Suggest treatment for severe acid reflux

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Posted on Tue, 3 Oct 2017 in Medicines and Side Effects
Question: I have a couple questions all based on the description below of my current state of health and the symptoms I'm seeing:


General Health:

I am a white male, a month shy of 48, 5'10.5" tall, and weigh around 275lbs.
I am a software engineer and spend much of my day working on a computer, thus am mostly sedentary.
I have struggled with weight my entire life and in three separate periods of my adult life I have achieved a normal weight and decent level of fitness.
My most recent period of being fit was for about 2 years between 6 and 4 years ago when I weighed 175-180lbs, walked, some jogging, and weight lifted regularly. My personal life took a bad turn and I fell back to my old habits of eating as a form of comfort and because emotionally I was in a dark place where I really just didn't care. By the time I emerged from this state a few years ago, the damage was done. I've had brief stints of trying to become active again but when I do I see almost no result and it is physically exhausting to the point of being almost debilitating. Considering my age and the level of obesity I don't find that surprising, though it is completely frustrating and demotivating.

Over the past 4-7 years, I've noticed a number of issues/oddities with my health. Some are minor and continuous and some only stay breifly before going away but then come back again later. Lately these issues have become more frequent, pronounced and chronic.


Symptoms:


Severe Acid Reflux -

- Burning
- Painful uncontrollable belching
- Pressure in center chest
- Discomfort (more of a cold-burning sensation)
- Have attempted Cimentadine but only if I really can't stand it (approx 6-7 tablets over the last 2-3 months). Results vary.
- Eating apples sometimes provides temporary relief.
- Some diet changes have helped.
- For a time, I'd awake in the morning and the back of my tongue and throat would feel burned, like I'd drunk something too hot. I started sleeping more propped up and that has helped some.


Respirtory -

- Occaisonal coughing for no reason, no apparent infection, congestion or other problem, just an urge to cough.
- Sometimes coughing won't stop easily.
- Occaisonal sensation of a constricted airway, shortness of breath.


Misc. upper body issues -

- At times, after eating, I develop a large buildup of phlegm which can cause me to retch, gag and choke.
- Occaisionally some foods feel like they become stuck in my throat, like there's some "ledge" between my epiglottis and esophagus and the food becomes lodged there.
- The glands just under the jaw have become tender to touch and feel hard.
- If I fall asleep sitting up, I often wake up choking on spit or phlegm.
- Often feel stiff in the neck and shoulders, sometimes in the chest. (Could be due to the changed sleeping posture).


Circulatory (?) -

- Dark spots and splotches on my feet and ankles. They don't hurt or itch or anything, just there.
- Hands and arms easily go numb. When holding a phone, driving, pushing a lawnmower, etc.
- Right thigh is almost constantly numb and sometimes has a burning sensation. I've been awoken at night with my thigh in extreme burning pain, like it feels when a limb has fallen asleep and stayed that way for far too long. When it is numb it often becomes over sensitive to touch. Recently, near the knee there is slight swelling, like fluid accumulation. Sometimes the thigh just itches incessantly.


Other issues -

- Problems with urinating, getting started, and especially getting the flow to stop.
- Problems deficating. I'll feel the need but nothing happens or I just need to pass considerable gas. I've also started going more frequently with less to show for it.
- I have on rare occasions noticed blood when wiping. However, the blood is very bright red so it seems more likely from hemorrhoids.
- To that point, I am fairly sure I have hemorrhoids but they never bother me with itching, burning or discomfort, so I just ignore them.
- I tire easily and seem to have trouble regaining energy after increased activity.
- I have trouble sleeping at times. I'll wake up with a start for no apparent reason, or at times, I have the sensation that I haven't been breathing.
- Recently it seems that wounds (scrapes, cuts, bruises, etc.) seem to take longer to heal than they used to.



So now to my Questions:

1) I have no regular doctor and aside from 3-4 visits for one-off items or some stitches or something, I haven't seen a doctor for a physical or general care in over 30 years. So my first question is, given the description of things below, who would be the best to go see: General, Family, Internal, Gastroenterologist, Endocrinologist, Cardiologist, Oncologist, Urologist, other?

2) Given these symptoms, I get the feeling that I'm facing multiple different issues and not necessarily related ones. I've done a lot of reading online and have an idea what some of these could indicate as a root cause. But I would like to hear the opinions of professionals. What types of issues could these be pointing to?

3) Assuming these are not all symptoms of a single root cause, which possible conditions are more critical to have investigated first?

4) What level of urgency should I be applying to this? Can I afford to take the time to find the right type of doctor and then wait for an appointment to open up, only to then have to decide if I like that doctor and possibly choose another and start over? Or should I get myself into an urgent care facility today?
doctor
Answered by Dr. Prof. Kunal Saha 3 hours later
Brief Answer:
Likely to be due to GERD

Detailed Answer:
Thanks for asking on HealthcareMagic.

I have gone very carefully through your query. Your problem seems to be due to gastritis or gastroesophageal reflux. 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 will reflux into the food pipe 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.


Coming to the rest of your questions:
- If you see a doctor, you can see a Gastroenterologist
- Rather than going to the urgent care trying out the mentioned suggestions would help

Hopefully that should help.

Let me know if I could help further.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha 25 minutes later
Dr. Saha,

Thank you for your fast and thorough response. I have a few questions:

1) The respiratory problems I mentioned - do you feel they could be explained due to esophageal irritation and swelling pressing on the trachea due to GERD, and that they do not suggest perhaps a potential for esophageal tumor, especially when coupled with the general fatigue?

2) Do you have any thoughts on the discolorations on my feet or numbness that I'm experiencing in my limbs, especially the right thigh, which has become particularly uncomfortable?

Thank you for your expertise.
doctor
Answered by Dr. Prof. Kunal Saha 31 minutes later
Brief Answer:
Respiratory symptoms could be due to GERD

Detailed Answer:
Let me try to address the issues

1. The respiratory issues could be explained by GERD. Try the suggested steps. If they do not help, we could have to rule out other causes. I do not suppose that it indicates a esophageal tumor, even when coupled with the general fatigue.

2. Please upload an image and I will try to guide you accordingly.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4403 Questions

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