The most interesting thing from a clinical point of view from your
episode with the doctor is how important it is to communicate
effectively and to deal with the patient's concerns. Too often doctors
forget that something they see a thousand times the patient has only
seen once and it's in them. But just as in every other profession,
there are nice ones and unpleasant ones.
This doctor probably wanted to save you the expense of scoping if you
were paying out of pocket (I think I read somewhere in these posts that
you were paying for the exam). If your symptoms and exam are supportive
of the diagnosis of GERD (more later), a therapeutic trial of acid
suppression is warranted before scoping. It sounds as though it was the
correct choice. Scoping can be done later if you do not do well.
Gastroesophageal reflux disease (which is not really a disease) is quite
common. It has always existed, but in the "old days" people ate lots of
antacids to deal with it. I believe it is more prevalent now due to
lifestyle changes including high fat diets and excess body weight. Even
10 lbs of extra weight can cause reflux. There are people who have it
at in childhood due to congenital weakness of the diaphragmatic
constriction of the esophagus. Most people over 35 have a natural
relaxation of the esophageal hiatus in the diaphragm (a hiatal hernia)
but when overweight (more than 50% of Americans), the abdominal pressure
forces acid up the esophagus often.
The acid can cause heartburn, but often causes ear pain, sore throat,
hoarseness and in those who use their voices for more than daily speech,
impairment of function. High fat or large meals, carbonation, mint,
alcohol, coffee/tea and tobacco can increase reflux as can tight
clothing. Reflux increases when recumbent typically. You can have no
daytime symptoms, then awaken with a sore throat and hoarseness.
Acid blockers such as Zantac/Pepcid/Tagamet/Axid called H2 blockers
(I'll leave the pharmacology out to save space) and
Prilosec/Aciphex/Protonix/Nexium/Prevacid called proton pump inhibitors
or PPI's which are more potent can reduce the amount of acid made.
While symptoms can clear quickly, the reflux can continue. Digestive
enzymes are even more damaging of the vocal apparatus than the acid, so
weight loss and lifestyle changes to reduce reflux are very important
for singers. There has not been any good data to show any long term
damage from properly used acid suppression, but the PPI's are VERY
EXPENSIVE - about $100-150 per month. Although, in my experience, in a
person who has few lifestyle problems but has had a bout with reflux, a
month therapy often suppresses the problem for a long time.
Now here's the thing about dealing with doctors as I see it. Most of us
enter training with the determination to be as good as we can be. The
traditional training process puts high value on having all the knowledge
necessary to avoid doing the wrong thing. An old saying goes, "The
lawyer trains to learn there is a library; the doctor trains to become
the library." Too many traditional medical professors use fear and
intimidation when students do not have the necessary information at
their fingertips so many doctors develop a discomfort with questioning
and a compensatory air of infallibility. Yes, it's counterproductive
and many of us in medical education are trying to stop it, but these
things change slowly. So, don't be afraid to say, "I don't understand,
could you explain it further" or "I can help myself more with more
knowledge." Then if you don't get the time or attention you need, find
someone else. There are a lot of doctors who will take the time to
educate you.
John Messmer, M.D.
Assistant Professor, Family and Community Medicine
Penn State Hershey Medical Center
> -----Original Message-----
> From: Lea Ann Martin [mailto:LeaAnn@k...]
>
>
> Well I am amazed! I took one of this aciphex...last night
> before I went to bed....and this morning my throat doesn't
> hurt. I can SING! So far so good....did a few scales a
> minute ago and I am sort of encouraged. Maybe this guy
> wasn't an idiot after all.
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