1 00:00:00,120 --> 00:00:03,640 Hello, and welcome to Karen's Medical Coron. I'm Karen O'Day. 2 00:00:03,640 --> 00:00:07,160 I'm a family nurse practitioner and a certified nurse midwife in Santa Fe, 3 00:00:07,160 --> 00:00:07,993 New Mexico. 4 00:00:08,270 --> 00:00:13,040 I have a family practice as well as aesthetic practice and 5 00:00:13,040 --> 00:00:16,240 bioidentical hormone replacement therapy for patients. 6 00:00:16,520 --> 00:00:21,120 Today we're gonna be talking about something that I see frequently in the family 7 00:00:21,480 --> 00:00:26,280 practice aspect of the practice, and that is, uh, people who have, 8 00:00:26,530 --> 00:00:30,960 uh, silent reflux or loren pharyngeal reflux as it's better known, 9 00:00:31,610 --> 00:00:35,080 um, professionally. Now, uh, 10 00:00:35,080 --> 00:00:39,920 the symptoms can be a little bit hard to determine what's causing the problem, 11 00:00:40,260 --> 00:00:43,400 and that's why it turns into a bit of a detective hunt. 12 00:00:43,700 --> 00:00:47,680 But if people know the signs and symptoms, sometimes they can, uh, 13 00:00:47,890 --> 00:00:51,960 do some dietary environmental lifestyle modifications to see if it helps their 14 00:00:51,960 --> 00:00:54,120 symptoms prior to coming in for evaluation. 15 00:00:54,730 --> 00:00:59,240 So theary pharyngeal reflux occurs when you have a small amount of stomach 16 00:00:59,240 --> 00:00:59,880 contents, 17 00:00:59,880 --> 00:01:04,640 so stomach acid coming up into the larynx and the pharyngeal area. 18 00:01:05,170 --> 00:01:09,720 So heartburn is when you have stomach acid that comes just into the 19 00:01:09,720 --> 00:01:14,600 esophagus. That's where we have people who complain of heartburn. 20 00:01:14,600 --> 00:01:18,760 They'll take anti acids. A although a lot of times with lore, pharyngeal reflux, 21 00:01:18,760 --> 00:01:23,320 they don't have heartburn because the amount of acid required to cause 22 00:01:23,320 --> 00:01:28,240 symptoms in the throat is much less than what's required in the esophagus. 23 00:01:28,610 --> 00:01:30,520 So a lot of times I'll see patients, 24 00:01:30,520 --> 00:01:33,720 they come in and they're complaining of chronic throat clearing, 25 00:01:34,010 --> 00:01:36,200 or they're having a little bit of a sore throat, 26 00:01:36,200 --> 00:01:38,720 worse in the morning than another time is during the day. 27 00:01:38,990 --> 00:01:42,600 They might also complain of, uh, 28 00:01:42,600 --> 00:01:44,760 what's called a globus sensation in the throat, 29 00:01:44,890 --> 00:01:49,160 or feeling like there's a ball of mucus stuck in their throat or a lump in the 30 00:01:49,160 --> 00:01:52,180 throat. Sometimes people will have chronic cough, 31 00:01:52,490 --> 00:01:54,220 they may have some hoarseness. 32 00:01:54,380 --> 00:01:58,100 Sometimes that'll be worse in the morning and kind of gets better throughout the 33 00:01:58,100 --> 00:01:58,500 day. 34 00:01:58,500 --> 00:02:03,140 Sometimes they'll have a little bit of increase in postnasal drip, 35 00:02:03,710 --> 00:02:07,060 uh, choking sensation in the throat. Um, 36 00:02:07,060 --> 00:02:10,500 but one of the main things that I hear about is just the chronic throat 37 00:02:10,500 --> 00:02:14,980 clearing. Uh, they'll feel like they have a cold and it just doesn't get better, 38 00:02:14,980 --> 00:02:18,020 or they'll have a cold, and then after the cold is gone, 39 00:02:18,020 --> 00:02:19,500 they'll continue with these symptoms. 40 00:02:19,640 --> 00:02:24,580 One of the most common causes of recurrence of 41 00:02:24,580 --> 00:02:27,780 lary pharyngeal reflux is having an upper respiratory infection, 42 00:02:28,030 --> 00:02:29,940 because if you're coughing a lot, 43 00:02:30,130 --> 00:02:33,900 you're actually putting pressure on the, um, 44 00:02:34,700 --> 00:02:38,460 closure between the stomach and the esophagus, 45 00:02:38,460 --> 00:02:43,060 and that can let acid escape, uh, little bit of it up into the throat. 46 00:02:43,550 --> 00:02:47,140 So this can be really bothersome for people. They also, uh, 47 00:02:47,140 --> 00:02:51,540 can't seem to clear it up with routine, uh, treatments like, uh, 48 00:02:51,540 --> 00:02:55,700 cough medicine or antihistamines. So they'll come in for evaluation. 49 00:02:56,130 --> 00:02:59,920 When we look at laryngeal reflux and these symptoms, 50 00:03:00,130 --> 00:03:02,640 there's a couple of ways to diagnose it. 51 00:03:02,800 --> 00:03:07,240 Sometimes providers will initially try, uh, to do a, 52 00:03:07,850 --> 00:03:11,760 um, kind of a tentative diagnosis and have people do things at home, 53 00:03:12,090 --> 00:03:16,560 as well as give them antacids or what we call proton pump inhibitors 54 00:03:16,770 --> 00:03:21,680 to see if their symptoms get better. But for an actual diagnosis, 55 00:03:21,700 --> 00:03:26,280 the gold standard, which I don't know if it's done a lot, 56 00:03:26,850 --> 00:03:29,200 uh, would be what's called a Hemi pH. 57 00:03:30,050 --> 00:03:34,120 So a Hemi pH is a hypo pharyngeal esophageal, 58 00:03:34,930 --> 00:03:36,080 um, test, 59 00:03:36,080 --> 00:03:40,520 which checks the pH of 60 00:03:41,030 --> 00:03:45,000 refluxed contents into the, um, 61 00:03:45,980 --> 00:03:49,520 lgo pharyngeal area over a 24 hour period of time. 62 00:03:49,850 --> 00:03:51,400 It is an invasive test, 63 00:03:51,400 --> 00:03:55,200 so a lot of times that might not be done as a first line treatment, 64 00:03:55,200 --> 00:03:59,960 but it is considered the gold standard. However, a lot of, um, ear, 65 00:03:59,960 --> 00:04:02,720 nose and throat providers and, uh, 66 00:04:02,720 --> 00:04:05,880 with my training in E N t I do that in my office as well, 67 00:04:06,250 --> 00:04:11,120 is with a flexible fiber optic laryngoscopy where you can actually take a 68 00:04:11,120 --> 00:04:16,000 little magnified scope and go in through the nose down to the base 69 00:04:16,000 --> 00:04:20,360 of the throat and evaluate the vocal cords and the, um, 70 00:04:21,140 --> 00:04:25,760 the entire area to see if you see any staining from acid, uh, 71 00:04:25,760 --> 00:04:29,800 to check for any polyps or masses. Uh, 72 00:04:29,800 --> 00:04:34,280 you can check the paraform sinuses, see if they're, uh, a little bit, uh, 73 00:04:34,560 --> 00:04:38,200 swollen, and that can oftentimes give a diagnosis. 74 00:04:38,200 --> 00:04:43,080 You can have the person move their vocal cords to determine how 75 00:04:43,080 --> 00:04:44,400 the vocal cords are working. 76 00:04:45,020 --> 00:04:48,440 And so this is oftentimes when somebody's referred to ear, nose, and throat, 77 00:04:48,440 --> 00:04:52,520 the testing that would actually be done because it's an an in-office procedure, 78 00:04:52,520 --> 00:04:57,320 it's very, very easy to do. It takes only a few minutes to do it. 79 00:04:57,520 --> 00:05:02,200 Sometimes people will have it done without any type of numbing to the nasal 80 00:05:02,230 --> 00:05:03,020 cavity, 81 00:05:03,020 --> 00:05:07,720 and sometimes other people will have a little bit of Afrin and, 82 00:05:08,050 --> 00:05:12,640 um, topical lidocaine placed so that they don't feel the scope. 83 00:05:12,930 --> 00:05:17,480 Uh, but the scope usually isn't painful. It usually just makes your eyes water, 84 00:05:18,050 --> 00:05:22,600 uh, going in through the nose bypasses the gag reflex so that the patient isn't 85 00:05:22,600 --> 00:05:23,000 gagging. 86 00:05:23,000 --> 00:05:26,560 So it's an easy way to kind of check to see what's going on at the base of the 87 00:05:26,560 --> 00:05:30,800 throat. Now, things that can also cause these symptoms, 88 00:05:30,800 --> 00:05:34,200 so we have to have what's called a differential diagnosis because you can't 89 00:05:34,200 --> 00:05:38,720 assume that everybody who has chronic throat clearing or some hoarseness has 90 00:05:38,760 --> 00:05:42,840 laryngeal reflux. So differential diagnosis would be, you know, 91 00:05:42,840 --> 00:05:47,480 an upper respiratory infection, uh, asthma, allergies, 92 00:05:47,920 --> 00:05:50,600 sinus infection, uh, 93 00:05:50,600 --> 00:05:55,320 chronic inflammatory conditions of the upper respiratory tract. And also, 94 00:05:55,340 --> 00:05:57,040 you know, obviously anytime. 95 00:05:57,880 --> 00:05:58,840 Somebody has symptoms, 96 00:05:59,050 --> 00:06:03,600 we always have to rule out that we see any masses or nodules or potential for, 97 00:06:03,610 --> 00:06:04,640 uh, for cancer. 98 00:06:05,530 --> 00:06:08,640 So once the diagnosis is made, 99 00:06:08,640 --> 00:06:13,440 whether it's made through the Hemi pH test or through, um, 100 00:06:13,960 --> 00:06:16,920 flexible fibro optic laryngoscopy, um, uh, 101 00:06:16,920 --> 00:06:20,680 there are things that can be done to help treat the symptoms. So, 102 00:06:21,930 --> 00:06:25,680 uh, we usually tell the patients initially that, uh, 103 00:06:26,250 --> 00:06:30,760 dietary environmental and lifestyle modifications need to be made because there 104 00:06:30,760 --> 00:06:35,240 really isn't a magic pill to treat Lorenzo pharyngeal reflux. Now, 105 00:06:35,240 --> 00:06:39,480 if you have heartburn, you can take an antiacid like say, uh, 106 00:06:39,800 --> 00:06:44,440 Tums or Pepcid or maybe a proton pump inhibitor like Prilosec 107 00:06:44,490 --> 00:06:46,640 or otherwise known as omeprazole, 108 00:06:46,740 --> 00:06:49,880 and symptoms tend to get better in about 20 minutes. Well, 109 00:06:49,880 --> 00:06:53,800 sometimes when patients with laryngeal reflux are placed on these medicines, 110 00:06:53,870 --> 00:06:58,840 they don't work as well because it takes a long time 111 00:06:58,890 --> 00:07:02,520 to start to damage those delicate tissues with just a little bit of acid. 112 00:07:02,520 --> 00:07:05,920 And so it's gonna take a long time for that area to heal. 113 00:07:06,250 --> 00:07:07,920 So I always tell my patients, 114 00:07:08,020 --> 00:07:12,920 you have to do the environmental dietary lifestyle modifications 115 00:07:13,290 --> 00:07:14,800 in order to have symptom relief, 116 00:07:14,800 --> 00:07:19,520 and if you want to have a prescription for the antacids or the 117 00:07:19,520 --> 00:07:23,040 proton pump inhibitor, that may make your symptoms better quicker. 118 00:07:23,860 --> 00:07:27,640 But things that people can do at home as far as dietary wise, 119 00:07:28,340 --> 00:07:32,880 the first is to eat smaller meals. So instead of three big meals a day, 120 00:07:32,980 --> 00:07:36,760 you would want eat five small meals a day. And in these meals, 121 00:07:36,760 --> 00:07:41,440 you wanna avoid foods that increase your acid production or 122 00:07:41,840 --> 00:07:45,960 increase your reflux into the throat. So that would be anything fried, 123 00:07:46,760 --> 00:07:51,760 anything fatty, anything that's dipped in batter or rolled in breadcrumbs, 124 00:07:51,900 --> 00:07:56,560 you wanna avoid spicy foods. So that includes foods like, uh, 125 00:07:56,820 --> 00:08:00,280 hot sauce or green chili. Uh, 126 00:08:00,640 --> 00:08:04,080 anything that is, uh, gonna burn the throat. 127 00:08:04,600 --> 00:08:06,680 Other things to avoid would be alcohol, 128 00:08:06,770 --> 00:08:10,920 because alcohol not only relaxes the closure, 129 00:08:10,920 --> 00:08:15,920 that esophageal sphincter that isn't closes off the stomach to keep acid 130 00:08:15,920 --> 00:08:19,360 in, but it also relaxes with alcohol. 131 00:08:19,930 --> 00:08:21,400 So when you drink alcohol, 132 00:08:21,400 --> 00:08:26,080 you'll have a slight relaxation of that closure and allow a little bit of acid 133 00:08:26,080 --> 00:08:28,520 to come into the throat. Alcohol, 134 00:08:28,550 --> 00:08:33,160 even if it's sweet also is, can be caustic to the throat. It, 135 00:08:33,170 --> 00:08:35,880 it burns the throat as it goes down. Uh, 136 00:08:35,880 --> 00:08:40,040 and that's pretty apparent with some of the harder alcohol, uh, products, 137 00:08:40,040 --> 00:08:44,080 but it's also occurring even if you're drinking a leor, that's pretty sweet. 138 00:08:45,090 --> 00:08:48,480 So alcohol would be something to be avoided. Caffeine as well. 139 00:08:49,160 --> 00:08:53,560 Caffeine not only needs to be avoided because it also relaxes that closure 140 00:08:54,100 --> 00:08:57,680 and will let just a little bit of acid come up into the throat. 141 00:08:57,900 --> 00:08:58,920 And that's again, 142 00:08:59,070 --> 00:09:03,200 what we wanna avoid in order for healing of those delicate tissues to occur. 143 00:09:03,720 --> 00:09:07,360 Other things that can cause you to have more acid into the throat would be 144 00:09:08,000 --> 00:09:12,920 anything like garlic or onions, any citrus fruit like oranges, 145 00:09:13,390 --> 00:09:15,520 lemons lines, grapefruits, 146 00:09:16,280 --> 00:09:19,640 anything that has carbonation in it. So if you're burping, 147 00:09:19,670 --> 00:09:21,880 you're putting acid into your throat. 148 00:09:22,530 --> 00:09:27,200 So if it's carbonated water, if it's carbonated soda, 149 00:09:27,410 --> 00:09:31,280 no matter what it is, if you're consuming carbonated beverages, 150 00:09:31,380 --> 00:09:35,720 you are going to have some reflux of, uh, 151 00:09:35,720 --> 00:09:37,240 acid into your throat. 152 00:09:37,440 --> 00:09:41,560 Other things that you would wanna avoid would be chocolate. Chocolate. 153 00:09:41,810 --> 00:09:46,320 As well as mints also causes an increase of, uh, 154 00:09:46,970 --> 00:09:49,080 um, acid into the throat because it again, 155 00:09:49,650 --> 00:09:54,600 relaxes that closure into the, uh, from the esophageal spiner, 156 00:09:54,830 --> 00:09:58,320 allowing acid to come up into the throat. Um, 157 00:09:58,320 --> 00:10:03,240 other things that you would want to avoid would be anything that is 158 00:10:03,240 --> 00:10:06,520 hard to digest, and that's why we say a lot of fried foods, 159 00:10:06,520 --> 00:10:09,800 you wanna stay away from those as well. Um, 160 00:10:10,590 --> 00:10:13,850 you wanna drink increased amount of water, uh, 161 00:10:13,850 --> 00:10:17,570 because that's good for your system, although don't overfill with water. 162 00:10:17,570 --> 00:10:21,850 That's why you should eat approximately five meals a day and not, and, 163 00:10:21,850 --> 00:10:26,130 and also drink water throughout the day. But you wanna stop consuming, uh, 164 00:10:26,130 --> 00:10:31,010 foods and you wanna stop consuming fluids about two to three hours before you go 165 00:10:31,010 --> 00:10:34,490 to bed, because if you lay down with food or liquid in your stomach, 166 00:10:34,490 --> 00:10:39,290 it's gonna put pressure on the esophageal sphincter, and that's going to allow, 167 00:10:39,770 --> 00:10:42,770 again, a small amount of acid to come into the throat. 168 00:10:43,620 --> 00:10:47,210 So making sure you're sitting upright after you eat a meal, 169 00:10:47,430 --> 00:10:50,450 not laying down for two to three hours after eating a meal, 170 00:10:50,550 --> 00:10:53,570 and then exercise as well. A lot of people want to exercise and, 171 00:10:53,570 --> 00:10:58,450 and carrying extra weight also puts extra pressure on that esophageal closure 172 00:10:58,450 --> 00:11:00,490 and allows acid to come into the throat. 173 00:11:00,490 --> 00:11:05,330 So maintaining a good weight is really important and people wanna exercise 174 00:11:05,790 --> 00:11:08,170 and maybe get some of that extra weight off, 175 00:11:08,230 --> 00:11:13,210 but don't exercise for at least an hour to two hours after you eat 176 00:11:13,210 --> 00:11:17,450 because you also don't wanna put pressure again on that closure and cause a 177 00:11:17,450 --> 00:11:21,090 little bit of acid to come into the throat. And that includes bending over, 178 00:11:21,090 --> 00:11:25,170 getting pans out of the, out of your cupboards if they're down on the ground, 179 00:11:25,170 --> 00:11:27,730 you know, bend at your knees so that you're not bending over, 180 00:11:27,730 --> 00:11:32,610 putting the head below the level of the heart and increasing that pressure in 181 00:11:32,610 --> 00:11:35,370 the stomach. Uh, other things that, uh, 182 00:11:35,370 --> 00:11:39,210 you wanna do is you wanna avoid wearing any tight clothing because tight 183 00:11:39,410 --> 00:11:44,050 clothing, again, is putting pressure on the outside of the body, 184 00:11:44,540 --> 00:11:45,650 uh, to the inside, 185 00:11:45,650 --> 00:11:50,650 it increases the pressure to let a little bit of acid come up into 186 00:11:50,650 --> 00:11:54,400 the throat. And then when people have things that come up, 187 00:11:54,400 --> 00:11:57,240 like if they have allergies or an upper respiratory infection and they're 188 00:11:57,240 --> 00:12:01,640 coughing, that's definitely, uh, going to increase their symptoms. 189 00:12:01,740 --> 00:12:05,280 And so there's not a lot that you can do about that when you happen to have a 190 00:12:05,280 --> 00:12:08,600 cold or you have allergies except to try and, and, uh, 191 00:12:08,600 --> 00:12:13,240 either take home remedies or medications prescribed by your provider to help 192 00:12:13,240 --> 00:12:17,970 treat those symptoms. Other things that you can do to help treat your symptoms, 193 00:12:18,420 --> 00:12:18,770 um, 194 00:12:18,770 --> 00:12:22,490 of acid coming into the throat is sleeping with the head of your bed elevated. 195 00:12:22,590 --> 00:12:23,010 Now, 196 00:12:23,010 --> 00:12:27,970 that does not include stacking pillows and sleeping on a stack 197 00:12:27,970 --> 00:12:31,410 of pillows that actually can make your symptoms worse because when you sleep 198 00:12:31,410 --> 00:12:34,330 with stack pillows, you tend to scrunch up at night and again, 199 00:12:34,330 --> 00:12:37,930 putting more pressure on your stomach and allowing acid to come into the throat. 200 00:12:38,270 --> 00:12:41,210 But you can buy bed blocks, you can buy them almost anywhere. 201 00:12:41,210 --> 00:12:43,650 You can buy them at Target, you can buy them at Walmart, 202 00:12:43,650 --> 00:12:46,770 you can order them online. And those, uh, 203 00:12:46,770 --> 00:12:50,810 bed blocks will either be, you know, starting at about four inches, 204 00:12:50,810 --> 00:12:52,330 going up to about eight inches. 205 00:12:52,520 --> 00:12:57,370 I'll usually tell people to start at a little lower wedge just because you 206 00:12:57,370 --> 00:13:01,490 don't wanna feel like you're quite so elevated all at once. Um, 207 00:13:01,630 --> 00:13:04,370 but you can start where wherever you'd like, but that again, 208 00:13:04,370 --> 00:13:08,850 helps take pressure off of the stomach and, and, uh, so, 209 00:13:08,850 --> 00:13:11,490 so those are some of the things that can help relieve your symptoms. 210 00:13:11,660 --> 00:13:13,730 So if people are doing those things, 211 00:13:13,910 --> 00:13:18,050 and they can also take anything like, uh, antacids, 212 00:13:18,050 --> 00:13:21,250 as long as they're not contraindicated with any other medicines you're taking. 213 00:13:21,620 --> 00:13:26,290 So that would be things over the counter like Tums or, um, 214 00:13:26,960 --> 00:13:30,410 Pepcid or, um, uh, 215 00:13:30,410 --> 00:13:34,450 you could take a proton pump inhibitor over the counter like omeprazole. Again, 216 00:13:34,450 --> 00:13:35,690 if it's not contraindicated, 217 00:13:35,690 --> 00:13:38,610 you wanna check with your provider prior to taking any over-the-counter 218 00:13:38,610 --> 00:13:43,050 medications. And again, these are not magic pills. So a lot of times, 219 00:13:43,480 --> 00:13:46,850 most of my patients don't wanna take medication because again, 220 00:13:47,150 --> 00:13:50,330 all medication has side effects. So I'll tell 'em, you know, 221 00:13:50,940 --> 00:13:55,810 if you can do all of these changes and give it about four to 222 00:13:55,810 --> 00:13:59,290 six weeks, you'll start to see changes. But it's not overnight. 223 00:13:59,290 --> 00:14:02,250 You can't make a dietary change. You can't raise the head of your bed and, 224 00:14:02,250 --> 00:14:05,930 and expect for your symptoms to go away overnight. That tissue has to heal. 225 00:14:06,100 --> 00:14:07,770 So when you have that inflamed tissue, 226 00:14:07,840 --> 00:14:10,530 you're secreting extra fluids to try to heal it. 227 00:14:10,670 --> 00:14:15,210 And that tissue is a very delicate, and it does take a while to get better. 228 00:14:15,210 --> 00:14:19,570 So I usually tell patients don't expect to see any symptom relief for four to 229 00:14:19,570 --> 00:14:19,970 six weeks, 230 00:14:19,970 --> 00:14:24,330 and then you really won't see how well you're doing a symptom-wise for about 231 00:14:24,330 --> 00:14:28,650 three months. And then if you go back to foods that you were eating before, 232 00:14:29,160 --> 00:14:33,210 that can cause you to have that reflux into the throat. Like say, tomatoes, 233 00:14:33,210 --> 00:14:36,130 which we know are acidic, uh, and you have symptoms, 234 00:14:36,440 --> 00:14:41,090 well that's because your tissue is being, uh, damaged again. 235 00:14:41,350 --> 00:14:46,250 And so a lot of these changes for larygeal reflux are need to 236 00:14:46,250 --> 00:14:51,050 be permanent changes or else you'll have symptoms. Again, these symptoms can, 237 00:14:51,050 --> 00:14:54,410 can also, you know, if you don't treat Loren pharyngeal reflux, 238 00:14:54,410 --> 00:14:58,290 what's the dangers of not treating it well? The dangers of not treating it is, 239 00:14:58,290 --> 00:15:01,690 it, it, you can have some acid that actually gets past those, uh, 240 00:15:01,970 --> 00:15:05,490 vocal cords and down into the, 241 00:15:05,590 --> 00:15:08,290 the lung tissue that can make asthma worse. 242 00:15:08,290 --> 00:15:12,690 It can make any type of chronic obstructive pulmonary disease worse, 243 00:15:12,980 --> 00:15:15,090 it can give you, uh, 244 00:15:15,090 --> 00:15:19,170 if it's coming up past that area into the back of the throat, 245 00:15:19,340 --> 00:15:24,130 it can actually irritate the sinuses and just cause a lot of, uh, sinus, 246 00:15:24,130 --> 00:15:27,770 uh, irritation and chronic sore throats. Uh, 247 00:15:27,770 --> 00:15:32,130 it changes the tissue over time at the DNA level and can, 248 00:15:32,130 --> 00:15:36,930 if it's not treated, predispose you to having cancer, uh, in your throat, 249 00:15:36,930 --> 00:15:41,090 in the vocal cords, uh, or the area known as the vocal voice box. 250 00:15:41,740 --> 00:15:44,410 So it is important to treat it. Now, 251 00:15:44,410 --> 00:15:49,050 sometimes people will have severe symptoms and they have been on medication 252 00:15:49,050 --> 00:15:50,210 from their provider. 253 00:15:50,760 --> 00:15:54,490 They are making all of the dietary environmental lifestyle modifications, 254 00:15:54,490 --> 00:15:58,490 and sometimes they'll need to be seen by gastroenterology 255 00:15:58,980 --> 00:16:02,890 because ear, nose and throat is usually the one that will diagnose it initially. 256 00:16:03,790 --> 00:16:05,530 But if it's not improving, they may, 257 00:16:05,750 --> 00:16:08,690 you may need a referral to go to see gastroenterology, 258 00:16:08,780 --> 00:16:11,090 to see what's going on in the stomach, 259 00:16:11,090 --> 00:16:13,810 because sometimes if people have a hiatal hernia, 260 00:16:14,360 --> 00:16:18,970 that can make symptoms worse and make it a little bit resistant to, uh, 261 00:16:18,970 --> 00:16:22,930 these treatments. And so if it's severe, there are, uh, 262 00:16:23,170 --> 00:16:26,730 surgical interventions that can be done that can help correct the symptoms. 263 00:16:27,350 --> 00:16:31,970 But seeing what you can do at home, you know, avoiding, uh, 264 00:16:32,050 --> 00:16:36,130 foods that are offensive, making sure you're carrying, uh, 265 00:16:36,130 --> 00:16:37,250 your optimal weight, 266 00:16:37,440 --> 00:16:41,010 making sure that you're eating five small meals a day and not three 267 00:16:42,570 --> 00:16:43,403 wearing loose clothing, 268 00:16:43,750 --> 00:16:48,450 not laying down for two to three hours after you eat can all be, 269 00:16:48,660 --> 00:16:52,450 um, remedies that can help you substantially at home and help keep you off 270 00:16:52,450 --> 00:16:56,130 medications and hopefully help keep you off the path to surgery. 271 00:16:56,900 --> 00:16:59,570 So this was just a short, um, 272 00:17:00,620 --> 00:17:04,760 introduction to symptoms of loreal reflux. 273 00:17:05,370 --> 00:17:10,160 Uh, heartburn is different again because it's affecting the esophagus and it 274 00:17:10,280 --> 00:17:12,720 actually causing that pain in the esophagus, 275 00:17:12,980 --> 00:17:16,920 but it's all caused by the same stomach contents, which is acid. 276 00:17:17,530 --> 00:17:21,880 So we'll be putting on the website, um, a handout for, 277 00:17:22,330 --> 00:17:26,000 uh, people to look at that give you these environmental dietary lifestyle 278 00:17:26,000 --> 00:17:29,640 modifications. And then if you feel like you need to take any medication, 279 00:17:29,640 --> 00:17:34,160 if your symptoms aren't getting better, uh, again, don't, don't wait. 280 00:17:34,160 --> 00:17:38,640 See your healthcare provider, uh, if they are unable to do, um, 281 00:17:39,310 --> 00:17:43,040 a scope on you to take a look in the vocal cords, request a referral to ear, 282 00:17:43,040 --> 00:17:46,520 nose, and throat, and it's a simple procedure. It's not painful, 283 00:17:46,710 --> 00:17:50,560 they can do it quickly and tell you, you if indeed yes, 284 00:17:50,560 --> 00:17:54,600 that is what they believe is going on. Or if you need, uh, 285 00:17:55,230 --> 00:17:59,800 more, uh, thorough, uh, evaluation with the Hemi pH test, 286 00:18:00,130 --> 00:18:03,000 uh, which you know, may or may not be necessary, 287 00:18:03,000 --> 00:18:07,960 or if you need evaluation by gastroenterology. So if you have any questions, 288 00:18:08,450 --> 00:18:10,600 if you would like to, uh, 289 00:18:10,600 --> 00:18:15,280 hear about any other topics or you have any input, 290 00:18:15,280 --> 00:18:19,840 please feel free to, um, contact us at, 291 00:18:19,970 --> 00:18:22,760 uh, our email, which is, uh, 292 00:18:22,760 --> 00:18:26,480 evercare family practice@gmail.com or on our website, 293 00:18:27,100 --> 00:18:30,200 www.evercarefamilypractice.com. 294 00:18:30,500 --> 00:18:35,240 You can call us at (505) 780-8301 or you can 295 00:18:35,240 --> 00:18:38,880 leave, um, a message on Facebook, 296 00:18:39,330 --> 00:18:44,190 on Instagram, YouTube, or on any of the, 297 00:18:44,840 --> 00:18:47,510 um, podcast that this is broadcast on. 298 00:18:47,810 --> 00:18:51,510 And I wanna thank Kathy and Amanda 299 00:18:52,450 --> 00:18:57,190 and Serena and all of the listeners out there from, 300 00:18:57,200 --> 00:19:00,110 uh, California that we've seen on our site. 301 00:19:00,310 --> 00:19:04,470 Thank you for listening and we appreciate, again, any input. 302 00:19:04,470 --> 00:19:07,950 And thank you for, uh, taking time, uh, 303 00:19:07,950 --> 00:19:11,670 to listen to our podcast and, uh, have a good night.