reflux

Voice Troubles – Episode 117

March 12, 2018 in Podcasts tagged hemorrhage / hoarse / laryngitis / pain / paralysis / reflux / vocal lesions / voice by Cynthia Hendrix

Laryngitis

Laryngitis, known as inflammation of the larynx, is the most common cause of hoarseness and voice loss. It is very common in viral infections, such as a cold, flu, or adenovirus. Acute laryngitis is caused by an illness, while chronic laryngitis may be a secondary symptom of another problem like acid reflux, smoking, or severe thrush.

There is a lot of advice that goes around about what can “cure” laryngitis or get rid of hoarseness. Hydration is always key. Some of the other advice is more anecdotal. But above all, whatever you do for a hoarse voice, DO NOT WHISPER!

Laryngopharyngeal Reflux Disease (LPRD)

LRPD is a condition where stomach acid refluxes into and burns the vocal cords. It may or may not accompany GERD. It causes intermittent to chronic hoarseness, swallowing troubles, throat pain, or a constant sensation that something is stuck in your throat.

Misuse and Overuse

Misuse of your voice is defined as the inefficient use of your voice. It may stem from poor posture, poor breath support, or poor hydration. Overuse of your voice is defined as excessively loud or prolonged use of your voice.

Lesions

Vocal cord lesions are benign growths on the vocal cords that interfere with normal vibration. These can result from repeatedly prolonged periods of misuse or overuse. They will cause chronic hoarseness or sporadic voice-silencing. They come in three varieties and are all treatable: nodules, polyps, and cysts.

Nodules require vocal rest and voice therapy and training to help make sure they don’t happen again. Polyps and cysts require micro-surgery where the growth is removed, and then rest and therapy and training will follow.

Hemorrhage

If you have a sudden loss of voice after yelling, then it is possible a hemorrhage occurred. A hemorrhage is when blood vessels in the surface of the vocal cord burst and fill it with blood. COMPLETE REST is required until the blood is reabsorbed by the body.

Paresis and Paralysis

Paresis is the fancy word for weakness. Vocal weakness can occur during a viral infection or after neck or throat surgery. It can be temporary and strength will return on its own after a recovery period, or it can be permanent. Prolonged or permanent vocal weakness can be improved somewhat through therapy and training.

Paralysis, on the other hand, is neurologically based, whether damage happened in the area of the brain that controls the voice and supporting structures, or the nerves in and around the larynx are damaged. This can also be temporary or permanent and is generally one-sided.

Symptoms of a weakened or paralyzed vocal cord include noisy breathing – like something is hanging in the way of the air flow. And breathy talking – like when someone is trying to use their “sexy” voice and there’s more air making noise than vocal vibrations. There is a surgical repair process that involves taking the working vocal fold and stretching it over so when it activates, it will still come in contact with the unmoving vocal fold.

Callbacks

Voice
Thrush – Mouth Issues

Connect with me

Support us on Patreon

Give us your Feedback

Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Music Credits: Up In My Jam (All Of A Sudden) by – Kubbi https://soundcloud.com/kubbiCreative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 http://creativecommons.org/licenses/b…Music provided by Audio Library https://youtu.be/tDexBj46oNI

Gag Reflex – Episode 115

February 12, 2018 in Podcasts tagged esophagus / gag reflex / hypersensitive / larynx / pharynx / reflux / swallow / vomit by Cynthia Hendrix

Gag Reflex Basics

The official name of your gag reflex is the pharyngeal reflex or laryngeal spasm. Trigger points for the gag reflex can be found on the roof of the mouth, back of the tongue, in the tonsil area, the uvula, and the back of the throat. The purpose of this reflex is to prevent objects from entering the throat that did not first progress through the normal swallowing process. It also helps prevent choking.

Gag Reflex Progress

When the reflex is triggered, the soft palate raises to close off the nasal passage. Then the pharyngeal muscles contract on both sides to try and force whatever made it too far down back up into the mouth. If the input is strong enough, it can also trigger vomiting (this is how vomiting is induced in eating disorders such a bulimia).

Do you Gag?

One in three people lacks a gag reflex, which means rather large things can enter their throats without triggering a reflex. This is possibly how sword-swallowing got its start.

The other side of this coin is someone with a hypersensitive gag. They can have trouble swallowing large pills and large bites of food. Dentist visits and even neckties can trigger this unpleasant reflex. It can be a part of a larger issue, such as Sensory Processing Disorder or Autism. Or it can be a preconditioned issue due to a previous experience. In either case, speech or occupational therapy can be done and will include desensitizing areas of the mouth to touch.

Other Protective Reflexes

The Reflexive Pharyngeal Swallow is a triggered swallow that clears the pharynx of residue. The glottis will close and allow the pharynx to move stuff to the digestive tract. This is a protective mechanism to keep stuff out of the airways.
Phayngoglottal Closure Reflex happens when the glottis closes inside the larynx without the continuation of a swallow.
Phango-Upper Esophageal Sphincter Contractile Reflex occurs during any type of reflux from the stomach. While some stomach contents may make it past the lower esophageal sphincter, so the upper one prevents it reaching into the throat and mouth.

Bottom Line

All of these reflexes are protective to prevent choking or improper ingesting of things. They can be damaged to different degrees during head trauma or stroke. But surprisingly, smoking causes the most damage to the protective reflexes on the pharynx.

Callbacks

Swallowing

Mouth Parts

Connect with me

Support us on Patreon

Give us your Feedback

Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Bad Breath – Episode 114

February 5, 2018 in Podcasts tagged bad breath / dentist / Diabetes / disease / dry mouth / food / halitosis / liver kidney / oral health / reflux / smoking by Cynthia Hendrix

Bad Breath Basics

Halitosis, aka bad breath, can have many causes. Some bad breath you can prevent with the choices you make, but some bad breath can be a sign of a more serious issue or disease.

Oral Health

You should brush your teeth for at least 2 minutes twice a day, including the surface of your tongue, then rinse your mouth with an antibacterial mouthwash. Follow one of your brushing sessions with a good flossing. This allows you to get any food debris and bacteria build-up out of the way on a daily basis.

You should see your dentist twice a year for a deep cleaning and a check-up on your overall oral health. Your dentist will be able to help you with bad breath issues that may stem from more complicated issues like cavities, gum disease, poorly-fitting dentures, or thrush.

Dry mouth, whether due to your natural biology, medication side effects, or mouth-breathing, can lead to bad breath due to the imbalance of bacteria growth.

Your Choices

Smoking and other tobacco products can make your breath smell bad even when you are not actively using it.

The foods you eat also affect the status of your breath. The compounds that cause eaten and digested foods to smell contain sulfur-based compounds. These include broccoli, cabbage, brussel sprouts, onions and garlic, coffee, and fish. The funny thing about these smelly compounds is that they can actually make your WHOLE BODY smell (including your breath as well as other exiting air) until they have passed all the way out of your body!

Diseases

Infections, such as bronchitis, pneumonia, and sinusitis, can lead to distinctive bad breath. Postnasal drip can lead to bad breath as well. Pharyngeal diverticula that trap old food bits can make your breath smell, as well as tonsil stones that are calcified debris trapped by the tonsils. Bad breath can also be indicative of acid reflux or GERD.

Certain diseases that have telltale breath smells include diabetes, liver disease, and kidney disease.

People with diabetes are at risk of a medical emergency known as Diabetic Ketoacidosis, in which a lack of insulin renders the body’s cells unable to use the available sugar. The body starts burning fatty acids for energy and the waste product is ketones. Ketones cause the body to become very acidic. This leads to a rapid transfer of water (extracellular fluid rushes into the blood to try and neutralize and dilute the ketones and then the kidneys rapidly try to flush out the acidic fluid through the urine) which can lead to fatal dehydration. Clinicians are taught that people experiencing ketoacidosis may have fruity-smelling breath or breath that smells like acetone or nail polish remover.

People with liver disease may have breath that smells musty or like a mildewing basement. And people with kidney disease may have breath that smells fishy or like urine or ammonia. Ammonia is a typical by-product that is released in urine. Someone with kidney disease may not be able to filter out the ammonia compounds effectively. Therefore, the ammonia compounds will circulate in the blood.

Call Back

Brush your tongue – Tastebuds
Tonsil stones – Tonsils
Pharyngeal diverticula – Dysphagia

Connect with me

Support us on Patreon

Give us your Feedback

Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Reflux vs Ulcer [Show Notes]

February 15, 2016 in Podcasts tagged acid / GERD / heartburn / reflux / stomach / treatment / ulcer by Cynthia H.

Gastro-Esophageal Reflux Disorder

GERD, or just Reflux.

Reflux is a word that is used to describe something in your body that flows backwards. The fluids in your body have a certain direction they naturally flow for your body to work properly. If they start flowing backwards, it’s called reflux, and can lead to problems.

Is that like heartburn?

Yes, heartburn is a type of mild reflux. Something (like a certain type of food or overeating) causes the stomach acid to bubble back up into the esophagus.

Overeating or other physiological disorder can cause the lower sphincter to not close tightly or completely.

Ulcer

They lining of your stomach produces the acid, thus it’s intended to be resistant against the acid. The lining of the esophagus is not intended to handle that acid. And stomach acid is way more acidic that our saliva or acidic foods that we may eat.

Now, if the acid-producing (and acid-resistant) lining of the stomach wall gets injured, and the layers underneath come in contact with the acid, it causes pain.

Would that cause someone to throw up blood?

Yes, it possibly would. Any tissue that is living and working in your body, requires a blood supply to bring in nutrients and carry out waste. So, the walls of your stomach is full of blood vessels. If the acid, eats through the layers and gets to the blood vessels, that blood will spill into the stomach. Unfortunately, your digestive system isn’t intended to digest large amounts of blood. The pain from the acid plus the large amounts of blood can lead to nausea and vomiting.

How I assess ulcer or reflux

Where does it hurt?
– Reflux: in the esophagus or throat (even to the point of hoarseness)
– Ulcer: Stomach

Does it hurt worse when you’re hungry or after you eat?
– Reflux: hurts after food has gone into stomach or you lay down at night because you don’t have gravity holding the acid down into the stomach.
– Ulcer: hurts when the stomach is empty because the acid only comes in contact with the stomach lining, rather than having food to work on.

Treatment

The treatment for both is the same. The goal for both is to reduce the acid production. People will try to self-treat by taking tons and tons of OTC antacids (liquid or tablets). Antacids are bases, so they goal is to neutralize the acids, but once that amount has moved into the intestines, the base is gone and the acid is till there. Other acid reduces are OTC as well. Histamine 2 Receptor Blockers (Pepcid, Zantac) can start to work within 30 minutes. Proton Pump Inhibitors (Prilosec, Prevacid, Nexium) can take up to 2 weeks to reduce the acid, so not intended for instant treatment.

Bottom Line

Whether it’s ulcers or reflux, your doctor needs to know what’s going on so they can monitor your progress. Anything that manipulates cells in your body (whether stomach cells damaged in an ulcer or esophageal cells being corroded by acid) can cause cellular changes that may become cancer.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page

Music Credits: “Radio Martini” Kevin MacLeod (incompetech.com) Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Stomach Acid Overview

July 20, 2015 in Podcasts tagged antacids / medication / reflux / stomach acid by Cynthia H.

A yellow fruit submerged in a clear liquid, with bubbles of many sizes clinging to the outside of the fruit. This demonstrates the activity of stomach acid when food is introduced.

Stomach Acid Basics

Stomach acid causes heartburn.

Long-term reflux problems leads to a GERD diagnosis.

Stomach acid has a pH of 2.

Low pH = acid; High pH = base

Stomach acid is Hydrochloric acid (HCl)

Some Biochemistry

The molecules of the acid like to spend their time joining together and breaking apart. So by attaching to something else instead of each other is how it can be dangerous but also how it helps digest food quickly.

Your stomach is designed to hold this strong acid safely.

There are pumps in the cells of the lining of your stomach that produce the acid.

Proton pumps work kind of like a water wheel – they move protons from inside the cell to outside to the stomach cavity.

Hydrogen atoms are made up of 1 proton (positive charge) and 1 electron (negative charge). So if you take the electron away from hydrogen, you are left with a proton with a positive charge.

Another process that helps create acid in the stomach relies on histamines.

They are not quite the same as the histamines that you hear about in relation to allergies. But there is a particular type of histamine that is only in your stomach.

Acid-reducing Medications

There is a class of medications for reflux called Proton Pump Inhibitors (PPI). These medications turn off the pumps so they pump less protons into the stomach.

The medications for the histamine process are called Histamine 2 Receptor Blocker (H2RB).

H2RB’s work faster than PPI’s. Just like you can take an antihistamine and it block histamines causing allergies in just a dose or two, H2RB’s can work as fast as one or two doses. That is why they are advertised to treat heartburn after you eat or to help prevent heartburn before you eat.

PPI’s take up to 2 weeks to reach maximum effect.

The third option for heartburn are your antacids. They are bases that go into your stomach acid and help neutralize it.

OTC Medications (by class)

Antacids: Tums, Rolaids, Maalox, Mylanta – fastest

H2RB’s: Pepcid, Zantac, Tagamet – all have generics, all OTC

Tagamet can have drug-drug interactions with other prescription medications, so caution is advised.

PPI’s: Prilosec, Prevacid, Nexium – some generic, newly OTC – slowest

Cautions

The downside to having reflux medications available OTC and people having the opportunity to self-treat is if there are any cellular changes in your esophagus.

Your esophagus is not designed to be in contact with that level of acid. As those cells are injured, they eventually change and can become cancer.

Fun Tidbit

Just like the cells of your skin are epithelial cells and their job is to keep the inside things in and the outside things out. Your digestive tract is also lined with epithelial cells. So technically the food you eat doesn’t go inside your body, it just moves through this tract that is “outside turned in”.

Holla

@steve_tessler‘s question: After he eats, he coughs for 30 minutes, and sometimes sneezes. Is this considered GERD? Cannot eat nuts or seeds due to diverticulitis. If he sits and rests it doesn’t get so bad, but if he has to be active right after a meal, it is.

Recommendation: try a H2RB morning and night and see if it contains the acid after meals. The next option could be a slight food allergy, possibly gluten, so cutting out certain foods would be necessary.

Connect with me

Support us on Patreon

*NEW* Join the Pharmacist Answers Podcast Community on Facebook

Subscribe: iTunes, Stitcher, GooglePlay, TuneIn Radio

Like the Facebook page