pete

To all (Howard - if you get to read this, please respond, I would appreciate
it so much),

I am having a lot of trouble right now with no solution (as I have made note
of recently in another thread). I am not a candidate for fundo, and that
would only help my problems above the LES anyway. My PPI's are not working,
and certainly not the H2 blockers. I burn and sting almost all the time
(stomach, esophagus, chest, throat and tongue), like I did in 2004 when my
prevacid stopped working after seven years (increasing the dose didn't
help) - protonix also failed with large doses, and then I took prilosec and
it helped and I took it for approx 3 years, and now that has failed, and I
just started taking aciphex now, with no help.

Just had my yearly EGD a month ago, and everything basically okay except for
my pre-existing polyps first reported in 2004 (no doubt caused by my taking
prevacid for 7 years), and mild gastritis - esophagus okay, pathology
negative for short barretts - no esophageal ulcers, erosions, masses,
strictures, varices, or inflammatory changes were seen.

I believe it is acid causing the problem (versus non-acid) since antacids
seem to help (but not for long - eating also seems to help, but not for
long), and the 10 years that I was on PPI's enabled me to be pain free (when
they were working of course), and when I used to stop taking them as a test,
I would get worse and improve once going back on them (which to me indicates
an acid condition). Now I think they have stopped for good.

But now I am wondering if a non acid situation could also be involved. I
have rolls of pH paper (good range, ie 5.5-8) and have been checking my
saliva constantly (looking for trends, etc). I know the ideal saliva pH is
supposed to be 7.4 (like the blood and spinal fluid I believe), and I
believe it may go down in the six range with age and lifestyle changes, and
I guess it goes way down with cancer.

It seems that my saliva tends to measure (6-6.4) when I get up, and at
various times in the day when I am burning, and then it will rise after
taking an antacid (naturally I wait a while) and it seems to rise after
eating (and then waiting a while). It reads a solid 7.4 or 7.6 right after
salivating from eating something, and checking it right away, which is a
good indication that my saliva right after eating is basic, like it should
be - lol.

So my main question is this. If my saliva is 6-6.4 throughout much of the
day and night (and for sure when I am burning), isn't that an indication
that I am indeed having acid reflux, versus non-acid reflux. In other
words, I would think that if non-acid reflux was causing my burning, pain
and discomfort, then my saliva pH would definitely be above 7 all the time
(ie, pure water is neutral, and say 7.0 - and water doesn't cause you to
burn). Or could the pH be 7-8 (or higher) in the esophagus and stomach, but
register as 6 in your saliva - I don't see how.

I have read all of Howard's posts in the last 3 years and have saved a large
number of them, so there is no need to explain ambulatory pH testing and
impedance testing to me :-) . I am not a candidate for fundoplication.

Please help in any way you can regarding the usefulness and validity of my
saliva pH test questions, especially Howard. Thanks...Pete

bob noble

Pete,
I must of missed this somewhere?
Why aren't you a candidate? Sure sounds like you should be as you have all
the symptoms I had before my fundoplacation. And the operation fixed them.
Sorry for not answering your question,................. again. :O)
--
Bob Noble
http://www.sonic.net/bnoble

bob noble

I will say this about Saliva Pete, if you'll not mind the long windy post.
:O)

When I was having all the trouble like you, I and my dental hygienist
noticed
that my lower teeth on the front sides were etching rather fast causing
rather nasty cavities. I also noticed that a lot of saliva was coming out of
the corners of my mouth at times, which I mostly thought, at the time it was
older age. What I didn't notice at this time and realized after the fundo
that my spit also had almost no bubbles in it and was rather thin and
watery. By the way, etching teeth is likely acid, but I didn't measure.

Anyway, after the fundo operation, I, my dental hygienist and my dentist at
different times, noticed my saliva had more bubbles then normal. Lots of
them and my saliva has also thickened up a lot. And I think the itching of
the teeth is residing, but that's a hard one to pin down. As far as I can
tell, the stuff you are talking about wrong with you could be cured with a
fundoplacation operation. And believe me, I was just as doubtful of the
fundo
as you, likely moreso. It took me over a year before I decided to go with
it.

The real point Pete, is everything is interconnected. Screw up one and the
other will try to react to keep things working or whatever?

--
Bob Noble
http://www.sonic.net/bnoble

pete

Thanks Bob...I don't really want to get into all of the reasons for not
wanting a fundo, and have never even come close to trying to pursue it (when
my PPI's worked everything was okay except for the polyps).

First of all I am definitely afraid to have it for the possible risks
involved with the swallowing, belching, vomiting (and I have bad experiences
with other surgeries). Second they don't do the lap nissen where I live and
my gastro says it's a waste of time and doesn't work (but I will agree that
he doesn't know much about it), so I would have to pursue this in the next
big city and go through all the tests again (I went to Baltimore in 2004 for
a second opinion and had the 24 hour ph and manometry, and got nothing out
of it at all - and my gastro didn't even know how to read the damn report -
it's a long story and I wrote about it three years ago). Third I don't have
anyone to help me (other than one person, and it is difficult at best).
Fourth, like I have wrote in here several times lately, I don't see how a
fundo will improve problems below the LES (I have burning and stinging from
the stomach, esophagus, chest, throat and tongue). A fundo will only help
above the LES.

I was hoping Howard would answer my post, by maybe reading it via someone
else's post, since he has me blocked. I wish we could resolve our past
problem but I guess not. I was really looking for some answers to the
detailed points I made about my saliva pH and using it as a tool to help
determine if my reflux is acid versus non-acid (I am sure it is acid like I
said). If you understand pH, and read what I wrote it would make sense to
you, I hope.

Oh well, I am screwed. Thanks for your post...Pete

bob noble

Hi Pete,
I'm not sure Howard has you blocked, but he has already stated something
that people just don't seem to get and maybe just doesn't have anything else
to say after saying that. It's like he stated some facts and you're not
listening. :O)

There is only one cure for gerd. And that is the fundo operation. It doesn't
matter if it's acid or base. It's stuff going back past the les that causes
the problem.

I fought this idea myself for a long time

And I won't beat around the bush this time and I'll state it flat out. A
fundo operation can and does change what goes on below the
operation........... Period.

I didn't exactly take to the side effect idea early on either. Sometimes I
like to be able to vomit to get rid of something I ate or drank that is
causing problems. It's a side effect that can be dealt with. It hasn't been
a problem for me. The can't burp thing hasn't been a problem either. It can
all be dealt with easier then the gerd.

Actually, after the fundo operation, my stomach area doesn't get so messed
up and upset and the need get rid of the stuff by vomiting doesn't seem to
happen anymore.

I went through a lot of what you are going through and I know you just have
to take the path you take to get there.

Bob Noble
http://www.sonic.net/bnoble

howard mccollister

Thank you Bob. It's not surprising to see such a simple mechanism dismissed
in favor of elaborate alternative explanations in an effort to avoid the
concept of having surgery.

I certainly understand reluctance to have surgery, and I understand the fact
that that reluctance manifests itself in a wide variety of...uh..."unusual"
interpretations of upper gastrointestinal physiology and anatomy, such as
the confusion over PPI's, the effect of H pylori, salivary pH etc etc. And
that confusion also results in a plethora of websites hawking alternative
nostrums that supposedly addresss those bogus mechanisms, right down to the
salivary pH strips that can be found in almost any homeopathy store or web
site.

Admittedly, I'm an allopath through-and-through. Worse than that, I'm an
allopath who is a surgeon. I make no apologies for the fact that I demand
real science and investigative technique before endorsing a particular
treatment. I've been doing this awhile. I am aware that much of the reason
people turn to these bogus treatments is failure on the part of many doctors
to adequately listen to and educate their patients, or in some cases just
plain ignorance on the part of the doctor. I try to keep an open mind about
alternative medicines because it's important to some of my patients, but I
admit it's often hard because a lot of that stuff is just plain laughable.

I've learned not to get frustrated at people who don't take my advice, or
don't want to listen to my interpretation of the physiology and anatomy. I
can only advise them based on what I know and what I've observed over 25
years. I'll help where I can, and if my opinion isn't needed or wanted,
that's OK too. I have plenty of work to do without spending any effort
worrying about anonymous, faceless.

So, all that said, I'm here if I can help. If not, that's OK too.

HMc

pete

Howard does have me blocked (or plonked or killfiled) for something that
happened in the sci med ng a couple years ago. Screw that, I was just
trying to find out some info on saliva ph. I damn straight know what causes
GERD, and I have read about the fundos (from Howard) for 3 years now and it
doesn't need to keep being repeated.

Did you read my reasons for not wanting to pursue one - I gave you four
reasons. And I don't agree it would help below the LES, but Howard won't
comment because he doesn't read my posts.

I have had enough. I was trying to ask some questions about saliva pH, not
trying to get into a damn argument about how fundos are the greatest thing
since apple pie. Many people have had bad results with them - and I know it
depends on the skill of the surgeon - da da da da.

Pete

bob noble

Yes, I read your reasons, but everything is a trade off. You want to keep
the gerd, with all it's pains, that's your trade off.

I'm a patient, with experience in this thing. You can believe whatever you
want and unfortunately, believing wrong or refusing to believe the facts is
only going to hurt you, not me. I got rid of all the gerd stuff and am very
happy with it.
I tell you I had the fundo and it most diffidently stopped all the pains
below the les. You don't want to believe that?

I'm not going to plunk you because you refuse to believe, but I can see why
some might do that to you.
No offence, but you seem to be your own worst enemy.


--
Bob Noble
http://www.sonic.net/bnoble

tim j.

I was concerned with the risk of difficulty swallowing and put the
Nissen of for a year. Yes, it's a bit difficult for the first few
weeks, but overall the swallowing problem is less severe now than
pre-op, because my esophagus doesn't stay irritated. If necessary,
you can learn to relax enough to allow belching and vomiting.
Personally, I see the "difficulty vomiting" as an added benefit of the Nissen.


If I had a doctor nay-saying a procedure when he didn't know much
about, I'd be looking for another doctor. Was this the same doctor
who didn't know how to read the report? If I were in your shoes, I'd
find the closest place that did them and get a referral to a doctor there.

A valid point, but how much and what kind of help do you expect to
need? I was back on my feet 2 days after the surgery, and I am a
single parent with 2 kids.

Let's put that argument aside for a moment. You know you have GERD.
This procedure, properly done, can correct the problem. So if you
continue to have problems below the LES, at least you will be rid of
the GERD. I continue to battle IBS problems, but I'm thankful every
day that I don't have that wretched reflux anymore.

bob noble

Hey Pete,
This paragraph just sticks me wrong. :O)
You've had enough? What kind of crap is that to say to people that have been
trying to help you? I told you all I know abort my knowledge on the saliva
topic and let you know what cured the problem. Howard has flat equivocally
stated that ph didn't matter in the gerd problems in another thread a short
time ago, so why should he even try to help someone with your attitude?

I sure am not trying to, .........get into a damn argument, .............on
the fundos being the greatest thing. Unfortunately, at this point in
medicine, it is the only cure for gerd. But, luckily, there is at least one
thing that can do it.

Many people have had very good results with the fundo, over ninety percent,
so your statement of many people have had bad results with them is true but
out of proportion.. Yes, many people that never had the opportunity to get a
fundo got other complications and died or just felt like hell the rest of
their lives. I was feeling like hell and finally decided to do something
about it, before it caused something else to go wrong.

You are now where I was not too long ago and you will have to make that
decision. There is only one cure for gerd. Do you want to get better and,
maybe feel great, or do you want to feel like hell and take the chance of
something else going wrong?

You chose, I already did. :O)


--
Bob Noble
http://www.sonic.net/bnoble