Super sick in the morning

Hello all-

I am having a really big problem, and I have no idea why. I am about five weeks out from my DS and hernia repair surgery, and I am waking up every morning super sick. My surgeon said that this should have taken care of my bile reflux problem, so he took me off of all my medications right after the surgery. Well that didn't work. I am now back on all of the medications that I took before the surgery and an addition one to help this flair up. I will wake up in the morning with extreme nausea and bile all the way in my mouth and sometimes even into my nasal cavity it feels like. I have tried eating things, but I don't know if I am eating the wrong things, but it doesn't help. Drinking doesn't seem to help. I take a dissolveable nausea pill, but with only limited relief. It will go away within an hour or two, but I don't have that kind of time to wait every morning, or the constitution to deal with it everyday. Has anyone else had this problem? Any ideas?

Part of your problem is due to getting a LoopDS from Cottam in SLC. In a two anastomoses, there is no physical way for the bile to get to the sleeve as it would have to go down the bilopancreatic limb and then head UP to the sleeve. The LoopDS only has one anastomoses and a much greater risk of bile reflux.

Cottam is only doing the LoopDS now, as part of a clinical trial that he and Roslin in NYC were conducting. http://bariatricfacts.org/threads/dr-daniel-cottam-bmi-of-utah.2661/

Emily, welcome! I'm very sorry you're having such a bad time of it.
@southernlady could be right about you still having bile reflux because of your surgeon no longer doing the standard of care 2 anastomosis DS and instead doing the loop DS, which makes bile reflux possible (though not guaranteed to happen). The bottom line is that you need some kind of work-up to determine why you are having this problem so that something can be done about it. Have you discussed having upper endoscopy? Whatever the problem, that may sort it out.

Those are definitely things that I am going to look into, but any temporary ideas? Right now it is 3:30 AM and I was just woken up by painful bile running up my chest and into my mouth. Any ideas on how to get a full nights sleep and/or wake up feeling ok?

Emily said:

Those are definitely things that I am going to look into, but any temporary ideas? Right now it is 3:30 AM and I was just woken up by painful bile running up my chest and into my mouth. Any ideas on how to get a full nights sleep and/or wake up feeling ok?

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Sleep in a recliner? That way your head stays higher than your body.

Hi and welcome @Emily ! I'm sorry you are so sick - that sounds awful. Liz' idea of keeping the head elevated during sleep makes sense. Hang in there!

Please - and I don't mean this as a diss - stop saying you had a DS. You didn't. You have a SADI and your problems are SADI-specific if you're vomiting bile.

One of the cures is getting your surgery revised to a proper DS, which would not be that difficult of a procedure in skilled hands, almost certainly doable laparoscopically. Just divide the ilium upstream of the duodenal-ileal anastomoses and make the second anastomosis by attaching the cut end to your ileum 100-125 cm proximal to the ileocecal valve. That would send all the bile far away from your pyloric valve and stop the bile reflux permanently. You'd have a longer than usual alimatary tract, but not by much (300 vs 250 cm).

If you had bile reflux before your surgery, IMO you should never have been given a SADI, which has bile reflux as a well-known complication. I would demand that Cottam fix it (he WAS a competent DS surgeon), NOW, and for free. It was IMO never likely to fix preexisting bile reflux - it was more likely to make it worse.

https://www.dssurgery.com/single-anastomosis-duodenoileal-bypass-sadi/
"The length of the biliopancreatic limb [in a proper DS] is so long that it does not allow bile to reflux back into the duodenum or back to the stomach causing the complication of bile reflux gastritis. With the single anastomosis of the SADI, the length of the bowel where the bile meets the duodenum is shorter than it is in normal anatomy. This significantly increases the possibility of the bile reflux."

@southernlady, would it make sense to move this post to the SADI forum?

hilary1617 said:

@southernlady, would it make sense to move this post to the SADI forum?

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Yes, since we do know Cottam does the LoopDS (SADI) not the DS.

Are you sure this is bile and not stomach acid (acid reflux) coming up? How do you know?