Should I Consider Surgery for My Condition?
Hello! I am a 20-year-old male diagnosed with Neurofibromatosis type 1 (NF1), standing at 5 feet 1 inch and weighing 160 pounds. I've been dealing with irritable bowel syndrome (IBS) and gastroesophageal reflux disease (GERD) since 2020. Initially, I was treating my condition with ranitidine at a dosage of 150 mg twice daily until its recall, after which I resorted to several over-the-counter and prescription antacids under the supervision of a pediatrician. Eventually, I began using pantoprazole upon a referral to a gastroenterologist, which provided considerable relief, but I had to stop this medication due to concerns about possible small intestinal bacterial overgrowth (SIBO). After monitoring my condition for a month, my symptoms reoccurred rapidly. I was prescribed Nexium at 20 mg along with continuing my current medications, which include amitriptyline at 10 mg and dicyclomine at 30 mg. Just two days ago, I underwent an endoscopy, which revealed LA Grade B erosions and a 5 cm hiatal hernia, despite being on Nexium for two months. I have since increased my Nexium dosage to 40 mg starting yesterday. The persistent issues I'm facing include regurgitation, night time reflux, and a burning sensation. My gastroenterologist has recommended surgery for several reasons, including the chronic nature of my symptoms, the presence of NF1, the moderate size of the hiatal hernia, and the potential hazards associated with prolonged use of proton pump inhibitors (PPIs). Should I seek a surgical consultation, or would it be wise to first try the increased dosage of Nexium at 40 mg? The procedure suggested to me is a hiatal hernia repair along with fundoplication. Thank you!
Answers (1)
6/24/2025, 10:40:57 PM
OpenHealth AI
It sounds like you're facing a complex situation with your gastroesophageal reflux disease (GERD) and hiatal hernia, along with your neurofibromatosis type 1 (NF1). Your experience with medication and the recent endoscopy results have understandably raised some concerns about your treatment options.
Main Points
- Your gastroenterologist has recommended surgery due to the severity of your symptoms and the potential complications with long-term PPI usage.
- Increasing your Nexium dosage is an option, but your underlying issues and medication history suggest that surgery could provide more effective and lasting relief.
Explanation
GERD can significantly affect your quality of life, especially when it leads to complications like erosions and regurgitation, as you've described. The presence of a hiatal hernia often contributes to ongoing reflux symptoms. While medications like Nexium can provide temporary relief, they may not address the root causes, especially if you're experiencing such persistent symptoms.
Surgery, specifically a hiatal hernia repair along with fundoplication, aims to correct the underlying anatomical issues that cause GERD. This procedure can potentially offer long-term relief and reduce or eliminate your dependence on medications, which is especially important considering your concerns about side effects from prolonged PPI use.
Next Steps
-
Consider Surgical Consultation: Scheduling a consultation with a surgeon who specializes in gastrointestinal procedures will allow you to discuss your specific situation and get a comprehensive understanding of the surgery, including benefits and risks.
-
Monitor Symptom Response: If you're hesitant about surgery, you can give the new Nexium dosage (40 mg) a trial period of 4-6 weeks while closely monitoring your symptoms. Document any changes or improvements, as this information can be valuable in discussions with your healthcare providers.
-
Lifestyle Modifications: In conjunction with treatment, consider making lifestyle changes to help alleviate reflux symptoms. This includes:
- Eating smaller, more frequent meals rather than large ones.
- Avoiding foods and drinks that trigger your symptoms (e.g., spicy foods, caffeine, alcohol).
- Elevating your head while sleeping.
- Maintaining an appropriate weight.
-
Regular Follow-up: Keep regular follow-ups with your gastroenterologist and report any significant changes in your symptoms, both positive or negative.
Given your health history and current medication concerns, the decision for surgery should be carefully considered. Evaluating both surgical and medical options will help you make an informed choice that aligns with your health goals. Please feel free to reach out if you need further clarification or support.
Related Questions
Understanding Post-Concussion Syndrome
A 45-year-old male, standing at 5'11" and weighing 250 pounds, experienced an incident on March 16 where he fell and struck the back of his head. Initially, he endured headaches for several days, which he managed with Advil. However, on March 25, while attending college, he began to feel dizzy, lightheaded, and weak. Seeking advice from an EMT instructor, she suggested it was likely a concussion and recommended a visit to urgent care. Since urgent care was unable to provide the necessary treatment, he was directed to the emergency room. While in the ER waiting area, he noticed a decline in his cognitive abilities. When the triage nurse inquired about the reason for his visit along with other standard questions, he found himself struggling to respond accurately. For instance, when asked for his address, he only provided the name of his city instead of the full street address. Once admitted to the ER, a CT scan was conducted, which fortunately revealed no signs of a brain bleed. After some questioning, the attending physician noted that he had trouble with responses and, following additional assessments, identified him as having a moderate concussion. Consequently, he was referred to a neurologist who arranged for concussion therapy. As he departed the ER, he started to notice a gradual recovery of his cognitive functions. Over the next three months, he experienced fluctuating symptoms, including headaches, dizziness, and feelings of lightheadedness. Approximately two weeks ago, while at work, he experienced another episode of confusion reminiscent of his earlier ER visit. He has three inquiries regarding his condition: 1) If he experiences confusion again, should someone escort him to the ER or call for emergency assistance? 2) What kind of support can the emergency room provide in such situations? 3) If he ends up being admitted to the hospital, what typically occurs during that process?
Unexpected Lumps on Mother's Legs and Arms Leave Doctors Puzzled
Experiencing tenderness and discomfort. Notable swelling around her ankles. Feeling of constriction while standing up, particularly in the ankle region. Episodes of night sweats are occurring. The condition began on her legs, with some manifestations emerging on her left arm. This is her account of the symptoms. At 47 years old, standing approximately 5'9" and weighing around 180 pounds, she is a female who has been relying on Tylenol for pain relief; she doesn't take any other prescribed medications. She smokes cannabis and uses e-cigarettes occasionally, as well as consumes alcohol occasionally. Generally, she maintains good health; however, she faces gastrointestinal issues, which doctors have yet to pinpoint and suspect might be associated with her current condition. She has been dealing with this issue for a considerable time, yet these lumps are relatively new, leading to uncertainty about any possible connection. Gluten intolerance tests returned normal results, and she has also undergone X-ray examinations of her lungs, with results anticipated soon. Her physician speculates it may be related to dermatological factors, although they remain uncertain. My mother is finding it challenging to endure the wait for definitive answers. I hope someone out there can provide assistance. Images will be shared in the comments section for those who wish to see them. Be warned: those who are squeamish should proceed with caution before looking at the comments!
Is an MRI Necessary for My Son's Persistent Back Pain?
I have a 12-year-old son who has been suffering from persistent back pain, primarily located in the T12-L3 area, for the past 14 months. This daily discomfort is hindering his ability to engage in sports activities, and despite taking breaks from sports like running and Jiu jitsu, the pain continues unabated. Recently, he mentioned that the pain has begun to disturb his sleep, especially over the last couple of months, with relief only occurring when he first wakes up in the morning before he gets out of bed. Last winter, we sought physical therapy for four months, but it proved to be ineffective. More recently, I attempted chiropractic treatment for two months, which also failed to provide any relief. Over-the-counter NSAIDs have offered minimal help, and a trial of consistently taking them for a few weeks led to stomach discomfort. We have consulted with a pediatric orthopedist on two occasions, where he underwent X-rays each time. The doctor attributed the symptoms to growing pains and expressed no significant concern. During the examinations, the only notable finding was a mild two-degree scoliosis, along with typical issues like a rounded back and forward shoulders—common in many kids today likely due to excessive screen time. After expressing my frustrations as a parent, the chiropractor suggested we consider an MRI, prompting me to reach out to his pediatrician for a referral. My son also has autism and anxiety, meaning that any MRI will require sedation. I find myself wrestling with thoughts about whether his pain might stem from sensory issues, causing him to perceive discomfort more acutely, and perhaps this is not a serious concern after all. However, a few weeks ago, following a cross-country practice, he experienced significant pain for several days, forcing us to cancel some summer plans. Now, I am torn about whether to proceed with the MRI, given the associated stress it might impose on him. I seek opinions from medical professionals on whether this step is warranted now, or if my anxiety and frustration are leading me to overreact. He has not lost weight, there are no fevers or unusual bruising, and his measurements put him at approximately the 40th percentile for height and 60th for weight. Any guidance or reassurance would be greatly appreciated!
Am I Putting My Kidneys at Risk?
Age: 37 Gender: Female Height: 5 feet 10 inches Weight: 250 pounds Ethnicity: Caucasian Duration: Approximately 2 days Location: Washington, USA Pre-existing Health Concerns: I don't have any significant health issues aside from knowing a relative who has only 25% kidney function and mentioned he wasn’t as cautious as he should have been. Additionally, I’ve dealt with ADHD since childhood, and I suspect I might be autistic, although that hasn't been officially diagnosed. Being neurodivergent sometimes leads to compulsive behavior. Current Medications: Adderall, Zoloft, Gabapentin, Montelukast. I also take a daily non-iron multivitamin and over-the-counter Zyrtec. Having recently come across a great deal on watermelons, I ended up purchasing two. Meanwhile, my wife bought two more on a different shopping trip. While she took half of one camping, I stayed home with 3.5 large watermelons, each weighing between 10 and 15 pounds. Since fruit spoils quickly and I have a deep fondness for watermelon, I made the choice to mostly eat it for the next three days, with little else—perhaps a cheese sandwich and some cheese with crackers to vary my diet. When I felt thirsty, I would simply consume more watermelon. Typically, watermelon keeps my urine clear, so I didn't think it was an issue. On the fourth day, I woke up experiencing painful muscle cramps and feeling quite dehydrated. It struck me that I hadn’t had anything other than watermelon for three days, prompting me to drink actual water for the first time during this period. I couldn’t recall my breakfast or lunch, but I know dinner involved finishing the last of the watermelon. The cramps returned, which made me realize that the excessive watermelon may have been depleting my electrolytes, so I resolved not to buy more watermelon for some time. That night, I noticed a strange odor in my urine, which was no longer clear. Given my history of urinary tract infections occurring every few years, starting with cloudy urine, I didn’t worry too much and went to sleep. The following morning, my urine remained cloudy but without the anticipated pain during urination. Curious about the relationship between watermelon and cloudy urine, I searched online but only found alarming references to stage four kidney failure. None of the articles mentioned the quantity of watermelon consumed. While it seems improbable that I have stage four kidney failure since my urine isn't dark—just cloudy—I do remember the caution my uncle exercises, living with only a quarter of his kidney function. This raises concerns that I may have jeopardized my kidney health, potentially creating an issue that requires urgent medical attention. Should I seek medical help right away, or could this be a wait-and-see situation for a few days, with a visit to the doctor only if my condition doesn’t improve? I’ve experienced similar compulsive eating urges before but have always consumed water during those periods, preventing issues like this, even when I’ve indulged in high-fiber fruits.
Awaiting More Test Results: Navigating Health Concerns
At age 27, I'm currently not on any medications but use cannabis on a daily basis and drink occasionally—only once in the last three weeks at a social event. My medical history primarily involves kidney-related issues. I've been struggling with kidney stones for the past several years, passing a stone or two roughly every ten months. Each time I seek help, imaging studies reveal that due to the stones’ positions, there are no feasible medical interventions available. Here’s a summary of my pertinent medical findings: - The left kidney is atrophic and contains nine lower pole renal calculi, with the largest measuring approximately 14mm. There’s no evidence of hydronephrosis. The right kidney appears normal in size and shape without any stones. There are nine calculi apparent in the left hemipelvis, with the distal ones causing mild hydroureter. - Lower thorax examination is within the normal range. - Liver looks normal with no complications noted. - The gallbladder is under-distended, and there are no abnormalities in the biliary ducts. - The pancreas shows no issues, with no lesions or swelling. During a renal ultrasound utilizing grayscale and color Doppler techniques, the findings include: - The right kidney measures 12.5 cm and shows no signs of obstruction or stones. - The left kidney, at 7.2 cm, appears thinner with one stone measuring about 1.42 x 1.14 cm. - The urinary bladder shows no concerning features. Next, I had a dynamic renal scintigraphy to assess my kidney function after intravenous administration of Tc99m-MAG3. Post-injection, images were captured to evaluate blood flow and renal function. - The left kidney, though smaller, demonstrated adequate uptake and excretion of the radiotracer, contributing only 12% to overall renal function, indicating some level of preservation despite its size. In March, after passing another stone, I underwent additional blood tests and noted a high PSA level and possibly elevated CBC (though I haven’t yet accessed the full results). I need to register on a different portal to view them. Kidney disease runs in my family. Numerous relatives, including my mother, grandmother, sister, uncle, and great-grandfather, have experienced significant kidney issues, particularly with stones. Additionally, there is a familial history of prostate and bladder cancer, affecting various male relatives in my family, including my uncle and both grandfathers' brothers. I’m trying to remain calm, but I’ve been advised to undergo urine cytology tests to rule out certain conditions. I consulted AI on what potential implications my blood results and family history might indicate, and it raised concerns about prostate cancer. I realize that AI might be overly cautious, similar to how WebMD often defaults to cancer, but the thought lingers in my mind, causing me some anxiety. Given my blood results and medical background, how concerned should I be about the possibility of cancer? I understand that definitive answers will come only after the tests are completed, but I would appreciate any informal insight regarding my situation.