Living with GERD

GERD - Gastrointestinal Esophageal Reflux Disease

Gerd is also known as a 'hiatal hernia'. The round muscle at the diaphragm under the lungs, where the esophagus passes between the lungs, through the diaphragm, and into the stomach, is the sphincter muscle that is the center of the problem known as reflux disease.

The first problem is the guck in the stomach. The sphincter muscle fails to keep all that food-being-digested in the stomach, letting it burble and rush back up the esophagus (heart burn), into the throat, into the sinuses (sinus infection), and occasionally to be ejected from the mouth as vomit. Occasionally particles will be aspirated down into the lungs.

Acid burns inside the body

Heart burn. It has come to be known as primarily a marketing slogan for Tums, Rolaids, and Alka-Selzer, a common discomfort that is very minor. Acid Burn. There, does that make more sense? You chew your food and it mixes with saliva which contains some mild acids and enzymes to begin breaking down the food. Then you swallow. That mixture of food enters the stomach and gets mixed with some serious acids. The stomach agitates and mixes the food until it is all an expected consistency, then gradually released into the small intestine. This is normal, and required for good health. When you get heartburn, or reflux, some of that acid and food washes back up the throat, damaging the esophagus and any other place the acid contacts. Because so many reflux episodes happen at night in your sleep, many people are only aware of waking at night or in the morning with a sore throat, or painful sinuses. More severe episodes will wake most people - vomiting or choking.

Diagnosis - The Endoscopy

Your doctor will perform an endoscopy to pass a tube with a camera down your throat to look for evidence in the throat and stomach of a hiatal hernia (the sphincter doesn't keep food in your stomach) and reflux damage. Note that this may or may not be a pleasant experience but can be a lifesaver. See, the stomach acids over time will damage the throat. It can cause sections of the esophagus to constrict or partially close off -- causing choke, or inability to swallow for periods of time. I have sat at my plate with a mouthful of food, and unable to get anything down for up to ten (10) minutes, before I got treatment. After repeated stomach acid injury, some of the throat cells will become similar to stomach cells to try tolerating the acids. Some cells will further change, after more reflux episodes, to Barrett's cells (Barrett's syndrome), then to an intermediate stage, before becoming cancerous. That's right -- your heartburn is not minor. Left untreated you can risk cancer.

Chronic sinus infection, ear infection, unexplained sore throat, repeated night time vomiting and choking. These are powerful reasons to see your doctor and ask about reflux. Stomach cramps from ulcers, spasms of the diaphragm, and discomfort in the chest or abdomen can mean many things, and should be understood with your doctor.

GERD - Now What?

Your doctor will have some things to tell you. This may include:

Elevate your bed. A 4-6 inch lift of the head of the bed may help reduce pressure on the sphincter at the top of the stomach, and may reduce number of reflux episodes at night.
Avoid caffeine. Avoid alchohol, onions, chocolate. These things relax the sphincter, which is the cause of reflux episodes.
Smaller meals. Big meals cause the stomach to fill -- putting pressure on the sphincter that should be containing the stomach contents inside the stomach.
Fatty foods. Avoid these, because they are harder to digest, remaining in the stomach longer. That means you are more likely to eat something else, or drink something, before the fatty foods are digested and passed on to the intestines. Adding more liquids or fluids increases the volume of stuff in the stomach, and increases chance of a reflux episode.

Additional things I have found or been told.

Small drinks. A big drink of water, or Gatorade, or milk, is the same as a big meal - a big volume of stuff in the stomach. Get a small glass, and use it more often.
Warm and hot drinks. Until you can go a month without a reflux episode you don't have it under control. Until then, consider ice cubes a very dangerous item on the table. Don't. Your stomach is temperature sensitive - when the temperature of the food is lower than body temperature everything will sit taking up space in the stomach until it all gets warmed up to body temp. That is, a dish of ice cream, a cold drink (even ice water) will stop your food from being digested. Increasing the risk that that stuff will still be there hours later when you sit down to your next snack or meal. Getting the 'freeze' under control was one of my bigger problems. Instead, drink water, decaffeinated green tea. It may look strange, but water can be more interesting if you nuke it in the microwave. Whether you heat to warm or coffee-hot, it helps speed digestion. Part of what makes soup a 'comfort food' is the warmth. Use that; you can use the comforting in your life!
Healthy Choice meals. A balance of real food, reasonable portion size, and reduced fat. I *like* the vanilla ice cream - a small dish, and not with meals. This is not really diet food, and can be an introduction to simple, GERD friendly meals. I am sure there are other brands that work as well.
Keep the stomach warm. Like cold foods, letting my abdomen get chilled stops digestion.
Cough drops. Use cough drops for soreness in the throat. Wal-Mart and other stores sell store-brand mentho-lyptus drops in big bags. Keep them handy.
Antacids. At every episode take four -- one every one to two minutes. Remember, this is an acid burn, whether you feel pain or just a taste or pressure. The antacid treats the burn in the throat. You are probably taking other stuff to weaken the stomach acid. Get the store brand, keep them handy -- a jar of at least 30 in the car, bathroom, by the bed, in your desk or shop, in your locker or bag at the club. In a pinch, frequent small sips of water can help dilute and wash the acid in the throat. Beware of drinking a lot of water, since you want the stuff in the stomach to stay there, not float it all back up your throat on a glass of water!
Saline nasal mist. Buy this at the drug store or grocery store nose drugs shelf. Two squirts in each side and blow, once and hour, for sinus infection. Look into a Neti-wash or other sinus irrigation for nasty night-time episodes where everything burns. Then get the saline mist because acid in the sinuses will be a sinus infection. Really.
Aloe Vera juice. Aloe Vera is good for burns. Reflux is an acid burn. Drink a couple of ounces two or three times a day, to soothe and heal your throat and stomach. Also good to wipe on your skin for poison oak/poison ivy (after washing first with soap and water!). This is one of those tree-hugger, back-to-earth, organic Mother Earth News wacko things that works. Works well even with modern medicine. Albertson's charged $11 for a gallon, Wal-Mart $7, it keeps really well in the refrigerator (several months for me). It helps heal ulcers and lesions in the esophagus and stomach. Also remember the Aloe Vera Juice -- many small sips -- with a nasty reflux episode.
Graham crackers. They soak up liquids in the stomach, can help calm things. One or two is a snack, a box is a problem -- too much stuff in the stomach!
Alka-Selzer. This works, and is a Bigger Gun to use for more severe episodes. Keep some in the bathroom.
Chiropractor. Be sure your back is aligned -- especially around the nerve that activates the stomach (slows digestion), the diaphragm and the esophageal sphincter (spasms and weakened function). Ask about the 'soft tissue adjustment for a hiatal hernia'. This soft tissue (no bones involved) is something you can learn to do to help align the esophagus, the diaphragm, and the stomach to reduce the likelihood of reflux.
Watered juice. Orange and grape juice were too acid for me. I avoid orange juice, and mix grape juice or peach-grape juice with water, about 1/4th glass of juice and fill with water. The juice goes further, I get more water and less reflux.
Catsup, ketchup, and other spicy tomato sauces do not work. Honey, mustard, rosemary, and mayonaisse, in moderation, make acceptable condiments.
Aspirin. Aspirin is a frequent cause of heartburn. Learn to take one tablet one or two times a day instead of two or three tablets every 3 to 4 hours. And accept that a day with aspirin is a day with heartburn. Moderation, get it? Aspirin does some good things for the body that tylenol doesn't, besides block pain. But there are consequences.

Health Considerations

OK, you raised your bed, you take your meds and Aloe Vera juice. You are eating less food at more frequent intervals, you avoid ice, caffeine, alcohol, fatty foods, you are having very few episodes, none of them severe (taste, pain, or vomit). You now have to deal with the next two problems -- that weakened sphincter muscle, and your meds.

The weakened sphincter is the simpler problem to solve -- exercise. Walking is good, you will want to work with your doctor or chiropractor about exercises to strengthen the abdomen. Overall activity improves health, speeds digestion, and reduces volume of stagnant stuff in the stomach.

The other problem is the meds for reflux. They take various ways and times to reduce the injury that stomach acid causes when reflux happens. That means that your food is not being digested by the intended acid. Talk to your doctor about this -- mine recommended a Vitamin B complex to compensate for the inability of the body to any longer utilize some of the nutrients in your food. Spring Valley 'Natural B' (at Wal-Mart for me) seems to be a good daily choice for me. Depending on your diet and preference, a can of live-culture yogurt each week or more often, or daily acidophilous. I found a pleasant chewable acidophilous tablet that is strawberry flavored, and enjoy the odd yogurt.

Psyllium husk. That is, Metamucil without the sugar and flavors -- the 'active' part. Psyllium husk does a couple of good things for the body, a couple of which are becoming real important for you. First is mucous. Mucous is a general lubricant in the body, not just a leak from your nose. The body's natural cycle is to dispose of mucous throught the intestines and rectum, but that route can be overloaded -- plugged up. Leading to constipation and hard stools. And slowed digestion. Remember, we want to speed up digestion so stuff doesn't sit in the stomach longer than really needed. The body has use for two different 'kinds' of fiber in the diet -- soluble fiber that dissolves into the blood, circulates through the cells and lymph system and helps carry wastes back to the intestines for disposal, and insoluble or bulk fiber that stays in the intestine and moves food and stuff along. Psyllium husk is high in both soluble and insoluble fiber, and helps reduce 'transit time' -- the time it takes from when you eat food until you pass the residue as stools. Ideally this should be 24-36 hours, often it is over 48-72 (with constipation and hard stools). You will need lots of water to make the psyllium husk work for you, at least another full glass of water each day. Oatmeal is good for 'roughage' or insoluble fiber, stewed prunes are good, but neither is as efficient as psyllium husk. Because psyllium husk is inert (not a chemical) it is not habit forming, at least no more so than washing your hands. Think of Psyllium husk or even metamucil with your next mucous episode, uhh, I mean, next cold, flu, or allergy attack. Surprisingly, psyllium husk can also be very comforting with diarrhea, at least the week long bout I had with food poisoning.

Water. Drink lots. Drink mostly warm water, room temp is fine (unless you are ice fishing ;-). Water, like exercise, helps lubricate the body and keeps all the systems running smoothly. My rule of thumb is to drink enough water that my urine is clear. Unless I just had my Vitamin B with all it's colored components flushing through.

Night time meals. This is a serious problem for those of us prone to reflux. I skip supper if it gets to be later than 6 pm, or plan on staying up 4-6 hours after I eat. Really. My mother introduced me to 'nuked dogs' -- microwaved hot dogs -- that I can usually get away with when I need something to eat at night. I split a piece of single-serving cheese, lay it on a hot dog bun, sprinkle some rosemary, lay on a hot dog, wrap in a paper towel, and nuke for 45 seconds. I actually prefer 'Bar S' brand smoked sausage links, and nuke for 55 seconds, and often skip the paper towel (the bun is a bit less consistent). Popcorn usually works for me, I air-pop the corn, melt a tablespoon of butter or oil in the microwave, and sprinkle over the popped corn, then lightly sprinkle with popcorn salt. Morton makes Popcorn Salt by grinding the crystals smaller -- a small sprinkle gives more salt taste. As I mentioned above, graham crackers.

A matter of time

I imagine if you were to light a match to your finger several times a day, your finger would develop sores, the sores would get worse, and your finger would take longer to heal the longer you kept on lighting those matches.

Well, that is what is happening in your throat with each reflux episode/heartburn. The key for me was to take every single occurence very seriously. That includes avoiding problem foods, the timed sequence of antacids to support my throat, and cough drops to soothe and heal.

Once you start managing the problems that are most likely to trigger a reflux episode you should see less direct heartburn and reflux pain. It will take time, a lot of time, to repair all those acid burns. Consider these suggestions and advice to be life changes, not just therapy for the heartburn. Hopefully after a couple of clean annual endoscopy exams you can get off the meds, which will help restore your body's ability to utilize the micronutrients in your food.

Blessed be!

Comments: DraftResourceMeister

Updated: 2005-06-21 - bk