Elderly Mother with Hiatus Hernia

[SheWolf]

My mother has had digestion problems for most of her adult life, having a sensitive stomach and also in later years bouts of IBS.

About a year ago she started having a lot of problems swallowing food and keeping it down. She had acid reflux but also an overactive gag reflex, which sometimes caused her to bring up lots of saliva, even when she'd only had a mouthful of food. Also, she was diagnosed with a hiatus hernia years back and often took anti acid tablets for it, although she'd got very lax about taking the tablets.

Things all came to a head this summer, when she was vomiting almost daily and her weight dropped down to 6.5 stone! I asked the GP on several occasions if Mum should have an endoscopy but every time was told that it was too invasive and they probably wouldn't find anything. The doctor tried various tablets but nothing seemed to work, and because my mother had also been depressed and neglecting herself the psych consultant diagnosed "passive suicidal behaviour". She was admitted to a psych unit, where they gave her a course of ECT and coaxed her to eat small meals regularly. However, the symptoms still persisted, until one day I mentioned to the nurse that Mum had never had an endoscopy done. She was amazed and managed to get Mum referred for one. Just before they discharged her, the endoscopy was done and they said her throat was very constricted and needed 'stretching'. Finally she had a second endoscopy done, where they stretched her throat. This was all very unpleasant for poor old Mum, as you can imagine. The consultant said the whole thing was really caused by her hiatus hernia sending acid up her throat, causing ulcers, making it inflamed. He prescribed Omeprazole, saying she needs to be on it for the rest of her life. He said ideally they would operate to fix the hernia, but as Mum is nearly 85 they would rather treat with the tablets. Trouble is, the tabs are making her IBS worse - the other day she didn't make it to the loo and was in a right state (no. 2s). Also, her throat is still sore and her breath smells quite bad, despite me scrubbing her dentures and getting her to gargle. I hope it's not infected.

Sorry for the rambling post, but I'm concerned that a lot of time has been wasted already and that the meds are not the answer. I believe the op could be performed 'keyhole' method, so am wondering whether I should push for this. I also wonder if the real reason they don't want to operate is simply an issue of costs? I'd be grateful for any advice please.

[Anne001]

Hi She Wolf,

My mum also has a hiatus hernia and IBS (I wonder if the two are related in some way??). However, although my mum is constantly bringing up phlegm, and only weighs about the same as yours, she is not prescribed anything to help and is advised against surgery. On the plus side, unlike you this has not aggravated her iBS.

I wonder if your mum would be better without the tablets and just living with the side effects of the hernia? I think it would be easier for you both if the IBS could get under control. Maybe a referral to a dietician? My mum cannot eat ANY green vegetables, for example, but every case is different. I do understand how worrying this is but I think the hernia and the IBS are two separate problems (although I am most certainly no expert).

Anne x

[SheWolf]

Thanks Anne. You're probably right, about just helping Mum to live with the condition.

Latest update: when I called in on her this afternoon she had messed herself again. She was sat in her chair, refusing to admit that anything was wrong, even though the smell hit me as soon as I opened the door and it was obvious. Managed to get her upstairs to the bathroom but she refused point blank to go in the shower. Got her to wash and put clean clothes on. All this was before the carer was due to visit - wonder what Mum would have done if I'd not called today? She's too ashamed and embarrassed to ask for my help, let alone the carers, so that makes it all worse than it needs to be.

All very upsetting and unpleasant but I think as it's happened twice in less than a week, all since the new meds, it must be down to them, so I've stopped them with immediate effect. In this case the side effects are too much for Mum to handle. I plan to speak to the GP about it, when I can get an appt, but for now I'll just see how things go.

On the plus side, her breath smelt fine today so I think her throat has healed up now, so that's one good thing. I just wish Mum would try to help herself when these things happen, instead of just wallowing in the mess until somebody (usually me) discovers it. She's not disabled or anything, but seems to just go into denial about anything toilet related. I've made sure she has wet wipes, disposable panties and gloves etc, but instead of sorting it out herself Mum just pretended it had happened. I just keep thinking; How long would she have sat in her own mess if I hadn't called in?

[cheryl]

Hi my mum has also has had a prob with hiatis hernia for many years, after several bouts of vomiting which over time got worse and more frequent she finally ended up in hospital because she'd been vomiting every 20-30 mins for several hours and had been bringing a combination of blood and what looked like coffee grounds sorry to be so graphic . But it is important for you and your mum to understand that without proper treatment and diet how bad a hiatis hernia can become. One of the worst things is that they can become dehydrated and loose certain essential blood salts etc which will make your mum weak and confused, and sometimes have similar symptoms as a stroke.
If the Omeprazol doesn't suit her this could be that they started her on too high a dose, if they prescribed 40mg or above you could ask them to reduce it to 20mg, and if need be take the 20mg twice a day. Or swop to Lansaprozol which is the same type of drug as Omeprazol but some people get on fine with one and not the other. Or swop to Cimetidine which is different group of drugs that act in slightly different way.
Another thing to consider with these antiacid drugs is when and how your mum takes them follow the instructions exactly as that can make a big difference to how well the drug works and is tolerated.
The specialist at the hospital recommended that my mum should really be on a soft food diet, basically mash every thing that can be mashed, leave out high fibre foods as they are hard to digest. Remove the crusts from bread and she shouldn't eat anything crispy, crunchy, fatty, spicy, sugery, also food with skin on even peas baked beans, lentils etc sweet corn is very hard to digest as is cucumber,tomatoes, small fruits like raisins, currants, sultanas all can cause a problem as they can get trapped in the bulging bit of the hernia and basically sort of ferment there causing inflamation.
Porridge is good and stewed fruit, particularly apples as they have a soothing affect on the stomach. Chicken and fish are ok not smoked fish, beef is hard digest, small amount of lamb or pork not to offten though. Five small meals are better than larger meals 3 times a day. Your mum prob would benefit from sleeping slightly upright, or at least could try raising the the top of the bed either by putting something under the mattress and/ or bed base.
Hope some of the above helps it is a difficult thing to manage and even being very careful still can have flare up of the hernia for no apparent reason.

[SheWolf]

Thanks Cheryl, all useful info for when I see the GP next week.

For months Mum was virtually on a liquid diet anyway - milkshakes, soup, custard and chocolate were her mainstays. Then while she was in hospital they pushed her to eat proper meals, thinking it was all in her mind... food aversion etc. One of the nurses had got a bit nasty one day and made the comment 'if you can eat chocolate, you can eat proper food!' which seemed pretty harsh to me. Mum hasn't got many pleasures in life, living with an alcoholic husband who also has dementia, so it's no wonder she turned to chocolate. In any case, once the endoscopy results came back, they all realised Mum had good reason to be fearful about eating. She's had an awful year, I just hope next year will be better for her.

Now she is on Fortisip which she loves... prescription is for 2 a day but she tends to have more, given the chance, which means at least she is getting her vitamins and keeping hydrated. She also manages mashed potato, scrambled eggs, and occasionally cottage pie, which I always give her a teaspoon to eat, so she doesn't take big mouthfuls, then she manages OK. For a long time Mum has avoided any type of bread or any crusty/crunchy foods, as she found they kept getting stuck. She doesn't seem to mind too much that her diet is restricted, but being incontinent long term would really distress her.

[The Green Archer]

Hi She Wolf Mums also has a Hiatus Hernia she has trouble with swallowing, i send you big ((((((HUGS))))) hope things turn out ok, would write more to compare but i'm so tired, i Know join the club. take care.