Mr. Asthma » Allergic Asthma

GERD, allergies, or something else?

admin — Mon, 11 Aug 2003 00:00:00 +0000

Question:

I have been experiencing difficulty swallowing persistantly for about 2 months. I am actively persuing this with my gastroenterologist as well as my allergist, however I am am looking for insight and ideas of what might be causing this. A bit about my medical history… I am 25 years old male, 5′ 11" tall, and weigh 135 lbs (underweight for my height, but healthy). I bike or run 2-3 times a week, and lift weights 1-2 times a week. I typically eat a lot (perhaps sometimes overeat). I was diagnosed with "erosive esophagus" during an endoscopy about 1.5 years ago and have been on prevacid 30mg since then. I also have significant nasal allergies, and have been getting allergy injections for about 2 years now. Don’t know if any of that is relavent, but just in case… My symptoms…It feels like my throat is swollen. Not sore, just swollen/irritated. In the morning when I wake up, it is typically fine, but as the day wears on it begins to become worse, and it is definitely worse after meals. If I eat a full meal (or especially if I overeat, it becomes accutely worse, to the point where I feel short of breath, although I can really still breath fine). The sensation is not painful, but just very uncomfortable…like I have to keep swallowing, but can’t get everything down, if that makes sense. There have only been a few instances where it was bad enough that I could not eat. Usually I feel fine WHILE I am eating but then the problem is worse once I am done, and persists for several hours afterwards. I frequently feel like I need to burp, but can’t. Sometimes when I do burb, it makes the feeling in my throat worse (perhaps stomach juices are making it the whole way up to my throat?). I have not had much heartburn, because I take the prevacid. Doubling my prevacid to 30mg twice daily did not help. If anything, it made the problem worse. When this first started, my allergies were flaring up and I had a significant amount of drainage, so I thought the problem might be allergy related. Since then, my allergies have cleared up, but the problem persists (this is when it became more apparent that it was worsened by eating full meals). A couple of questions…. If this is GERD related, why isn’t the prevacid keeping my stomach acid at bay? Is there another medication I should try? Prilosec or Nexium perhaps? I was fine on Prevacid for over a year. Might this be an allergic reaction to the medication? Could this be allergy related? Would it make sense that my drainage from allergies makes it worse? Any insight is appreciated. -mark

Response:

Sounds like Gerd. Feel like you have the lump in the throat? If I eat a full meal (or especially if – Hide quoted text — Show quoted text -> I overeat, it becomes accutely worse, to the point where I feel short > of breath, although I can really still breath fine). The sensation is > not painful, but just very uncomfortable…like I have to keep > swallowing, but can’t get everything down, if that makes sense. There > have only been a few instances where it was bad enough that I could > not eat. Usually I feel fine WHILE I am eating but then the problem > is worse once I am done, and persists for several hours afterwards. I > frequently feel like I need to burp, but can’t. Sometimes when I do > burb, it makes the feeling in my throat worse (perhaps stomach juices > are making it the whole way up to my throat?). I have not had much > heartburn, because I take the prevacid. Doubling my prevacid to 30mg > twice daily did not help. If anything, it made the problem worse. > When this first started, my allergies were flaring up and I had a > significant amount of drainage, so I thought the problem might be > allergy related. Since then, my allergies have cleared up, but the > problem persists (this is when it became more apparent that it was > worsened by eating full meals). > A couple of questions…. > If this is GERD related, why isn’t the prevacid keeping my stomach > acid at bay?

It doesnt work on everyone… > Is there another medication I should try? Prilosec or Nexium perhaps?

yes > I was fine on Prevacid for over a year. Might this be an allergic > reaction to the medication?

No but ask your doctor to change your meds. > Could this be allergy related? Would it make sense that my drainage > from allergies makes it worse?

Alot of people have allergies and gerd. I dont think the two are related but you can ask your doctor. > Any insight is appreciated. > -mark

I have the lump in the throat feeling, asthmatic feeling because of acid, and sometimes pains… it is acid reflux. I have never had the endeoscopy like you have but plan too… There are surgeries that can be done because of them but its up to you and your doctor to discuss the alternatives. Ask me any questions.

Response:

I think you need to see a specialist. Perhaps visit a swallowing clinic. There are many good ones in the US. Where are you located?

– Hide quoted text — Show quoted text -> I have been experiencing difficulty swallowing persistantly for about > 2 months. I am actively persuing this with my gastroenterologist as > well as my allergist, however I am am looking for insight and ideas of > what might be causing this. > A bit about my medical history… I am 25 years old male, 5′ 11" tall, > and weigh 135 lbs (underweight for my height, but healthy). I bike or > run 2-3 times a week, and lift weights 1-2 times a week. I typically > eat a lot (perhaps sometimes overeat). I was diagnosed with "erosive > esophagus" during an endoscopy about 1.5 years ago and have been on > prevacid 30mg since then. I also have significant nasal allergies, > and have been getting allergy injections for about 2 years now. Don’t > know if any of that is relavent, but just in case… > My symptoms…It feels like my throat is swollen. Not sore, just > swollen/irritated. In the morning when I wake up, it is typically > fine, but as the day wears on it begins to become worse, and it is > definitely worse after meals. If I eat a full meal (or especially if > I overeat, it becomes accutely worse, to the point where I feel short > of breath, although I can really still breath fine). The sensation is > not painful, but just very uncomfortable…like I have to keep > swallowing, but can’t get everything down, if that makes sense. There > have only been a few instances where it was bad enough that I could > not eat. Usually I feel fine WHILE I am eating but then the problem > is worse once I am done, and persists for several hours afterwards. I > frequently feel like I need to burp, but can’t. Sometimes when I do > burb, it makes the feeling in my throat worse (perhaps stomach juices > are making it the whole way up to my throat?). I have not had much > heartburn, because I take the prevacid. Doubling my prevacid to 30mg > twice daily did not help. If anything, it made the problem worse. > When this first started, my allergies were flaring up and I had a > significant amount of drainage, so I thought the problem might be > allergy related. Since then, my allergies have cleared up, but the > problem persists (this is when it became more apparent that it was > worsened by eating full meals). > A couple of questions…. > If this is GERD related, why isn’t the prevacid keeping my stomach > acid at bay? > Is there another medication I should try? Prilosec or Nexium perhaps? > I was fine on Prevacid for over a year. Might this be an allergic > reaction to the medication? > Could this be allergy related? Would it make sense that my drainage > from allergies makes it worse? > Any insight is appreciated. > -mark

Response:

Can H. Pylori cause esophagitis? Has anyone had symptoms where it just feels like the esophagus is swollen/irritated? I rarely ever get heartburn anymore, but the one thing I have noticed is, if I take prevacid 30mg twice a day, the symptoms become accutely worse. This almost seems like an infection to me. Interestingly, if I stop the prevacid for a day or so, I do get mild heartburn, but it actually feels sort of soothing, and I don’t have the swollen feeling or difficulty swallowing while the heartburn is there. I just can’t stand this uncomfortable swallowing feeling. Anyone have any experience with something like this? I have an endoscopy scheduled for sept 2nd, and am doing a 24hour pH test on Sept 11, so hopefully those 2 tests will reveal something… -mark – Hide quoted text — Show quoted text – > I think you need to see a specialist. Perhaps visit a swallowing clinic. > There are many good ones in the US. Where are you located? > I have been experiencing difficulty swallowing persistantly for about > 2 months. I am actively persuing this with my gastroenterologist as > well as my allergist, however I am am looking for insight and ideas of > what might be causing this. > A bit about my medical history… I am 25 years old male, 5′ 11" tall, > and weigh 135 lbs (underweight for my height, but healthy). I bike or > run 2-3 times a week, and lift weights 1-2 times a week. I typically > eat a lot (perhaps sometimes overeat). I was diagnosed with "erosive > esophagus" during an endoscopy about 1.5 years ago and have been on > prevacid 30mg since then. I also have significant nasal allergies, > and have been getting allergy injections for about 2 years now. Don’t > know if any of that is relavent, but just in case… > My symptoms…It feels like my throat is swollen. Not sore, just > swollen/irritated. In the morning when I wake up, it is typically > fine, but as the day wears on it begins to become worse, and it is > definitely worse after meals. If I eat a full meal (or especially if > I overeat, it becomes accutely worse, to the point where I feel short > of breath, although I can really still breath fine). The sensation is > not painful, but just very uncomfortable…like I have to keep > swallowing, but can’t get everything down, if that makes sense. There > have only been a few instances where it was bad enough that I could > not eat. Usually I feel fine WHILE I am eating but then the problem > is worse once I am done, and persists for several hours afterwards. I > frequently feel like I need to burp, but can’t. Sometimes when I do > burb, it makes the feeling in my throat worse (perhaps stomach juices > are making it the whole way up to my throat?). I have not had much > heartburn, because I take the prevacid. Doubling my prevacid to 30mg > twice daily did not help. If anything, it made the problem worse. > When this first started, my allergies were flaring up and I had a > significant amount of drainage, so I thought the problem might be > allergy related. Since then, my allergies have cleared up, but the > problem persists (this is when it became more apparent that it was > worsened by eating full meals). > A couple of questions…. > If this is GERD related, why isn’t the prevacid keeping my stomach > acid at bay? > Is there another medication I should try? Prilosec or Nexium perhaps? > I was fine on Prevacid for over a year. Might this be an allergic > reaction to the medication? > Could this be allergy related? Would it make sense that my drainage > from allergies makes it worse? > Any insight is appreciated. > -mark

Response:

> Can H. Pylori cause esophagitis? Has anyone had symptoms where it > just feels like the esophagus is swollen/irritated? I rarely ever get > heartburn anymore, but the one thing I have noticed is, if I take > prevacid 30mg twice a day, the symptoms become accutely worse. This > almost seems like an infection to me. Interestingly, if I stop the > prevacid for a day or so, I do get mild heartburn, but it actually > feels sort of soothing, and I don’t have the swollen feeling or > difficulty swallowing while the heartburn is there. I just can’t > stand this uncomfortable swallowing feeling. > Anyone have any experience with something like this? > I have an endoscopy scheduled for sept 2nd, and am doing a 24hour pH > test on Sept 11, so hopefully those 2 tests will reveal something…

No, H. Pylori has nothing to do with GERD. In fact, for reasons that aren’t entirely clear, an H. pylori infection tends to ameliorate GERD. The EGD and 24 hour ambulatory pH test will be definitive. The pH test will tell whether or not you do have esophageal reflux, and the EGD will demonstrate whether or not you have the COMPLICATIONS of GERD, such as erosive esophagitis, stricture, or Barrett’s esophagus. 24 hour catheter-based ambulatory pH testing is a little problematic and its accuracy is impaired compared to more modern methods. It’s important, while the catheter is in place, to live a normal life. That is, eat the things you normally eat, do your normal activities etc. These things are hard to do when you have a tube down your nose connected to a device on your belt. A better test is 48 hour wireless ambulatory pH testing. This test uses a small, capsule-sized pH sensor that wireless transmits pH data to a pager-sized device you wear on your belt, or keep within 4 or 5 feet of you. There is no cather, it is completely comfortable, you can shower, eat or do any other normal activity. It is far more accurate than catheter-based pH testing. Look at http://tinyurl.com/k4yz for information on this method of pH testing and ask your gastroenterologist if it’s available to you. HMc

Response:

> Since then, my allergies have cleared up, but the >problem persists (this is when it became more apparent that it was >worsened by eating full meals).

I suggest you try a completely gluten-free meal and see if you get the symptoms. You have some characteristics of undiagnosed celiac disease. Don .

Response:

- Hide quoted text — Show quoted text -> Can H. Pylori cause esophagitis? Has anyone had symptoms where it > just feels like the esophagus is swollen/irritated? I rarely ever get > heartburn anymore, but the one thing I have noticed is, if I take > prevacid 30mg twice a day, the symptoms become accutely worse. This > almost seems like an infection to me. Interestingly, if I stop the > prevacid for a day or so, I do get mild heartburn, but it actually > feels sort of soothing, and I don’t have the swollen feeling or > difficulty swallowing while the heartburn is there. I just can’t > stand this uncomfortable swallowing feeling. > Anyone have any experience with something like this? > I have an endoscopy scheduled for sept 2nd, and am doing a 24hour pH > test on Sept 11, so hopefully those 2 tests will reveal something… > No, H. Pylori has nothing to do with GERD. In fact, for reasons that aren’t > entirely clear, an H. pylori infection tends to ameliorate GERD. > The EGD and 24 hour ambulatory pH test will be definitive. The pH test will > tell whether or not you do have esophageal reflux, and the EGD will > demonstrate whether or not you have the COMPLICATIONS of GERD, such as > erosive esophagitis, stricture, or Barrett’s esophagus. > 24 hour catheter-based ambulatory pH testing is a little problematic and its > accuracy is impaired compared to more modern methods. It’s important, while > the catheter is in place, to live a normal life. That is, eat the things you > normally eat, do your normal activities etc. These things are hard to do > when you have a tube down your nose connected to a device on your belt. A > better test is 48 hour wireless ambulatory pH testing. This test uses a > small, capsule-sized pH sensor that wireless transmits pH data to a > pager-sized device you wear on your belt, or keep within 4 or 5 feet of you. > There is no cather, it is completely comfortable, you can shower, eat or do > any other normal activity. It is far more accurate than catheter-based pH > testing. > Look at http://tinyurl.com/k4yz for information on this method of pH testing > and ask your gastroenterologist if it’s available to you. > HMc

Thanks for the info. I will definitely ask my doctor about the "wireless" verysion of the pH test. That sounds much more reasonable. I guess if its not available, I will still do the catheter-based test, as it sounds like that test can provide a lot of good information. I already know from a past endoscopy that I have (or at least HAD) erosive esophagus. I didn’t have any heartburn at the time of that diagnosis, but was prescribed prevacid 30mg, and have taken that daily since then (about 1.5 years ago). I am very young for this, and I know that surgery might be a good option for me, based on the results of the pH test. I read about the Stretta procedure, which sounds interesting. Has anyone had that procedure, or does anyone have any advice on it? -mark

Response:

> I read about the Stretta procedure, which sounds > interesting. Has anyone had that procedure, or does anyone have any > advice on it?

I have done the Stretta procedure many times. Patient selection is critical to success of this procedure, but in the appropriate patient, it is an excellent option. It is entirely outpatient, has very few complications, very few side effects, and no activity or diet restrictions. The major disadvantage is that it can take months for the effects to manifest themselves. It has about an 80% – 90% success rate (off all meds within 1 year). Can’t be done in patients with a large hiatus hernia. Relative to anti-reflux procedures, I do about 60% lap fundoplications and 40% Stretta. If you have a history of erosive esophagitis observed on EGD, then the pH testing has little value since it is already established that you have severe GERD and that is the point of pH testing. You will need esophageal manometry, however, to make sure you have adequate esophageal function and no underlying motility disorders. HMc

Response:

Actually, I am on a gluten free diet full time already I was diagnosed with celiac disease about 8 years ago. The GERD symptoms started shortly afterwards, and became severe about 3 months ago. It hasn’t been a very fun summer… -mark – Hide quoted text — Show quoted text -> Since then, my allergies have cleared up, but the >problem persists (this is when it became more apparent that it was >worsened by eating full meals). > I suggest you try a completely gluten-free meal and see if you get the > symptoms. You have some characteristics of undiagnosed celiac disease. > Don .

Response:

Thanks for the feedback. I am definitely intrigued by the Stretta procedure. I am very young (25 years old) to be having GERD this bad. I want to weigh my options and make the appropriate choices, in terms of meds, or surgery, and if surgery, which one. I have heard that the long term relapse rate is quite high with the lap fundoplications, and the complications such as dysphagia, difficulty belching, vomiting, etc., scare me a bit. I like the idea of the Stretta procedure, but I guess it is too new to know if it will work long term (like for the rest of my life). Do you have any thoughts on this? Can a Stretta procedure be done more than once if needed? Last endoscopy, i was diagnosed with erosive esophagus (just 1 ulcer, I believe). No hiatus hernia at that time (1.5 years ago). I was on 30mg of prevacid since then, until it stopped working earlier this summer. I am trying aciphex 20mg right now, but I can’t tell if it is helping any better yet. It just seems surprising to me that I could still have symptoms, while on prevacid 30mg, which is pretty strong, right? I will find out more results in a little over a week when I have another endoscopy done. Are there any chances that being on a moderate/high dose of PPIs can allow problems such as yeast esophagitis, or something of that nature to happen in an immuno-competant person? I feel like I am digging with a question like that, but this came on very suddenly, and has been very persistant for a couple months. -mark – Hide quoted text — Show quoted text -> I read about the Stretta procedure, which sounds > interesting. Has anyone had that procedure, or does anyone have any > advice on it? > I have done the Stretta procedure many times. Patient selection is critical > to success of this procedure, but in the appropriate patient, it is an > excellent option. It is entirely outpatient, has very few complications, > very few side effects, and no activity or diet restrictions. The major > disadvantage is that it can take months for the effects to manifest > themselves. It has about an 80% – 90% success rate (off all meds within 1 > year). Can’t be done in patients with a large hiatus hernia. Relative to > anti-reflux procedures, I do about 60% lap fundoplications and 40% Stretta. > If you have a history of erosive esophagitis observed on EGD, then the pH > testing has little value since it is already established that you have > severe GERD and that is the point of pH testing. You will need esophageal > manometry, however, to make sure you have adequate esophageal function and > no underlying motility disorders. > HMc

Response:

– Hide quoted text — Show quoted text -> Thanks for the feedback. I am definitely intrigued by the Stretta > procedure. I am very young (25 years old) to be having GERD this bad. > I want to weigh my options and make the appropriate choices, in terms > of meds, or surgery, and if surgery, which one. I have heard that the > long term relapse rate is quite high with the lap fundoplications, and > the complications such as dysphagia, difficulty belching, vomiting, > etc., scare me a bit. I like the idea of the Stretta procedure, but I > guess it is too new to know if it will work long term (like for the > rest of my life). Do you have any thoughts on this? Can a Stretta > procedure be done more than once if needed? > Last endoscopy, i was diagnosed with erosive esophagus (just 1 ulcer, > I believe). No hiatus hernia at that time (1.5 years ago). I was on > 30mg of prevacid since then, until it stopped working earlier this > summer. I am trying aciphex 20mg right now, but I can’t tell if it is > helping any better yet. It just seems surprising to me that I could > still have symptoms, while on prevacid 30mg, which is pretty strong, > right? > I will find out more results in a little over a week when I have > another endoscopy done. > Are there any chances that being on a moderate/high dose of PPIs can > allow problems such as yeast esophagitis, or something of that nature > to happen in an immuno-competant person? I feel like I am digging > with a question like that, but this came on very suddenly, and has > been very persistant for a couple months.

At 25, with a history of erosive esophagitis , the chances that PPI’s will control your GERD for the rest of your life are negligible, even with lifestyle modifications. Long term use of PPI’s will result in increasing polyp formation in your stomach due to the trophic changes of unopposed gastrin, but there is no evidence to support the assertion that it will increase your risk of gastric cancer. Stretta is new. It’s specific long-term effect isn’t known. However, the long term effects of radiofrequency energy on human tissue are known. Once collagen is deposited in the LES, and the afferent nerves are ablated, the science of the issue would lead one to believe that the effects are permanent. There are no long term studies to prove this, however. Yes, Stretta can be done more than once. Lap fundoplication is a good operation. The recurrence rate is 6-10% at 5 years in competent hands, the specific recurrence rate is surgeon-dependant. Dysphagia tends to be a temporary phenomenon, about 2-6 weeks and depends very much on the pre-operative motility of the esophagus. The decreased ability to belch can be problematic, but tends to decrease with time as the patient learns to not swallow air (now that he doesn’t need to do that to clear acid from the esophagus). IME, most patients find that to be an acceptable trade-off compared to a lifetime of poorly-controlled, or uncontrolled, GERD. HMc

Response:

>Actually, I am on a gluten free diet full time already I was >diagnosed with celiac disease about 8 years ago. The GERD symptoms >started shortly afterwards, and became severe about 3 months ago. It >hasn’t been a very fun summer…

Are you on a dairy-free diet? Don .

Response:

Hello again. I just had my endoscopy today. They said things looked "normal", which sounds like good news to me. They gave me 4 pictures that they said we would discuss at my follow-up appointment (2 weeks from now). I don’t know what each picture is of. Just for fun, are there any gastroenterologists out there that could respond telling me exactly what I am looking at in each picture? I posted them at: http://members.verizon.net/~vze23dzw/Pictures/marksinners_ed.jpg Thanks! -mark – Hide quoted text — Show quoted text -> Thanks for the feedback. I am definitely intrigued by the Stretta > procedure. I am very young (25 years old) to be having GERD this bad. > I want to weigh my options and make the appropriate choices, in terms > of meds, or surgery, and if surgery, which one. I have heard that the > long term relapse rate is quite high with the lap fundoplications, and > the complications such as dysphagia, difficulty belching, vomiting, > etc., scare me a bit. I like the idea of the Stretta procedure, but I > guess it is too new to know if it will work long term (like for the > rest of my life). Do you have any thoughts on this? Can a Stretta > procedure be done more than once if needed? > Last endoscopy, i was diagnosed with erosive esophagus (just 1 ulcer, > I believe). No hiatus hernia at that time (1.5 years ago). I was on > 30mg of prevacid since then, until it stopped working earlier this > summer. I am trying aciphex 20mg right now, but I can’t tell if it is > helping any better yet. It just seems surprising to me that I could > still have symptoms, while on prevacid 30mg, which is pretty strong, > right? > I will find out more results in a little over a week when I have > another endoscopy done. > Are there any chances that being on a moderate/high dose of PPIs can > allow problems such as yeast esophagitis, or something of that nature > to happen in an immuno-competant person? I feel like I am digging > with a question like that, but this came on very suddenly, and has > been very persistant for a couple months. > At 25, with a history of erosive esophagitis , the chances that PPI’s will > control your GERD for the rest of your life are negligible, even with > lifestyle modifications. Long term use of PPI’s will result in increasing > polyp formation in your stomach due to the trophic changes of unopposed > gastrin, but there is no evidence to support the assertion that it will > increase your risk of gastric cancer. > Stretta is new. It’s specific long-term effect isn’t known. However, the > long term effects of radiofrequency energy on human tissue are known. Once > collagen is deposited in the LES, and the afferent nerves are ablated, the > science of the issue would lead one to believe that the effects are > permanent. There are no long term studies to prove this, however. Yes, > Stretta can be done more than once. > Lap fundoplication is a good operation. The recurrence rate is 6-10% at 5 > years in competent hands, the specific recurrence rate is surgeon-dependant. > Dysphagia tends to be a temporary phenomenon, about 2-6 weeks and depends > very much on the pre-operative motility of the esophagus. The decreased > ability to belch can be problematic, but tends to decrease with time as the > patient learns to not swallow air (now that he doesn’t need to do that to > clear acid from the esophagus). IME, most patients find that to be an > acceptable trade-off compared to a lifetime of poorly-controlled, or > uncontrolled, GERD. > HMc

Response:

> Hello again. I just had my endoscopy today. They said things looked > "normal", which sounds like good news to me. They gave me 4 pictures > that they said we would discuss at my follow-up appointment (2 weeks > from now). I don’t know what each picture is of. Just for fun, are > there any gastroenterologists out there that could respond telling me > exactly what I am looking at in each picture? I posted them at: > http://members.verizon.net/~vze23dzw/Pictures/marksinners_ed.jpg

#1 is the gastroesophageal junction from above, #2 is the distal stomach (antrum) and pylorus, #3 is a retroflexed view of the GE junction from underneath, #4 is the upper part of the stomach. I agree, they all look normal. HMc

Response:

Thanks for the information. I am very pleased that things look normal. I didn’t walk away with concrete answers as to what is causing my symptoms, but at least I know now that there is no active damage or anything like that causing the problem. In picture #1, the LES looks like it is open a little. Is that normal? Also, it looks to me like my esophagus is very wide at the bottom. Is this just my perception? Next is the pH test to determine how things are functioning. Fun, fun… -mark – Hide quoted text — Show quoted text -> Hello again. I just had my endoscopy today. They said things looked > "normal", which sounds like good news to me. They gave me 4 pictures > that they said we would discuss at my follow-up appointment (2 weeks > from now). I don’t know what each picture is of. Just for fun, are > there any gastroenterologists out there that could respond telling me > exactly what I am looking at in each picture? I posted them at: > http://members.verizon.net/~vze23dzw/Pictures/marksinners_ed.jpg > #1 is the gastroesophageal junction from above, #2 is the distal stomach > (antrum) and pylorus, #3 is a retroflexed view of the GE junction from > underneath, #4 is the upper part of the stomach. > I agree, they all look normal. > HMc

Response:

> Thanks for the information. I am very pleased that things look > normal. I didn’t walk away with concrete answers as to what is > causing my symptoms, but at least I know now that there is no active > damage or anything like that causing the problem. > In picture #1, the LES looks like it is open a little. Is that > normal? Also, it looks to me like my esophagus is very wide at the > bottom. Is this just my perception? > Next is the pH test to determine how things are functioning. Fun, > fun…

Nah, the LES looks normal. However, during the course of an EGD, it will relax and contract, so a single snapshot doesn’t necessarily convey the true overall state of the LES. I assume that the endoscopist took it as a representative picture, knowing he only had 4 shots that he could take on the Mavigraph on each sheet. HMc

Response:

Well, its been a while since I updated this thread, but I have some testing progress today. I had the esophageal manometry this morning, immediately followed by the insertion of the pH tube. I must say, this test is very unpleasant, but I do like that I can see the readout right on the display. I have had heartburn off and on all day, and typically when I check the pH, while feeling heartburn, it read, .8 – 2 or so. About half of the time the upper pH sensor reading is also near the same (.8 – 2). Looks to me like the reflux is significant. Of course I’ll get the real results tommorrow when they transfer the data from the digitrapper. Hope to also get the manometry results tomorrow… -mark – Hide quoted text — Show quoted text -> Thanks for the information. I am very pleased that things look > normal. I didn’t walk away with concrete answers as to what is > causing my symptoms, but at least I know now that there is no active > damage or anything like that causing the problem. > In picture #1, the LES looks like it is open a little. Is that > normal? Also, it looks to me like my esophagus is very wide at the > bottom. Is this just my perception? > Next is the pH test to determine how things are functioning. Fun, > fun… > Nah, the LES looks normal. However, during the course of an EGD, it will > relax and contract, so a single snapshot doesn’t necessarily convey the true > overall state of the LES. I assume that the endoscopist took it as a > representative picture, knowing he only had 4 shots that he could take on > the Mavigraph on each sheet. > HMc

Response:

> Well, its been a while since I updated this thread, but I have some > testing progress today. I had the esophageal manometry this morning, > immediately followed by the insertion of the pH tube. I must say, > this test is very unpleasant, but I do like that I can see the readout > right on the display. I have had heartburn off and on all day, and > typically when I check the pH, while feeling heartburn, it read, .8 – > 2 or so. About half of the time the upper pH sensor reading is also > near the same (.8 – 2). Looks to me like the reflux is significant. > Of course I’ll get the real results tommorrow when they transfer the > data from the digitrapper. Hope to also get the manometry results > tomorrow… > -mark

Yes, it does indeed sound like severe GERD. However, you have a history of erosive esophagitis, IIRC, so that severe GERD diagnosis has already been made. How did the manometry turn out. I’ll bet you have decreased motility and a low resting LES pressure. Keep us posted on your progress. I am interested to see what your doctor does with the diagnosis, and how well his/her proposed treatment works for you. HMc

Response:

So glad the pH test is over. I have posted the results of manometry page, by page at: http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg and the pH test at: http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg My reflux was really bad during the day of the test, which I guess is good for testing purposes? Sounds like the LES is the prime cause, by looking at the results. I have a followup with my doc on Oct 2nd to discuss the results and future treatment. In the meantime, What’s the diagnosis, Doc? -mark – Hide quoted text — Show quoted text -> Well, its been a while since I updated this thread, but I have some > testing progress today. I had the esophageal manometry this morning, > immediately followed by the insertion of the pH tube. I must say, > this test is very unpleasant, but I do like that I can see the readout > right on the display. I have had heartburn off and on all day, and > typically when I check the pH, while feeling heartburn, it read, .8 – > 2 or so. About half of the time the upper pH sensor reading is also > near the same (.8 – 2). Looks to me like the reflux is significant. > Of course I’ll get the real results tommorrow when they transfer the > data from the digitrapper. Hope to also get the manometry results > tomorrow… > -mark > Yes, it does indeed sound like severe GERD. However, you have a history of > erosive esophagitis, IIRC, so that severe GERD diagnosis has already been > made. How did the manometry turn out. I’ll bet you have decreased motility > and a low resting LES pressure. > Keep us posted on your progress. I am interested to see what your doctor > does with the diagnosis, and how well his/her proposed treatment works for > you. > HMc

Response:

– Hide quoted text — Show quoted text -> So glad the pH test is over. I have posted the results of manometry > page, by page at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg > and the pH test at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg > My reflux was really bad during the day of the test, which I guess is > good for testing purposes? Sounds like the LES is the prime cause, by > looking at the results. I have a followup with my doc on Oct 2nd to > discuss the results and future treatment. In the meantime, What’s the > diagnosis, Doc? > -mark

– Hide quoted text — Show quoted text -> > Well, its been a while since I updated this thread, but I have some > > testing progress today. I had the esophageal manometry this morning, > > immediately followed by the insertion of the pH tube. I must say, > > this test is very unpleasant, but I do like that I can see the readout > > right on the display. I have had heartburn off and on all day, and > > typically when I check the pH, while feeling heartburn, it read, .8 – > > 2 or so. About half of the time the upper pH sensor reading is also > > near the same (.8 – 2). Looks to me like the reflux is significant. > > Of course I’ll get the real results tommorrow when they transfer the > > data from the digitrapper. Hope to also get the manometry results > > tomorrow… > > -mark > Yes, it does indeed sound like severe GERD. However, you have a history of > erosive esophagitis, IIRC, so that severe GERD diagnosis has already been > made. How did the manometry turn out. I’ll bet you have decreased motility > and a low resting LES pressure. > Keep us posted on your progress. I am interested to see what your doctor > does with the diagnosis, and how well his/her proposed treatment works for > you. > HMc

OK, here’s the way I see it. Your esophagus functions OK – body peristalsis is satisfactory. Your lower esophageal sphincter functions OK – relaxes appropriately and has satisfactory residual pressure after wet swallows. The resting LES pressure is low indicating some laxity. Your esophagus is actually in pretty good shape – much better than I would have guessed. However, your pH test (which demonstrates really severe GERD, BTW) shows that most of your reflux occurs while upright, and after meals. There is very little reflux while supine. This indicates to me that your GERD is far more related to transient inappropriate LES relaxation than it is to low resting pressure, although both factors are playing a role. This, in conjunction with the relatively low resting pressure, your age, the severity of your GERD, and your history of erosive esophagitis, indicates that medical or lifestyle management is HIGHLY unlikely to control your symptoms or prevent damage / Barrett’s to your esophagus. I perceive that a laparoscopic gastric fundoplication is your only realistic option. HMc

Response:

- Hide quoted text — Show quoted text -> So glad the pH test is over. I have posted the results of manometry > page, by page at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg > and the pH test at: > http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg > http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg > My reflux was really bad during the day of the test, which I guess is > good for testing purposes? Sounds like the LES is the prime cause, by > looking at the results. I have a followup with my doc on Oct 2nd to > discuss the results and future treatment. In the meantime, What’s the > diagnosis, Doc? > -mark > > > Well, its been a while since I updated this thread, but I have some > > > testing progress today. I had the esophageal manometry this morning, > > > immediately followed by the insertion of the pH tube. I must say, > > > this test is very unpleasant, but I do like that I can see the readout > > > right on the display. I have had heartburn off and on all day, and > > > typically when I check the pH, while feeling heartburn, it read, .8 – > > > 2 or so. About half of the time the upper pH sensor reading is also > > > near the same (.8 – 2). Looks to me like the reflux is significant. > > > Of course I’ll get the real results tommorrow when they transfer the > > > data from the digitrapper. Hope to also get the manometry results > > > tomorrow… > > > -mark > > Yes, it does indeed sound like severe GERD. However, you have a history > of > > erosive esophagitis, IIRC, so that severe GERD diagnosis has already > been > > made. How did the manometry turn out. I’ll bet you have decreased > motility > > and a low resting LES pressure. > > Keep us posted on your progress. I am interested to see what your doctor > > does with the diagnosis, and how well his/her proposed treatment works > for > > you. > > HMc > OK, here’s the way I see it. > Your esophagus functions OK – body peristalsis is satisfactory. > Your lower esophageal sphincter functions OK – relaxes appropriately and has > satisfactory residual pressure after wet swallows. The resting LES pressure > is low indicating some laxity. Your esophagus is actually in pretty good > shape – much better than I would have guessed. > However, your pH test (which demonstrates really severe GERD, BTW) shows > that most of your reflux occurs while upright, and after meals. There is > very little reflux while supine. This indicates to me that your GERD is far > more related to transient inappropriate LES relaxation than it is to low > resting pressure, although both factors are playing a role. This, in > conjunction with the relatively low resting pressure, your age, the severity > of your GERD, and your history of erosive esophagitis, indicates that > medical or lifestyle management is HIGHLY unlikely to control your symptoms > or prevent damage / Barrett’s to your esophagus. I perceive that a > laparoscopic gastric fundoplication is your only realistic option. > HMc

Thanks for the evaluation. I don’t suppose I am a candidate for the Stretta procedure? The laparoscopic gastric fundoplication worries me a little because of the possible complications. I don’t know…maybe in my case it would be very straight forward, and unlikely to have complications, but it is definitely a little scary to me. Also, I have heard other doctors say that it is unlikely for it to last long term (I’m talking 10 years +, or for a lifetime…). Do you have an opinion about that? Thanks again for taking time to give me advice through this process… -mark

Response:

– Hide quoted text — Show quoted text -> > So glad the pH test is over. I have posted the results of manometry > > page, by page at: > > http://members.verizon.net/~vze23dzw/pictures/reflux/page1.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page2.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page3.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page4.jpg > > and the pH test at: > > http://members.verizon.net/~vze23dzw/pictures/reflux/page5.jpg > > http://members.verizon.net/~vze23dzw/pictures/reflux/page6.jpg > > My reflux was really bad during the day of the test, which I guess is > > good for testing purposes? Sounds like the LES is the prime cause, by > > looking at the results. I have a followup with my doc on Oct 2nd to > > discuss the results and future treatment. In the meantime, What’s the > > diagnosis, Doc? > > -mark > > > > Well, its been a while since I updated this thread, but I have some > > > > testing progress today. I had the esophageal manometry this morning, > > > > immediately followed by the insertion of the pH tube. I must say, > > > > this test is very unpleasant, but I do like that I can see the readout > > > > right on the display. I have had heartburn off and on all day, and > > > > typically when I check the pH, while feeling heartburn, it read, .8 – > > > > 2 or so. About half of the time the upper pH sensor reading is also > > > > near the same (.8 – 2). Looks to me like the reflux is significant. > > > > Of course I’ll get the real results tommorrow when they transfer the > > > > data from the digitrapper. Hope to also get the manometry results > > > > tomorrow… > > > > -mark > > > Yes, it does indeed sound like severe GERD. However, you have a history > of > > > erosive esophagitis, IIRC, so that severe GERD diagnosis has already > been > > > made. How did the manometry turn out. I’ll bet you have decreased > motility > > > and a low resting LES pressure. > > > Keep us posted on your progress. I am interested to see what your doctor > > > does with the diagnosis, and how well his/her proposed treatment works > for > > > you. > > > HMc > OK, here’s the way I see it. > Your esophagus functions OK – body peristalsis is satisfactory. > Your lower esophageal sphincter functions OK – relaxes appropriately and has > satisfactory residual pressure after wet swallows. The resting LES pressure > is low indicating some laxity. Your esophagus is actually in pretty good > shape – much better than I would have guessed. > However, your pH test (which demonstrates really severe GERD, BTW) shows > that most of your reflux occurs while upright, and after meals. There is > very little reflux while supine. This indicates to me that your GERD is far > more related to transient inappropriate LES relaxation than it is to low > resting pressure, although both factors are playing a role. This, in > conjunction with the relatively low resting pressure, your age, the severity > of your GERD, and your history of erosive esophagitis, indicates that > medical or lifestyle management is HIGHLY unlikely to control your symptoms > or prevent damage / Barrett’s to your esophagus. I perceive that a > laparoscopic gastric fundoplication is your only realistic option. > HMc > Thanks for the evaluation. I don’t suppose I am a candidate for the > Stretta procedure? The laparoscopic gastric fundoplication worries me > a little because of the possible complications. I don’t know…maybe > in my case it would be very straight forward, and unlikely to have > complications, but it is definitely a little scary to me. Also, I > have heard other doctors say that it is unlikely for it to last long > term (I’m talking 10 years +, or for a lifetime…). Do you have an > opinion about that? Thanks again for taking time to give me advice > through this process…

If I recall your situation, you would be a candidate for Stretta and that may be a good option for you. Very little downside to that procedure, except for the fact that it may take up to a year for the effects to fully manifest themselves. HMc

Response:

Do steroids work on everone?

admin — Sat, 30 Nov 2002 00:00:00 +0000

Question:

– Hide quoted text — Show quoted text -> > *There is a small per cent of asthmatics who don’t respond to steroids. > > It’s called steroid-resistant asthma. > Very interesting posts. I was going to post a similar question when I > noticed this thread. > Every winter I get colds that end up as asthma. I have very few asthmatic > problems during the rest of the year. Right now I have had 2 weeks of > relatively mild asthma following a cold. Since the doctor is seeing my > pattern now for a couple of winters, she gave me a sample of Advair 100/50 > to try for the winter. I took it twice (24 hours total use) and stopped. > It was almost as bad as prednisone for me, and that is *bad*, regarding > side > effects. But most puzzling to me was that I had a big increase in my > asthma > during that 24 hours. Wheezing and coughing. When I reached 12 hours > after > the final dose, there was a noticeable improvement as it wore off. > I called and she put me on Singulair instead. Now, 2 hours after my first > dose, my asthma is getting bad again. Same result as the Advair, except > no > side effects noticeable. > Singulair is not a steroid, right? > Albuterol helps, although 2 puffs makes me jittery so I ususally limit it > to > 1 puff. > So, what is the course of action I should ask the doctor to look at? I > have > not really had thorough testing for asthma. > Has your doctor tried you on Nasalcort?

Rhinocort, which is probably very similar? I stayed with the Singulair and it seems to be helping. Time will tell.

Response:

Right, Singulair is not a steroid. Interesting it would give you that response in only 24 hrs. As for the albuterol, take the two puffs as ordered you’ll feel no more shakey with two than one and it does go away. Also, two puffs are required for effective relief. It is not good to play doctor especially with asthma meds.

– Hide quoted text — Show quoted text -> *There is a small per cent of asthmatics who don’t respond to steroids. > It’s called steroid-resistant asthma. > Very interesting posts. I was going to post a similar question when I > noticed this thread. > Every winter I get colds that end up as asthma. I have very few asthmatic > problems during the rest of the year. Right now I have had 2 weeks of > relatively mild asthma following a cold. Since the doctor is seeing my > pattern now for a couple of winters, she gave me a sample of Advair 100/50 > to try for the winter. I took it twice (24 hours total use) and stopped. > It was almost as bad as prednisone for me, and that is *bad*, regarding side > effects. But most puzzling to me was that I had a big increase in my asthma > during that 24 hours. Wheezing and coughing. When I reached 12 hours after > the final dose, there was a noticeable improvement as it wore off. > I called and she put me on Singulair instead. Now, 2 hours after my first > dose, my asthma is getting bad again. Same result as the Advair, except no > side effects noticeable. > Singulair is not a steroid, right? > Albuterol helps, although 2 puffs makes me jittery so I ususally limit it to > 1 puff. > So, what is the course of action I should ask the doctor to look at? I have > not really had thorough testing for asthma. > Thanks!

Response:

> It was almost as bad as prednisone for me, and that is *bad*, regarding side > effects. But most puzzling to me was that I had a big increase in my asthma > during that 24 hours. Wheezing and coughing. When I reached 12 hours after > the final dose, there was a noticeable improvement as it wore off. > I called and she put me on Singulair instead. Now, 2 hours after my first > dose, my asthma is getting bad again. Same result as the Advair, except no > side effects noticeable.

It IS possible to be allergic to steroids and Singulair. I am. Joan Joan Marie Verba http://www.sff.net/people/Joan.Marie.Verba

Response:

Has your doctor tried you on Nasalcort? I’ve found that one puff in each nostril twice a day does a lot to control my asthma. Steroids do work for me, although I hate the side-effects; the mood swings, the joint pain, the headaches. GERD also causes asthma and I’m on prilosec for that. All in all, I have a heck of a time taking all these pills and the only thing that keeps me straight is one of those big pill organizers. I am on Singular which must be taken at night and I see little benefit from it. Currently I’m coming down from a bad episode that resulted in an ER visit and steroids. I’m hoping that I’ll be out of here before spring hits. Sue – Hide quoted text — Show quoted text -> Thanks!

Response:

> *There is a small per cent of asthmatics who don’t respond to steroids. > It’s called steroid-resistant asthma.

Very interesting posts. I was going to post a similar question when I noticed this thread. Every winter I get colds that end up as asthma. I have very few asthmatic problems during the rest of the year. Right now I have had 2 weeks of relatively mild asthma following a cold. Since the doctor is seeing my pattern now for a couple of winters, she gave me a sample of Advair 100/50 to try for the winter. I took it twice (24 hours total use) and stopped. It was almost as bad as prednisone for me, and that is *bad*, regarding side effects. But most puzzling to me was that I had a big increase in my asthma during that 24 hours. Wheezing and coughing. When I reached 12 hours after the final dose, there was a noticeable improvement as it wore off. I called and she put me on Singulair instead. Now, 2 hours after my first dose, my asthma is getting bad again. Same result as the Advair, except no side effects noticeable. Singulair is not a steroid, right? Albuterol helps, although 2 puffs makes me jittery so I ususally limit it to 1 puff. So, what is the course of action I should ask the doctor to look at? I have not really had thorough testing for asthma. Thanks!

Response:

– Hide quoted text — Show quoted text -> I have intermittent asthma. I’m 35 years old and have tried inhaled steroids > at least three times in my life. Each time I gave the steroids at three > months to kick in. And I have never noticed any perceptible improvement. I > am now on 4 puffs – twice a day (220 flovent). I am aware that steroids are > preventers (anti-inflamatory) and are not meant to provide instant relief > like albuterol. > I just read your Nov 18th article: "Asthma Guidelines Revised to Reflect > Best Scientific Knowledge" and it reaffirmed "unequivocally that inhaled > steroids are the ‘gold standard’ of asthma treatment". My doctors all look > at me like I’m crazy when I tell them steroids don’t work for me. > My symtoms come and go. I have had long stretches symtom free. And long > stretches symtom-full. In both cases, steroids never seem to help. Also, > earlier this year I had a very bad few weeks with asthma and my doctor gave > a steroid pill. It had no effect. > I HAVE had noticible improvements from long and short acting brinodilators > (serevent and albuterol) and Singulair seems to help. > A few other things that seem to be contrary to the asthma norm: > 1. I don’t have alergies – I had scratch and shot tests and they all came > out negetive. > 2. My symtoms are almost always between 3:00 PM and 11:00 PM. I never wake > up in the middle of the night from asthma. > 3. Colds and flues seem to make myasthma better – not worse. > So my question is: is there some small percentage of asthmatics that don’t > respond to steroids? Do I maybe have something other than asthma? > "We are each an experiment of one." – Dr. George Sheehan > Just do what works for you – take Singulair, take Serevent, and see if > being on those all the time takes care of your symptoms.

I’d check my environment thoroughly to find out exactly is different between 3 pm and 11 pm and the rest of the time. Don’t rule out allergies. Those tests are merely for certain specific common allergins. You might be reacting to something that’s not at all on the tests. Where are you and what are you doing differently between 3 and 11 and even shortly before that? For some of us, almost nothing works. I’ve been on every asthma medication known to man and right now am back on prednisone. Sue

Response:

- Hide quoted text — Show quoted text – > I have intermittent asthma. I’m 35 years old and have tried inhaled steroids > at least three times in my life. Each time I gave the steroids at three > months to kick in. And I have never noticed any perceptible improvement. I > am now on 4 puffs – twice a day (220 flovent). I am aware that steroids are > preventers (anti-inflamatory) and are not meant to provide instant relief > like albuterol. > I just read your Nov 18th article: "Asthma Guidelines Revised to Reflect > Best Scientific Knowledge" and it reaffirmed "unequivocally that inhaled > steroids are the ‘gold standard’ of asthma treatment". My doctors all look > at me like I’m crazy when I tell them steroids don’t work for me. > My symtoms come and go. I have had long stretches symtom free. And long > stretches symtom-full. In both cases, steroids never seem to help. Also, > earlier this year I had a very bad few weeks with asthma and my doctor gave > a steroid pill. It had no effect. > I HAVE had noticible improvements from long and short acting brinodilators > (serevent and albuterol) and Singulair seems to help. > A few other things that seem to be contrary to the asthma norm: > 1. I don’t have alergies – I had scratch and shot tests and they all came > out negetive. > 2. My symtoms are almost always between 3:00 PM and 11:00 PM. I never wake > up in the middle of the night from asthma. > 3. Colds and flues seem to make myasthma better – not worse. > So my question is: is there some small percentage of asthmatics that don’t > respond to steroids? Do I maybe have something other than asthma?

*There is a small per cent of asthmatics who don’t respond to steroids. It’s called steroid-resistant asthma. *Yes, this reaction to steroids, as well as your symptom history, raises some doubt about your asthma diagnosis. Asthma is diagnosed using spirometery; lung function measured before and after adminstering a bronchodilator; a significant improvement postbronchodilator, say 12%, tends to support an asthma diagnosis. If in doubt a methacholine challenge test may be given. Note that steroids, including steroid inhalers, should be used in the minimum dose to control the problem, due to side effects. If they don’t help they shouldn’t be used. Whether they help depends on peak flow readings and symptom control. You may want to seek a 2nd opinion from a teaching hospital with a good pulmonary dept. Links: http://library.nationaljewish.org/MSU/13n2MSU_StRe_Asthma.html Steroid-Resistant Asthma Excerpt: "Steroid-resistance Inhaled glucocorticoids have become the mainstay of asthma therapy. Treatment with oral glucocorticoids is the most potent therapy available for acute asthma regimen for patients with severe disease. Unfortunately, however, a small fraction of asthmatics are steroid resistant and do not benefit from standard treatment. Obviously it is critical to identify these patients as soon as possible. Patients who do not respond to low steroid doses are often placed on higher doses, which in steroid-resistant (SR) asthmatics can cause significant adverse effects without providing significant benefit. In addition, because steroids patients is a challenging medical problem. There are no definitive statistics on the prevalence of SR asthma, but a rough estimate is that it occurs in less than 5% of the asthmatic population. The differential diagnosis includes sinusitis, gastroesophageal reflux, congestive heart failure, an anatomic abnormality, immunodeficiency, interstitial lung disease, and bronchopulmonary dysplasia. Other conditions that could masquerade as SR asthma include poor patient compliance with therapy, drug interactions with glucocorticoids, abnormal glucocorticoid absorption or elimination, food sensitivity, environmental factors, and psychosocial factors."

Response:

Almost word for word I’ve had the same experience as you. The only difference I note is that for me the inhaled (not the pill – which did nothing at all) steroids made my symptoms worse. No question it’s asthma and ventolin works like a dream. Eventually, I got to see a consultant who simply advised that there is no point in taking steroids, if they aren’t doing you any good. Once that wisdom propagated down to my growing list of GPs, I was taken more seriously.

Response:

I have intermittent asthma. I’m 35 years old and have tried inhaled steroids at least three times in my life. Each time I gave the steroids at three months to kick in. And I have never noticed any perceptible improvement. I am now on 4 puffs – twice a day (220 flovent). I am aware that steroids are preventers (anti-inflamatory) and are not meant to provide instant relief like albuterol. I just read your Nov 18th article: "Asthma Guidelines Revised to Reflect Best Scientific Knowledge" and it reaffirmed "unequivocally that inhaled steroids are the ‘gold standard’ of asthma treatment". My doctors all look at me like I’m crazy when I tell them steroids don’t work for me. My symtoms come and go. I have had long stretches symtom free. And long stretches symtom-full. In both cases, steroids never seem to help. Also, earlier this year I had a very bad few weeks with asthma and my doctor gave a steroid pill. It had no effect. I HAVE had noticible improvements from long and short acting brinodilators (serevent and albuterol) and Singulair seems to help. A few other things that seem to be contrary to the asthma norm: 1. I don’t have alergies – I had scratch and shot tests and they all came out negetive. 2. My symtoms are almost always between 3:00 PM and 11:00 PM. I never wake up in the middle of the night from asthma. 3. Colds and flues seem to make myasthma better – not worse. So my question is: is there some small percentage of asthmatics that don’t respond to steroids? Do I maybe have something other than asthma?

Response:

"We are each an experiment of one." – Dr. George Sheehan Just do what works for you – take Singulair, take Serevent, and see if being on those all the time takes care of your symptoms. -S-

Response:

how long will a steriod inhaler last ?

admin — Wed, 20 Nov 2002 00:00:00 +0000

Question:

Ted I’m sorry for jumping on your doctor. Glad h e didn’ have to experience my big feet. Was under the impression he t o o k you off the ’steroid. You later clarified by saying <<>> Apparently you both did the right thing by checking out whether absence of the medication brought back the symptoms. Our situation may be smilar. I’ve been using albuterol and steroids for some eight years for my symptoms. And my two sccessive pulmonologists in that time both diagnosed me with COPD/emphysema.My present lung doctor says he doesn’t really know whether I have COPD. He was honest enough to tell me he has no explanation for one of my symptoms. But as far as my asthma goes, I remember way back in high school I was one of the kids who couldn’t run all the way around the reservoir, could only run a block or two. And in boxing I could do two one minute rounds. But I would die in the third. And never knew I had asthma until seven or eight years ago when this other thing, whatever it is, kicked in. So anyway Ted, I think you’re doing very well pursuing and evaluating your symptoms. Looking into it and finding some answers before it gets a chance to get worse. Good luck—jack

Response:

> Ted said his doctor, having read steroids wern’t much good for COPD took > him off Pulmicort. > Ted I hope you’ve found another doctor.

Ted’s doctor is correct. Inhaled steroids do not prevent long term progression of disease in COPD as they have been shown to do in asthma. What they do is to prevent and treat exacerbations. If a person with COPD is not having frequent exacerbations then there is little proven benefit from them. If your experience differs then the two things I would consider are whether there might be a component of more typical (i.e. allergic) asthma or if you have some continuing trigger that leads to frequent exacerbations. — CBI, MD

Response:

> > Ted said his doctor, having read steroids wern’t much good for COPD took > him off Pulmicort. > Ted I hope you’ve found another doctor.

I did reply but my ISP was having problems that day. > Ted’s doctor is correct.

I am willing to take meds that help but prefer to avoid any more than neccessary. I keep very good records of my PEFs with software that I wrote so my doctor encouraged a test to determine if the Pulmicort was really helping. I weaned off the Pulmicort over a 7 day period and observed that I lost about 40 points on my PEF over a 112 day period. I then re-started the pulmicort and, at 23 days, my PEF readings appear to be increasing although it is a bit soon to draw hard conclusions. > Inhaled steroids do not prevent long term progression of disease in COPD as > they have been shown to do in asthma. What they do is to prevent and treat > exacerbations. If a person with COPD is not having frequent exacerbations > then there is little proven benefit from them. > If your experience differs then the two things I would consider are whether > there might be a component of more typical (i.e. allergic) asthma or if you > have some continuing trigger that leads to frequent exacerbations.

I suspect that the COPD may be associated with asthma and the Pulmicort is helping the later. I have not seen a reference that makes clear the difference and what is needed for differential diagnosis. Suggestions? TIA Ted

Response:

Ted said his doctor, having read steroids wern’t much good for COPD took him off Pulmicort. Ted I hope you’ve found another doctor. jack

Response:

> Ted said his doctor, having read steroids wern’t much good for COPD took > him off Pulmicort. > Ted I hope you’ve found another doctor.

You are making a whole bunch of assumptions. Have you personally looked into steroids for COPD? Can you supply some references? Ted

Response:

Please pardon my brevity the other day. Hope to catch the right moment, and soon, to extrapolate on my comments. My experience as a patient will, more than anything else, be the basis of what I may have to say. Ted. Thanks for your forbearance. jm (background) Ted had written in reply to

Ted said his doctor, having read steroids wern’t much good for COPD took him off Pulmicort. (Jack says)Ted I hope you’ve found another doctor. (Ted says) You are making a whole bunch of assumptions. Have you personally looked into steroids for COPD? Can you supply some references? Ted >>>

Response:

writes – Hide quoted text — Show quoted text -> how long does the effects of a steroid inhaler last ? for example if i stop > taking it , when will the help (go away) ? >Recently my doctor read a report that suggested that steroid inhalers >aren’t much help in most cases of COPD which is what we think I have. >So I weaned off the Pulmicort over a one week period. >I keep very good records of my PEF and wrote software to plot the data. >My performance deteriorated over a two month period so after a further >period of 50 days to be sure we weren’t seeing a random fluctuation, I >went back on it. It appears things are improving again but I can’t be >sure yet as it has only been two weeks. >That should give you some idea of the time scales involved.

It varies in different people is the best answer IMHO. Sometimes I have not noticed the red marker in the window on my inhaler, and wondered why I’ve started coughing, which would be after a couple of days of a low dose. When I started using it I also had a similar very fast response – over a couple of days my PEF chart sorted itself out – the morning lows vanished and the general level moved up a bit. — Five Cats

Response:

– Hide quoted text — Show quoted text -> how long does the effects of a steroid inhaler last ? for example if i stop > taking it , when will the help (go away) ? > Recently my doctor read a report that suggested that steroid inhalers > aren’t much help in most cases of COPD which is what we think I have. > So I weaned off the Pulmicort over a one week period. > I keep very good records of my PEF and wrote software to plot the data. > My performance deteriorated over a two month period so after a further > period of 50 days to be sure we weren’t seeing a random fluctuation, I > went back on it. It appears things are improving again but I can’t be > sure yet as it has only been two weeks. > That should give you some idea of the time scales involved. > Ted

Ted, My experience with my mother, who had COPD, there was a huge difference whether or not if she was on a steriod inhaler. She was also on serevent which helped alot. Just FYI. Kathy

Response:

how long does the effects of a steroid inhaler last ? for example if i stop taking it , when will the help (go away) ?

Response:

> how long does the effects of a steroid inhaler last ? for example if i stop > taking it , when will the help (go away) ?

Recently my doctor read a report that suggested that steroid inhalers aren’t much help in most cases of COPD which is what we think I have. So I weaned off the Pulmicort over a one week period. I keep very good records of my PEF and wrote software to plot the data. My performance deteriorated over a two month period so after a further period of 50 days to be sure we weren’t seeing a random fluctuation, I went back on it. It appears things are improving again but I can’t be sure yet as it has only been two weeks. That should give you some idea of the time scales involved. Ted

Response:

> how long does the effects of a steroid inhaler last ? for example if i stop > taking it , when will the help (go away) ? > Recently my doctor read a report that suggested that steroid inhalers > aren’t much help in most cases of COPD which is what we think I have. > So I weaned off the Pulmicort over a one week period.

Yes and no. The study pbservation was that steroid inhalers do not improve the baseline ling function of people with COPD but they do help to reduce exacerbations. The theory/tie-in with other observations is that the inflammatory response of asthma is mostly eosinophils (associated with allergies and parasitic infections). The cells seen in COPD at its baseline are granulocytes (usually fight bacterial infections). During exacerbations of COPD the cellular response changes from granulocytes to eosinophils. As it turns out eosinophils are much more sensitive to steroids. — CBI, MD

Response:

Things to avoid?

admin — Sun, 10 Nov 2002 00:00:00 +0000

Question:

If someone have asthma, what are some of the common places or things should I tell them to stay away from? Nathan

Response:

>If someone have asthma, what are some of the common places or things should >I tell them to stay away from?

About the only things that would apply to all asthmatics would be tobacco smoke and ozone. Otherwise – it depends on what his/her asthma triggers are. "It’s not American foreign policy, or the plight of the Palestinians, or America’s longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." ‘Christian Century’ magazine

Response:

> >If someone have asthma, what are some of the common places or things should >I tell them to stay away from? > About the only things that would apply to all asthmatics would be > tobacco smoke and ozone.

Sulfur dioxide will cause bronchospasm. Indeed, in sufficient concentration, sulfur dioxide will cause bronchospasm even in people who don’t have asthma. — Steven D. Litvintchouk

Response:

>If someone have asthma, what are some of the common places or things should >I tell them to stay away from?

Tobacco smoke first and foremost. If they smoke they should give up ASAP. Anything they are allergic to, if they have allergies. People with coughs & colds. Anything which makes their asthma worse, which varies widely from person to person but will almost always include air pollution from traffic. >Nathan

– Five Cats

Response:

I just know I'm going to regret this but…

admin — Sun, 10 Nov 2002 00:00:00 +0000

Question:

at www.allergybuyersclub.com they have a consumer’s panel that rates these products you might look at. As a physician, I have heard favorably about National Allergy and Allergy Control copanies that market allergy products. Murray Grossan, M.D. http://www.ent-consult.com http://www.TinnitusRelief.net http://www.emedicine.com/ent/topic516.htm

Response:

Hi Group, I need to get a new vacuum cleaner… Our old (three whole years) Turbo Hepa Dustbowl Deluxe and combination sand blaster fell over for about the hundredth time (top heavy) and to my delight, broke it’s dust leaky neck. I won’t name the brand, but we got it at Sears (along with lots of empty promises about how clean it operated). Oh yea… its initials were Hoover. Anyway… I would love to see a few brand/model suggestions from group members that can include dust mites as a trigger. It can be any type (even bagless) that has the usual cleaning attachments. I’ll even grovel if you’ll make a few suggestions. I’d love to know what YOU are using and like. So far, my Google searches keep leading me to allergy supply outlets and major manufacturers. The former sell things I’ve never heard of for a LOT of money and the latter I’ve decided not to blindly trust this time around. If you are in the business of selling vacuum cleaning equipment to the public, I would prefer NOT to hear from you at this time (I’ve probably already seen your web sites anyway). I want to hear from the people who actually have to live with these things. My sincere thanks in advance. Dan Rhea "Loyalty is for family, friends and country, not operating systems, compilers and computers" – Dan Rhea, 1986

Response:

– Hide quoted text — Show quoted text -> Hi Group, > I need to get a new vacuum cleaner… Our old (three whole years) > Turbo Hepa Dustbowl Deluxe and combination sand blaster fell over > for about the hundredth time (top heavy) and to my delight, broke > it’s dust leaky neck. I won’t name the brand, but we got it at Sears > (along with lots of empty promises about how clean it operated). Oh > yea… its initials were Hoover. > Anyway… I would love to see a few brand/model suggestions from > group members that can include dust mites as a trigger. It can be > any type (even bagless) that has the usual cleaning attachments. > I’ll even grovel if you’ll make a few suggestions. > I’d love to know what YOU are using and like. > So far, my Google searches keep leading me to allergy supply outlets > and major manufacturers. The former sell things I’ve never heard of > for a LOT of money and the latter I’ve decided not to blindly trust > this time around. > If you are in the business of selling vacuum cleaning equipment to > the public, I would prefer NOT to hear from you at this time (I’ve > probably already seen your web sites anyway). I want to hear from > the people who actually have to live with these things. > My sincere thanks in advance. > Dan Rhea > "Loyalty is for family, friends and country, not operating systems, > compilers and computers" > – Dan Rhea, 1986

Hi Dan, A central vac is the best. It is vented outside, no bags, no filters, not much noise either. I have used one for over 25 years, and have never had a problem using it. We got a new vac at work, super duper hepa filter, etc.etc. I have an asthma attack within minutes of it being turned on. I am allergic to dust, dust mites, mold, the usual stuff. I have a Sears, but they don’t sell them any more. It was made for Sears by Whirlpool, don’t know if they still make them. Good luck in your search. Mabel

Response:

Ultracet more harmful than Ultram?

admin — Sat, 09 Nov 2002 00:00:00 +0000

Question:

Why, on the print out from the pharmacy, does it say Ultracet should be taken only for five days? It seems people are on Ultram long term. Is it the acetominophen that can cause damage – to the stomach or something? I’m getting amazing pain relief from Ultracet yesterday and today, and hadn’t gotten relief from Ultram when I tried it before. If Ultracet *is* dangerous and Ultram not, I’d be happy to revisit Ultram again. Can someone explain why the pharmacy warning about Ultracet? All it is is Ultram mixed with acetominphen. Thanks Jen

Response:

> Why, on the print out from the pharmacy, does it say Ultracet should > be taken only for five days? It seems people are on Ultram long term. > Is it the acetominophen that can cause damage – to the stomach or > something? > I’m getting amazing pain relief from Ultracet yesterday and today, and > hadn’t gotten relief from Ultram when I tried it before. If Ultracet > *is* dangerous and Ultram not, I’d be happy to revisit Ultram again. > Can someone explain why the pharmacy warning about Ultracet? All it > is is Ultram mixed with acetominphen.

Acetaminophen (and aspirin) is toxic to the liver and kidneys, which is why it’s not safe to take in the long term at high doses. There is a safe limit, but that can vary depending on the state of the person’s liver, drinking alcohol etc. I think the stated maximum daily dosage of Acetaminophen (APAP) is 4000mg. It’s the NSAIDs which harm the stomach, I don’t think acetaminophen does. So that’s why opioids are used for long-term pain relief – they aren’t toxic over the long term. Unfortunately there are many opioid-phobic doctors who would rather destroy their patients livers than give them safe pain medication. If you are taking one of the following medications, consult your doctor before taking any product containing acetaminophen: Questran (cholestrol-lowering drug), Nydrazid (isoniazid), Dolobid/Motrin (Nonsteroidal anti-inflammatory drugs), Oral contraceptives, Dilantin (phenytoin), Coumadin (warfarin), and Retrovir (zidovudine). — Katharine S. DEFINITION: Computer – A device designed to speed and automate errors.

Response:

oh my gosh .. just read your post ..and I DO take questran ..and am on Norco 10/325 … where can I find out more … ? thanks – Hide quoted text — Show quoted text -> Why, on the print out from the pharmacy, does it say Ultracet should > be taken only for five days? It seems people are on Ultram long term. > Is it the acetominophen that can cause damage – to the stomach or > something? > I’m getting amazing pain relief from Ultracet yesterday and today, and > hadn’t gotten relief from Ultram when I tried it before. If Ultracet > *is* dangerous and Ultram not, I’d be happy to revisit Ultram again. > Can someone explain why the pharmacy warning about Ultracet? All it > is is Ultram mixed with acetominphen. > Acetaminophen (and aspirin) is toxic to the liver and kidneys, which is why > it’s not safe to take in the long term at high doses. There is a safe limit, > but that can vary depending on the state of the person’s liver, drinking > alcohol etc. I think the stated maximum daily dosage of Acetaminophen > (APAP) is 4000mg. It’s the NSAIDs which harm the stomach, I don’t think > acetaminophen does. > So that’s why opioids are used for long-term pain relief – they aren’t toxic > over the long term. Unfortunately there are many opioid-phobic doctors who > would rather destroy their patients livers than give them safe pain > medication. > If you are taking one of the following medications, consult your doctor > before taking any product containing acetaminophen: Questran > (cholestrol-lowering drug), Nydrazid (isoniazid), Dolobid/Motrin > (Nonsteroidal anti-inflammatory drugs), Oral contraceptives, Dilantin > (phenytoin), Coumadin (warfarin), and Retrovir (zidovudine). > — > Katharine S. > DEFINITION: Computer – A device designed to speed and automate errors.

Response:

Jen, the acetomenophen/Tylenol in Ultracet, in large amts CAN be damaging to the liver. I think the optimum dose of acetomenophen is approx. 3,500-4,500mg(?)…not sure of exact amt, but I’m sure someone here knows. Just keep track of how much you’re getting in the Ulracet, OTC & other meds. You can check with your DR or Pharmacist. Good to hear that it works well for your pain. Peace~Stacie P.S. it’s aspirin, Cortisone & NASAIDS that are rough on the stomach.

Response:

You can find out a lot about those meds on the "Net through Google, but you might be better off if you buy a copy of the PDR Pocket Guide To Prescription Drugs, a handy book which gives information on each drug, how much to take, drug interactions, side effects, etc. In the US it costs $6.99; $8.99 Canadian.

– Hide quoted text — Show quoted text ->oh my gosh .. just read your post ..and I DO take questran ..and am on Norco >10/325 … > where can I find out more … ? > thanks > > Why, on the print out from the pharmacy, does it say Ultracet should > > be taken only for five days? It seems people are on Ultram long term. > > Is it the acetominophen that can cause damage – to the stomach or > > something? > > I’m getting amazing pain relief from Ultracet yesterday and today, and > > hadn’t gotten relief from Ultram when I tried it before. If Ultracet > > *is* dangerous and Ultram not, I’d be happy to revisit Ultram again. > > Can someone explain why the pharmacy warning about Ultracet? All it > > is is Ultram mixed with acetominphen. > Acetaminophen (and aspirin) is toxic to the liver and

kidneys, which is why > it’s not safe to take in the long term at high doses. There is a safe limit, > but that can vary depending on the state of the person’s liver, drinking > alcohol etc. I think the stated maximum daily dosage of Acetaminophen > (APAP) is 4000mg. It’s the NSAIDs which harm the stomach, I don’t think > acetaminophen does. > So that’s why opioids are used for long-term pain relief – they aren’t toxic > over the long term. Unfortunately there are many

opioid-phobic doctors who > would rather destroy their patients livers than give them safe pain > medication. > If you are taking one of the following medications, consult your doctor > before taking any product containing acetaminophen: Questran > (cholestrol-lowering drug), Nydrazid (isoniazid), Dolobid/Motrin > (Nonsteroidal anti-inflammatory drugs), Oral

contraceptives, Dilantin – Hide quoted text — Show quoted text -> (phenytoin), Coumadin (warfarin), and Retrovir (zidovudine). > — > Katharine S. > DEFINITION: Computer – A device designed to speed and automate errors.

Response:

> oh my gosh .. just read your post ..and I DO take questran ..and am > on Norco 10/325 … > where can I find out more … ? > thanks

Check with your pharmacist and/or doctor – it might be an issue, or it might just be just a precaution to cover their backs in case .0000001% of people react badly to the combination. I was surprised when I saw that oral contraceptives are on the list – I take them, but no doctor has every indicated concern when I’ve been on anything with APAP in it… — Katharine S. DEFINITION: Computer – A device designed to speed and automate errors.

Response:

>Acetaminophen (and aspirin) is toxic to the liver and kidneys, which is why >it’s not safe to take in the long term at high doses. There is a safe limit, >but that can vary depending on the state of the person’s liver, drinking >alcohol etc. I think the stated maximum daily dosage of Acetaminophen >(APAP) is 4000mg. It’s the NSAIDs which harm the stomach, I don’t think >acetaminophen does.

Katharine and Stacie – Thank you for the information. I’m wondering how long you can take acetonminphen? I just reread the physician’s info (at www.ultracet.com) and it says: "ULTRACET is indicated for the short-term (5 days or less) management of acute pain." I don’t drink at all and my liver is fine now; I get tested often. I’ve been on Celebrex for over a year and I’d like to find something different. Maybe I will try Ultram again, if I can tolerate Ultracet. It’s giving me a very heavy, cloudy head. And I’m wondering if it’s even making me feel more depressed. >So that’s why opioids are used for long-term pain relief – they aren’t toxic >over the long term. Unfortunately there are many opioid-phobic doctors who >would rather destroy their patients livers than give them safe pain >medication.

Only speaking for my own doctor. He has given me *many* opioids and I just can’t tolerate the side effects. It’s horrible. I’m terribly sensitive to side effects yet in horrible pain. He is truly willing and wanting to give me absolutely anything that would help me. He has no fear at all of prescribing med after med to see how I’ll respond – if it will help and if I can tolerate it. I’m kind of a tough case all the way around. I’m really so miserable right now. What do you guys do when it all just gets you down? Seeing doctors, being disabled, feeling sick, medicated feeling; sometimes it’s just too much. >If you are taking one of the following medications, consult your doctor >before taking any product containing acetaminophen: Questran >(cholestrol-lowering drug), Nydrazid (isoniazid), Dolobid/Motrin >(Nonsteroidal anti-inflammatory drugs), Oral contraceptives, Dilantin >(phenytoin), Coumadin (warfarin), and Retrovir (zidovudine).

I noticed on the site that it can reduce the seizure threshold, so that could be the reason for some of those listed. I wonder if that NSAID holds true for others, like Celebrex, as well. This is the first page of the physician’s info – http://www.ultracet.com/hcp/hcpabout.html and there’s a link to another that’s a .pdf file – the complete info. What do you do when you start to think it’s just not fair, I can’t take it, and you can’t shake the feeling? I definitely feel "heady" – headche-ish sort of thing. Does anyone else feel that on Ultram? Or even Tylenol I guess? I wonder why Ultracet would work when Ultram and Tylenol on their own don’t. Is there something about a combination? I think the only thing that’s ever helped me are antiinflammatories. If only I were allowed to take Toradol or I wasn’t allergic to Prednisone I think I’d be a functional person. Sorry I rambled. Thanks again for loking that up for me and answering my question. Jen

Response:

Jen writes: Katharine and Stacie – Thank you for the information. I’m wondering how long you can take acetonminphen?

Mold in Workplace

admin — Mon, 16 Sep 2002 00:00:00 +0000

Question:

Hi everyone, I am new to the group. My situation is that I work in a building which has documened mold in the building (2 environmental stuides have been done which show it). My questtion is, can asthma be made worse by working in this environment? Before you ask while I am still there I work for the government who moves slowly on anything and have too many years already worked to just walk away. I also cannot afford to take leave without pay. I notice that my symptoms are worse at work than when I’m home. Thanks. Pamela

Response:

> I am new to the group. My situation is that I work in a building > which has documened mold in the building (2 environmental stuides have > been done which show it). My questtion is, can asthma be made worse > by working in this environment? > Before you ask while I am still there I work for the government who > moves slowly on anything and have too many years already worked to > just walk away. I also cannot afford to take leave without pay. > I notice that my symptoms are worse at work than when I’m home.

Yes, mold at work can make the asthma worse. If you aren’t planning on leaving that environment, the only optiions I can think of are: (1) see your doctor about increasing the dose or adding to your current medications or (2) buy a HEPA filter and run it in your office. However, you may find that you will need to leave (a choice between one’s health and one’s job is a tough one; I’ve been through it more than once and eventually I simply had to leave). Joan

Response:

If the mold gets into the air circulation, you could have an allergic reaction to it. Mold can also cause various lung diseases such as hypersensitivity pneumonitis. http://www.chestnet.org/education/pccu/vol14/lesson06.html Excerpts: Disease Ventilator lung Antigen Source Contaminated humidifiers, dehumidifiers, air conditioners, heating systems Probable Antigen Thermophilic actinomycetes Thermoactinomyces candidus T vulgaris Penicillium sp Cephalosporium sp Amoeba sp Klebsiella sp Candida sp Maybe consider wearing an NIOSH N-95 surgical mask. http://www.3m.com/product/m_index/Mask,_3M(TM)_Health_Care_N95_Partic… http://products.3m.com/us/healthcare/products/healthcare-medical.jhtm… If there is mold in the air circulation, there could be other contaminants in addition. E

Response:

You could ask the management to repair the building. If they refuse or drag their feet look for employment elsewhere, or ask to be transferred citing medical reasons. Lane

– Hide quoted text — Show quoted text -> Hi everyone, > I am new to the group. My situation is that I work in a building > which has documened mold in the building (2 environmental stuides have > been done which show it). My questtion is, can asthma be made worse > by working in this environment? > Before you ask while I am still there I work for the government who > moves slowly on anything and have too many years already worked to > just walk away. I also cannot afford to take leave without pay. > I notice that my symptoms are worse at work than when I’m home. > Thanks. > Pamela

Response:

pnemonia, in March–still coughing

admin — Sun, 01 Sep 2002 00:00:00 +0000

Question:

– Hide quoted text — Show quoted text -> It is mostly yellow, sometimes white. The Pulmonary doctor said it > is better that I am still able to cough it up–this was about a month > ago. He was not concerned. > During routine blood work this past week, I had an elevated > WBC. I will talk to the family doc this week. > Can the stuff I am still coughing up and the WBC be related? > You might still have a lingering infection. > Or maybe chronic bronchitis. > Should I call the Pulmonary specialist? > Yes. Have a sputum culture tested for infection. A sputum culture done > by saline lavage is best–samples the junk down there without > contaminating it too much with post nasal drip (which might have > different bugs in it). > I am open for any suggestions! BTW–I do take a full > menu of asthma meds–(flovent/seravent, allegra, humibid) > What antibiotics were you on? > When did you stop taking them?

When I was diagnosed with the pneumonia back in March, I was on Vantin, for 21 days. The 1st 5-8 days, I was basically on the sofa. I was really, really weak. After about day 10, I started to resume somewhat normal activities. 10 days after completing the vantin, a fever returned and pain in my back; I then took avelox for 14 days. Since then, a nagging cough that never went away. In the morning after using the neb–I can bring all kinds of stuff up; NEVER was like this before the penmonia. In June, the doctor said I was ok, continue with regular meds. I will call on Tuesday morning and tell him about the elevated wbc. Thanks – Hide quoted text — Show quoted text -> — > Steven D. Litvintchouk

Response:

- Hide quoted text — Show quoted text – > Hi–I have asthma–controlled fairly well until this past spring. > I had a bad bout of pneumonia and since then, still coughing up > junk. Prior to the pneumonia, I never coughed up stuff! (sorry to > be gross) > It is mostly yellow, sometimes white. The Pulmonary doctor said it > is better that I am still able to cough it up–this was about a month > ago. He was not concerned. > During routine blood work this past week, I had an elevated > WBC. I will talk to the family doc this week. > Can the stuff I am still coughing up and the WBC be related? > Should I call the Pulmonary specialist? > I am more annoyed that I can’t get rid of this junk! > I am open for any suggestions! BTW–I do take a full > menu of asthma meds–(flovent/seravent, allegra, humibid) > thanks

Pneumonia that doesn’t clear in a few weeks may be something else, maybe a secondary infection. Next step should be to see the pulmo doc for a chest x-ray [these are routinely given for those with persistent pneumonia]. The elevated WBC could be suggesive of another lung condition, like for example ABPA [allergic bronchopulmonary aspergillosis]. See: http://www.ehendrick.org/healthy/00036780.html Excerpt: "Description ABPA is an allergic reaction to a species of Aspergillus called Aspergillus fumigatus. It is sometimes grouped together with other lung disorders characterized by eosinophilia — an abnormal increase of a certain type of white blood cell in the blood — under the heading of eosinophilic pneumonia. These disorders are also called hypersensitivity lung diseases. ABPA appears to be increasing in frequency in the United States, although the reasons for the increase are not clear. The disorder is most likely to occur in adult asthmatics aged 20-40. It affects males and females equally." E

Response:

Hi–I have asthma–controlled fairly well until this past spring. I had a bad bout of pneumonia and since then, still coughing up junk. Prior to the pneumonia, I never coughed up stuff! (sorry to be gross) It is mostly yellow, sometimes white. The Pulmonary doctor said it is better that I am still able to cough it up–this was about a month ago. He was not concerned. During routine blood work this past week, I had an elevated WBC. I will talk to the family doc this week. Can the stuff I am still coughing up and the WBC be related? Should I call the Pulmonary specialist? I am more annoyed that I can’t get rid of this junk! I am open for any suggestions! BTW–I do take a full menu of asthma meds–(flovent/seravent, allegra, humibid) thanks

Response:

> It is mostly yellow, sometimes white. The Pulmonary doctor said it > is better that I am still able to cough it up–this was about a month > ago. He was not concerned. > During routine blood work this past week, I had an elevated > WBC. I will talk to the family doc this week. > Can the stuff I am still coughing up and the WBC be related?

You might still have a lingering infection. Or maybe chronic bronchitis. > Should I call the Pulmonary specialist?

Yes. Have a sputum culture tested for infection. A sputum culture done by saline lavage is best–samples the junk down there without contaminating it too much with post nasal drip (which might have different bugs in it). > I am open for any suggestions! BTW–I do take a full > menu of asthma meds–(flovent/seravent, allegra, humibid)

What antibiotics were you on? When did you stop taking them? — Steven D. Litvintchouk

Response:

Hello from a newbie with a perfume problem

admin — Mon, 19 Aug 2002 00:00:00 +0000

Question:

> Lisa, the first case I read of severe acute reaction to Intal happened to a > small girl, upon her first puff of the drug in her doctor’s office. How > long ago did this happen to you? > I’m just as pleased you missed the name of the toothpaste. The reaction > happened decades ago – and, I shouldn’t have mentioned the name of the > product anyway. > Larry

The fall of 1998. I was curious to the ingredient in the toothpaste not the brand. I am also allergic to barium (for UGI’s). It too is supposedly inert. However, something it is mixed with also causes a severe reaction. I can do iodine though. Go figure. Lisa

Response:

> I was too superficial, wasn’t I. Your experience is recognized, but has been > reported very rarely, and my failure to mention it was a major error in > judgement. The allergy caveat should be applied to everything. the most > surprising episode I have seen myself happened after using Maclean’s > toothpaste. > Larry

No problem. I wished the Intal worked. What was in the toothpaste that caused the reaction? Lisa

Response:

>> I was too superficial, wasn’t I. Your experience is recognized, but has been > reported very rarely, and my failure to mention it was a major error in > judgement. The allergy caveat should be applied to everything. the most > surprising episode I have seen myself happened after using Maclean’s > toothpaste. > Larry > No problem. I wished the Intal worked. What was in the toothpaste that > caused the reaction? > Lisa

Lisa, the first case I read of severe acute reaction to Intal happened to a small girl, upon her first puff of the drug in her doctor’s office. How long ago did this happen to you? I’m just as pleased you missed the name of the toothpaste. The reaction happened decades ago – and, I shouldn’t have mentioned the name of the product anyway. Larry

Response:

– Hide quoted text — Show quoted text -> Sorry you have had that experience, Pete. The drug is benign, and there > literally is no lethal dose. It was the first great advance in asthma > therapy after inhaled bronchodilators, was used extensively in those years > (was it the 70s?), and I can think of no reason why one should not try it. I > have prescribed it many hundreds of times of times, even before it became > available in the US, and have been pleased with it as a pre-insult > medication in about 50% of the patients. Try Intal, Florrie. > Larry > Hi Larry, > Intal put me in ICU for a week. One puff shut me down completely. My > doctor had me try it in his office before sending me home with a > script. Within minutes, I was in respiratory distress and came quite > close to a full blown code. Trying it in his office probably saved my > life. By the way, I had just finished a PFT and was breathing in the > 90% range. I was having problems with running and he suggested adding > Intal to my medications. It definitely wasn’t benign for me. The stuff > almost killed me. > Lisa

I was too superficial, wasn’t I. Your experience is recognized, but has been reported very rarely, and my failure to mention it was a major error in judgement. The allergy caveat should be applied to everything. the most surprising episode I have seen myself happened after using Maclean’s toothpaste. Larry

Response:

> Personally, all that "fluffy" powdered Intal hitting the back of my throat > would generally precipitate a coughing bout which would cause a severe > asthma attack in its self

As with any other medication, Intal is not for everyone. I have had anaphylactic reactions to both Intal and Tilade. Joan

Response:

Thanks for the suggestions everyone. I will definitely ask my dr about the Intal, thanks for the idea. It would be good to have a medication as a back-up at least while I’m trying to deal with the people problem.

Response:

> Sorry you have had that experience, Pete. The drug is benign, and there > literally is no lethal dose. It was the first great advance in asthma > therapy after inhaled bronchodilators, was used extensively in those years > (was it the 70s?), and I can think of no reason why one should not try it. I > have prescribed it many hundreds of times of times, even before it became > available in the US, and have been pleased with it as a pre-insult > medication in about 50% of the patients. Try Intal, Florrie. > Larry

Hi Larry, Intal put me in ICU for a week. One puff shut me down completely. My doctor had me try it in his office before sending me home with a script. Within minutes, I was in respiratory distress and came quite close to a full blown code. Trying it in his office probably saved my life. By the way, I had just finished a PFT and was breathing in the 90% range. I was having problems with running and he suggested adding Intal to my medications. It definitely wasn’t benign for me. The stuff almost killed me. Lisa

Response:

– Hide quoted text — Show quoted text ->> Hi everyone, I’m new! I’m 30, female, asthmatic since 3 years old >> with varying degrees of severity, currently moderate and relatively >> well controlled with medication most of the time. > >> Thanks for any help and I hope you’re all feeling well at the moment. > Use Intal (cromolyn sodium) 30 minutes before entering the house, and > every > four hours during continuing contact. You can perfectly safely continue > using all of your other medicines at the same time. > Larry > Perhaps Larry ought to have added some caveats to his post, along the lines > of – "you might try", "this works for me" or "DISCUSS WITH YOUR PHYSICIAN". > Personally, all that "fluffy" powdered Intal hitting the back of my throat > would generally precipitate a coughing bout which would cause a severe > asthma attack in its self

Sorry you have had that experience, Pete. The drug is benign, and there literally is no lethal dose. It was the first great advance in asthma therapy after inhaled bronchodilators, was used extensively in those years (was it the 70s?), and I can think of no reason why one should not try it. I have prescribed it many hundreds of times of times, even before it became available in the US, and have been pleased with it as a pre-insult medication in about 50% of the patients. Try Intal, Florrie. Larry

Response:

– Hide quoted text — Show quoted text -> Hi everyone, I’m new! I’m 30, female, asthmatic since 3 years old > with varying degrees of severity, currently moderate and relatively > well controlled with medication most of the time. > Thanks for any help and I hope you’re all feeling well at the moment. > Use Intal (cromolyn sodium) 30 minutes before entering the house, and every > four hours during continuing contact. You can perfectly safely continue > using all of your other medicines at the same time. > Larry

Perhaps Larry ought to have added some caveats to his post, along the lines of – "you might try", "this works for me" or "DISCUSS WITH YOUR PHYSICIAN". Personally, all that "fluffy" powdered Intal hitting the back of my throat would generally precipitate a coughing bout which would cause a severe asthma attack in its self So…… either divorce hubby (not recommended) or divorce his familly ’til their house trained! Pete

Response:

– Hide quoted text — Show quoted text -> Hi everyone, I’m new! I’m 30, female, asthmatic since 3 years old > with varying degrees of severity, currently moderate and relatively > well controlled with medication most of the time. > Since I have been living with asthma virtually all my life I haven’t > faced too many problems I couldn’t handle but this one is troubling > me. > I recently married into a family in which all the ladies feel the need > to douse themselves in perfume, hairspray and goodness knows what > else, and not just on special occasions either. They’re also big fans > of room freshener. Naturally as luck would have it I react to all > these things and suffer for hours (sometimes days) after a visit to > the in-laws. I did a search and noticed a lot of you have the same > problem and I was wondering how you deal with it when avoiding the > people concerned is simply not a solution. > Unfortunately they are not the world’s most helpful people and haven’t > picked up any subtle hints (eg me reaching for the ventolin and my > hubby suggesting the prob might be all the fumes!) so I’d like ideas > for managing the situation. My MIL has a friend with severe asthma > and maintains that if this lady can manage at her house, I can – but > I’ve spoken to the friend and her asthma is intrinsic and/or weather > related, not allergic. > Thanks for any help and I hope you’re all feeling well at the moment.

Use Intal (cromolyn sodium) 30 minutes before entering the house, and every four hours during continuing contact. You can perfectly safely continue using all of your other medicines at the same time. Larry

Response:

I have fragrance allergy (or more likely sensitivity). I have learned that subtlety does not work. I have a sign over my cubicle telling people to leave and use the phone if they are wearing strong perfume or cologne and I bluntly tell them that I am allergic to their perfume and somebody else will have to help them. >Unfortunately they are not the world’s most helpful people and haven’t >picked up any subtle hints (eg me reaching for the ventolin and my >hubby suggesting the prob might be all the fumes!) so I’d like ideas >for managing the situation. My MIL has a friend with severe asthma >and maintains that if this lady can manage at her house, I can – but >I’ve spoken to the friend and her asthma is intrinsic and/or weather >related, not allergic.

Simply tell your MIL that you and her friend are different people with different asthma triggers. And that If she continues to wear the strong fragrances she will not be allowed in your home. There are times to be nice – but not when your health is on the line. "It’s not American foreign policy, or the plight of the Palestinians, or America’s longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." ‘Christian Century’ magazine

Response:

I would draw a line in the sand – one has to do this with one’s in-laws from time to time. I would let your husband be the point person and, if I were you, I’d be completely silent. Make it clear that, if they want the two of you at their house, they’ll refrain from doing things that cause you to have trouble breathing. It’s that simple. We’ve had a few such encounters on both sides of our family, each of us being the point person for the other and, after a few tense times, it’s all worked out very well. FWIW, I’m very perfume sensitive but most relatively expensive perfume bothers me much less than the inexpensive stuff, e.g., I can almost be in the room when my wife applies Chanel No. 5 – she gets it now for her birthday from me and the kids – but the cheaper stuff she used to buy for herself was just unbearable – it would be at least half an hour before I could enter the room, or so it seemed. -S- – Hide quoted text — Show quoted text – > Hi everyone, I’m new! I’m 30, female, asthmatic since 3 years old > with varying degrees of severity, currently moderate and relatively > well controlled with medication most of the time. > Since I have been living with asthma virtually all my life I haven’t > faced too many problems I couldn’t handle but this one is troubling > me. > I recently married into a family in which all the ladies feel the need > to douse themselves in perfume, hairspray and goodness knows what > else, and not just on special occasions either. They’re also big fans > of room freshener. Naturally as luck would have it I react to all > these things and suffer for hours (sometimes days) after a visit to > the in-laws. I did a search and noticed a lot of you have the same > problem and I was wondering how you deal with it when avoiding the > people concerned is simply not a solution. > Unfortunately they are not the world’s most helpful people and haven’t > picked up any subtle hints (eg me reaching for the ventolin and my > hubby suggesting the prob might be all the fumes!) so I’d like ideas > for managing the situation. My MIL has a friend with severe asthma > and maintains that if this lady can manage at her house, I can – but > I’ve spoken to the friend and her asthma is intrinsic and/or weather > related, not allergic. > Thanks for any help and I hope you’re all feeling well at the moment.

Response:

Hi everyone, I’m new! I’m 30, female, asthmatic since 3 years old with varying degrees of severity, currently moderate and relatively well controlled with medication most of the time. Since I have been living with asthma virtually all my life I haven’t faced too many problems I couldn’t handle but this one is troubling me. I recently married into a family in which all the ladies feel the need to douse themselves in perfume, hairspray and goodness knows what else, and not just on special occasions either. They’re also big fans of room freshener. Naturally as luck would have it I react to all these things and suffer for hours (sometimes days) after a visit to the in-laws. I did a search and noticed a lot of you have the same problem and I was wondering how you deal with it when avoiding the people concerned is simply not a solution. Unfortunately they are not the world’s most helpful people and haven’t picked up any subtle hints (eg me reaching for the ventolin and my hubby suggesting the prob might be all the fumes!) so I’d like ideas for managing the situation. My MIL has a friend with severe asthma and maintains that if this lady can manage at her house, I can – but I’ve spoken to the friend and her asthma is intrinsic and/or weather related, not allergic. Thanks for any help and I hope you’re all feeling well at the moment.

Response:

New asthma trials underway

admin — Thu, 01 Aug 2002 00:00:00 +0000

Question:

– Hide quoted text — Show quoted text -> News Item: > Daclizumab (Zenapax) is being investigated as a treatment for asthma. This > drug has been used since 1997 in patients receiving kidney transplants to > prevent rejection. It is a humanized monoclonal antibody that binds to > receptors on activated T cells, which are directly involved in allergic > inflammatory processes in asthma. Daclizumab may block processes that lead > to symptoms of asthma. > Does this mean that it may only work on asthmatics whose main problem is > actual IgE-mediated allergies? > That’s not my problem. > My inflammation is caused by air pollution, chronic infection, etc.

That’s my case as well, but I thought that it might be interesting to others here.

Response:

Yes. Lp

Response:

> News Item: > Daclizumab (Zenapax) is being investigated as a treatment for asthma. This > drug has been used since 1997 in patients receiving kidney transplants to > prevent rejection. It is a humanized monoclonal antibody that binds to > receptors on activated T cells, which are directly involved in allergic > inflammatory processes in asthma. Daclizumab may block processes that lead > to symptoms of asthma.

Does this mean that it may only work on asthmatics whose main problem is actual IgE-mediated allergies? That’s not my problem. My inflammation is caused by air pollution, chronic infection, etc. — Steven D. Litvintchouk

Response:

>News Item: >Daclizumab (Zenapax) is being investigated as a treatment for asthma. This >drug has been used since 1997 in patients receiving kidney transplants to >prevent rejection. It is a humanized monoclonal antibody that binds to >receptors on activated T cells, which are directly involved in allergic >inflammatory processes in asthma. Daclizumab may block processes that lead >to symptoms of asthma.

ZENAPAX