Manometry & Ph Results

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Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/2/2012 2:29 PM (GMT -6)   
Hey Guys,


I just got back from Dr. Koufman's office. Needless to say, the exams were highly uncomfortable but necessary.

Here are my results:
ph- 64 episodes of reflux into the throat
manometry- 100% normal motility (except for slightly lazy esophagus, which she says almost everyone with reflux has), as well as normal valve pressures.

Dr. K thinks this is vagus nerve related and told me that after 3-6 months of treatment, she is going to get me off of all medications. However, she said I will have to remain cognizant of my diet for the rest of my life. She also said that she thinks there are one or more particular trigger foods that she believes are affecting my reflux.

I go back in 3 weeks to do the emg.

For now, I was put on protonix 40 mg 2x day and 300 mg of prescription zantac at night and am feeling grateful that Dr. K thinks I'm a "typical Dr. Koufman patient" and that I will get well soon.


My only question is how can I be experiencing so many reflux episodes if both valves are normal? Can I be experience a multitude of transient relaxations?


Thanks for all of your support throughout the last few months =)

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5004
   Posted 3/2/2012 2:39 PM (GMT -6)   
Faith,
Have you started a food journal to find your triggers? You've probably read my posts, but if not, just check out some by putting the keywords in the search box at the top of the page.

Eliminating trigger foods helps for a lot of people. I don't know of any "cures" though.

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/2/2012 2:45 PM (GMT -6)   
Thanks Alcie. I have been journaling but it's hard to pinpoint trigger foods, since my reflux is mostly quiet unless I am undergoing a flare-up.
Feel Good,

-Faith

speedygerd
Regular Member


Date Joined Jan 2012
Total Posts : 87
   Posted 3/2/2012 2:56 PM (GMT -6)   
Do you have GERD or LPR? I have pretty severe GERD and am wondering if Dr. Koufman can help with that as well...

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/2/2012 4:39 PM (GMT -6)   
Hi,

Sorry to hear that. I actually have LPR. I'm not sure if she takes GERD patients, but she has extensive knowledge regarding reflux as a whole. I imagine she would be able to help you, since she uses many of the same diagnostic tests as gastro's. I would suggest calling her office.
Feel Good,

-Faith

AtomicGerd
New Member


Date Joined Mar 2012
Total Posts : 2
   Posted 3/2/2012 4:53 PM (GMT -6)   
Hi Faith,
 
I have GERD for many years and am taking Protonix 40 mg 2x day and 150 mg of Zantac at night (when necessary.)
 
What is the condition of your LES, since the stomach contents are leaking back into your esophagus and therefore into your throat? Perhaps you have a pinhole in the LES which is not detectable by today's technology?
 
Just because the Esophageal Manometry is normal, that is because they are not smart enough to detect everything.
 
How is this doctor going to treat you?
 
Curious.
 
AtomicGerd :)
 
P.S. What is full name and location of this MD? smilewinkgrin

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/2/2012 6:02 PM (GMT -6)   
Atomicgerd,

I guess everything is possible but I also underwent an endoscopy.

I am on her reflux diet and am hopeful because she is the one that discovered LPR to begin with. She told me I am a simple and common LPR case, and that I'm one of those who don't need lifetime treatment. Interestingly, I've been on her diet an stopped medications before these procedures and I havent had any rebound symptoms. However, the day I had te ph test I ate a bunch of acidic stuff all day to detect my reflux at it's worst.

Both my les and ues have normal pressures and she believes I have an issue with my vagus nerve as well as certain triggers that are causing this. My Gastro also said my les looked perfect when I underwent endoscopy, but needed a manometry to be sure. I'm going back to her in three weeks so I'm not sure what other medications she will add.

joe1619
Regular Member


Date Joined Dec 2009
Total Posts : 293
   Posted 3/4/2012 12:51 PM (GMT -6)   
how do i contact her.  i have bad lpr also.  after surgery i gradually added traditionally banned foods and wonder if i should stay away from them..ive ate a lot of chocolate since surgery.  ive heard of her

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/4/2012 1:36 PM (GMT -6)   
Hey Joe,

I'm sorry to hear that you have LPR too. Just google Dr. Jamie Koufman and write NYC in your web browser.

She has a very specific diet for reflux, particularly for those who suffer from LPR, which includes a strict 2-week induction diet followed by a lifetime maintenance period.

Here is the list of approved foods for the first two weeks:
Agave
Aloe vera juice
Artificial sweetener (2 tsp/day max)
Bagels and non-fruit low-fat muffins
Banana
Beans – all kinds
Bread – whole grain and rye
Caramel (fat-free, 4 tbsp/wk)
Celery
Chamomile tea
Chicken, not fat, no skin, chix stock
Coffee, max 1 cup/day
Egg whites
Fennel
Fish, no fat prep
Ginger
Graham crackers
Herbs (no peppers, citrus, garlic, mustard)
Honey
Melon
Mushrooms (raw or cooked)
Oatmeal and all whole-grain cereals
Olive oil max 2 tbsp/day
Parsley
Pasta (no acid sauce)
popcorn, no fats
Potatoes & other root vegetables
Rice, especially brown
Skim milk (also soy or lactaid skim)
Vegetable soups
Tofu
Turkey (no fats)
Vegetables (no onion, tomato, peppers)
Vinegarette max 1 tbsp/day
Whole grain breads, crackers, cereal


You can buy her book called: "Dropping Acid, The Reflux Cookbook & Cure"


Hope this helps
Feel Good,

-Faith

joe1619
Regular Member


Date Joined Dec 2009
Total Posts : 293
   Posted 3/4/2012 1:50 PM (GMT -6)   
thx faith.  im not getting a lot of responses.  my surgeon told me i could eat whatever/whenever.  he said late night dinner didnt matter and i could eat chocolate drink wine etc.  i think had i stayed on a strict diet i would not be here today and id be feeling better.  thank you

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/4/2012 2:01 PM (GMT -6)   
Joe,

I'm sorry to hear that, I know how important it is to have someone to speak to during a time like this and wanted to tell you that my e-mail is listed in my profile, so feel free to send me a message if you have any questions or just need to talk.

Your surgeon probably told you that because he assumed that the nissen would stop all reflux, but I think in the initial months, it is important to still stay on some sort of reflux diet until everything heals. As far as Koufman's diet goes, it makes tons of sense. She believes that LPR suffers are not only being attacked by acid, but also by pepsin. Stomach acid is active at a ph of 1-4, and I believe pepsin is activated by acid that is at a ph of 5 both by reflux coming up and by what is going down to your tummy. So her philosophy is to eat everything above a ph of 5, so that you can so called "flush the acid and pepsin out."

Are you taking ppi's now? If you can make an appointment with Dr. K, I say def. go for it. She is the only person who has been able to give me some piece of mind, as well as the answers and treatment I will need.

Take good care and let me know if I could be of any help to you
Feel Good,

-Faith

Alcie
Veteran Member


Date Joined Oct 2009
Total Posts : 5004
   Posted 3/4/2012 2:46 PM (GMT -6)   
Faith,
Except for the vinaigrette, Dr. Koufman's foodlist are all mostly sulfite-free. Interesting.

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/4/2012 2:49 PM (GMT -6)   
That is interesting because sulfites also have a tendency to increase asthmatic symptoms up to as much as 5%. Before I had LPR, I always noticed that red wine gave me the worst headache. Wonder if there is a relationship?
Feel Good,

-Faith

LocalGuy23
Veteran Member


Date Joined Sep 2011
Total Posts : 620
   Posted 3/4/2012 4:04 PM (GMT -6)   
Faith,

What kind of LPR symptoms do you have? Do you have any burning sensations? LPR is so hard to define. Its like a big general term for hard to resolve GERD....

LocalGuy23
Veteran Member


Date Joined Sep 2011
Total Posts : 620
   Posted 3/4/2012 4:06 PM (GMT -6)   
Also, how does the Vagus Nerve play a role in all of this. I remember reading about it.....I even went as far as taking some nerve drugs....such as lyrica but it didn't help with my symptoms.

I did have Nissen with helped but I believe I'm still getting some symptoms. I hope with time it will go away but how long do we have to wait.....

I'm 4 weeks post op......

I had terrible stomach pains and uncomforatable feelings pre op and that went down since surgery so I know something happneded. But my throat and mout still feel sore.......I know it take a long time to heal.....I wish I could fast forward the months and hope to see some healing....

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/4/2012 5:09 PM (GMT -6)   
Hey Maximus,

I didn't see this post prior to responding on the other thread. I'm not exactly sure what role the vagus nerve plays, but I do know that in addition to the output that this nerve delivers to various organs of the body, the vagus nerve conveys sensory information about the state of the body's organs to the central nervous system. Up to 80-90% of the nerve fibers in the vagus nerve are sensory nerves communicating the state of the viscera to the brain. The vagus nerve is also called the pneumogastric nerve because it innervates both the lungs and the stomach.
Additionally, the lower esophagus is richly invested with vagal nerve endings and failure/relaxation of the lower esophageal sphincter allows digestive contents to leak in a retrograde fashion from the intestine and stomach. This allows corrosive digestive juices including acid and proteolytic enzymes to encounter, irritate and stimulate vagal nerve endings which over time become eroded and sensitized.Our brain receives the information via this communication network and, rightly so, becomes alarmed thus triggering involuntary protective reflex responses.

As far as your recovery goes, I'm sure you heard this plenty of times, but you are still at a very early stage in your healing. I believe with time, you will continue to improve. Are you taking any kind of medications now?
Feel Good,

-Faith

Faith224
Regular Member


Date Joined Sep 2011
Total Posts : 299
   Posted 3/4/2012 5:12 PM (GMT -6)   
Also, regurgitation of digestive/intestinal contents into the lower esophagus can trigger a vagal nerve response that results in tissues swelling, injury, scarring and mucus production in the paranasal sinuses as well as the larynx and pharynx without the affected tissues ever having come in direct contact with regurgitated digestive secretions.
Feel Good,

-Faith
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