 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Sinusitis / January 2006Square one....
Hi I was here a couple of months ago with lots of questions as I was struggling with a sore throat, bad breath and PND. I was being treated with antibiotics for what my ENT thought was a sinus infection. The treatment didn't resolve the issue and my catscan was fine save for a couple of small polyps and slightly wide turbinates. The ENT thought my sinuses were in good shape. She then said it was laryngeal pharyngeal reflux (without scoping, just based on my symptoms) and prescribed Nexium. The last two months have been awful...to make a long story short. I have had lots of problems with chest pains, belching and food digestion. All these things happened AFTER taking the antibiotics and nexium. I couldn't handle the nexium and am now using protonix. My symptoms wax and wane, so I don't know if in fact the acid reflux medicine is working or not. So 3 months later, I still have...a sore throat, bad breath and lots of PND. The sorer the throat, the harder it is to swallow and I get that weird globus feeling. A gastroentologist did an upper endoscope and found my esophagus and stomach in fine health. No problems. He can't confirm the refluxing. But his diagnosis was that the TIPS of my arytenoids had mild erythema which is inconsistent with the pattern of LPR. I was in a bit of a daze when he told me this after the scope (I was put out) so I didn't ask too many questions. I've left a note with him but have yet to hear back. His recommendation was to go back to the ENT. I'm shopping around for new one so it may be while before I get an appointment. Any ideas? Anyone gone through something similar...any hope? >Hi I was here a couple of months ago with lots of questions as I was >struggling with a sore throat, bad breath and PND. I was being treated >with antibiotics for what my ENT thought was a sinus infection. The >treatment didn't resolve the issue and my catscan was fine save for a >couple of small polyps and slightly wide turbinates. CAT scans need to be interpreted very carefully A better doctor may find more. > The ENT thought >my sinuses were in good shape. She then said it was laryngeal >pharyngeal reflux (without scoping, just based on my symptoms) It is extremely easy to use the scope to check for reflux - almost every single ENT I have gone to has looked at the larynx for stains with the scope. So that tells me that that you need to switch ENT's and go to one who is competent. If you have no other means of selecting one, try going a major University medcial center and seeing the doctor with a long waiting time for an appointment (do *not* go to a clinic though). The ones with the short wait times are usually novices. Actually it is better to look up their credentials on the Internet etc. too. >and >prescribed Nexium. The last two months have been awful...to make a [quoted text clipped - 15 lines] >recommendation was to go back to the ENT. I'm shopping around for new >one Ah that's good. >so it may be while before I get an appointment. >Any ideas? Anyone gone through something similar...any hope? Sure you just had a less than ideal doctor. The PND is coming from "somewhere". A good rhinologist should be able to find the inflammation or other cause. I am not at all convinced that it is reflux. I think you need to find a good *internist* (specialist in internal medicine) also in case something systemic is going on. Have you had complete workups for thyroid, anemia, etc? I am a grad student at a major university, so the good news is that there is a big hospital on campus. The bad news is that my primary care doctor is whoever will see me at the student health center. I try to see the same doctor, but it doesn't always work out. The problem is that the last doctor I saw there knowsI am going through depression, so his attitude is that it's all in my head. If I keep going to counseling, things will be okay. That may be true, but meanwhile I have had symptoms off and on for the last six months. I have not had a complete workup. I had a cardiology work done to make sure my chest pains weren't heart-related, I had very good results. I also had a blood test for allergies. It came back for mild cat allergy but I haven't even seen a cat in ages. None of my neighbors in my apt. building are cat owners and neither my friends. I'm tied to the school hospital because of $$ and convenience. I have to get my current ENT to refer me to another ENT in the hospital or else I have to go outside of the university. I will give this to the new year and see if protonix is going to work (and if I 'relax' over the winter break). If not, I will tell the ENT I want a 2nd opinion. Btw, when my pnd is in control, my throat still hurts. With lots of pnd though, my breath is really rank. Man, I wish I had insisted that she looked down my throat with her scope! >I am a grad student at a major university, so the good news is that >there is a big hospital on campus. The bad news is that my primary [quoted text clipped - 14 lines] >new year and see if protonix is going to work (and if I 'relax' over >the winter break). If not, I will tell the ENT I want a 2nd opinion. Yes it may be possible to game the Student Health system to get the best medical advise but I think you may need to be very assertive in that case. Asking for second opinions sounds exactly right. They may have various appeal procedures etc, to allow access to further opinions. Or if the school has a medical schooll then sometimes you can just call up some senior doctors in the medical school and ask for advise at least. If they are all interns and residents (junior doctors) that may be ok but if the problems persist then you may need somone really experienced. Probably they would give you thyroid and anemia and white blood cell counts if you asked - they are just blood tests. Otherwise you could try to get added to your parents health insurance policy (if you are of a suitable age), or see if there is some other policy you are eligible for, that does not exclude pre-existing conditions. Some states have guaranteed health plans. Or offerto the Helayth service to help pay for some referrals....... >Btw, when my pnd is in control, my throat still hurts. Yes the sore throat worries me. It does not seem that we have a satisfactory explanation for it, which could mean that it is something completely unrelated, such as thyroid...... > With lots of >pnd though, my breath is really rank. Man, I wish I had insisted that >she looked down my throat with her scope! On 12/16/05 10:47 PM, in article 4ac7q1la9qmgf2ar7to5cu6s5mn8i5279b@4ax.com, >> Hi I was here a couple of months ago with lots of questions as I was >> struggling with a sore throat, bad breath and PND. I was being treated [quoted text clipped - 54 lines] > also in case something systemic is going on. Have you had complete workups > for thyroid, anemia, etc? I think the problem today is that Reflux is the disease of the week - or month. Can't get pregnant? Reflux Not popular in shool? Reflux Headaches? Reflux Mean and rotten to your parents? Reflux. There are definite tests for reflux - laryngoscopy or serial ph testing . Problem is that it takes weeks to see if the acid inhibitor really works and by that time the "cold" or throat might have gone away on its own. There are real cases of reflux, but it seems that no one walks out the door these days without this diagnosis. Most important is the instructions for treating it: no food after 8 PM, head of bed elevated, avoid caffeine and hot spicy foods. Any readers have other suggestions? I have been going back and forth with the same thing for years. The ENTs say it is reflux; the GI doctors say it isn't I do have reflux, but I've been to 3 different GI doctors who say it isn't causing the sinus problems. Not much showed on Ct scans, but was finally diagnosed with osteitis; that's probably not your case though; I'm just pointing out that sinusitis is sometimes very difficult to diagnose. It has been my experience and others on the board that you can still have significant sinus disease without it showing much on CT scans, especially if it is in the ethmoids. You might try taking a 2nd protonix at night and see if that helps, but if you are having a smell from the PND, I would think that would be from bacteria and not reflux. It does sound like you should get your thyroid checked, because I think it can sometimes cause sinus problems too. Also the antibiotics can cause stomach upset, but sometimes you need to be on them for an extended time to make sure all of the infection is cleared up. If one isn't working, then maybe try another. If that faills, you may need to try using something like amphotericn nasal wash as you may be having a hypersensitivity reaction to molds (not typical allergy). Good luck!!! kathyw > On 12/16/05 10:47 PM, in article 4ac7q1la9qmgf2ar7to5cu6s5mn8i5279b@4ax.com, > [quoted text clipped - 65 lines] > Headaches? Reflux > Mean and rotten to your parents? Reflux. Bingo! I'm glad to see that you've noticed this too! > Any readers have other suggestions? Avoid alcohol and don't smoke. Both alcohol and nicotine exacerbate reflux. Avoid stress. If necessary, consult a psychotherapist to help you deal with stress. I saw a study that showed that nearly ONE HUNDRED PERCENT of patients with anxiety disorders (depression, obsessive-compulsive, etc.) had some kind of gastrointestinal symptoms. Treat the anxiety disorder and the GI symptoms can resolve themselves. There's an old adage in the gastroenterology departments: "It's not what you eat. It's what's eating you."  SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. Thanks so much for the comments, I really do appreciate them. There's so much to cover...this will be a long one. Reflux advice: My question isn't really about what to do about it. I am taking medication and following the diet and lifestyle restrictions. Okay, sometimes I sneak in some cheese, etc. But otherwise, avoiding the citrus acid, elevated the bed, blah, blah. My dilemma is whether or not I actually have reflux, which some of your comments covered. Since the day the ENT diagnosed the LPR, I have been skeptical and worried that she was just being a little lazy. All the pains and problems I have had since being on medication distracted me but now that the GI and cardiac doctors have found nothing, I am refocusing on the PND and sore throat. I have had tons of PND the last couple of days while on the protonix. So either it's not reflux or the medication isn't stopping enough of the acid. I am seeing a pyschologist weekly and am hoping to slowly but surely get better. A decade ago, I would get IBS type symptoms during finals while as an undergrad. But it would only be for a few days and it stopped altogether after graduation. So I am prone to GI problems when under stress, but months and months of symptoms is a new thing. MY PND is white and very, very thick. Like old Elmer's glue. Occassionally, something dark yellow will pop out if I have skipped a nasal washing or two but otherwise nothing colorful. And yes, my small polyps are in my sphenoid and ethmoid sinuses. But other than the PND and sore throat, I do not have the crushing sinus pain and headaches. I had a couple of sinus attacks in the past and I know what that feels like and I just don't have it now. Kathy, that's pretty scary that it's been years and your doctors can not conclude whether or not you have acid reflux? > MY PND is white and very, very thick. Like old Elmer's glue. > Occassionally, something dark yellow will pop out if I have skipped a > nasal washing or two but otherwise nothing colorful. That sounds like it could be chronic sinusitis. > And yes, my small polyps are in my sphenoid and ethmoid sinuses. But > other than the PND and sore throat, I do not have the crushing sinus > pain and headaches. I never get sinus pain or headaches. My main symptom is the constant discolored PND. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. I do have documented acid reflux, but the GI doctors keep insisting that it isn't causing my sinus problems. I take medication for it. There is a specialist at Wake Forrest University that does a double pH probe testing for laryngeal esophageal reflux. I've considered going there, but I don't seem to have the digestive problems except when I am draining and then the drainage burns my digestive tract. Mine is mainly the clear-jelly like to white glue like junk also now, although it used to be dark brown. When I don't drain, I have the sinus pain, but no digestive problems. So I've concluded that the inflammatory products in the drainage are the main thing that upsets my digestive system. Also, I have a lot of other complex problems occurring from a massive exposure to mold from a "remediation" at my former workplace, so it's hard to know exactly what is happening with me, but the type of drainage that you are describing is exactly what I have. I called the ENT today to discuss my GI visit results and she said erythema of the arytenoids IS a sign of LPR. But in general that any parts of vocal cords can be imflammed by either something from above or from below. So it's not strictly a LPR thing. She was pretty dimissive of the GI's diagnosis. Funny when I first saw the GI, I heard that the ENT sends way too many people over to their department when they can't figure out what's wrong...it would be funny if I wasn't one of these patients. Anyhow, she knows I want to change doctors and I thought she would be happy to get rid of me, but she actually returned my call promptedly and we had a pretty lengthy discussion...so I agreed to try Astelin and that I would see her in Janaury. *sigh* Saw ENT today and her diagnosis is that I have a swollen throat and inflammation in my nose. Tada! That's what she told me in September too! Though at the time she said it was a sinus infection. Now like Kathy, ENT thinks I have two disparate problems. Acid reflux causing the sore throat and rhinitis that causes the inflammation in my nose. Said I probably have always had low grade rhinitis, but am acutely aware of it now because of the addition of the acid reflux. Astelin hasn't really helped. ENT doubled my protonix from 40 to 80mg. Trying this for 6-8 weeks. Also linked the acid reflux to my depression/stress condition. If this doesn't work, I don't know what else will. ENT is convinced it's acid reflux. She used the scope this time at least. I have also told her repeatedly of the intermittent white gluey mucous, but the ENT doesn't seem to think it a big deal. Keep us posted on this. I will be interested to see how you do on the extra protonix. I was on 4 nexiums a day and it didn't help, but hopefully it will in your case. Kathyw Wow, 4 nexiums. Isn't there a chance that your problem wasn't acid reflux-based then? I just talked to the gastro and he said to stick with the higher doses of protonix and then schedule a meeting with him in a month. The next step would be a PH test. He can't say if it's acid reflux or not, but he did bring up again the acid reflux debate between Ents and Gastroentologists. He used very emphatic words to describe how Ents are just convinced to no end that sore throat that are hard to treat must be caused by acid reflux. I am down to 2 nexiums a day now.. I think that whatever was/is still somewhat draining from my sinuses was/is causing most of my digestive problems. I do have intermittant gastritis and duodenitis and have had grade II esophagitis, but have had 2 pH probes and a Barium swallow that don't show significant reflux. So I still have a lot of reservations about reflux causing my sinus problema. I was even recommended at one time to have the surgery for it, which I almost did. I'm glad now that I didn't. My current treatment is helping somewhat now. I won't mention it, because my history is very complicated and am still not sure exactly what the problem is except it involves inflammation and possibly still infection in the ethmoid bones. I have finally found a good ENT and am hoping he won't give up on me. My experience with most ENTs up to this point has been if they don't see it on CT scan or during endoscopy, it doesn't exist. And if you don't have the drainage on the day of the appointment, most will not believe you when you say that you do on most days. If they don't know the cause, then they blame it on something else. I also have the pain when I don't drain. If the ENT doesn't see it when it isn't draining, then it has to be in the bone or beyond their ability to see it with the scope, which I think would be true with the posterior ethmoids. Mine is always postnasal drainage. It very seldom comes out my nose These are some questions you might want to consider? How are your teeth? I was told that if you have a lot of reflux, the acid would erode the enamel. My dental hygenist keeps telling me that my mouth is alkaline because I form a lot of plaque, but very seldom get cavities and my teeth are in excellent shape to be 57 years old: no fillings except in molars, have 2 caps, but never even had a root canal. I actually even used some pH strips to test it myself and it was almost always alkaline. Are you symptoms worse when your sinuses are draining or when they are not? Mine are worse with the drainage. I don't seem to have very many digestive symptoms when I don't drain, but the sinus pain and pressure are awful then. Your problem may be reflux. I'm just telling you my experience. But I would be very skeptical, especially if you don't improve on the higher dose of protonix. Kathyw I have acid reflux. The night is the worst for me. I take OC Prilosec at night and it helps a lot. My MD told me to take it for 3-4 nights for these attacks. That is what I call them as I do not have the reflux all the time. My head is raised at night, nothing to eat for 3 hours before going to sleep. shirleyann > Hi I was here a couple of months ago with lots of questions as I was > struggling with a sore throat, bad breath and PND. I was being treated [quoted text clipped - 12 lines] > working or not. So 3 months later, I still have...a sore throat, bad > breath and lots of PND. What color is your PND? > Any ideas? Anyone gone through something similar...any hope? I've been thru all this--and much more besides. This "reflux diagnosis" was a big fad in recent years because they found that people can get sore throats and laryngitis from reflux. The problem is that doctors seem to be using it as the default diagnosis when they can't figure out what else may be wrong. Since zillions of people have reflux, that's very convenient for them. But I went thru that whole nine yards, all those tests, and the gastroenterologist said the same thing: My problem must be chronic sinusitis, not reflux. In my case, it was very simple: I didn't get yellow-green PND from reflux. The problem is that even CT scans miss things. My surgeon told me that when he finally operated on me, he found sinus disease that he himself couldn't see on the CT scan. This has now happened to me TWICE, with TWO sinus surgeries. I suggest you find an ENT who will diagnose you based on your symptoms and history, even if your CT scan is negative. That was the only way I was able to make progress. SignatureSteven D. Litvintchouk Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.