Posted 8/3/2014 12:20 AM (GMT 0)
I'd like to start with a brief but old story:
There's a guy who falls into a hole and can't get out. He sees a doctor walking by. He shouts to the doctor, "Hey, doc! Can you help me out?" The doctor writes a proscription and throws it down to him.
Soon, he sees a priest walking by, and he cries up, "Father, can you help me out." The priest says a prayer and keeps walking.
Finally, the man's friend walks by. He yells, "Hey, buddy! Can you help me get out of here?" But the friend jumps into the hole with him.
"What the hell did you do that for?" he asks. "Now we're both down here."
"That's true," his friend replies. "But I know the way out, and I'm going to help you."
I have for the last two years suffered from LPR, GERD, post-viral vagal neuropathy, vocal fold paresis, and candida overgrowth. My symptoms have been odynophonia (painful speaking and the worst symptom), burning tongue, heartburn, dysphagia, slightly dysphonia, morning sore throats, inflamed nostrils, and others. I have seen about 25-30 doctors at the personal cost of thousands of dollars. I am only 27.
I have had a mixed result of success. I'm not your friend in the sense that I've met any of you, and I don't "know the way out" per se, but I do hope that my stories and experiences and advice might be of some assistance.
Before I get started, here are other postings from me about my situation(s) from the previous two years.
https://www.healingwell.com/community/default.aspx?f=45&m=2811704
https://www.healingwell.com/community/default.aspx?f=45&m=2993613
https://www.healingwell.com/community/default.aspx?f=45&m=2945755&g=2961766#m2961766
https://www.healingwell.com/community/default.aspx?f=45&m=2946590&g=2961765#m2961765
https://www.healingwell.com/community/default.aspx?f=45&p=1&m=3039127#m3039140
Here is my blog article giving a more detailed description about my experience:
http://www.chrisandthemovies.com/2014/06/bigger-than-life-movie-that-speaks-to-me.html
So here we go. Below are some pieces of advice that might help you. I've tried to include some sources.
1. Diet matters
You've probably been told by a doctor to avoid coffee, chocolate, and fast food, but it's not quite that simple for LPR sufferers. The reason is that the damaging enzyme that flows back to the larynx (via acid reflux) is pepsin, and it is activated at anything lower than a ph of 7. Therefore, I recommend reading Koufman's famous study advocating a sort of "pepsin detox" featuring a fairly strict 2-week diet of bland foods (all vegetables except onions and tomatoes, no fruit except bananas and melons, and only chicken/organic turkey and salmon; 1 cup of coffee a day is permissible as well as only Chamomile tea).
http://koufmansrefluxteststrips.com/wp-content/uploads/2011/10/Koufman-LowAcid-Diet-paper1.pdf
An old-time remedy is water with baking soda. The bicarbonate raises the PH from a 7; the problem is that it's not much of a raise, and the sodium could give you problems. My recommendation is to purchase an alkalizing flask. But beware: Many argue that drinking alkaline water is tampering with your body's ability to break down food. I'm not sold on this, but just to be safe, I generally am much more judicious with it than I used to be, so now I might drink it upon rising and before bedtime.
2. Don't be too afraid of PPIs
But use with caution. Because LPR is so much more challenging to beat than GERD, ENTs seem to recommend 80 mg (not 40 mg) of PPI therapy for 4-6 months. But beware of two things: 1) If a GI tells you that LPR "doesn't exist," tell them that they're an idiot. 2) An endoscopy and Bravo Test are generally not accurate tests for diagnosing LPR. You MUST get videostroboscopy (where an ENT will slowly push a camera through your nose to get a view of your larynx), pharyngeal/esophageal manometry (which hurts like hell, but you need it), high-definition airway and esophageal ph monitoring (pretty uncomfortable, but it's the only way to get a more long-term reading of the ph of your throat), and if you're also suffering from odynophonia and possible PVVN, then you'll need a laryngeal neurodiagnostic reading.
One final warning--you really need to be under the supervision of a doctor when using PPIs. Don't let Larry the Cable Guy and his bad commercials fool you: These are not simple drugs. Many patients (myself included) have stopped taking them and then noticed a sudden rebound of acidity.
3. It might get worse before it gets better
When you drastically cut out low-ph foods, your esophagus sort of "returns to normal." That is, it might begin to feel normal sensations again, and your esophagus was so beat up that it got used to acid exposure. So if plain oatmeal is giving you "heartburn" while you're treating your reflux, it likely actually isn't.
4. You might need the surgery, but...
The "surgery," which could come in the form of Nissen, LINX, TIFF, etc., could be helpful, and there is some research that indicates that the surgery trumps PPIs. But keep in mind that it should be a last resort, that it comes with its own form of complications, and that in a Swoger et al study, only 10% of patients reported any laryngeal improvements after one-year post-op.
5. Try alternative methods
I think everyone would rather treat these conditions naturally as opposed to expensive medicine. My chiropractor believes that my bad posture and forward head position is contributing to my odynophonia and my reflux. So he believes diaphragmatic breathing exercises can help. Here's an article about a study using such methods:
"While some lifestyle modifications such as losing weight or sleeping with your head slightly elevated have been shown to help, most heartburn sufferers have to rely on medications, usually proton pump inhibitors (PPIs) or even undergo surgery. However, long-term intake of PPIs has been raising concerns as of late, and any form of surgery is a risky endeavor.
Given this, Austrian researchers questioned if a different type of lifestyle modification — strengthening the diaphragm — could help ease GERD symptoms. See, for many GERD patients, the reason for the disease lies in a physiological inability to close the muscle at the end of the esophagus, which works in synergy with the diaphragm. By strengthening the diaphragm, they reasoned you could improve GERD symptoms.
Researchers divided 19 adults with non-erosive GERD into two groups. One group was taught how to do specific abdominal breathing exercises that involved contraction of the diaphragm. They were asked to do the exercises for 30 minutes daily for four weeks. The second group did not do the breathing exercises.
Both groups were allowed to continue use of current GERD medications, including PPIs, but not antacids.
Researchers measured for pH in the esophagus, pressure in the esophagus, and quality of life, using two different scales: the GERD Health-Related Quality of Life Scale and the Gastrointestinal Quality of Life Index.
At the end of the four weeks, researchers found no difference in terms of pressure in the esophagus, use of PPIs, or scores in the Gastrointestinal Quality of Life Index, which tends to focus on the emotional and psychosocial issues of GERD.
However, when it came to pH, researchers found a significant decrease in acid exposure in the breathing group versus the control group. The breathing group also had significant improvement in their scores in the GERD Health-Related Quality of Life Scale, which tends to focus specifically on heartburn symptoms.
Researchers then took the study one step further and offered long-term follow-up to all 19 participants at the end of the study period. They taught the breathing techniques to the control group and asked all participants to practice 30 minutes a day for at least nine months.
At the end of the nine months, they found that 11 of the 19 patients had continued to do the exercises (six from the initial breathing group and five from the control group). Those that continued enjoyed significant and pronounced decrease in their acid reflux symptoms as compared to those who did not continue the exercises. Additionally, those who did the training had a significant decrease is their dependence on PPIs.
Researchers concluded, 'Our work shown that a breathing exercise can improve GERD as assessed by [quality of life] score, pH-metry, and PPI usage. With increasing prevalence of GERD, a non-pharmacological intervention like breathing exercise could have an important role in reducing the disease burden of GERD.'"
http://www.peakhealthadvocate.com/2434/breathing-exercises-for-acid-reflux-relief/
Additionally, walking can help with digestion (as can chewing gum). From an article in the New York Times:
"Over the years, researchers have found that a post-meal walk, as short as 15 minutes, can in fact help with digestion and improve blood sugar levels. In one study in 2008, German researchers looked at what happened when people ate a large meal and then consumed either an espresso or an alcoholic digestif — like brandy or flavored liqueur — or walked at a slow pace on a treadmill. Walking, they found, sped the rate at which food moved through the stomach. The beverages had no effect."
http://well.blogs.nytimes.com/2013/06/24/really-the-claim-taking-a-walk-after-a-meal-aids-digestion/?_php=true&_type=blogs&_r=0
Here's an article on posture, hiatal hernias and reflux:
http://erikdalton.com/hiatal-hernia-acid-reflux-gerd/
Finally, about the gum chewing, there's a bit of controversy about which kind is the best. Some say to choose sugar-free, others say that those contain dangerous chemicals like aspartame (which is another medical controversy in of itself). Xyltiol-flavored gum tastes good and supposedly helps prevent cavities (I doubt it), but my personal favorite is an Arabic gum called Lami gum. It's pretty flavorless and borderline gross, but seems to be the safest. I have traditional Chinese lozenges from Taiwan that I use, but I haven't been able to find any in the States.
6. But beware of alternative medicine
There simply is no research out there that supports the idea that Apple Cider Vinegar and/or digestive enzymes are helpful for reflux sufferers. Look, if a doctor recommends it, try it, and if they work, then continue using them. But for me, using them were a severe step in the wrong direction.
http://www.dietsinreview.com/diet_column/06/common-myths-about-acid-reflux/
7. Try to remain hopeful.
As a teacher, I'm constantly concerned about permanently damaging and/or losing my voice. But I still retain a mixture of McCartney's optimism ("It's getting better all the time") and Lennon's pessimism ("It couldn't get any worse"). Here's an article that keeps me optimistic:
"There are artificial limbs to help people walk and artificial hearts to keep people alive, and soon, a groundbreaking new technology could let some of the world's greatest singers sing again. The concept of artificial vocal cords is something that goes back many years, according to Steven Zeitels, one of the most renowned vocal surgeons in the world and one of the leading researchers on the project. He has previously performed what many consider career-saving procedures on the likes of Adele, Steven Tyler, Roger Daltrey, Cher, Lionel Ritchie and Julie Andrews. Now Zeitels is working with MIT professor Robert Langer and his team of scientists to create artificial vocal cords, which would not only benefit singers, but also cancer patients and those who have lost their voices to aging or disease."
http://www.huffingtonpost.com/2012/08/23/artificial-vocal-cords-singers-cancer-patients_n_1825513.html
Please let me know if you have any questions.