new medical challenges

Approximately 6 months ago I began to experience some minor lightheadedness.  I tolerated it because that's what I do, waiting for it to go away.  It has lingered until now.  Finally, last month I decided to make an appointment with my ENT doctor and seek the cause of the problem.  Long story short, after testing I have been diagnosed with Meniere's disease.  This disease is not curable and has several symptoms including tinnitus (ringing in the ears), loss of hearing, dizzyness, lightheadedness, and several others.  Obviously, my symptoms presently only have to do with some inner ear discomfort and lightheadedness.  Early on my symptoms could more aptly be called dizziness insomuch as there was more spinning effects in my experience.  Now, I am mainly just lightheaded.  

There are limited treatments for this disease.  My doctor has presently prescribed Maxzide, a diuretic reducing the fluid and sodium retained by the body used primarily to treat high blood pressure.  The doctor also put me on a low salt regimen limiting my intake to 2000mg daily.  Fluid reduction is important because fluid pressure on the inner ear causes Menieres.

This has presented challenges.  First, the GERD medication I take is Zegerid OTC, which my gastroenterologist prescribes.  This med works for me.  Many RX insurance plans now exclude so many heartburn meds.  Zegerid was found after several years of trying different meds and dealing with insurance coverage.  Here's the PROBLEM!  Zegerid is unique in that it utilizes sodium bicarbonate (baking soda) as an absorption agent for the active ingredient, omeprazole.  In fact it contains 1200mg of this form of sodium.  And, I take one in the morning and one at night.  So, from the Zegerid alone I'm getting 2400mg of sodium!  Am thinking this has maybe greatly contributed to getting Menieres.  

Now, after taking Maxzide for Menieres for one week, my GERD is going crazy.  The first few days were awful!  However, thankfully, it has settled down.  However, after one week on this drug I quit taking it today.  The side effects were too hard for me.  Side effects include nausea, flu-like symptoms, and tiredness.  I basically have felt miserable for a week, no energy, flu-like, and unable to function.

I now have to work with my gastroenterologist to find a non-sodium substitute for Zegerid.  The ENT also has to find another med for my Menieres.  I hate these circumstances!  I hate medical problems.  As a runner for 30 years, someone who has maintained their ideal weight for 25 years, and someone who has eaten correctly for 25 years I am having problems not associated with obesity and poor fitness, but problems in other areas.  Ever tried running 5 miles when you are dizzy.  Don't try it!!

muscular concerns and antibiotics

If you have followed my posts you know that I am a firm believer in fitness.  For me, my family history forced me to take a hard look at my own personal fitness in my late 20's.  My father died at age 64 of heart disease and my mother died at age 64 from breast cancer.  My oldest sister died at age 60 of lymphoma cancer.  My fraternal grandfather died in his 40's and my maternal grandfather died of heart disease in his 60's.  In my late 20's, after losing both my parents, examining the health history of my family line, I decided to be intentional about my health.

Diet, exercise, and stress management are essential to my personal fitness program.  Multiple blog posts give evidence to this.  Even then, also documented is my struggle with GERD and other health concerns.  Some things just happen!

For the last several years I have struggled with an ear problem causing pain and discomfort, especially during sinus drainage events (which, thankfully, I don't have much of).  I am blessed NOT to have any struggles with allergies.  I find that a good hard run usually clears up many of my sinus problems.  However, this persistent ear problem has been a challenge.  Finally, after multiple attempts to solve my ear problems my family doctor referred me to an ear, nose, and throat specialist.  I am pleased to say that progress is being made. Regrettably, because of the ongoing ear problem, I have lost about 15% of my hearing in that ear.

All of this to say, that during the course of treatment for my ear problems, I was put on the antibiotic Levaquin, a strong drug used to treat pneumonia.  Coincidentally, as the weather turned much colder I began to experience muscle pulls in my calf muscles.  I thought it was due to the colder temps so I began wearing running tights and used cut-off sock tops to keep my calf muscles warm during my runs.  I also did extra pre-run stretching of my calf muscles, which I still do.  For over a month I experienced extreme frustration with my calf muscles pulling and getting tight during my nightly runs.  After my runs I iced down my calfs on both legs.

Toward the end of this period of calf muscle problems I was referred to the ENT specialist for my ongoing ear problems.  My doctor happens to be a runner also.  During the exam and while reviewing my medical history he noticed I was currently taking Levaquin.  He asked if I was experiencing any muscular problems in my legs regarding my running.  Of course, I unloaded telling him about my frustration with pulled calf muscles for the last month.  Then he laid a bombshell on me.  He said I should limit my running for the next 4 weeks until the Levaquin gets out of my system (I was about to finish the prescription).  He said that Levaquin has a known side effect of causing pulled leg muscles, especially Achilles tendon tears!  Holy smoke!!  He said I was probably lucky I had not ruptured my Achilles and to be very careful.

So, I did curtail my running for a month.  I gradually resumed my running regimen 3 weeks ago and have gradually worked my way back up to my normal workout.  Thankfully, the problem with muscle pulls in my calf has gone away and I now have confidence that I am not going to rupture my Achilles tendon, at least as a result of Levaquin.  I still try to stretch my Achilles properly pre and post-run just to be sure.  I am thankful for a doctor who recognized my dangerous situation because he was a runner also.  I hope you don't have a similar problem with pulled muscles related to the consumption of antibiotics!

causes of GERD

Causes of Gastroesophageal Reflux Disease

By Sharon Gillson, About.com Guide

Updated February 24, 2010

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

If you suffer from Gastroesophageal reflux disease, you may wonder why you are suffering from it, and if there are certain conditions that can cause GERD.

It Starts With the Lower Esophageal Sphincter (LES)

This muscular tissue opens and closes the lower end of the esophagus. The LES helps maintain a pressure barrier that keeps the contents of the stomach from moving up into the esophagus. This is done by an area of smooth muscles and hormones. If the muscles weaken and lose tone, the LES can't close completely after food enters the stomach, which allows acid from the stomach to back up into the esophagus. There are several things that cause the LES to malfunction:

Impaired Stomach Function

More than half of GERD sufferers have abnormal nerve or muscle function in the stomach which, in turn, causes food and stomach acid to be digested too slowly. This will cause a delay in stomach emptying its contents, increasing pressure in the stomach and increasing the risk of acid reflux.

Medications May Cause GERD

There are various drugs, both over-the-counter and prescription, that can increase the risk for GERD, and worsen the symptoms in those who already suffer from GERD.

• NSAIDs
• Nonsteroidal anti-inflammatory drugs include aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen (Aleve). They are commonly associated with causing peptic ulcers, and also may cause GERD or increase the severity of symptoms in people who already have GERD. Research has shown that long-term NSAID users were twice as likely to have GERD symptoms as non-NSAID users.
• Other Drugs That Can Cause GERD
• This list is not an inclusive list of drugs that can cause GERD. Other drugs may also cause or worsen GERD. It is important to consult your doctor if you start experiencing any symptoms.
• Calcium channel blockers - used to treat high blood pressure and angina.
• Anticholinergics - used in drugs that treat urinary tract disorders, allergies and glaucoma.
• Beta adrenergic agonists - used for asthma and obstructive lung diseases.
• Dopamine - used in Parkinson's disease.
• Bisphosphonates - used to treat osteoporosis.
• Sedatives
• Antibiotics
• Potassium
• Iron pills

Asthma May Cause GERD

More than half of asthmatic sufferers also have GERD. It is still debated whether asthma causes the GERD, or if GERD causes the asthma for these persons.

• Some experts think the coughing that accompanies asthmatic attacks can lead to changes in pressure in the chest, which can trigger reflux. Also, certain asthmatic medications that are used to dilate the airways may also relax the LES, leading to reflux.
• Some experts think that since GERD has been associated with several other upper respiratory problems, it may also be a cause of asthma, rather than a result of asthma.

Pregnancy and Hormones May Cause GERD

Hormones also affect the LES. For example, the increase of the hormone progesterone during pregnancy relaxes the LES. Thus, it's not abnormal for pregnant women to experience heartburn.

Diabetes

People with diabetes, especially Type 1 diabetes, often develop a condition called gastroparesis. This condition affects about 20 perecnt of diabetics and is characterized by delayed stomach emptying. Pressure within the stomach can increase, which in turn can result in reflux.

Hiatal Hernias May Cause GERD

The hiatus is a small hole in the diaphragm muscle, and the esophagus fits through as it joins the stomach. This hole is usually a snug fit, but for some people it may weaken and enlarge. When this happens, part of the stomach may protrude into it, producing a condition that is called hiatal hernia. The hernia may impair LES function. So far, there is no evidence that a hiatal hernia causes GERD, but it may increase GERD symptoms in persons with both conditions.

Abnormalities in the Esophagus Can Cause GERD

There are some studies that show that most people with atypical GERD symptoms, such as feeling like there is a lump in the throat, hoarseness or chronic cough, have abnormalities in the esophagus. These abnormalities include:

• Motility Abnormalities - Problems with spontaneous muscle action in the esophagus, called peristalsis, commonly occurs in GERD sufferers. Studies haven't determined if peristalsis is the cause or the result of long-term GERD.

To view this page in its original form, please visit: http://heartburn.about.com/od/gerdacidrefluxdisease/a/causes_of_gerd.htm

©2011 About.com, Inc., a part of The New York Times Company. All rights reserved.

dieting, part 2

This is a continuation of the earlier post.

I am convinced that the diet industry and the endless cycle of dieting endured by many adult Americans have contributed to the poor health and obesity problem in our society today.  In my humble opinion (IMHO), I believe that adults who engage in periodic cycles of weight gain and dieting without changing their attitudes and lifestyle about food and exercise have contributed greatly to our national healthcare crisis.  I write this without facts and research, however, I deeply believe in this theory.  I grieve for family and friends who seek to lose weight periodically without permanently changing their eating habits and food choices.  Regular (4-5 times @ week) strenuous exercise requires a discipline that many people just don't have or can accommodate.  I hate that for them!

I firmly believe that dieting is a short term solution to a long term problem.  Unless you learn to live and eat healthy (proper foods and regular strenuous exercise), temporary abstinence, calorie, fat, and carb reductions only contribute to the re-gain of lost weight.  This also causes accelerated anxiety and mental fatigue and strains every area of your life including your relationships at home and work.

Maybe my answer is too simple.  Yet, I am convinced that the remedy to obesity and poor health for many in our society is a cessation of dieting and a permanent change in what we eat and how we exercise.

I never diet.  I watch lots of television.  I have deserts occasionally.  I enjoy an occasional fine steak meal.  I love sweet ice tea!  However, I refuse to consume any of those foods in excess.  And, I exercise strenuously with regularity.  I weigh myself first thing every morning and never allow myself to vary from my target / ideal weight by more than several pounds.  My waist size is 33 inches and has been for 20 years!  I consume 80+ ounces of water daily.  I try to maintain a level metabolism by eating 3 meals per day (and, I do fail at that when work and life get too consuming).  Breakfast is the most important meal of the day, however, for years, I skipped breakfast.  Not any more!!  But, no chicken-biscuits or egg croissants.   My breakfast consists of a whole grain muffin, an apple or/and banana, and two cups of coffee.  Both for health and GERD treatment, I consume raw fruits and vegetables throughout the day.

dieting and health

After college in my twenties and thirties I struggled with weight gain and dieting.  As previously posted when I entered my mid-thirties I made a serious commitment to changing my eating lifestyle, not just dieting and serious cardio-exercise.  As a result of making these permanent changes in my eating habits and winning the exercise discipline battle, I was able to lose weight from 200+ pounds down to my ideal weight for my height which is 6'2", 170 lbs.  Through proper eating, exercise, and lifestyle management, I have been able to stay at that weight for over 25 years.  Prior to that, I struggled through a pattern of putting on pounds, dieting, losing pounds to a desired weight, then putting the pounds back on, and repeating the cycle.  I was not exercising regularly, eating red meat almost every meal, and consuming other foods that were both unhealthy and high in fat content, including deserts.  My blood pressure was beginning to increase very gradually as was my cholesterol.  I watched my father battle heart disease and lose the battle in 1980.  I saw myself drifting into the same battle.

I have been diligent in having an annual physical exam accompanied by the expanded blood analysis.  In 1994 I went had a thorough medical exam at the Cooper Clinic in Dallas, Texas.  Dr. Cooper attained much renown in the 1970's with his books and work in the field of exercise science.  For years my resting pulse rate has been in the high 40's.  My blood pressure is always < 120/80 (target norm).  The only issue that has been a problem has been a high cholesterol drift that began about 8 years ago.  Medically, it was determined that this was genetic and not due to my diet or lifestyle.  I agree with that diagnosis as my father battled cholesterol in a day when there were no drugs to reduce bad cholesterol.  I have taken 10mg daily of Crestor (statin) for the last 7 years.  This, along with proper diet and exercise has kept my cholesterol index in the 150's, which is acceptable.

In 2004 I was hospitalized with a pulmonary embolism (blood clot in lungs).  It's a long story, but this was caused by complications from taking a drug to kill a tuberculosis issue.  I tested positive for TB after traveling extensively abroad in the early 2000's doing mission work.  The drug took care of the TB issues, but created a side effect of a blood clot.  The clot was the size of a dime in my right lung and was extremely painful.  However, after 6 weeks of treatment and 6 months of consuming blood thinning drugs, I was totally recovered.  I was back on the streets running within 6 weeks and have never experienced any further problems.

One issue involving GERD did come about from the blood clot experience.  My doctor suggested that I take a baby aspirin (81mg) daily.  I did so until several months ago when I deduced that this was contributing to an increase in reflux and GERD problems.  I do believe the medical evidence for taking a baby aspirin daily to aid in the prevention of heart disease.  However, for GERD sufferers like myself, consuming aspiring is like throwing gasoline on a fire.  The acid effects of aspiring are too difficult to tolerate, even the coated versions.

I'm going to complete my discussion of dieting in the next post.

more words on treatment

My doctor has always been mystified about treating my GERD.  Because I am not overweight it seems to frustrate his idea of what causes my condition to continue to proliferate.  My personal take on my GERD is that as a life-long sufferer, my chemical digestive system is simply too acidic.  It is made worse by stress and diet.

Years ago as my running and exercise increased I began to take OTC acid reducers such as Tums.  I would usually chew two of these immediately prior to going on a 3-5 mile run.  They worked to keep my esophageal burning to a minimum while running.  However, since getting on the Nexium, then Zegerid regimen, I no longer have to use chew-able acid reducers.   I also tried Prilosec OTC but the Zegerid OTC seemed to work better.  My doctor had previously prescribed a 40mg version of Zegerid which I had used successfully.  Zegerid contains a dose of sodium bicarbonate which is an old treatment for indigestion.  I now go to Costco and purchase a 3-pack of Zegerid for an approximate one month supply, since my doctor approved 40mg per day.  The OTC Zegerid pill contains 20mg.  I take one in the morning and one at bedtime.

About 7 years ago this same doctor performed a regular colonoscopy.  He also took advantage of the opportunity to do an esophageal endoscope, which did not reveal any major esophageal issues associated with my GERD.  When he does my next colonoscopy in several years, I plan to ask that he also do the esophageal endoscope at the same time.