Reflux & pain

Question
I am 5 1/2 years post RNY surgery, which I had in my home country (NZ) and it has been very successful. I am now living in Indonesia, where the medical services I can access generally know very little about bariatric surgery, so I am very grateful to have found this site!

I have two issues I would like advice on:
1) I had my gall bladder removed (with open surgery) 10 years ago, and over the last few years I have experienced an occasional  'bulging' sensation in the rib area under my right breast, that seems to be associated with any form of straining, or sitting for long periods. This seems to be getting more frequent. My weight loss (50kg) was stable until around 18 months ago, but In the l year, I have gained around 4kg, and I am wondering if I might have a hernia, and if I should get this problem checked out (probably need to travel to Singapore if so)?
2) For the last 48 hours, I have been experiencing extreme belching, and some pain in my stomach. It came on after I ate lunch (meat, veg, fruit) during a meeting at work, when I probably ate too fast and was talking instead of chewing. Initially, I had a very full, bloated, uncomfortable feeling, then found I couldn't eat or drink without great discomfort and some nausea. I had very little sleep the first night, as every time I lay down the symptoms got worse. I started taking 'Losec' and two days later, it has improved some, but I am still having a lot of burping and wind. Any advice on what is going on, and how to avoid this again would be very welcome.

Answer
Caz,
I am a bit limited in giving you specific medical advice since I have not met you in person, but my sense is that you are on the right track with both issues.

1) a painful bulge in the area of a prior incision has a reasonable chance of being a hernia.  The odds are this has been present at a smaller level for quite some time, but the fact it is now beginning to bother you would indicate that it is time to seek medical attention.  If a hernia is present, then surgical repair will probably be appropriate.

2) your pain and difficulty eating would fit with irritation or perhaps an ulcer in your gastric pouch.  An acid-blocking medication such as 'Losec' is a good start, but this too should be evaluated further by a physician in person.  I'd recommend you try to be seen by a bariatric surgeon, who can also probably handle the hernia question in #1.  While the evaluation is pending, it is a good idea to continue taking the 'Losec.'  It is also important to avoid smoking and avoid medicines in the aspirin family (including ibuprofen, aleve, tolectin, naproxen, etc), since tobacco and aspirin meds are likely to cause ulcers.  Tylenol is OK to take for pain.

Best of luck!
Dr JP

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