Just wondering if anyone here is clear how the medical community seperates these two disorders in a clear fashion. Those supposed sufferes of LPR who show now visible sign of disease and may even have quite low 24 hour PH readings etc, may still be diagnosed as having LPR on the belief the slight amount of acid is causing some nerve damage in the throat which is not visible but nontheless seen as responsible for the symptoms experienced by the patient. How this distinction is made without consideration of Cricopharyngeal spasm. I do not know C.S has a little less credibility in terms of a "real disorder" but it certainly seems clear that streess alone seems to be responsible for some part of theses symptoms. Any thoughts?
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Hm, my understanding as far as I know is that LPR is the one that is diagnosed but CS is not the same thing, but I'm not entirely sure on the distinction myself! Does anyone else have an idea?
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HFG- thanks for responding. I have seen you post intelligent comments on this board before, so I hope you do not mind if I respond at length on some of my thoughts on Globus, LPR, Cricopharyngeal spasm, TMJ, etc. In other woords the whole gamut of causes for some of these throat symptoms which can be very similar. I came into this world of wierd throat problems after taking up cigarette smoking for about a year and a half. During this period I had noticed that I seemed to be having an unusually sore throat and some hoarseness, but attributed it to smokiinga nd assumed it would resove when I stopped. However I would stop for a week at a time or so and would find the symptoms did not really seem to resolve.Then I began to worry that something more was wrong. Nonetheless I continued to smoke out of a combination of addiction and afear I had that something was seriously wrong but that I did not have to confront if I continued smoking. It was a serious case of denial that I could use the belief that stopping smoking would cure my symptoms when down deep I knew there was a more serious problem. To say the least this strategy worked havoc with guilt towards my desire to be healthy, and what I was potentially doing to my Wife who I love immensly.
Sorry for all the personal background, but some is necessary if I am to explain my interactions with this disease. Finally I reached a point where there was some type of feeling in my throat that caused something similar to a gaging reflex. I stopped smoking and sought medical attention at some of the local clinics. The symptoms at this point had developed into a somewhat sore throat, globus, earache and nasal drip. I was basically told we don't know what that could be, but keep coming back every two weeks. Well I became a little annoyed with that and began hitting the internet to find out what I could. Unfortunately what caught my eye first was throat cancer since many of my symptoms were consistent withit and I had this whole stored up smokers guilt thing. At this point an ENT assured me he was concerned about throat cancer as well. So as I waited out the almost two weeks for a laryngoscopy, the anxiety over throat cancer became almost unbearable. During this period I lost my appetite, lost 15 pounds in a couple of weeks, and ate nothing the last five days before I had the laryngoscope. Of course this loss of appetite convinced me even more in the direction of cancer, and was well convinced I was done for. However the scope showed no sign of cancer. This was of course an emotional moment for wife and I, so much so that we did a poor job of asking what were the causes of my symptoms. I was told it was probably anxiety and would resolve itself in the future. So I had one happy day believing life would return to normal, until I began to ponder reflux problems. Then the next day I hit the internet and found LPR. It is of course not a barell of laughs in its levels of uncertainity, both in diagnosis and resolution. I called back the doctor who had scoped me and asked if he had looked for LPR damage. He said he had seen no damage indicative of the disease. I continued to try to make appointments with other ENT's and heard from many of them that ENT's do not "do" LPR, that it is a disease for GI doctors which is of course simply wrong.
So I tell you my story not only because it seems like an opening step in bonding here with others of similar predicaments, but also to emphasize the trouble the medical establishment seems to have in diagnosing these symptoms. If for example the first clinicians I had seen, told me that my symptoms were indicative of either reflux,disease, anxiety or possibly cancer that information would have saved me a considerable amount of anxiety and delay in treatment time. Why did the ENT who took my scope not mention that he had looked for reflux damage and this could be a likely cause of my symptoms? And also the lack of even knowing about LPR in a wide range of ENT offices in my area at least. All of thes indicate some problems in doctors diagnosing, or at least mentioning, what are some pretty common symptoms for some pretty common disorders
One last point on my experience with ENT's so far. The second ENT did an upper laryngoscope on me as well ,though this time he put the scope through the UES (upper esophugual sphincter). when I reacted with some sensitivity to the puncture of the UES, he told me that gave me 90 percent chance of having LPR caused symptoms since people with LPR react to the puncture of the of the UES. The question I have for him, now,and I believe this might be of importance to the readers as well, is whether someone with globus caused by anxiety alone would also react to the puncture by the scope. This goes back to the point in the earlier post, and that point is there seems to be some unidentified, and un-acknowledged by the medical community, overlap in supposed anxiety caused globus symptom and that same symptom when it is being listed as an LPR symptom. ENT's have supposedly claim the reason LPR sufferers have no visible damage to the larynx and presumably the UES is because small scale damage to nere endings is occuring to acid reflux. I have no real quibble with gven the case histories reflux damage remain the most likely for these seemingly invisible symptoms being linked to LPR, but at the samr time it should be admitted that a bit of a categorical leap has taken place with visible symptom LPR sufferers and those who show no damage on scopes. And in the case of Globus I think there is every reason to believe that LPR suffers may be "causing" (if you don't mind the expression) Globus wth an anxious reaction as well. The only difference might be that some irritation or other acid related complex's are compeling an anxious reaction in LPR sufferers
On a personal level the question is of only mild import since I realize the fight against stress is obviously key in my battle with LPR ansd whether it is cused by a direct rection causing globus or whether it is stress induced acid from stomach seeminglydoes not make too much difference. But it does in the sense that globus, or something close to it, is perhaps the only signifcant throat symptom I have.My Globus does react well to the taking of Xanax which gives me more reason to believe it might be controlled by relaxation or anti- anxiety medication before actually controlling my reflux. I do believe it is likely I have reflux given my history, and some other symtoms including chest and back pain. But to what degree which symptoms are being caused by which causes I ,and the doctors in my opinion, are fishing.
Sorry if this is a bit long. To sum up, my disaapointment with the medical community, or perhaps it could be stated,my disaapointmentwith the levels of communication between the medical community and patient community over this disease is a problem. I know there are discussion boards wher M.D's occasionally participate, but wouldn't it be great if there were boards where there was some really feedback between activists on this board or others who could summarize a lot of the patient perspectives being expressed on discussion boards regarding LPR and Globus, and communicate those to Doctors who participate. I understand it is not going to happen for a lot of reason, but in terms of the important communication necessary to improve the understandings of this disease"it would help if it did take place. The doctors office visits alone is not an adequate public form for the interaction necessary,
While that will not happen, I have looked at a lot of the info about these throat problems, and it some point would like to share what I have with whoever is interested. In the last few weeks I have seen some of the old archived boards with individuals who had solid understandings of the issues involed with what we a re talking about, but now it seems like there are a lot of new folks grasping for understandings and perhaps only a precious few who can introduce them to the issues. Pardon if I am presumptous, and if there are voices here who are more expert than mine, I will gladly defer. But if you HFG, or anyone else think there is a need to get up something like a factsheet summary of the issues surrounding LPR and Globus which could be occasionally posted here when newbie threads start up it might be beneficial.
Thanks for bearing with me
Matt
P.S I have only been working on LPR and Globus for about a month, but I have been very into it.
Sorry for all the personal background, but some is necessary if I am to explain my interactions with this disease. Finally I reached a point where there was some type of feeling in my throat that caused something similar to a gaging reflex. I stopped smoking and sought medical attention at some of the local clinics. The symptoms at this point had developed into a somewhat sore throat, globus, earache and nasal drip. I was basically told we don't know what that could be, but keep coming back every two weeks. Well I became a little annoyed with that and began hitting the internet to find out what I could. Unfortunately what caught my eye first was throat cancer since many of my symptoms were consistent withit and I had this whole stored up smokers guilt thing. At this point an ENT assured me he was concerned about throat cancer as well. So as I waited out the almost two weeks for a laryngoscopy, the anxiety over throat cancer became almost unbearable. During this period I lost my appetite, lost 15 pounds in a couple of weeks, and ate nothing the last five days before I had the laryngoscope. Of course this loss of appetite convinced me even more in the direction of cancer, and was well convinced I was done for. However the scope showed no sign of cancer. This was of course an emotional moment for wife and I, so much so that we did a poor job of asking what were the causes of my symptoms. I was told it was probably anxiety and would resolve itself in the future. So I had one happy day believing life would return to normal, until I began to ponder reflux problems. Then the next day I hit the internet and found LPR. It is of course not a barell of laughs in its levels of uncertainity, both in diagnosis and resolution. I called back the doctor who had scoped me and asked if he had looked for LPR damage. He said he had seen no damage indicative of the disease. I continued to try to make appointments with other ENT's and heard from many of them that ENT's do not "do" LPR, that it is a disease for GI doctors which is of course simply wrong.
So I tell you my story not only because it seems like an opening step in bonding here with others of similar predicaments, but also to emphasize the trouble the medical establishment seems to have in diagnosing these symptoms. If for example the first clinicians I had seen, told me that my symptoms were indicative of either reflux,disease, anxiety or possibly cancer that information would have saved me a considerable amount of anxiety and delay in treatment time. Why did the ENT who took my scope not mention that he had looked for reflux damage and this could be a likely cause of my symptoms? And also the lack of even knowing about LPR in a wide range of ENT offices in my area at least. All of thes indicate some problems in doctors diagnosing, or at least mentioning, what are some pretty common symptoms for some pretty common disorders
One last point on my experience with ENT's so far. The second ENT did an upper laryngoscope on me as well ,though this time he put the scope through the UES (upper esophugual sphincter). when I reacted with some sensitivity to the puncture of the UES, he told me that gave me 90 percent chance of having LPR caused symptoms since people with LPR react to the puncture of the of the UES. The question I have for him, now,and I believe this might be of importance to the readers as well, is whether someone with globus caused by anxiety alone would also react to the puncture by the scope. This goes back to the point in the earlier post, and that point is there seems to be some unidentified, and un-acknowledged by the medical community, overlap in supposed anxiety caused globus symptom and that same symptom when it is being listed as an LPR symptom. ENT's have supposedly claim the reason LPR sufferers have no visible damage to the larynx and presumably the UES is because small scale damage to nere endings is occuring to acid reflux. I have no real quibble with gven the case histories reflux damage remain the most likely for these seemingly invisible symptoms being linked to LPR, but at the samr time it should be admitted that a bit of a categorical leap has taken place with visible symptom LPR sufferers and those who show no damage on scopes. And in the case of Globus I think there is every reason to believe that LPR suffers may be "causing" (if you don't mind the expression) Globus wth an anxious reaction as well. The only difference might be that some irritation or other acid related complex's are compeling an anxious reaction in LPR sufferers
On a personal level the question is of only mild import since I realize the fight against stress is obviously key in my battle with LPR ansd whether it is cused by a direct rection causing globus or whether it is stress induced acid from stomach seeminglydoes not make too much difference. But it does in the sense that globus, or something close to it, is perhaps the only signifcant throat symptom I have.My Globus does react well to the taking of Xanax which gives me more reason to believe it might be controlled by relaxation or anti- anxiety medication before actually controlling my reflux. I do believe it is likely I have reflux given my history, and some other symtoms including chest and back pain. But to what degree which symptoms are being caused by which causes I ,and the doctors in my opinion, are fishing.
Sorry if this is a bit long. To sum up, my disaapointment with the medical community, or perhaps it could be stated,my disaapointmentwith the levels of communication between the medical community and patient community over this disease is a problem. I know there are discussion boards wher M.D's occasionally participate, but wouldn't it be great if there were boards where there was some really feedback between activists on this board or others who could summarize a lot of the patient perspectives being expressed on discussion boards regarding LPR and Globus, and communicate those to Doctors who participate. I understand it is not going to happen for a lot of reason, but in terms of the important communication necessary to improve the understandings of this disease"it would help if it did take place. The doctors office visits alone is not an adequate public form for the interaction necessary,
While that will not happen, I have looked at a lot of the info about these throat problems, and it some point would like to share what I have with whoever is interested. In the last few weeks I have seen some of the old archived boards with individuals who had solid understandings of the issues involed with what we a re talking about, but now it seems like there are a lot of new folks grasping for understandings and perhaps only a precious few who can introduce them to the issues. Pardon if I am presumptous, and if there are voices here who are more expert than mine, I will gladly defer. But if you HFG, or anyone else think there is a need to get up something like a factsheet summary of the issues surrounding LPR and Globus which could be occasionally posted here when newbie threads start up it might be beneficial.
Thanks for bearing with me
Matt
P.S I have only been working on LPR and Globus for about a month, but I have been very into it.
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Matt, I couldn’t agree with you more. I too suffer from endless counts of misdiagnoses. I am sorry to hear you have been going through the same frustration. My problems started three years ago and just recently (2 weeks ago) I was finally properly diagnosed with LPR, Gastritis and Cricopharyngeal Spasms. In September 2006 I woke up after falling asleep on the couch with a tickle in my throat. When I woke up the next morning I felt like I had a superball in my throat. I panicked and drove myself to the ER. I thought something was stuck in my throat but after the ER Dr. looked me over, took my temp and blood pressure and felt my throat, he claimed I had anxiety and the lump was cause by that. Well everyone has anxiety at some point in their life and I do believe a stressful situation can cause a lump in the throat. BUT this was not my anxiety, I was convinced the lump in my throat was not cause by anxiety but it was causing anxiety. I waited for it to get better but a week went by and the lump was still the same. I went to my Doctor, whom I had trusted for 15 years and he told me the same thing, anxiety. Over the next couple of weeks the lump in my throat became worse and at moments it felt as if someone was choking me. The pressure in my throat became so tight I couldn’t eat at times. One day it was so bad, the tightness was more than just uncomfortable, it was causing pain. My doctor admitted me into the hospital for an emergency END (endoscopy). I had several blood tests and an END that was performed by the GI Doctor on call. He found a minimal hiatal hernia and maybe GERD. I would like to know where does MAYBE come into a professional diagnoses. He claimed there was nothing he ‘saw’ that would explain the lump in my throat feeling or the pain I was having intermittently. Therefore I was diagnosed with GERD and globus and was given a PPI and xanax. I ended up in the ER a few more times after my hospital visit. The last time I went in was because I could not even eat, the lump felt like it was getting tighter and tighter. There was a doctor’s assistant who was going over my symptoms and he told me I was acting like an old lady making up a story to get attention! I was shocked by his treatment! He even went as far as saying to me that I was acting more ill than the patient next to me and he was dying of cancer. Usually in any other situation I would have given him a piece of my mind and asked to speak with someone in charge but in that moment I felt so vulnerable and a little insane that this man made me cry. I felt so alone and now these doctors are pretty much telling me I am crazy and it is all in my head. Finally my doctor did a full work up on me, MRI of my throat, CAT scan of my thyroid, and more blood tests in his efforts to prove to me that this was indeed anxiety. He put me on an anti-depressant Trazodone and told me to take 3 xanax a day. I gave up, the medical professionals were starting to make me believe that maybe this ‘was’ just all in my head. I learned to deal with the lump in my throat, took the Trazodone but gave up the xanax (Working Mom and xanax don’t make a good combo). I moved from Orange County to Northern California in the meantime. I would have good days and bad days with my throat. Finally after 9 months of having a lump in my throat I woke up one morning and it was gone! Completely gone like it never happened!!!!!! I continued to take the anti-depressant but was never satisfied with my diagnoses but was greatful the feeling was gone. A few months went by and I started having respiratory problems and my stomach was always aching. New doctors here told me I had asthma and post nasal drip. My chest was so tight one night I felt like I could barley breathe. My husband took me to the ER and they gave me a breathing treatment and told me my lungs sounded good. I found a wonderful Allergist and she tested me, I do not have asthma. She told me I have acid reflux. I felt like I could trust her and explained my history, she said she has seen patients like me and that the lump in my throat could possibly be VCD (Vocal Chord Dysfunction) and that is caused by acid reflux going up into the larynx. AH HA, something other than anxiety!!! I decided I was going to get off the Trazidone and use the Aciphex she gave me as a trial for my stomach. Coming off an anti-depressant was the worse feeling I ever experience. But after 3 weeks I began to live a ‘normal’ life once again. Until…this August… the lump came back! Armed with new fabulous insurance, I found some specialists. I was having the exact same feeling as I did 3 years ago. On my first visit with the GI doctor I felt confident this doctor would help me. Why? Because he listened to me for 1.5 hours. Yes, he actually listened, which is something that all of the other doctors (minus the allergist) did not do. That week I was in for an END where he found gastritis (inflammation of the stomach), polyps in my stomach and GERD. For good measure, he dilated my esophagus. Luckily the polyps were benign, he put me on medication to heal my stomach, Achiphex x2 a day. My symptoms got worse and I felt heartburn for the first time ever. I was changed to Kapidex, same thing my symptoms got worse. My throat was tighter after he dilated, it felt again like someone was strangling me. He had me go in for an esophageal manometry test (that is one evil test) and ordered blood work again. I of course started doing tons of research on the internet, reading medical journals, and scouring several books (thanks Barnes & Noble). Waiting for my results I found an ENT that specialized in swallowing problems. The ENT performed the larynscopy and confirmed my thoughts… I have LPR and I am having Cricopharyngeal Spasms, which is why I feel like someone is strangling me sometimes. My GI doctor confirmed as well. FINALLY I had real diagnoses, after 3 years of doctors making me think I am crazy or that this was just anxiety. I wish I could go back to each one, especially the one that made me cry and let them know what was really causing that ’globus’ feeling. I found a PPI that didn’t make me feel sick, Nexium. I didn’t take all the prescriptions my GI doctor gave me, instead I changed my life style; I quit smoking (smoking is bad for reflux), quit eating anything that could possibly cause reflux, no coffee, chocolate. After just gaining 10 pounds in 20 days (thanks Nexium), I quit taking Nexium. I take a flexeril 10mg when I have a spasm and I am home. I was told that the lump and spasms will stop on their own, but it takes time. For the rest of my life I will have to manage acid reflux, make sure I eat right, continue to not smoke, no coffee, etc. I can’t give up chocolate though; I have to have one vice! Sorry this is so long and if you have hung in there and read this whole post you will know you are not alone in the frustration of finding a competent doctor. My only advice I can offer is always trust your body, if you know something isn’t right, then it probably isn’t. Good luck and hang in there!
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Thankyou for being so specific with your symptoms and medications...I have had these same symptoms with a barrage of testings, numerous doctors all telling me it is anxiety. I did have an upper gi where I drank the juice while being x-rayed but they said i did not have reflux because my valve was closing just fine. Was just wondering if you had this test too and if they found that your valve was faulty or fine...my point is to find out if you can have a normal GI result but because of the Cricopharyngeal Spasm have reflux due to that and not due to an actual faulty valve? Thanks again for all your information and helping others with trying to deal with this horrible sensation.
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Thanks for such a great information. I have similar symptoms for 4 months now. After spending hours and hours and internet I think I have Cricopharyngeal Spasm, even thourgh my doctors are telling me it is an acid reflux, I do not think it is, since I do not have any reflux symptoms, Also, I was on Dexolant for month and a half that was suppose to help, but it did not. I was on Nexium and Zontac for a week and and did not help. My symptomps are all day every day, traveling from upper to lower throat and at times in the back of my throat I have a very dry weared feeling that I have to have water right away. Sometime it feels like globus, sometimes it is something sharter it is very hard to exxplain. Can you please give me more details. And I am wondering how are you feeling, now. Hope you are feeling better.
thanks
thanks
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I know exactly how mine happened. I was engaged in sexual intercourse with my wife and while laying on my back with her on top I kept holding my head up. Well, worse came to worse...no pun intended, and I started feeling this odd lump in my throat. Bam, spasms started then and my sleeping on a couch a lot is not helping. Yawning, coughing while your head is in a weird position (chin on chest) will spark an outburst. Stress comes from anxiety and the less you try to not think of it the more you do.
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Hi Matt,
My Mom has a lot of throat problems, coughing etc. She's had a lot of testd and what she has is a cricopharyngeal spasm which is easily treated with botox injections. Also, before doctors arrived at this conclusion, they though it was GERD and put her on Nexium.
Hope this helps.
Maria
My Mom has a lot of throat problems, coughing etc. She's had a lot of testd and what she has is a cricopharyngeal spasm which is easily treated with botox injections. Also, before doctors arrived at this conclusion, they though it was GERD and put her on Nexium.
Hope this helps.
Maria
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My Mom has cricopharyngeal spasm and it is easily treated with Botox injections. Ask your ENT about this. It is very inexpensive and low risk.
Hope this info helps.
Hope this info helps.
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Maria- Can you please tell me the nature of your mom's symptoms? Are they made worse by stress, or do they appear regularly without a trigger mechanism? My GP thinks I have an anxiety problem, but this has persisted for 3.5 years for no reason.
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I have suffered from spasms in the cricopharangeal area on and off for 2-3 years now. My GP believes that they are cricopharangeal spasms, but with stuff like this, it's hard to get a correct or definite diagnosis, as cricopharangeal spasms don't seem to be a well known thing. Yes, stress makes them worse, but they can be triggered by other things, such as failure of the upper oesophageal sphincter to work correctly, or even by eating things like nuts and seeds. They can last for weeks or months at a time.
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I forgot to say that in my case, stress is not always the trigger. Remember, they can be caused by the UES not working correctly and that is a mechanical issue, not a mental one. The symptoms themselves can cause great stress and if you suffer from these spasms, they will often happen whether you have a lot of stress or not, and if you are having them and then have a stressful day, it WILL make them worse! I have severe oesophageal dysmotility, so that is a contributing factor in my case... As always, being as stress free as possible is always good, but not always attainable every day. I apply a tea towel soaked in hot water to the area to help relax the spasms, which, even though they don't stop, is very relaxing and gives some relief.
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I had a cricopharangel spasm (CS) several years ago. Stress at work and then going on holiday in the Alps with a difficult boyfriend gave rise ot the spasm, I was virtually unable to walk uphill, as someone said it was like trying to breath out of the window of a fast moving car. One evening I had a bit of a 'melt down' on the shoulder of boyfriend and after a lot of tears the spasm lifted.
Eight weeks ago I was due for some major spinal surgery and the tight throat happened again. This time it has lingered on, not helped by lying flat on my back for several weeks and eating virtually horizontal. I have been for hospital checks for everything possible for post op. problems with breathlessness but I'm all clear.
A GP prescribed PPI's but I haven't taken them. I have considered LPR, drink Gasviscon at night and have sodium bicarbonate drinks and drink a goo of sodium alginate to protect the throat to neutralise the pepsins but I know deep down its CS.
So far I have tried: A towel soaked in hottish water wrapped around my throat, and drunk how water at the same time which helps the cough. I also ( when very alone) put my head between my knees and try to cry and really sob loudly to kill off the 'stress' with some limited results. I reckon some wild exercise like trampolining or wave jumping could get the stress out.
Sips of neat Vodka help for a few minutes, as does chilly oil in a drop of water.
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lilly if that is all u have to say cos its "annoying "u...u may need relaxants!! lol
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