Vegal Nerve Injury

Question
I was diagnosed with vegal nerve injury after my gastric bypass (RNY) in June 2003 (I went to Mayo Rochester, MN and they did 6 weeks worth of tests and diagnosed it in Oct 2004). I have since been put on a feeding tube to help with nutrition as there are alot of foods I cannot tolerate (meat, fish, dairy in significant quantities, protein shakes, nuts, etc). I have severe gastroparesis with dismotility of my entire intestinal tract. IT has been suggested to me many times that I should consider a reversal of my gastric bypass surgery to see if it would help with the nausea as I have nausea daily. I throw up daily sometimes multiple tmes a day. My doctor (surgeon) is now concerned with the amount of throwing up I do cause it has caused a huge amount of wear on my teeth and he is afraid the my esophagus is next (I had 16 fillings my last dental visit and i got religiously every 6 months). My dentist told me this is from the vomitting and its going to result eventually in needing dentures if it is not controlled soon. My surgeon said there is no guarantee that the reversal would fix or completely solve the problem but that if it improved my life at all, than it was worth it. He also said that he would be willing to put everythign back and at the same time put in a lap band so if I started to gain weight again, he could fill it to restrict my eating some but it would not be as restricted as it is now (my pouch never stretched at all, every test shows a tiny pouch that can only hold an egg worth of food). So I guess I need to know this:
1) Do you have any other suggestions on what I can do to help the nausea (I am on two nausea meds already)
2) Any other ideas on pain control ( I go to a pain clinic and every three months they do celiac plexus blocks and they help with pain control cause of how bad the lack of motility is, food gets stuck alot in the intestinal track causing severe pain)
3) What is the success rate of a reversal for fixing any of the problems especially the gastroparesis I got from the vegal nerve being cut during my original surgery
4) any other suggestions on anything.
I do have a profile on obesity help that documents most of what has happened since the surgery. It is
http://www.obesityhelp.com/morbidobesity/members/profile.php?N=L1050521248

Thanks for anything you can offer. I am kind of at a loss and scared right now

Answer
Alannah,
My compliments on your clear description of the problem.  I have to say this is a really challenging issue that all of us in bariatric surgery encounter from time to time.  By this, I am not referring specifically to Vagal nerve injury but I am referring to the situation where a patient has prolonged nausea and/or pain that we can't figure out.

It sounds to me as if your surgeon has continued to follow along all this with you, and that is a great thing.  He or she is to be complimented for that.

In answer to your questions:
1) My only suggestions are: to give your pouch and your upper intestine a "rest" for a couple of months to see if they improve.  This could be done by giving you IV nutrition, or by a smaller surgical procedure that involved placing a tube into your intestine downstream from all the other work to see if you can receive nutrition successfully at that anatomic area.  Also, really work to eliminate any medication that interferes with gut function, especially the entire class of narcotic pain meds.

2) Pain control is a really sticky wicket.  Note that most of the things available to treat pain, such as narcotic meds, patches, and celiac blocks, also interfere with recovery of intestinal motility.  If you and your surgeon go with a period of IV nutrition I would also recommend you wean off all pain therapy during that time to see if your gut can recover function.

3)  I have not had experience with reversal after cutting the Vagus nerve, though I will add that when a person has been as ill as you have, for as long as you have, it is very difficult to recover to normal function.

I hope this is helpful to you, with my best wishes,
Dr JP

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