Hernia Repair

[theguyfromanotherforum]

I know there is an older thread about this, but I need some info.

 

As I mentioned a few times I have a lot of problems with breathing and reflux which I am positively and absolutely sure is due to my (sliding) hiatal hernia. I would be willing to do a surgery in Bangkok and was quoted around 350k baht for a surgery. Honestly, at this point the price is not an object as I suffer from this 24/7, however, the doctor advised me several times that they don't recommend doing the surgery and has actually told me that if I can I should do this in Canada.... a rather strange reply coming from a private hospital I thought.

 

Anyway, I know there are 2 types of this surgery.... open and Laparoscopic.... however, from what I read they are both done through the abdomen? I am pretty sure I read somewhere that this surgery can also be performed through the mouth. Any advice on this surgery in Bangkok would be appreciated. I will probably go and do this in Canada in case there are complications, but I would like to see options in Bangkok if it is less hassle as I would have to go back, wait to establish residency etc, etc.....

[SaintLouisBlues]

If it's the traditional hiatus hernia then it's the upper part of your stomach pushing up through your diaphragm and into your chest region. I'm not sure how that could be treated by an insertion via the mouth, as the diaphragm has to be repaired. It can be effected both of the ways you describe. The recommendation about where to do it may relate to the relative skills of the surgeons at the hospital . My experience of Thai hospitals including BNH is that they're at least one knowledge cycle behind a comparable hospital in the West for many medical conditions. Personally I'd get a second opinion from a non-profit place, say, Saint Louis Hospital of which I and a number of friends have had good experiences

[Thanyaburi Mac]

2nd opinion is 2nd-ed....

 

Don't know about repair through the mouth but I've had two open hernia opns here but long ago and no idea what the cost was.  Longer recovery time, 3-4 weeks, altho back home after five days. However, even Bumrungrad has on their www site an average cost for open repair of hernia of baht 180,000 for this opn.

 

For comparison, I also had a laparoscopic removal of the gall bladder here at Vibhavadi hospital in 2007, baht 107,000.  Essentially zero recovery time it seems, two nights in the  hospital.

 

For further reading:

 

http://www.webmd.com/digestive-disorders/open-inguinal-hernia-repair-herniorrhaphy-hernioplasty

 

http://www.webmd.com/digestive-disorders/laparoscopic-inguinal-hernia-repair

[Sheryl]

Thsi is a hiatal hernia so above references not really relevant.

 

Hiatal hernia repair is a major and complex procedure.

 

It cannot be done through the mouth, but can be done laparascopically.

 

Experience with it is limited in Thailand, not many surgeons with expertise in it  and thsioe which have, have been doing it for only a few years. If it were me and I had the option, I would have it done back in the West where there is much more experience with it. 

 

If you must do this in Thailand, then see one of these surgeons:

 

Assist.Prof.Sqn Ldr.Dr. Poochong Timratana

Asst. Prof Chadin Tharavej

 

Both are Bumrungrad, Prof. Poochong is also at Bangkok Hospital

 

This procedure will cost you a small fortune (actually, not so small) at either Bumrungrad or Bangkok Hospital.

 

Prof. Poochong is also at Rajawithi Hospital, which has a semi-private after hours clinic  where you might be able to see him (no guarantee) see here for description http://www.thaivisa.com/forum/topic/904921-rajavithi-surgery-extra-clinic-location/

 

 

And Prof. Chadin is also at Chulalongkhorn which has an after hours clinic as well, may be able to consult him privately there. 13 th floor, main OPD building, from about 4 PM Mon-Fri and also Saturday mornings, appointment required and have to go in person to make it.

 

[theguyfromanotherforum]

4 hours ago, Sheryl said:

Thsi is a hiatal hernia so above references not really relevant.

 

Hiatal hernia repair is a major and complex procedure.

 

 

 

 

 

Thanks, as I am also confused.

 

Is the procedure for this called Nissen fundoplication?

 

" This procedure will cost you a small fortune (actually, not so small) at either Bumrungrad or Bangkok Hospital."

 

I am guessing this would be the correct price (350k) I got quoted then as I had endoscopy at the same hospital.

Edited October 2, 2016 by theguyfromanotherforum

[Sheryl]

Yes, Nissen fundoplication is a type of laparoscopic repair of hiatal hernia..

 

I am surprised not more than  350K, I would  expect more like 500K based on what they charge for  procedures of similiar complexity.

 

In either case, if you can afford this, then both of the surgeons I mentioned have privileges at Bumrungrad.  The first one (Prof. Poochong) is there most days of the week.

[Thanyaburi Mac]

Oops, I confused the two types of hernias, I had the simple one.

 

FYI, I have a couple of friends who knock down ThaiVisa because of incorrect info, my response to them is, sure, but the incorrect info get corrected quickly, usually.

 

Mac

[sinbin]

23 hours ago, theguyfromanotherforum said:

As I mentioned a few times I have a lot of problems with breathing and reflux which I am positively and absolutely sure

I too had your problems along with a cough. I had a CT scan and found it to be caused by Lower Left Lobe thickening. Why don't you go for a scan to be sure, to be sure? 

Go see on 'Isaan forum'.

Spirometer test cost in Korat.

 

 

Edited October 3, 2016 by sinbin

[theguyfromanotherforum]

28 minutes ago, sinbin said:

I too had your problems along with a cough. I had a CT scan and found it to be caused by Lower Left Lobe thickening. Why don't you go for a scan to be sure, to be sure? 

Go see on 'Isaan forum'.

Spirometer test cost in Korat.

 

 

 

Well, I don't have a cough, just difficulty breathing, silent reflux and occasional slight pain where hernia is located. Since endoscopy confirmed hiatal hernia and from what I read all these symptoms pretty much fit there is little doubt in my mind regarding the diagnosis. 

 

One thing that puzzles me is that doctor said I was practically born with this hernia, but I never had a single issue until I got sick in Japan and was coughing for 3 months non stop. I mentioned this to a doctor and he said it's not possible to get hernia like this, but I read on some reputable sites that chronic cough can indeed cause a strain which develops hernia.

 

 

 

 

[sinbin]

34 minutes ago, theguyfromanotherforum said:

 

 

Quote

I don't have a cough, just difficulty breathing

t

Quote

there is little doubt in my mind regarding the diagnosis. 

 

Quote

 I got sick in Japan and was coughing for 3 months non stop.

 

 

 

 

 

You don't have a cough now but you did for 3 months non stop. Which is a long time for a cough. "There is no doubt in my mind" which seems to be self diagnosed. So why not treat yourself to a CT scan which will show a 'hernia', if you really have one? It doesn't hurt and then you should be 100% certain as to your diagnosis.

 

Quote

It is wrong to always blame a hiatus hernia for pain and indigestion. Hiatus hernias generally do not cause acute pain. This symptom may result from other disorders, such as peptic ulcers or even heart disease. Some patients with coronary heart disease fool themselves into believing their discomfort is due to a hiatus hernia. If upper-abdominal pain or indigestion occurs, people should not mislead themselves into thinking the cause is a hiatus hernia.

 

Edited October 3, 2016 by sinbin

[theguyfromanotherforum]

 

52 minutes ago, sinbin said:

You don't have a cough now but you did for 3 months non stop. Which is a long time for a cough. "There is no doubt in my mind" which seems to be self diagnosed. So why not treat yourself to a CT scan which will show a 'hernia', if you really have one? It doesn't hurt and then you should be 100% certain as to your diagnosis.

 

 

 

I am 100% certain about (not my) diagnosis as Endoscopy, not CT scan confirmed it.

 

 

I am actually the guy who thinks about the worst possible scenario and the so-called cardiac asthma, coronary disease COPD were first on my list. I have carefully read about symptoms for years, been misdiagnosed with Asthma (because passing the Symbicort and Ventolin is the easiest thing for doctors to do) and am aware of dozens of diseases that can cause breathing difficulties. The only persistent symptoms are "silent refulx" symptoms which are caused by this hernia.

Edited October 3, 2016 by theguyfromanotherforum

[sinbin]

3 hours ago, theguyfromanotherforum said:

 

 

I am 100% certain about (not my) diagnosis as Endoscopy, not CT scan confirmed it.

 

 

I am actually the guy who thinks about the worst possible scenario and the so-called cardiac asthma, coronary disease COPD were first on my list. I have carefully read about symptoms for years, been misdiagnosed with Asthma (because passing the Symbicort and Ventolin is the easiest thing for doctors to do) and am aware of dozens of diseases that can cause breathing difficulties. The only persistent symptoms are "silent refulx" symptoms which are caused by this hernia.

 

 

You need to thank Sheryl for the info below. I think your condition can be controlled with medication. No need for an operation. Hence why you may be having difficulty to find a surgeon who will do the operation.

 

Quote

 

Did the endoscopy also show gastritis? If so, need to treat that, including eradication of H. Pylori if indicated. (They may need to wait for test results to know that.) That you have a hiatus hernia does not necessarily mean it is the main cause of your distress. Only if it is a large one in the absence of gastritis would that be likely.

Surgery is a last resort and often unnecessary.

The usual management is:

1. Avoid caffeine (or minimize it) as this weakens the sphincter between esophagus and stomach, promoting acid reflux.

2. Avoid eating large amounts at one time -- smaller portions and then wait a bto for a second helping if desires. Overfilling the stomach will lead to reflux.

3. Avoid lying down flat for 2 hours after eating.

4. If the problem is mainly at night, an extra pillow may help.

5. A PPI such as omeprazole is often prescribed.

Some good resources:

http://www.mayoclinic.com/health/hiatal-hernia/DS00099

http://www.nhs.uk/Conditions/Hernia-hiatus/Pages/Introduction.as

 

 

Edited October 3, 2016 by sinbin

[theguyfromanotherforum]

1 hour ago, sinbin said:

 

 

Thank Sheryl for what? The above answer was not for me and as far as I understand Hernia affects people in a lot of different ways. I would even be willing to risk a lot of long term side effects with omeprazole if the pill was effective. With hernia there is other stuff that is getting out besides acid (like bile) and there is no medication for that as I was told. If diet and meds were simply an answer to this I would have done it long time ago.

 

And yes, when I do drink alcohol once a year it does make me feel terrible afterwards. I get a lump in my throat and it burns abdomen.... certainly a feeling I never experienced before getting this defect 3 years ago.

 

Of course, I may be completely wrong about everything, but all the symptoms point to this.

 

[sinbin]

On 02/10/2016 at 10:32 AM, theguyfromanotherforum said:

the doctor advised me several times that they don't recommend doing the surgery

3 years and you can't find a doctor to do the operation? May be the doctors are right in telling you you don't need one?

Edited October 3, 2016 by sinbin

[theguyfromanotherforum]

5 minutes ago, sinbin said:

3 years and you can't find a doctor to do the operation? May be the doctors are right in telling you you don't need one?

 

?

I really don't understand why are you posting on this thread? You seem to have bad comprehension skills first stating I self diagnosed myself without even reading that I actually had a hernia/reflux diagnosis with endoscopy and now guessing that I have been looking for doctors to operate on me for 3 years while in fact I only asked in one hospital - the same hospital I got diagnosed with Hiatal hernia.

 

 

 

 

 

 

[theguyfromanotherforum]

Sheryl, perhaps you remember my whines about reflux and having almost extreme difficulties breathing. This has been going on for almost 5 years now.

 

Yesterday while browsing 7/11 I came across some herbal pills that treat flatulence. It had a nice pic of acidic stomach, so I thought why not. I took 2 pills and now even after 2 days I am barely having any symptoms whatsoever. I will wait a bit longer to make sure it is not some placebo effect playing with my head, but I wonder if this reflux that gives me so much problems breathing is  actually due to excessive gasses I have in my chest (I mean around that area). I do feel most of the time like almost an air balloon is living right in the center of my ribcage. 

 

Is this even a reflux? I am still very convinced that hiatus hernia is giving me all these problems, but perhaps this should have been treated with different meds and not anti acids.

 

Does this make sense to you?

 

 

[Sheryl]

Definitely you have reflux, having a hiatal hernia does not mean no reflux, on the contrary it is one of several possible causes of reflux.

 

Reflex is caused my stomach acids rising back up into the esophagus (and in some people, all the way up into the pharynx.) There is a sphincter between esophagus and stomach (Lower Esophageal Sphincter or LES) that normally prevents this, but it can be overridden by two things:

 

1. weakening of the sphincter (age, caffeine are usual causes; also some drugs)

 

2. increased pressure in the stomach (pushes the fluid up despite the sphincter). This can be caused by several things, alone or in combination:

- overeating (distends stomach and puts upward pressure on the LES)

- lying down too soon after eating (gravity no longer working in your favor)

-hiatal hernia (literally squeezes the stomach)

-excess gas in the stomach or even in the small intestines  (enough pressure in small intestine will push the stomach upward)

 

Since anti-flatulance meds are helping you it is likely that this last factor was part of it in your case, with or without any other factors

 

In addition to the medication you might do well to try to figure out what is causing the excess gas formation. Could be what you eat, how fast you eat, not chewing throughly, or a tendency to swallow air (often related to anxiety)

 

Please post a pix of the med you took, may be helpful to others and also then I canadvise re safety of long term use

 

There are no medications that actually cure  a hiatal hernia. The only definitive treatments are weight loss and surgery. However surgery is rarely necessary. Medications given for hiatal hernia do not change either the hernia or the amount of reflux, they only make the contents of the reflux less acidic and thus less irritating (but do so at a price).   Losing weight, eating smaller amounts at a time, elevating head of bed, not eating before lying down and avoiding build up of excess gas will all help prevent reflux due to h.h. (as well as reflux in people without h.h.) even tough the h.h. remains.

 

The only way to diagnose a h.h. is by endoscopy or barium swallow. Just because you have reflux does not mean you have h.h. And in any case, short of surgery, the measures to take are identical whether reflux due ot h.h. or not. It is the reflux noit the h.h. per se that is the problem. It is quite possible to have h.h. with no symptoms or problems from it.

 

[theguyfromanotherforum]

Yes, interesting how even in private hospitals they never went into so much detail like you did. Anyway, I am now almost certain that it is the excess gas that is giving me so many problems as I never really had any typical reflux symptoms.

 

The meds are herbal. Here's the pic

 

 

The ingredients from a web site are 

 

Turmeric	120 mg
Cinnamon	40 mg
Coriander seed	100 mg
Nutmeg	30 mg

 

 

Interestingly I used to take turmeric and it wasn't helping much, but this mix for some reason is. 

[Sheryl]

Thanks, very interesting.

 

Can't see any problem with taking this long term.

[theguyfromanotherforum]

This is really helping me. Much, much better effect than Omeprazole. Taking omeprazole I was feeling maybe 40% better, taking this 85-90% better.

 

I am someone who is really skeptical of herbal remedies, but after 5 years I have had a week of very very mild symptoms. My constant (like non-stop) symptoms are difficulty breathing (especially breathing in), lump in throat, mucus buildup in throat and for the lack of a better diagnosis dyspepsia. 

 

I still have some difficulty with breathing at night, but this is probably due to the fact I just can't sleep any other way but flat. Anyhoo, if you are suffering from Reflux I recommend you give this a try. The only thing you can lose is 10 baht at 7/11

 

 

 

 

[Sheryl]

Great to hear. Suggests that in your gas, gas build up was the main culprit behind the reflux.

 

Unfortunately not all 7-elevens carry it - I already checked out where I am.  But the good news is it can also be bought online http://sandm.co.th/en/shop/handy-herb-airess/

 

I intend to try it myself as I also have some reflux.

[anthoma]

23 hours ago, theguyfromanotherforum said:

This is really helping me. Much, much better effect than Omeprazole. Taking omeprazole I was feeling maybe 40% better, taking this 85-90% better.

 

I am someone who is really skeptical of herbal remedies, but after 5 years I have had a week of very very mild symptoms. My constant (like non-stop) symptoms are difficulty breathing (especially breathing in), lump in throat, mucus buildup in throat and for the lack of a better diagnosis dyspepsia. 

 

I still have some difficulty with breathing at night, but this is probably due to the fact I just can't sleep any other way but flat. Anyhoo, if you are suffering from Reflux I recommend you give this a try. The only thing you can lose is 10 baht at 7/11

 

 

 

 

I have the same symptoms as you. For many years i've been struggling with difficult breathing (breathing in), lump in my troat, have to clear my voice all the time spesiell when i talk alot. Been to many spesialists, tried all kinds of medication and diets but nothing helped. I'm like you sceptical to herbs and stuff, but after reading about your experience i went to 7-eleven and bought som of these tablets. To early to really believe that this really will help me in the long run, but so far after one week i feel alot better. 

But then i read the link that Sheryl put out and there it say that its not recommended for people with heart disease. I had a heart attack 3 years ago and they put in a stent. Doctor say that my heart i pumping about 80% but thats not seriouse. I take cholesterol medicines, betablokkers and aspirin.

So now i dont know if i will take the chance to take this herbs. I have appointment with my cardiologist 22 november som maybe ask him what he think.

Forgive my bad english, but im a Norwegian som my english is not perfect.

 

 

 

 

[tonray]

17 hours ago, Sheryl said:

Great to hear. Suggests that in your gas, gas build up was the main culprit behind the reflux.

 

Unfortunately not all 7-elevens carry it - I already checked out where I am.  But the good news is it can also be bought online http://sandm.co.th/en/shop/handy-herb-airess/

 

I intend to try it myself as I also have some reflux.

MaxValu stores also carry it. 

[theguyfromanotherforum]

Having recommended Airess here I owe it to the community especially Sheryl to recommend something else. 

 

This is my last month in Canada, so I decided to try a few things. One of them is pure (99.8%) Aloe Vera juice. Ordered several buckets from Wall Mart and just after 2 days the stuff works better than I imagined. The constant breathing problems that I have are 90% better just from drinking the juice. The best part is I can eat crap, drink coffee and just have a grass of juice and 2 hours later I'll feel better.

 

The only problem is night time. I don't think I will ever sleep better no matter how much I raise my body.

 

Now I absolutely dread going back to Thailand as I am unsure that I will be able to find a proper Aloe Vera juice. Does anyone have any clue where to find the non sugary version widely available in stores.

 

 

 

 

[Sheryl]

You could try asking this company. Annoyingly their website does not list products.

http://www.bangkokaloe.com/contact.php

 

And this place has supposedly organic product but I suspect at least some sugar added

http://aloedrinkforlife.com/

 

Lazada kicks up these (eliminating those with some other juice mixed in)

https://www.lazada.co.th/products/polvera-neutral-v-aloe-vera-juice-9967-i207869193-s312936260.html?spm=a2o4m.searchlist.list.9.6d9350c5CC3W5n&search=1

 

 

It is very easy to get aloe vera plants here, why not make your own?

https://www.youtube.com/watch?v=3IS_OIf0Y0Q

 

As far as I can tell all you do is remove pulp, soak it and rinse to remove gunk then put in a blender with some water and blend.

 

Thanks for the tip, Airess did the trick for me and I now only need to take it occasionally but will keep in mind.