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I am just starting to recover from a 2 week bout of [I]something[/I] and what you describe happens to me too. The congestion is not deep in my lungs but higher in the respitory track - in the esophogus area. When i start coughing up the mucus, it gets caught up in my gag reflex and I start dry-heaving... violently. It is extremely painful. Here is what I do when this happens...

First of all - stand up immediately. I have found that standing helps your body expectorate the mucus. Go to your bathroom sink and turn the hot water on full blast. Lean over the sink and throw a towel over your head. The steam you inhale will quickly dislodge the "glue" that is making you gag. And because you are over the sink you can spit in out. It doesn't hurt to look at the mucus you cough up to see what color it is. This can help your doctor know if you are infected. And if there is any blood in the mucus you should contact your doctor right away.

I will tell you that this past week I have been unable to lay down to sleep. As soon as I lay down, the mucus gets built up in my throat and chest and I start choking. If you can, find a comfy chair where you can sleep sitting up. If you don't have one, prop up a stack of 4-5 pillows so you can sit up in bed and sleep that way. And if that doesn't work, sleep on your stomach instead of your back. Sometimes I find relief by sleeping on my stomach, but instead of putting my pillow under my head (which would elevate it), I put 2 pillows under my chest - letting my head hand down over the front edge of pillows. This helps to prevent the mucus from moving from your sinus into your chest and you can blow it out your nose instead.

Just some ideas...
I'm confused. In your earlier posts you said that the choking was from post nasal drip or mucus. Now you are saying that is from acid and burping. There is a HUGE difference here.

I have to tell you that based on your earlier posts it does NOT sound like you have reflux. Acid reflux is when your stomach acids leak through the diaphram up into the respitory track. This can be caused by a variety of things - hiatal hernia, ulcers, allergies, etc. The result is usually EXTREME burning and discomfort which results in coughing and choking. But there is something specific that you are choking on and it is usually obvious that it is gastro-intestinal in nature.

The fact that you cannot identify what is causing your choking and that you NEVER once mentioned burning or acidity makes me wonder if you have not described your symptoms clearly to your doctor. You need to clarify if your symptoms seem to be related to a cold or respitory infection - this would normally be accompanied by the general feeling of having cold/flu, feeling "sick," feeling burning in your sinuses or congestion in your nose, ears, throat or chest. On the other hand, if you do not feel sick, do not have excessive congestion, do not have a stuffy nose, but you do have burning in your chest after eating or laying down, then it could be reflux.

Its also not uncommon to suffer from side effects or allergic reactions to either your own cold (excessive mucus) or to the medications you have been taking. I hate to see you go on reflux meds when in fact you are suffering from a cold , virus, or allergies.

I recommend that you start keeping track of EVERYTHING that you consume (in a little notebook) - not just food, but drinks, meds, anything - even brushing your teeth. Then also enter when you have symptoms - the time and day. After about a week you may see a pattern. Symptoms are not always immediate with allergies - sometimes it can take 2-6 hours to have a reaction to something.

I have just recovered fully from my illness - after 3 doctor visits and 3 different antibiotics I was officially diagnosed with pneumonia. It took a total of 4 weeks to fully recover and I am still quite exhausted. I did get some heartburn from the antibiotics I was on, but for the most part, my choking was directly related to my lung infection.
i think there's some simple things you can do to alleviate your symptoms. the first is to not have any dairy, or foods with dairy content as they create excess mucous in your system. the second step is to keep a plastic bag next to you at all times, and spit any and all mucous out of your system, as mucous is inflammatory to your throat and lungs, and can even cary or worsen your infection in those areas. i don't recommend cough drops as they are extremely high in sugar: excess of sugar can affect your mood, make you feel tired etc. if your throat really hurts you can garlge with epsom salts and do what the previous post said: breathe steam.

if you have post nasal drip you should do everything to avoid sleeping on your back. i also like to keep a small bowl on my bed that i can spit into during the night...that way i can breathe easier and reduce my chance of spreading the infection.
You guys can add me to your list as well. I caught an awful virus that was floating around, one which attacked the sinuses. Those of us who were unlucky enough to catch it had chronic watering eyes (and itchy as heck), itchy nose, constant sneezing, post nasal drip and a cough that occurred almost never in the day time but was AWFUL at night. There was nothing that could be taken for this as it was a virus, but I will admit that those Cold FX pills worked wonders. All symptoms went away but I still have post nasal drip and an occasional cough, but I am in week 8 already. My doctor told me that this one will take several weeks to go away completely, and there's nothing he can give me to help.

Scooter: Burping is a symptom of only a very few things (ulcer, hernia, reflux, or anxiety) so that could be why you got the diagnosis you did. Post nasal drip does burn and often will cause a sore throat because of it. When it is thick it will sit at the back of your throat and you will definately feel it, like a big goober. Trying to cough it up will remove some of the mucous but the lump feeling will remain -- the key is to thin it out. If you actually feel a lump there is a condition called "Globus Hystericus" which causes this, and I do believe it is caused from anxiety. I doubt highly that the Prevacid has helped with anything, but moreso it's that time has passed and your body is healing. Post nasal drip is a bugger to get rid of as it can linger for MONTHS. Years ago I once had it for YEARS. I had to be careful to never cry because if I did, it felt like I was choking to death and if I didn't vomit on my own I'd have to make myself barf in order to breathe.

George: You should try going to a doctor that will look in your nose, and not your throat. Post nasal drip is caused by an inflammation or infection of the nasal membranes.

Roguescot: It is not abnormal to vomit only mucous even after eating if you have post nasal drip, [U]especially if you are making yourself vomit[/U]. There is just an abundance of mucous present and your body will only heave out what's on top. If you continued trying to make yourself vomit after the mucous is done exiting, the rest will follow.

Everyone: There is only one thing that will help with post nasal drip but nobody likes doing it, including myself. You have to put some salt water in the palm of your hand, inhale it into one nostril, and spit it out. Then you have to do it again with the other nostril.

Also, the best thing for the coughing is a cough [U]syrup[/U] with codiene.

Hope this helps. :)
I've read all your posts on this subject and found I have combinations of many of your symptoms. there seems to be a lot of confusion on the subject and so many treatments that could lead to a lifetime of wild goose chases.

I've had post nasal drip (or so I call it) for the past 20 years. I have been prescribed every type of inhaler imaginable and they have been of no help. I just gave up trying.

I am the owner of a Moluccan cockatoo and thought I might be alergic to her, as the "drip" seem to start from the time I acquired her (20 years). I went to an allergist who detected no allergies, but gave a few inhalers to try, none worked.

Then it was suggested by my doctor to see an ENT specialist to find a cause of the post nasal drip. I had scans of my sinuses, but the doctor could find nothing wrong there. And suggested I see an allergist. Even though I had already tried one, I made an appointment with another who detected a
"feather allergy." Ah ha! My bird was the culprit! However, after having her as a pet for 20 years, I can't get rid of her. This doctor also prescribed an inhaler, which not to my surprise, didn't work. My internist suggest I go back to this allergist and see if i can get a "sensitivity shot" for the allergy. I haven't done that yet.

Fast forward to now, when I started having heartburn rather frequently compared to the past. Accompanying the on and off bouts of heartburn, coming after eating or bending over after eating, was a dull pain in my stomach just above the navel. Adding to those two symptoms, was something new. Gagging and choking at night - four five times over the past two months. it would always be the same. I would be dreaming that I was choking, it would become unbearable and would seem like I couldn't breathe and would choke to death. I would struggle to wake up, finally doing so, choking and gagging and having to clear the mucous from my throat. I thought this was buildup from my chronic post nasal drip. Friends suggested sleep apnea, which it sounded a lot like, only not exactly. Too many sleep apnea symptoms not in evidence.

i went to my doctor who thought I might have gallstones. (I only went for the stomach ache and not the gagging--I didn't connect the dots at the time). I also told her about the heartburn. I had a gallbladder doppler imaging which revealed two large gallstones, which were calcified indicating they had been there a while and probably not the cause of my discomfort--so the gallbladder gets to stay, at least for now. However, my upper GI and barium swallow indicated I had a small hiatal hernia, which caused GERD. i also found that with GERD you don't always get heartburn, or acid regurgitation into the throat, like I always thought. My doctor said that my hernia/GERD could also be causing the gagging at night, since the amount of reflux was "significant", going all the way up my esophagus. And this could be worse at night when lying prone.

Now I've started taking prilosec once a day and reglan one hour before going to bed. Small meals more often as opposed to three larger ones per day. Nothing to eat two hours prior to bedtime. And elevating the head of my bed on 6 inch blocks.

Is it the bird? Is it the GERD? Is it the hernia? Is it the drip? is it adult asthma? When you have something wrong with you, sometimes I think a doctor has to also be Sherlock Holmes to find the cause. And doctors these days don't always have the time to do detective work for a condition that patients can "probably" live with.

I've just begun treatment this week, so we'll see what happens to my symptoms. Hope some of this is helpful to sufferers of similar symptoms. :)
Andrew,

You have the CLASSIC symptoms of laryngopharyngeal reflux (LPR), which is a form of GERD (gastro-esophogeal reflux). Basically, the acid in your stomach is refluxing all the way into your throat. I have NO DOUBT based on your description that you have LPR.

I know this is what you have because sensation of "lump in the throat" plus "chronic cough" are 2 classic symptoms of LPR.

So you need to go and visit the Acid Reflux message board. Then you need to get to an ENT and Gastroenterologist in your closest metropolitan city. Small-town docs and suburban docs don't see enough LPR to make heads or tails of it. Pick a teaching hospital in an urban area.

If you are in Maryland, Delaware, NJ, NY, or CT, please see the sticky on the top of the Acid Reflux board for some doctor names. Otherwise, purchase a Castle Connely list of best doctors for your area.

You need to see an ENT to "get scoped", and you need a gastro to do an endoscopy.

You also can hopefully relieve your symptoms by taking 2 doses of a max-strength proton pump inhibitor each day (PPI).

For instance, you can take Nexium, Prilosec Brand, Aciphex, or Zegerid, 2x per day.

This should help your symptoms significantly. In best case scenarios, they will completely relive the problem. Sometimes they relieve it to a degree./
Andrew,
Wow! What a reply! I guess that by now you've gone and independently researched "laryngopharyngeal reflux", if not - please do. There's loads of information on the internet about it.

Since you live in the UK, you need to be aware that the medications I listed are typically sold under different brand names than in the U.S. You might want to figure out those brand names before you go to a doctor. Since you think that LPR is a distinct possibility, I also want to recommend that you start with the PPI called Nexium (don't know the UK equivalent name, or if there is one).

Nexium, time and time again, becomes the PPI of choice for people with LPR. I don't know why exactly, it has a slight structural difference, but it should be the first (and hopefully last) PPI that you try in treating this condition. You will need to immediately begin taking 2 doses of the 40 mg Nexium every day. I highly recommend taking the 2 doses together first thing in the morning. If after 30 days no improvement, then switch to one in the morning and one in the evening. One thing you will learn is that everyone responds somewhat differently to the meds and timing of the meds, so you may need to experiment. Should meds ultimately fail or be inadequate, there are surgical options to explore. Still, the Nexium 2x per day is the best way to start. Beware - most doctors (at least in the US) have relationships with pharma sales people and these relationships affect which drugs they prescribe to their patients. You may need to be highly vocal about insisting on Nexium. Because if the Dr likes the Aciphex rep better, then he's gonna fight you on it. But hopefully you'll see a top top doctor in the UK - and here's one to go to who "gets it": My doctor is one of the leading authoritieis on LPR in the U.S. and his co-author on his latest book is from England. Perhaps you can contact him - John Rubin. I pulled the following quote from one of my old posts:

"I learned that this doctor, Robert Sataloff (the head of the practice I go to in Philadelphia) just published the latest edition titled "Diagnosis and Treatment of Voice Disorders" in May 2006 and his co-author is John Rubin, M.D., from the U.K. Sounds like he is the go-to guy in your country for this stuff, and maybe if you can't visit him, perhaps his practice can point you in the right direction locally."

John S. Rubin, M.D., is a Consultant Ear Nose and Throat Surgeon at The Royal National Throat Nose and Ear Hospital Division of The Royal Free NHS Trust, where he is the Lead Clinician of the Voice Disorders Unit as well as Clinical Director. He is also a Consultant ENT Surgeon at St. Bartholomew's Hospital, Honorary Senior Lecturer at University College London and Visiting Associate Professor at The Albert Einstein College of Medicine in New York.

I also pulled the following from another of my old posts at the acid reflux board. I believe the article I reference is available online if you search for it:

"Hi everyone, On May 16th, 2006, the publication GI Motility Online published an exhaustive article titled "Laryngeal and pharyngeal complications of gastroesophageal reflux disease", written by regory N. Postma, M.D. and Stacey L. Halum, M.D.This is the most complete and exhautive article detailing LPR I have ever read. Given it's publication date, it is also up-to-date. Read it while it's still available. I was very pleased to see how it categorized LPR into different states - minor, major, and life-threatening. The authors truly recognize the differences between GERD and LPR and go as far as to say they are related, but unique entities, and LPR can be further segmented by severity. It also discusses treatment for each level of LPR.
I think this is the article that you've been dreaming about - to give to your friends and family so they really understand what you are going through with this nasty disease."


Andrew - you are so young to be going through this, I really do feel for you. I was 28 when I was diagnosed 4 years ago, and I really thought my world was about to end. But about 85% of us with LPR get very good results with pharma/surgical management. I pray that you are one of those!

Best,
aswander
Another fantastic reply :D I really appreciate you writing all this, it's helped me massively.

Before you wrote the first reply I bought a Neti Pot thinking that my problem could be sinus related. If you don't know what a Neti Pot is, do a Google Image search and have a 10 minute laughing fit at it's weirdness. Trust me, if you never have the need to do it, don't! lol. It's very bizarre. But it does really clear your sinuses, I've done it 3 times now, once in the morning and once in the evening and when I get Nexium I'll stop doing it and see what happens, if it actually did do something.

Anyway, something very very weird happened this morning. I bought some Gaviscon (very basic take off the shelf acid tablets I'm sure you know) so I took 4 last night before going to bed. 4 is apparently the average maximum but more doesn't really do harm, and this morning I woke up... I didn't have the morning cough!!! I don't know whether this was a luck thing or a fluke but I'm going to try the same tonight and see what happens. It's the first time in more than 3 years!! My throat didn't feel mucus-y until now at 10:30pm, it's getting a bit thick-ish. I was very weirded out by it today. If it works tomorrow I'm going to do a test and walk around the supermarket and see if I can talk by the time I get to the checkout (I usually can't). It's made me believe that I definitely have LPR and my faith has been restored, it's thanks to you.

I'll write here tomorrow to say if the Gaviscon works tonight too. I'm not sure though whether to tell the doctor that the Gaviscon had this effect on me (presuming it works tonight too) because he might say, well let's go on a basic drug... and I don't want that, I want it to be powerful and get rid of it all completely. I'll be aggressive in asking for Nexium. I've been reading that Prevacid has some horrible side effects so I'll make sure I get Nexium.

I can't believe that the answer could be this simple. How could I let this go on for 3 years and lead me into depression and away from social life? It all seems so easy... I'm annoyed yet very very very happy. OMG the prospect of a life?!?!?!?!? Argh!!! I've turned down moving in with someone because of this and I said I wanted to get it sorted first so this could truly be a new beginning. Rest assured aswander, that you have changed my life and although we're only connected on this forum, you'll always be in my heart as the one that brought life back to me. I feel a ballad coming on... hehe Oooh I know, whenever I hear Evanescence and Bring Me to Life from now on, you will be in my thoughts. I know it's weird talking like this to you over the Internet but seriously you have shown me where life lies... in Nexium!!! All hail Nexium!!!

I'll stop lol

Andrew





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