Suggest Remedy For Discharge Of Slimy Mucus Out Of Throat
ANITICHOLINERGICS WILL HELP.
Detailed Answer:
Hi Madam,
As per your clinical data,the symptoms in my opinion can be attributed to a condition called "Ptyalism/ SIALORRHEA",as a diagnosis of exclusion(even though all your symptoms do not totally correlate to the condition mentioned,AND as most of the investigations have turned out to be yielding no results )which is excess production of saliva.
This can be due to various causes,but past neurological condition like pituitary adenoma and its subsequent surgery in your case seems to be the only closely attributable cause.
This is not a serious condition to be worried of,but its management can be quite challenging.
Drugs like glycopyrolate,atropine,scopalamine-anticholinergics will be useful in reducing the saliva production.
Other measures like botox inj can be helpful.
In extremely resistant cases surgical measures like salivary gland removal is done to offer permanent cure.
Consult your treating doctor and discuss with these treatment options.
I hope this info is helpful to you,
Wish you a good health,
Thank you.
MULTIDISCIPLINARY APPROACH IS NEEDED.
Detailed Answer:
Hi Madam,
Thanks for writing back to me.
I understand your concern and the amount of trauma you are currently going through.
GERD surgery(partial fundoplication) will not yield any positive results in your case as your barium swallow,pH and manometry testing are normal ,ruling out the cause being GERD.So just forget it.
This challenging condition is better managed with multidisciplinary team approach,which includes primary care physician,orthodontist,dentist,speech therapist,otolaryngologist and neurologist.
The goal of treatment is a reduction in excess salivary flow(which can be assessed by salivary gland scintigraphy and salivary duct cannulation),while maintaining a moist and a healthy oral cavity avoiding dry mouth.
Treatment plan includes:
1.ensure adequate hydration-2l/day.
2.avoid mucous thickening agents like dairy products.
3.avoid caffeine and alcohol.
4.suck sweets to stimulate saliva production and swallowing.
5.steam inhalation and humidification.
6.papase enzyme tabs
7.pine apple juice.
8.suck on crushed ice.
9.postural changes,support collars,manually assisted cough technique.
10.dark grape juice and tea.
Drug therapy includes:
amitriptilline,atropine,hyocine,benztropine,glycopyrrolate and benzhexol.
REFRACTORY CASES RESPOND TO:
suction
radiation
surgery
botox toxin inj.
key messages:
1.early involvement of multidiciplinary team.
2.combined approach.
3.always start with non invasive,reversible and least destructive approach.
4.surgery should be the last resort.
I hope this info is helpful to you.
thank you,
take care
X-RAY FLOUROSCOPY ESPHAGRAM PHARNX/LARYNX
1. ABNORMAL ESOPHAGEAL MOTILITY WITH INTERMITTENT ESOPHAGEAL SPASM.
2. SMALL HIATAL HERNIA - 4 CM IN WIDTH. THIS EXTENDS ABOVE THE DIAPHRAGM APPROXIMATELY 5 CM.
WHAT DOES THIS TEST INDICATE? IS GERD OUT OF THE PICTURE? SO JUST FORGET IT?
i APPRECIATE YOUR FEEDBACK ON THIS. YOU HAVE DONE YOURSELF JUSTICE BY TELLING ME HOW TO PROCEED WITH THIS BATTLE i AM FACING. NOW YOU CAN UNDERSTAND MY DILEMMA. i AM SICK. REAL SICK. I AM READY FOR A DIAGNOSIS AND A CURE RIGHT NOW AS WE SPEAK.
THANK YOU SO MUCH FOR YOUR VALUABLE KNOWLEDGE AND EXPERIENCE TO GET ME THROUGH THIS DIFFICULT TIME I AM GOING THROUGH RIGHT NOW.
I LOOK FORWARD TO HEARING FROM YOU WITH MY QUESTION I JUST ASKED YOU ABOUT GERD. YOUR A WONDERFUL AND CARING DOCTOR. I WISH ALL THE DOCTORS DOWN HERE WHERE I AM AT WERE MORE LIKE YOURSELF AND ACTUALLY TAKE THE TIME TO REALLY LISTEN TO WHAT THE PATIENTS HAVE TO SAY. THAT IS A VERY IMPORTANT TO HAVE AND TO SHARE.
Controlling esophageal dysmotility can be helpful.
Detailed Answer:
Hi Madam,
Thanks for your appreciation and writing back to me.
I have carefully gone through your flouroscopy reports.
Esophageal dysmotility disorders with associated spasms have excellent treatment options.
This disorder can largely contribute to your symptoms.
Controlling this disease can help to largely reduce your drooling saliva along with improvement in your overall health.
This disorder can be treated with drugs like nifedipine,nitrates and botox injectons.
Surgery namely "THORACOSCOPIC MYOTOMY on esophagus produces very good outcomes inpatients who do not respond to medical management.
Hiatal hernia of size 4 cms is of very insignificant size to produce symptoms of GERD (acid reflux)
But nonetheless i strongly recommend you to follow up its size by periodic upper gut endoscopy.
NOTE: Only sliding variety of hiatal hernia is associated with symptoms of GERD and NOT others like 'rolling type'.
So kindly confirm the type of hernia you have by once again going through your reports.
I hope this info is helpful to you,
In case of further queries ,post them to http://bit.ly/drsureshheijebu
Thank you,
Wish you a good health
Take care
my best wishes to you ahead.
Detailed Answer:
Hi Mam,
Thank you so very much for your compliments.i would try by all means to live up to the expectations.
I really appreciate your determination towards your health.
Will be really pleased to receive your upcoming health updates.
God bless you.
please go ahead.
thank you.
take care
I just got back from my Dr.s appointment with my Gastroenterologist. I gave him all my updated symptom list and he did a routine exam on me. He has come to the conclusion that it is not GERD. He told me to talk to my Neurologist at MD XXXXXXX Cancer Center. I am going to get in touch with my doctor there and tell him what the doctor said today and get his opinion on the condition problems I have been facing. He also said that it was more than likely not to be related to a CSF Leak. He said if that were the case that I would be in more agonizing pain than I am. He said he didn't know what else to do and try because I gave him a list of every thing we have tried so far and nothing has worked yet. He threw his hands up in the air and said he doesn't know what is going on. He ordered a CBC Blood Test and a BMP test. The results should be in by the end of the week. I have to call the Blood Lab tomorrow and ask them to send me a copy of the results as well. I want to know what exactly what the reading said.
I've got another question for you my dear...Do you know if Cushing's Syndrome can come back if you had both your Adrenal Glands removed? Why is that? Because I am having some of the same exact symptoms I had before when I was diagnosed with Cushing's Disease. The very same symptoms. I am very worried about this. I need some help right away. I don't know what is going on. GERD and CSF Leak has been ruled out now. I am confused as can be. Please reply to me with your answer about this Cushings Disease. I look forward to hearing from you. Take Care and have a Great Day. Bye. Bye.
Steroid dose reduction is enough.
Detailed Answer:
HI,
Welcome back !
Very happy to hear that your doctor has ruled out GERD.So our evaluation headed in the right direction.
Madam i tell you ,you can still have Cushing's syndrome,even though you had Bilateral Adrenelectomy.
This in your case is possible as you are taking 3 different steroids namely fluticasone,hydrocortisone,and fludracort.
This long term exogenous steroid administration can produce such similar symptoms of what is called "IATROGENIC OR PHYSICIAN INDUCED CUSHING'S SYNDROME.
This is relatively easier to deal with;mere reduction of the dose of these steroids can help to ameliorate your symptoms.
So there is nothing much to worry about it.
If possible kindly let me know what your neurologist has said and also the test results of CBC and BMP.
Looking forward to hear from you again,
my best wishes to you again,
wish you a good health ahead.
Thank you,
Take care
You are an amazing man and doctor to say the least. You are very important to me. You have shared considerable knowledge and valuable information with me that I need to know. If it had not been for you answering my questions especially about Cushing's Disease I would still be in the dark regarding this condition. You don't know how much I value your knowledge, skills, education and expertise. You have got a lot going for you. Keep up the good work. It shows.
I will definitely let you know the results of my CBC and BMP Blood Tests. As a matter of fact my Dr.s office called me earlier this morning and told me that she had gotten some of the CBC blood work back from the lab already. She told me that all my blood tests came back good and I was within normal range. None of my tests were out of range. She said my Kidneys showed good and now all she is waiting on is my BMP results. She said that she is waiting for my Liver reading to come in. She said she had to contact the lab this morning because they had only tested 1 part of the BMP and that they needed to complete the and finish the test. As soon as I get a copy of the actual blood work in the mail I will be more than happy to give you the results in more detail if you want. Tomorrow I have to go have blood drawn for my Endocrinologist. He ordered: ACTH, Comprehensive Metabolic Panel, Free Thyroxine, Hemoglobin A1C, and a Lipid Panel to check Choleserol, HDL, LDL, NON-LDL and Triglycerides. I always have to have my bloodwork done and up to date prior to my appointment with him. He likes to have the results back from the lab when I come in to see him. That is just fine with me. As soon as i get those labs in I will fill you in on the results of those tests as well. I have decided that I am going to wait until my ACTH results come in before talking to my Dr.s at MD XXXXXXX about my symptoms being related to Cushing's Disease. I want to know the results of that test prior to me calling them. I want to know that I have all the stuff I need prepared for our talk.
Thank you so very much. You have a nice day and take care of yourself. Talk to you soon.
your appreciation received
Detailed Answer:
Hi Madam,
you are going through an extraordinary and comprehensive test panel.
my best wishes to you.
you are just amazing with your health checks.
awaiting the test reports and your doctors opinion.
god bless you,
take care,
thank you
Yes, I am patiently waiting on the results to come in and then I will talk to my Dr.s I just got back from doing my other lab work that told you about up bove. ACTH, etc. Right now I am in the process of looking up and researching Esophageal dysmotility and it's symptoms, etc. What type of specialist should I see for this? I've already seen 2 ENT's. Why couldn't they figure this out like have done?
Thank you for your compliments. I am in deed a type of person who keeps up with her health. Yes sir.
Take care,
Thank you.
Consult Interventional Gsatroenterologist
Detailed Answer:
Hi Madam,
Good to have you back,
I suggest you the following investigations for excellent evaluation of esophageal dysmotility disordeers.they include
1.Digital chest x ray
2.Esophagogram.
3.MOST IMP:High resolution(36 channel catheter with 1cms sensor) esophageal manometry with XXXXXXX pressure monitoring.
4.Endoscopic Ultrasonography.
The last two are recently developed .
i suggest you have them without fail.
Consult an expert interventional Gastroenterologist.
A high index of suspicion is needed to figure this out.
Awaiting your health reports.
My best wishes to you,
Take care
Bye
I just now got a phone cll my Gastroenterologist Nurse and she told me that she got the Liver results in just this morning ad everything came back normal. So now I am really at a loss. I don't konw what is going on now. I had blood tests ran yesterday too for my upcoming appointment with my Endocrinologist. I hope he can help me shed some light on this matter. I will let you know th results of that particular test when I get it back. Talk to yo soon my dear. I will keep your above information on what to do close at hand. Thank you very much. I appreciate you and all you have to share with me. Your the best. Talk to you soon.
Awaiting your test results
Detailed Answer:
Hi madam,
Very nice to have you back,
And extremely more nice that your Liver functions came out normal,
eagerly awaiting your remaining test results and the valuable opinion of both your Gastroenterologist and Endocriinologist.
Please keep the info updated to decide the next line of action in context to your esophageal dysmotility.
Very happy yet again to receive your appreciation.
God bless you,
Take care