Acid Reflux – not just for smoking, drinking, middle-aged men.

acid-reflux-causes

Back in December, I had a bad cold and lost my voice, but got over it.  Mid-January, I started feeling like my voice was going out again, but this time, I didn’t have any cold symptoms.  My primary doctor, never one to over-prescribe (I prefer it that way), said, “Maybe you just have acid reflux.  Take some OTCs and see how it goes.”

Acid reflux?  I scoffed–I can count on one hand the number of times I’ve had heartburn in my entire life.  I eat pretty darn healthy, exercise regularly, drink rarely, and have an app that encourages me to get to bed at a reasonable hour.  I’m well under 50, not overweight, I don’t smoke, and I’m not a man.  How could I possibly have acid reflux?!

So, I took a couple Tums and some Pepsid, but it didn’t make any difference.  I also did what I usually do for my voice – herbal lemon lozenges, lemon ginger tea with honey, and lots of water and rest.  After trying to sing for a whole band practice, I became completely aphonic.  Not great for someone who uses their voice professionally.  After three days of being unable to make any sounds at all and now experiencing full-on heart burn ’round the clock, I went back to my doctor who was concerned but didn’t really have anything new to suggest except reflux.  I got a referral for an ENT and fortunately got an appointment an hour later.

The ENT did a nasolaryngoscopy and said that it looked a little irritated but there wasn’t much swelling so he wouldn’t even give me a cortisone shot to get my voice back.  He gave me a prescription for a powerful proton pump inhibitor – Protonix, and said, “If it works, you have reflux.”  He made it sound like no big deal.  He even said he goes off and on PPI’s periodically to manage his own reflux.

By the way, PPI’s ARE a big deal.  Being on them short term messes up your digestion because they lower the amount of acid in your stomach, so you don’t digest your food well, leading to diarrhea.  Also, they are not localized in their effects–they lower acid in your body systemically which isn’t good because you need acid for your lysosomes to properly remove cellular wastes.  In addition, there are a whole host of other health concerns from long-term use:

“…known risks, including C. difficile infections, which can cause chronic diarrhea; pneumonia; low magnesium levels, which can cause muscle spasms; heart palpitations and convulsions; and fractures of the hip, wrist, or spine. Fracture risks are generally highest in people who’ve taken high doses of the drugs for more than one year.”

from – http://www.webmd.com/heartburn-gerd/news/20160608/proton-pump-inhibitor-health-risks#1

I took the pills twice a day for several days and my voice slowly returned, but I was still experiencing heartburn, and an altogether new sensation–a feeling of a giant lump, like food, stuck at the back of my throat.  The technical term for this is globus pharyngis, and doctors aren’t really sure what causes it.  Some believe that there is a problem with the coordination of the swallowing muscles and perhaps they tense up and don’t relax, giving an uncomfortable sensation.  All I know is, it’s annoying, lasts for hours on end, and wasn’t improved at all by taking PPI’s.

Then I went to the library and did some research about reflux and GERD (gastroesophageal reflux disease) and found that while, yes, I was experiencing acid reflux, heartburn, and globus sensation, these don’t equal a diagnosis.  These are symptoms.

This is why I get annoyed with Western medicine–I wasn’t diagnosed.  I was treated symptomatically and it sort of helped, but not 100%, and new problems arose.  I also met with a GI specialist to get a second opinion as I didn’t want to be married to these heavy-duty pharmaceuticals forever.  He basically said the same thing as the ENT.  He also refused to do any further testing to find the underlying cause of the reflux, essentially saying, “What does it matter?  You’ll have to treat it the same way, no matter the cause: modified diet, PPIs or H2 blockers, sleep on a slant, don’t eat 4 hours before bed.”

But here’s the thing: you can have acid reflux for a number of reasons including: over-production of acid in the stomach, under-production of acid in the stomach (yeah, counter-intuitive), a stomach that is slow to empty, a hiatal hernia, a weak lower esophageal sphincter caused by lots of things (including taking muscle relaxants).

Also, some fun facts I discovered: having silent reflux might be the reason you are over-producing mucus and have a constant post-nasal drip.  It also makes you prone to getting more sinus infections, and can cause asthma-like symptoms or leave you short of breath.

Coughing Man - Arrows

Depending on the root cause of the reflux, there may be some different treatment options.  I found another GI who was willing to do an upper endoscopy.  This revealed that my reflux is caused by a medium-sized hiatal hernia.  After even more research, I learned that the current surgical treatments for this aren’t that amazing (fundoplication, Lynx, a type of laparoscopic surgery).  Also, I found I don’t have GERD, I have LPR (laryngopharyngeal reflux), a.k.a. “slient reflux” which is why I don’t get heartburn, but I get throatburn and lose my voice easily.  Still, at least I have a diagnosis and can keep up with any new treatment developments.

Overall, I’m still struggling.  I am having a hard time with eating in general, as sometimes foods that should be “safe” seem to give me a problem.  And if I over-eat, eat too quickly, or eat too close to bedtime, it doesn’t matter what it is–I turn into a Gremlin.

gremlins

Oh, and as far as home remedies, I haven’t found any that work.  I got a slant-pillow but I still wake up with a sore throat most mornings.  The whole drinking water and slamming your heels down thing doesn’t seem to magically move my stomach back into its rightful position.  Self-adjusting my abdominal fascia doesn’t offer any relief either.  And for Chrissake, do NOT drink shots of apple cider vinegar.  If that shit worked, there would be no other treatment for hiatal hernia.  Some people anecdotally swear they get relief from these, but I’m hear to tell you there isn’t any research to back that up, and this girl didn’t find it to be true (though I didn’t try the ACV, that’s just cray).

One non-dietary thing that does seem to help is lowering my stress level with better sleep, avoiding unpleasant stimuli, and meditation.  I don’t think it was a coincidence that my symptoms had a sudden onset right around the time a certain popular vote-loser took office and my stress levels ramped up significantly.

There are some theories as to why acid reflux, GERD and LPR are on the rise.  When I find something credible and research-based, you’ll be the first to know.  Stay healthy friends.