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Thread: Does Laryngopharyngeal Reflux Ever Go Away???

  1. #1
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    Does Laryngopharyngeal Reflux Ever Go Away???

    Help! I'm miserable!!

    My throat closes up after food. Two trips in the ambulance led to a "Mystery Diagnoses Tour" to several specialists including a lung doctor (not asthma), a Gastrointestinal doc (who didn't see anything in a barium swallow), an ENT, a chiropractor, and finally a specialist who studies the larynx ("onolarynologist"?)

    After several weeks, I finally have an answer to what has been causing my throat to close up. It's my vocal chords. I have been diagnosed with an accute case of laryngopharyngeal reflux (LPR). It's basically acid reflux in the throat that causes my vocal chords to close the airway.

    I'm sure you all know how horrible this feels. I have extreme food sensitivity, I have to follow a strict diet. (The blander the better) I'm afraid to eat out and I have anxiety swallowing, etc...

    So,

    When will this go away? DOES it go away? Will I never be able to enjoy green curry with tofu again? I don't fully understand why, if I am taking the Prilosec as prescribed and faithfully following the non-offending diet, this is not getting better after 2 weeks?

    Please help,

    April

  2. #2
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    If this is really LPR, it may take higher than normal doses of meds..(problibly 40mg Prilosec 2x daily) and a longer period of time to see relief...(3-6 months). If the larnyx or pharnyx are damaged from the acid they take a long time to heal. You might also investigate Fundoplication surgery to see if you would be a good candidate.

  3. #3
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    Is there one med that is better than another?

    I'm taking two over-the-counter prilosec a day. Does prescription Prevacid work better? What about a "Prev pack"? My husband had that when he had acid reflux caused by a bacteria in his stomach.

  4. #4
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    My ENT feels that the best approach is an aggressive one. The OTC Prilosec isn't really strong enough, even double dosing. It also isn't exactly the same as prescription (the way in which the medication is released from the binder).

    Anyway, regarding your question... LPR can be episodic, but the initial damage takes time to heal and that healing can only come about with STRONG acid suppression, sad to say.

    The best approach that medicine has now is double dosing of a prescription PPI (like Prevacid, Nexium, Acifex, Prilosec) and an H2 inhibitor (Pepcid, Zantac or Axid) at bedtime (and not a wimpy dose of either). Average time to initial relief, about 6 months.

    Some people are able to cut back on their medications after awhile, more or less, depending... because LPR is episodic. However, the actual reasons and factors are not clearly known so what usually happens is that the symptoms return.

    Anyway, this just applies to LPR, not GERD. You'll likely achieve better results with prescription doses and time. There is life after LPR, within limits to a greater or lesser degree. It is very individual.

    By the way, in my case, the only way I tolerate the Nexium is by taking digestive enzymes with my meals... possibly to make up for the acid suppression.

    Good wishes.

  5. #5
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    Thanks NBrazil -a few questions...

    Thank you for your reply. I'm so happy to find other people who have been through this. LPR seems a bit rare compared to most people who get Gerd or just bad heartburn. I went straight to LPR (silent reflux) with no warning.

    I can't take Nexium until our deductible is met. (It's $168 dollars!) Right now, I take 2 Prilosec a day and 2 pepcid ac a day -One before bedtime.

    I am a bit concerned about taking all this stuff. I hear many people complain of constipation as a side effect of these meds long term. What is this digestive enzyme and where do you get it? I assume it helps your lower digestive track while you are taking acid prohibitors for the upper half.

    It's been about a month now. I am doing slightly better (no chocking episodes) but I still cannot eat anything spicy or with intense "flavor". I'm avoiding trigger food, alcohol, eating late at night, etc..

    Thanks for your reply.

  6. #6
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    Digestive enzymes can be found at most places that sell nutritional supplements. You might check out the posts by NYer, who reports using a digestive enzyme called AbsorbAid, which I am trying. Seems to help.
    Best to you

  7. #7
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    AJ -

    I replied in detail to your questions on another thread (the "cause" of LPR). Anyway, AstraZenica has a Purple Card program now that helps one to pay for Nexium, Basically, it lowers the out-of-pocket payment to either $25 or $50 depending on your insurance coverage/co-payment, it may be worth your while to investigate with the following caveat... they change these programs all the time, and so someday you may be in a situation where you can afford it now, but not then. This very nearly happened to me through changes in our insurance coverage. This is the cruel side of this condition in that treatment is expensive and the insurance companies do not distinguish Nexium usage. It is very hard to get that prescription for DOUBLE doses of expensive Nexium approved!!!

    You may look into trying Acifex or Prevacid instead - they may work for you. Or discuss with your ENT quadrupling the OTC dose (I believe it is half as effective - but don't quote me or try it on your own - ask your specialist). Regardless, what you are doing is the best you can with OTC medications (note, I do know that the bedtime Pepcid dose should be 40 mg).

    It is wise to be concerned about acid suppression - and the recommendations regarding digestive enzymes is appropriate. And, of course, there can be side effects from the PPI's themselves. It is unfortunate, but that's the way it is.

    Best wishes again.

  8. #8
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    My failing sphincter...

    The pharmacist told me that taking double amounts of OTC Prilosec was the same as Nexium. I've heard varying opinions on what medicine works better. I understand that there is one medicine that can improve the function of the sphincter -not just suppress acid. Anyone know what it is?

    It makes sense to treat the sphincter (preferably without surgery)Does the sphincter heal on its own? Or, is it a complete malfunction that is probably screwed up forever.

    I like this forum because I have not had much luck with my doctors! The best doctor I've had is a voice specialist from Emory. She diagnosed what was going on, but cannot prescribe meds. My gastro guy is lame. I need to find another one.

    Should I be seeking an ENT or a Gastro specialist?

    NBrazil, I notice that you are from Atlanta. Do you know of a Gastrointestinologist who specializes in LPR? You know, someone who treats not only the acid but the whole mechanism of the problem?

    Thanks so much.

    Also, I'm trying to get pregnant. I can't be taking all this crap if I get pregnant can I? I guess I won't worry about that until I actually get pregnant. But I dont want to screw anything up with major medicines.

  9. #9
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    AJ -

    No, I do not know of a GI doc that specializes in this because it is not really a GI issue, more an Otolaryngo issue, so an ENT is more appropriate... one that has a focus on voice problems.

    While there are others (I once volunteered for a clinical test of a diagnostic device for LPR at Crawford Long, but I can't remember the physician who was conducting it. He seemed VERY knowledgeable!), I can suggest my ENT who is unique in her understanding of LPR, she has it herself!!!!

    But I can tell you what the treatment will be, Nexium 40 mg twice a day and Axid (300 mg) at bedtime (or Ranitidine, 150 mg). She treats it aggressively.

    If you want to know her name and phone number, just ask. She spends a lot of time with her patients, answers all questions and is supportive. But, hey... that's all you can ask for, really, because there isn't much you can do for this condition otherwise.

    The good news is that it can be episodic and give you breaks... symptomatically waxing and waning. But in the end, there is no treating the mechanism (UES), only treating the symptoms. Medical science has nothing more to add.

    That much being said, I still believe that it is reversible, the key is finding the "cause," energetically in one's psyche. Yes, I'm a believer in dis-ease being just a final manifestation of distortions in our energy fields - but that doesn't fall under western science. In other words, you may choose to check out alternative treatments (like acupuncture) because, who knows?

    Anyway, let me know if you want my doctor's name, I sure she would be happy to see you.

  10. #10
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    What are Digestive Enzymes for?

    I heard my name mentioned! (Thanks, Joanne!)
    Here is an excerpt from a website about enzymes. (The full URL link is: [url]http://www.se1.us/health/enzymes/enzymes_faq.html[/url]).
    I copied the part that is specifically about digestive enzymes and it is a pretty good explanation of what they are and what they do:

    HOW DO DIGESTIVE ENZYMES WORK IN THE STOMACH?

    The stomach has two distinct divisions: Fundus (upper part) and Pylorus (lower part). The eaten food remains in the upper part for approximately one hour. This is where predigestion takes place. The fundus is where digestive food enzymes begin to break down the food into carbohydrates, fats and protein.

    Raw foods supply their own digestive enzymes, thus saving the stomach from supplying all the enzymes. Cooked foods, which have no enzymes, must wait in the fundus until the stomach supplies the enzymes. Predigestion by food enzymes occurs in every creature on earth. The only exception is the human being on an enzyme free diet.

    The upper section has no peristalsis (movement of food), acid, or pepsin and therefore, if enzymes are not provided in the diet, only minimal digestion can occur. The lower stomach (pylorus) performs the second step in digestion, but of protein only. In the lower part of the stomach, pepsin (a powerful digestive enzyme) and hydrochloric acid continue the digestive process.

    The predigested food now enters the small intestine. Here, the pancreas and small intestine cells secrete their enzymes to further break down the food into glucose (carbohydrates), fatty acids (fats) and amino acids (proteins) for absorption into the villi (absorption cells in the small intestine).

    The human stomach is really two stomachs with separate functions. Our stomachs have been provided with the means of permitting outside enzymes to help with the burdens of digesting food. Thus, we don't have to make all of our own digestive enzymes to digest our food. This will allow us to make more metabolic enzymes as needed and make us more healthy.

    When we eat raw foods the enzymes in the food are activated by heat and moisture in the mouth. Once active, these enzymes digest a significant portion of our food and make it small enough to pass through the villi (small projections found in the small intestines) and into the blood.

    Metabolic enzymes found in the blood then take the digested 45 known nutrients and build them into muscles, nerves, bones, blood, lungs, and various glands. Every cell in the body depends on certain enzymes. Each enzyme has a specific function in the body which is referred to as enzyme specificity.

    A protein digestive enzyme will not digest a fat and a fat enzyme will not digest starch. Enzymes act upon chemicals and change them into another chemical, but remain unchanged themselves. Simply stated our chemicals are changed from their original identity by the enzyme to another chemical with a different identity. Without enzymes nothing in our body would work.


    DOES OUR BODY PRODUCE LESS ENZYMES AS WE GET OLDER?

    Bartos and Groh (researchers) enlisted 10 young men and 10 old men and used a drug to stimulate the pancreatic juice flow. The juice was then pumped out and tested. It was found that considerably less of the enzyme amylase was present in the pancreatic juices of older men. It was determined that the enzyme deficiency of the older group was due to exhaustion of the cells of the pancreas.

    Other research indicates that not only are there fewer enzymes in the pancreas but also in the trillion cells in our body as we age. The pancreas must borrow these entities stored in the cells to make the enzyme complex. This could be a definition of "old age" because old age and debilitated metabolic enzyme activity are synonymous. If we postpone the debilitation of metabolic enzyme activity, then we might delay the aging process and possibly increase the life span to its genetic potential.

  11. #11
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    Hi April,
    I am responding to your post in the other thread becuase it's pertinent to this thread and I didn't want to go off-topic...
    I highly recommend AbsorbAid digestive enzymes. They're a little hard to find locally, but you can find them online without any problem. I like [url]www.vitacost.com[/url] because they're cheap.
    Here's a link to their site - specifically to the AbsorbAid:
    [url]http://www.vitacost.com/Natures-Sources-AbsorbAid[/url]

    Just for the heck of it, I tried something last week called "Digest Gold" and it didn't sit well with me - after a few hours of feeling kind of queezy, I took the AbsorbAid and was OK again. The Digest Gold is also a digestive enzyme and supposedly pretty potent. Who knows - anyway, I've had good results with the AbsorbAid, so you might want to give that a shot rather than trying some others that may not help. But since (like me) you sound like you want to get them in a hurry and get started on them, order them for next day delivery. It's more expensive, obviously, but you get it faster!

  12. #12
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    Of course its obscure ;)

    I was just looking at GNC for absoracid but no luck. Guess I'll have to order online.

    I was also thinking about getting some sort of pro-biotic. You now, all these prilosec pills and pepcid ACs are preventing acid (we hope) -which also kills off bacteria in our stomach. I thought about that side effect as I had a belly ache last night and this morning. That would suck if I got a bacterial infection on top of all this!

    Does Absorbacid also have beneficial "good bacteria" or do I need to get a pro-biotic for that? (like the good stuff that is found in yogurt but doctor says to stay away from dairy)

    Thanks,
    April

  13. #13
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    GNC doesn't carry that stuff. They mostly just carry their own brand. See above for where you can easily find it.
    No, AbsorbAid is not a probiotic nor does it contain any. But yes, you ought to take a probiotic, too.
    I like Natren's probiotic products ([url]www.natren.com[/url]). You can also find them in Whole Foods and a lot of Health Food stores.

  14. #14
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    April,
    Here's a link to stores in Atlanta that carry Nature's Sources products, so they probably carry AbsorbAid:
    [url]http://www.naturessources.com/State%20Retailers/retailers.asp?st=ga[/url]

    For anyone else here's the link to click on your state and find retailers:
    [url]http://www.naturessources.com/retailers_map.asp[/url]

    I see Vitamin Shoppe carries it, too, but I don't know if that's online only or in the stores, too.

    (Hey, I should write to them and ask for commissions, LOL!)

    Hope this helps.
    -NYer

  15. #15
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    Since you are in Atlanta, Whole Foods has its own brand of digestive enzymes, Wholezyme. This is fine, I use it - no need to go searching.

    They also have probiotics (I like Udo's) - but you can eat Kefir too, if you are into it.

    Finally, I got to thinking... the ENT I use isn't just a drug dispenser, as I said, she has LPR herself and is very interested in helping.

    Among other things she tracks your progress with a video stroboscopic examination of your throat. She also is willing to prescribe Baclofen, but that would be a last resort in my opinion (it is addictive in a manner similar to Benzodiazepines)

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