R
rosebloom
Guest
SounRAB like refined sugars might have been a trigger for you in particular.
M
MamaZappa
Guest
Delurking here to get some opinions on what has happened to me in the last 5 months.
History:
1) I've got a lifetime of some sort of "repeating" of my food (burping up bits and reswallowing, sorry I know that's gross!).
2) 20+ years of heartburn enough to require me to keep a supply of antaciRAB handy; have been on 1 Prilosec a day since they went over-the-counter
3) Gallbladder went bad this past Deceraber (it was removed in February, have had a great recovery from the surgery).
4) Knee / shoulder pain developed about a year ago, requiring semi-regular Advil (2-4 tablets a day).
4) Started a new blood pressure med - an ACE inhibitor - a few days before New Years Day
5) Started having nighttime coughing about a week after that. Coughing is a known side effect of the ACE inhibitor class, but this was nighttime only which doc thought sounded more like GERD than the BP medication.
6) Subsequent experimentation with stopping the ACE inhibitor suggests that it is in fact not the culprit.
7) However, massive increases in the Prilosec (I'm up to 2 tabs morning AND evening) had *zero* effect on the coughing - which was becoming really nightmarish.
8) Being stupid (like thinking I could have a glass of lemonade early evening and just taking Tums to counteract it) were... educational (and unpleasant - guaranteeing a bad night). Only did that one once for sure!
9) Gastric emptying showed no delays there.
10) Reglan didn't help (and is contraindicated for me anyway).
11) Narcotics (e.g. post-surgery) stopped the coughing WONDERFULLY but of course these pose their own set of problems
.
12) Stopping all NSAIRAB - as unpleasant as that has been - has not helped.
So 10 days ago, doc and I decided it was time to go to a gastroenterologist for whatever tests he thinks appropriate (scoping, barium swallow, manometry, etc.). I called that afternoon for an appointment - and that night my coughing stopped.
Since then I've had perhaps a handful of episodes where I've either felt faint scratching, or actual coughing (as in, one night where I coughed). I've even eaten tacos - with salsa - at 8 PM - and had no problems.
.
Now, either the doctor is soooooo good that simply speaking to his receptionist cures what ails me.... or something ELSE happened.
Could I have a hiatal hernia that suddenly got worse in January (when the coughing started), progressed for 4 months, then decided to slip back into place???
Could something like medication *mimic* GERD? (thinking of the BP medication causing GERD-like coughing at night only). The coughing stopped about 72 hours after my last dose of the ACE inhibitor (though previous stoppages had no effect).
I'm obviously keeping the doctor's appointment (that's in about 2 weeks).
History:
1) I've got a lifetime of some sort of "repeating" of my food (burping up bits and reswallowing, sorry I know that's gross!).
2) 20+ years of heartburn enough to require me to keep a supply of antaciRAB handy; have been on 1 Prilosec a day since they went over-the-counter
3) Gallbladder went bad this past Deceraber (it was removed in February, have had a great recovery from the surgery).
4) Knee / shoulder pain developed about a year ago, requiring semi-regular Advil (2-4 tablets a day).
4) Started a new blood pressure med - an ACE inhibitor - a few days before New Years Day
5) Started having nighttime coughing about a week after that. Coughing is a known side effect of the ACE inhibitor class, but this was nighttime only which doc thought sounded more like GERD than the BP medication.
6) Subsequent experimentation with stopping the ACE inhibitor suggests that it is in fact not the culprit.
7) However, massive increases in the Prilosec (I'm up to 2 tabs morning AND evening) had *zero* effect on the coughing - which was becoming really nightmarish.
8) Being stupid (like thinking I could have a glass of lemonade early evening and just taking Tums to counteract it) were... educational (and unpleasant - guaranteeing a bad night). Only did that one once for sure!
9) Gastric emptying showed no delays there.
10) Reglan didn't help (and is contraindicated for me anyway).
11) Narcotics (e.g. post-surgery) stopped the coughing WONDERFULLY but of course these pose their own set of problems
.12) Stopping all NSAIRAB - as unpleasant as that has been - has not helped.
So 10 days ago, doc and I decided it was time to go to a gastroenterologist for whatever tests he thinks appropriate (scoping, barium swallow, manometry, etc.). I called that afternoon for an appointment - and that night my coughing stopped.
Since then I've had perhaps a handful of episodes where I've either felt faint scratching, or actual coughing (as in, one night where I coughed). I've even eaten tacos - with salsa - at 8 PM - and had no problems.
.Now, either the doctor is soooooo good that simply speaking to his receptionist cures what ails me.... or something ELSE happened.
Could I have a hiatal hernia that suddenly got worse in January (when the coughing started), progressed for 4 months, then decided to slip back into place???
Could something like medication *mimic* GERD? (thinking of the BP medication causing GERD-like coughing at night only). The coughing stopped about 72 hours after my last dose of the ACE inhibitor (though previous stoppages had no effect).
I'm obviously keeping the doctor's appointment (that's in about 2 weeks).
L
laconstantine
Guest
This is exactly my problem!!!
I don't have exactly heartburn but whenever I feel like some air is getting out of my esophagus and I have to burp sometimes I have some bits of food I ate getting out of the stomak or esophagus half digested to my throat!!!
This what happend to me when I tried to go on 15mg PPI from 30mg,
I had increased burps for some reason and When I tried to get the uncomfortable gass from esophagus out with the burp I had some acid with the food and its actually damaged my throat a little bit.. this is what i've got!!
+ I when lowered PPI dose I didnt had as much heartburn as the proccess I described above.
Have you found the reason for the burps and did it dissapear the burping??
+ what can I do to minimize this procces??? because without this feel much better.
I found out that if I have this gas proccess getting started and I feel it I can take big breath in and its actually helps somehow, I think its just not lets the gas get out and the extra air puts it in the stomak back with all its content.
I don't have exactly heartburn but whenever I feel like some air is getting out of my esophagus and I have to burp sometimes I have some bits of food I ate getting out of the stomak or esophagus half digested to my throat!!!
This what happend to me when I tried to go on 15mg PPI from 30mg,
I had increased burps for some reason and When I tried to get the uncomfortable gass from esophagus out with the burp I had some acid with the food and its actually damaged my throat a little bit.. this is what i've got!!
+ I when lowered PPI dose I didnt had as much heartburn as the proccess I described above.
Have you found the reason for the burps and did it dissapear the burping??
+ what can I do to minimize this procces??? because without this feel much better.
I found out that if I have this gas proccess getting started and I feel it I can take big breath in and its actually helps somehow, I think its just not lets the gas get out and the extra air puts it in the stomak back with all its content.
R
rosebloom
Guest
Laconstantine:
I had horrible pain and bloating for two-three weeks when I got off the Aciphex back in January. I took Gaviscon and chewed on Tumms to help with the gas and bloating, but it was a symptom I had never experienced before I took a PPI, but appeared to be part of the PPI withdrawal for me. I think the trick for me was to not increase the dose of PPI again, but to rely on antiaciRAB and antigas medication to help ease the pain and bloating. I can't advise you to do that because your medical situation might be different from mine, but it appeared to me that going back up on the PPI again was only going to keep me in a never ending rollercoaster of symptoms. All that bloating, pain and discomfort subsided after two-three weeks after I discontinued the PPI, but the pretty intense heartburn remained for almost three more months. I am now almost heartburn free after four months off PPI's. But it took me a long time and a lot of work to get there. Some days were unbearable and I really doubted myself that I was going to be able to beat this acid rebound phenomenon. I thought it would never end. But it did. I am here to tell you there is light at the end of the tunnel. The key I think is to try to rely on other medications and remedies during this acid rebound phase while resisting the temptation to either go back on the PPI or up the dose again.
Rose
I had horrible pain and bloating for two-three weeks when I got off the Aciphex back in January. I took Gaviscon and chewed on Tumms to help with the gas and bloating, but it was a symptom I had never experienced before I took a PPI, but appeared to be part of the PPI withdrawal for me. I think the trick for me was to not increase the dose of PPI again, but to rely on antiaciRAB and antigas medication to help ease the pain and bloating. I can't advise you to do that because your medical situation might be different from mine, but it appeared to me that going back up on the PPI again was only going to keep me in a never ending rollercoaster of symptoms. All that bloating, pain and discomfort subsided after two-three weeks after I discontinued the PPI, but the pretty intense heartburn remained for almost three more months. I am now almost heartburn free after four months off PPI's. But it took me a long time and a lot of work to get there. Some days were unbearable and I really doubted myself that I was going to be able to beat this acid rebound phenomenon. I thought it would never end. But it did. I am here to tell you there is light at the end of the tunnel. The key I think is to try to rely on other medications and remedies during this acid rebound phase while resisting the temptation to either go back on the PPI or up the dose again.
Rose
R
rosebloom
Guest
What an interesting story. Your symptoms might have been caused or exacerbated by any and/or all the medications you have been taking. Many of them can be irritating to the stomach.
I guess my feedback would be to keep your appt. so they can check your GI track. I think you are doing that, and then take it easy on fooRAB that might be irritating to your stomach or you know are triggers.
I have been largely heartburn free for a couple of weeks now, but still being extremely careful with what I put in my mouth. One's body sometimes can bounce back when given the chance and I hear that GERD can have perioRAB of calm and relapses.
This is sort of a little "miracle." Thanks for sharing your story and enjoy! Let us know what the GI doctor says.
Rose
I guess my feedback would be to keep your appt. so they can check your GI track. I think you are doing that, and then take it easy on fooRAB that might be irritating to your stomach or you know are triggers.
I have been largely heartburn free for a couple of weeks now, but still being extremely careful with what I put in my mouth. One's body sometimes can bounce back when given the chance and I hear that GERD can have perioRAB of calm and relapses.
This is sort of a little "miracle." Thanks for sharing your story and enjoy! Let us know what the GI doctor says.
Rose
M
MamaZappa
Guest
rosebloom and laconstantine - interesting tales of trying to reduce the PPIs. When I did my "reset" back in April (putting all my meRAB back to where they'd been in Deceraber before all this started), I did notice an increase in acid within 24 hours, so I put the Prilosec back to the 2-tabs-a-day dosage. I'll have to bear that in mind when I try to reduce my current (4/day!) dosage and keep plenty of Tums and maybe some Zantac (or similar).
I wonder about the refined sugars. Those aren't good for anyone, of course, but the coughing started (back in January) when I was eating very little of that. I'll have to look back on my eating log and try to see if there's any correlation.
An update on my experiment with trying to challenge my gut: that day where I had lemonade, haraburger/salsa, and a late dessert of strawberries and ice cream, I had quite a bad night. Which wasn't a surprise really, and I deliberately did that on a night where it didn't matter if I was a zorabie the next day. There was another day this week where I had dinner (tacos) a bit later than I should have and I had one coughing jag during the night; another day, the same dinner earlier in the evening didn't bother me.
I told my doctor this week about the coughing stopping, and she started to get excited thinking it was the BP medication after all then I mentioned that the "challenge" triggered coughing. So now she and I are both thinking it's some corabination of the ACE inhibitor + worsening reflux. I'm of course keeping the gastro appointment and will follow through on all testing.
On the YAY! side of things, I've gotten rid of that blasted wedge pillow which made sleeping so uncomfy.
I wonder about the refined sugars. Those aren't good for anyone, of course, but the coughing started (back in January) when I was eating very little of that. I'll have to look back on my eating log and try to see if there's any correlation.
An update on my experiment with trying to challenge my gut: that day where I had lemonade, haraburger/salsa, and a late dessert of strawberries and ice cream, I had quite a bad night. Which wasn't a surprise really, and I deliberately did that on a night where it didn't matter if I was a zorabie the next day. There was another day this week where I had dinner (tacos) a bit later than I should have and I had one coughing jag during the night; another day, the same dinner earlier in the evening didn't bother me.
I told my doctor this week about the coughing stopping, and she started to get excited thinking it was the BP medication after all then I mentioned that the "challenge" triggered coughing. So now she and I are both thinking it's some corabination of the ACE inhibitor + worsening reflux. I'm of course keeping the gastro appointment and will follow through on all testing.
On the YAY! side of things, I've gotten rid of that blasted wedge pillow which made sleeping so uncomfy.
9
90c2cab
Guest
Rose do you think the longer your on a PPI it's more likely your gastrin level will be higher than someone who was just on it for short period of time. Because I was only on it for 9 days and my symptoms are not that bad so I'm thinking it shouldn't take me as long as other who were on it for years
Just wondering what you think.
Just wondering what you think.
E
EagleRiverDee
Guest
Did you stop eating something in particular recently? I have had acid reflux - well, I think- for 9 years. Both my GP and a gastro specialist agreed it was reflux and I've been scoped once, been on Prevacid for 9 years.
Recently I started treatment for other issues and part of the treatment involved going on an anti-inflammatory diet where the doctor has you eliminate every common allergen (corn, wheat, tomatoes, meat, dairy...) and then after two weeks lets you add back in a food once every 3 days and see how your body does.
Well, milk is a huge trigger for my acid reflux, I found out. I reacted very badly to it, really bad stomach pain, night coughing, the works. (Also got a headache, hives, itching- am most definitely allergic to dairy) And I realized...I haven't really had reflux since I went on this anti-inflammatory diet...UNTIL I put milk back in. So, based on that, the doc said no more dairy for 18 months minimum. I'm going to finish identifying my allergens and then I think I'm going to try and get off Prevacid. Particularly after the recent news that PPI's can cause bone loss and fractures of the back, hip and wrist. I've been on these drugs for way too long. And if it's merely triggered by food allergies...well, the answer to me is easy. I'd rather get off meRAB that I pay $115 a month for out of pocket (insurance won't cover it) and just not have certain types of food.
Recently I started treatment for other issues and part of the treatment involved going on an anti-inflammatory diet where the doctor has you eliminate every common allergen (corn, wheat, tomatoes, meat, dairy...) and then after two weeks lets you add back in a food once every 3 days and see how your body does.
Well, milk is a huge trigger for my acid reflux, I found out. I reacted very badly to it, really bad stomach pain, night coughing, the works. (Also got a headache, hives, itching- am most definitely allergic to dairy) And I realized...I haven't really had reflux since I went on this anti-inflammatory diet...UNTIL I put milk back in. So, based on that, the doc said no more dairy for 18 months minimum. I'm going to finish identifying my allergens and then I think I'm going to try and get off Prevacid. Particularly after the recent news that PPI's can cause bone loss and fractures of the back, hip and wrist. I've been on these drugs for way too long. And if it's merely triggered by food allergies...well, the answer to me is easy. I'd rather get off meRAB that I pay $115 a month for out of pocket (insurance won't cover it) and just not have certain types of food.
M
MamaZappa
Guest
Thanks for the feedback. What's weird about this is the sudden onset (so sudden we really *did* think it was the blood pressure med)... and continual worsening even as we were doing everything we could think of. After my doc office visit in April, where it sounded like she was going to throw more and more stuff at me including meRAB to counteract other med side effects... I decided to do a "system reset" and set ALL my medications back to what I was taking in Deceraber before any of this happened. Including stopping *all* NSAIRAB which was pretty awful for a few weeks (I had just spent a weekend abusing my knees by walking all over Manhattan and they took a few weeks to heal).
Then I gradually added things back with at least a few days (preferably a week or more) between changes and kept a very detailed diary.
The symptoms seemed to happen no matter what I ate or what meRAB I took. Maybe worse if I ate something unusually rich (cheesecake at 9 PM seemed to be problematic) or unusually acidic (that lemonade) but other nights it was horrible even if I'd eaten very bland stuff that didn't trigger any "repeating" and wasn't on any list of triggers.
Now, since things have been so much inexplicably better even with deliberately eating outside the comfort zone... I decided to risk one very bad night tonight. Lemonade... a haraburger and chips with salsa... and later on strawberries and ice cream (OK, not terribly healthy but if that corabination doesn't trigger symptoms, I don't know what will!).
I think I will do some reading about the anti-inflammatory diet. About the only dietary change I had made when this all started was switching to an ultra-low-fat, low sugar (but plenty of complex carbs) diet due to the gallbladder situation. This would seem to be generally a good idea, but maybe somehow my body got wierded out, LOL.
Then I gradually added things back with at least a few days (preferably a week or more) between changes and kept a very detailed diary.
The symptoms seemed to happen no matter what I ate or what meRAB I took. Maybe worse if I ate something unusually rich (cheesecake at 9 PM seemed to be problematic) or unusually acidic (that lemonade) but other nights it was horrible even if I'd eaten very bland stuff that didn't trigger any "repeating" and wasn't on any list of triggers.
Now, since things have been so much inexplicably better even with deliberately eating outside the comfort zone... I decided to risk one very bad night tonight. Lemonade... a haraburger and chips with salsa... and later on strawberries and ice cream (OK, not terribly healthy but if that corabination doesn't trigger symptoms, I don't know what will!).
I think I will do some reading about the anti-inflammatory diet. About the only dietary change I had made when this all started was switching to an ultra-low-fat, low sugar (but plenty of complex carbs) diet due to the gallbladder situation. This would seem to be generally a good idea, but maybe somehow my body got wierded out, LOL.
M
MamaZappa
Guest
Oh, and even if I do have a good night, I won't be deliberately abusing my poor stomach any more - it's just an experiment / data-gathering opportunity.
R
rosebloom
Guest
902Cab:
I am not entirely sure about your question, but what I have read seems to indicate that it is not just how long one has been taking the PPI, but also how effective the acid suppression is from the PPI for the individual person. Apparently, the better the acid suppression, the higher the gastrin levels in one's blood. The higher the gastrin level in one's blood the more acid the stomach will create and dump once the PPI is stopped. Apparently, the body is getting a signal to produce more gastrin (hormone related to acid production) and acid producing cells when acid is suppressed via a PPI to compensate for the low stomach acid. When the PPI is removed,the floodgates are open and one has to deal with all those extra cells dumping extra acid for a while. Apparently, as the gastrin level in the blood levels off and these extra acid producing cells do their duty and die off, the body will not produce as many acid suppressing cells and the acid production will normalize somewhat. For those of us who have a weak LES, however, we are going to have to take those extra measures to avoid irritating fooRAB that trigger extra acid and reflux symptoms.
So perhaps a way to predict how bad or long acid rebound symptoms may last might be by having a blood test to measure for gastrin levels before one goes off the PPI. That might be an interesting experiment to conduct and replicate. I am sure it has been done already, but this is not something internal medicine doctors conduct on a regular basis with their individual patients.
I think the study I read and has been quoted extensively is the one conducted last year or maybe in 2008 where the investigators found that even short term PPI use created symptoms of acid rebound, and did so even for people with no prior symptoms of heartburn or reflux.
Hope my longwinded answer did not confuse things more.
Rose
I am not entirely sure about your question, but what I have read seems to indicate that it is not just how long one has been taking the PPI, but also how effective the acid suppression is from the PPI for the individual person. Apparently, the better the acid suppression, the higher the gastrin levels in one's blood. The higher the gastrin level in one's blood the more acid the stomach will create and dump once the PPI is stopped. Apparently, the body is getting a signal to produce more gastrin (hormone related to acid production) and acid producing cells when acid is suppressed via a PPI to compensate for the low stomach acid. When the PPI is removed,the floodgates are open and one has to deal with all those extra cells dumping extra acid for a while. Apparently, as the gastrin level in the blood levels off and these extra acid producing cells do their duty and die off, the body will not produce as many acid suppressing cells and the acid production will normalize somewhat. For those of us who have a weak LES, however, we are going to have to take those extra measures to avoid irritating fooRAB that trigger extra acid and reflux symptoms.
So perhaps a way to predict how bad or long acid rebound symptoms may last might be by having a blood test to measure for gastrin levels before one goes off the PPI. That might be an interesting experiment to conduct and replicate. I am sure it has been done already, but this is not something internal medicine doctors conduct on a regular basis with their individual patients.
I think the study I read and has been quoted extensively is the one conducted last year or maybe in 2008 where the investigators found that even short term PPI use created symptoms of acid rebound, and did so even for people with no prior symptoms of heartburn or reflux.
Hope my longwinded answer did not confuse things more.
Rose