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2) Erythrocyte sedimentation rate,
3) Thyroid function tests,
4) Muscle enzymes;
5) Anti-nuclear antibodies (ANA)
6) Adrenal function test
9) Anti-SSA (Ro) or Anti-SSB (La)
10) Coombs test
12) skin biopsy
13) Esophageal manometry
14) 24 hours pH estimation of food pipe
15) Sleep studies
Sjogren syndrome and systemic lupus erythematosus should be ruled out for her symptoms.
If all these are normal; a diagnosis of fibromyalgia or chronic fatigue syndrome would be considered. Meanwhile following would be helpful for pain and her other symptoms;
) Aerobic exercise; low-impact aerobics, walking, water aerobics, stationary bicycle.
2) Heat, massage, and other treatments like sauna, hot baths and showers, hot mud, and massage.
3) Trigger-point injections,
5) Chiropractic manipulation,
6) Myofascial release
7) Neural pulse stimulation (CNP) device
8) Cognitive-behavioral therapy (CBT) and operant-behavioral therapy (OBT)
9) Relaxation training and biofeedback
10) Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen
11) Opioid analgesics (hydrocodone, oxycodone, fentanyl, morphine),
13) Estrogen receptor modulator raloxifene
14) St. John's wort, ginseng, valerian, botanical oil, melatonin, magnesium, dehydroepiandrosterone
Supplements and alternative integrative therapy protocols are;1) Evening primrose oil2) Acetyl-l-carnitine3) Alpha-lipoic acid4) Benfotiamine (Milgamma), 100 mg, is a lipid-soluble vitamin B1 analogue
5) Vitamin E
1) Barium esophagography
2) Ambulatory 24-hour pharyngoesophageal pH monitoring
3) A biopsy of the larynx which may show laryngitis.
Since you are not responding to the medications; Nissen fundoplication surgery may be needed. Following specialists are needed to work in tandem for treatment;
1) ENT specialist
3) Speech therapist, and
Following measures are helpful:
1) Small 5-6 meals a day.
2) Last meal should be eaten 3 hours before lying down.
3) Avoid; fried or fatty foods, chocolate, peppermint, alcohol, coffee, carbonated beverages, citrus fruits or juices, tomato sauce, ketchup, mustard, vinegar.
4) Eat slowly so air is not swallowed.
5) Swallowing therapy by a speech-language pathologist.
6) Lose weight if obese or overweight.
7) Elevate the head of the bed by 6 inches.
8) Avoid tight clothing.
Her gas and intestinal symptoms would be helped by;
1) Avoid a) Cabbageb) Beerc) Legumesd) Cheesee) Beans 2) This may help; a) Bismuth subsalicylate (PeptoBismol)b) Activated charcoalc) Simethicone; (Maalox, Mylanta); Simethicone causes gas bubbles to break up.d) Beano; contains an enzyme (alpha-galactosidase), which helps to breakdown certain complex carbohydrates. All are available without prescription. Avoid foods that appear to aggravate symptoms. These may include milk and dairy products, certain fruits or vegetables, whole grains, artificial sweeteners etc. But this is based on the personal observation for the aggravating food. 3) Investigations by your physician; a) Upper gastrointestinal endoscopyb) Colonic transit time.c) CT scan
Discontinue the following if she does them;
1) gum chewing,
3) drinking carbonated beverages, and
4) gulping food and liquids.
I would be happy to assist you further, if you need any more information.