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Dr. Andrew Rynne

Family Physician

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OVERVIEW: The below conditions started in Feb of 2018. Three

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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4261 Questions

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Posted on Tue, 29 Jan 2019 in Ear, Nose and Throat Problems
Question: OVERVIEW:
The below conditions started in Feb of 2018. Three main factors that led up to my current medical conditionS which I have listed below, and I apologize for the length of this message:
- A vertigo attack on a business trip followed by continuous dizziness and intensified dizziness up through today. (Feb 2018)
- A month later a had a lump in my throat. Difficulty swallowing food - went on a soft food diet for over two months. (March 2018)
- I had Laparoscopic Groin Hernia Repair done the same week that I had an EGD. A few days after the EGD. I have had daunting acid reflex which continues to today. (April 2018)
TEST SUMMARY STOMACH, THROAT, AND ABDOMEN:
1.     I have had two Esophageal Manometry tests and both show that my sphincters are ok - (20 in a scale between 0 to 40) (April - May)
2.      Diagnosed with LPR – stopped smoking, and followed all the rules for LPR went On PPIs (May – July)
3.     ENT has scoped me several times and all seems to look fine in my throat and voice box – which makes no sense to me.
4.     Swallow test done – all looked fine
5.     Gastric emptying test done and all looked fine
6.     Barium test done (32 ozs and 4 hours of scanning – not sure of the name – all was fine
7.     Another EGD and a 24-hour PH test done while on PPIs and all looked fine. (Aug)
8.      End of Aug I had another EGD along with a Bravo Test done at a different location off PPIs for 7 days. And was diagnosed with GERD and a 2.5cm hiatal hernia. (I never get heartburn and don’t think that I have the typical symptoms of heartburn. My symptoms include:
I have lost confidence my the local system and doctors after 11 months of tests and daily debilitating agony which is why I am reaching out to you sir.
SYMPTOMS: STOMACH, THROAT, AND ABDOMEN
1.     An uncomfortable feeling of fullness after eating.
2.     No appetite
3.     Never Thirsty
4.     Can’t gain any weight back – unintentional weight loss (50#) from 3/18 – 7/18
5.     A continuous irritation where my larynx /Adams apple/thyroid cartilage is after eating and drinking water. The feeling is aggravated more with head movement or motion such as driving a car, eating and drinking liquid.
6.     Burning in the same general area most of the time– Tung burns sometimes mostly after my last meal
Water burns and irritates this area as does almost anything that comes in contact with this area.
7.     Sore throat especially after drinking water in the larynx area and back of my throat.
8.     A feeling of sharpness, pressure and restriction in the same general area which gets worse at times and throughout the day depending on the day and activities such as long conference calls, trying to stay will hydrated to avoid constipation.
9.     Constant Hoarseness eighty percent of the time that gets worse with talking and throughout the day.
10.     A feeling of this area being swollen which is further aggravated by head movement or just walking around the house
11.     Substantial gas after drinking water and eating food most of the time – 15 to 30 minutes or so after either
12.     STRONG stomach churning after meals and drinking water, and at night
13.     EXAMPLES
-     Morning on empty stomach – I drink 16 oz of liquid – lay back down for 30 minutes or so – load churning, and popping sounds in upper and center abdomen and causes gas.
-     4 hours or so after my last meal (4 to 5 pm) 8 to 9 pm load churning followed by a liquid vapor that irritates larynx /Adams apple/thyroid cartilage area/ Sometimes higher to the roof of my mouth and tonsils. The more this area churns the worse it is in my throat and voice
QUESTIONS:
- Any suggestions on what's the most likely cause of my symptoms might be?
- Do my symptoms sound like GERD to you?
- What other tests would confirm GERD and weak sphincters is the cause, rather than something lees?
- Any recommendations on how I can rule out that my other below symptoms are not related to the above symptoms?
- I am fearful to have fundoplication surgery unless I am confident of the outcome and cause
Any suggestions on the best type surgery if it comes to this. I am considering the LINX Procedure because it is less invasive and can be undone – If you were going to have surgery in this area what surgery option would you pick.?
-
SYMPTOMS: DIZZINESS
DEFINITIONS:
-     Dizziness: Feeling lightheaded, faint, foggy, woozy, weak, and unsteady
-     Intensified Dizziness: Moments of a false sense that my surroundings are distorted or moving or a false sense that I am moving (Not spinning)
-     Vertigo – My surroundings are spinning
HISTORY and TESTS:
-     Originally diagnosed with BPPV - Nystagmus were present in both eyes from Feb 2018 through XXXXXXX 2018 - Epley maneuvers were done - typically made it worse rather than better
-      ENTs said the Nystagmus were no longer present and did not know what to do.
-     I went to see a neurologist and an EMG was conducted on my legs. The result was neuropathy in my legs, but no connection to the dizziness.
-     I then went to see an audiologist
-     VNG test was normal
-     MRI of my head was fine with the exception "mild supratentorial and pontine white matter FLAIR hyperintensities most likely chronic microvascular ischemic changes.".
-     No SSCD
-      The VEMP test reviled off the chart readings in my left ear and slight constant horizonal nystagmus
-     Last month I went to seem my ophthalmologist – found constant horizonal nystagmus’
-     Just had an exam by an Otology/Neurotology physician – who also found slight constant horizonal nystagmus
Symptoms
1.     Continuous dizziness all day and night with bouts of intensified dizziness - Continuous Foggy Feeling -Difficulty thinking, remembering, and concentrating
Examples
2.     Walking or moving around quickly intensifies the dizziness
3.     Spinning slowly or moving quickly in one circle STRONGLY intensifies dizziness and creates a distortion of my visual focal point to the left and to the right and crates a time delay of focusing on the actual focal point. Causes intensified dizziness and affects my balance
4.     Tilting head back and then straight forward - temporarily intensifies the dizziness
5.     Looking up intensifies the dizziness (Example: Grocery Isle signs at HyVee
6.     Sitting at my computer or lying in bed watching TV I get bouts of Intensified Dizziness
7.     Laying down supine and sitting up intensifies the dizziness
8.     Bending down and looking upward with my head tilted intensifies the dizziness
9.     Aggressive head movement backwards and forward can invoke Vertigo
10.     Walking in the dark affects and intensifies my dizziness and balance
11.     Working on my computer with my reading glasses on intensifies the dizziness
12.     Balance is off; however, some days are better than others
13.     Driving in traffic intensifies the dizziness
14.     Scrolling up and down on my cell phone intensifies dizziness
15.     Difficulty thinking, remembering, and concentrating.
16.     Complex visual situations intensify the dizziness (Not spinning)
Examples:
17.     Stop lights with lots of moving traffic in different directions
18.     Going through a car wash - intensifies the dizziness
19.     Driving in the rain with the wipers going
20.     Scrolling on my computer up or down fairly fast
21.     Shifting my head back and forth between two computer screens
QUESTIONS:
1.     What's your opinion of the most likely cause of my symptoms?
2.     What tests would you recommend to further identify the problem?
3.     How would you rule out any connection between the reflux, stomach and the dizziness or would you?
4.     What type of specialist would be best educated to look at the combination of my symptoms?
5.     Any suggestions are very much appreciated. The combination of the conditions has turned my life upside down. Thank you in advance for any suggestions or help that you can provide.
Respectfully XXXXXXX

default
Follow up: Dr. Prof. Kunal Saha 0 minute later
OVERVIEW:
The below conditions started in Feb of 2018. Three main factors that led up to my current medical conditionS which I have listed below, and I apologize for the length of this message:
- A vertigo attack on a business trip followed by continuous dizziness and intensified dizziness up through today. (Feb 2018)
- A month later a had a lump in my throat. Difficulty swallowing food - went on a soft food diet for over two months. (March 2018)
- I had Laparoscopic Groin Hernia Repair done the same week that I had an EGD. A few days after the EGD. I have had daunting acid reflex which continues to today. (April 2018)
TEST SUMMARY STOMACH, THROAT, AND ABDOMEN:
1.     I have had two Esophageal Manometry tests and both show that my sphincters are ok - (20 in a scale between 0 to 40) (April - May)
2.      Diagnosed with LPR – stopped smoking, and followed all the rules for LPR went On PPIs (May – July)
3.     ENT has scoped me several times and all seems to look fine in my throat and voice box – which makes no sense to me.
4.     Swallow test done – all looked fine
5.     Gastric emptying test done and all looked fine
6.     Barium test done (32 ozs and 4 hours of scanning – not sure of the name – all was fine
7.     Another EGD and a 24-hour PH test done while on PPIs and all looked fine. (Aug)
8.      End of Aug I had another EGD along with a Bravo Test done at a different location off PPIs for 7 days. And was diagnosed with GERD and a 2.5cm hiatal hernia. (I never get heartburn and don’t think that I have the typical symptoms of heartburn. My symptoms include:
I have lost confidence my the local system and doctors after 11 months of tests and daily debilitating agony which is why I am reaching out to you sir.
SYMPTOMS: STOMACH, THROAT, AND ABDOMEN
1.     An uncomfortable feeling of fullness after eating.
2.     No appetite
3.     Never Thirsty
4.     Can’t gain any weight back – unintentional weight loss (50#) from 3/18 – 7/18
5.     A continuous irritation where my larynx /Adams apple/thyroid cartilage is after eating and drinking water. The feeling is aggravated more with head movement or motion such as driving a car, eating and drinking liquid.
6.     Burning in the same general area most of the time– Tung burns sometimes mostly after my last meal
Water burns and irritates this area as does almost anything that comes in contact with this area.
7.     Sore throat especially after drinking water in the larynx area and back of my throat.
8.     A feeling of sharpness, pressure and restriction in the same general area which gets worse at times and throughout the day depending on the day and activities such as long conference calls, trying to stay will hydrated to avoid constipation.
9.     Constant Hoarseness eighty percent of the time that gets worse with talking and throughout the day.
10.     A feeling of this area being swollen which is further aggravated by head movement or just walking around the house
11.     Substantial gas after drinking water and eating food most of the time – 15 to 30 minutes or so after either
12.     STRONG stomach churning after meals and drinking water, and at night
13.     EXAMPLES
-     Morning on empty stomach – I drink 16 oz of liquid – lay back down for 30 minutes or so – load churning, and popping sounds in upper and center abdomen and causes gas.
-     4 hours or so after my last meal (4 to 5 pm) 8 to 9 pm load churning followed by a liquid vapor that irritates larynx /Adams apple/thyroid cartilage area/ Sometimes higher to the roof of my mouth and tonsils. The more this area churns the worse it is in my throat and voice
QUESTIONS:
- Any suggestions on what's the most likely cause of my symptoms might be?
- Do my symptoms sound like GERD to you?
- What other tests would confirm GERD and weak sphincters is the cause, rather than something lees?
- Any recommendations on how I can rule out that my other below symptoms are not related to the above symptoms?
- I am fearful to have fundoplication surgery unless I am confident of the outcome and cause
Any suggestions on the best type surgery if it comes to this. I am considering the LINX Procedure because it is less invasive and can be undone – If you were going to have surgery in this area what surgery option would you pick.?
-
SYMPTOMS: DIZZINESS
DEFINITIONS:
-     Dizziness: Feeling lightheaded, faint, foggy, woozy, weak, and unsteady
-     Intensified Dizziness: Moments of a false sense that my surroundings are distorted or moving or a false sense that I am moving (Not spinning)
-     Vertigo – My surroundings are spinning
HISTORY and TESTS:
-     Originally diagnosed with BPPV - Nystagmus were present in both eyes from Feb 2018 through XXXXXXX 2018 - Epley maneuvers were done - typically made it worse rather than better
-      ENTs said the Nystagmus were no longer present and did not know what to do.
-     I went to see a neurologist and an EMG was conducted on my legs. The result was neuropathy in my legs, but no connection to the dizziness.
-     I then went to see an audiologist
-     VNG test was normal
-     MRI of my head was fine with the exception "mild supratentorial and pontine white matter FLAIR hyperintensities most likely chronic microvascular ischemic changes.".
-     No SSCD
-      The VEMP test reviled off the chart readings in my left ear and slight constant horizonal nystagmus
-     Last month I went to seem my ophthalmologist – found constant horizonal nystagmus’
-     Just had an exam by an Otology/Neurotology physician – who also found slight constant horizonal nystagmus
Symptoms
1.     Continuous dizziness all day and night with bouts of intensified dizziness - Continuous Foggy Feeling -Difficulty thinking, remembering, and concentrating
Examples
2.     Walking or moving around quickly intensifies the dizziness
3.     Spinning slowly or moving quickly in one circle STRONGLY intensifies dizziness and creates a distortion of my visual focal point to the left and to the right and crates a time delay of focusing on the actual focal point. Causes intensified dizziness and affects my balance
4.     Tilting head back and then straight forward - temporarily intensifies the dizziness
5.     Looking up intensifies the dizziness (Example: Grocery Isle signs at HyVee
6.     Sitting at my computer or lying in bed watching TV I get bouts of Intensified Dizziness
7.     Laying down supine and sitting up intensifies the dizziness
8.     Bending down and looking upward with my head tilted intensifies the dizziness
9.     Aggressive head movement backwards and forward can invoke Vertigo
10.     Walking in the dark affects and intensifies my dizziness and balance
11.     Working on my computer with my reading glasses on intensifies the dizziness
12.     Balance is off; however, some days are better than others
13.     Driving in traffic intensifies the dizziness
14.     Scrolling up and down on my cell phone intensifies dizziness
15.     Difficulty thinking, remembering, and concentrating.
16.     Complex visual situations intensify the dizziness (Not spinning)
Examples:
17.     Stop lights with lots of moving traffic in different directions
18.     Going through a car wash - intensifies the dizziness
19.     Driving in the rain with the wipers going
20.     Scrolling on my computer up or down fairly fast
21.     Shifting my head back and forth between two computer screens
QUESTIONS:
1.     What's your opinion of the most likely cause of my symptoms?
2.     What tests would you recommend to further identify the problem?
3.     How would you rule out any connection between the reflux, stomach and the dizziness or would you?
4.     What type of specialist would be best educated to look at the combination of my symptoms?
5.     Any suggestions are very much appreciated. The combination of the conditions has turned my life upside down. Thank you in advance for any suggestions or help that you can provide.
Respectfully XXXXXXX

doctor
Answered by Dr. Prof. Kunal Saha 7 hours later
Brief Answer:
You can feel free to consult a gastroenterologist

Detailed Answer:
Thanks for using the Ask a Doctor service.

I have gone very carefully through your query. Our gastrointestinal tract has a forward propulsive movement (peristalsis) that moves the food material forward as it is digested, absorbed and finally expelled as feces. If somehow this movement gets hampered, food along with the digestive juices would stagnate, stomach acid can reflux (GERD) into the food pipe even if the sphincters are ok, and on the other hand the bowel habits would not be proper. Degradation of undigested food in the intestines by the intestinal bacteria would lead to the excess gas formation.

In order to relieve yourself, you need to do the following:
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take Prilosec (omeprazole) once daily before breakfast.
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep (fluoxetine) 20 mg tablet (long term anxiolytic and a prescription drug) once daily for at least 2 months (it may take time for the action to set in). Discuss about this with your treating physician.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.
* Try these prior to considering fundoplication.

Seeing a gastroenterologist would be ideal for you.

Hopefully that should help.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Prof. Kunal Saha 0 minute later
Brief Answer:
You can feel free to consult a gastroenterologist

Detailed Answer:
Thanks for using the Ask a Doctor service.

I have gone very carefully through your query. Our gastrointestinal tract has a forward propulsive movement (peristalsis) that moves the food material forward as it is digested, absorbed and finally expelled as feces. If somehow this movement gets hampered, food along with the digestive juices would stagnate, stomach acid can reflux (GERD) into the food pipe even if the sphincters are ok, and on the other hand the bowel habits would not be proper. Degradation of undigested food in the intestines by the intestinal bacteria would lead to the excess gas formation.

In order to relieve yourself, you need to do the following:
* Avoid spicy food. Take small but frequent meals. Avoid long gaps between meals.
* Avoid alcohol intake (if it a part of your habit).
* Take Prilosec (omeprazole) once daily before breakfast.
* Take plenty of green leafy vegetables as well as other sources of dietary fibers. Take fiber supplements like isabgol/psyllium husk or senna. I would insist you to increase your dietary fiber intake.
* Regular morning walk and exercise to keep the bowel movements proper.
* If I had a patient like you I would perhaps have suggested Prodep (fluoxetine) 20 mg tablet (long term anxiolytic and a prescription drug) once daily for at least 2 months (it may take time for the action to set in). Discuss about this with your treating physician.
* Take curd or yogurt on daily basis. It contains beneficial bacteria and should help.
* Stress reduction has a very important role to play. Yoga and meditation should help.
* Try these prior to considering fundoplication.

Seeing a gastroenterologist would be ideal for you.

Hopefully that should help.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
default
Follow up: Dr. Prof. Kunal Saha 6 hours later
Thank you for your prompt answer Sir. Any thoughts on the Dizziness and if there is a possible connection between the reflux and dizziness.

Respectfully, XXXXXXX
default
Follow up: Dr. Prof. Kunal Saha 0 minute later
Thank you for your prompt answer Sir. Any thoughts on the Dizziness and if there is a possible connection between the reflux and dizziness.

Respectfully, XXXXXXX
doctor
Answered by Dr. Prof. Kunal Saha 10 hours later
Brief Answer:
Possible due to age related degenerative changes

Detailed Answer:
The dizziness is possible independent of the reflux. The organ of hearing that lies in our inner ear (vestibulocochlear apparatus) is also associated with the sense of balance. Age related sensorineural degradation of this apparatus could give rise to the complaints that you are describing. Certain viral infections can give rise to such presentations as you have described but at an age like yours, degenerative changes are more likely. I would insist you to get an audiometry done. It will possibly point to the underlying cause. Meclizine is an over the counter medication that can help. Vestibulocochlear stabilizing agents like cinnarizine or betahistine might be needed but since these are prescription medicines you might need to visit a doctor to get these prescribed. You also need to take plenty of water and fluids to drink.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Prof. Kunal Saha 0 minute later
Brief Answer:
Possible due to age related degenerative changes

Detailed Answer:
The dizziness is possible independent of the reflux. The organ of hearing that lies in our inner ear (vestibulocochlear apparatus) is also associated with the sense of balance. Age related sensorineural degradation of this apparatus could give rise to the complaints that you are describing. Certain viral infections can give rise to such presentations as you have described but at an age like yours, degenerative changes are more likely. I would insist you to get an audiometry done. It will possibly point to the underlying cause. Meclizine is an over the counter medication that can help. Vestibulocochlear stabilizing agents like cinnarizine or betahistine might be needed but since these are prescription medicines you might need to visit a doctor to get these prescribed. You also need to take plenty of water and fluids to drink.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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