SOS...Laryngopharyngeal Reflux...SOS

[Jaffa 5]

My wife is using 40mg Nexium....MUST be taken at least 30 minutes before you eat in the morning. She tried other things, and they didn't work as well.

Also it is extremely important to take acid preventers at least 30 minutues ahead of time. Some people may even need an hour for it to get absorbed and in the blood stream enough to shut of the acid production.

Also, you may want to go back to easier food for a few days to settle things down.

[LAN2k 18]

Jaffa- Thank you for the tips. I've been on Protonix for just about a full week now, ( 40mgs in the morning and 40 at night for a total of 80 mgs. per day). I still feel that throat irritation, lump and nasal drip. I am researching to find a gastroenterologist who has bariatric experience. In the meanwhile if I don't feel a marked improvement using the protonix I will check to see if my insurance will cover nexium. I will be sure to wait at least 30 minutes after taking my PPI in the morning before eating Breakfast. Thanks again.

[ouroborous 519]

Lis, did you ever find out anything about the Carafate (sucralfate)?

[LAN2k 18]

I left a message for my PCP to call me back ASAP! I am fairly sure that she will phone in a prescription directly to my pharmacy...only thing is I'm waiting for her to call me back which usually takes a couple of days (hopefully by Monday if not I'll call again). I hope it helps with the throat inflammation and nasal drippyness. I will ask for the Carafat in the generic brand "Sucralfate". You did say it's by prescription only?

[Jaffa 5]

Taking any PPI at least 30 minutes prior to eating is critical....it can't work if it isn't in your bloodstream before you eat.

My wife found this info out the hard way.

[LAN2k 18]

I'm going to use this as protocol Jaffa-thanks so much.

[deletedsally 8]

Sorry you are having trouble with this Lis...You may have already searched this out, but there are some foods that tend to aggravate problems with reflux. I've had problems with GERD in the past, and some of the foods that seem to make mine worse are chocolate, Peanut Butter, green peppers, & artificial sweetners. I can trigger a problem with reflux very easily just by eating chocolate--it causes the muscle around the esophagus to relax.

I hope your doctor is able to help you with this, and that you start feeling better soon!

Gastroesophageal Reflux Disease Diet

Learn how the new Prebiotic soluble fibers benefit bowel health and many GI disorders

Purpose

The esophagus is the tube that carries food from the throat to the stomach. However, it is not just a simple tube. The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach. It acts to prevent the reflux of stomach acid into the esophagus.

Symptoms occur when this specialized muscle weakens and allows stomach acid to splash up into the esophagus. These symptoms include heartburn, chest discomfort, and bitter Fluid flowing up into the mouth. Chest discomfort can occur. If the stomach juice trickles into the breathing tubes, hoarseness, cough, and even shortness of breath can occur. This entire problem is called GERD (Gastroesophageal Reflux Disease). A number of factors, including certain foods, may cause the lower esophageal muscle to relax, causing GERD.

Nutrition Facts

A diet designed to prevent or reduce acid reflux is usually easy to follow. The basic food groups of cereals, vegetables, fruits, dairy products, and meats can be eaten with only a few limitations. So, this diet generally meets the Recommended Dietary Allowances (RDA) of the National Research Council. A Vitamin C supplement may be needed if an individual does not tolerate citrus foods such as orange, Tomato, etc.

Special ConsiderationsThe lower esophageal muscle can be weakened by factors other than food. The following recommendations may be helpful in reducing symptoms:

1. Stop using tobacco in all forms. Nicotine weakens the lower esophageal muscle.
   
2. Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.
   
3. Do not lie down immediately after eating. Avoid late evening Snacks.
   
4. Avoid tight clothing and bending over after eating.
   
5. Eat small, frequent portions of food and snack if needed.
   
6. Lose weight if overweight. Obesity leads to increased reflux.
   
7. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.
   
8. The following foods aggravate acid reflux, and should be avoided:
   
   • fatty or fried foods
     
   • peppermint and spearmint
     
   • whole milk
     
   • oils
     
   • chocolate
     
   • creamed foods or Soups
     
   • most fast foods
     

[*]The following foods irritate an inflamed lower esophagus and may need to be limited or avoided:

• citrus fruits and juices (grapefruit, orange, pineapple, tomato)
  
• coffee (regular and decaffeinated)
  
• caffeinated soft drinks
  
• tea
  
• other caffeinated beverages
  

[*]Spicy or acidic foods may not be tolerated by some individuals.

Gastroesophageal Reflux Disease Diet

Learn how the new prebiotic soluble fibers benefit bowel health and many GI disorders

Purpose

The esophagus is the tube that carries food from the throat to the stomach. However, it is not just a simple tube. The lower esophagus has a specialized muscle around it that usually stays tightly closed, opening only to allow food and liquid into the stomach. It acts to prevent the reflux of stomach acid into the esophagus.

Symptoms occur when this specialized muscle weakens and allows stomach acid to splash up into the esophagus. These symptoms include heartburn, chest discomfort, and bitter Fluid flowing up into the mouth. Chest discomfort can occur. If the stomach juice trickles into the breathing tubes, hoarseness, cough, and even shortness of breath can occur. This entire problem is called GERD (Gastroesophageal Reflux Disease). A number of factors, including certain foods, may cause the lower esophageal muscle to relax, causing GERD.

Nutrition Facts

A diet designed to prevent or reduce acid reflux is usually easy to follow. The basic food groups of cereals, vegetables, fruits, dairy products, and meats can be eaten with only a few limitations. So, this diet generally meets the Recommended Dietary Allowances (RDA) of the National Research Council. A Vitamin C supplement may be needed if an individual does not tolerate citrus foods such as orange, tomato, etc.

Special ConsiderationsThe lower esophageal muscle can be weakened by factors other than food. The following recommendations may be helpful in reducing symptoms:

1. Stop using tobacco in all forms. Nicotine weakens the lower esophageal muscle.
   
2. Avoid chewing gum and hard candy. They increase the amount of swallowed air which, in turn, leads to belching and reflux.
   
3. Do not lie down immediately after eating. Avoid late evening Snacks.< br />
4. Avoid tight clothing and bending over after eating.
   
5. Eat small, frequent portions of food and snack if needed.
   
6. Lose weight if overweight. Obesity leads to increased reflux.
   
7. Elevate the head of the bed six to eight inches to prevent reflux when sleeping. Extra pillows, by themselves, are not very helpful.
   
8. The following foods aggravate acid reflux, and should be avoided:
   
   • fatty or fried foods
     
   • peppermint and spearmint
     
   • whole milk
     
   • oils
     
   • chocolate
     
   • creamed foods or soups
     
   • most fast foods
     

[*]The following foods irritate an inflamed lower esophagus and may need to be limited or avoided:

• citrus fruits and juices (grapefruit, orange, pineapple, tomato)
  
• coffee (regular and decaffeinated)
  
• caffeinated soft drinks
  
• tea
  
• other caffeinated beverages
  

[*]Spicy or acidic foods may not be tolerated by some individuals.

[LAN2k 18]

Thanks Katt I really just hope that this will not be a life long condition. The adjustments necessary for the sleeve are hard enough. Prior to the surgery my surgeon told me eventually I would be able to eat any foods I liked, including Indian, Mexican, ThAi...spicy etc. NOw I am looking at narrowing my dietary options even more!? Oh I hope this thing fixes! Thanks for making time to respond and put up all that information.

Edited June 5, 2010 by LAN2k

[LAN2k 18]

Hi all I just read this from an e-news letter I read regularly. I would appreciate if after reading it ,(at your convenience), you would consider what this doctor has to say and give me your position. Mind you, I am not about to go off my PPI medication without the expertise and care of an alternative doctor who has thorough knowledge of digestive health implications after having both a hiatal hernia-repair and VSG surgery. Thanks in advance. Here is the link-

Natural Ways to Relieve Heartburn Symptoms

Please keep this in mind as you read the above article: I attempted to speak with the ENT (that diagnosed my condition as Laryngopharyngeal Reflux), with regard to research in alternative, holistic medical approach, he cut me off mid sentence and abruptly asked "What is your question?" His impatience forced me to switch gears and so I asked him if, in light of the surgery I had, could he say how excessive my stomach acid production was or if it were possible that I hadn't been producing enough? His answer was this..."I don't know." And then he went silent. And after a few seconds of silence between us he asked..."Is that it?" I said, "Yes I suppose it is thank you very much."

[educationrulz 18]

Hi all I just read this from an e-news letter I read regularly. I would appreciate if after reading it ,(at your convenience), you would consider what this doctor has to say and give me your position. Mind you, I am not about to go off my PPI medication without the expertise and care of an alternative doctor who has thorough knowledge of digestive health implications after having both a hiatal hernia-repair and VSG surgery. Thanks in advance. Here is the link-

Natural Ways to Relieve Heartburn Symptoms

Please keep this in mind as you read the above article: I attempted to speak with the ENT (that diagnosed my condition as Laryngopharyngeal Reflux), with regard to research in alternative, holistic medical approach, he cut me off mid sentence and abruptly asked "What is your question?" His impatience forced me to switch gears and so I asked him if, in light of the surgery I had, could he say how excessive my stomach acid production was or if it were possible that I hadn't been producing enough? His answer was this..."I don't know." And then he went silent. And after a few seconds of silence between us he asked..."Is that it?" I said, "Yes I suppose it is thank you very much."

Lis,

This is so wierd, but after replying to your post over a week ago, my ENT has diagnosed me with this same condition! I still can't get my tongue around the official term. :cursing: It started with my pulmonologist clearance on June 1st. When he looked at my throat, he said it looked awful. So, I had been putting off going to my ENT, even though I'd had a sore throat for several weeks, just because I hadn't been able to fit the appointment in. After the pulmonology visit, I decided to go to the ENT.They got me in to see him on June 3rd.

He said my throat wasn't that bad and that he wanted to examine me more. He numbed my nose with some disgusting spray and stuck that long rubber tube all the way through my nose to my throat to look at the larynx. He said it looked fine so there wasn't any damage to be concerned about, but based on the symptoms I've been having, it's probably that silent reflux thing. He then prescribed omeprazole 40 mg every morning to reduce the acid.

At that point, I decided to tell him I"m about to have WLS just so he would be fully informed. I got a REALLY strange look and some seconds of silence...kinda of like what your ENT gave you. :drool5: He then said the PPI wouldn't be a problem pre-op. Now, I'm kind of feeliing like this might have been a hasty diagnosis since we were talking about taking my tonsils out about a month ago. But, if the PPI helps all these throat isses (which the ENT said are caused by the excessive acid) then I'll take it. I'm not clear on how taking it once a day will help since I clearly eat more than once a day...

Sorry to ramble on about this but I guess I'm still trying to work it out in my head (as my burping seems to increase in frequency by the day ). Luckily I have my Upper GI clearance in 3 days and preop with my surgeon in 5 days, so I'll definitely run all of this by both docs to get their opinion. At this point, I wouldn't be surprised to find out that I have a hernia.

I hope you get more clarity on things on your next MD visit. I would think the GI doc might be a little more level headed about your WLS than the ENT was.

[deletedsally 8]

Sorry the ENT was not more helpful. GERD is probably not his area of expertise--and unfortunately, it sounds like polite communication with his patients isn't either.

My opinion about Dr. Mercola (not just his recommendations about GERD) is that he has a lot of valuable information about health/nutrition that is being disseminated over the internet. However, I think he is "on the fringes" and sometimes recommends potentially dangerous practices. I would not trust his recommendations without plenty of other input. For example, he recommends drinking unpasteurized milk.

In an ideal world, his opinions about raw milk being better for you are probably true--but we don't live in utopia--and I have seen some of the nastiest "organic" farms imaginable that are peddling their products to unsuspecting consumers. One guy that tells people that he is an Amish farmer lives in the middle of a rusty old junk heap, that was dirty enough to upset my 4 year old grandson. The guy milks his cows in a feces and fly infested stall that is directly adjacent to an algae covered table where he slaughters his chickens. If someone followed Dr. Mercola's instructions and bought "real milk" being distributed by this friendly farmer, how long would it be before they got really sick?

Anyway, all I'm saying is that some of Mercola's recommendations are sound, and other's are questionable. I think it would be relatively easy for you to make some modifications to your diet and elevate the head of your bed to see if it helps. Taking hydrochloric acid?? Not something I would do.

[wannalise 15]

Lis,

Would a resolution to this help with some of the problems you've had post op? I know that you are not to the solution phase just yet, but maybe its in a round about way good news to finally know whats going on.

[pnw218 14]

I think his basic list of things to change is good and is similiar to changes I have made to reduce my stomach pain.

I can't comment on the raw milk issue and would overall say that moderation is typically the key. You could try most of the things on the list and see if it helps. I was taking 1 or 2 20mg omeprazole prior to surgery. Now I am taking only 1 and rarely feel like I "need" to take it. Not ready to wean off of it yet tho.

There are times that "regular" milk is calming for your stomach and other times will upset it, depending on the issue. I drank very little milk prior to my sleeve, mostly because I was usually lo carbing. Now I drink it and have no issues at all.

Regardless of what you do with the natural remedies, I definitely think a new medical dr is a good idea. I would want to slap him. In fact, I haven't chewed anyone out for a long time and am probably overdue ... what's his name and number?? LOL

Be proactive : )

[LAN2k 18]

I'll first say thank you all for your input, which is of great value to me...(would be nice if we could have VST telephone conferencing eh?)

Mary, I suspect I had this "SILENT" acid reflux condition pre surgery too...it was through the required pre-examination by a gastroenterologist who did an upper endoscopy that I found out I had a "small" hiatal hernia. I didn't realize that a hiatal hernia can cause acid reflux symptoms, until I read the page of literature the ENT handed me after scoping me...(BTW, he was much nicer in person than he was over the phone). When you have an hiatal hernia part of the upper stomach sort of slips up into the esophagus, so it makes sense that acid would then creep up into the throat. The thing is that the surgeon who did my sleeve also repaired my hernia, but the problem persists, (even with PPI med.) Ouroborous takes something called Carafate that coats the esophagus protecting it from irritation. I am waiting for my PCP to see if she will give me a prescription for it. This may assist to alleviate symptoms. Ultimately I am looking for a cure.

Oh please keep me up to date with your surgery and the outcome of your pre-op examinations!!! I don't recall if you have already posted your date? It must be coming up rather soon. I in turn will post any developments (good or not) as I continue to find a fix for this LPR.

Katt- I'm sort of compelled to go with "conventional medicine" at this juncture UNLESS I am willing (and able) to pay out of pocket to consult and treat with an alternative medical practitioner, (since health insurance doesn't cover holistic and/or preventive medicine). I also am cautious about things such as raw milk, unless of course I am able to know its coming from a reliable safe source...and again that level of quality is high maintenance usually at a high price...I do what I can. I think if I hadn't the sleeve I'd be more apt to try things like hydrochloric acid, and other natural remedies, (Apple Cider Vinegar, etc...) but having a 4oz tube for a stomach I don't feel so invincible.

Anna- OMG a solution would be a HUGE relief...these symptoms do not only cause me to feel nagging physical distress but emotional distress as well. The thing for me that has come to light is that without the excess of food/planning/shopping/thinking/cooking/sharing/eating....and without the excess of FAT on my body, (almost to goal), I am SUPER sensitive now to many bodily sensations, (except for my libido it's totally gone,since surgery), so I've all this time (formally occupied with food obsessions), to feel and believe me I really feel every little quirk. Identifying this throat/nose/sinus thing as an acid reflux issue helps...a little, but I'm confounded thus far with the lack of know how within the realm of conventional medicine. It seems they have means, (mostly ineffective) to subdue or mask symptoms but no real knowledge of the dynamics behind the problem especially when they learn that the stomach has been anatomically altered. It's like either they don't really listen or they do but lack the knowledge of how each part of the body relays to another. I'm rambling now Anna...sorry but thanks for having a keen insight into me.

I think his basic list of things to change is good and is similiar to changes I have made to reduce my stomach pain.

I can't comment on the raw milk issue and would overall say that moderation is typically the key. You could try most of the things on the list and see if it helps. I was taking 1 or 2 20mg omeprazole prior to surgery. Now I am taking only 1 and rarely feel like I "need" to take it. Not ready to wean off of it yet tho.

There are times that "regular" milk is calming for your stomach and other times will upset it, depending on the issue. I drank very little milk prior to my sleeve, mostly because I was usually lo carbing. Now I drink it and have no issues at all.

Regardless of what you do with the natural remedies, I definitely think a new medical dr is a good idea. I would want to slap him. In fact, I haven't chewed anyone out for a long time and am probably overdue ... what's his name and number?? LOL

Be proactive : )

I'm with you there "proactive" is key. I have been incorporating natural remedies into my regime which includes PPI medication etc. I am learning as I go and trying my best to use common sense and intuition like (listening to my body) and standing up for myself when consulting with respective doctors. I know what you mean about chewing someone out in fact I have only once had a bit of a confrontation with a doctor over an issue with medication. That was for a brief moment with the surgeon who did my sleeve. Later, in a round about way, he apologised by an admission that my research was correct and the Reglan he was pumping into me did have some really bad side effects! Thanks for the willingness to back me up!

[Lonna 1]

I just got diagnosed with LPR as well. I had my sleeve done in Sept. 2010. I started suffering from severe acid reflux approximately 3 weeks after the sleeve. A year later I found out I had 4 ulcers in my esophagus after an endoscopy. After treating and healing them I had another endoscopy that revealed I have Barretts. I take 40 mg omeprazole 2x a day. I started having the lump sensation in my throat and heaviness in my chest so they did a test to check my symptoms by putting a tube in my nose and down my throat. I had to wear it for 24 hrs. while it recorded my reflux. After reviewing the results of the test, the Dr. diagnosed me with LPR. They explained to me that the only cure is Fundoplication surgery but by me having the sleeve, the surgery is impossible. So the only thing I can do right now is take my medicine to keep the acid levels down so they won't back up into the esophagus. Hopefully someone will come up with a better alternative especially for the people with the sleeve.