Treating Reflux Disease and Hiatal Hernias
Published in the Spring 2012 Issue of ProHealth Magazine.
|Suffering for years from severe acid reflux and an undiagnosed hiatal hernia, Randy Smith despaired of ever living a normal life. After he consulted with Joseph Houda, MD, everything changed.
Randy Smith developed such severe acid reflux that it changed the way he lived a decade of his life.
The 55-year-old attorney began skipping dinner in an attempt to avoid the painful burning that woke him up out of a dead sleep nearly every night. Nonetheless, the reflux persisted, becoming more intense over time and manifesting itself in peripheral health issues such as wheezing and other breathing problems.
The acid that first burned his esophagus was soon spilling over into his lungs as he lay asleep. The pain was so intense that it would jolt him awake, and he would clench his fist tight enough to leave traces of blood in his palm.
Consequently, he gave up many of his daily routines, such as exercising and walking his dogs. He also added routines, including consuming large quantities of antacids, taking a high-dosage prescription drug for reflux, and undergoing breathing therapy to address the scarring that had taken place in his lungs.
Still, nothing was working. As Randy explains, “I dreaded going to bed at night. I put my bed at a two-foot incline and propped myself up with eight pillows to keep myself from rolling over. I just kept thinking there was no way I could go through this for the rest of my life.”
Finally, Randy told his primary care physician that he couldn’t take the daily struggle any longer and needed more help. His doctor referred him to Joseph Houda, MD, in practice with Cardiothoracic Surgery Associates at Miami Valley Hospital. As a cardiothoracic surgeon, Dr. Houda specializes in surgeries of the thorax (chest) – the part of the body cavity from the neck to the abdomen.
Dr. Houda would soon discover Randy’s acid reflux was part of a bigger issue.
More than Reflux
Dr. Houda ordered a series of tests, including a CT scan of Randy’s chest and abdomen, to evaluate his condition. The test revealed a hiatal hernia, a condition in which the upper part of the stomach bulges through an opening in the diaphragm. (The diaphragm separates the thorax from the abdomen.)
Randy had felt something wrong for some time, describing it as a “hard round egg” in the middle of his chest, but he had dismissed it as a symptom of his acid reflux. With a hiatal hernia, it’s much easier for stomach acid to float back and forth between the stomach and the esophagus, causing uncomfortable symptoms such as heartburn and chest pain. The condition is common in people over the age of 50, whose muscular composition has become more lax, and also in people who are obese.
A large number of people who have hiatal hernias aren’t even aware of it. In those who do experience symptoms, most are able to treat the condition by changes in diet, weight loss, smoking and alcohol cessation or with medication. But if the problem is too severe, as in Randy’s case, it must be addressed with surgery.
Surgery was not a new idea for Randy. He had been introduced to the option four years earlier but opted out when he learned he would have to leave Dayton to have it done. “I was told at the time that treating acid reflux with surgery wasn’t something that was commonly done in Dayton, so I would need to go to Cleveland or Cincinnati,” Randy recalls.
|Joseph Houda, MD
This time, however, he was more receptive because he had a new diagnosis (hiatal hernia), a new surgeon (Dr. Houda) – and he would have a private room in MVH’s new patient tower.
Dr. Houda recently joined the cardiothoracic team at MVH after completing advanced training in cardiothoracic surgery, thoracic surgery and esophageal surgery. The addition of Dr. Houda is one of many steps MVH has taken to expand its work in esophageal and general thoracic capabilities. “It is definitely an exciting new frontier,” Dr. Houda says. “We are making significant strides [in treating esophageal conditions] and will continue to do it through new capabilities, including robotic surgery.”
Randy underwent four hours of surgery on Oct. 6, 2011, to repair the hernia and address the acid reflux problem. During the minimally invasive surgery, Dr. Houda made five small holes in Randy’s abdomen, through which he delivered small instruments and a camera to his diaphragm.
To repair the hernia, Dr. Houda performed a laparoscopic paraesophageal hernia repair, which involved separating several of Randy's organs, including his stomach and colon, from his diaphragm. He then repaired the hole in the diaphragm with stitches. (In some cases, if the hole is too large, it is repaired with a patch.)
To alleviate the reflux, Dr. Houda performed a “Nissen fundoplication.” In this procedure, the upper curve of the stomach (the fundus) is wrapped around the bottom of the esophagus and sewn into place so the lower portion of the esophagus passes through the stomach. This surgery strengthens the valve between the esophagus and stomach, thereby stopping acid from backing up into the esophagus as easily.
Randy spent three days in the hospital so the swelling in his esophagus and stomach opening could be monitored and he could receive fluids.
A Dramatic Difference
Randy says the change in his life was almost instantaneous. He returned to work a week after the procedure. He hasn’t taken any more acid reflux medication and no longer has a need to create a nest of pillows in his bed every night. He feels as if he has his life back – enjoying a full-night’s rest without interruption and having the freedom to eat full meals at night.
Randy will be monitored on a routine basis. While his hernia and reflux issue were addressed, Dr. Houda discovered Randy has developed Barrett’s disease, a condition that occurs when tissue damage associated with acid reflux results in abnormal esophagus tissue. Left untreated, it can – in a small number of patients – lead to esophageal cancer.
Meanwhile, Randy is excited to have a chance to become active and healthy once more. He’s now able to walk up and down stairs and take his dogs out for walks without wheezing. Perhaps most importantly, he is able to work with his primary care physician to address other health issues that had been hard to distinguish from his severe reflux problem for so long.
For more information on cardiothoracic surgery, visit www.mvh.org/heart.