New and unsure of next step

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horizon
New Member


Date Joined Nov 2011
Total Posts : 19
   Posted 11/21/2011 3:10 PM (GMT -6)   
 Hi everyone!  I have been lurking for awhile and recognizing myself in some of you. I never had trouble with indigestion until 2010 when I started having gas,pressure in chest and shoulder blades and LOTS of burping.  I had been taking more advil than usual due to dental issue, so I ascribed it to that. However, the problem didn't go away after I had addressed the dental problem. I took Zantac and finally a 14 day course of Prilosec and a month later Prevacid before I went to my PCP.
 
  He told me to take pepcil 20 mg for two weeks and this helped. After I stopped, I eventually had trouble with symptoms again. He ordered an upper GI series and also suggested that I might need a GB US. I am homeschooling/taking care of my disabled child, so time and money are an real problem for me.  I did the upper GI series and it was normal. So, I continued on managing symptoms when they occurred with Pepcid and Tums. I also got the papaya enzymes. The intial symptoms are OK right now. I still burp, but the chest and shoulder pressure are gone for the most part.
 
  Well, about two weeks ago, I got the lump in the throat that feels like a plug of mucous. Actually, I have felt and seen mucous. It is present most of the time. My throat is sore and raspy at times too. I elevated the head of my bed,have been watching my diet and doing sinus rinses.  Should I go to the ENT now? I don't need a referral, but I will have to meet a deductible again when the new year starts. My DH has to watch my child if I go to med appointments and this means time away from work- so I want to manage things as efficently as I can. If I go back to the PCP, I feel like it will just be adding another step.  I am pretty confused and stressed out! 
 
Thanks for listening!
 
 

Post Edited (horizon) : 11/21/2011 1:39:43 PM (GMT-7)


bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 417
   Posted 11/21/2011 3:55 PM (GMT -6)   
If money is an issue as you say, don't schedule an appointment with your ENT.  He can't really help you.  I've been this route...and all it does is cost money, cause you to wait longer to get scheduled with a GI, go through the initial office visit, etc.  Your ENT can write prescriptions for you, but that's about all.  He can't schedule the tests you need.
 
When you say the upper GI was "normal", how much was looked at during this exam?  In terms of efficiency, this would have been a perfect time to do the Bravo pH study, and killed two birds with one stone, so to speak.  Did the doctor do biopsies to test for eosinophilc esophagitis?
 
The lump you describe is likely a cricopharyngeal spasm, which is a common occurrence when LPR symptoms first manifest.  LPR is a more complex form of GERD with atypical symptoms (there are a whole bunch of odd symptoms attributed to LPR, which can make it difficult to diagnose without proper tests -- the ones you describe are among them), and is caused when the reflux passes both the LES and the pharyngeal sphincters.  I have been struggling with LPR myself, as have many other members here on this board.
 
Sleeping on a wedge is helpful, although, unfortunately, it doesn't do much for LPR except keep the bulk of the acid away from your throat.  Six inches is recommended, but in my experience, twelve inches is better. 
 
Another problem with LPR is the aerosolization of the stomach acid, and this vapor can travel and accumulate on soft tissues in the throat.  If you can, I would stick with antacids and H2 blockers for now, because they are cheaper than PPIs.  Unfortunately, if you use H2 blockers regularly, you will probably reach a point when you develop a tolerance for them and they no longer work.  This is when you should make the move towards PPIs.  If you can tolerate PPIs, these may serve you well, although they do nothing to stop the non-acid components of reflux that can burn throat tissues as well.
 
There are a lot of good people here who can listen, and offer their support when needed.  Best of luck!
 
-Bruce

opnwhl4
Veteran Member


Date Joined Dec 2008
Total Posts : 4961
   Posted 11/21/2011 8:14 PM (GMT -6)   
horizon-

Welcome to Healing well.

By upper GI series, what tests sis you have done? I ask because this could be just a barium swallow or an EGD, PH study, and manometry along with the barium swallow or an EGD alone. Please provisde some additional info.

I agree with Bruce that usually an ENT doesn't help much.

Take care,
Bill
opnwhl4
Moderator: GERD/Heartburn
Nissen 6/06 and 5/09
#3 on 8/24/11

horizon
New Member


Date Joined Nov 2011
Total Posts : 19
   Posted 11/21/2011 9:39 PM (GMT -6)   
 Thanks for the feedback- you have already helped me!  I confess as soon as I had throat symptoms, I leaped on the idea that an ENT would be able to figure it out and make it stop ( I am way out there on that one from all I have read!) I was concerned that my PCP would be upset if I went to a specialist without consulting him though-so I am glad to get the information from you that the ENT road would probably not be the way.
 
  The upper GI I had was a a basic barium swallow. I drank the chalky liquid and the radiologist watched it travel through me while I shifted positions when he directed. When they said it looked OK/normal, they really didn't give me much detail and I didn't know what to ask. The PCP had wanted to do a GB ultrasound along with the barium test at first, but I delayed that one due to my time and money concerns. My mom thinks I should have the PCP schedule this before year's end, but I just don't think it is my gallbladder. Of course, I'm not a doctor though I feel like I have tried to over-think this whole thing to death as it affects my daily life.  I do know that the Pepcid helps, but I feel best when I take the 20mg once a day without a break and I haven't done that consistently. I am not sure if it will help the throat issues because those just started about 2 1/2 weeks ago.  I just elevated the bed, so maybe that will help.
 
 I feel like I frustrate the doctors because it is hard for me to do multiple tests and follow-up. Since my issues have been more chronic than acute, I feel guilty getting my husband to take off unnecessarily, but my relatives are too old to handle my son anymore.  It really helps to talk it over with people who have been down this same road. I can't tell you how much I appreciate it!

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 417
   Posted 11/21/2011 10:35 PM (GMT -6)   
Just a clarification -- an "upper GI" is an endoscopy, or EGD for short.  While a barium swallow offers important information, it doesn't allow a direct visual inspection, nor an opportunity for a Bravo pH study or biopsies.  If your doctor feels like GERD is a likely candidate for your symptoms, I would think that an EGD and Bravo would be at the top of the list.
 
It's unlikely that your PCP can schedule tests through other doctors without initial office visits.  You'll eventually need to find a good GI who's familiar with GERD -- not always a simple task.
 
-Bruce
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