Lpr

[doctormom]

Please help....I have been diagnosed with LPR after a year and 20 doctors. I have never seen my symptoms anywhere. In addition to hoarseness, I have fluid in what seems like the E-tubes. It crackles and at the same time I have nasal congestion. When all this is happening, my ears are hissing. When there is no fluid and no congestion, my ears are not hissing. Has anyone had acid back into the nasal passage and E-tubes. I am going crazy. I cannot take the PPI's because I have adverse reactions to them. I think I want surgery. Thank you for your help. Sandy

[Hawk]

Originally posted by doctormom
Please help....I have been diagnosed with LPR after a year and 20 doctors. I have never seen my symptoms anywhere. In addition to hoarseness, I have fluid in what seems like the E-tubes. It crackles and at the same time I have nasal congestion. When all this is happening, my ears are hissing. When there is no fluid and no congestion, my ears are not hissing. Has anyone had acid back into the nasal passage and E-tubes. I am going crazy. I cannot take the PPI's because I have adverse reactions to them. I think I want surgery. Thank you for your help. Sandy

A couple of thoughts.. It may not be acid getting into the e-tube so much as mucus being created in reaction to the acid.

I have had to deal with similar congestion and crackling with the hissing... all of my life. When I reached my thirties I discovered that if I stopped drinking milk the symptoms were greatly reduced. If I drink one glass of whole milk I feel like I am getting a cold. The mucus starts forming almost instantly. I believe (not tested) that I might have an allergy to a protein that they put into milk call casein.

[doctormom]

Thank you for your reply. Yes, it is mucus, I forgot to mention that. However, I am not allergic to dairy products. For the last 2 months I have not used milk. I am using soy milk. I think that does not cause mucus but could be wrong. The doctor told me soy was ok. When the mucus builds I cannot get rid of it immediately. Sometimes I have to wait a day or two in order to blow it out. This is the most frustrating thing ever. I feel I have no life. I thought I had tinnitus because of the hissing but am now not sure. I also have hyperacusis which is a collapsed tolerance to sound and cannot stand noise. I'm beginning to think this is all connected to the acid reflux. Thank you for any help that any one can give me.

[The Pard]

Hi Doctormom,

If stomach acid gets into the eustacian tubes that are supposed to drain the middle ear, it can cause scar tissue to form and block the drainage, leading to the throat. Babies who are put to bed with a bottle of milk and are not burped can be
more susceptible to ear infections because the milk can get into the tube and turn sour causing
an infection.
An ear infection is like arthritis of the bones that convey sound and left untreated, can impair
the hearing. Antibiotics are needed for this.

Has a doc looked into your ear to rule out a fluid
buildup behind the eardrum?

Take care..
The Pard

[doctormom]

I have been to 20 doctors. This is not an exaggeration. I have been trying to get to the bottom of some ear problems for 15 months. It was only 2 months ago with doctor number 20 than I was diagnosed with LPR. I have no infections. I have tinnitus and hyperacusis and visited all 19 doctors to get a handle on that situation. It could be that LPR is causing the other problems but since I cannot take any of the meds. I am having a hard time fixing it. I took prevacid 15 mg. once a day and got sick from it. In addition to which, doctors do not return calls where I live. Thank you for your help. I probably will receive better help and information here than with any doctor. I don't know why everything is turning to mucus. I have watched my diet very carefully and I am very thin.

[The Pard]

Hi Doctormom,

There is a possibility of your trouble with sound being due to nerve damage. Sometimes a concusion
or a less forceful blow to the head can cause
trouble. Exposure to loud noise can sometimes be the start to tinnitus. Are you using a noise machine to mask the sound when trying to sleep?

Have you had an MRI to rule out a tumor or other
growth pressing on the hearing nerve?
Neurontin or Tegretol can sometimes lessen the
sensitivity to sound. It may give you some relief
while you keep looking.
Xanax is also able to reduce tinnitus.
When I was a child I can remeber having an ear that hurt like a toothache when sound was received. It was an infection.
If you have never had a blood test for mycoplasma, ureaplasma and chlamydia it could be helpful. (especially if other symptoms are present and other tests for infection are negative.)

Since you are thin, vitamin defficiency must be
considered and ruled out.

If you have no other signs of nerve damage like
tingling, burning or itching of the extremities, vision changes, fibromyalgia etc. then it is less likely to be a systemic problem like Lyme disease. If it is worsening with time, then you may need to rule out this less likely cause.
A neurologist is a better choice than an MD.

Here is a link which shows how little is really known about treating the hyperacusis. http://www.tinnitus-hyperacusis.com/About/Hyperacusis/hyperacusis.html

I wish you luck...
The Pard

[doctormom]

Thank you so much for all the helpful information. As I have been to 20 doctors, everything you have mentioned has been addressed. I had MRI's, etc. I have never had a blow to the head or been exposed to loud noise. I am very aware of the tinnitus and hyperacusis support boards. Thank you very much for mentioning them. I have had all kinds of allergy testing, mold testing and you name it. I sincerely think it is coming from my stomach. I have not had endoscopy but have and videostrobeoscopy. That is when the discovery was made. Every doctor I went to gave me a different answer. Tubes, sinus surgery, turbinate surgery, etc. None of these made sense to me. Nobody could agree. These were the top doctros in my area in their field. I have not sought the help of a GI person yet. I do believe that LPR is the main problem. When the videostrobeoscopy was performed, the doctor could see the mucus. However, getting him to return my call is impossible. I feel very scared that something very serious is going on. Thank you

[werner]

maybe you can find out whether it's LPR,
when you make a diary of what and when you
eat/drink and when you have ear-problems.
Also, when you feel bloated and burp, that
could increase LPR-risk , I think.

[doctormom]

I feel there is a connection. Usually, about 3 or 4 hours after I eat, I can actually feel things backing up. I start to get a sour taste in my mouth, my nose gets congested and my ears start to crackle. I am extremely careful with diet, with regard to eliminating those reflux culprits. I feel since I have not addressed this with proper meds, etc. it is just getting worse. I feel it is stress related. I am high anxiety and stress easily. This all happened about 2 months after Sept 11. I feel there is a connection. I just need a doctor who can spend more than 15 minutes and listen to my history. Thank you everyone. Is there some way to rid yourself of this without taking the PPI's. Is there anything holistic that can help. Has anyone tried acupuncture?

[af]

Originally posted by doctormom
I feel there is a connection. Usually, about 3 or 4 hours after I eat, I can actually feel things backing up. I start to get a sour taste in my mouth, my nose gets congested and my ears start to crackle. I am extremely careful with diet, with regard to eliminating those reflux culprits. I feel since I have not addressed this with proper meds, etc. it is just getting worse. I feel it is stress related. I am high anxiety and stress easily. This all happened about 2 months after Sept 11. I feel there is a connection. I just need a doctor who can spend more than 15 minutes and listen to my history. Thank you everyone. Is there some way to rid yourself of this without taking the PPI's. Is there anything holistic that can help. Has anyone tried acupuncture?

It is most likely from your LPR, no doubt about it. My FIRST symptom after I noticed my stomach bloating was ringing in my ears which coincides with each heartbeat. Went to the doc, he checked my ears and said they looked fine. Gave me the dumb look. Idiot.

If you are cannot take PPI's then have you tried H2's? You can buy OTC zantac (ranitidine) and take a couple of them 3-4X's a day and see if that helps any. Other than these, surgery is likely your best option. Good luck :)

[doctormom]

Yes, I have tried otc zantac 75 mg. and I got sick. I have had this problem with meds my whole life. I have been thinking about cutting it in half and seeing how that works, although, at that dose, I don't know if I would benefit. I would like to know more about the surgery. How it is done, does it have a lasting affect? I don't like the idea of surgery one bit but I can't stand all these symptoms either. I am overwhelmed by the positive responses that I keep getting. Thank you everyone, so much. This seems like such a caring community of people.

[af]

Originally posted by doctormom
Yes, I have tried otc zantac 75 mg. and I got sick. I have had this problem with meds my whole life. I have been thinking about cutting it in half and seeing how that works, although, at that dose, I don't know if I would benefit. I would like to know more about the surgery. How it is done, does it have a lasting affect? I don't like the idea of surgery one bit but I can't stand all these symptoms either. I am overwhelmed by the positive responses that I keep getting. Thank you everyone, so much. This seems like such a caring community of people.

If you have had a double-probe pH test to confirm the LPR, then I would have surgery if I was in your shoes. If you have not had the PH test, then you should have it, in order to confirm concretely the problem. Your doc would benefit from the numbers.

But, if I was in your shoes and I could not take any meds, then I'd be running to the scalpel. Even if the surgery fails a few years down the road, you CAN have it re-done.

Good luck! :)

[doctormom]

Thank you for telling me about the PH test. That is something I have not had done yet, only the videostrobeoscopy. Can you tell me more about it and how concrete is the information they receive from it? Would a endoscopy be necessary from a GI doctor? I am a baby when it come to anything where I need anesthesia. I assume the PH test is not difficult. Thank you for your help. For some reason, the ENT's where I live are so highly specialized that one only sees the ears and another only the nose, etc. If you go to an ENT and his specialty is ears, he doesn't know what to do about your nose. It is unbelievable.

[The Pard]

Hi Doctormom,

I agree with you that the LPR is the main cause of the ear troubles. Acid does not belong in the ear or the sinuses. Even the fumes can cause trouble.

Before you jump into something like a serious surgery, at least have a blood test for Helicobacter Pylori and a breath test for the Urea
that is given off. Since you have burping and bloating, and are limited in the meds you can take, it might be worthwhile taking the triple
therapy for HP because there is a 20% chance of being infected even after negative test results.
http://www.drmirkin.com/archive/7128.html


What were the circumstances under which this all began?

It is hard to believe that you can not tolerate the meds that are able to settle the acid production.
Which ones have you tried? There has to be something that you can take.

Good luck in your decision..
The Pard

[werner]

there are many different meds to reduce stomach acidity,
often people who can't tolereate some of them can tolerate
another one.

you should find a description of the PH test from a
link from hbh main page, I think.
I also saw a curve PH/time which typically showed reflux some hours
after eating even in healthy people.

The fundo surgery corrects the LES, but in your case (LPR) the UES
could be the bigger problem.
PH-double-probe or manometry could measure this.

doctors are more qualified than yourself in general, but you
have more time for yourself and can specialize on your problem !
So do your own research in internet, google,pubmed/medline,etc.
finding the right keywords, that's the important thing in
internet-search

[doctormom]

Everyone has been so helpfu. I do not know what UES is. I have had problems with my ears for 15 months. It has only been in the past 2 months that I have been given this diagnosis of LPR. However, I know of no one with my symptoms with the mucus in the nose and ears. I am hoping this diagnosis is correct because at this point, I do not even know where else to go or what to do. I have tried pravicid 15mg. and otc zantac 75 mg. I have been trying to get my doctor to return my call for 2 weeks to try something else. I wrote a letter because he has not been responsive. I want to change doctors but cannot find one at this time who is familiar with this problem. I could always go to a GI doctor but that would mean waiting a couple of months to get in as this particular specialty is extremely busy. I have private insurance, but nonetheless, it is difficult. I feel very grateful to have found this message board. I do not have heartburn or any of the classic symptoms of GERD. I am going to look into this PH test but am not quite sure how it will change the outcome. Is the treatment different after knowing the results of the PH? Thank you for any help anyone can give me. I am more that appreciative of the support I am finding here. One thing that concerns me is the need to continue with meds, after finding one that works, for such a long period of time.

[werner]

UES = upper esophageal sphincter ,
also cricopharyngeus.

You can search for these terms , I also remember
some posts on the old board and some good links
to online articles where this is explained.

tell me, if you want them but can't find them

the PH test will reveal if and how much reflux you have.
People here recommended to insist on a double-probe-PH
test in case of LPR.

I assume that doctors or/and insurance companies want this test
before doing any treatment.

[af]

Originally posted by doctormom
Everyone has been so helpfu. I do not know what UES is. I have had problems with my ears for 15 months. It has only been in the past 2 months that I have been given this diagnosis of LPR. However, I know of no one with my symptoms with the mucus in the nose and ears. I am hoping this diagnosis is correct because at this point, I do not even know where else to go or what to do. I have tried pravicid 15mg. and otc zantac 75 mg. I have been trying to get my doctor to return my call for 2 weeks to try something else. I wrote a letter because he has not been responsive. I want to change doctors but cannot find one at this time who is familiar with this problem. I could always go to a GI doctor but that would mean waiting a couple of months to get in as this particular specialty is extremely busy. I have private insurance, but nonetheless, it is difficult. I feel very grateful to have found this message board. I do not have heartburn or any of the classic symptoms of GERD. I am going to look into this PH test but am not quite sure how it will change the outcome. Is the treatment different after knowing the results of the PH? Thank you for any help anyone can give me. I am more that appreciative of the support I am finding here. One thing that concerns me is the need to continue with meds, after finding one that works, for such a long period of time.

Unless you live in a city, you may not be able to find a local doctor that is familiar with your problem and has experience in dealing with it. the pH test needs to be a "double probe" test, in which they put one probe just above the stomach, and the other one just above the upper esophageal sphincter (which is higher up in the esophagus). That way, if you are refluxing up above the upper sphincter, they can tell it and it might be a strong indicator that you needed surgery.

I waited two months to get into a dr in st. louis since I basically live in boondocks usa.
You might try bumping up your OTC zantac to 150 mg (two tabs), as that is the Rx dose. If it was me and if I had no side effects notable, I would take two tabs at least 3 times a day for a while just to see if that would help significantly.

some of us do not have classic symptoms of GERD. I did not. I had pain, but don't have heartburn or indigestion. I guess we are all wired differently with different symptoms and problems.

[doctormom]

Believe it or not, I do live in a major city, Los Angeles. The first doctor I ever saw for this 15 months ago, is the doctor who operated on Rush Limbaugh. He is also Ronald Reagan's doctor. There is no shortage of doctors, just doctors who don't want to take the time unless you have an important name. I have been to UCLA, USC, Beverly Hills and everything in between. The insurance companies pay them so little that they don't want to spend more than 15 minutes with you. That is not enough time to take a good history and do a proper exam. If they wanted to spend the time to be good detectives, I think I could get to the bottom of it. For a doctor to not return calls when I am trying to find the right meds, is uncaring. If 15 mg. prevacid and 75 mg. zantac is too strong, I don't know what can work. I am very worried about all of this since I am the only one with these symptoms. It is making me think I have something very serious going on that has not be detected yet. I have not been to a GI doctor but maybe that is where I belong. I am just too scared. You have all been so caring and supportive. Thank you.

[macmember]

Originally posted by The Pard
Hi Doctormom,

There is a possibility of your trouble with sound being due to nerve damage. Sometimes a concusion
or a less forceful blow to the head can cause
trouble. Exposure to loud noise can sometimes be the start to tinnitus. Are you using a noise machine to mask the sound when trying to sleep?

Have you had an MRI to rule out a tumor or other
growth pressing on the hearing nerve?
Neurontin or Tegretol can sometimes lessen the
sensitivity to sound. It may give you some relief
while you keep looking.
Xanax is also able to reduce tinnitus.
When I was a child I can remeber having an ear that hurt like a toothache when sound was received. It was an infection.
If you have never had a blood test for mycoplasma, ureaplasma and chlamydia it could be helpful. (especially if other symptoms are present and other tests for infection are negative.)

Since you are thin, vitamin defficiency must be
considered and ruled out.

If you have no other signs of nerve damage like
tingling, burning or itching of the extremities, vision changes, fibromyalgia etc. then it is less likely to be a systemic problem like Lyme disease. If it is worsening with time, then you may need to rule out this less likely cause.
A neurologist is a better choice than an MD.

Here is a link which shows how little is really known about treating the hyperacusis. http://www.tinnitus-hyperacusis.com/About/Hyperacusis/hyperacusis.html

I wish you luck...
The Pard

Since you mentioned Chlamydia, could you clarify the difference in the venereal desease and the pneumonia Chlamydia and the one you mentioned here?

I have read that lesions in the heart, leading to blockages can be caused by pneumonia with the Chlamydia bacteria involved. A year before my heart attack I had a severe case of pneumonia. No one ever tested me for the strain or even mentioned the chance of it causing a lesion.

The only Chlamydia I had ever heard of before this was a venereal disease.

Thanks...Beverly

[The Pard]

Hi Beverly,

Chlamydia is the same organism, but it can affect
different parts of the body.

It is possible to have someone who is infected sneeze in your vicinity and you can be infected
if your immunities are vulnerable.
It does not require sexual contact.

http://www.drmirkin.com/archive/6852.html
http://www.drmirkin.com/archive/7056.html
http://www.drmirkin.com/morehealth/g107.htm
http://www.drmirkin.com/joints/9094.html
http://www.drmirkin.com/archive/7162.html
http://www.drmirkin.com/morehealth/g144.htm

I hope that you found the info that you need.

The Pard

[macmember]

Originally posted by The Pard
Hi Beverly,

Chlamydia is the same organism, but it can affect
different parts of the body.

It is possible to have someone who is infected sneeze in your vicinity and you can be infected
if your immunities are vulnerable.
It does not require sexual contact.

http://www.drmirkin.com/archive/6852.html
http://www.drmirkin.com/archive/7056.html
http://www.drmirkin.com/morehealth/g107.htm
http://www.drmirkin.com/joints/9094.html
http://www.drmirkin.com/archive/7162.html
http://www.drmirkin.com/morehealth/g144.htm

I hope that you found the info that you need.

The Pard

Thank You so much for the info. Wonder why my really good cardiologist would not want to test and see if I still have the germ in my system that could cause another heart attack? It is really sad. Since I have approached the subject before and he blew me off, I wonder how I would address it again?

Is there a good location such as this for Heart Patients on the Internet?

Thanks Again.....Beverly

[The Pard]

Hi Beverly,

Print those reports that have the journal referrences related to the heart and underline
in RED all that applies to you. Take them to your doc on the next visit and simply ask why you were
scorned for mentioning it before. Don't be afraid of hurting his feelings like he did yours.

The journal referrences should be enough to make him take the articles seriously. It should be enough to at least get you tested for chlamydia.
If I had a heart attack I would be insisting on taking either Azithromycin or doxycycline for as long as it takes. You don't have to wait for
more reasons.

Good luck..
The Pard

[doctormom]

Hi,
A doctor from Scripps Clinic in La Jolla, Ca. called me. I have never met him but he heard about my story. He is trying to set me up with a doctor in Santa Monica. He explained to me the process of why mucus gets into the E-tubes. Apparently, it is not uncommon with LPR patients. I couldn't write down fast enough when he was explaining but I did write the word Water Brash. This basically explains what the mucus is. I felt so relieved that someone actually told me this is not uncommon. If he doctor in Santa Monica does not treat this then I think I will go to San Diego for a few days and be treated by this wonderful human being. He did not know me and had the kindness to spend 15 minutes on the phone with me and told me to call him in the future if I had any questions. I have his home phone number. It seems the bigger the doctors are, the more apt they are to help. I am just passing this info on in the event that someone else has these symptoms and needs some help. He feels, as some of you have suggested, that the next step is the PH test. Thank you everyone for all your help. I will keep you posted. Sandy

[Gord]

Ahh finally a post worked. I just wanted to say that I read a report recently that showed a 100% disruption in the inner ear's ability to move fluids out from between cells, thus causing a number of complaints not the least of which is that feeling of fullness and equalization problems. That 100% disruption occurs when stomach acid reaches the tubes via LPR. I had this for years and didn't know the cause. Once the LPR is under control however the ear returns to normal...thankfully. My ear has not felt this good in a dozen years. I've had the LPR under control for about two months now.

[doctormom]

Gord,
If possible, can you please, please tell me where that article is that you are referring to. I am amazed that ENT's do not know this. If you read my other posts, you will see that I have been to 20 doctors. Thank you so much for that information.

[doctormom]

Gord, P.S.
During this period of time, did your ears ever hiss as a result of the fluid? I actually have mucus in my ears that at some point within a couple of days, I am able to blow out my nose. Then it builds again. Everything is so interconnected, it is no wonder when one thing breaks down, other things breakdown as well.

[Gord]

I'm sorry doctormom, I didn't save the article and I found it on an Internet search. It is a relatively new piece of information. My ENT was familiar with it. The researcher did not know why the acid interrupted the inner ear's ability to move fluids but only found a 100% disruption in every subject.

The key here is to lower the acid with PPI. I use Prilosec. Control anxiety. I use Xanax. Change eating habits to reduce the severity of reflux. Eat less more often. Don't eat for four or five hours before going to bed. And use a bed wedge if you have to. These things will all help the acid from reaching the ear. Good luck.

[doctormom]

Do you know anything about milk products? I am not allergic to dairy and only use soy milk products. However, I feel it is also a culprit. Do you know what else could be in this milk product that could cause a problem with LPR? I decided to not use it for awhile to see if it made a difference. It is too soon to tell at this point. I drink one cup of tea for breakfast but am thinking about eliminating that as well. Have not been able to find a PPI that doesn't cause me a problem. Also having trouble finding a doctor. So many ENT's don't really treat this. I live in the L.A. and you would think that there would be plenty to choose from. Any help is greatly appreciated.

[doctormom]

For anyone who has raised their bed about 6 inches off the floor, did you slip down on the bed? I am going to try raising my bed up on blocks but I feel like I will slip down. Does anyone have any suggestions? Thank you

[af]

Originally posted by doctormom
For anyone who has raised their bed about 6 inches off the floor, did you slip down on the bed? I am going to try raising my bed up on blocks but I feel like I will slip down. Does anyone have any suggestions? Thank you

1. I keep a couple of pillows at the foot of the bed under the covers/sheets, and that pretty much takes care of any slippage.

2. Don't use satin sheets! ;)

[Patrick]

Yeah, flannel sheets seemed to work well for me, to keep from sliding off the bottom of the bed. Plus, I kept the sheets tucked in at the bottom.

Also, you may not need to go quite that high. I used 4" concrete landscaping blocks and those seemed to work really well.

[doctormom]

Thank you for your replies. I bought 2" wood blocks so I will try 4" and see how that works. The thought of slipping out of bed is not very desirable.

[Rebecca]

Hi doctormom,

For what it's worth... I could never seem to master sleeping with blocks under my bed. I would wake up on the other side of the bed, or hanging off the bed, etc. Then I bought a bedwedge at the Relax the Back store and it has done wonders. It was expensive ($175), but was well worth it. Here's the link http://www.relaxtheback.com/global/product/pg_product_detail.cfm?TID=561930134656600323024867&CFID=82301346&CFTOKEN=640323028&Site=main&Group_ID=1739

--Rebecca

[doctormom]

Rebecca,
Thank you for the good tip. I have a Relax a Back store in my area and I will go in and see how comfortable it will be for me. I am only 5ft and some things don't hit me in the right area. Perhaps this will do the trick.

[Hawk]

Also check out www.propuppillow.com

They seem to address how the wedge fits to the back quite well.

[doctormom]

Hawk,
Thank you for the information on the pillow. However, if you have LPR and it can happen 24 hours per day while standing, does it matter if you have your bed tilted while sleeping? I have been curious about this for awhile. Thank you for your help.

[Hawk]

Originally posted by doctormom
Hawk,
Thank you for the information on the pillow. However, if you have LPR and it can happen 24 hours per day while standing, does it matter if you have your bed tilted while sleeping? I have been curious about this for awhile. Thank you for your help.

When you are laying down you are not getting the assistance of gravity to keep the content of the stomach in place. So, raising the head of the bed or using a special pillow would not hurt anything and may help.

I know in my case, using Prilosec resolves most of my symptoms (and watching what I eat a drink) but if I sleep flat I can tell the difference.

Maybe some with LPR will include their comments.

[macmember]

Originally posted by Hawk
When you are laying down you are not getting the assistance of gravity to keep the content of the stomach in place. So, raising the head of the bed or using a special pillow would not hurt anything and may help.

I know in my case, using Prilosec resolves most of my symptoms (and watching what I eat a drink) but if I sleep flat I can tell the difference.

Maybe some with LPR will include their comments.

I tried Prilosec and it did not help. I went to prescription strength Zantac and can tell a difference in the amount of pressure I can feel in my chest. My problem is that I do have serious heart disease and do not know the difference in angina and this LPR ( if that is what I have)! I AM SOOOOOO CONFUSED.. Before I tried the Zantac I was taking a lot more Nito. If anyone can tell me how to tell the difference I would appreciate it.

[af]

Originally posted by macmember
I tried Prilosec and it did not help. I went to prescription strength Zantac and can tell a difference in the amount of pressure I can feel in my chest. My problem is that I do have serious heart disease and do not know the difference in angina and this LPR ( if that is what I have)! I AM SOOOOOO CONFUSED.. Before I tried the Zantac I was taking a lot more Nito. If anyone can tell me how to tell the difference I would appreciate it.

There are no hard and fast ways to discriminate between stomach and heart pain (I'm an old cardiac nurse, FWIW), however here are some things to consider:

1. A 24-hour Holter monitor is the first test I would consider: reason being, you can make a diary and note when your pain is worse, and the doc can check your EKG and see if there is any sign of EKG ischemia during the painful episodes. It's not a sure thing, but it could be helpful if anything positive showed up on the EKg when you had pain.
2. IF you can bring on the same pain with physical activity, then that is a plus for it's being cardiac. For instance, if you can walk and have the same pain, then that's more likely to be your heart.
3. Heart pain often radiates to other places, such as the neck, jaw, or most commonly the left arm. Stomach pain MIGHT do this, but generally not as predictably.
4. Try a nitro and see if it gives relief. It MIGHT still give relief for stomach problems, however if you get QUICK relief (I mean within one-two mins), then this is more likely the heart. When nitro relieves stomach pains, it's usually relieving esophageal spasms, and the relief tends to occur more slowly.

Again, these are just my thoughts, and there are no hard and fast rules in this game. It can be a challenge, even for a cardiologist!

[macmember]

Originally posted by af
There are no hard and fast ways to discriminate between stomach and heart pain (I'm an old cardiac nurse, FWIW), however here are some things to consider:

1. A 24-hour Holter monitor is the first test I would consider: reason being, you can make a diary and note when your pain is worse, and the doc can check your EKG and see if there is any sign of EKG ischemia during the painful episodes. It's not a sure thing, but it could be helpful if anything positive showed up on the EKg when you had pain.
2. IF you can bring on the same pain with physical activity, then that is a plus for it's being cardiac. For instance, if you can walk and have the same pain, then that's more likely to be your heart.
3. Heart pain often radiates to other places, such as the neck, jaw, or most commonly the left arm. Stomach pain MIGHT do this, but generally not as predictably.
4. Try a nitro and see if it gives relief. It MIGHT still give relief for stomach problems, however if you get QUICK relief (I mean within one-two mins), then this is more likely the heart. When nitro relieves stomach pains, it's usually relieving esophageal spasms, and the relief tends to occur more slowly.

Again, these are just my thoughts, and there are no hard and fast rules in this game. It can be a challenge, even for a cardiologist!

1) I have a Left Bundle Branch Blockage and nothing shows up on the EKG, so that wouldn't work.

2) Physical Activity does not bring on my severe angina spells. Emotions (mental stress) or just NOTHING brings it on. I have been confirmed as having coronery artery spasms by the Interventionist. Physical activity wears me down and then I have chest pressure but not normally severe angina.

3) The pain does radiate to my collarbone, neck and jaw a lot of the time.

4) Sometime Nitro works right away and sometime it takes up to 6-7 during a 15-20 minutes period.

5) Would you say that if oxygen slows it down or relieves it in 15-20 minutes that it is the heart?

I do appreciate your input, even if you are not a Doctor, you are experienced.

[af]

Originally posted by macmember
1) I have a Left Bundle Branch Blockage and nothing shows up on the EKG, so that wouldn't work.

2) Physical Activity does not bring on my severe angina spells. Emotions (mental stress) or just NOTHING brings it on. I have been confirmed as having coronery artery spasms by the Interventionist. Physical activity wears me down and then I have chest pressure but not normally severe angina.

3) The pain does radiate to my collarbone, neck and jaw a lot of the time.

4) Sometime Nitro works right away and sometime it takes up to 6-7 during a 15-20 minutes period.

5) Would you say that if oxygen slows it down or relieves it in 15-20 minutes that it is the heart?

I do appreciate your input, even if you are not a Doctor, you are experienced.

Oxygen should not relieve stomach/esophagus pain. That's a vote for heart.

Bummer that you have a LBBB, that really screws everything on the EKG.

You have what is called "variant angina" or in older time "prinzmetal's angina". This is a hard nut to crack, as you know by now. Nitrates are THE most effective medication for controlling this kind of pain. Calcium blockers are also very noted for decreasing spasm problems on a preventative basis (but unfortunately not good for GERD, from what I read).

Are you on any anti-anxiety agent or anti-depressant? One of these might help both heart and stomach...just a thought...

If it was me, I would probably treat any pain as though it were my heart FIRST, and if that did not work, then would treat my stomach/esophagus. Since heart medicine (nitrates) can help esophagus spasms, heart treatment might help digestive tract pain anyway.

I understand your frustration. Just having vasospastic angina in and of itself is a horrible frustration!! In 20 years of cardiac nursing we never found a totally suitable treatment for this. Some of us have it, most of us don't. It's hard to know why some are selected as the unfortunate few who suffer with this problem.

[macmember]

Originally posted by af
Oxygen should not relieve stomach/esophagus pain. That's a vote for heart.

Bummer that you have a LBBB, that really screws everything on the EKG.

You have what is called "variant angina" or in older time "prinzmetal's angina". This is a hard nut to crack, as you know by now. Nitrates are THE most effective medication for controlling this kind of pain. Calcium blockers are also very noted for decreasing spasm problems on a preventative basis (but unfortunately not good for GERD, from what I read).

Are you on any anti-anxiety agent or anti-depressant? One of these might help both heart and stomach...just a thought...

If it was me, I would probably treat any pain as though it were my heart FIRST, and if that did not work, then would treat my stomach/esophagus. Since heart medicine (nitrates) can help esophagus spasms, heart treatment might help digestive tract pain anyway.

I understand your frustration. Just having vasospastic angina in and of itself is a horrible frustration!! In 20 years of cardiac nursing we never found a totally suitable treatment for this. Some of us have it, most of us don't. It's hard to know why some are selected as the unfortunate few who suffer with this problem.

Just FYI...I do take Zoloft and Calcium Channel Blockers already. Things could be a lot worse. It just bothers me when I don't know if the pain is my heart or not. It's a shame that I broke my fortune telling ball.
Thanks
Thanks

[af]

Originally posted by macmember
Just FYI...I do take Zoloft and Calcium Channel Blockers already. Things could be a lot worse. It just bothers me when I don't know if the pain is my heart or not. It's a shame that I broke my fortune telling ball.
Thanks
Thanks

Well, there are some things that we have to lay in the hands of God, maybe this is one of them. Sometimes we try to bear the burden ourselves, when in actuality we need to be turning them over to Him. If you believe in God, may this be the way that you find relief, since the earthly doctors don't seem to have a decent cure or treatment.

A preacher once told me that our biggest problem is that we have faith, but we don't use it. We end up bearing the load ourselves instead of dumping it at the feet of Jesus. May you find peace and help in using your faith, whatever faith that may be.

(Pardon my digression into non-medical things, but sometimes this is the better answer for us.)
Good luck and may you find peace and relief. ;)