Gord diagnosis, but scared !

wow mz Julie, when I had throat issues 100 years ago, my dr insisted he check my throat before giving me any guidance...of course the reasoning is "cause"...virus, bacteria, toxin, autoimmune response, and/or reflux?....can I assume it's reflux? and reflux can consist of all of the gastric juices including bile, stomach content (unprocessed foods and bacteria). Saliva is a huge huge barrier that protects our throats, and one of the big players that help us within the oral cavity is the helpful L Salivarius probiotic. A lozenge now and then thru out the day...while this helps, it's not the root cause of reflux...but its an "aid" nonetheless.

I've an "idea" as to what Dr or Prof De Souza Pereira used in his study of omeprazole vs melatonin cocktail...will try and research it...and let you know if you wish...it will take time as I must be certain each does no harm, and has no "medical conflicts"...and because we are NOT identical twins, what works for me may or may not work for another...tinkering around with "mini" things often produce better results than any other method....example...some have used small amount of calcium citrate...melatonin...combo with some success at reducing reflux...and some merely using alkaline water...but diet including "what when how much" one eats is most important along with "positioning" after a meal....claudio

I replied to you earlier but don't know where it went! Do you know Donclaudio if PPI's can make bile reflux worse? And if so if you stop taking them would the bile reflux improve? You seem to have a great deal of knowledge with all this. How do you manage your condition and is it tolerable? I must admit that I am just looking for abit of hope!!

Julie,

I am on the road..will respond when I return home. Bile is produced in the liver,stored in gall bladder (if we have one).ppi's block acidfrom stomach lining. The normal ratio therefore is modified by ppi's. Clsudio

Thank you so much for your help. xxx

HI julie,

what are your trigger foods?

intolerances?

alergies?

I am almost ready to give you my "thinking" and some

suggestions...Its been a difficult day today..not medically..wife has a "whip" in one hand and a "stop watch" in the other...preping for visitors...Claudio

Hi Donclaudio, my trigger foods are probably coffee and chocolate. Do you know much about bile reflux? It's horrible and hard to treat so any advice is welcome.  Am taking colestyramine, nexium, probiotics, digestive enzymes, slippery elm. Am looking at also trying psyllium husks also. Again thank you for your help.

julies,

This is what I know about bile reflux...bile is very errosive to the throat, PPI's increase the amount and concentration.

There was a recent article in the American Chest Journal with a study that kinda went like this:

researchers found that, while total reflux events and acid reflux events decreased considerably with PPI treatment, "nonacidic reflux" events, such as stomach bile regurgitation, were significantly greater with PPI treatment. Researchers suggest that this increase in nonacid reflux events may explain persistent symptoms in some patients, despite being treated with PPIs.

I would suggest you check the enzymes your taking to be sure your not "increaseing" the production of bile.and if you will be using phyllium husk powder, a reminder its inulin and can produce gas based on quantity, so go with 1/4 to 1/2 tea spoon initialy WITH your probiotics.

You've put some "stress" on your liver...your water consumption should increase (8.2 plus ph) and consider Milk thistle 100mg max an hour or so pre bedtime for the next 2 weeks.

Sore throat and difficult swollowing...a temp fix...I'm on a termianl patient forum, patients with same use D...its a prescription but can be found in a cough syrup R, if I state the name, this post will be deleted as it may be considered advertising. send me a pm, and I'll give you both the med and the cough syrup name. You should not stop nexium cold turkey...so the sooner you have melatonin available the sooner you can taper it.

I will also give you the a safe method to terminate the nexium in the private msg..

Correct me if I'm mistaken..you've had the Fundo? if so, give me your thought put as to pre and post experience? claudio

Thanks for your reply Donclaudio although it has frightened me abit! So looking at what you've said. Do I need to stop the Nexium because I'm on 40mg x 2? Also are digestive enzymes contra-indicated with bile reflux? Yes I had a Fundoplication 18 months ago but it has made no difference at all, in fact I feel slightly worse. The only thing that really helped me was Reglan but I couldn't stay on it because of the side effects. How do I send a private message?

I've sent you a pm...

40mg is a tad much...I would think 20mg x 2? I was hoping only 20mg x1...let me know if 40 x 1 or 20 x 2...

And I do not comprehend why colestyramine use of this drug to improve bile reflux?? As a result loss of bile acids, more plasma cholesterol is converted to bile acids in the liver to normalize levels.

I would think FGF19 would be a better targeting area for regulating bile. (milk thistle)...do a plos one for FGF-19..

claudio

Hi Donclaudio, I was definitely on 40mg x 2 daily but this week have cut down to 20 mg x 2 of Nexium. I'm on a Bile Reflux site and it's standard practice to use colestyramine said a "bile binder". So you think that probiotics are ok but maybe digestive enzymes aren't?

Julie, some digestive enzymes may contain bile salts...if so, use those that do not have these salts...enzymes as you know work on a one on one basis..i.e. lactose via lactase enzyme...or carbs via amylase...."personally" I would prefer you get your enzymes from lactic acid fermented..plant and dairy products..subject of course to your tolerances.

The fundo was to have "prevented" reflux?? in particular Bile?

Is it possible post op, you may have stretched the location due to a heavy meal?

we tapered as follows after the tripple therapy for HPylori, 40mx (20 x 2)

day one: 20 mg thru day 5 replacing the 1 20mg with one tab of bismuth (262mg)

day six 20 mg every other day for 7 days using bismuth on the skipped day.

The option for you would be using "melatonin vs bismuth"

will send you via pm the melatonin weening protocol.from the study mentioned earlier..Claudio

I've had a barium swallow and 24 hr motility test and they show that the Nissen's is mean't to be working! What do melatonin and bismuth do?

Julie,

good job re initial nexium reductiion.The colestyramine

binds to bile in the colon.Again, As a result , loss of bile acids, more plasma cholesterol is converted to bile acids in the liver to normalize levels. Where is the gain?

Bile is necessary but "you don't want it in your throat" right? What you want is No Reflux...its difficult sometimes to see the forrest when in inside and see only trees...I too have this problem, and sometimes too often.

Probiotics are very good, and some that need to get beyond the stomach, need a transporter/chaperone...the psyllium husk will help accomplish this task. Enzymes are OK provided you know which enzymes you need and where they are useful and not harmful...thus the reason I prefer femented plant foods...and fermented dairy...

You can make home made kimchi without the spice...simple, and you can add the good gobo or daikon root as well...youtube for some basics.

Yogurt and kefir a tad more labor intensive but studies have shown that they are very potent compared to commercial products. Claudio

Bismuth, we used it for acid dilution (raising the ph slightly)

and as a bacteria suppressant.

Melatonin in studies has shown "almost" the same effectiveness as omeprazole (PPI) without side effects...in one "very small) study, it also red to strenthten the LES...imo study too small to be a "sure thing"...and because melatonin cannot be patented, no studies that I'm aware of but hope to see some from the big nutritional lab in Shanghai. Claudio

Thanks for all your advice. Is the melatonin prescription? I'm abit nervous about taking it because I've heard that it can make you drowsy and I'm on sleeping tablets already. Thanks again for all your help.

Julie,

you didn't mention you were are a sleep med?? I need to know what you are taking so that anything I might suggest is appropriate.

And sleep meds "can" relax the LES.

Claudio

Hi Donclaudio, I'm actually on an anti- depressant called Mirtazipine but it also makes you sleep.

Melatonin can be obtained on line. Until I know exactly what you put into your system, other than what you've mentioned, my suggestons might be unhelpful...stuff be they vitamins or meds can """increase""" or """decrease"" effectiveness of one or may ""checkmate."""

Claudio

Julie,

Mirtazipine

there are 112 references (studies) for this medication, its predessor and the newer version...I haven't the time to study all of these 112, just "skimming" they are all over the place..good not so good...some in combo etc...both melatonin and Dex should not be considered while on this medicatiion. nor any other med without a skilled pharmacist approval...guideline....

I haven't a suggestion to replace either...I've have had some experiences with klonopin, Amitriptyline, used for sleep side effect...and my sense is not to add anything due to so many "possibilities"..again..both good and not so good...therefore, don't use either unless a pharmacist approves..Claudio

Looking for further advice ! I completed my month's course of Omeprazole a week ago and so far no recurrence of sore throat. However, am left with phlegmy throat which is sometimes blood stained in the morning. Am still stressing myself out. Should I return to gp or wait to see if symptoms settle more ?? Am watching diet, trying to eliminate any triggers. Don't want more Omeprazole if I can help it.

Hi Suzy,

very happy you've not had "rebound".

I would schedule an appointment with an ENT, you can always cancel it should it not be necessary.

Since your phlegmy in the ""mornings"" has some bl blood, its quite possible the humidity may be inadequate at this time...an easy "check", place a large wide mouth bowl of water near bedside over the next few nights...

If this clears it up, you can cancel the EnT appointment unless you yet wish to have an expert evaluate your condition...I don't think a GP has the skills and experience of an ENT specialist.

No need to "stress out", a mild virus can cause the phlegm, and this is the time of year for these to be around...be sure to protect yourself in grocery stores as basket and cart handles can harbor bad guys.

I'll consult with ann and nick about my suggewtion and see if Nick has ideas...he is either in Tokyo or Yokohama, could be a few days before we touch base...please let me know how it goes with the bedside water...to lift your spirits some, do a youtube search for cutibabyinchina, a 3 year old singls like an angel, try the 3.45 video...my best to you...claudio

Suzy,

Niick just called..said he thinks you've had the mucus for some time, and its most likely a side effect of the anti depressant...there are two side effect suspects..one..throat swelling and dry mouth...both will elicit an immune response much like that of "dry eye" when excess tears develop.

The ENT could collaborate with a specialist within this specific area to offer solutions...In the meantime...drink plenty of cool water, try some papaya or mango merely to see if it "helps"....claudio

Thank you. Am drinking lots of water so hopefully that will help. Should certainly assist the weight loss !!!! Do you think it is worth returning to gp or shall I hang in and see if it improves ?? Thanks again

Its a toss up, you could call for an appoi.tment, chances are it

Won't be scheduled for two or so weeks...plenty of time to

cancell it ..if if .claudio