Which doctor?

I'm pretty sure I have developed an acid reflux problem. This is not really a surprise, since it's common among people with asthma and I already have that. I figure I should see a doctor about it, but I assume that will involve some tests that will ending up costing money since my health insurance is not great. For starters, the copay is higher for a specialist than it is for a primary care physician. So, does anyone know if a PCP would be able to treat this, or would they just refer me to a gastroenterologist or other specialist?

If a PCP can handle it, I will go ahead and make an appointment. But if they're going to just send me to a specialist right away, I will wait until next month when I go for my annual asthma checkup with my pulmonologist, and get a referral from him.

I don't technically have a PCP right now. I didn't like the one I had been going to, and the practice where she worked was very disorganized when it came to record keeping and appointment scheduling. So I switched to a different doctor at a different practice. Shortly after one quick visit with her, I received a letter saying that she was leaving the practice. So I plan to go to another doctor at that same practice, but haven't needed a PCP since then -- they don't seem to treat most of the things I need a doctor for.

Does anyone know if GERD/reflux falls under the category of "primary care" or not?

Thanks!

Mine did, and they put me on prilosec for-ev-er. Awful stuff, and when you wean off it you get the worst rebound acid you'll ever experience. Be sure to try the non drug options first, they list them out pretty well on WebMD.

Reflux is commonly treated by primary care doctors, unless you have other chronic gastrointestinal conditions.

Definitely primary care. They might refer you if it's complex/they can't get it under control - but they can try something first. I would only go specialist if you need a colonoscopy anyway/have a family history of esophageal issues (cancer, etc.)

Slight diversion ahead: Are you taking anything now? The reason I'm asking (and I'm only sharing my experience - definitely not medical advice) is that I was taking Zantac occasionally. I started needing it more, and my doctor wanted to put me on Prilosec. That didn't feel right to me. I took myself off Zantac and did a very controlled diet for 2 weeks (only meat/veggies). I then gradually returned to my regular diet. At first, I had occasional reflux (I took tums) - now I have none. I *have* learned that I have a slight intolerance to some dough conditioners found in cheap bread and pizza. Gluten is fine - good bread, pasta, etc. Just not the crappy stuff. So long as I avoid that, nada. I have gone back to my regular diet (with that one exception) without issue (though I am now tweaking it for other reasons). Rebound is definitely real - and you can get it while you're on the drug (at least I did).

Now - reflux isn't something you want to have long term - so definitely seek a doctor's opinion. I just wanted to share what happened to me since I was headed down the permanent medication route.

Thanks all!

I am taking Zantac now, as an antihistamine to help with the flare-up of chronic hives that I've been dealing with since last winter. Previously when I was taking Zantac and then stopped taking it, I had some reflux problems so I went back on a lower dose for a while and then stopped completely with no problems. The hives are not nearly as bad now as they had been over the summer, so I was going to step down to the lower dose again, but figured I should stay on the higher dose due to the reflux problems. The prominent symptom right now is that feeling of something stuck in my throat. I've also found that walnuts, almonds and honey make me feel sick to my stomach.

Looking at the webmd site, I haven't used it in a while and they have made it extremely user-unfriendly, from my point of view. But it seems to say the same thing that the Mayo Clinic site says. Most of the foods to avoid are things I rarely eat. I don't drink coffee but do drink lots of soda -- it is my big bad habit and it will be hard to give that up. I really don't want the hives to flare up again, either. Oh well.

Now I just have to remember who the primary care doctor I went to last year was...

You could also try Prevacid, as H2RA's become less effective over time, and some reflux patients find that switching between Zantac and Prevacid keeps them well controlled.

Has anyone actually looked into your swallowing issue? I wonder whether it is reflux or something else. I don't know whether that would best be looked at by an ENT or a GI doc though....

I don't have trouble swallowing, just have a feeling like something is in the back of my throat, which is a symptom of GERD. A couple of family members with reflux problems have had the same symptom. In addition, a few times recently I've had that nasty sour acid backwash in my throat, after eating a big meal (which I don't typically do -- I'm more of a smaller 4 meals a day person).

I did have my throat looked at by two ENTs last year, plus a CT scan of my neck and chest, when my left vocal cord went all paralyzed after a bad cold. I seem to have recovered completely from that. I had some hoarseness a couple of months ago which I think was related to the new asthma inhaler that I switched to, but it was minor.

I'm thinking I will attempt to cut back on the Diet Coke and will also cut the Zantac dose in half. I have a theory that the Zantac is preventing any actual heartburn symptoms, so stepping back on it should tell me if that theory is correct or not.

You will see a marked improvement when you stop drinking soda. Another big help for me was not eating within four hours (minimum) of bedtime, my belly wasn't doing very much after that so much less option for acid to flood my throat when I laid down.

Definitely have it treated whichever doc you see. I had a friend that thought it was no big deal and after a while it turned into precancerous spots in her esophagus.




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Originally Posted by ny biker

Thanks all!

The prominent symptom right now is that feeling of something stuck in my throat. I've also found that walnuts, almonds and honey make me feel sick to my stomach.

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I'm right there with you. I've been having trouble swallowing (feels like something is stuck) every so often for a few years, but recently it's bad enough that I can't continue to eat and swallow, and sometimes it will make me vomit. It's really embarrassing if I'm around people and I have to keep running to the restroom in a restaurant.

I went to an ENT (that I liked through ear issues, and I don't have a PCP) and he did a quick scope to see that there wasn't anything obvious he could see in my throat and sent me for a barium swallow test. I have definite signs of reflux damage, and he said take Prilosec for several months (he said it will take time for the damage to heal). He did say that I should start weaning off of it in 6 months because long term use is linked to osteoporosis (and I already take lots of calcium and am concerned because I've had some stress fractures.) He said I should be looking for "trigger" food to try to find a long-term fix (he mentioned coffee, alcohol, etc.) He said if I can't find a trigger food, in six months he'll send me to a gastroenterologist because they have other long-term medicines available that might not have the side effects of Prilosec. The ENT said it is very important to treat because reflux can lead to esophageal cancer.

So far, my digestion seems a little weird, but I think I'm just getting used to the Prilosec.

Okay so cutting back on the Diet Coke definitely helped, but yesterday and the day before I had some heartburn/sour stomach issues that required Tums. So I called the doctor this morning and they had an appointment available this afternoon.

Meanwhile -- related or not? This past Saturday I did a long bike ride, 62 miles. The previous Sunday I rode 52 miles. About 10 miles from the end of both rides I developed a bad side stitch -- cramp in my my diaphragm -- that made deep breaths very painful. The first time it happened, the pain went away as soon as the ride was over. The second time it happened, it took about an hour for the pain to subside. Dr. Bing Search indicates that a possible cause is a hiatal hernia, which can also cause acid reflux. But it's also possible that this is all just a coincidence. Due to cooler weather I was not drinking as much water as usual, and when I eat during rides it's a mix of Gu and fig bars or cereal bars, so it's possible that I wasn't drinking enough to digest the Gu properly. Also this might sound weird but both times the temperature had gone from chilly to warm, so I had taken off my vest and put it in my jersey pocket. I don't usually ride with anything filling my pockets so it's possible I was arching my back a bit and the change in position was affecting my breathing.

Interestingly, during Saturday's ride I was chatting with someone who also has had recent problems with reflux. For her the symptom was difficulty breathing. She has had throat problems related to an accident which she thought might be the cause, so she went to her ENT who scoped her throat and found swelling due to acid reflux. For her one of the main culprits was peppermint. She feels that a PCP would probably have initially misdiagnosed her and focused on lung problems. I think she's probably right because one of my family members had a similar experience last year, with lots of lung function tests and months of taking asthma medication that was not needed. On the other hand last year I went to an ENT who refused to believe that a larynx problem could affect my breathing. So I suppose it all comes down to the fact that the human body is complicated and hopefully we can find the right doctors to help us sooner rather than later.

I still have the checkup with the pulmonologist scheduled for later this month, and will be mentioning the reflux problem to him regardless of how things go today. But hopefully today things will go well.

Just to update... the doctor recommended that I continue to take Zantac if needed for continuing symptoms of reflux, and cut out trigger foods and beverages. She did not recommend Prevacid or Prilosec because they have more side effects. She did not order any tests. Her practice is affiliated with a local hospital so she has access to the tests I had done last year, which she felt was sufficient. One of them showed a hiatal hernia.

So I have gone from 32+ oz of Diet Coke per day down to 16 oz once or twice a week. How boring. I'm drinking more tea and water than before, or at least I expected to. I'm finding that I'm really just drinking much less overall, to the point where I am probably dehydrated some days. Having a full glass or bottle of water nearby is not enough to make me drink it. So last night I ordered a nice cheerful water bottle from Bed Bath and Beyond, with pink flowers on it. Yes I have plenty of water bottles at home already but I wanted one that is easier to clean and BPA-free. I also ordered a new glass pitcher, again I have a pitcher already but it's old and plastic so I figured I'd go for BPA-free there too. The plan is to keep a pitcher full of iced tea in the fridge at home, and probably also try some powdered drink flavoring (Crystal Light or similar) in the water bottle. I'm trying to keep calories close to 0, so fruit juice is out. I know that infusing water with fresh fruit is also an option but since I live in a household of one I think I'd end up throwing away produce that spoils before I can use it.

I'm also still taking Zantac but at a lower dose than before. I'm hoping to phase it out entirely soon. Most days I do not have any symptoms.

Also I liked the new doctor a lot, so that's a very good thing.

Your primary physician can treat it, if it is only mild. You will be transferred to a gastroenterologist if you are diagnosed with chronic symptoms of acidty and stomach ulcer.