Coughing Caused by ... Acid Reflux!

[CRLLS]

Quote:

Originally Posted by splitwdw This is like the kid's game "whisper down the lane" or "telephone". The OP went from having "coughing/throat clearing when I lie down to sleep" to almost everyone (except Bestwifeever, Meadbh and WR2) diagnosing him with gerds. The OP could have mild allergies or postnasal drip and not even know it. You can develop allergies as you age even if you didn't have them when you were younger. Unless postnasal drip is severe you won't feel "dripping". OP, stop experimenting and go to your doctor. You said in your first post that you have had this problem for years and you mentioned this problem to your doctor. It sounds like you haven't gone to the doctor for this specific problem. Though you said in a later post that your doctor thought you (your experiments??) were on the right track. You shouldn't be annoyed with your doctor because even if you have LPR, it states in the very beginning of those 2 links that you posted in your first post, that it's hard to diagnose and you haven't been going to your doctor for this problem. Maybe stop reading Dr. Google and make an appointment with your doctor.

All good advice, but what to do when the dr's say "I don't know what the problem is" ? DW has been having coughing for over years now. It started out coming on at various times of the year and working into needing antibiotics. Then later grew to occurring most of the year. Mostly an unproductive, dry cough during the day and when she 1st lies down for bed for a few minutes. Over the years, she's been to her GP(s), Gastro specialists, pulmonologists, ENT specialists. Nobody has been able to get it under control. Things seem to get under control for a few weeks, then it comes back. She can't even laugh without bringing on a coughing spell. She takes mints when we go out to movies or other public places to try to control the cough urge. She has been diagnosed with a Hiatal Hernia by the ENT guy but not recommended for surgery. We have found no magic control medicine yet. She is aware of, and concerned about the long term effects of PPI's, (and other long term medication use). Last time, the Pulmonologist suggested another upper throat MRI (I think that was the test) with the intent of checking the Hiatal hernia again. That's when our insurance situation changed. (4 changes in insurance coverage and new deductibles over the last 2 months and into early next year). She is holding off the tests until February when Medicare kicks in.

So I told her about the daily apple cider vinegar routine the other day. We found the non-pasteurized stuff "with Mother" and are trying a couple of teaspoons in the AM. After about 4 days, it seems to be reducing (nearly eliminating) her cough. Maybe that is a Placebo. We will have to see with time. BTW, This thread reminded me of my childhood when my Mom gave me honey and vinegar in water to sooth a cough. What goes around, comes around, I guess.

Most Dr's are great and nobody should treat themselves IMO, but with today's knowledge base (google etc.), self investigation is warranted. "Trust, but verify" is a good policy to follow IMO.

[travelover]

Quote:

Originally Posted by splitwdw .......... The OP went from having "coughing/throat clearing when I lie down to sleep" to almost everyone (except Bestwifeever, Meadbh and WR2) diagnosing him with gerds. The OP could have mild allergies or postnasal drip and not even know it. ......

I suggested this in post #6

[NW-Bound]

Quote:

Originally Posted by CRLLS All good advice, but what to do when the dr's say "I don't know what the problem is" ? DW has been having coughing for over years now. It started out coming on at various times of the year and working into needing antibiotics. Then later grew to occurring most of the year. Mostly an unproductive, dry cough during the day and when she 1st lies down for bed for a few minutes. Over the years, she's been to her GP(s), Gastro specialists, pulmonologists, ENT specialists. Nobody has been able to get it under control... Most Dr's are great and nobody should treat themselves IMO, but with today's knowledge base (google etc.), self investigation is warranted. "Trust, but verify" is a good policy to follow IMO.

Doctors are experts, not God. The human body is very complex, and a patient needs to be informed to talk intelligently with his doctors, and to give them feedback during the course of treatment.

Doctors are expected to treat all kinds of ailments, but they might not have seen a case like yours among his past patients. They do not suffer from your maladies to know what it is like. They are, well, humans.

[NYEXPAT]

For many years I had acid reflux and the doctors ran all kinds of tests and finally said I was missing the valve at the top of my esophagus. Years later I moved to Peru and never experienced it again.

[Meadbh]

Quote:

Originally Posted by NYEXPAT For many years I had acid reflux and the doctors ran all kinds of tests and finally said I was missing the valve at the top of my esophagus. Years later I moved to Peru and never experienced it again.

I'll bet you are eating better in Peru!

[TromboneAl]

My experimentation will provide information that I can share with my doctor when I see her.

At this point, the problem is much better, which I attribute mostly to cutting way back on alcohol and coffee (even morning coffee). Now, when I lie down I only have to go through about ten minutes of clearing my throat gently and trying not to cough (I think coughing makes it worse, sending more acid up from the stomach).

It seems that what I eat for dinner makes little difference. I expected problems from the tomato sauce on spaghetti squash, but it was no worse.

BTW, here's my mychart-email conversation with my doctor:

SUBJECT: Coughing, Throat Clearing due to Acid Reflux?

Hi, Dr. V,

My frequent coughing and throat clearing has continued. After some more research, I'm wondering whether it's due to acid reflux (for example, Laryngopharyngeal Reflux (Silent Reflux): Causes, Treatment, Diet, and More ).

It's clearly worst when I lie down in bed or after I eat a meal with a lot of coffee. I never have any heartburn or indigestion.

To investigate, I took omeprazole for two weeks and avoided all alcohol, coffee, chocolate, and other triggers. It got better (but didn't go away). However, I'd rather cough a bit than give up those things.

Do you think that's what's causing the coughing?

I'm treating it by drinking less coffee (and often chamomile tea instead), eating dinner earlier, chewing non-mint gum, and avoiding some of the triggers. I'm experimenting with baking soda.

Do you have any other suggestions?

Thanks,

Al

---------------

Her response:

GERD can certainly cause chronic cough (other causes of a cough lasting longer than 4-6 weeks includes asthma and allergies) . You are doing all of the right things.

Sometimes it's hard to know for sure without endoscopy/evidence of esophagitis (or laryngitis on laryngoscopy), but a trial of a proton-pump inhibitor like you tried (especially if it helped) is reasonale.
Staying upright after meals and dietary changes, like avoiding citrus/spicy/caffeinated/minty foods can help, as you are doing.

I'd be happy to listen to your lungs in an appt if it continues to bother you. There could also be respiratory causes, and a chest xray would not be unreasonable if it persisted for months.

[Meadbh]

Is Dr. V. Getting paid for email consultations? I hope so. Because we are not.

My bill will be $400.

[braumeister]

Quote:

Originally Posted by TromboneAl avoided all alcohol, coffee, chocolate

If I ever get to that point, just shoot me!

[Silver]

Have you ever had an EGD (Esophagogastroduodenoscopy)? It's an endoscope of your upper GI.


Hiatal Hernia's can cause all of the symptoms you are describing.


I put $20 bucks on that......keep us posted.

[TromboneAl]

Quote:

Originally Posted by braumeister If I ever get to that point, just shoot me!

Tell me about it.

Sent from my Nexus 7 using Early Retirement Forum mobile app

[NW-Bound]

Quote:

Originally Posted by Meadbh Is Dr. V. Getting paid for email consultations? I hope so. Because we are not. My bill will be $400.

$400 for answering an email? That's more than 4x what my US doctor gets for seeing me in an office visit, and he still has to share it with his nurses, and his clerical staff.

I thought having doctors answering emails at a reduced fee would be a good way to lower the cost of healthcare.

[Meadbh]

Quote:

Originally Posted by NW-Bound $400 for answering an email? That's more than 4x what my US doctor gets for seeing me in an office visit, and he still has to share it with his nurses, and his clerical staff. I thought having doctors answering emails at a reduced fee would be a good way to lower the cost of healthcare.

You do understand that I am being somewhat sarcastic. ??

My point is that the doctor's work has value. It's not the writing of the email that you are paying for; it's the years of training and experience. Just like any other professional.

I looked up the tariff billable for emails in a Canadian province where I worked for many years. A tariff of $15.65 (Canadian) can be billed when another healthcare professional solicits a professional opinion from a physician. Woo hoo!

If a patient asks an opinion by email, the physician cannot collect any fee. Obviously a physician would be well advised to avoid taking on the risk of getting sued over an email opinion if he/she is not getting paid for it. Furthermore, responding to the patient's email takes time (which may include researching the best answer to the question), which delays the physician from doing other, billable work. It makes perfect sense that Dr. V. asked Al to make an appointment to see her.

He should visit soon, before he goes to Sweden and eats meatballs.

[NW-Bound]

Quote:

Originally Posted by Meadbh If a patient asks an opinion by email, the physician cannot collect any fee. Obviously a physician would be well advised to avoid taking on the risk of getting sued over an email opinion if he/she is not getting paid for it. Furthermore, responding to the patient's email takes time (which may include researching the best answer to the question), which delays the physician from doing other, billable work. It makes perfect sense that Dr. V. asked Al to make an appointment to see her.

I totally agree. I never work for free, and so do not expect my doctor to.

It's the $400 number you quoted for an email that scared me. I thought, gah, if Canadian doctors charge so much, how they can claim that their healthcare system is less expensive.

Quote:

He should visit soon, before he goes to Sweden and eats meatballs.

Or T-Al can stay here and buy Swedish meatballs at IKEA, like I do.

[TromboneAl]

Lena makes great meatballs, the recipe was passed down from her dad, who used moose meat.

Communicating with my doctor via email (actually through the MyChart system) has been amazing. I'm not sure how the payment works, but she's very good about responding.

When I need advice on "Should I come in to see you?" I don't just get the standard, CYA response of "Yes."

Once I went in to see her and asked about increasing the dosage for my medication, and she said, "You know, you could have done that via email. You didn't have to come in."

Maybe I'm so weird that she'd prefer email.

[TromboneAl]

Lena's Meatballs:

Swedish Meatballs


.3 cup carbquick (or .3 cup breadcrumbs)
.75 cup heavy whipping cream (HWC)
2 lbs ground beef (or ground moose meat if in Sweden)
.5 medium onion chopped very very finely
1 tsp salt
.25 tsp ground white pepper
1 egg
Butter (see below)




Mix carbquik (or breadcrumbs) with about .5 cup of HWC until it’s the consistency of thick pancake batter.




Mix this with remaining ingredients (except butter). Form 1 inch meatballs.




1. Put 2 TBS butter in cast iron skillet
2. Brown 10 meatballs at a time in very hot cast iron skillet (well-browned)
3. Lower heat
4. Scrape pan drippings into saucepan, put meatballs in saucepan




Add half cup of heavy whipping cream to saucepan.
Simmer saucepan on low heat
Repeat steps 1-3 until all meatballs are in the saucepan.

[NW-Bound]

I have never made Swedish meatballs myself, so will have to try the above recipe.

To tie into the thread topic, I have to ask if eating Swedish meatballs help or hurt the acid reflux problem. The ingredient list looks innocuous. I wonder about the onion content. I eat tons of onion, like French onion soup, but everybody is different.

[MRG]

Wish I could find some Moose. You can buy deer, elk, bison, yak..... I cannot find Moose. It's the best red meat ever! Yum.

[Meadbh]

Thanks for the recipe, Al! Around here I can probably find moose meat more easily than carbquick. (I had to look that up).

Here is another Swedish meatball recipe with amusing demonstration (temperature in degrees C):

https://youtu.be/GXhfcAJdLC4

[RAE]

Quote:

Originally Posted by CRLLS All good advice, but what to do when the dr's say "I don't know what the problem is" ? Most Dr's are great and nobody should treat themselves IMO, but with today's knowledge base (google etc.), self investigation is warranted.

Totally agree with this. This is getting off-topic, but I went to a couple different doctors with some troubling symptoms I was having this past spring. Had a bunch of blood tests, and both docs said based on the results, everything looked "normal". Neither doctor had any idea what was causing my symptoms, so I really got no help there. With blood test results in hand, I went online and started looking around, and eventually found that my iron panel results were actually quite high (right at the top of the reference range for transferrin saturation and ferritin). The numbers did not raise any red flags with either doctor, but they were still much higher than what is considered optimum. So I began to suspect that the excess iron in my blood and system (iron overload) was a major cause of the symptoms. If you have excess iron, the only efficient way to get rid of it is to donate blood. So I did that, and about 80% of the symptoms disappeared right away. After the second blood donation two months later, the symptoms are now completely gone. I just got the results from the latest iron panel blood test, and both the transferrin and ferritin have come down a lot (still above optimum, but much lower than before). I guess someone could argue that donating blood and the disappearance of symptoms were not related, but all I know is that I feel much better now. This does not mean that I have no faith in doctors anymore, but I am also a believer in self-investigation when the situation warrants it.

[audreyh1]

Quote:

Originally Posted by RAE Totally agree with this. This is getting off-topic, but I went to a couple different doctors with some troubling symptoms I was having this past spring. Had a bunch of blood tests, and both docs said based on the results, everything looked "normal". Neither doctor had any idea what was causing my symptoms, so I really got no help there. With blood test results in hand, I went online and started looking around, and eventually found that my iron panel results were actually quite high (right at the top of the reference range for transferrin saturation and ferritin). The numbers did not raise any red flags with either doctor, but they were still much higher than what is considered optimum. So I began to suspect that the excess iron in my blood and system (iron overload) was a major cause of the symptoms. If you have excess iron, the only efficient way to get rid of it is to donate blood. So I did that, and about 80% of the symptoms disappeared right away. After the second blood donation two months later, the symptoms are now completely gone. I just got the results from the latest iron panel blood test, and both the transferrin and ferritin have come down a lot (still above optimum, but much lower than before). I guess someone could argue that donating blood and the disappearance of symptoms were not related, but all I know is that I feel much better now. This does not mean that I have no faith in doctors anymore, but I am also a believer in self-investigation when the situation warrants it.

Fascinating!