Checking for true vagus nerve damage?

• By Novagrad
• Posted June 13, 2009 at 6:58 pm
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I'm not sure if there is any type of test for nerve damage to the vagus nerve. I'm not sure if manometry would show that or if it's a diagnosis of exclusion. Why would you have damage? Did you have surgery, like a nissen fundoplication? I think I have vagus nerve damage from abdominal surgery that I had, but no doctor has suggested that for sure.

Mimi

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• By KNIGHTLIGHT
• Posted June 13, 2009 at 10:27 pm
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My friend Kathy believes her Vagus nerve was damage
when her gallbladder was removed.
I believe the vagus nerve originates in the brain,
hard to get to I would imagine.
I would think a post mortum autopsy might confirm
if was damaged.

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• By NancyL
• Posted June 14, 2009 at 10:57 am
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I believe my vagus nerve was damaged from my nisson preceedure. My surgeon told me that I had a 10% chance that the vagus nerve would be damaged during the surgery and the gastro paralysis could occur. But I was told I would certainly die without the surgery and I did not believe I could be so unlucky as to be one on the 10% on top of already having such a rare condition. I was taught in paramedic school that your vegus nerve controls the urge to bear down when making a BM. It seems to makes sense to me that when everything in my surgery was "text book perfect" and I completely lost any sensation to bear down along with paralysis of the colon that the nerve had something to do with it. There is a whole lot doctors still do not know about how the body works so it could be something else entirely.

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• By GutPain
• Posted June 14, 2009 at 11:25 am
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I know that Mayo in Jacksonville has vagal nerve testing listed in their GI section, but it does not give a description of the test.

I do know that the vagus nerve is the center part of the autonomic system, and controls heart rate, breathing and gives you senses like needing to go to the bathroom. I would imagine the testing would not be able to section off branches of the system but I could be wrong. The vagus nerve can be damaged from straining, diabetes, surgery, neuropathy that I know of.

Lauren, I know that by your tone you are anxious, like everyone else, myself included. Are you getting any therapy to cope with it? The mind is so powerful !!

Read up on neuroplasticity. I believe that through this process out brain can bypass broken down nerves and reconnect through another path. It's sort of re-innervation process.

ALL THE BEST !

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• By jacy1
• Posted June 14, 2009 at 12:21 pm
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I read these posts with interest because I truly belieive ( and my former cardioogist in Arizona sort of hinted to the possibility) that my vagus nerve was somehow affected when I ended up with a pacemaker implant when in the emergency room about four years ago. Hardley anybody who has pacemaker surgery has problems, but I became deathly ill and thought I would die, and I have had problems with my heart ever since. Well about five month after the surgery and being on a beta blocker, I apruptly ( I mean overnight) had a change in bowel habits. All kinds of tests and they told me I had IBS. Well I sort of managed for about a year with Zelnorm, Amatiza etc. Then the extreme pain and nothing, Lost about 40 lbs and was living on Golytely etc to survive. I finally went to the Mayo clinic who finally determined that my
internal anal shpinctor would not open allowing for defecation - motility in colon was fine. Biofeedback and physical therapy did not work for me and I ended up with a colostomy and now wear a bag. ( life is so much better for me now). However I firmly believe damage to the vagus nerve is what caused my intestinal problems.

Having a "learning" doctor do the pacemaker implant, because I ended up in the emergency room at a teaching hospital did not help me at all!

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• By hopefulx2
• Posted July 23, 2009 at 2:22 pm
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Hello,

I don't really know where to start. My relative has vagus nerve damage due to a nissen fundoplication surgery. It took 2 1/2 years of doctoring, tests, and endless re-testing to finally get help. She was pushed and shoved through the cracks of a medical system that was totallly denying her problem. Instead of being compassionate and open-minded; many of the doctors were very defensive. She was accused of being non-compliant, having mental health issues and being a drug addict. The medical system continually tried to discredit her.

She suffered horrible gas bloat syndrom which made her look pregnant. The doctors denied this was an issue until she took photographs and showed them to anyone who would listen and look.

She had constant pain and complained that the nissen was too tight. She had nerve twitching and her eye fluttered continually.

She tried many over-the counter remedies as she is quite sensitive to meds and wanted to avoid prescription meds if possible. All the standard anti-gas meds were tried with very little success. Activated charcoal did not work. Drinking novocaine (an rx drug) did offer some relief. Narcotic medications relieve pain but can cause "narcotic bowel" and make things worse. Very hot tea also gave a little temporary relief.

There were countless test that were run and run again. It always seemed that the doctors were putting her off or hoping she would just go away.

She took photos, wrote letters and literally had to beg and cry for help.

She had several scope tests, had ct-scans, had her esophagus streched, and had a motility test. The later did not reveal very much. She was recommended for bowel retraining, which did not address the issue of nerve damage. Finally, she had a Sham-Feeding Test which confirmed that her vagus nerve was virtually flat-lined.

She had a drastic procedure to correct the problem. Her nissen was taken down; something she was told is never done. Well, apparently it is done. She also had a gastric by-pass. This was not done for weight reduction but as a means of by-passing the damaged nerve and area.

This was a very delicate surgery demanding the most skilled surgeon. The recovery may take up to a year and is not easy - temporary feeding and decompression tubes and A LOT of pain.

She is slowly improving and the eye twitching stopped immediately. She has had to make many changes to her lifestyle.

It took much perserverance and near bancruptcy to find the right diagnosis and the right doctor. She had to be very careful in what she said as the medical community does not like to be critical of their peers.

I am also fighting a similar problem. Just 2 weeks prior to my relative's nissen surgery, I had gallbladder surgery by the same surgeon.

Since then, I have had gas bloat syndrome, and also have a number of nerve-related symptoms. I immediately noticed a change in the shape of my stomach, particularly the lower abdomen. I have pain and tingling in my tongue, jaw, arms down to my fingertips. There is muscle fluttering and spasms around my eyes and in my legs. The constant fluttering makes me achy and tired. It acts like fibromyalgia. I think that many fibromyalgia cases might be traced back to nerve damage in surgery; possibly laproscopes are to blame. Why do so many people develop fibromyalgia these days?

The gas bloat causes much discomfort and nausea. I have noticed a change even in my voice and heart rate. Incontinence is also an occassional problem. I have become very sensitive to noise and can't enjoy music. I feel like I have a giant tuning fork in my chest which is constantly vibrating.

I am not able to belch or pass air very well.

The only relief I find is drinking carbonated beverages and eating a pureed diet. Oatmeal, thin soup, thin mashed potatoes and baby food seem to cause less bloating and symptoms.

I know that I need to keep fighting for answers, but it's hard when you are tired and hurting. Even with insurance, many costs are not covered.

I guess I just wanted to say to anyone out there who wonders if vagus nerve damage could happen from nissen or gallbladder surgery; the answer is YES! As a layperson, I am not offering medical advice. I just want to encourage people to keep trying as you know your body and you know when something is wrong.

Thanks for listening.

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• By GI_dysmotility
• Posted July 26, 2009 at 10:21 pm
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Hi,
I'm really sorry and suprised to hear that having the nissen fundo or a cholecystectomy (gallbladder removal) performed causes vagus never damage. We have 12 cranial nerves, the vagus never being one of them and I believe it's located on the left near the temporal lobe.

Have you tried accupuncture? I know it won't solve your issues but may help somewhat.

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• By momskids193
• Posted July 27, 2009 at 1:26 pm
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Hello, I had a Billroth 2 last summer done for severe ulcer disease. This last spring my GI doc did a scope and said that my vagus was so damaged that it is dead. Don't know how he could tell but said that it will not start working again more than likely. Wish there was a specific test to see if it is really dead. I don't know what the symptons will be, but I do have severe dumping syndrome and now they said that I may have GP also because of the "dead vagus nerve" LInda

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• By GPAllie
• Posted July 27, 2009 at 2:07 pm
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You can be checked for vagus nerve function. The diabetes doctor Richard Bernstein wrote The Complete Diabetes Solution. It's a great book that devotes an entire chapter chapter to GP. He has more suggestions on helping GP than I've seen anywhere else. He also discusses his feeling that the gastric emptying study is useless and that he believes the vagus nerve needs to be checked to see if it is dead or still somewhat alive. He discusses something called an R-R interval study. The results of the interval study correlate to the percentage that the vagus nerve is still working.

I can quote his entire statement on the above. Just let me know and i'll type the paragraphs. Although I highly recommend the book!

Feel better!

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• By mphotographer
• Posted July 28, 2009 at 2:31 pm
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Hi GPAllie-
Please quote his statement! This sounds like a book that all of us with GP should read and so interesting to hear that the GES is useless! I too had my GB removed and the GP symptoms started 6 months later. I recovered well from surgery (also had 1/2 my liver removed because of a large, benign tumor) and then the GP symptoms popped up. However, I also got the flu and this can also be a cause of GP. There are also idopathic (unknown) causes which is very frustrating.

I have been wondering if I should get the GES test done again since it's been a year since I was diagnosed, but...since I still can't eat anything more than I am, I figure, what is the sense? I think I will get this book instead. My GI said that the vagus nerve could have been "clipped" during my surgery or damaged by the flu and if it was from the flu, it could regenerate itself or repair itself and the GP symptoms would go away (6 months to 2 years-I am going on a year).

This is a great discussion and I hope surgeons somehow get the message that this can be a complication of surgery-and esp. removal of the GP. I hope more research goes in this direction.
Mphotographer

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• By GPAllie
• Posted July 28, 2009 at 3:01 pm
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Mphoto,
I guess doc bernstein wrote a little more than a paragraph...1.5 pages. So I'll try to summarize. But do get the book because he has all kinds of help including exercises and massage devices his patients have used to help their GP. Since diabetes is a leading cause of GP, and doc bernstein is a type 1 diabetic specializing in diabetes only, I think he's seen a lot more GP than most GIs and has a lot more advice.

Okay, here goes some points from his book--
All attributed to Chapter 22, Delayed Stomach Emptying, Gastroparesis, Richard Bernstein MD
Book title: Diabetes Soluion:
-R-R Interval Study (RRIT) test function of vagus nerve.
-RRIT is performed using standard electrocardiogram
-Vagus nerve is large and includes functions of heart rate and digestion
-Vagus nerve can be damaged by high blood sugars but doc bernstein believes that long term blood sugar control can reverse damage caused from high sugars
(his reversal took 13 years)
- If vagus nerve is working right, there should be a considerable difference in heart rate between inhaling and exhaling. By measuring the variation in heart rate with deep breath, doctors can get a picture of how much function is impaired
-in nondiabetics, heart rate increases when they inhale deeply and slows when they ehale fully.
-21 year old non diabetic in good health has a slowing of 75percent (typical)
-70 year old diabetic has a slowing of 30 percent (typical)
-The RRIT, the variation is measured by looking at the interal between "R points" or peaks on the trace of the Electrocardiogram
-A low heart rate variability can be a good indication that a patient is likely to have a problem with GP.
-RRIT checks the ability of vagus nerve to regulate heart rate; if nerve fibers are impaired, the branches that activate the stomach are probably also impaired.
-Grossly abnormal RRIT demonstrates GP
-If your heart rate varies only 28 percent between in/ex hale, then you will likely have mild GP; if your variation is 20percent, then moderate GP. If less than 15 percent, then severe GP (footnote in chapter 21, p. 347)

I really pared the above down but I think I got the essentials.

You can buy the book on Amazon. The book is the only place I found comprehensive info and treatments for GP.

Mphoto - send me a message and perhaps I can provide additional info.

Take care.

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• By GI_dysmotility
• Posted July 28, 2009 at 5:52 pm
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I'm sorry - correction for typo: "the vagus never" should be "the vagus NERVE" is one of them.

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• By GPAllie
• Posted July 28, 2009 at 10:14 pm
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Thanks GI-dys, it was difficult for me to type all that in and not make a typo.

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• By Jce355
• Posted August 11, 2009 at 2:56 pm
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Thank you for the info GPAllie. I haven't looked for Dr. Bernstein's book as yet but will. I got to this site with a search for "testing vagus nerve damage".
I may be in denial that I have it. I am an RN of almost 20yrs with some health issues that I fight. My GI who did colonoscopy and endoscopy in June thought my symptoms were most likely GP. I said NO. He said I could take Reglan. I said NO. Too many bad side effects. This was just prior to the scopes while I was on the table. My symptoms started after having a cervical facet block in early May of this year. Quite possible that damage to vagus nerve was done. I have read little however that GP causes diarrhea. It is usually the opposite. I have most of the other symptoms but the diarrhea is horrid and weakening. Types of foods make no difference. A green salad is better than meat on my stomach. The scopes revealed chronic inflammation with suspicion of ulcer healed since I had been on Nexium for a month prior. I have tried to rule out any of my medications causing the diarrhea by leaving each off for a week at a time with no change in bowel habits, nausea, bloating and gas. It is totally unpredictable. I go back to GI doc tomorrow as I am desperate. One other theory is possible. I have Hashimoto's thyroiditis with two nodules on my thyroid gland. With this I still have my thyroid gland which sputters and spurts out some thyroid hormone as it is dying. I also take supplemental med. The radiation from the guided flourescopy to do the facet block could have affected the thyroid gland and the nodules, causing an over excretion of thyroid hormone which would cause a hyperthyroid state, increased metabolism and therefore increased cell replication of the gut and diarrhea. I don't know which would be better to have at this point, the GP or the nodules increasing and the thyroid overacting. Calming that isn't so easy and may be a cancer risk if the nodules have grown. Swallowing is harder now so possibly. Also a feeling with GERD.
Back to your note about Bernstein's test: I checked my heart rate with inspiration and expiration. Doesn't look good. No real change and I did it with my stethescope to be sure of the count. Guess I'll ask the GI doc about doing an EKG to check my QRS segment if I can convince him of the validity of the test. Thank you for the info.
So does anyone else have the problem of diarrhea with the GP instead of retention?

Thank you all and I wish you all better health.
JCE

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• By mphotographer
• Posted August 11, 2009 at 4:00 pm
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Hi JCE-
I am sorry to hear that you have so many medical issues that you have had to deal with. I am glad you found this site though! Yes, a number of other people on this site have problems with diarrhea with GP along with bouts of constipation. I generally have to work to get my bowels going, but earlier in the month, I had a bout with diarrhea that I also could not pinpoint the cause. I am back to my "usual" GP bowel movements now and I really didn't change anything. So....as far as the posts I've read here and what I have personally experienced, yes, diarrhea can be part of GP. Take care and I hope you get some answers soon-Mphotographer

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• By Jce355
• Posted August 11, 2009 at 5:04 pm
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Thank you mphotographer. I really appreciate your caring enough to read the lengthy note I wrote. I function well and deal well with the issues I have. I believe attitude is a lot with one's health. Support is essential and I'm blessed with that from my husband. As so many patients, even I as an RN have a hard time finding physicians to listen to symptoms and the order in which they've occured. As I asked of one whom I'd driven over 60 miles to see about a year ago, "Since I drove for over an hour to get here, waited for another hour in the waiting room, I'd appreciate it if you would give me more than ten minutes of your time to actually listen if you could please?" He slowed down and we've had a much better relationship since. However, he is the very physician that did the cervical facet block this past spring that may have done the vagus nerve damage. He had done two prior blocks without any adverse affects. I wish everyone a better life!

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• By jerseygirl01
• Posted August 11, 2009 at 8:29 pm
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Just joined because of strange mild symptoms that I have and want to add my support to GPAllie's suggestion that those with GP get Bernstein's book. My husband has type II diabetes and we've followed much of Bernstein's advice with good results. Just switching from regular metformin to extended release metformin made a huge difference in his life. While he doesn't have GP, he does have drug induced erratic diarrhea. Now on our 1,300 mile drive to Florida, we celebrate all the exits we can drive by where we used to dive off the interstate in a panic for a bathroom.

Bernstein has walked the walk and he knows how to give a patient the knowledge to manage problems like neuropathy and GP. Read the book if you can, then keep it for reference.

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• By mphotographer
• Posted August 12, 2009 at 9:18 pm
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Good for you JCE, for letting the doctor know what you went through to see him. As an RN, you know that sometimes doctors need reminders that their patients are human beings and that each person is deserving of their 1:1 attention. Especially since we pay so much $ to see them! I hope things start looking up for you-I am glad you have a supportive husband-Mphotographer

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• By Jce355
• Posted August 14, 2009 at 8:37 am
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Thank you to mphotographer for simply reading and following me. Here is an update on MY trials that may be of help to others: I'm an Rn for approx. 20 yrs with cardiac and diabetes background BUT I think part of my brain may have gone down the toilet recently as the brain fog is severe at times so bear with me please. I do believe this is due to electrolyte embalance because of ongoing diarrhea. 1. cervical spine problems with 3 facet blocks. Last of which May of this year (09). Good results until last one which left me with severe abdominal pain, nausea, some diarrhea immediately following and sharpened neck pain on left side. Assumed ulcer from too much NSAID (motrin, asprin) use over the years to avoid narcotics. Primary phys. put me on Nexium ordered endoscopy & colonoscopy esp. since my mother had died of colon CA. Month later had scopes. If ulcer had been present it had healed. Found chronic inflammation of stomach lining only. GI doc said probable Vagus nerve damage from so many neck problems resulting in GP. Suggested reglan. I said no because of parkinson like side effects of reglan and was in denial of the GP so started searching for symptoms and tests for it. Also starting eliminating my meds one at a time for at least five days to see if any of them were causing the diarrhea and pain. The symptoms could be intermittent. Not everyday but about every two to three days. GI doc had said call if I needed him but didn't until 2mos later after I had eliminated all my meds and gotten worse. Also had found info here and thought of possibility of the radiation exposure of radio guided facet block causing exaserbation of the nodules on my thyroid gland. I also have Hashimoto's thyroiditis with two nodules on the left. An autoimmune disorder/disease in which the thyroid gland is being killed by the body and sputters and spurts out thyroxine until it expires. This is a form of hypothyroidism in which one needs to take thyroid hormone replacement but be monitored often because of the unpredictable amount the gland sputters and spurts out on it's own. Radiation can make it produce more and put one in a hyper thyroid state which can cause diarrhea. Needless to say, the GI doc didn't think this the case but I know it's still a possibility and have an appt. with endocrinologist at my endo's office next week for ultra sound of my nodules and labs. Couldn't get appt with my endo till end of Sept. Saw my GI doc day before yesterday, Aug. 12. He palpated abdomen and immediately said he thinks I have bacteria in my small intestines with mild diarrhea predominant IBS possibly. Gave me antibiotic-Xifaxan 200mg 3xday x 7days then eat 4oz of Activia yogurt each day to put good bacteria back into gut. Also said to read up on the diarrhea pred. IBS diet. Everything I read about the drug is positive. No side effects to speak of. Has helped IBS sufferers as well as Crohn's sufferers. I would think they would have to have the bacteria for it to help however. It is NOT a binder it is only an antibiotic which works and stays only in the gut. Symptoms are much like the IBS so maybe. I finally got about a 30% on the Bernstein test for GP though just counting heart rate. I have not done it with an EKG. I need to contact a couple of nurse friends to see if they can do one. Docs won't do it for me. Had regulare gyno exam yesterday and told him about problem. Told him had read IBS symptoms can mimic ovarian cancer so website I found suggested CA-125 lab. He said if I had ovarian CA I would already have cysts on ovaries which I do not but if it would make me feel better he would order some tests including an ultra sound to check. He is very understanding and supportive. I said I trusted his knowledge and declined. I am on day 3 of the xifaxan for the bacteria in the gut with less pain but the diarrhea persists. It should start to subside in another day or two according to what I was told and read. Another point is: My chiropractic adjustments seem to improve the diarrhea so I go back to the vagus nerve damage or impingement being a possibility. Symptoms can mimic so many different things. If we jump on a treatment for one of them sometimes the treatment itself can cause our symptoms to be worse or cause more problems. We can also have more than one problem causing the symptoms as I believe I may have some vagus nerve damage or impingement along with at least one other problem. Just in case someone would like to look at the IBS link which I think is good, here it is http://www.helpforibs.com/ Sorry this is long but I feel for everyone of you and hope something I write may be familiar and help. I will update as to whether the xifaxan helped in a few days and try to get the EKG done to test Bernsteins theory on me. You are all in my prayers!

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• By Tiffh
• Posted August 26, 2009 at 1:44 pm
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I had the RRIT done last week. You get the results immediately as it is the doctor (at least mine) that performs the test. My neurologist specializes in autonomic neuropathy and he has taken my issues very seriously although I only consider my GP to be mild (no vomiting and zofran/phenergran as needed). The results of the test showed that my vagus nerve was damaged as my heart rate was too slow during the inhale/exhale part. He ordered a blood test to check for a certain virus antibody (can't remember which one) and told me to repeat both tests in 6 mos. I have not received the result of the blood test yet, but I am hopeful that this neuropathy has been caused by a virus that I can treat. We are always looking for answers right?! In the meantime, I am continuing my hypnosis and taking my supplements and most importantly, taking one day at a time.

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