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Ask A. Schuyler, NP Your Own Question
A. Schuyler, NP
A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 15925
Experience:  Board Certified NP, MS, RN. 25 years private practice & hospitalist
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I have had a sore throat 5 months. It started with

Customer Question

I have had a sore throat for nearly 5 months. It started with an infection in my nasopharynx, which was treated with Augmentin and Prednisone. After that, throughout the month of January, I would have a sore throat for at least part of every day, but I always felt better by morning.
In February, my sore throat became more persistent, and at that time I cut out coffee and alcohol, and ate only an alkaline diet (based on Jamie Koufman's "dropping acid" book). I saw no improvement, and tried Prilosec OTC for two weeks, which also did not provide relief. At that point (end of February), I saw an ENT who prescribed Omeprazole 40 mg/day. I began to take this, but after two weeks, my symptoms appeared to be worsening significantly (burning feeling in my throat), and I was suffering from some very bad side effects (severe headaches/nausea).
I saw my primary care doctor, who referred me to a GI specialist. He took me off the Omeptrazole and prescribed Nexium 40 mg. This also gave me bad side effects. I was only able to take it for two days because it made my head and neck hurt so much that I could not go to work.
I saw another ENT who recommended I take Zantac 150 mg 2x/day. I did this for two more weeks, but saw no improvement.
I had an endoscopy with bravo pH monitoring on April 6. The endoscopy showed some mild gastritis and esophagitis (LA Class A), but my GI doctor was not concerned about this. The pH monitoring showed one episode of prolonged acid reflux over 48 hours, but this episode did not correlate with my symptoms. Note: at the time of the pH monitoring, I had been off all acid suppressing drugs (PPIs and H2 blockers) for 10 days.
My GI doctor thought this was bile reflux and prescribed Sucralfate 4x/day, which has not made an improvement. I saw another GI doctor who said it could still be acid reflux and prescribed Prevacid 30 mg 2x/day. My symptoms worsened on Prevacid, so I stopped. I returned to the first GI doctor, who prescribed Amitriptyline 25 mg, in case I am experiencing hypersensitivity. I have been taking it for six days, and have not improved.
My symptoms change from being a raw sore throat, to feeling like my tonsils are swollen, to feeling like my throat is burning or stinging. I always feel best in the morning and get worse as the day goes on, but I have not been able to correlate my symptoms with any of the food I eat. I seem to have gotten worse over the past several months, despite eating a strict, low acid diet, and significantly altering my lifestyle. I always eat small meals, and make sure to stop eating 3-4 hours before I go to sleep. I sleep on an incline, on my left side.
I understand my LPR diagnosis, but I do not understand how to fix it. I do not want to get surgery, because I have read many papers that suggest that surgery is most helpful for those with traditional GERD symptoms, and I do not have any of those.
Please help. Is this definitely LPR? Is there anything else it could be? What doctor should I see next? I feel that I am out of options. This has completely ruined my life.
Submitted: 5 months ago.
Category: Health
Expert:  DrThomasMD replied 5 months ago.
HiWhat is your question?
Customer: replied 5 months ago.
Did you not read the entire post I typed out? I want to know if my symptoms are LPR related, or if there is anything else they could be. I also want to know how I can successfully treat this, and what kind of specialist I should be seeking out at this point. I would appreciate it if you could read my entire post, because these questions are listed at the end of it, but I would appreciate it if you could also review my history that I have provided.
Expert:  DrThomasMD replied 5 months ago.
I actually posted another answer, and it did not appear hereSlight glitch.LPR can take 3 months before it even begins to respond to omeprazole.I would use pentoprazole, which in studies acts faster.Yes this can be your problem.The specialist is a gastroenterologist. OK, so you might have more questions or want to give me more information: Please use reply to expert if you have further questions. When you are ready, please click a positive rating [hopefully excellent—that’s how we are paid, per rating]. If you forgot something, come back. I am here
Customer: replied 5 months ago.
Okay, but in my original post, I explained that I have seen 2 GI doctors already and 2 ENTs, who have not been able to help me. I have also explained that I respond very poorly to PPIs. If I could stay on the PPI therapy, I gladly would, but they make my symptoms worse (burning throat), and also produce unbearable side effects. I outlined this in my original question.
Customer: replied 5 months ago.
I would like to know if there is another type of doctor who can help me because the GI and ENT doctors I have seen have basically told me there is nothing more they can do.
Expert:  Dr Basu replied 5 months ago.
Ok --in that case, this is likely caused by the teeth whitening process.Will improve gradually.However, if pain worsens, infection should be suspected.Antibiotic course will be required in that case.Best wishes
Customer: replied 5 months ago.
I don't think this is a response to my question, as I have not had my teeth whitened.
Expert:  A. Schuyler, NP replied 5 months ago.
You wrote "...My symptoms change from being a raw sore throat, to feeling like my tonsils are swollen, to feeling like my throat is burning or stinging...." When you have these symptoms, what does the doctor actually see? Is the throat red and are the tonsils actually swollen? Has anyone ever run a throat culture to see if there is some infection (very, very unlikely after 5 months)? Thanks, ***** *****~
Customer: replied 5 months ago.
They say it looks a little red/inflamed in my throat. Sometimes one of my tonsils will be a bit swollen, but not enough to concern any of the doctors I have seen. They don't seem too concerned and I feel that the amount of pain I am in is out of proportion with my doctors' expectations.I have had four throat cultures taken over the past four months, but they have all been negative.
Customer: replied 5 months ago.
Also, I do have a need to clear my throat often, but it is usually not productive. I try not to clear my throat because causes more pain.
Expert:  A. Schuyler, NP replied 5 months ago.
With negative throat cultures, there is no infection. The fact that there is no pain in the morning but it develops through the day also is consistent with no infection. If it were post nasal drainage, the ENT would have seen it and treated that. I suspect that it is muscular and may be caused by stress. You can discuss this with a speech language therapist (your primary can refer you to one) to help you consciously relax the muscles that are causing the problem. Other treatments for this are cognitive behavioral therapy. Some people benefit from medication for anxiety such as one of the SSRI drugs. Please let me know if you have additional questions about this. Kind regards, ***** *****~

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