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

[Amethyst]

TL DR: Recently I've developed severe acid reflux symptoms, with follow-on sinus infection. I now think I may have had AR/GERD for a while. No clue what's causing it; always had a strong digestion.


I realize no one can diagnose me online; am just looking for help in marshaling my facts, so as to make most effective use of Dr. Visit(s). No nightmare scenarios, please - I realize it could be anything, which is why I'm going to the Dr.

• 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 think I have found a cause for my non-seasonal sinusitis: acid reflux. In the past, I've always had a strong digestion. Since last Friday, though (nightly for a week), I've been waking early with horrible reflux for no apparent reason (didn't eat or drink anything out of the ordinary - I keep a diary). Dry cough, burning nose and sinuses, gurgling stomach, waking up in the middle of the night with burning pain in my esophagus. I didn't know what it was until I looked up my symptoms. I thought it might be my fish oil supplements, since I could taste them, but quitting them hasn't brought much relief. Gut feels better after standing up and eating, but sinus/nose/throat are raw.

• Thinking back to December, before the sinusitis, I remember feeling queasy in the mornings, very like morning sickness. At that time, I chalked it up to "nerves" because we were getting ready to go away on vacation (I hate that crazy period just before leaving).

• Thinking back farther, to last summer, my dentist found a cavity, the first in years. I have very sensitive teeth. Yet I am fanatical about oral hygiene, and use special fluoride rinses and pastes for sensitive teeth. Makes me think there's been some acid erosion going on.

• Cannot identify any habit, food, or drink that's changed significantly in the past year, other than cutting back caffeine. I have taken calcium and multivitamin supplements for many years, so those are unlikely to be the cause.

• I'm already compliant with the "lifestyle" recommendations that I've seen online (stop smoking, lose weight, reduce alcohol and caffeine, eat yogurt, don't eat fatty foods, raise your pillow). The drugs for acid reflux/GERD sound terrible. Antacids are constipating and can interfere with nutrition. PPI's are implicated in dementia! And I am not quite ready to default to "All part of getting older, dear."
• So, I need to see a doctor. As we all know, their time with patients is limited and they have protocols to follow. I am trying to come up with the best way to present this complicated mass of symptoms and suspicions to my internist (where the Insurance wants me to start), so as not to end up on more of a medical merry-go-round than absolutely necessary. Don't want to say too much or too little.

Thoughts?

 

[OldShooter]

... make most effective use of Dr. Visit(s). ... Thoughts?

Not the kind of answer you were expecting, but your concern is not something that I ever worry about. Have you investigated availability and cost of concierge medical options in your area?

In exchange for paying an annual fee, my wife and my Dr. appointments are scheduled for an hour long and are available on very short notice including same day if there is an issue. Email and telephone contact is easy and fast. I am on a first name basis with everyone in the office and any administrivia is handled quickly and efficiently. The three docs in the practice rotate carrying a cell phone that is answered 24x7.

If you can find and justify the cost for this type of care it will eliminate your angst.

 

[Carpediem]

I developed bouts of acid reflux in the past 6 months but it appears I now have it under control (for the most part). The changes I made include:

- Drinking less coffee (1-2 cups a week). Substituted with green tea.

- Drinking less wine (1-2 glasses a night) and adding 2-3 oz of water to it. Plus, I switched from Chardonnay to Pinot Noir.

- Started taking a probiotic supplement everyday.

- Started eating Activia yogurt for the probiotics.

- Continued taking a straight shot of apple cider vinegar everyday.

Certain types of 'medicine' can make mine flair up if I'm not careful but it only lasts one night.

My DW has been battling sinus issues and actually lost her taste and smell for a couple of months. The doc prescribed some surface steroid nose drops (from a compound pharmacy) and her taste and smell returned after the inflammation went down. She has sworn off Flonase as she's convinced it causes her more issues than it helps.

Good luck and hope you feel better soon.

 

[Hermit]

I think this cookbook is a good place to start. I got it on Amazon.
Dropping Acid: The Reflux Diet Cookbook & Cure

There are others with more types of meals that work. Try staying away from the normal foods that cause problems for a while: chocolate & strong coffee for me. Try a wedge to sleep on. Lots of suggestions in a previous thread on the subject. Lots of info on the web.

 

[Chuckanut]

My acid reflux went away when I went to a lower-carb diet. If I eat a lot of carbs, it comes back.

 

[redshift]

I developed bouts of acid reflux in the past 6 months but it appears I now have it under control (for the most part). The changes I made include:

- Drinking less coffee (1-2 cups a week). Substituted with green tea.

- Drinking less wine (1-2 glasses a night) and adding 2-3 oz of water to it. Plus, I switched from Chardonnay to Pinot Noir.

- Started taking a probiotic supplement everyday.

- Started eating Activia yogurt for the probiotics.

- Continued taking a straight shot of apple cider vinegar everyday.

Certain types of 'medicine' can make mine flair up if I'm not careful but it only lasts one night.

My DW has been battling sinus issues and actually lost her taste and smell for a couple of months. The doc prescribed some surface steroid nose drops (from a compound pharmacy) and her taste and smell returned after the inflammation went down. She has sworn off Flonase as she's convinced it causes her more issues than it helps.

Good luck and hope you feel better soon.

+1 re: probiotics. For me that seems to have done away with my heartburn and GERD. Was taking Omeprazole, but not anymore.

 

[Beldar]

Thoughts?

Can you communicate to your doctor prior to a visit, i.e. patient portal? I say that because your post here clearly provides background information the Doctor may want and if you could get it to him/her prior to the visit it may save time explaining the finer details of your history.

Just a suggestion, I can do that with my Doctor prior to each visit.

_B

 

[Ian S]

Severe acid reflux and/or GERD is not something to be trifled with. Especially if the onset seems sudden and you haven't had any big changes in eating habits. A visit to to your GP will probably result in a prescription for a PPI drug like the generic version of Protonix. If your health plan permits seeing a specialist without referral, you may want to directly consult with a gastroenterologist who will still likely prescribe a PPI but may also be concerned enough with how your symptoms began to consider an endoscopy.

Whatever you do don't ignore the problem; GERD can lead to Barrett's esophagus and potentially (although rarely) to esophageal cancer. My GERD was more of a nuisance and flareups were easily treated with a drink of milk or liquid antacid. But I'm now on a high dose of a PPI and have been diagnosed with Barrett's meaning an endoscopy every few years to catch cancer early should it ever appear. I've known two people to die of esophageal cancer and it's a miserable way to go.

 

[Livefree]

Back in 2011 I had bad Acid Reflux. Doc put me on a double dose of prilosec for 2 weeks and it went away. Never really bothered me again.

 

[Mr._Graybeard]

My acid reflux went away when I went to a lower-carb diet. If I eat a lot of carbs, it comes back.

I've read theories that a gut overpopulated with microbes that feed on carbs/sugars can produce enough digestive gas to drive stomach acid into the esophagus. Cutting carbs also helps my reflux; adding probiotics through yogurt, raw cider vinegar or dietary supplements can't hurt either.

I heard a nutritionist say that the quantity of acid in the stomach actually tends to decline with age.

 

[Amethyst]

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?

 

[marko]

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

I know you didn't ask me but my concierge charges me $125 a month for a one year contract. Does not take insurance of any kind, can spend an hour with me if necessary and see me on the same day.

Very similar to OldShooter as far as access. Not sure of his cost.

 

[MRG]

Severe acid reflux and/or GERD is not something to be trifled with. Especially if the onset seems sudden and you haven't had any big changes in eating habits. A visit to to your GP will probably result in a prescription for a PPI drug like the generic version of Protonix. If your health plan permits seeing a specialist without referral, you may want to directly consult with a gastroenterologist who will still likely prescribe a PPI but may also be concerned enough with how your symptoms began to consider an endoscopy.

Whatever you do don't ignore the problem; GERD can lead to Barrett's esophagus and potentially (although rarely) to esophageal cancer. My GERD was more of a nuisance and flareups were easily treated with a drink of milk or liquid antacid. But I'm now on a high dose of a PPI and have been diagnosed with Barrett's meaning an endoscopy every few years to catch cancer early should it ever appear. I've known two people to die of esophageal cancer and it's a miserable way to go.

+1

When I had a sudden onset my internist sent me out for a good old fashion scoping. Yeah, I remember that scoping, the doc's office screwed up on getting the anesthesia. I was really sick and said go ahead. Hope I'm never that sick again.[emoji12]

Have you ever used a netti pot or similar apparatus? Might give it a try instead of Flonase, sometimes I wonder if Flonase helps or hurts.

My GERD went away after massive diet changes, but you're already eating well. When I was really sick, I thought a banana and yogurt in the morning were better than any meds.

ETA: I remember a suggestion about booking two back to back appointments for serious issues. Al least you don't have a 12 minute limit.

 

[tfudtuckerpucker]

If your doctor doesn't recommend an EGD, I would want to know why not.

 

[Amethyst]

Thanks, Marko. I guessed the fee covers that one doctor's services, but not another specialist' s?

I know you didn't ask me but my concierge charges me $125 a month for a one year contract. Does not take insurance of any kind, can spend an hour with me if necessary and see me on the same day.

Very similar to OldShooter as far as access. Not sure of his cost.

 

[ivinsfan]

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.

 

[OldShooter]

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

We pay $5K/year for two. One person is $3K/year. The concierge practice is actually a specialty offering of the "big" clinic that we usually use and it is a PPO for us, so we have easy access to all the docs and recommendations from our concierge doctor re the best ones to see.

We also use the concierge doc as a "project manager" watching over other care, like when DW had a hip replacement last year. When she was in the hospital he monitered her status on the computer system, called her almost daily, and visited at last once. The nurses were blown away; they had never seen a primary care doc even slightly involved before. For us, his job was to review all the docs, nurses, interns, drugs, etc and make sure everything fit together and nothing got missed. In these situations, there is normally no single person in charge of the whole rodeo, which leads to dropped balls and misunderstandings between specialists.

 

[marko]

Thanks, Marko. I guessed the fee covers that one doctor's services, but not another specialist' s?

Yes. The fee just covers my personal doctor. You still need insurance for specialists, hospitals, Rx etc. I get 12 visits per year, a physical and he will make house calls (!!!!) for an extra $50. I can talk to him via Skype, email or phone etc.

 

[Bamaman]

Here you are with numerous health problems, and it sounds as if you're too cheap to see a doctor or doctors. Acid reflux is a serious, serious problem and nothing to mess with. You need to be referred to a gastroenterologist immediately.

My wife has a huge hiatal hernia where the esophagus meets the stomach. It allows stomach acids to enter the esophagus when she eats the wrong foods. This most often happens in her sleep when she is in horizontal position.

The dangers with reflux are that it erodes the esophagus' almost like a burn. it is absolutely miserable. My wife wakes up with stomach acid going down into her lungs--and it quickly sets up a bad case of pneumonia. And she has been close to being in her death bed twice in the last three years with reflux induced pneumonia.

The steps we follow are eating supper no later than 6:00 pm. She takes Nexium every day. And sleeps with her head and shoulders elevated on an electric adjustable bed. She avoids spicy foods. And she sees her doctors often because she doesn't have many hospitalizations left in her for this problem.

If you have acid reflux very often, see a doctor quick. Maybe immediate steps can be taken prior to doing irreparable damage to your throat.

 

[ivinsfan]

Here you are with numerous health problems, and it sounds as if you're too cheap to see a doctor or doctors. Acid reflux is a serious, serious problem and nothing to mess with. You need to be referred to a gastroenterologist immediately.

My wife has a huge hiatal hernia where the esophagus meets the stomach. It allows stomach acids to enter the esophagus when she eats the wrong foods. This most often happens in her sleep when she is in horizontal position.

The dangers with reflux are that it erodes the esophagus' almost like a burn. it is absolutely miserable. My wife wakes up with stomach acid going down into her lungs--and it quickly sets up a bad case of pneumonia. And she has been close to being in her death bed twice in the last three years with reflux induced pneumonia.

The steps we follow are eating supper no later than 6:00 pm. She takes Nexium every day. And sleeps with her head and shoulders elevated on an electric adjustable bed. She avoids spicy foods. And she sees her doctors often because she doesn't have many hospitalizations left in her for this problem.

If you have acid reflux very often, see a doctor quick. Maybe immediate steps can be taken prior to doing irreparable damage to your throat.

What's with the first line, she's asking how to talk to the doctor, why are you scolding her and calling her cheap? Sorry your wife and you by default struggle with this issue, but that was kind of cheap shot.

 

[Mr._Graybeard]

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 don't think the dr. will have a problem with this diagnosis. He/she probably sees a dozen or more acid reflux cases every week in people over 50.

 

[Meadbh]

As a former physician, I appreciate your wish to be an organized historian. I recommend you write down your responses to the following points (many can be yes or no). If you have a patient portal available, you can copy and paste your summary into it.

1. Describe the symptoms of your Principal Complaint in detail. Looking through your OP, I couldn’t find sufficient detail. Your doctor needs to know:
- what is the sensation? Pain? Burning? Acid in your mouth? Nausea? Vomiting?
- how bad is it on a scale of 1-10?
- what are you doing when it happens? Lying down? Does it wake you up? Does it ever happen when you are standing?
- how long does it last?
- what, if anything, makes it better?
- what makes it worse?
- is it accompanied by other symptoms, e.g. shortness of breath, choking, coughing?

2. Once the Principal Complaint has been described in detail, outline any relevant recent and past history:
- diet including alcohol
- weight changes
- smoking history
- medications
- self medication if any
- past abdominal or chest surgery
- respiratory infections including sinusitis
- any cardiac problems
- thyroid issues
- anxiety

This should make it easier for you and your doctor to focus on a plan of investigation and subsequent treatment. Best of luck!

 

[braumeister]

My acid reflux went away when I went to a lower-carb diet. If I eat a lot of carbs, it comes back.

Same here. It's a very clear, direct relationship.

I am not a big consumer of refined carbohydrates.

Can you remove the word "refined" and say that your intake is very low? Seriously, it's not just me -- I know several people who also eliminated their GERD problem by moving to a LCHF diet.

 

[Amethyst]

Hmm, I'm curious, what in my post caused you to think I was being cheap?

This sort of proves my point about how hard it can be to communicate something complicated, especially since I am a little upset about it all just now. That is why I turned to the forum as a sounding board for how to talk to the internist, which is where my insurance (and the practice itself) want me to start. I know there will be referrals to specialists.

I am trying, though, not to imagine what I might have, nor self-diagnose, but instead to give the Dr. the information she needs so that she can do that for me.

Here you are with numerous health problems, and it sounds as if you're too cheap to see a doctor or doctors. Acid reflux is a serious, serious problem and nothing to mess with. You need to be referred to a gastroenterologist immediately.

My wife has a huge hiatal hernia where the esophagus meets the stomach. It allows stomach acids to enter the esophagus when she eats the wrong foods. This most often happens in her sleep when she is in horizontal position.

The dangers with reflux are that it erodes the esophagus' almost like a burn. it is absolutely miserable. My wife wakes up with stomach acid going down into her lungs--and it quickly sets up a bad case of pneumonia. And she has been close to being in her death bed twice in the last three years with reflux induced pneumonia.

The steps we follow are eating supper no later than 6:00 pm. She takes Nexium every day. And sleeps with her head and shoulders elevated on an electric adjustable bed. She avoids spicy foods. And she sees her doctors often because she doesn't have many hospitalizations left in her for this problem.

If you have acid reflux very often, see a doctor quick. Maybe immediate steps can be taken prior to doing irreparable damage to your throat.

 

[Amethyst]

Thank you! I will do as you say.

As a former physician, I appreciate your wish to be an organized historian. I recommend you write down your responses to the following points (many can be yes or no). If you have a patient portal available, you can copy and paste your summary into it.

1. Describe the symptoms of your Principal Complaint in detail. Looking through your OP, I couldn’t find sufficient detail. Your doctor needs to know:
- what is the sensation? Pain? Burning? Acid in your mouth? Nausea? Vomiting?
- how bad is it on a scale of 1-10?
- what are you doing when it happens? Lying down? Does it wake you up? Does it ever happen when you are standing?
- how long does it last?
- what, if anything, makes it better?
- what makes it worse?
- is it accompanied by other symptoms, e.g. shortness of breath, choking, coughing?

2. Once the Principal Complaint has been described in detail, outline any relevant recent and past history:
- diet including alcohol
- weight changes
- smoking history
- medications
- self medication if any
- past abdominal or chest surgery
- respiratory infections including sinusitis
- any cardiac problems
- thyroid issues
- anxiety

This should make it easier for you and your doctor to focus on a plan of investigation and subsequent treatment. Best of luck!