Posted 4/2/2016 7:11 AM (GMT -6)
Thanks for your reply Sharon! I've had several tests, not all - barium series, gallbladder ultrasound, upper endoscopy with biopsies for celiac and eosinophilic esophagitis, H. Pylori, basic blood tests - all came back negative, except for reflux diagnosed on the barium series. Endoscopy showed only mild inflammation of the stomach, no erosion of the esophagus. Very surprised I don't have a hiatal hernia.
I've taken many of the classic triggers out of my diet - citrus (I LOVE orange juice, but alas, no more), soda, mint, fried foods, beer, anything else highly acidic. I do allow myself tomatoes very sparingly, for example on a restaurant sandwich or a couple slices of pizza on rare occasion, and it doesn't seem to bother me. Same with chocolate. I've found that some gluten containing foods set me off, strangely not all - bagels, flour tortillas, some breads, so I choose gluten free options for those foods. I wasn't a coffee drinker for most of my life, in the last year before my reflux started I became pretty dependent on it. Now I only have one cup once a week, usually Saturdays when my wife and I make breakfast at home, and normally it's fine, but once in a while it gives me that "gut rot" feeling like when you drank too much alcohol the night before. Then again, there are plenty of times that I get that feeling after taking my PPI with a glass of water in the morning, or even before that.
So, aside from coffee and glutenous foods bothering me once in a blue moon, nothing gives me classic "heartburn" type reflux. All the other things I avoid because that's what modern medicine says to do, not because they bother me. And of course I don't eat within 3 hours of bedtime. If I could pinpoint any additional certain foods that cause problems, I would happily exclude them from my diet. But my problems seem to come and go regardless of meal times or what I eat. I would consider what I'm doing now to be a reasonable diet. I hear about people eating only steamed vegetables and unseasoned chicken, or drinking crazy amounts of kefir and bone broth, or taking 11 betaine HCL tabs at each meal, and I don't consider those things to be reasonable. I can exclude foods as needed, but I don't have time to spend my whole day focusing on what I eat. Some of the more intense reflux diets sound like between shopping and preparation they would be a full time job, I already have one of those!
My overall stress level is low. I'm a dentist (I guess one of us IS a medical professional, sorry to be a wise @$$ :) ), sometimes when I'm in the middle of an especially tough procedure I get a flare up of chest pain, even if it's been several hours since I've eaten anything. So yes, I think you're absolutely right about stress, it plays a part! Fortunately I've been able to manage it decently now that I know what I'm dealing with.
I've seen my family doctor, an internist, and currently being seen by a gastroenterologist, sort of. All the GI specialists in my area are insanely busy, so I've only actually met my specialist once, for about 15 seconds before my anesthesia kicked in for my endoscopy. No, I'm not exaggerating. They do those things like patients are on an assembly line. When I have consultations at his office, I see a PA. She's very sweet, but honestly she could be replaced by a robot that says "you have reflux" and switches you to a different PPI every visit. I just started on Protonix 40mg 1xday this week. So far it's been less effective than the Prilosec/Nexium OTC I was taking twice a day, but I'm trying to give it some time to take effect.
It's frustrating to have such a hard time getting attention from my gastroenterologist. I know it's because they're so overloaded with patients, many of which probably have more urgent problems than I do. But when a patient comes to me, their problems get taken care of ASAP. If there's pain, they see the doctor, and either get treatment or medication and a plan for treatment within a week. It takes me two months to get in to my specialist, and I don't even get to talk to him, so frustrating!!!
Sorry to be so contradictory, as you're trying to help - it's just hard to still be dealing with this after taking so many of the "right steps." I'm going to stay on the Protonix for another week or two, if I don't see improvement perhaps I'll try Lansoprazole.