Update 1 month after Heller myotomy and partial (Toupet) wrap

(For a much shorter summary with only the important details, please skip to the last paragraph)

History: Well, I'm about 2 days shy of celebrating my first full month post-op. I had the Heller myotomy with Toupet fundoplication to treat early stage Achalasia, and thought my experiences might help those of you considering the operation. A brief history first, though feel free to skip ahead to the next paragraph if you only want to hear about my recovery. I started having oesophageal spasms in 2008 after I returned from a trip to Asia. Classic sub-sternum chest pain at 4 or 5 am in the morning that brought me to my knees, lasting for 20-30 minutes on average. I found that limiting food at night reduced their occurrence. Later I discovered that a giant gulp of water with no air in my mouth could relieve the symptoms immediately. All doctors thought it was GERD and prescribed PPIs, and blamed me for not following a strict diet when I still reported issues. Diet modifications ultimately reduced the incidence of spasms though, and I convinced myself that I also had simple acid reflux. In 2014, I began to have dysphagia, starting with a Subway sandwich. It was terrifying, and I thought that I was going to choke to death. It happened with increasing frequency until late 2015 when every meal resulting in some amount of choking. Doctors still argued that it was acid reflux, and told me to get back on the PPIs. I moved to another state (in the US) with excellent doctors who thought itmay have been Schatzki's ring. I had stool samples, an exhausting amount of blood work, chest X-rays, then a, endoscopy. Next was a barium swallow that showed a blockage. Fortunately the doctor didn't perform a dilation, since Achalasia sufferers have a higher risk of oesophageal performation. Next was the manometry, which is the definitive test. The doctor personally read the results, and assured me his diagnosis of achalasia was 100% correct because he actually trained under the person who invented the technique. I was told that I was in Stage I, and that the prognosis should be good if I have surgery. If Stage II had developed, I would have noticed a relief of symptom as the oesophageal loosens from nerve cell death, and dysphagia resolves. This is a nasty part of the disease because people in Stage II often believe that their medications are working for their mistaken diagnosis of GERD. Meanwhile, you're slowly developing megaesophagus. 

Surgery/Diet: I opted for a manual Heller myotomy with partial (Toupet) fundoplication. While the success of surgery is 90% compared to 99% in POEM as I'm read in some papers, the risk of GERD is 10% with manual surgery vs 35% with POEM. I decided on a Toupet because this typically has less complications than a Nissen. No diet changes before surgery except for no food before midnight. The surgery went well, but I was extremely uncomfortable the two nights I stayed in the hospital. The bed hurt my back, I experienced spasms, I had to get cathetered two times, and I felt nausea. I made it home on the 3rd day and just drank bone broth and nutritional shakes. On day 4, I slowly ate macaroni and cheese without too much trouble, then salmon and yams on day 5. This caused me a lot of stomach pain mostly likely because of charred edges. I went back to baby food, porridge, shakes, and cream of wheat for days 6 and 7. On day 8, I had crippling pain in my sides. I thought I might have been kidney damage from the pain killers, so I stopped all medicine. I improved over the next couple days. I also had spasms, but they were different now. Instead of lasting 20 minutes, they lasted 5 hours. They were more "diffuse", and water didn't help but they were unmistakeably spasms. In week 2, I began to introduce solid food again. Soft catfish, poached eggs, even chicken nuggets with the fried exterior pulled off. I still experienced dysphagia and thought it would never go away. By day 16, I was eating regularly. I had Thai curry with massive chunks of beef, potato, and onion over rice (with spasms). Sake and wine gave me no issues and I ate everything except bread. My spasms have gotten better, and dysphagia is almost gone. I ate a double cheeseburger with bread two days ago, and had a buffet today, both of which would have given me terrible dysphagia in the past. While I got full very quickly during weeks 1-3, I'm now back to my usual portion sizes.

Summary: I had a Heller myotomy with Toupet fundoplication 7 years after noticing symptoms. I was pretty much back to a regular diet between weeks 2-3, and could even tolerate bread into week 3. Noncarbonated alcoholic drinks are fine, and I plan to try beer this week. I still avoid food 3 hours prior to bed, liquids 30 minutes prior to bed, and sleep on a slight incline out of habit. I eat a bit slower but this isn't necessary. I can also eat regular portion sizes again. I still have slight dysphagia, and the surgeon said this will never completely go away because I lack peristalsis. However, it's much improved. I still get spasms that last longer, and don't resolve with water. The surgeon said these will resolve themselves in Achalasia patients as our nerve cells deteriorate. 

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