avoid gummy foods, such as bananas, untoasted bread and bread products.

• Sit up straight when you eat. This way, gravity can help food move through your digestive tract. After you eat, continue to sit for 30 to 60 minutes.

• Eat your last meal or snack at least 2 to 3 hours before you go to bed…”

• 2.  http://www.mayoclinic.org/diseases-conditions/gastroparesis/basics/causes/con-20023971

“Causes - By Mayo Clinic Staff

It's not always clear what leads to gastroparesis. But in many cases, gastroparesis is believed to be caused by damage to a nerve that controls the stomach muscles (vagus nerve).

The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move normally into your small intestine to be digested.

The vagus nerve can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine…

Symptoms - By Mayo Clinic Staff - Signs and symptoms of gastroparesis include:

Vomiting…Nausea…A feeling of fullness after eating just a few bites…Abdominal bloating…Abdominal pain…Changes in blood sugar levels…Lack of appetite…Weight loss and malnutrition

• When to see a doctor - Make an appointment with your doctor if you have any signs or symptoms that worry you…”

  3.  http://www.mayoclinic.org/diseases-conditions/gastroparesis/basics/tests-diagnosis/con-20023971

  Basic tests that are conducted to determine causes of Gastroparesis

  4.  http://www.mayoclinic.org/diseases-conditions/gastroparesis/basics/treatment/con-20023971

  possible medications

  5.  http://www.webmd.com/digestive-disorders/digestive-disorders-gastroparesis

“…Gastroparesis is a condition in which your stomach cannot empty itself of food in a normal fashion. It can be caused by damage to the vagus nerve, which regulates the digestive system.  A damaged vagus nerve prevents the muscles in the stomach and intestine from functioning, preventing food from moving through the digestive system properly. Often, the cause of gastroparesis is unknown…

Other Treatment Options for Gastroparesis

In a severe case of gastroparesis, a feeding tube, or jejunostomy tube, may be used. The tube is inserted through the abdomen and into the small intestine during surgery. To feed yourself, put nutrients into the tube, which go directly into the small intestine; this way, they bypass the stomach and get into the bloodstream more quickly…

Using an instrument through a small incision, botulinum toxin (such as Botox) can be injected into the pylorus, the valve that leads from the stomach to the small intestine. This can relax the valve, keeping it open for a longer period of time to allow the stomach to empty…”

6.  http://www.healthline.com/human-body-maps/vagus-nerve

“…The vagus nerve is one of 12 cranial nerves. It is the longest of the cranial nerves, extending from the brainstem to the abdomen by way of multiple organs including the heart, esophagus, and lungs. Also known as cranial nerve X, the vagus forms part of the involuntary nervous system and commands unconscious body procedures, such as keeping the heart rate constant and controlling food digestion…”

__________________________End of references________________ 

My wife has been vomiting every day since her surgery a month ago. She is vomiting a clear thick slimy mucus that's generated from the stomach. Has anyone else had this problem or issue?

Did you vomit clear liquid. Mucus? 
my wife has been naus for over 2 months every day 24/7. We can't figure out what is wrong. 
please respond. 
thank you.