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Dr. Thomas, MD
Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56848
Experience:  Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
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I have been dealing with gastro issues. for the last 15 months.

Resolved Question:

I have been dealing with gastro issues. for the last 15 months. I have had a colonoscopy and endo. The only thing that was found was diverticulitis whic has resloved and I have learned to deal with it.

The problem now is LPR. I have all the classic symptoms. I should mention that I was on PPIs for 4 or 5 years - first Prilosec OTC and then Aciphex and finally dexilant. Those helped with the normal GERD, but have been of no effect for LPR.

To make matters worse, I am a voice teacher and am required to use my voice a lot, of course. All I want to know is whether this stuff ever goes away.
Submitted: 1 year ago.
Category: Medical
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello from JA

I am Dr. Thomas, MD, board certified in internal medicine and integrative medicine, so I cover a lot of ground and will be happy to help you with your question. We can correspond back and forth as needed.

I will either give you an answer right away or have questions for you. Either way, use reply to expert until you are ready to rate the answer: Please note that answers for information and education only.

Please remember that we are only paid for positive ratings and bonuses and this helps us to help you. Please do not click a 1 or 2 [negative] rating as this only negatively rates the expert helping you.

OK
In fact LPR is very difficult to treat and not all cases respond to the medications.

If the medicines have not worked after 4 to 5 years then consideration for Nissan fundoplication surgery needs to be given. As this would most likely stop the reflux altogether.

Before doing this, since this is essentially a structural problem [angle of the sphincter is not adequate] I try to treat it structurally in my practice, specifically with OMT or osteopathic manipulative treatment, which is a deeper balancing of bodily structural processes.
You find masters in this here
www.cranialacademy.com

One small study showed OMT effects to be enhanced with acupuncture, so I combine the two.

So far, very good success.

Let me know if you have further questions. If you have any concerns just use reply to expert until you are ready to rate a positive for your satisfaction..

Please click on one of the positive ratings [smiley faces]: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

Customer: replied 1 year ago.


I have read and heard from my ENT that the fundoplication surgery is not always effective with LPR. Much more with classic GERD. My question is, does LPR ever resolve on its own? Is it possible that I will have to live with this awful stuff?


 


Also, I should have said that I never had this problem until the endo. Any connection?

Expert:  Dr. Thomas, MD replied 1 year ago.
I have had it resolve completely, but not on its own, but with the above measures that I describe to you.

There is no known connection to having an endo.

Please click on one of the positive ratings [smiley faces]: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

Customer: replied 1 year ago.
Relist: Answer quality.
My answer was not at all satisfactory. I have researched this issue exhaustively. In addition, I have been seen by two "board certified" doctors who treat this disorder. I feel that this paerticular Dr. is the wrong one to answer my question. I would much rather have had an ENT or Otolaryngologist.
Expert:  Vakul Aren replied 1 year ago.

Persistent LPRD(laryngopharyngeal Reflux disease)can be difficult to treat by behavioural /life style modification alone.Prolonged and aggressive therapy may be required for management of LPRD. The drugs include prolonged use of PPIs(sometimes may be needed to be taken twice a day),H2 receptor agonists like Famotidine,prokinetic drugs(these are usually avoided due to cardiac side effects and diarrhea),Sucralfate(a cytoprotective drug for the mucosa),antacids like Tums and others used for heartburn. Lifestyle modifications include- losing weight if obese. avoiding alcohol and tobacco. avoiding chocolate,mint,spicy foods,citrus fruits,red wine,tomato-based foods,fats and fried foods. take dinner at least 3 hours before retiring,avoid lying down after eating Quit smoking. avoid tight clothes around the waist.,elevation of head end of bed by 8-10 inches and a board under the mattress at the head end to prevent acid reflux. Ruling out or diagnosing and treating H pylori infection will help. Avoid voice strain,loud speaking or whispering,avoid clearing of the throat(instead use sips of water the clear the cords),sip water between intervals if doing public speaking,voice rest and hygiene is essential. Endoscopy will not cause or increase the disease.Regular ENT visits and direct laryngoscopy and videostroboscopic examination of the vocal cords will help keep a check on the efficacy of the treatment.Twice daily PPI therapy has been used in many patients for long durations to help treat the pharyngeal and laryngeal inflammation and granulomatous tissue growth.Ruling out other diseases like hiatus hernia,Scleroderma,Bile induced duodeno-gastro-oesophageal reflux,achalasia,eosinophilic eosophagitis will help.

Vakul Aren, Doctor
Category: Medical
Satisfied Customers: 3380
Experience: MBBS,DTM&H,30 years of experience
Vakul Aren and 3 other Medical Specialists are ready to help you
Expert:  Dr. Thomas, MD replied 1 year ago.
Hello
I would like to thank the other expert for agreeing with my points.

I have noticed a negative rating from you..that rates the expert, not other problems you have had....is there a question that has not been answered?

Is there something else I can help you with?
Customer: replied 1 year ago.


Yes, there seems to be disagreement among the different disciplines of medicine. My Otolaryngologist says one thing, my GI doctor another and you another. Does no one have a definitive answer for this problem?


 


I mean, if a person has an ulcer, that can be determined, right? If he has a hernia, the same. Why then can't I get someone to say, "this is what you have" and this is what you do to treat it?


 


I know you can't diagnose me from a distance, but I'm trying to figure this out. I looked up the link you provided. It seems to me that an Osteopath is a chiropractor. Is that so? If not, how do they differ?

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
I am glad to help you but you gave me a negative rating
The positive rating on the other expert does not reverse that, and I would seek to reverse that rating as all it does is rate me negatively with JA
I did not see any new information presented by the other expert.
So please click a positive on this post as I answer, and then come back as needed.

As you have stated, the anti-acid treatment has helped but not with the LPR
This is not that uncommon, as LPR can be intractable.

In fact an osteopath is nothing like a chiropractor.
A DO has all the training and status of an MD in the US.
In addition some specialist in OMT, or osteopathic manipulative therapy.
And Sutherland cranial techniques.
And visceral cranial techniques.

This is much deeper in moving things around than what chiropractors do.
So even internal organ dynamics can be affected.
That is why I have seen success in clearing up reflux completely, as I described above.
The DO will have a different take on diagnosing you, and it is often a problem in the movement of the skull bones, sacral bones, diaphragm, or else where that needs to be corrected.

Let me know if you have further questions. If you have any concerns just use reply to expert until you are ready to rate a positive for your satisfaction..

Please click on one of the positive ratings [smiley faces]: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

Customer: replied 1 year ago.


I'm sure that your proctice is not in Tampa, FL. That being he case, how do I find a DO that is competant and as confident as you seem to be in dealling with this issue of LPR?

Expert:  Dr. Thomas, MD replied 1 year ago.
Hello
I still have 2 poor service ratings from you
I will be glad to help you on new questions
But can you click a smiley face here, then we can continue?
Customer: replied 1 year ago.

I will be happy to click the smily face after ou converstaion is concluded

Expert:  Dr. Thomas, MD replied 1 year ago.
OK
Here are the criteria.
The DO does 90 to 100 % of his practice hands on.
Has been doing this for at least 10 years, hands on.
What is your zip code?
Customer: replied 1 year ago.

Thank you, XXXXX XXXXX sorry for copping an attitude, but I have been handed from Dr. to Dr. over the last 15 months and my frustration level is very high at this point. It's nothing persoanl, I assure you. My zip is 34638 but my business zip is 33609 in Tampa.

Expert:  Dr. Thomas, MD replied 1 year ago.
Check here
R. William Taylor DO 2004 100%
River of Life Osteopathic
XXXXX
Ocoee (Orlando Area), FL 34761
(NNN) NNN-NNNNFREE
billytaylordo@yahoo.com
http://www.riveroflifedo.com

And here

Laura T. Rampil DO * 1992 100%
922 Lake Baldwin Ln. #B
Orlando, FL 32814
(NNN) NNN-NNNNFREE
ramp7799@bellsouth.net
http://www.laurarampil.vpweb.com
About: 72 miles

If you go to the web site I gave you, and put in your zip, this is the type of think it pulls up.
You can call the docs and talk with them.

You can also call the cranial academy for more information.

Please click on one of the positive ratings [smiley faces]: the only way we are compensated for time and expertise. If you are not done or satisfied, use reply to expert [not poor/negative]. Come back anytime. Bonuses are great…but your satisfaction is my goal.

Future questions? Ask for DrThomas in the question title or see my profile to request me. Save my profile to your browser favorites http://www.justanswer.com/medical/expert-dr-thomas

Dr. Thomas, MD, Board Certified Physician
Category: Medical
Satisfied Customers: 56848
Experience: Internal Medicine--practice all of internal medicine, all ages, family, also Integrative, CAM, etc
Dr. Thomas, MD and 3 other Medical Specialists are ready to help you

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