Cough, Vomit And Retching...anyone Have This?

You have come to the right place. Chronic cough is frequently caused by acid refluxing into the throat, and unfortunately, most doctors have never heard of this condition, which is called layngopharyngeal reflux (LPR). It can strike at any age, and is thought to be caused by a weakened upper esophogeal spinchter muscle (though researchers are currently investigating the possibibility that the larynx itself begins producing acid by mistake).

When the acid (super strong HCl, pH of 2) gets into the throat, it damages the soft tissues that have no natural protection against acid. A typical response is to constantly cough (or throat clear) to move the acid off the larynx.

Most LPR patients have 1 or more of the following symptoms: chronic cough (like you), chornic throat clearing, sensation of something stuck in the throat/"lump" in the throat. Some people also develop asthma-like symptoms that don't respond to asthma treatments. This happens because when the acid gets into the throat, it gets accidentally aspirated back down the other pipe - the windpipe and into the lungs, damaging the lung tissue.

But it's treatable, and despite what you read on this board, it does not require any tests at all to make a diagnosis. Instead, your doctor should go ahead and prescribe you the medication used to treat the condition. If you respond (improvement after about 30 days, though it can be earlier), it is sufficient to be considered a diangosis in itself. However, since you have had this condition for 15 years, they should schedule you for an endoscopy anyway - which is usually done under sedation, in which the doctor uses a scope to check the condition of your esophogous - looking for damage. However, the same medications that you will be on for LPR are used to treat a damaged esophogous, so you should absolutely go and start the medications now!

The medications are called Proton-Pump Inhibitors (PPIs) and they simply reduce the amount of acid your stomach produces. The less acid your stomach produces, the less that can escape and irritate your throat. Alas, it only treats the symptoms of the disease and not the cause, but it's the best we've got and can be very very effective.

Now this is the critical part - whatever PPI you choose to take, you MUST MUST MUST take 2 doses per day! Standard treatment for LPR is 2 doses, and most doctors do not know this, because they've learned that standard treatment for its sister condition, hearburn/GERD is 1 PPI dose per day. So it is probably going to be up to you to correct them if they are incorrect. If they resist, simply direct them to the U.S. government's pubmed database ([url]http://www.pubmedcentral.nih.gov/[/url]) where they can find citation after citation that confirms LPR must be treated with 2 doses of a PPI per day.
You can even search it yourself for "LPR" or "laryngeal reflux" or "laryngopharyngeal reflux" and pull up dozens of citations that describe the latest research and treatment.

In the U.S.A., we have 5 PPIs to choose from and they might have different names in your country. By prescription, we have Nexium, Aciphex, Prevacid and Protonix. Nexium is the latest drug on the market (2001) and though usually the most expensive here, is often the one that works when the others fail. It has a significantly different structure that my doctor says "allows more people to significantly metabolize it better". I've been on 2 doses of it per day for 4 years.

We also have an over-the-counter PPI (we can buy it without a prescription) called Prilosec. It used to be available by prescription, but went OTC when it lost its patent. Prilosec was the first PPI to ever be produced. It's maker, Astrazeneca, followed it up with Nexium in 2001. However, from reading the posts on this board over the last year, it seems that most people with LPR do not greatly benefit from Prilosec - it seems to be a better treatment for GERD. There are people with LPR on it - and seems mostly because it's a cheaper drug, but they aren't the ones I'm seeing who have achieved a good recovery, in general.

When you begin taking your PPIs, you need to consider the timing of your doses. Some people take them together first thing in the morning (like me) and many others take 1 dose in the morning and the other dose in the evening (because PPIs typically wear off after about 17 hours). You simply need to expermiment to find out what works best for you. My morning version works for me because I am a classic daytime refluxer - one of the hallmarks of LPR is the tendancy for a LPR patient to reflux and have symptoms mostly during the daytime when they are upright. As soon as I lie down, I stop coughing (no reflux when I am prone). This is the opposite of someone with GERD - who typically refluxes when lying down at night.
So for me, I need the double dose of my Nexium first thing in the morning when I wake up. If I stay up late I begin to feel it wear off, but as soon as I hop into bed, any breakthrough symptoms go away until I wake up in the morning.

And finally, you may need to experiment with which PPI you take. There are too many instances on this board where people have tried 4 or 5 of the PPIs before settling on the one that works for them. Not every PPI will likely work the same for you.

And since you haven't been treated before, it may take about 30 days for you to notice improvement after beginning the PPI regimen, so hang in there and keep going - because given time, these medications usually work! Sometimes improvement comes faster, but you've probably developed a lot of erosions in your throat over time, and just like a cut or scrape on your skin, those erosions will need a few weeks of being acid-free to heal!


SOURCE::: http://www.healthboards.com/boards/showthread.php?t=398511

http://sniff.numachi.com/pages/tiPIGINEB4.html

The Famous Pig Song

The Famous Pig Song
(Clarke Van Ness, music by F. Henri Klickmann)

'Twas an evening in October, I'll confess I wasn't sober,
I was carting home a load with manly pride,
When my feet began to stutter and I fell into the gutter,
And a pig came up and lay down by my side.
Then I lay there in the gutter and my heart was all a-flutter,
Till a lady, passing by, did chance to say:
"You can tell a man that boozes by the company he chooses,"
Then the pig got up and slowly walked away.

Walked away, walked away,
He was really too particular to stay.
"You can tell a man that boozes by the company he chooses,"
Then the pig got up and slowly walked away.

Then I heard a gentle mooing, it was like a pigeon cooing,
As a home returning cow stopped in her stride,
And her eyes were big and gentle; her expression sentimental,
As she curtsied low and sat down by my side.
Then I saw her eyelids flutter and a tear fell in the gutter,
As the owner of the cow did loudly say:
"Leave that brute this moment, Sonja, or your milk will curdle on ya,"
Then the cow got up and slowly walked away.

Walked away, walked away,
She was really too particular to stay.
"Leave that brute this moment, Sonja, or your milk will curdle on ya,"
Then the cow got up and slowly walked away.

Then the moon began to shine in that old gutter I reclined in,
Thinking of the weakness of the human race,
When a dog sat down beside me, and I thought he came to chide me,
Till he gently licked the stubble on my face.
In the gutter, still reclining, I began "Sweet Adeline-ing,"
While the dog raised up his head to loudly bay;
Then his mistress said, "Come, Fido, that disgusting man may bite you,"
Then the dog got up and slowly walked away.

Walked away, walked away,
He was really too particular to stay.
Then his mistress said, "Come, Fido, that disgusting man may bite you,"
Then the dog got up and slowly walked away.

Down the street there came a clatter, and a gentle pitter-patter,
As a pair of goats along the gutter ran;
And it seemed that Billy knew me, for he quickly drew up to me,
While his wife munched on an empty sardine can.
Then again my pulse did flutter, and my heart was soft as butter;
Till the Nanny goat, unto her mate, did say:
"William dear, your social status don't include men such as that is,"
Then the goat got up and slowly walked away.

Walked away, walked away,
He was really too particular to stay.
"William dear, your social status don't include men such as that is,"
Then the goat got up and slowly walked away.

Then I started in to mutter and I rose up from the gutter,
Then I sadly went about my lonely way;
I was weary, sick and busted; I was really quite disgusted,
And I vowed to sign the pledge that very day.
For each humble, lowly creature, a great lesson he can teach ya,
Like the one learned while I in the gutter lay;
In the tavern, do not tarry, when you've got all you can carry,
But take up your load and slowly walk away.

Walk away, walk away,
For the "Horrors" is an awful price to pay,
In the tavern, do not tarry, when you've got all you can carry,
But take up your load and slowly walk away.

CODA
Now lately I've been thinking that I will quit my drinking.
I'm going to leave off whiskey, beer and grog,
For there's no consolation, but only aggravation,
You can't even find friendship with a hog.

(Alternate last stanza)
I began to scratch the gravel, on my all fours I did travel,
I rambled down the road the best I could.
When I awoke next morning, just as the day was dawning,
I was in a hog pen away out in the woods.
Then the hogs began to grumble, I started and I stumbled,
I fell right in their midst and there I lay.
Then one by one they started, till all the herd departed,
Yes, every hog got up and walked away.

Walked away, etc.

My New Monkey Song.

I chased a monkey up a Jasmine tree.. Monkey turned around looking back at me. He said I bet you think I'm a real Mon-Key... but I'm a statue turned around looking back at you!... mt.MT.Mt

THREE :::Meet a grid rule

This link will need to be copy, cut. and pasted into the box at the top of your browser. http://www.gridrules.net/


What are Social Security’s Medical-Vocational Guidelines (the “Grid” Rules)?
When you apply for disability, Social Security evaluates your case using a very detailed set of rules. These rules are designed to help Social Security employees, no matter where they are located, evaluate every case in a uniform manner.

The Grid Rules Only Apply When You
Have Physical Limitations

At the top of this site, you will see buttons labeled “Sedentary,” “Light,” and “Medium.” These terms refer to your physical capacity for work, and are defined as follows:

Sedentary: Sedentary work means that you are able to sit for up to 6 hours in an 8 hour day, and lift up to 10 lbs. occasionally during a day

Light: Light work means that you can stand and walk for up to 6 hours in an 8 hour day, lift 10 lbs. frequently and 20 lbs. occasionally

Medium: Medium work means that you can stand and walk for up to 6 hours in an 8 hour day, lift 25 lbs. frequently and 50 lbs. occasionally

You can only use the grid rules if you have a physical limitation. Purely mental health problems or a pain diagnosis without lifting and standing restrictions will not allow you to use

TWO :::Prove that your functional capacity for work (i.e. Residual Functional Capacity) is less than sedentary

This link will need to be copy, cut. and pasted into the box at the top of your browser.
http://www.socialsecurity.gov/OP_Home/cfr20/404/404-1545.htm

It is the actual page from the social security administration for Disability Evaluation Under Social Security(Blue Book- September 2008). It is Your residual functional capacity.

ONE :::Meet a listing

This link will need to be copy, cut. and pasted into the box at the top of your browser.
http://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm

It is the actual page from the social security administration for Disability Evaluation Under Social Security(Blue Book- September 2008). It is the Listing of Impairments - Adult Listings (Part A.

http://www.ssdanswers.com/three-winning-arguments-in-disability-cases/

Three Winning Arguments in Disability Cases
3
As a large federal bureaucracy, the Social Security Administration has a dizzying array of procedures and forms that it uses to process disability cases. Social Security procedure manuals require disability adjudicators and judges to use something called a "sequential evaluation process" to evaluate every disability case. In case you are interested, the five steps of the process are as follows:

Are You Working?
Is Your Condition “Severe”
Does Your Condition Meet a Listing?
Can You Perform Your Past Relevant Work?
Can You Perform Any Work
Hundreds of words have been written about each step of this process and the Appeals Council and District Courts produce voluminous written opinions that explain what each of these words mean and how they should be applied.
As a busy attorney dealing with disability cases on a day to day basis, I don't have the time or patience to deal with the minutia of Social Security jurisprudence. Instead, I worry about what it takes to win.

With apologies to the drafters of Social Security's POMS – Programs Operation Manual System, it has been my experience that there are 3 ways to win a case:

ONE :::Meet a listing
TWO :::Prove that your functional capacity for work (i.e. Residual Functional Capacity) is less than sedentary
THREE :::Meet a grid rule
You can read more about how I apply these three "theories of disability" in a back case by clicking on the link.

In my experience about 15 of cases that end up at hearings are decided under a listing theory and about 15% are grid rule cases. That leaves approximately 70% of the cases that I try as RFC cases. Note that my percentages may be similar or different that what you might experience where you live.

In my view, Social Security disability practice fits fairly neatly into this three theory box. I use this approach in every case in my office and I am always able to fit the facts of any particular case into one, two or all three of these arguments.

If you are a lawyer and you want to learn more about how I set up and manage my practice, I am teaching a course entitled "Creating a Social Security Disability Practice at Solo Practice University, an on-line learning resource.