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    Old 03-15-2010, 04:06 AM   #46
    Flyerfan
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    Re: Getting off PPI's and acid rebound

    Quote:
    Originally Posted by rosebloom View Post
    Hi Flyerfan:

    I thought Aciphex was a wonder drug. Once I was put on it, I could eat and drink anything and everything I wanted with no reflux or heartburn whatsoever. Aciphex was my best friend.
    These were my thoughts exactly.

    Quote:
    Originally Posted by rosebloom View Post
    I am currently taking 150 mg Zantac twice a day (morning and night). I recently started taking a regime of orange peel extract (D-Limonene extract) every other day for twenty days along with the DGL, digestive enzymes and probiotics.
    How often do you take DGL?

    Quote:
    Originally Posted by rosebloom View Post
    Once the PPI is removed, the gastrin signals the parietal cells in the stomach to start releasing acid and what we get is an acid storm that can last for weeks until gastrin levels normalize and we return to a baseline of symptoms (whatever you were experiencing when you were put on PPI's in the first place).
    In my research, I also read about the acid rebound so I knew what to expect. However, I don't know what I will return to once gastrin levels normalize because I don't ever remember having any problems in the first place (at least as far as heartburn, chest pain, etc is concerned)

    Quote:
    Originally Posted by rosebloom View Post
    From what I have read, you can supplement your PPI with an H2 blocker like Zantac during the withdrawal phase.

    I was able to cut my 20 mg tablet of Aciphex in half and took 10 mg for a few weeks before I finally went off it completely and began to take the Zantac.
    Was your Aciphex enteric coated? Did cutting it make it less effective? That is what I heard anyway.

    Quote:
    Originally Posted by rosebloom View Post
    Apparently carbs force the stomach to produce acid, and a diet low on carbs reduces stomach acid and reflux. I am not a scientist, but have already read about this from different sources and different internet sites. Apparently the acid produced as a response to ingesting protein is used to digest that protein and does not linger in the stomach.
    The lower carbs, I think, are definitely helping. I eat around 100mg per day (around 5-6 servings). The digestion thing makes sense.

    Quote:
    Originally Posted by rosebloom View Post
    I don't think my reflux will ever be "cured." I have accepted it is a chronic condition and I'll probably have to take some type of medication my entire life. At this point, my goal is to try to use the H2 blockers rather than the PPI's. H2 blockers have not been associated in the literature with hip fractures or stomach tumors, likely because they are not as effective in blocking the production of stomach acid as the PPI's.

    Sadly, I have received no information and little support from my doctors. Neither doctor told me about the calcium malabsorption with PPI's or acid rebound. I have found all this information on my own.
    I am prepared to watch my diet the rest of my life. My diet was horrible before anyway. The way I've been eating the past couple months is way better for me. I've lost 14 lbs and counting. I only need another 10 lbs to get to a "normal" weight.

    I understand the "no information" from the doctors. They just want to put a bandaid on it. They are either misinformed or don't have the time to investigate.

    Did you ever think of going to a naturopathic doctor? I've been thinking about that.

    Good luck and I look forward to checking in and seeing your results. All the best.

    Sharon

     
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    Old 03-15-2010, 07:14 PM   #47
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    Re: Getting off PPI's and acid rebound

    Hi Sharon:

    As far as the Aciphex, I don't know if they make more than one type of tablet. Mine were 20 mg, round and small, and I had no trouble cutting them in half with one of those pill guillotines you can buy at the pharmacy. I never knew they were enteric coated or that they could not be split (Then again, aspirin is enteric coated and I have to trouble splitting one in half and taking a half if I need to).The half dose (10 mg) worked very well. It was actually when I started to cut that half in half that I began to experience symptoms. I guess 5 mg is not enough to suppress acid. I actually told my family doctor that I was splitting the 20 mg pills in half and she said "OK." Maybe she does not know any better. But split them I did, and they still seemed to work pretty well while I was using the halves (10 mg).

    The reason I refer to going back to a baseline is that I have been through seven weeks of pretty severe symptoms, but have begun to feel almost "normal" on the Zantac now that I am at the beginning of my eighth week off Aciphex. Before, I was feeling pretty crappy even on two 150 mg daily doses of Zantac.

    I don't take DGL all the time. I only take it when my throat feels raw, which has not occurred for three or four days. I don't find it very pleasant and it makes everything I eat taste like it. But there were a few weeks there when I was sucking on those pills three or four times per day. I was also taking teaspoons of honey to soothe my throat and esophagus and drinking the aloe juice. I have cut back on most of that by now that the Zantac and low carbs seem to finally be doing the trick. It is hard to remember to take all that stuff unless you feel miserable. I also had to be careful not to drink too much aloe juice as it gave me stomach cramps and diahrrea. A little aloe went a long ways for me.

    In my particular case, and assuming that my rebound symptoms have now begun to finally subside, it has taken almost two entire months for me to go for three entire days without experiencing heartburn or some other gastric symptom. I took my last Aciphex on January 20th or so.

    When I first got off the Aciphex, not only did I experience horrible heartburn, but I also began to experience symptoms I never had before the PPI's. These included: stomach pain, bloating, feeling of pain on the pit of my stomach, gas, and general indigestion. I have not experienced heartburn or indigestion for three entire glorious days, and I am being very careful to keep those carbs down and still stay off coffee, onions and other irritants. I love my coffee and love bread, rice, potatoes and all that good starchy stuff. But I'll stay away from them if I can manage my symptoms and stay off PPI's for good.

    If I can continue to maintain my present functioning and have decent days like the past few days, then I have finally begun to turn the corner. But I don't want to declare victory too soon.

    I think the low carbs are helping. I also think the orange peel extract is helping (or at least not hurting). I guess the trick is to keep that esophagus and throat coated and minimize the damage as much as possible as we are going through rebound. I took quite a bit of Gaviscon during the first couple of weeks. Rather than allow the heartburn to go on, I would take a tablespoon of liquid Gaviscon and start to feel better after ten minutes or so.

    I was very discouraged many, many days. There were days when I felt I was doing better, but others I felt I was going backwards. Three days forward, four days backward. I am going on spring break for a few days and hope I can hold on to my healthy diet and not give in to too much temptation. I am taking the DGL along just in case. Too bad I can't take a bottle of aloe juice on the plane.

    The one thing I would do differently if I had to do it all over again is to get off the Aciphex more slowly. I cut the pills in half for a week, then cut those halves in halves for a few days and, in about two weeks, I had stopped taking it completely and started the Zantac. I might do as you suggest to start alternating one day on Aciphex and the next on Zantac. Then, maybe one day of Aciphex, and two on Zantac and so on until you are taking more days of Zantac and less Aciphex. There has to be an easier way than the way I went about it.

    My goal at the beginning was to stay off Aciphex for at least three months to see if I could work through the rebound and get to a level where I could keep my symptoms manageable. Maybe I am there or maybe not. GERD is a fickle disorder. I'll report when I get back from spring break.

    Congratulations on your weight loss and hard work. I am sure they'll pay off health-wise.

    Rose

     
    Old 03-18-2010, 04:42 AM   #48
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    Re: Getting off PPI's and acid rebound

    Rose:
    Just a quick note as I'm off to work....

    I hope you succeed. I would hate for you to have to go through months of this and not get better. I am very interested in your progress so please keep posting.

    Right now I'm sticking with one 20mg Aciphex every other day, nothing in between except the natural stuff. I've been OK because I've been very disciplined with my diet. Nothing...I mean nothing that I think will cause reflux. I have a doctors appt end of the month and I want to tell him what I'm doing and see what he says about splitting the pill. I'm still thinking about doing the Zantac instead.

    Would it be easier to go off the Zantac eventually than a PPI? Just wondering if you know that. That's a question for the doctor I guess.

    This is a nasty thing, this reflux. It's almost like street drug withdrawal when you try to stop the meds.

    Good luck and keep me posted. Have fun on spring break!

     
    Old 03-18-2010, 05:24 AM   #49
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    Re: Getting off PPI's and acid rebound

    I thought I'd provide a quick update on my divorce (from PPIs). About 3 weeks ago now I had a GI virus and took nothing at all over the course of a weekend. After this "cold turkey" stop I decided to not go back on the omeprazole and see what happened. So far, so good. No big acid rebound, although I may be refluxing and not noticing it. There are times when I feel a slight tightness in my chest right around the area of the LES, but I've decided I'm just not going to medicate for that (if it even is reflux). If I start noticing alot of reflux, my plan is to take an H2 blocker occasionally and only as REALLY needed, but I've not needed it yet. I am eating very healthfully and getting alot of exercise and so far my body is holding steady. It may be that I haven't had the bad acid rebound that some of you have experienced because I wasn't on the omeprazole all that long (just about 4 months when I stopped). I'll post an update if anything changes.

     
    Old 03-18-2010, 09:02 AM   #50
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    Re: Getting off PPI's and acid rebound

    Quote:
    Originally Posted by abbydabbydew View Post
    I thought I'd provide a quick update on my divorce (from PPIs). About 3 weeks ago now I had a GI virus and took nothing at all over the course of a weekend. After this "cold turkey" stop I decided to not go back on the omeprazole and see what happened. So far, so good. No big acid rebound, although I may be refluxing and not noticing it. There are times when I feel a slight tightness in my chest right around the area of the LES, but I've decided I'm just not going to medicate for that (if it even is reflux). If I start noticing alot of reflux, my plan is to take an H2 blocker occasionally and only as REALLY needed, but I've not needed it yet. I am eating very healthfully and getting alot of exercise and so far my body is holding steady. It may be that I haven't had the bad acid rebound that some of you have experienced because I wasn't on the omeprazole all that long (just about 4 months when I stopped). I'll post an update if anything changes.
    That's great. Hope it continues for you.

    Like you I am eating very well and getting exercise. Even when I did do my "experiment" going cold turkey a couple months back it wasn't unbearable, but I wasn't doing the things I'm doing now. I'm doing every other day with the Aciphex and like you, I get that tightness too in that area and a little heartburn but not bad. A little Gaviscon here or there but I'm not doing that regularly.

    I hope to beat this thing!

     
    Old 03-18-2010, 01:29 PM   #51
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    Re: Getting off PPI's and acid rebound

    Hello All,
    I am so glad I came across the board. I had been on PPI for 4-5 years! I began with Reflux symptoms, coughing and loss of voice after eating, as a result of a stressful life and business. Started taking Nexium, then Aciphex, then Protonix, then Kapidex, then back to Protonix. But after several years I thought the side effects were outweighing the initial symptoms, so just recently I started taking 15 mg of Prevacid (over the counter) 2 x a day. I started to feel so good that I cut down even more to only 1 15 mg in the morning.

    At the same time, I switched my menopause meds (Climara Pro) to Climara patch and prometrium at night. Boy that was not a good idea! I started to feel like my stomach was getting very nervous and growly and started noticing that I would wake up congested and constantly felt something in my throat. Then just this past weekend, on my way back from a great little getaway...I ended up in ER with my throat swelling up and a full blown panick attack. As the previous poster noted; who wouldn't panic when your throat is closing up on you... i could literally not swallow. I was treated for a food allergy (but this has not been verified). I didn't totally believe it was a food allergy because i have had this nagging post nasal drip and throat swelling before and new that it was a cause of GERD and/or anxious stomach due to my hormones. The suggested culprit was shrimp even though I have had shrimp many times before.

    So now I am scheduled to see an Allergist I have to find out if it was a food allergy or what i now suspect (a result of acid rebound).

    I am also seeing a Gastro in a couple of weeks to evaluate my GERD symptoms and a try to develop a strategy plan.

    But I have to admit this is all SO frustrating to experience so many symptoms at once and not be sure what is the REAL cause, this alone can drive you crazy...who wouldn't get anxiety.

    In any case, I just wanted to thank everyone for posting their experiences because it does help substantiate some of my initial feelings about my own symptoms. I wish you all luck.
    I definitely plan on eventually weaning myself completely off the PPI but will prepare a very careful exit strategy first.
    Thanks again!

     
    Old 03-21-2010, 11:35 AM   #52
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    Re: Getting off PPI's and acid rebound

    How'd it go this week, Rose?

     
    Old 03-21-2010, 03:03 PM   #53
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    Re: Getting off PPI's and acid rebound

    Not bad. I was bad a couple of times and had a cup of decaf coffee and both times experienced heartburn. The rest of the time I may have felt slight heartburn after meals which I was able to fight off chewing gum and drinking a bit of water. I am still on my 150 Zantac twice per day and finishing up the D-Lemonene pills (every other day). I have cut down on the DGL a little bit and the Aloe, but I am trying to stick to my diet of low carbs and no offending foods as much as possible. I am definitely not in agony and have noticed that my days are no longer revolving around obsessing about rebound symptoms and whether or not I am going to experience heartburn after I eat.

    I think I can probably stay off the Aciphex if I eat carefully, avoid coffee (I am sad about that) and keep taking the Zantac. I may be able to eventually go to the 75 mg pill twice a day, but I don't think I'll ever be able to be medicine free again. I just hope I can avoid the PPI's. Their superior acid suppression is also what makes it harder for the stomach to absorb the calcium and such. Thank you for asking.

    It was not hard to keep to a low carb diet during the vacation. Fortunately, almost everyone sells a salad with chicken or a similar protein and I was able to keep the carbs to mostly mornings.

    Rose

     
    Old 03-21-2010, 03:11 PM   #54
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    Re: Getting off PPI's and acid rebound

    Quote:
    Originally Posted by jayner1 View Post
    Hello All,
    I am so glad I came across the board. I had been on PPI for 4-5 years! I began with Reflux symptoms, coughing and loss of voice after eating, as a result of a stressful life and business. Started taking Nexium, then Aciphex, then Protonix, then Kapidex, then back to Protonix. But after several years I thought the side effects were outweighing the initial symptoms, so just recently I started taking 15 mg of Prevacid (over the counter) 2 x a day. I started to feel so good that I cut down even more to only 1 15 mg in the morning.

    At the same time, I switched my menopause meds (Climara Pro) to Climara patch and prometrium at night. Boy that was not a good idea! I started to feel like my stomach was getting very nervous and growly and started noticing that I would wake up congested and constantly felt something in my throat. Then just this past weekend, on my way back from a great little getaway...I ended up in ER with my throat swelling up and a full blown panick attack. As the previous poster noted; who wouldn't panic when your throat is closing up on you... i could literally not swallow. I was treated for a food allergy (but this has not been verified). I didn't totally believe it was a food allergy because i have had this nagging post nasal drip and throat swelling before and new that it was a cause of GERD and/or anxious stomach due to my hormones. The suggested culprit was shrimp even though I have had shrimp many times before.

    So now I am scheduled to see an Allergist I have to find out if it was a food allergy or what i now suspect (a result of acid rebound).

    I am also seeing a Gastro in a couple of weeks to evaluate my GERD symptoms and a try to develop a strategy plan.

    But I have to admit this is all SO frustrating to experience so many symptoms at once and not be sure what is the REAL cause, this alone can drive you crazy...who wouldn't get anxiety.

    In any case, I just wanted to thank everyone for posting their experiences because it does help substantiate some of my initial feelings about my own symptoms. I wish you all luck.
    I definitely plan on eventually weaning myself completely off the PPI but will prepare a very careful exit strategy first.
    Thanks again!
    Hi Jayner 1:

    Sorry for your trip to the ER and feeling your throat close in on you.

    I have a good friend who ate shrimp all her life and had a similar situation once. She ate shrimp at a restaurant, felt her throat closing, took some benadryl she had in her purse for allergies and drove herself to the hospital. Not sure why she did that, but she did. She arrived in the nick of time, was treated, given an EPY (sp?) pen, and told to avoid shrimp.

    She subsequently tried to eat a little bit of shrimp again to test the allergy and after a very small bite, started to feel her throat closing again. She gave herself the shot and vowed to never eat shrimp or shellfish again.

    Therefore, your throat closing may have nothing to do with the PPI or anxiety, expect that one's throat closing would certainly trigger an anxiety attack in me as well. I can't imagine the sensation of not being able to breathe.

    My only warning about PPI's, since you are starting or dealing with Menopause, is to have a Dexa scan to see how the PPI's may be affecting your bones, how much calcium you need, etc. Also, I was recently told by my doctor that it is a good thing to have one's levels of vitamin D checked to see if they are low. If so, we then need to take more vitamin D3 to assist with calcium absorption.

    I consider myself an informed person and didnot know any of this until recently. I feel like such a "Duh" for not knowing or checking.

    Even if you need to continue to take your PPI, there may be ways to prevent bone loss if you take more vitamin D3, calcium citrate (which is more easily absorbed even without stomach acid), etc.

    Hope you are feeling better soon.

    Rose

    Last edited by rosebloom; 03-21-2010 at 03:11 PM.

     
    Old 03-21-2010, 03:21 PM   #55
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    Re: Getting off PPI's and acid rebound

    I understand there will be good and bad days but it sounds like you may be rounding the corner. Cutting out the things you were used to eating and drinking is hard. I've been watching my diet pretty closely since the beginning of the year but I'm finding it hard to figure out what to eat. It takes more planning and preparation and sometimes I eat a different meal than my husband but it's way better than my diet before, which was pretty crappy.

    Until I get to the doctor in a week and tell him what I am doing, I am trying a step down approach to getting of the Aciphex. Two days Aciphex, 1 day Zantac 150, then slowly add more days Zantac, less Aciphex. I hope it works. Today was the first day I took a Zantac but it didn't seem like it worked too good. Did it work instantly for you or did it take a few days? I wonder doctors approve taking Zantac OTC long term?

     
    Old 03-21-2010, 10:51 PM   #56
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    Re: Getting off PPI's and acid rebound

    It's weird how this process works. I have experienced quite a bit of heartburn tonight after dinner. I had a pretty decent dinner of baked fish with almonds (trout almondine) and carrots. No bread, no carbs, nothing fried and nothing but a little water to drink with dinner. Then, I came home and took my vitamins and whamo! I have experienced heartburn for close to three hours even after taking Gaviscon twice and sucking on two DGL tablets. All I can think of is that I took a bunch of vitamins after a fairly light supper and that may have irritated my stomach.

    I still hope I am turning the corner as you say but episodes like tonight are frustrating, particularly after I just posted here that I had done well for nearly my entire vacation. When this happens it makes me feel that this is a random process that has nothing to do with what I eat and not eat. Rationally, I know that is probably not true, but tonight I am feeling frustrated by the apparent setback.

    Rose

     
    Old 03-22-2010, 09:24 AM   #57
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    Re: Getting off PPI's and acid rebound

    Quote:
    Originally Posted by rosebloom View Post
    Hi Jayner 1:

    Sorry for your trip to the ER and feeling your throat close in on you.

    I have a good friend who ate shrimp all her life and had a similar situation once. She ate shrimp at a restaurant, felt her throat closing, took some benadryl she had in her purse for allergies and drove herself to the hospital. Not sure why she did that, but she did. She arrived in the nick of time, was treated, given an EPY (sp?) pen, and told to avoid shrimp.

    She subsequently tried to eat a little bit of shrimp again to test the allergy and after a very small bite, started to feel her throat closing again. She gave herself the shot and vowed to never eat shrimp or shellfish again.

    Therefore, your throat closing may have nothing to do with the PPI or anxiety, expect that one's throat closing would certainly trigger an anxiety attack in me as well. I can't imagine the sensation of not being able to breathe.

    My only warning about PPI's, since you are starting or dealing with Menopause, is to have a Dexa scan to see how the PPI's may be affecting your bones, how much calcium you need, etc. Also, I was recently told by my doctor that it is a good thing to have one's levels of vitamin D checked to see if they are low. If so, we then need to take more vitamin D3 to assist with calcium absorption.

    I consider myself an informed person and didnot know any of this until recently. I feel like such a "Duh" for not knowing or checking.

    Even if you need to continue to take your PPI, there may be ways to prevent bone loss if you take more vitamin D3, calcium citrate (which is more easily absorbed even without stomach acid), etc.

    Hope you are feeling better soon.

    Rose
    Hi Rose,
    Well this week has been tough for me every since my trip to the ER last weekened. The doctor increased my estrogen dose patch, but am have still been feeling anxious, which in turns upsets my stomach, which in turns causes this post nasal drip that gets stuck on my throat. So I have gone back to taking Protonix 40 mg every day and the post nasal drips seems to be getting a bit better.
    My doctor had already tested me for calcium and vitamin deficiciencies and of course they are low from taking the PPI's for so long, so I am taking high does of Vitamin D, calcium magrate etc.
    Unfortunately, yesterday my husband took me out to dinner and once again I began feeling panicky, and couldn't get anything down my throat, so ended up not eating and having to take my dinner home. Ugh...
    Well I have several doctor appointments and just hope it all gets sorted out soon.
    Thanks for the good wishes, and glad to hear that you have sorted out all your issues. I am hoping that eventually after I get my hormones and thyroid levels all in sync again, I will too try to wean off the PPI (or take as least as possible) eventually !
    Good luck with your continued success.

     
    Old 03-22-2010, 03:19 PM   #58
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    Re: Getting off PPI's and acid rebound

    Quote:
    Originally Posted by rosebloom View Post
    It's weird how this process works. I have experienced quite a bit of heartburn tonight after dinner. I had a pretty decent dinner of baked fish with almonds (trout almondine) and carrots. No bread, no carbs, nothing fried and nothing but a little water to drink with dinner. Then, I came home and took my vitamins and whamo! I have experienced heartburn for close to three hours even after taking Gaviscon twice and sucking on two DGL tablets. All I can think of is that I took a bunch of vitamins after a fairly light supper and that may have irritated my stomach.

    I still hope I am turning the corner as you say but episodes like tonight are frustrating, particularly after I just posted here that I had done well for nearly my entire vacation. When this happens it makes me feel that this is a random process that has nothing to do with what I eat and not eat. Rationally, I know that is probably not true, but tonight I am feeling frustrated by the apparent setback.

    Rose
    Don't ya hate that. You can be real good at what you eat and it still kicks you in the butt. I'm no doctor but I think when you start to have more good than bad days it's a good thing.

    I hope to get there one day. Today I made the decision to go back to the Aciphex everyday (for now) until I talk everything over with my GI doc which I don't see for another 3 weeks. He'll probably send me for a scope. I've only had one before and it was OK but I'd feel better getting a green light before trying anything. Uggh! How I hate tests.

    Keep up the good work.

     
    Old 03-22-2010, 09:10 PM   #59
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    Re: Getting off PPI's and acid rebound

    Thanks for the good wishes. I finally ended up taking a third Zantac last night at about 1:30 in the morning (about six hours after the last one) when I realized the heartburn was just not going away. I took it again this morning, was fine this morning and up till lunch, then had some heartburn after lunch (not as bad as last night) and then nothing tonight, no heartburn after dinner. It is just as if my stomach had gone to rest or decided to give me a break tonight. I'll keep working on it. I am giving myself at least three months off PPI's before I make my decision to stay off them permanently or go back to them. But I need to give it a decent shot to see if I can work through the rebound and not experience heartburn almost daily.

     
    Old 03-26-2010, 07:15 PM   #60
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    Re: Getting off PPI's and acid rebound

    I seem to have one bad day, three good days and then another bad day. I had pretty bad heartburn last Monday afternoon-evening, then three fairly decent days and today, after following the same routine and taking the same medications/supplements, etc., I started having heartburn at around 10:00 A.M. and pretty much had it all day. I took DGL, drank lots of water and ate minimally and still had heartburn. I came home, took my evening Zantac and ate a dinner of chicken and vegetables. I am keeping my fingers crossed to see what happens once my stomach starts to empty. But it is very discouraging. I don't know if this is the way it will be from now on, and if I am through the acid rebound or not. I have now been about two months off PPI's.

    Just got through taking the 20 days of D-Limonene (orange peel extract) and I am still experiencing heartburn (on top of taking Zantac, DGL and everything else). So that did not work for me very well (sadly). Anyway, I will continue to post and report what is going on, what I am trying and if anything is working or not working.

    Today has not been a good day. I was stuck at work and could not run home to get antiacids or to the store to buy some. I pretty much had to suffer all day with this nonsense. It is discouraging because I am trying so hard to try all the different suggestions.

    Rose

     
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    ppi (proton pump inhibitor)



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