starwarsmum

Hi everyone

I saw a surgeon yesterday (apparently the best in Western Canada) and
he was awesome. He knows more about GERD than my gastroenterologist,
internist and GP put together and was the first person to be able to
answer all of my questions! He restored my faith in our health care
system He is sending me for a repeat 24 hr pH, this time off meds,
and then a swallowing study, and then a repeat motility test in a year
to see if my esophageal motility issues are progressive. He is
concerned that I may have achalasia and doesn't want to operate until
he can be certain that that is not the case. (There is no impedance or
Bravo testing available here)

I have two questions that I forgot to ask yesterday:
1. Should I be taking supplements? He told me that the PPI and H2
blocker are interfering with absorption, and are playing a role in my
low iron count. I'm already taking iron and calcium, should I be
taking a B vitamin supplement or should I get my B12 level checked
first? This surgeon is the first doctor I've gone to that said this
was an issue, everyone else has denied it.

2. He said that I need to stay on the PPI (I went off of it at the
start of the month to try it) because I am having some symptoms while
off it (although I can live with them). He would rather I take the PPI
and be symptom free. Why would this be? He said I'm refluxing either
way, it's just not acidic on the PPIs. Does acid do more damage than
bile? Will acid reflux be more likely to cause motility problems than
non-acid reflux?

Thank you Howard for all of the information you give out on this list,
it helped me to ask specific questions yesterday, and to be informed
going in so that I wasn't shocked at everything I was told.

Amy

I'll suggest that you just go ahead
and take a B vitamin formulation especially
B-12 and folic acid. Understand I am
not a Doctor, this is just my opinion.

Just remember the longer you take and
the higher the dose of PPI meds you take, the
more likely you'll have adverse effects from
the meds. PPI meds weaken the bones
and don't assume this action is solely
by impaired calcium uptake out of
GI tract with suppressed acid release.
Though I will add you likely need more
vitamin D3 given that your Canadian
and more vitamin K because you are
likely eating a standard diet of some sort.
Again this is my opinion and this
may not be ideal if you have various
medical conditions.

It is nice he has a good "bedside manner",
but that doesn't mean you should embrace
the conventional medicine without question
even when provided with their best guesses
or explanations. Some of the orthodox medical
care providers I used were good/nice/caring people but
in the end I ended up being of the opinion
that the conventional model of GERD and
it treatment were rather flawed.

Recall that the use of PPI meds speeds
gastric atrophy, so I'd suspect as the years
go by your stomach may release less and less intrinsic
factor which is needed for B-12 absorption.
Hence, you may in time need either B-12 shots
or high dose milligram + sized tablets to force
the issue. Do a PUBMED search.

I'd suggest talking to a alternative medicine
provider for a TRUE second opinion. The one
I suggest my GERD and dyspepsia was from
too little acidity being released in the stomach.
While I don't fully agree in that I believe
GERD result in part from a leaky lower esophageal
sphincter with the bulk of the damage taking
place at night when one sleeps on a level bed.
Anyway the Alt Doc had me start on betaine HCL
capsules as a trial. It helped. And provided
I sleep on an incline along with the acid supplement
I am good. It has been 3 and half years
since I was on PPI meds and it is nearly ten years
since my fundo which went leaky after a year.
And I am not saying this way is for everyone
but for some us it works.

Just my radical opinion.
Best Wishes..............Trig

vanny

I suspect that your surgeon is being cautious with you because he has seen
what oesophageal cancer can do - usually it kills because it is caught too
late and it is difficult to treat if the tumour(s) is not operable.

I am managing my GERD with the lifestyle changes and an alkali diet. It can
be challenging, but I passed trial by fire yesterday evening in the
supermarket when I returned a packet of sweets to the shelves.

A few weeks ago my internist was quite happy for me to titrate the PPIs down
to 20 mg Omeprazole on alternate days. I still have reflux - it is not going
to go away on its own given that I have a weak LES and intestinal
strictures/stenoses, but a disciplined approach has helped me to reduce my
drug load and I have been able to take a PPI holiday for a few days at a
time.

I obviously am concerned about the long-term effects of the medication, but
I am on steroids, Opium, daily chemotherapy, etc., so the PPIs are the least
of my worries, as is GERD when it comes to that. As high a quality of life
as I can maintain is all important to me at this stage of the game and a
little discipline goes a long way.

Vitamin C increases the absorption of iron in the body and vitamin D
increases the absorption of calcium. I take a calcium and vit. D all in one
tablet. If you have a good diet (no fast food or packaged meals or empty
calories) and chew well you should not need any supplements, with the
exception of vitamin B12 for the reasons stated by the other poster. 1 mg
vitamin B12 taken sublingually each day should be fine to top up the B12
supples (stored in large quantities - enough for a couple of years - in the
liver). What the body does not require it will shed.

Folic acid is in the majority of foods, so given a good diet there should be
no reason to take this unless you are pregnant or have been shown to be
folic acid deficient. I had folic acid deficiency induced optic neuropathy
last year because my doctors didn't notice how ill I was with malabsorption
and maldigestion due to complications post-surgery for Crohn's, but it had
nothing to do with PPIs or GERD.
http://content.karger.com/ProdukteDB....asp?Doi=48300

Please note that the food pyramid has been replaced by a new food pyramid
http://www.washingtonpost.com/wp-srv...iet_042005.gif
Milk obviously will exacerbate your GERD. If you are worried about your
vitamin levels then you could discuss with your doctor taking a chewable or
sublingual kiddies vitamin tablet each day - anything more would be just
throwing money down the toilet - literally.

Once you get your lifestyle GERD-friendly then you could, with the
permission of your doctor, start experimenting with titrating the meds down.
The most important thing with GERD is regular EGDs, again on the advice of
your doc., to screen for cancer as some 10% of GERD patients end up with
Barretts oesophagus with 0.5% of these developing oesophageal cancer.
http://www.medicalnewstoday.com/articles/49864.php
http://www.webmd.com/heartburn-gerd/...om-acid-reflux

I have endoscopy (EGD) every 2-3 years, but it varies from doc. to doc. I am
happy with this and if I wanted it more frequently I don't think that my
doctor would refuse me, but without any severe symptoms I think that it
would be a complete waste of resources - given that I don't have to pay for
anything except approximately 30 Euros medicine copayments each month here
in Germany.

Vanny

"starwarsmum" <mum2my2boys@shaw.ca> schrieb im Newsbeitrag
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starwarsmum

If you are worried about your
vitamin levels then you could discuss with your doctor taking a
chewable or
sublingual kiddies vitamin tablet each day - anything more would be
just
throwing money down the toilet - literally.
Once you get your lifestyle GERD-friendly then you could, with the
permission of your doctor, start experimenting with titrating the meds
down.

Am I not absorbing a multivitamin? Do they need stomach acid to be
absorbed? Would it help to take it before the PPI in the morning? I
take a new heme iron supplement which I'm tolerating much better than
the other ones I've tried in the past.

My lifestyle is as GERD friendly as it can be (thank you Vanny for
your posts on this, it helped my find the modifications I need to
make) but I still get symptoms when I try to reduce my meds, so I've
been told by the surgeon and the gastroenterologist that I need to
stay on them. I keep asking though!

Thanks to both of you, I will keep at it!

Amy

vanny

Assuming that you have a healthy gut (apart from the dysfunctional LES
problem) and are chewing properly, you should be absorbing virtually
everything from your diet on moderate doses of PPIs with the caveat of the
vitamin B12/intrinsic factor problem and calcium for the bones - hip
fracture increased in patients on longterm PPI treatment.
http://www.google.de/search?hl=de&q=...+PPI+use&meta=
The biggest problem with the reduced acid due to PPIs in the stomach is that
the chewed food is not as broth-like as it should be. This is why GERD
sufferers must eat slowly and chew well to allow the pancreatic enzymes good
access to the food-broth as it passes into the duodenum, which will allow
the small intestine to absorb as many nutrients as possible

If you have an inquiring mind and are interested in learning where
everything is absorbed in the gut there is a great diagram here
http://www.cmaj.ca/cgi/content/full/166/10/1297

With a healthy diet, you don't need multivitamins unless your doctor says
so. You can also prophylactically nip the possibility of hip fracture in the
bud by increasing daily calcium intake in the diet and doing the recommended
daily amount of movement and exercise. The vitamin B12 problem can be
overcome by taking it sublingually. A healthy diet is far better for you
than vitamin tablets - roughage in the diet helps maintain proper motility
of the gut and is indicated to protect against cancer.

I have short bowel syndrome after multiple surgeries for Crohn's and cannot
take vitamin tablets - I have to have all my vitamins injected, but take
vitamin B12 sublingually because of anaphylactic shock (very rare) the third
time I injected it. The sublingual route is a proven and effective route -
my B12 levels are great, now.

It would seem that I am lucky and my LES is not as dysfunctional as it could
be, thus I can control it well with the lifestyle changes. That said, I had
to lie down yesterday afternoon after doing a bit of light housework and
total exhaustion thereafter. When I woke up an hour and a half later I felt
terrible with acid burns in my brain (OK, slight exageration here), so I
know that I am refluxing.

Vanny

"starwarsmum" <mum2my2boys@shaw.ca> schrieb im Newsbeitrag
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starwarsmum

If you have an inquiring mind and are interested in learning where


Thanks for this info, I feel much better now knowing that it's the
small intestine that does the absorbing. I do notice that I pass food
undigested if I eat too fast, so I must remember to slow down and
chew! It makes sense to me now why this happens.

That said, I had

I get that too! It gives me a headache and my ears feel wet and
painful. Good description!

Thanks!
Amy

vanny

Ear infection (otitis media) has been attributed to/associated with GERD
http://www.emedicine.com/email/gerd/issue1-5.htm and LPR.
http://www.pediatric-ent.com/learnin...pharyngeal.htm

Like yourself I find it easier to work around my illnesses when I know why
it is happening and what I can do to control it.

Vanny

"starwarsmum" <mum2my2boys@shaw.ca> schrieb im Newsbeitrag
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starwarsmum

Ear infection (otitis media) has been attributed to/associated with
GERD
http://www.emedicine.com/email/gerd/issue1-5.htm and LPR.
http://www.pediatric-ent.com/learnin...pharyngeal.htm
Like yourself I find it easier to work around my illnesses when I know
why
it is happening and what I can do to control it.

That first article especially was awesome! I've been laughed at many
times for mentioning earaches, now at least I know I'm not crazy! I
had a terrible time with sore throats and sinus infections before
starting on PPIs, I had those long before I had typical GERD symptoms.
You're right, if I understand the physiology I'm far more likely to
stick with the lifestyle changes.

Amy

vanny

I also had sore throats for months at a time at the end of the '90s and was
told by my GP that it was due to stress. I did not have any heartburn, but I
did have bronchitis in 2001 and sinusitis in 2002 or thereabouts. I was
diagnosed with erosive oesophagitis and severe gastritis by EGD in Jan.
2003.

Vanny


"starwarsmum" <mum2my2boys@shaw.ca> schrieb im Newsbeitrag
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starwarsmum

Wow, I remember getting the stress theory, along with 'it's viral'
quite often. That's brutal that you had erosions before having
heartburn. Makes me wonder how long people suffer before getting the
right diagnosis, and how many people are living with it that don't
have to be.

Amy