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Old 09-22-2005, 08:14 AM   #1
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prilosec 2x's a day???

is it ok to double up on my prilosec, i have been taking it for months and still get the food coming back up and the feeling of fullness/congestion in my throat, occasionally while i am making myself cough i will get some phlegm to come up but i still have that feeling of a lump... is it ok to double up i take 20mg now?? thanks

 
Old 09-22-2005, 11:05 AM   #2
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Re: prilosec 2x's a day???

If you are coughing, you may have LPR (laryngeal pharyngeal reflux). Standard treatment is 2 doses of a PPI per day (at 40 mg per dose). Sounds to me like you are underdosing yourself significantly. Also, if it is LPR, Prilosec is not the drug of choice. Try Nexium - just ask your doctor for a weeks supply of samples. If it works better in my experience, when Prilosec completely failed for me (even when I was taking 8 pills a day). Now I take 2 Nexiums and am healthy!

See this article:
http://www.jaapa.com/issues/j20050801/articles/lpr0805.htm

 
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Old 09-22-2005, 11:56 AM   #3
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Re: prilosec 2x's a day???

wow, 8 pills a day?? what was your symptoms that you were having? did your throat feel congested and like there was something in there?? thanks

 
Old 09-22-2005, 08:40 PM   #4
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Re: prilosec 2x's a day???

Before successful Nexium treatment, I had a severe and unrelenting cough. I mean unrelenting - as in every minute of the day that I was sitting or standing. The only relief I had was lying down on my right side. There was a sense of never being able to fully clear my throat. The more I coughed, the worse it got, but I couldn't not cough either. Yes, there was a lump like sensation in my throat. The acid caused erosions throughout my sinus passages, causing extreme sinusitis -like symptoms. My nose was stuffed 100% all the time, and there was buring in the sinuses.

At the time of my diagnoses, I had asked myself right before it, how much longer could I go on like this - and I wouldn't have lasted more than a few months. I was ready to end it as a result of the f***cking LPR. It 100% destroyed all the quality of my life. Luckily, Nexium gave it all back to me. I am one of the lucky ones with a 99% response. Still get a little coughy, but very manageable.

 
Old 09-23-2005, 05:17 AM   #5
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Re: prilosec 2x's a day???

I went to an ENT and he looked at my throat and said it was irritated from the heartburn and that was it, he didnt even give me a prescription other then an allergie and sinus one.....i have post nasal drip all the time and the side where the irritation in my throat is the side my nose is always stuffed. But i need to get a new doc, when i make myself cough it feels like my thoat or esophageas is sticking together then releasing, its crazy it has messed with my quality of life because all i can think of is i have cancer!!!!

 
Old 09-26-2005, 05:53 AM   #6
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Re: prilosec 2x's a day???

I'm in the same boat with all of you and have just started taking Nexium twice a day. I've only been on it a few days but I can see subtle differences in my throat. My throat was raw and irritated and had white stuff on it. The throat mucous was killing me as well as the constant coughing. I am hoping the Nexium will continue to improve my situation. It took a long time to get a diagnosis. Now my ENT believes that LPR could have caused my cryptic tonsils requiring a tonsillectomy at age 50!!!!

Last edited by dbaum; 09-27-2005 at 02:19 AM.

 
Old 09-26-2005, 07:37 AM   #7
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Re: prilosec 2x's a day???

How long did it take before you got a diagnosis? Its been one year for me and still no diagnosis, just self medicating myself with prilosec that doesnt really work, now i have to make an appointment with my GP and get them to refer me to another ENT, unless my GP gives me nexium, i think i need something stron to heal my throat, I am freaking though thinking i have undiagnosed cancer!!

 
Old 09-27-2005, 02:18 AM   #8
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Re: prilosec 2x's a day???

I started down this road about a year ago. I started going to an ENT for my tonsils that were just a mess. He diagnosed them as cryptic and suggested they be removed. So, April of last year I did that. After the surgery, my throat was just not right and the mucous kept increasing and I was just so uncomfortable. He did a CT scan on my sinuses believing the drainage was coming from there. The scan showed my left frontal sinus to be completely blocked. However, I never had any sinus symptoms. But he was about 80% certain the drainage was coming from this blocked sinus. So, in July I had sinus surgery. Still no change. He briefly mentioned "silent reflux" but never went any further. At this point I had not heard of it so I dismissed the idea.

In August there was still no improvement and now he was convinced that I had fungal sinusitis. So, he prescribed Amphotericin-B sinus was twice a day. This did not help. I was at my wits end and my ENT was ready to send to an allergist. Then I remembered what he said about "silent reflux." I did some research on this topic and found out about LPR. I had all the symptoms. I called my ENT and he sounded almost relieved. He told me I was not off base but he thought he had addressed this issue with me. He immediately started me on Nexium twice a day. I am scheduled to see him next month for a follow up but I can see a small improvement. Mornings are still tough but I think this is going to work.

That's my journey. It was a tough road and most all of it could have been avoided if LPR had been identified earlier.

 
Old 09-27-2005, 06:59 AM   #9
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Re: prilosec 2x's a day???

Hi Dbaum,

I remember you from the Adult Tonsillectomy thread. I too had cryptic tonsils and stones that I got removed. My ENT thought mine were as the result of LPR and he wanted that resolved first but I just wanted rid of them. My main reason was the lousy taste and breath I thought and hoped the stones were causing. Well I was ok for 3 days post op but the pnd, throat clearing, stinging nostrils, congestion, acidic taste and breath returned although less odorous than with the stones. I have since undergone an endoscopy and 24 hour ph monitoring and await anti-reflux surgery shortly. I have a sliding hiatus hernia and loose lower esophaegal sphincter. My ph monitoring showed numerous significant incidents of LPR throughout the day and night. The PPI's did not work for me as it turns out I have a structural problem.

I am particulary interested in your sinus problem and subsequent surgery. For the past few months I have had terrible headaches, tenderness around the eyes and a run down feeling....in addition to continual LPR. My GP suspected an infected maxillary sinus but anti-biotics were no use. I am of the opinion that I do have a bacterial sinus infection immune to or out of reach of the drugs and want a CAT scan done to see. Did your surgery rake out the infection or just drain the pus from the sinus ? It could be that the infection is still there causing the PND ? From having this condition for over a year now my personal view is that long standing exposure to the LPR (silent reflux) induces sinusitis when the acid fumes cause inflammation in the nasal passage which causes congestion and poor drainage and allows a bacterial infection to take hold in the sinus. The bacteria is then carried in the PND to the throat where it then gets into the tonsil crypts (created by acid erosion but exacerbated by food debris). Once there tonsils stones take hold. All the time the LPR worsens and its effects appear more namely globus, hoarseness, throat clearing, throat burning etc. From my recollection you did not suffer any taste or breath problems with the stones. Have you had any from the sinuses or LPR ?

Your thoughts much appreciated.

 
Old 09-27-2005, 10:42 AM   #10
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dbaum HB User
Re: prilosec 2x's a day???

Hi Ginger. I remember you as well. It's been a long road. Intially LPR was never discussed since my tonsils were very cryptic and I had several bad bouts of strep throat. So discovering LPR came after the fact.

My sinus surgery I do not believe was necessary if LPR had been diagnosed earlier. Even though I had a plugged frontal sinus I never had any symptoms like the ones you describe. My sinus surgery was to remove all the junk in the sinus whatever it may be. After that a course of antibiotics to clear things up should have done it. But it didn't.

Your symptoms do sound like chronic sinusitis and from what I have read the problems resulting from LPR are like you and I have both experienced. I would get the CT scan of your sinus and if there is a problem the surgery is no where near like the tonsillectomy. Believe me it's much easier. Ask your ENT to sent the junk off to be cultured for a fungal infection. There are only a few places in the country that do that kind of culture and it will take a couple of weeks to get the results back. If you are not responding to the usual course of antibiotics this may be your problem. There is a study that was done by the Mayo Clinic regarding fungal sinusitis and that's why my ENT put me on the amphotericin-B sinus washes twice a day. If this is your problem it should help. However it was not mine.

Let me know how it goes. We've both been through so much and it's just time to get healthy.

 
Old 09-27-2005, 12:31 PM   #11
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Re: prilosec 2x's a day???

its sounds like this has been a long road for a lot of people.........Did you ever have pain on swallowing with LPR? i occassionally have some pain on my right side behind the breast bone when swallowing, its not all the time just occassional...

 
Old 09-28-2005, 02:28 AM   #12
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Re: prilosec 2x's a day???

Thanks dbaum,

Yeah it's been 18 months since I first noted my LPR symptoms (globus,throat clearing) though in fairness I think it had been going on for sometime previous. From sufferers on other reflux threads it now looks like increased dental erosion (cavities and enamel) are an early indication of this problem as well as a persistant cough that does not go away. By the time the globus etc present it is often too late for many of us as the sinus problems have started (though we are unaware of them) and the microbial balance in the mouth is lost. It now looks that the tonsils were a by product of the LPR which may also have provided the infection also.

Interesting that you mention the Mayo study but I think they said that fungal infection was present at the same time as the bacterial infection. When I look at the symptoms of candida I feel it does explain a lot ie the lethargy, mind fog, sinusitis, and possibly the reflux. I have done the spit test regularly and it is mostly cloudy or stringy which is an indication of a yeast / fungal problem. I am having a candida blood test next month so hopefully it will shed some light on this. It could be simply the result of the anti-biotics I have been using although I do take acidophilis capsules to counter this. Who really knows.

The meds for the sinus have not worked so it's down the road of demanding a cat scan. I am keen to have this resolved prior to my fundo surgery. However, my GP is well nigh useless. I told him 2 years ago I think I have a hiatal hernia .....he told me I didn't. I told him I think my tonsils are chronically infected......he told me they weren't. I told him I am suffering acid reflux.....he told me I wasn't. You get the picture. The only reason I have got any handle on what may or may not be wrong with me is through my own determination and knowledge base.

It sounds like the meds might be working for you and indeed I hope they do. I think the issue is what is going to happen when you come of them or have to stay on them to maintain the benefical effect. Many others have had initial success but after dose is decreased or stopped the problem returns. My advice to you is even while the meds are working is to get an endoscopy or Barium x-ray done to see if there is any hernia or sphincter problem causing the reflux. The likelihood is that if the meds fail this is the reason.

Ginger

 
Old 09-28-2005, 04:30 AM   #13
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Re: prilosec 2x's a day???

Ginger, I know what you mean about GPs. I have had such issues with them. I, like you, learn on my own and go seek a specialist.

I am worried about long term use of Nexium and other such products, but time will tell. I will be seeing my ENT in two weeks to see what he thinks. But, I am wondering if a gastro doc would be the better choice. Any thoughts on that?

Jake, I have not had pain upon swallowing such as you describe. I do have pain, sometimes, on the left side of my throat. If I remember correctly some of the other folks on other threads on this board have mentioned chest pains from LPR but I can't remember if it was upon swallowing

 
Old 09-28-2005, 05:21 AM   #14
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Re: prilosec 2x's a day???

i only get the pain on one side of my throat but its more down in my chest area, i have heard other people with LPR mention that as well with chest pain..Sometimes when i do get a "productive cough" i can produce mucus but its really thick and yellowish, i do still get some wheezing as well....

 
Old 09-28-2005, 06:06 AM   #15
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Re: prilosec 2x's a day???

Hi dbaum,

Yes it's interesting. You need an ENT to diagnose LPR and to monitor the effects of the PPI ie has healing to the pharynx or larynx taken place. The source of the problem is the Lower Esophaegal Sphincter and any associated hiatal hernia. If the meds do not work or you are concerned about continued use then you will need a referral to a GI consultant to kick start this investigative process. My PPI (pantoprozole) did not make any difference and the side effects (lethargy, male breast tissue increase) was not worth it. As it turned out they were never going to help given the structural problem of my sliding hiatus hernia and poor functioning LES.

Hi Jake,

The mucous is either the result of a chest infection or more likely Post Nasal Drip. This can irritate the voicebox / throat along with the acid to induce coughing fits. A persistant cough is thought to be a very early indicator of LPR occuring. As for the pain upon swallowing this is more a symptom of significant GERD where the esophaegus lining is narrowed due to acid irritation. Also strictures can occur. Another cause of swallowing difficulties are pouch like openings in the esophaegal lining called diverticulums which not only narrow the gullet but catch food debris causing pain and food sticking sensation. Depending on where the pain is it could also conceivably be related to a problem with a hiatal hernia or sphincter which is perhaps not opening sufficiently to let food pass through.

Hope helps

 
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