Regurgitation of food
August 5, 2015 7:54 AM Subscribe
For the past few months, I've been steadily spitting up food after I eat. If it acts up it tends to keep happening for hours after I have last eaten. There was one time before I started GERD medication that I woke up in the morning with half-digested food in my mouth. Ack! I've had an EGD done, and he said it was normal, though he also said that he dilated my esophagus to 18mm, which is considered a normal width. I was on omeprazole and recently switched to lansoprazole, which isn't working as well. I'm getting heart burn now, too. Any advice?
Some more background: I'm a 22-year-old female. I had a chronic cough starting last September. I would cough so badly I would make myself gag or throw up. When it started, I went to my school's health center, where they gave me benadryl and sudafed. It went away for two months. Then it came back, and suddenly nothing was making it go away. Had a full work-up then, including chest x-ray and THREE breathing tests, all of which came back normal. They put me on flovent anyway, which helped tremendously, indicating, they said, that there was some form of swelling in my airway. I've been to an allergist and GI doctor. I have really bad allergy symptoms; I'm constantly congested, and I often get this feeling like there's water in my nose, but all allergy tests have come back negative. Allergy medicine never helped much anyway. The cough started when I moved into my new apartment. I'm now living back at home. When it was really bad, however, I would cough everywhere. Apartment was old and had furnaces for heating. I also get itchy eyes, which I have drops for.
I suspected cough-variant asthma for a really long time, but the allergist insisted that, since I had three normal spirometrys, that wasn't the case, even though I was on high doses of inhaled steroids for all of those tests. I know cough-variant asthma can present with normal spirometry, but she still INSISTED that it wasn't asthma or allergies. I'm off the inhalers and doing okay. She sent me to a speech pathologist, saying the cough could be "behavioral". I'm doing that now, and although I still often get the urge to cough, I can typically suppress it using the techniques she's showed me.
I also need to clear my throat CONSTANTLY, ESPECIALLY after eating. It's nearly nonstop, but once I eat I cant keep up with it anymore. I've been using techniques shown to me by the speech pathologist for that, too, and, although I don't CLEAR my throat, I can always feel gunk in there and can bring it up at any time. It affects my voice. I'm always froggy, and speech pathologist said she thought that was due to the mucous collecting in my throat. She referred me to an ENT, whom I'm seeing Friday. He's going to snake a camera up my nose and down my throat. She said that, if that's normal, it's "neurogenic" and I'm out of options, basically. She said they could teach me breathing exercises. I said I'm still spitting up food. She kind of fumbled, said I could do a barium swallow and mentioned pouches forming on my esophagus, which didn't show up on the endoscopy.
The manner of the regurgitation varies. Sometimes it comes back into my mouth, and other times it goes up into my throat, the muscles kick in, and it goes back down. Sometimes it just goes up and down. If I bend over food just pours out if it's acting up. It started last month, and is better than it was before I was medicated, though it's still there.
I'm frustrated. I don't know what to do. I have a strong family history of esophageal cancer. My grandfather died of it, and both my mother and uncle have Barret's esophagus. I'm starting to feel like nobody believes me because the tests are coming back negative. I have a panic disorder and I recently went off my meds. My psychiatrist suggested today it was psychological. But it started BEFORE I went off my meds, I've had far worse anxiety, and I just don't think that's it. I think stress makes it worse but I don't think that's it. If I had to guess I would say GERD + a motility disorder + some localized allergies. Any tips on where to go from here?
Some more background: I'm a 22-year-old female. I had a chronic cough starting last September. I would cough so badly I would make myself gag or throw up. When it started, I went to my school's health center, where they gave me benadryl and sudafed. It went away for two months. Then it came back, and suddenly nothing was making it go away. Had a full work-up then, including chest x-ray and THREE breathing tests, all of which came back normal. They put me on flovent anyway, which helped tremendously, indicating, they said, that there was some form of swelling in my airway. I've been to an allergist and GI doctor. I have really bad allergy symptoms; I'm constantly congested, and I often get this feeling like there's water in my nose, but all allergy tests have come back negative. Allergy medicine never helped much anyway. The cough started when I moved into my new apartment. I'm now living back at home. When it was really bad, however, I would cough everywhere. Apartment was old and had furnaces for heating. I also get itchy eyes, which I have drops for.
I suspected cough-variant asthma for a really long time, but the allergist insisted that, since I had three normal spirometrys, that wasn't the case, even though I was on high doses of inhaled steroids for all of those tests. I know cough-variant asthma can present with normal spirometry, but she still INSISTED that it wasn't asthma or allergies. I'm off the inhalers and doing okay. She sent me to a speech pathologist, saying the cough could be "behavioral". I'm doing that now, and although I still often get the urge to cough, I can typically suppress it using the techniques she's showed me.
I also need to clear my throat CONSTANTLY, ESPECIALLY after eating. It's nearly nonstop, but once I eat I cant keep up with it anymore. I've been using techniques shown to me by the speech pathologist for that, too, and, although I don't CLEAR my throat, I can always feel gunk in there and can bring it up at any time. It affects my voice. I'm always froggy, and speech pathologist said she thought that was due to the mucous collecting in my throat. She referred me to an ENT, whom I'm seeing Friday. He's going to snake a camera up my nose and down my throat. She said that, if that's normal, it's "neurogenic" and I'm out of options, basically. She said they could teach me breathing exercises. I said I'm still spitting up food. She kind of fumbled, said I could do a barium swallow and mentioned pouches forming on my esophagus, which didn't show up on the endoscopy.
The manner of the regurgitation varies. Sometimes it comes back into my mouth, and other times it goes up into my throat, the muscles kick in, and it goes back down. Sometimes it just goes up and down. If I bend over food just pours out if it's acting up. It started last month, and is better than it was before I was medicated, though it's still there.
I'm frustrated. I don't know what to do. I have a strong family history of esophageal cancer. My grandfather died of it, and both my mother and uncle have Barret's esophagus. I'm starting to feel like nobody believes me because the tests are coming back negative. I have a panic disorder and I recently went off my meds. My psychiatrist suggested today it was psychological. But it started BEFORE I went off my meds, I've had far worse anxiety, and I just don't think that's it. I think stress makes it worse but I don't think that's it. If I had to guess I would say GERD + a motility disorder + some localized allergies. Any tips on where to go from here?
That sounds exceptionally frustrating.
Unfortunately, when you're a 22-year-old female, many doctors will dismiss your symptoms as (a) not serious, and (b) caused or mediated by stress. This is not your fault and it's not something you should have to deal with. Unfortunately, it's the world we're in.
I would suggest the following when dealing with doctors:
-Remain calm, and be as clinical as you can about your symptoms. Quantify them. How often does this happen? What volume of food is rejected?
-Explain that this is a serious problem which is impacting your life in specific ways (and quantify as much as possible -- how many days do you miss work? How is it impacting your sleep? Etc.)
-Mention other symptoms even if they don't seem related.
-Mention your family history early and often.
If one doctor doesn't fix it, move on to the next. If you have a decent general practitioner, see them for a more general health screening (you never know, maybe the basic bloodwork will show something that was missed earlier) and ask them for referrals. I would start by looking for another GI and/or allergist to get second opinions.
On the nasal allergy front, IANAD, just a nasal allergy sufferer -- which specific fixes have you tried? If you've tried only one over-the-counter antihistamine, another may work better for you (I personally have no luck with Claritin, but Zyrtec works great for me; some people have the other outcome). OTC nasal steroid sprays can also be helpful if you use them consistently (and may also help with itchy eyes!). If you can tolerate it, the NeilMed nasal rinse bottle is helpful for many people. And if your symptoms are worse at night, try washing all your bedding on hot and adding an allergy-proof cover to your pillows -- get rid of any dust mites or other allergens that you can.
Also, what type of allergy testing did you get? The blood testing can be unreliable, so if they only ran that, ask if you can have the scratch testing done (which is still unreliable, but possibly less so than blood testing).
posted by pie ninja at 8:27 AM on August 5, 2015 [2 favorites]
Unfortunately, when you're a 22-year-old female, many doctors will dismiss your symptoms as (a) not serious, and (b) caused or mediated by stress. This is not your fault and it's not something you should have to deal with. Unfortunately, it's the world we're in.
I would suggest the following when dealing with doctors:
-Remain calm, and be as clinical as you can about your symptoms. Quantify them. How often does this happen? What volume of food is rejected?
-Explain that this is a serious problem which is impacting your life in specific ways (and quantify as much as possible -- how many days do you miss work? How is it impacting your sleep? Etc.)
-Mention other symptoms even if they don't seem related.
-Mention your family history early and often.
If one doctor doesn't fix it, move on to the next. If you have a decent general practitioner, see them for a more general health screening (you never know, maybe the basic bloodwork will show something that was missed earlier) and ask them for referrals. I would start by looking for another GI and/or allergist to get second opinions.
On the nasal allergy front, IANAD, just a nasal allergy sufferer -- which specific fixes have you tried? If you've tried only one over-the-counter antihistamine, another may work better for you (I personally have no luck with Claritin, but Zyrtec works great for me; some people have the other outcome). OTC nasal steroid sprays can also be helpful if you use them consistently (and may also help with itchy eyes!). If you can tolerate it, the NeilMed nasal rinse bottle is helpful for many people. And if your symptoms are worse at night, try washing all your bedding on hot and adding an allergy-proof cover to your pillows -- get rid of any dust mites or other allergens that you can.
Also, what type of allergy testing did you get? The blood testing can be unreliable, so if they only ran that, ask if you can have the scratch testing done (which is still unreliable, but possibly less so than blood testing).
posted by pie ninja at 8:27 AM on August 5, 2015 [2 favorites]
Okay, I assume you sleep laying flat.
Have you tried sleeping reclined, but not flat? (like in a recliner)?
posted by kschang at 8:30 AM on August 5, 2015 [1 favorite]
Have you tried sleeping reclined, but not flat? (like in a recliner)?
posted by kschang at 8:30 AM on August 5, 2015 [1 favorite]
She kind of fumbled, said I could do a barium swallow and mentioned pouches forming on my esophagus, which didn't show up on the endoscopy.
Definitely get this test done. I've had one. It's not the most fun thing I've ever done, but it's not that unpleasant.
If your tests don't reveal anything new, go see a neurologist. I don't know why your doctor would tell you that you're out of options if it's neurogenic. It just means you haven't found a cause or solution yet. I have a neurological problem that often causes swallowing symptoms (hence why I had the barium swallow test) so all hope is not lost. Just keep going to doctors and don't let them bully you or dismiss you.
In the meantime, get bed lifts and put them only at the head of your bed so you're sleeping at an incline. This helped me tremendously when I was younger and before I got on meds that controlled my symptoms well. It's funny to get used to but the gravity can help a lot.
posted by phunniemee at 8:31 AM on August 5, 2015
Definitely get this test done. I've had one. It's not the most fun thing I've ever done, but it's not that unpleasant.
If your tests don't reveal anything new, go see a neurologist. I don't know why your doctor would tell you that you're out of options if it's neurogenic. It just means you haven't found a cause or solution yet. I have a neurological problem that often causes swallowing symptoms (hence why I had the barium swallow test) so all hope is not lost. Just keep going to doctors and don't let them bully you or dismiss you.
In the meantime, get bed lifts and put them only at the head of your bed so you're sleeping at an incline. This helped me tremendously when I was younger and before I got on meds that controlled my symptoms well. It's funny to get used to but the gravity can help a lot.
posted by phunniemee at 8:31 AM on August 5, 2015
IANAD, but have some experience with not being able to effectively swallow food...
A good ENT will do a scope down your nose and probably order the barium swallow to see what's up. Both of those together should detect any actual physical abnormalities with your esophagus and ability to completely and thoroughly swallow your food. Hopefully the ENT doc will be able to identify problems or offer solutions.
In the meantime for sleeping, have you tried elevating your torso like kschang suggests? I sleep on a foam wedge, keeping my upper body elevated at 30 degrees due to my use of a feeding tube overnight. Perhaps that could help you not wake up with gunk in your mouth.
posted by Fukiyama at 8:31 AM on August 5, 2015
A good ENT will do a scope down your nose and probably order the barium swallow to see what's up. Both of those together should detect any actual physical abnormalities with your esophagus and ability to completely and thoroughly swallow your food. Hopefully the ENT doc will be able to identify problems or offer solutions.
In the meantime for sleeping, have you tried elevating your torso like kschang suggests? I sleep on a foam wedge, keeping my upper body elevated at 30 degrees due to my use of a feeding tube overnight. Perhaps that could help you not wake up with gunk in your mouth.
posted by Fukiyama at 8:31 AM on August 5, 2015
I have GERD that causes some similar symptoms. First of all there's a HUGE correlation between GERD and asthma, and the causality isn't clear. While it seems likely to be caused by chronic microaspiration, there are also theories that there are other connections, that somehow the nerve irritation of GERD causes the asthma. So don't dismiss the asthma yet -- it could be part of the GERD. I believe you that there's a physical connection, not just separate allergies.
On preview, I was also going to suggest not sleeping flat, and don't lie down after any meal, it's the single most important thing in keeping my own GERD cough down because when you're sleeping you aspirate a bit and it makes the cough and nasal symptoms worse all day. Make sure to sleep really very tilted (not on pillows -- prop the legs of the head of the bed on bricks or special lifts made for this.) Don't eat before you go to bed -- they say 3 hours, 4 is better. Also try to sleep on your left side which puts less pressure on your esophagus.
Get the barium swallow test. Try to find a gastroenterologist who actually specializes in the esophageal diseases and GERD.
posted by flourpot at 8:37 AM on August 5, 2015
On preview, I was also going to suggest not sleeping flat, and don't lie down after any meal, it's the single most important thing in keeping my own GERD cough down because when you're sleeping you aspirate a bit and it makes the cough and nasal symptoms worse all day. Make sure to sleep really very tilted (not on pillows -- prop the legs of the head of the bed on bricks or special lifts made for this.) Don't eat before you go to bed -- they say 3 hours, 4 is better. Also try to sleep on your left side which puts less pressure on your esophagus.
Get the barium swallow test. Try to find a gastroenterologist who actually specializes in the esophageal diseases and GERD.
posted by flourpot at 8:37 AM on August 5, 2015
My mother-in-law had similar symptoms and had to push the doctors a little harder and see a specialist or two before she was diagnosed. It turned out in her case to be a sphincter (I believe at the top of her stomach) that wasn't closing properly, and she spent many nights in a recliner because of it. It was cured surgically, eventually. I know how much discomfort this can cause so hopefully your doctors will get their asses in gear to help you get diagnosed.
posted by PussKillian at 8:44 AM on August 5, 2015 [1 favorite]
posted by PussKillian at 8:44 AM on August 5, 2015 [1 favorite]
Do you have any bowel symptoms? Diarrhea, constipation?
posted by amaire at 8:45 AM on August 5, 2015
posted by amaire at 8:45 AM on August 5, 2015
Response by poster: Thanks for the replies. I had scratch testing done. During one test, actually, another part of my arm (a couple inches away from where they put the actual allergens) got really red and then got a hive. There MAY have been some kind of liquid on the table, like a cleaning solution. They completely dismissed it. I find this really weird. The dots got some red spots but no hives where they put the actual allergen. I've tried various antihstamines and nasal sprays (benadryl, zyrtec, allegra, flonase, and other things I can't remember the name of) with varying degrees of success. I get marked allergy symptoms when I go outside in the morning.
Another thing to note--when I get sick, I get SICK. I work in childcare so I get sick a lot anyway, but a cold will really knock me out. GP knows about this, finds it strange but generally blames childcare. Allergist totally dismissed it. I seldom go to the doctor when I have a cold, even when it moves into my chest, which it always does. I know it will go away eventually.
Bowel symptoms... not really. My stomach/general digestive system can be.... fussy. I was told I have IBS a few years ago but I cut out lactose and the symptoms resolved. I still have days though were I get crampy.
I'll try raising the head of my bed.
posted by Amy93 at 9:02 AM on August 5, 2015
Another thing to note--when I get sick, I get SICK. I work in childcare so I get sick a lot anyway, but a cold will really knock me out. GP knows about this, finds it strange but generally blames childcare. Allergist totally dismissed it. I seldom go to the doctor when I have a cold, even when it moves into my chest, which it always does. I know it will go away eventually.
Bowel symptoms... not really. My stomach/general digestive system can be.... fussy. I was told I have IBS a few years ago but I cut out lactose and the symptoms resolved. I still have days though were I get crampy.
I'll try raising the head of my bed.
posted by Amy93 at 9:02 AM on August 5, 2015
Have you tried sleeping reclined, but not flat? (like in a recliner)?
I also use one of those foam wedge pillow things when I'm sleeping to help with my acid reflux. You should also leave a lot of time between your last meal and when you go to sleep. Speaking of food, what kind of dietary modifications have you tried? I find coffee, citrus, and spicy foods are some of my biggest triggers. I pretty much cut out the first two completely. I also cut down on tomatoes/tomato-based food and Diet Coke. Everyone has different triggers for GERD, but it's worth experimenting with diet changes if you haven't already. It doesn't solve the problem completely (I still take omeprazole every day to keep things under control), but diet changes definitely have helped me.
I've also heard a lot about possible ties between asthma/allergy symptoms and reflux. I've yet to get around to seeing an allergist, but I've always had lots of issues with hay fever/constant post nasal drip/etc. You should definitely try OTC allergy meds. I take Zyrtec daily and Benadryl when things get really bad. Claritin and Allegra don't work as well for me, but definitely experiment to see which, if any, help your symptoms. Also, with these daily allergy meds, make sure you take them for a week or so before deciding they don't help. Claritin in particular is supposed to need a few days to start to work.
I'll also nth getting a second opinion with a different GI doctor. Also, if it does seem like the allergy meds help some, then I would definitely say get a second opinion about the allergies.
posted by litera scripta manet at 9:05 AM on August 5, 2015
I also use one of those foam wedge pillow things when I'm sleeping to help with my acid reflux. You should also leave a lot of time between your last meal and when you go to sleep. Speaking of food, what kind of dietary modifications have you tried? I find coffee, citrus, and spicy foods are some of my biggest triggers. I pretty much cut out the first two completely. I also cut down on tomatoes/tomato-based food and Diet Coke. Everyone has different triggers for GERD, but it's worth experimenting with diet changes if you haven't already. It doesn't solve the problem completely (I still take omeprazole every day to keep things under control), but diet changes definitely have helped me.
I've also heard a lot about possible ties between asthma/allergy symptoms and reflux. I've yet to get around to seeing an allergist, but I've always had lots of issues with hay fever/constant post nasal drip/etc. You should definitely try OTC allergy meds. I take Zyrtec daily and Benadryl when things get really bad. Claritin and Allegra don't work as well for me, but definitely experiment to see which, if any, help your symptoms. Also, with these daily allergy meds, make sure you take them for a week or so before deciding they don't help. Claritin in particular is supposed to need a few days to start to work.
I'll also nth getting a second opinion with a different GI doctor. Also, if it does seem like the allergy meds help some, then I would definitely say get a second opinion about the allergies.
posted by litera scripta manet at 9:05 AM on August 5, 2015
Ah, sorry, total non-preview fail. I would really encourage a prolonged trial of one of the OTC allergy meds. Also, have you tried using one of those neti pots/sinus rinse kits? They can help with allergy flare ups or with colds/sinus infections. Mucinex can help loosen up all that post nasal drip, so I use that periodically, as well.
posted by litera scripta manet at 9:07 AM on August 5, 2015
posted by litera scripta manet at 9:07 AM on August 5, 2015
(IANA Healthcare Professional) For GERD, elevate the head of your bed several inches; you can buy risers of just use books or bricks. Drink water regularly but in small amounts. Eat plenty of fiber. Limit alcohol, fat, chocolate, citrus, spicy food, in the evening.
I have bouts of asthma that causes a chronic, non-productive cough, and it's caused by lung inflammation. Cold air aggravates it. When I stopped eating dairy because I realized that I have become lactose-intolerant, something that happens to many of us as we get older, my asthma improved markedly, as well as other inflammation symptoms. So, that's anecdata, but you don't really have to have dairy in your diet, and a trial of no dairy for a month has no downside, except for the lack of tasty, tasty, cheese. I miss pizza and ice cream, but life is better with reduced inflammation. (on preview, I see that you have gone non-dairy In my experiences, even a couple servings of ice cream can screw things up pretty badly. ) When the asthma flares up, I use a steroid inhaler, and eucalyptus lozenges help a lot.
posted by theora55 at 9:10 AM on August 5, 2015
I have bouts of asthma that causes a chronic, non-productive cough, and it's caused by lung inflammation. Cold air aggravates it. When I stopped eating dairy because I realized that I have become lactose-intolerant, something that happens to many of us as we get older, my asthma improved markedly, as well as other inflammation symptoms. So, that's anecdata, but you don't really have to have dairy in your diet, and a trial of no dairy for a month has no downside, except for the lack of tasty, tasty, cheese. I miss pizza and ice cream, but life is better with reduced inflammation. (on preview, I see that you have gone non-dairy In my experiences, even a couple servings of ice cream can screw things up pretty badly. ) When the asthma flares up, I use a steroid inhaler, and eucalyptus lozenges help a lot.
posted by theora55 at 9:10 AM on August 5, 2015
Response by poster: When I used allergy meds, I used them for a really long time. I took Zyrtec for years, Benadryl at night for months, and Allegra at night for months. I've been on and off Flovent since I was a teenager. I admit I could be better with the nasal sprays. The medication just hasn't seemed to be that effective lately. I have used a neti pot, once. Really cleared out bucketloads of crap in my nose. I should use it more often. It may help with the throat clearing.
Cold air makes the cough markedly worse. It's lovely and hot and humid here now, so I do wonder what will happen come fall/winter. I live in New York, just off of Lake Ontario, so winters here are ROUGH.
I'm... bad about food. I try to eat healthy. I do eat healthy, actually, but I already don't eat meat, and now I'm facing the prospect of my favorite healthy foods being cut out. So. I'm struggling. I'm working on it. I know it's important. I agree dairy products make it markedly worse. My mom had chronic sinus issues for years, and she cut out wheat and dairy and improved a lot. She eats them a lot now, though, and seems to do okay. I've often wondered about food allergies, giving the immediacy and severity of my reaction when eating, but I'm having a hard time noticing which foods make it worse, besides dairy.
posted by Amy93 at 9:17 AM on August 5, 2015
Cold air makes the cough markedly worse. It's lovely and hot and humid here now, so I do wonder what will happen come fall/winter. I live in New York, just off of Lake Ontario, so winters here are ROUGH.
I'm... bad about food. I try to eat healthy. I do eat healthy, actually, but I already don't eat meat, and now I'm facing the prospect of my favorite healthy foods being cut out. So. I'm struggling. I'm working on it. I know it's important. I agree dairy products make it markedly worse. My mom had chronic sinus issues for years, and she cut out wheat and dairy and improved a lot. She eats them a lot now, though, and seems to do okay. I've often wondered about food allergies, giving the immediacy and severity of my reaction when eating, but I'm having a hard time noticing which foods make it worse, besides dairy.
posted by Amy93 at 9:17 AM on August 5, 2015
I have acid reflux that has a strong affect on my upper respiratory system. Colds usually start as a sinus infection after getting acid in my throat or sinuses. It often gets into my chest too. GERD and other acid reflux issues are related to esophageal cancers because of the acid's effect on esophagus.
I take lansoprazole, and sleep on an angle. My doctor at the time was horrible and suggested I never over fill my stomach and stop snacking. For a few months I started to understand how anorexic people must feel. The only time my body wasn't pissed was when I had an empty stomach and lots of water. I was hungry, but no heart burn.
However, changing my diet was the the thing that made me finally feel well. I was very worried that I would have to give up wheat or other favorite foods. Turns out dairy was the biggest issue, and alcohol! I was irritated by many foods, and it was hard to test what was bothering me because I always felt bad. It wasn't until I ate super clean that I could feel the effect of one food over another. You may find it helpful to take out all high acid foods: tomatoes, onions, raw garlic, soda, alcohol, coffee, etc. I was able to narrow down my food choices with the help of a naturopathic doctor. YMMV but I found that she had more time than my doctor and worked with me to figure out how to feed myself without the consequences I had gotten used to.
It was super scary to think I'll never drink or eat ice cream again, but my mother gave me great advice. You can eat whatever you want, you just pay for it differently than most people. I don't slowly build a beer gut, I get heartburn and increase my chance of getting a cold.
posted by Gor-ella at 9:51 AM on August 5, 2015
I take lansoprazole, and sleep on an angle. My doctor at the time was horrible and suggested I never over fill my stomach and stop snacking. For a few months I started to understand how anorexic people must feel. The only time my body wasn't pissed was when I had an empty stomach and lots of water. I was hungry, but no heart burn.
However, changing my diet was the the thing that made me finally feel well. I was very worried that I would have to give up wheat or other favorite foods. Turns out dairy was the biggest issue, and alcohol! I was irritated by many foods, and it was hard to test what was bothering me because I always felt bad. It wasn't until I ate super clean that I could feel the effect of one food over another. You may find it helpful to take out all high acid foods: tomatoes, onions, raw garlic, soda, alcohol, coffee, etc. I was able to narrow down my food choices with the help of a naturopathic doctor. YMMV but I found that she had more time than my doctor and worked with me to figure out how to feed myself without the consequences I had gotten used to.
It was super scary to think I'll never drink or eat ice cream again, but my mother gave me great advice. You can eat whatever you want, you just pay for it differently than most people. I don't slowly build a beer gut, I get heartburn and increase my chance of getting a cold.
posted by Gor-ella at 9:51 AM on August 5, 2015
The major mucus issues make s me suspect food allergies as a contributor. Do a strict elimination diet and keep good notes about your symptoms. When I cut sugar and carbs waaaay back (like 20-30 grams of carbs/day) I can eat dairy without it producing mucus. When I'm eating a standard diet with high amounts of carbs, dairy stimulates major mucus production.
posted by quince at 9:51 AM on August 5, 2015
posted by quince at 9:51 AM on August 5, 2015
Unfortunately, until testing the doctors are doing identifies something they are probably going to continue treating you as though you're faking it somehow or it isn't really as bad as you say. This is a very common reaction toward women, especially young women. This means that you're going to have to take on the lion's share of doing what you can to figure this out yourself. If you can pin it down, THEN go back to the doctor, they may be able to actually help you instead of just shrugging.
I am fairly unfamiliar with GERD, but I'm 100% sure it's seriously abnormal for you to bend over after eating and have the contents of your stomach pour out your throat (!). To use a car analogy, that's not just a leaky valve, that's a valve that's completely failing to seal (pretty sure the throat has valves not dissimilar to car valves). The fact that doctors are basically calling this behavioral in light of that fact has me pretty concerned at their lack of taking this seriously. You should not have been referred to a speech pathologist for this, that's crazy. I would emphasize that heavily on your next doctor's visit.
Do use the neti pot every day if it helps. It's a very inexpensive easy way to help your body clear out some of the crap that's making you so congested. Won't solve the problem but managing the symptoms while you figure this out is really important for your own sanity and comfort.
Food allergies sounds quite possible to me as well. You can it pin down more specifically by keeping a food diary. In addition, dairy is known to cause excess mucus production, I find it quite noticeable when I haven't had any for a while then I have some how gunked up I feel. Try cutting out dairy for a few days and see how it goes. If it is the dairy you can always find ways to adjust and continue to eat healthy, it'll just take a bit of internet research on your part, but at least you'll know.
posted by zug at 9:54 AM on August 5, 2015 [3 favorites]
I am fairly unfamiliar with GERD, but I'm 100% sure it's seriously abnormal for you to bend over after eating and have the contents of your stomach pour out your throat (!). To use a car analogy, that's not just a leaky valve, that's a valve that's completely failing to seal (pretty sure the throat has valves not dissimilar to car valves). The fact that doctors are basically calling this behavioral in light of that fact has me pretty concerned at their lack of taking this seriously. You should not have been referred to a speech pathologist for this, that's crazy. I would emphasize that heavily on your next doctor's visit.
Do use the neti pot every day if it helps. It's a very inexpensive easy way to help your body clear out some of the crap that's making you so congested. Won't solve the problem but managing the symptoms while you figure this out is really important for your own sanity and comfort.
Food allergies sounds quite possible to me as well. You can it pin down more specifically by keeping a food diary. In addition, dairy is known to cause excess mucus production, I find it quite noticeable when I haven't had any for a while then I have some how gunked up I feel. Try cutting out dairy for a few days and see how it goes. If it is the dairy you can always find ways to adjust and continue to eat healthy, it'll just take a bit of internet research on your part, but at least you'll know.
posted by zug at 9:54 AM on August 5, 2015 [3 favorites]
If you're seeing a speech therapist for chronic cough and you have known severe reflux, I'm amazed they aren't considering that the two may be linked.
I'm a speech therapist but not a cough specialist. Our voice/ENT specialist gave me this website to read to help me understand more about the causes of chronic cough. Scroll down to gastroesophageal reflux disease and have a read.
I think visiting an ENT doctor is potentially really helpful. Here in the UK they are better at giving reflux advice and taking it seriously than some other specialties. ENT may also be helpful in linking the reflux, the cough and the nasal symptoms.
I think you should serious think about trying to link your symptoms to trigger foods. For many people, reflux isn't something that goes away, it's a lifelong process you have to control. Your family history makes this more likely. There are surgical options but you'll need to speak to a doctor about what options are possible for you. In the meantime, you can google 'lifestyle management acid reflux' or various phrasings of that and get some starting points.
Don't be too dismayed by the word 'behavioural' - chronic cough almost always has some behavioural element because our bodies aren't machines and we adapt to what they do. Keep going back to your doctors and telling them how all your symptoms affect you day to day.
Fingers crossed for you finding some relief.
posted by kadia_a at 10:23 AM on August 5, 2015
I'm a speech therapist but not a cough specialist. Our voice/ENT specialist gave me this website to read to help me understand more about the causes of chronic cough. Scroll down to gastroesophageal reflux disease and have a read.
I think visiting an ENT doctor is potentially really helpful. Here in the UK they are better at giving reflux advice and taking it seriously than some other specialties. ENT may also be helpful in linking the reflux, the cough and the nasal symptoms.
I think you should serious think about trying to link your symptoms to trigger foods. For many people, reflux isn't something that goes away, it's a lifelong process you have to control. Your family history makes this more likely. There are surgical options but you'll need to speak to a doctor about what options are possible for you. In the meantime, you can google 'lifestyle management acid reflux' or various phrasings of that and get some starting points.
Don't be too dismayed by the word 'behavioural' - chronic cough almost always has some behavioural element because our bodies aren't machines and we adapt to what they do. Keep going back to your doctors and telling them how all your symptoms affect you day to day.
Fingers crossed for you finding some relief.
posted by kadia_a at 10:23 AM on August 5, 2015
Thanks quinc for reminding me. SUGAR was the secret ingredient that does me damage. I had no idea what it was doing to. I quickly took up baking with alternative sugars (not regular or corn syrup) to find some sweet delicious things for me to eat!
posted by Gor-ella at 11:30 AM on August 5, 2015
posted by Gor-ella at 11:30 AM on August 5, 2015
I'd just like to second doing a very serious elimination diet, over the course of several weeks. My kids have dairy allergies and show it in consistently reproducible eczema, but they don't come up as allergic on a scratch test. Food allergies have not yet been adequately ruled out until you try elimination.
posted by Andrhia at 12:18 PM on August 5, 2015
posted by Andrhia at 12:18 PM on August 5, 2015
The ENT can help identify if reflux is irritating your pharynx or larynx (signs of edema, erythema, etc) which may be causing the chronic cough. If the reflux and allergy/sinus issues are under control yet you still have a chronic cough and throat clearing that has become behavioral, there are some behavioral strategies that a speech therapist can try with you - but only after everything else has been ruled out.
I also agree that you likely have an esophageal motility disorder of some type - could be esophageal dysmotility, achalasia, maybe a Zenker's Diverticulum (though I suspect it's dysmotility in combination with reflux issues). An EGD only looks at the structural aspects of the esophagus. You need a full GI workup including an esophagram (also known as a barium swallow study). That will help identify any functional/motility deficits.
posted by canda at 6:57 PM on August 5, 2015
I also agree that you likely have an esophageal motility disorder of some type - could be esophageal dysmotility, achalasia, maybe a Zenker's Diverticulum (though I suspect it's dysmotility in combination with reflux issues). An EGD only looks at the structural aspects of the esophagus. You need a full GI workup including an esophagram (also known as a barium swallow study). That will help identify any functional/motility deficits.
posted by canda at 6:57 PM on August 5, 2015
Response by poster: Thanks for the replies. You guys have brought up some great points to mention on Friday, when I go.
The thing with the throat clearing is it isn't involuntary, or in response to a sensation. I can literally bring up mucous all the time, and I do. To stop throat clearing, which is admittedly obnoxious (I've gotten countless rude glances when I do it while waiting in line--I'm sorry, that's not how I mean it!) I've started using the muscles in my throat to push up the phlegm, which I do literally... all... the time. It's very uncomfortable if I don't do it.
Honestly, the speech pathologist has been very helpful. She's looking at it very medically. At this point, I think they're entertaining the notion that all of it--including the cough--could be caused by GERD, but they're unsure. I think. It's hard to tell, really. They each seem to look at the set of symptoms concerning their speciality and my GP has tried to help put it together but I'm not seeing many concrete actions taken by anyone that put it together and develop a plan to deal with it. They each seem to be meandering around, prescribing symptom-based pills in the hopes that it helps. That's now what I want or need. The hope is that seeing the ENT will help. I think his role here is to try and put it together and really look at how things are interacting.
One thing I can say with almost absolute certainty now is the new acid reflux medication is NOT working. The assistant to the PA to the GI doctor (who knew this was such a hierarchy) called last week asking how I'm doing, so I think I'm going to call back and politely inform them that I'm going back on good ole omeprazole. At least that gave some relief. I'm getting heartburn constantly now.
posted by Amy93 at 7:28 PM on August 5, 2015
The thing with the throat clearing is it isn't involuntary, or in response to a sensation. I can literally bring up mucous all the time, and I do. To stop throat clearing, which is admittedly obnoxious (I've gotten countless rude glances when I do it while waiting in line--I'm sorry, that's not how I mean it!) I've started using the muscles in my throat to push up the phlegm, which I do literally... all... the time. It's very uncomfortable if I don't do it.
Honestly, the speech pathologist has been very helpful. She's looking at it very medically. At this point, I think they're entertaining the notion that all of it--including the cough--could be caused by GERD, but they're unsure. I think. It's hard to tell, really. They each seem to look at the set of symptoms concerning their speciality and my GP has tried to help put it together but I'm not seeing many concrete actions taken by anyone that put it together and develop a plan to deal with it. They each seem to be meandering around, prescribing symptom-based pills in the hopes that it helps. That's now what I want or need. The hope is that seeing the ENT will help. I think his role here is to try and put it together and really look at how things are interacting.
One thing I can say with almost absolute certainty now is the new acid reflux medication is NOT working. The assistant to the PA to the GI doctor (who knew this was such a hierarchy) called last week asking how I'm doing, so I think I'm going to call back and politely inform them that I'm going back on good ole omeprazole. At least that gave some relief. I'm getting heartburn constantly now.
posted by Amy93 at 7:28 PM on August 5, 2015
I don't know what is up with doctors but I went to one and said I think I have a problem with my gallbladder due to my horribly painful and annoying symptoms. I got every horrible expensive test including a colonoscopy, was prescribed multiple omeprazole and other stuff per day, doctor said no idea what is wrong. I went to %&*! webmd.com and put in my symptoms and noted down the 3 things it could be (gallstones top of the list) and then went back and asked for an ultrasound to check for them (why was this not the first test done???). Surprise! Gallstones! All happy now my gallbladder has been removed. My coworkers and friends have similar stories too. Please keep trying until someone listens and can help you. Doctors can be incompetent, dumb (someone was bottom of their class), mean, distracted, prejudiced etc.
posted by meepmeow at 9:05 PM on August 5, 2015
posted by meepmeow at 9:05 PM on August 5, 2015
Caffeine sometimes makes me pukey.
I also had similar problems before I had my gallbladder removed.
posted by Jacqueline at 5:06 PM on August 8, 2015
I also had similar problems before I had my gallbladder removed.
posted by Jacqueline at 5:06 PM on August 8, 2015
Response by poster: Quick update:
I had both the camera nose thingy done (I believe it's called a laryngoscopy) which revealed that my throat is inflamed. Really inflamed. I then went on to get strep throat, so I'm not sure if that caused the swelling, but I was asymptomatic during the test so I doubt. He said the chronic throat pain could be from LPR or allergies and he's going to experiment with different medications. Fine, check. First major problem that showed up.
I also had a modified barium swallow yesterday. That showed, in short, that the sphincter between my stomach and my esophagus has a nasty habit of locking shut. I took four sips of a drink. It is supposed to take literally one second for the food to enter my esophagus. Sphincter literally locked shut, my esophagus ballooned out, and the food stayed there for a minute. Literally a minute. 60 times longer than it should. Speech pathologist was alarmed and I have to talk to GI, whom I'm seeing next week, about what to do next. She looked me right in the eye and said they know now for certain that the problem is very real. She also said, however, that it could be "how I am", which makes NO sense because I have a malfunctioning body. It's not just some quirk. In her notes, she called it "intermittent severe esophageal dysmotility". Great.
I ALSO have this habit of regurgitating food hours after I eat and having it get stuck in my esophagus, so I think my sphinter is also relaxing to let food in and then locking. She didn't see it, though. I regurgitated after the test but not during.
In the meantime, my tonsils never returned to a normal size after supposedly getting strep. I went to the doctor two weeks ago, when I tested negative for strep. They're still huge. I went to my PCP today because speech pathologist URGED me to go see her. She looked at my tonsils, said OH GOD they're not supposed to look like that, took another culture, did bloodwork, and urged me to see ENT, like, really soon. CBC came back and my white blood cells aren't crazy high, so I probably don't have a terrible infection. She also tested for mono, but I'm not super tired, so I don't think that's it.
This is all kinds of crazy overwhelming, made markedly worse by the fact that I apparently broke my foot last week. I was unaware that I broke it until I went to PCP about my tonsils, mentioned that I'm still having trouble weight-bearing, and she ordered an x-ray. So while I'm totally floored by everything else, I'm also hobbling around, waiting to see an orthopedist.
Thank you for all the great replies. I did not pick a favorite because I couldn't; they were all wonderful.
posted by Amy93 at 6:39 PM on September 4, 2015 [3 favorites]
I had both the camera nose thingy done (I believe it's called a laryngoscopy) which revealed that my throat is inflamed. Really inflamed. I then went on to get strep throat, so I'm not sure if that caused the swelling, but I was asymptomatic during the test so I doubt. He said the chronic throat pain could be from LPR or allergies and he's going to experiment with different medications. Fine, check. First major problem that showed up.
I also had a modified barium swallow yesterday. That showed, in short, that the sphincter between my stomach and my esophagus has a nasty habit of locking shut. I took four sips of a drink. It is supposed to take literally one second for the food to enter my esophagus. Sphincter literally locked shut, my esophagus ballooned out, and the food stayed there for a minute. Literally a minute. 60 times longer than it should. Speech pathologist was alarmed and I have to talk to GI, whom I'm seeing next week, about what to do next. She looked me right in the eye and said they know now for certain that the problem is very real. She also said, however, that it could be "how I am", which makes NO sense because I have a malfunctioning body. It's not just some quirk. In her notes, she called it "intermittent severe esophageal dysmotility". Great.
I ALSO have this habit of regurgitating food hours after I eat and having it get stuck in my esophagus, so I think my sphinter is also relaxing to let food in and then locking. She didn't see it, though. I regurgitated after the test but not during.
In the meantime, my tonsils never returned to a normal size after supposedly getting strep. I went to the doctor two weeks ago, when I tested negative for strep. They're still huge. I went to my PCP today because speech pathologist URGED me to go see her. She looked at my tonsils, said OH GOD they're not supposed to look like that, took another culture, did bloodwork, and urged me to see ENT, like, really soon. CBC came back and my white blood cells aren't crazy high, so I probably don't have a terrible infection. She also tested for mono, but I'm not super tired, so I don't think that's it.
This is all kinds of crazy overwhelming, made markedly worse by the fact that I apparently broke my foot last week. I was unaware that I broke it until I went to PCP about my tonsils, mentioned that I'm still having trouble weight-bearing, and she ordered an x-ray. So while I'm totally floored by everything else, I'm also hobbling around, waiting to see an orthopedist.
Thank you for all the great replies. I did not pick a favorite because I couldn't; they were all wonderful.
posted by Amy93 at 6:39 PM on September 4, 2015 [3 favorites]
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posted by Amy93 at 7:56 AM on August 5, 2015