Monday, 19 January 2009

Throat Troubles


I'm so tired of this globus sensation. I have to keep telling myself it's not like it's anything serious - but imagine, if you will, that you wake up every day with a feeling that something is pressing against your Adam's Apple region. If you push it with your finger you'll know exactly how it feels. It's not exactly pleasant, but it doesn't hurt - it's just there. ALL the time. I have no trouble swallowing food (which is good, as if I did I'd have committed suicide by now) or drink (ditto), but there's no let up of symptoms. The only time I've ever been able to forget about it to the extent where it may even have gone away is:

A) Running/swimming: the sensation is either pushed so far from my mind due to the pain of exercise, or it actually goes away because I'm thinking of something else. I think the former more likely, as the sensation returns after I stop exercising, even when my mind isn't on it.
B) When I was helping Fisher tile the bathroom. Bending over cutting tiles, concentrating totally on what I was doing, meant the sensation vanished.
C) Giving a massage.

All of the above suggest that occupying my mind does help the symptoms, but it takes more than a simple distraction. For example, we had the neighbours round on Friday, for supper and drinks. It was a lovely evening, good chat, some laughs, a sensible amount of wine - and I wasn't thinking about my throat at all. However, the sensation never really went away, and after supper it was definitely worse.

I do think it gets worse after eating, which supports the theory of oesophageal reflux. However, after much research online, I've decided it might well be sensible to take laryngeal reflux - rather than GERD - into account. Dr Scott M. Kaszuba says this:

"GERD patients typically have heartburn, typically are supine refluxers, and typically have esophagitis while the opposite is almost true for LPR. They are hoarse and have dysphagia and globus, they do not have heartburn, they have laryngeal inflammation, and they do not have esophagitis."

I definitely don't get heartburn, I don't suffer reflux in bed, and I don't think I have oesphagitis. The first thing that alerted me to a potential problem was that I thought there was something slightly wrong with my singing voice - I was slightly croaky, and kept missing notes I should be able to get. The first thing on Kaszuba's list of LPR symptoms is vocal complaints. Then "swallowing and globus sensation type complaints" which is bang on. Lastly are pulmonary manifestations, which I don't have. Well - I mean, I've had a cough for the last few weeks, but so has everyone. It's definitely not connected, as it's pretty much gone now. I actually went for a run yesterday (2.4 pathetic miles in an utterly horrendous 30 minutes - horrendous even through the first 1.2miles was all uphill), and even though my cough was back with a vengeance for the rest of the day, it improved in the evening and is back to feeling ok today.

I digress. Back to Kaszuba. He lists what an ENT dude should look for in an LPR patient, but unfortunately, not being an ENT dude I can't comment. My ENT dude certainly said there was nothing wrong save a little redness, which Kaszuba lists (erythema), so I should think that means I'm not really suffering very much. My hoarseness is mild, and I'm sure I only notice it because I sing and have a very intimate knowledge of my own voice and it's abilities. So, the options are that I don't have LPR at all, or that I do and it's mild.

Oh - and I don't know if it's relevant, but apparantly I have a very large thyroid. Not abnormal, or troublesomely large, but certainly at the top end of acceptable. Something to bear in mind for the future, perhaps.

Anywayyy ... the most important bit is treatment. This is what old Kaszuba (god I wish he wasn't called Scott. It really puts a dent in my levels of trust) says.

Elevate the head of the bed 6-8 inches - Can do. No bother.
Maintain an ideal body weight
- O fuck off. Like I don't know that. I'm TRYING, damn you!
Do not lie down three hours after eating -
Going to presume he means 'leave 3 hours after eating before lying down', otherwise it's unusually specific. And incomprehensible. If I eat at 8, I can lie down at ANY TIME except 11pm?? No, I think not.
No problem.
Foods high in fat
- Grrr. Will try.
Spices -
Should be ok, if regrettable.
Acid -
DAMN. There goes my hydrochloric and sulphuric lunch.
Alcohol -NOOOOOO!
Caffeine -
.. that promote reflux including calcium channel blockers, sedatives, or nitrates. - Oh, right. Ok then. *Reinserts heroin drip*

"You can also chew gum, which increases salivary bicarbonate production and may neutralize the acid." - Yuck. Be damned to that. I'm not becoming some cow-like, masticating beast, permanently grinding away on the cud. And I hate chewing gum. But if it helps , I suppose I could give it a go.

He then goes into the pharmacalogical options, which are: antacids, H2 blockers, and PPIs. I'm on PPIs - but he suggests taking them before each meal. At the moment I'm taking one every morning and that's it, so the logical step is to up it to one twice a day, before breakfast and supper. My doc also backs this up, but has warned me that I really don't want to be on these things for the rest of my life. I agree. It's not about cost (god bless the NHS - £5 for about 3 months' supply of Nexium), it's about my body working the way it's supposed to. If I can get myself under working control with a high dose of Nexium to start with, I can then supplement it all by changing my diet, sleeping position, getting my weight down, and exercising. He doesn't mention exercise, but it always helps and never hurts. Once lifestyle has been altered, I should be able to wean myself off the drugs.

That's the plan, and the reason I'm blogging it is to make it more real, more of a decision - and, also, to help with records.

What other news? I mentioned the dinner with neighbours, and it was great. I had a panic with my Malay curry, which tasted awful to begin with, owing to the large number of shallots in the recipe. I forgot that frying shallots on a high heat tends to make them very bitter, so the curry tasted of sick for a while. Mmm ... a taste sensation. Turmeric bile.

I added a good gloop of honey, and after 2 1/2 hours of simmering it was all fine. I wouldn't call it my best curry ever, though. I'll be buying sweet shallots next time.

On an aside, and as a major pain in the arse, we have no heating. None. Nada. Zip. We also have a very lovely coating of snow outside, so you can imagine the joy. The geo-thermal people are coming on Wednesday to fix it. Wednesday. We have to live like Victorians until then, and I now have a hearty respect for the constitutions of our forebears.

Well ... like Victorians with electric heaters, that is. Our sitting room is tosie, thanks to the open fire and electric heater, and we've got an electric heater in the kitchen. Fortuitously, there's also a 1950s style electric bar-heater in our bedroom, which takes the edge off before we go to bed, but has to be switched off overnight, meaning the mornings are interesting. This morning, I awoke to find Baffie had forced her butt under the top edge of the duvet, and her top half - including head - under Fisher's pillow. How she was breathing I have no idea, but she was lovely and warm.

I must leave now because Fisher has just stormed in, declared that she "cannot make fire" and stormed out again. This means she has tried and failed to light the wood burning stove in Phid & Wheeler's room, so I must go and try my luck.



Ray Lucas said...

Much sympathy - I have slightly different throat complaints (but only slightly from the sounds of it and on the older plain Omeprazole), but I'd say the best thing is to have the treatment in place, as the scarring from acid reflux can give rise to much more serious throat problems later on.

I eat polos rather than chew gum... much more civilised!