Help w/Dr. visit: Acid Reflux and Sinusitis (LONG)

[Amethyst]

This is great advice, thanks! Yes, you only get a small piece of the Dr's attention each time (although the concierge idea is intriguing).

The examining room walls are thin, and I've had my Dr. walk in to my appointment after I (unavoidably) heard her counseling someone who was crying and upset (thank goodness, I could not hear exactly what was said). At that time, I was bursting with health and almost felt ashamed to be there!

Email or patient portal is fine. but DH has been doctoring this winter with a problem that flared up 5 years age and has resurfaced, most likely it's leading to an heart valve replacement.

So in the past 5-6 weeks we seen 2 cardiologists and a heart surgeon and IMO they don't really concentrate on you and your problems until you are actually sitting in front of them.

I'd take your list and condense it to the things you feel are most important, I'd write it up in a calendar type chart, where any progression of your symptoms is easy to see. Have it with you at the appointment of course. Use a few less details, if the doctor thinks something you mention is particularity important they will ask for more details.

You might have sinusitis and digestive problems too. Think about what you want to do if this doctors offers you drugs and wants to "see what happens" do you want to politely press for a referral ASAP. Emphasize that you have been doing most of the recommended easy fixes for reflux and yet things are getting worse instead of better.

That's my advice for what it's worth.

 

[PawPrint53]

I had bad acid reflux and spent years on PPIs. Lost 100 pounds, tried all the conventional things like elevating the head of my bed, etc. Went to a functional medicine doctor who suggested getting off gluten. Since that was the fad du jour, I scoffed, but did it. Haven't had any acid reflux since. I can occasionally eat gluten with no problem, but not, for example, two days in a row.

 

[Amethyst]

Let's see...not supposed to eat any carbohydrates...no gluten...but also, I have read, fatty foods are bad for heartburn...I don't like those anyway....no chocolate, alcohol, caffeine, citrus fruits...dairy is suspect....what's left? Meat and berries? I don't have any spare weight to lose!

 

[redduck]

I tend to do what Meadbh has suggested. It usually gets a good response from the MD. I always bring two hard copies to the doc's office so the doc and I can more easily go over the list. Additionally, I ask the doc (or his assistant, if that's whom I see first) to go over all the meds that I've listed to make sure all that info is up-to-date.

 

[Ian S]

Thanks for the personal experience, dietary advice, etc. but I'm really interested in how to present my case to the Dr. so it will all be taken into account (not just "I've had really lousy heartburn for a week").

I am not a big consumer of refined carbohydrates.

Getting the info to the Dr. in advance sounds like a good idea. I will ask the Dr.'s assistant if she has an email I could use. The practice has a "patient portal" but it's only for paying bills!

I'm limited to Preferred Providers under my insurance. OldShooter - what is the annual fee for the concierge, if you don't mind saying?

Since your problem is mainly at night, you might try eating your evening meal as early as possible (at least a few hours before you hit the hay.) After your evening meal don't eat or drink anything else except water until you get up in the morning. I was told that age can cause weakening of the sphincter that keeps stomach acid from getting into the esophagus. That's exacerbated by lying prone for hours. I'm not sure anything you say to your doctor will keep him from prescribing a PPI. I would not worry about going on one for a short period and so it might be worth a try to see if it helps. BTW, a prescription for generic PPI will almost certainly be cheaper than the weaker OTC versions.

 

[Meadbh]

.....or you could take a couple of Tums before going to bed.

 

[Want2rv]

Amethyst, Your struggle with sinusitis and seasonal allergies is similar to mine. I feel your pain and discouragement. After almost 4 years of flonase, allergy meds and sinus rinses with antibiotic treatments, I finally got referred to an ENT. Since I didn't have a sinus infection at that time but had the stuff stuck in my throat with the cough trying to get it out of my throat, I was sent for tests. One test was a contrast xray procedure of the esophagus to see if it could be silent acid reflux causing my problem as well as a ct of my face/sinus nose areas.
In the meantime, I was told to not have caffeine, alcohol, carbonated beverages, chocolate, citrus fruits or juices, garlic, onions, tomatoes, fried or spicy foods. Since I didn't want to take meds, I bought a book by Karen Frazier titled The Acid Reflux Escape Plan. If you have acid reflux, I would encourage you to read it. I changed my diet but I didn't feel much relief. The tests showed that I didn't have acid reflux but I do have enlarged turbinates and a crooked septum but not deviated. My sinus cavity was clear. I went back to the ENT to discuss possible surgery. My situation is that the surgery may or may not solve my problem. However the ENT wanted me to try going dairy free for 30 days to see if I have a dairy allergy that could be causing my issue. The doctor said dairy could cause my symptoms. Apparently it takes at least 21 days to clear dairy from your system. I am on week 1 of no dairy while still following the acid reflux diet.
I will post to let you know if going dairy free helps.
I wish you the best in figuring out your problem and hope you can solve it with changing your diet.

 

[Amethyst]

Thank you for your candid, caring post. Best wishes for your efforts to get better.

Amethyst, Your struggle with sinusitis and seasonal allergies is similar to mine. I feel your pain and discouragement. After almost 4 years of flonase, allergy meds and sinus rinses with antibiotic treatments, I finally got referred to an ENT. Since I didn't have a sinus infection at that time but had the stuff stuck in my throat with the cough trying to get it out of my throat, I was sent for tests. One test was a contrast xray procedure of the esophagus to see if it could be silent acid reflux causing my problem as well as a ct of my face/sinus nose areas.
In the meantime, I was told to not have caffeine, alcohol, carbonated beverages, chocolate, citrus fruits or juices, garlic, onions, tomatoes, fried or spicy foods. Since I didn't want to take meds, I bought a book by Karen Frazier titled The Acid Reflux Escape Plan. If you have acid reflux, I would encourage you to read it. I changed my diet but I didn't feel much relief. The tests showed that I didn't have acid reflux but I do have enlarged turbinates and a crooked septum but not deviated. My sinus cavity was clear. I went back to the ENT to discuss possible surgery. My situation is that the surgery may or may not solve my problem. However the ENT wanted me to try going dairy free for 30 days to see if I have a dairy allergy that could be causing my issue. The doctor said dairy could cause my symptoms. Apparently it takes at least 21 days to clear dairy from your system. I am on week 1 of no dairy while still following the acid reflux diet.
I will post to let you know if going dairy free helps.
I wish you the best in figuring out your problem and hope you can solve it with changing your diet.

 

[John Galt III]

Hello Amethyst, It's too bad we have to pay for a doctor and then do his/her job for him too, right? Ha Ha. I had a bad dry cough for years, and some minor burning in throat sometimes. Ignored it for years, then went to ENT who prescribed Prevacid (PPI). Worked like a charm. Stopped taking it after 1 month, and cough stayed away for a year. Cough came back. I'm now taking the lowest dose PPI I can find (15 mg ?) of generic Lansoprazole , which is only $14 for 42 on sale, over the counter. And get this, I only take it every other day. Working great so far. Changing my diet didn't help. I plan on taking the Lanso pills forever and hoping I don't have the side effects they talk about !!! At least I don't have the acid reflux cough any more. Good luck with the doctor visit(s).

 

[Mr._Graybeard]

I'm not sure anything you say to your doctor will keep him from prescribing a PPI. I would not worry about going on one for a short period and so it might be worth a try to see if it helps. BTW, a prescription for generic PPI will almost certainly be cheaper than the weaker OTC versions.

When I was having a reflux flareup, my PCP told me to take a PPI in the morning and an H2 blocker at night for a month -- for the H2 blocker I chose Ranitidine (generic Zantac). That knocked the symptoms down in a hurry. I stopped the dosage after two weeks because I felt better.

 

[Amethyst]

I hope the symptoms never come back!

When I was having a reflux flareup, my PCP told me to take a PPI in the morning and an H2 blocker at night for a month -- for the H2 blocker I chose Ranitidine (generic Zantac). That knocked the symptoms down in a hurry. I stopped the dosage after two weeks because I felt better.

 

[Amethyst]

Thanks...I hate taking meds even more than I dislike going to the Dr. I have yet to take anything that didn't have some noticeable side effect. Hope your symptoms stay away for good.

May I ask, did your Dr. do any tests before prescribing? Or just "Oh, you have reflux, here's an Rx"?

Hello Amethyst, It's too bad we have to pay for a doctor and then do his/her job for him too, right? Ha Ha. I had a bad dry cough for years, and some minor burning in throat sometimes. Ignored it for years, then went to ENT who prescribed Prevacid (PPI). Worked like a charm. Stopped taking it after 1 month, and cough stayed away for a year. Cough came back. I'm now taking the lowest dose PPI I can find (15 mg ?) of generic Lansoprazole , which is only $14 for 42 on sale, over the counter. And get this, I only take it every other day. Working great so far. Changing my diet didn't help. I plan on taking the Lanso pills forever and hoping I don't have the side effects they talk about !!! At least I don't have the acid reflux cough any more. Good luck with the doctor visit(s).

 

[Amethyst]

I do find it puzzling that some people say reflux is due to too much acid, so take PPI's; while others say it's because stomach acid becomes less effective with age, so supplement it with vinegar. How would you know which is which?

 

[Meadbh]

Thanks...I hate taking meds even more than I dislike going to the Dr. I have yet to take anything that didn't have some noticeable side effect. Hope your symptoms stay away for good.

May I ask, did your Dr. do any tests before prescribing? Or just "Oh, you have reflux, here's an Rx"?

Speaking of tests, if your doctor proposes doing a barium or gastrografin swallow, (they take video), be aware that it’s a very inaccurate test. A good history is more accurate.

 

[Mr._Graybeard]

I hope the symptoms never come back!

Unfortunately, it's a condition that doesn't just go away. And it runs in my family -- my mother had it, my sister has it. It's pretty common among older adults, as you can tell by this thread -- that's why I suggested that a physician shouldn't have any trouble diagnosing it.

I've found that apples can have a buffering effect in the stomach, BTW.

 

[Mr._Graybeard]

I do find it puzzling that some people say reflux is due to too much acid, so take PPI's; while others say it's because stomach acid becomes less effective with age, so supplement it with vinegar. How would you know which is which?

It's not from an excess of acid -- it's the sphincter that keeps the acid out of the upper tract that weakens. Doctors will tell you that some popular beverages also cause that sphincter to relax, increasing the potential for reflux.

People who take apple cider vinegar use the raw, unfiltered stuff, which has probiotic qualities. Theories have emerged that an imbalance in the gut bacteria can create reflux, so probiotics in the form of cider vinegar, yogurt (if not lactose intolerant) and probiotic capsules are recommended.

I've heard some doctors on medical call-in shows (anyone listen to "The Peoples Pharmacy?") say that intestinal gas can back up into the stomach and produce reflux.

 

[Amethyst]

A sphincter is muscles, right? I bet there's a way to strengthen it. Probably more of a mindfulness/relaxation type of activity than what we'd call an exercise, since it's inside the abdominal walls.

It's not from an excess of acid -- it's the sphincter that keeps the acid out of the upper tract that weakens. D

 

[Meadbh]

A sphincter is muscles, right? I bet there's a way to strengthen it. Probably more of a mindfulness/relaxation type of activity than what we'd call an exercise, since it's inside the abdominal walls.

Your oesophageal sphincter keeps food in your stomach. It is made of smooth muscle, which is not under voluntary control. So mindfulness won’t work.

https://medlineplus.gov/ency/imagepages/19841.htm

 

[Lsbcal]

• I've had seasonal allergies/sinusitis for ~30 years and use Flonase to stave it off. Two years ago I had an allergy test series (the kind where they stick little needles in your arms). I only react to pollen.

• Late last December, trees were bare, grass was dead, snow on the ground; no pollen. I developed sinusitis, then bronchitis, so bad I could hardly breathe, and ended up in Urgent Care where they took a chest X-ray (showed nothing serious) and gave me antibiotics.

• I now have sinusitis, in mid February. The trees and grasses won't start blooming for another couple of weeks.
• Between bouts of sinusitis, I seem to be always having to clear my throat.

...

I don't know about acid reflux but I do have my own experiences with pollen. It can be highly variable. Some years con be worse then others.

Could you be allergic to tree pollen and perhaps some grasses? In our region trees can pollinate in cold weather. My worst symptoms occur in January and February. Juniper and Cypress may be the cause in my case but it is hard to pin down the exact causes. It is probably also regionally dependent. Once I was in Yosemite Valley in the winter. Terrible pollen from Cypress I think. You could even see the pollen on the car windshield and the snow.

We went to the coast a few weeks ago and the wind flowing over the hills seemed to kick up the grass pollen (my guess anyway).

In addition to the Fluticisone (similar to Flonase) I go in for allergy shots. These have helped a lot over the years. But I don't think anyone I've mentioned this to who has allergies has decided to do this. However there are plenty of people in the waiting room so it is a popular solution. Medicare will help out a lot on this cost. You have to get up to a maintenance dose and then come in maybe once per month thereafter.

 

[Ian S]

A sphincter is muscles, right? I bet there's a way to strengthen it. Probably more of a mindfulness/relaxation type of activity than what we'd call an exercise, since it's inside the abdominal walls.

The problem is that it's not under your control so it would be hard to use your mind to strengthen it. A severe deficiency in the sphincter can be remedied surgically e.g. lapraoscopic fundoplication. There are other less invasive procedures that can have mixed results. The most intriguing to me is https://www.stretta-therapy.com/ and I have at times considered it but there is no one local that does it. I would have to go to San Diego or the L.A. area.

 

[omni550]

There are other less invasive procedures that can have mixed results. The most intriguing to me is https://www.stretta-therapy.com/ and I have at times considered it but there is no one local that does it. I would have to go to San Diego or the L.A. area.

My then-BF (in his 30s/40s at the time) had terrible eating habits and terrible gastric reflux. He was taking Prilosec (available as an Rx at that time) at an alarming rate. I was concerned about his developing Barrett's esophagus or cancer. His doc had him coming in 2x a year for scoping of the esophagus, etc.

In my research, I ran across the Stretta procedure. Then-BF found a local doctor who was trained in Stretta and he had the procedure done at Univ. of Michigan hospital. Sadly, it did zip, zero, nada to alleviate his issues.

Last I knew, then-BF was still consuming Prilosec at an alarming rate.

omni

 

[John Galt III]

Thanks...I hate taking meds even more than I dislike going to the Dr. I have yet to take anything that didn't have some noticeable side effect. Hope your symptoms stay away for good.

May I ask, did your Dr. do any tests before prescribing? Or just "Oh, you have reflux, here's an Rx"?

Yes, He looked through a scope which went up into my sinuses, through a nostril, and (possibly) all the way down to the larynx. Felt strange but not painful. No tube down the throat. BTW, he said my cough was caused by stomach acid actually getting up the esophagus, then into the trachea and causing lots of phlegm to be created to carry out the acid.

 

[Winemaker]

I'm not sure if this will help, but where is your location, and what kind of heating system do you have?

For a lot of us, winter has been pretty cold, with temps in the teens and single digits. Winter air is very dry, it's why mining disasters always occurred in winter months. Swampy, muddy areas underground became deserts, and forced air heat makes the air that much drier, drying the sinuses and throat. That in turn makes one more susceptible to viruses, dust and the like. Add some moisture to your air, but not too much, because that will trigger molds.

 

[Amethyst]

Thanks Ian, I doubt I would ever have heard of Stretta if you had not mentioned it. Surprising that no one in your area (Arizona, your profile says) would do it, since AZ is such a retirement mecca and GERD is associated with age. I was curious enough to put in my zip code, and several doctors came up w/i 25 miles.

The problem is that it's not under your control so it would be hard to use your mind to strengthen it. A severe deficiency in the sphincter can be remedied surgically e.g. lapraoscopic fundoplication. There are other less invasive procedures that can have mixed results. The most intriguing to me is https://www.stretta-therapy.com/ and I have at times considered it but there is no one local that does it. I would have to go to San Diego or the L.A. area.

 

[Amethyst]

Thanks for your thoughts...In the mid-Atlantic area, ragweed (my Nemesis) can indeed persist into late fall if it is warm, while maple trees (my other nemesis) can pollinate as early as late February in a warm winter. But my 2 episodes occurred outside those extreme times. There are online pollen reports for every zipcode, and the current report is "low/no pollen." I react when the report is "medium" or higher. Also I do not react to every kind of pollen (at least, according to the tests). Just certain species - ragweed, English plantain, maple, ash. Thank goodness, since I love flowers and love to stick my nose right in them to sniff.

I don't know about acid reflux but I do have my own experiences with pollen. It can be highly variable. Some years con be worse then others.

Could you be allergic to tree pollen and perhaps some grasses? In our region trees can pollinate in cold weather. My worst symptoms occur in January and February. Juniper and Cypress may be the cause in my case but it is hard to pin down the exact causes. It is probably also regionally dependent. Once I was in Yosemite Valley in the winter. Terrible pollen from Cypress I think. You could even see the pollen on the car windshield and the snow.

We went to the coast a few weeks ago and the wind flowing over the hills seemed to kick up the grass pollen (my guess anyway).

In addition to the Fluticisone (similar to Flonase) I go in for allergy shots. These have helped a lot over the years. But I don't think anyone I've mentioned this to who has allergies has decided to do this. However there are plenty of people in the waiting room so it is a popular solution. Medicare will help out a lot on this cost. You have to get up to a maintenance dose and then come in maybe once per month thereafter.