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Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain?

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ENT Specialist
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I was diagnosed with reflux 4 weeks ago. Burned my voice box and had crackly voice for 6 days. I think it was my eating habits and not my stomach acid that caused it. I had acl surgery 8 weeks ago. I laid in bed for weeks. Ate a huge supper at 9-930, went to bed at 10. I woke up one morning in bad pain. Could not even touch the skin on the outside of my throat. My family dr said I had a virus. I do not have have never had burning in my chest, maybe twice in my life acid came up in my thoat and Im 52. I not only ate a huge ceasar salad that night I drank several glasses of cranberry juice right before bed every night after surgery. Until I found out about the burn to voice box, I was drowning myself in hot fresh lemonaide, eating lemons and drinking cranberry juice like crazy. i feel like I burned my throat myself.I went to an ENT a week after this, he did a scope and started me on nexium 20 mgs.After being on nexium and totally changin eating habits, I have good day s and bad days. It doesn't burn, doesn't hurt to swallow, never has, it hurts, not constant, like contractions. If i talk for long periods of time, it hurts worse. So I stop talking. I can't explain the pain, I just know it is not a burning pain. WHY! I want my life back..... I have an apt with a gerontologist OCt. 29th in hopes she will scope the throat and stomach. I have sharp pains in my stomach but those didnt start till nexium. Its on my left lower side of throat and upper chest. Always has been on left side....I just need a professional to explain this pain...I am going crazy. I am a caterer, and to totally shut down on eating, is hard on me mentally. Thank you for your time
Posted Mon, 26 Nov 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 36 minutes later
Hi,

Thank you for your query.

1. Your acid reflux has probably been building up for months to years before your severe attack.

2. The discomfort in the cheat and throat pain may be due to Nexium (esomeprazole). Dryness of the throat and non specific chest and abdominal pain and discomfort are known side effect of esomeprazole. Ask your physician to change the medicine to rabeprazole, dexrabeprazole or pantoprazole. Domperidone may be added. Many weeks of therapy are required to control acid reflux along with dietary and lifestyle changes.

3. Loss of appetite is also a known side effect of Nexium. You may have to go easy on the quantity of the richer foods (common on catering menus) as you grow older.

4. You may share an endoscopic video of your throat, larynx, esophagus and stomach for further advice.

5. A normal person also has acid reflux 4-5 times a day but does not notice it, People who have more than 15-20 episodes of reflux on a day suffer the most. In addition to gastric acid, digestive enzymes and bile may reach the throat, worsening the burning in the throat. These enzymes may remain in the throat and get reactivated when the pH falls with the next reflux, damaging the delicate throat tissue faster.

6. Get a USG Abdomen done to rule out a hiatus hernia. H. pylori infection needs to be ruled out. Esophageal manometry and swallowing studies may be done.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 1 hour later
Ok, So I need to accept the fact its acid. I was taking 40mg of nexium the first two weeks. I was walking around in a cloud, headaches, super depressed. The family dr moved it to 20 mg. headaches went away and the couldy feeling, but these syptoms I am complaining about came about. I have prevacid and prilosec...Which one would you suggest..I am extremely sensative to meds. What a normal person takes, I need only 1/4. I do not take meds, never have unless surgery was involved. Also my back hurts all the time between my should blades where my bra would buckle. These all started up about 2 weeks ago. I do not ever want the pain to reoccur like I had with the burned voice box. I know now how to eat healthier and eat 3-4 hours before bedtime and sleep on 5 pillows. Will I have to worry about it creepy up on me again? and How long does it take a voice box to heal? Do I need the ppis in order to heal the voice box?
I forgot to tell you, I have had 3 bad sorethroat and sinus infections in the last 5 weeks. Been on amoxicillin a week each sorethroat espisode. 500 mg twice a day.
Thank you very much...
 
 
Answered by Dr. Sumit Bhatti 11 hours later
Hi,

Thank you for your writing back.

1. Your symptoms of cloudiness, depression, chest and stomach discomfort may be a side effect of Nexium and other proton pump inhibitor drugs. Prevacid and Prilosec are also drugs of the same class. If burning in the chest is not a common symptom, you may try Ranitidine (H2 receptor antagonist) instead.

2. Pain referred to the back indicates esophageal (food pipe) irritation or esophageal spasm. Try some antacid or Mucaine gel for a few days.

3. It is difficult to predict future attacks, however they will be lesser in intensity with the control measures followed religiously. Sleeping regularly with five pillows will result in neck pain and cervical spondylosis.

4. A Post Nasal drip (PND) due to sinusitis will increase gastritis and acid reflux.

5. Multiple courses of antibiotics will also cause gastritis and worsen acidity. Take a probiotic and multi-vitamins to lessen these side effects.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 2 hours later
Thank you for your professional advise. The only question unanswered was the voice box issue. Is it painful while healing and about how long does it take to heal. The scope the ent did showed redness to the back of the voice box. Thank you very much
 
 
Answered by Dr. Sumit Bhatti 12 minutes later
Hi,

Thank you for your writing back.

1. It will take a few days to heal. Control of acid reflux takes many weeks and hence you may face episodes of worsening of symptoms in between.

2. Use Mucaine gel, antacids and medicated gargles to soothe the throat.

Wishing you a speedy recovery.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 9 hours later
You were great! I appreciate ur quick response. All questions were answered! Thank you, XXXXXXX
 
 
Answered by Dr. Sumit Bhatti 22 hours later
Hi,

Thank you for writing back.

Wishing you good health.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 5 days later
Ok, I got acid reflux from meds after surgery September 16. My voice box ans irritated on the backside. I was put on nexium for a month. I never had any more symptoms of acid reflux, but, I kept the pain in my lower throat. It is a pulsing pain , it is the same muscle that lumps up when u cry or laugh, which I can't do either because of pain, I can't look up or yawn big because of pain. I have an apt with a gasteronologist in XXXXXXX Monday. It almost feels like an ulcer that u get in ur mouth. I have anxiety disorder and still recooperating from acl reconstructive surgery. I refuse to take any more ppi's from all their side effects. What is causing this pain?
 
 
Answered by Dr. Sumit Bhatti 16 hours later
Hi,

Thank you for your writing back.

1. The sensation of a muscle lump in the throat is known as 'Globus Pharyngeus'.

2. Inflammation of the throat, voice box or food pipe causes spasm of some of the numerous the muscles attached to these structures. There are many other causes for this 'Globus Sensation' such as cricophayngeal spasm (the muscle guarding the opening of the food pipe), esophageal motility disorders, stress, cervical spondylosis or ossification of the hyoid, laryngeal cartilages with age and so on.

3. This is a chronic process, often causing pain and discomfort and the recovery is slow. Treatment options may be discusses further after your Gastroenterologist's opinion.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 21 minutes later
Ok, I know I am a pain...But, you are so great to respond quickly, which for a person with high anxiety, helps. If I try and drink cold water, cold milk, it doesn't want to go down, it sits in the base of my throat,upper chest..I can feel the cold stop there. At times I don't know whether to dry and push it back out or just relax and wait for it to decide to go down. Why? I am so tired of drinking room temp water, which I have been drinking 64oz everyday since my surgery on August 16th,.....
 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your writing back.

1. You are in discomfort and seek relief.

2. You need to go through with the investigations to rule out any hold up of fluids or food before any regular treatment.

3. Get Mucaine Gel and take Zantac (Ranitidine) Effervescent and Domstal (domperidone).

4. Try to voluntarily relax your throat and food pipe. 'Globus pharyngeus' arises from an imbalance in the Autonomous Nervous System and creates conflicts in muscle tone during swallowing, breathing, talking, crying and laughing.

5. Cold water and milk will dry your throat (desiccating effect) and further worsen your symptoms. Try lukewarm water for a few days in stead.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 2 hours later
You have been so supportive and an encouragement ! I will let u know what dr Nguyen finds!!
 
 
Answered by Dr. Sumit Bhatti 8 hours later
Hi,

Thank you for writing back.

You may follow up with the results of the examination, investigations and treatment.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 2 days later
Well dr Bhatti, the gasteronologist was a wasted trip. After I explained to him that I have NO burning only pain at bend of esophigus and no heartburn, the pain I have endured the last 5 weeks, after taking nexium, Pepcid ac, Prilosec, totally changing my diet, l weighed 141#' I am 5'i", and now weigh 130 since this all began, and STILL have the same exact pain in my lower throat. He said it could be one of 4 things, 1. Stomach making too much acid referring pain there(so not right), 2. Viral causing bacterial infection, 3. Esophigidal spasm ( which he said nothing can be done), 4. (Since I was laying down most of time and eating four Advil a day up to the day this started), an Advil could have lodged in my bend and eroded my esophigus, which makes perfect sense. I have problems and have for years, food stopping at the bend and I have to swallow continuously trying the make the food go on down, sometimes when I eat and it stops there I can actually cough the food right back up! He said barium is scarce and most likely could not get any to do and upper gi. He said he could do an endoscopy and it probably wouldn't show any of the above! I'm like what kind of dr is this? So, I am on Zantac like u suggested, no one here has ever heard of mucaine, none of the pharmacies are this dr. I still do the carafate. I have a follow up Monday with my ent , which I'm sure he will do another scope. People ask me XXXXXXX is the pills working? I'm like how? I haven't had any symptoms but that one pain and it was there at start and there now. So, all the nexium and carafate and Pepcid ac twice a day, eating totally nothing and drinking nothing but water,,,,, why would the pain still be present! I am so sad and frustrated. Thank you , t
 
 
Answered by Dr. Sumit Bhatti 3 hours later
Hi,

Thank you for your writing back.

1. Oh, no problem, I don't mind being associated with a high performance car! : )

2. Laryngo Pharyngeal Reflux (LPR) is a distinct entity as compared to GERD (Gastro Esophageal Reflux Disease).

3. Esophageal spasm has many treatment options.

4. You have mentioned Advil for the first time now. Advil is known to cause gastritis and esophagitis and hence is a leading contender for your symptoms.

5. No tablet is expected to be lodged for a very long time as they are designed to disintegrate.

6. You need a second opinion and to do all the tests mentioned above.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 4 days later
Hello dr bhatti, I went to see my ent this morning for a follow up. He was upset at me because I quit taking my ppi. He said he understood the side effects , as I told him he agreed because he said he took nexium and had the same response. But I should have tried another like Prilosec. He explained to be this visit what he diagnosed me with. He said I had silent reflux, I have no symptoms, so it creeps up. He said when he scoped my lower throat and voice box was burned, he said it takes sometimes up to three months for it to heal. The ppi is to avoid further burns to an already injured burn. I was so depressed when he told me. I don't want to live with taking a pill forever and to have the fear of it creeping up on me again. What do u think? Is there surgery to fix it? If so, what's ur opinion of it? I start Prilosec tomorrow :/
 
 
Answered by Dr. Sumit Bhatti 2 hours later
Hi,

Thank you for your writing back.

1. Laryngo Pharyngeal Reflux (LPR), as mentioned above, is known as silent reflux.

2. Changing the PPI will not prevent the side effects. You have to change to a different class of drugs such as H2 receptor antagonists like Rantitidine (Zantac).

3. You may have to take regular medication for at least 8-10 weeks before you get lasting relief.

4. This is a common problem and is managed initially with medications and later by diet and lifestyle modifications. Surgery is a limited option in cases such as hiatus hernia (fundoplication) or paraesophageal hernia. You will need an Abdominal USG (Ultrasound) to rule this out.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 6 hours later
I have been taking Zantac as u suggested. I could tell a difference taking it vs nexium. I am able to eat better now. That's why I am panicing about going back on a ppi. I lost 12#s on nexium. I probably need to raise my Zantac dosage from 75 to 150. The only problem is I don't have any symptoms to measure by. The dr said I needed the ppi to allow healing in the upper esophigus and three months should do it! I don't have the burning but the pain is still in the bend, especially laughing,crying and talking too much, coughing to XXXXXXX taking XXXXXXX breaths, or yawning. This is why I hate living in small towns
 
 
Answered by Dr. Sumit Bhatti 4 hours later
Hi,

Thank you for your writing back.

1. If Zantac is working fine for you, you need not worry about going back on a PPI.

2. Both PPIs and H2 Receptor antagonists reduce acid production in the stomach but by different mechanisms.

3. You may also be able to take a lower dose of the PPI or avoid it completely if it does not suit you.

4. You will feel better in time. Add diet control and lifestyle changes. Do no eat any food that worsens your acidity. Eat at least two to four hours before sleeping.

5. The World over, high stress, overcrowding, pollution, and the pace of life in the larger cities is causing more health problems than those seen in smaller towns.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
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Follow-up: Diagnosed with reflux. Why am I experiencing discomfort in the cheat, loss of appetite and throat pain? 54 minutes later
You've been wonderful! I am so glad I have comfort in your opinions. I belch all the time, like hundreds of times a day. Can I take gas x with Zantac? I ask the pharmacists and he said yes, but I want to make sure. Also he suggested I take a probiotic. I think u suggested that earlier on, so I will run to get some. Thank you dr. Bhatti
 
 
Answered by Dr. Sumit Bhatti 32 minutes later
Hi,

Thank you for your writing back.

1. You may take Gas X (Simethicone) as it has no side effects. Peppermint oil in softules is useful. Peppermint liquid drops get inactivated by stomach acid.

2. Probiotics will help. Check if any particular brand suits you.

Wishing you good health.

Regards.
Above answer was peer-reviewed by
 
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