Hiatal Hernia and Nissan Fundoplication Surgery....

Running will not be a problem long term post laparoscopic repair. Though, continued shortness of breath with a hiatal hernia as the diagnosis is actually pretty concerning. 4cm is not huge, but not small either; and I question whether or not there is something else going on. A HH does not typically present with a fever either. I would seek a second or even third opinion. Something is off. By chance, did they mention the words "incarceration" or "para esophageal hernia"? Was a CT scan done of your chest?

There is certainly some debate about whether it is the cause, and obviously we will not be proceeding with surgery until we are more certain. The GI doc who performed the endoscopy did not think it was, the pulmonologist who sent me to him thinks it probably is. He says that HH is a rare cause of SOB, often missed. I have seen LOTS of doctors, but mostly cardiologists who have given me every heart test known to man (including caths) and found no cause of SOB.

I did not hear either of those words. I had two different CTs, and multiple X Rays, all negative. All blood work and pulmonary function tests were normal. The only thing that has been found is the HH and my history of GERD...

As far as the presenting with a fever, that is suspicious. I did go to a local NP for that, before the SOB ever started, and got a dexamethasone shot. When I didn't improve and started having very noticeable SOB, I foolishly went back, got another steriod shot and a prescription for prednisone and antibiotics...took those for two days and ended up in the ER with severe SOB and chest tightness.

In my "googling" attempts to play House M.D. and diagnose myself, I did notice some info possibly linking steroid uses with HH, but I have no way of knowing if that is valid or just random internet garbage.

jkm97 wrote:

As far as the presenting with a fever, that is suspicious. I did go to a local NP for that, before the SOB ever started, and got a dexamethasone shot. When I didn't improve and started having very noticeable SOB, I foolishly went back, got another steriod shot and a prescription for prednisone and antibiotics...took those for two days and ended up in the ER with severe SOB and chest tightness.

In my "googling" attempts to play House M.D. and diagnose myself, I did notice some info possibly linking steroid uses with HH, but I have no way of knowing if that is valid or just random internet garbage.

Man, I'm sorry that this is happening to you. No doubt, it's super frustrating. High dose steroids will cause reflux in 29% of patients, but I have not ever read or heard of any studies where a one time (2 time) dose will actually cause a HH. A HH is a structural defect. Ruling out a pulmonary embolus by CT and/or some type of pulmonary problem by the same method was very reasonable. Knowing that you have no cardiac defects as the etiology is also very reassuring. Speaking as a surgeon, I would be VERY reticent to jump into surgery for the symptoms that you're experiencing. Make sure you've absolutely exhausted every other possible diagnosis prior to any type of invasive procedure, minimally invasive or not. I'd also be very gun shy in returning to the nurse practitioner for future care.

Lol, yeah the NP is blacklisted as far as I'm concerned.

Yeah they looked for PE pretty thoroughly, and while I said that the cardiologists didn't find any cause of SOB, they did find a 60% blockage of the LAD and myocardial bridging (of the same artery at the point of the atherosclerosis) but they told me that it wasn't severe enough to cause symptoms...I saw several different cardiologists at two different hospitals, so I guess they are correct...

Yeah, I have had the reflux for many years, taken PPIs for it, and it doesn't really bother me...but the not being able to breath does. It is baffling to me, and apparently all of my doctors, how I could go from running 10-20 miles every 2-3 days (in addition to being a weightlifter for over ten years) to so SOB that I have a hard time teaching my classes (high school teacher) most days.

Of interesting note, myocardial bridging was recently mentioned in Dave Torrence's autopsy report. A bit strange that you've already got a 60% blockage of your LAD already at 38. Reflux can cause asthmatic type symptoms, but acute onset as you've described just doesn't fit the picture at all.

Well I have a massive family history of heart disease. Father had first MI at 32, died of second at 52. Brother had one last year at 39. So you can see why the docs went all in down that route. Both my dad and brother smoked, ate poorly, didn't workout, so I had assumed I could insulate myself to some degree by a better lifestyle, but that might not prove to be the case. I hadn't heard that about Torrence. The cardiologist I most trusted, a professor at the local University Hospital (Univ of MS) said there was some disagreement about bridging and its prognosis, but he characterized his assessment as "99%" sure that it wasn't causing my current symptoms, mostly because I have obviously had that for awhile, and as you said my symptoms came on suddenly.

Apparently I am just a medical mystery, something I would prefer not to be as it happens.

It's never good to be an "interesting case". Hoping you get it figured out, and back running. Good luck!

Lol, I realized that when they kept bringing the med students by when I was at the University...

I still have two more appointments with doctors I pretty well trust, and i won't go forward with the surgery until they think its the best option. I've had laparoscopic surgery before (appendix) and it wasn't bad at all, so i wouldn't hesitate to do so if I thought this would help...but I have my doubts, and I read about some potentially bothersome complications for a runner (like bloating, no ability to belch or vomit, all of which I might like to do in a 50 mile race, lol.)

Hello, I am also scheduled in for fundoplication surgery and am strugging to find information about how it has impacted other ultra runners. Did you have the procedure? Are you back running? Have you suffered any complications specifically when running? Hope you are well, thanks in advance :-)

Bump... getting scoped next week... i'm 99% sure I have a HH. Very bummed.

jkm97 wrote:

... Then my doctors noted that I had suffered from acid reflux since I was a teen, and began to suspect "silent reflux" and/or hiatal hernia, so I was given an endoscopy, which confirmed a 4cm hernia.

So now I am advised to consider the surgery, but upon reading about it I do have some concerns, and was hoping some other runners had undergone the procedures and been able to return to running. I can't run right now, still too much shortness of breath, so I would gladly jump into surgery head first if I thought it would help and I would be able to return to my long, slow, miles...

Any experienced help here would be greatly appreciated!

For reference: washed up D1 xc / track athlete, current surgery resident. Will respond to points raised by initial poster in the hope of helping latest poster.

What kind of hiatal hernia do you have? Type I? If so, there's no urgency to fix it. A good chunk of the population probably has one of these "sliding" hiatal hernias and don't really notice it. The issue with these is reflux (as you mentioned) and long-term exposure of the distal esophagus to stomach acid (really, bile acids), increasing your risk for esophageal cancer (which you do not want). However, if you have a type II, III, or IV hiatal hernia (aka "paraesophageal hernia", as some other person mentioned) you should probably get it fixed as there is a risk of getting some of your stomach (or other organ) trapped ("incarcerated") in your chest - which can lead to problems that you do not want.

The only long-term effects a laparoscopic hiatal hernia repair / Nissen would have on your running is the impact on your ability to crush like an entire pizza and a couple beers after a run - wrapping part of your stomach around your esophagus impacts your swallowing and your ability to take huge bites without really chewing.

jkm97 wrote:

As far as the presenting with a fever, that is suspicious. I did go to a local NP for that, before the SOB ever started, and got a dexamethasone shot. When I didn't improve and started having very noticeable SOB, I foolishly went back, got another steriod shot and a prescription for prednisone and antibiotics...took those for two days and ended up in the ER with severe SOB and chest tightness.

.

Jesus Christ. This is why NPs should not practice independently. This is also why Urgent Cares should not exist.

In summary, the lessons here are:

1. for all but the most basic of medical problems, you should see fellowship-trained physicians at a tertiary / quaternary academic hospital

2. if you have a problem and the word "surgery" even enters the conversation, you should talk to a surgeon. The best cardiologist in the world doesn't have the foggiest about gastrointestinal surgery.

[/quote]

For reference: washed up D1 xc / track athlete, current surgery resident. Will respond to points raised by initial poster in the hope of helping latest poster.

What kind of hiatal hernia do you have? Type I? If so, there's no urgency to fix it. A good chunk of the population probably has one of these "sliding" hiatal hernias and don't really notice it. The issue with these is reflux (as you mentioned) and long-term exposure of the distal esophagus to stomach acid (really, bile acids), increasing your risk for esophageal cancer (which you do not want). However, if you have a type II, III, or IV hiatal hernia (aka "paraesophageal hernia", as some other person mentioned) you should probably get it fixed as there is a risk of getting some of your stomach (or other organ) trapped ("incarcerated") in your chest - which can lead to problems that you do not want.

The only long-term effects a laparoscopic hiatal hernia repair / Nissen would have on your running is the impact on your ability to crush like an entire pizza and a couple beers after a run - wrapping part of your stomach around your esophagus impacts your swallowing and your ability to take huge bites without really chewing.[/quote]

Original post is from a few years ago stop who knows if OP will check back here.

I'm getting scoped next week to see what's going on so I don't know what grade HH. I'm thinking it's above 2...I constantly feel pressure near my xyphoid and under my left side ribs. Can't bend over to put on shoes without being very uncomfortable... basically feel like they're is a softball inside me. I originally was sent by my GP to a GI specialist bc I was getting food stuck in my esophagus and having reflux...GP noted "Esophageal Dysplasia" on the referral.

Ive still been running because that somehow relieves the pressure i feel in my chest. Once i stop running i'm right back where i started.

Ive been cranking out pushups and Ab work during quarantine and think i made an undiagnosed minor case of HH into a more severe case. I just want to be able to feel comfortable again.