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Acid Reflux

Acid reflux or GERD occurs when gas, liquid or food particles in the stomach return back up the esophagus (food tube) into the back of the throat (pharynx), mouth, nose, sinuses, middle ear tube (Eustachian tube), or middle ear. This results in irritation (inflammation) and discomfort of these areas. It is important to note that patients don’t always feel the irritation and the symptoms can be ‘silent’. When this occurs, your doctor might see evidence on your physical exam or note other symptoms that are concerning for reflux.

When the reflux enters the upper airway, it is called laryngeal pharyngeal reflux or LPR. When this occurs, it is called GERD/LPR. Unfortunately, up to 60% of the population will have reflux one or more times per week.

As many as 75% of individuals with asthma are at a higher risk of experiencing acid reflux symptoms. In fact, asthmatics are twice as likely to have GERD. Many severe asthmatics have GERD that makes their asthma more challenging to treat. The stomach contents may trigger nerves associated with asthma (particularly cough) or can actually enter the airways (aspiration) resulting in spasm, irritation and asthma symptoms. For these reasons, reflux needs to be considered in individuals with asthma.

Signs and Symptoms of GERD/LPR

  • Nasal congestion and sometimes runny nose
  • Postnasal drainage
  • Cough
  • Hoarseness (particularly in the morning), throat irritation/burning
  • Unusual or bitter taste in the mouth or the back of the throat (brackish water)
  • Difficulty swallowing or choking (particularly at night)  Recurrent sore throat, pneumonia, bronchitis, sinusitis, or ear infections
  • Constant throat clearing
  • Bad breath (halitosis)
  • Burning chest pain (can mimic heart attacks)
  • Abdominal fullness, gas, or belching after meals
  • Chest pain, burning or tightness in the chest after lying down or bending over

If GERD/LPR is diagnosed, your physician may recommend using medications to help block the effects of acid secretion. Anti-acids (like Rolaids or Tums) weaken and neutralize the acid in your stomach, but don’t affect the production of acid and don’t work to prevent symptoms. H2 blockers (like Zantac or Pepcid) lessen the production of acid in your stomach and help prevent symptoms. They tend to work longer but are not quick to act so they don’t alleviate symptoms quickly. Proton Pump Inhibitors or PPIs (like Prilosec, omeprazole or Nexium) are longer acting and make acid less prevalent in the gut. They work by preventing symptoms and must be taken on an empty stomach 30 minutes prior to eating.

All medications including those for acid reflux have potential side effects and these can be discussed with your provider.

Measures That May Help Alleviate Symptoms of GERD/LPR:

  • Elevate the head of your bed 6-8 inches (This can be done by placing the top bedposts on cinder blocks or using a wedge under the top of the mattress. Elevating your head on pillows is not as effective.)  Eat smaller, more frequent meals rather than large ones.
  • No eating or drinking at least 3-4 hours before bedtime.
  • Drinking fluids of any type before bedtime can result in stretching the stomach opening resulting in reflux.
  • Do not skip meals. This can actually result in a 15% increase in daily caloric intake. Skipping meals usually result in overeating of the remaining meals, which can overfill your stomach and increase acid reflux.
  • Lose weight, if needed. We know that those who are overweight do not respond as well to GERD meds as those who are of healthy weight.
  • Avoid bending over, straining, constipation or wearing tight clothes around the abdomen.

Eliminate the following foods and beverages (totally, if all possible)

  • Caffeinated and/or decaffeinated products
  • Alcohol
  • Carbonated beverages of any type
  • Chocolate
  • Mint (includes gums and toothpaste)
  • All types of citrus
  • Fried foods (includes many spicy or fatty foods)
  • Nicotine of any type
  • Dairy

Recent News

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Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew?

Runny nose, coughing, watery eyes – These are the symptoms Tess (not her real name) just couldn’t seem to shake.

The congestion set in after raking leaves.  Her first thought was, “Wow, I have caught a cold.”

But those pesky cold symptoms lingered.  She worried that perhaps she had contracted Covid, as some friends had tested positive for it recently. She felt fine but tested anyhow. Five negative Covid tests later, she was finally convinced it was not Covid.

So, it was not Covid. It was not a cold, and it was not influenza either. What was it?

It turns out the culprit was not a virus at all.  Tess was suffering from something called Cedar Fever.

“Cedar Fever is not really a fever and it is not a virus,” said Maya Gharfeh, MD, FACAAI, FAAAAI. “It is an allergic reaction to pollen from cedar trees, which do grow in abundance in this state and region. For some, the pollen triggers an allergic reaction.”

Most people worry about allergies in the spring and summer, but for some people, like me, allergies can also occur and sometimes be severe in the winter months too.

Cedar Fever

If you live in Oklahoma, Texas, Arkansas or Missouri or somewhere where these trees are common and have a sensitivity to the pollen, you may notice seasonal allergy symptoms from these trees in the winter months.

Millions of cedar trees release large amounts of pollen each year, with pollen production typically reaching a peak in mid-January.  Tree experts know that when it is dry and windy, pollen cones open and release pollen grains. Some people have even captured video and pictures of the pollen clouds blowing off trees. 

What Are the Symptoms of Cedar Fever?

Dr. Gharfeh explained cedar fever is often confused with a cold or flu because of the time of year when it is most prevalent.

Cedar Fever symptoms are like many common allergy symptoms, and may include a runny nose or nasal congestion, itchiness, and sneezing. As the name suggests, some people may notice a warmer body temperature as part of their symptoms.

“We are talking about a mildly elevated body temperature or feeling slightly warm,” Gharfeh stressed. “If you are experiencing a high fever, it is likely that it is something more than allergies and you should see a primary care provider if those symptoms don’t fade.”

Here are a few other symptoms that sometimes occur with Cedar Fever:

  • Sore throat
  • Coughing
  • Difficulty smelling
  • Plugged ears
How Do You Treat Cedar Fever?

Cedar fever should not put you at risk for any health complications, but the symptoms can be uncomfortable.

“As with so many allergies, the appropriate treatment depends upon the patient and the severity of his or her symptoms,” Gharfeh explained.

Common treatments at home may include:

  • Prescription medications
  • Over-the-counter antihistamines
  • Over-the-counter medications

“For some simple over-the-counter medications are sufficient, but if you find that those medications are not enough, it might be time to talk with your doctor or an allergy specialist,” Gharfeh said. “At the Oklahoma Allergy and Asthma Clinic, we have 100 years of experience helping people navigate life with allergies. We are able to help determine the best treatment for your allergies, which may include stronger prescription medications.”

Prevention of Cedar Fever

Gharfeh explained that for those most susceptible to Cedar Fever, avoiding pollen as much as possible can help.  Here are a few strategies that may help:

  • Avoid outdoor activities when tree pollen counts are high
  • Close windows and change air filters often to reduce pollen levels in your home
  • If you need to do yard work, wear a mask to reduce exposure to cedar pollen
  • Vacuum and clean your home regularly to reduce indoor allergens

Tess has learned to watch the pollen counts displayed daily by the official Oklahoma Allergy and Asthma Clinic website, taking precautions when the tree pollen counts elevate, especially to medium (yellow on the graph) or higher.  The clinic’s pollen count is posted daily Monday through Friday and can be found here: https://oklahomaallergy.com/allergy-report/

With a simple pollen count check daily and some allergy medications, Tess finds she is better able to maneuver Cedar Fever season.

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Oklahoma Allergy and Asthma Clinic celebrates its 100th Anniversary this year. Founded in 1925, the clinic has a century of patient-focused, state-of-the-art allergy and asthma care. Today, the clinic is home to 13 allergy and asthma specialists, caring for tens of thousands of patients a year from across Oklahoma, the region and nation.  OAAC also has earned the Better Business Bureau’s Torch Award for Business Ethics, the Oklahoman’s Community’s Choice Award for Top Allergy Clinic, 405 Magazine’s Best OKC Allergy Clinic and the Journal Record’s Reader’s Rankings Award, among others. In addition, the clinic remains a staunch supporter of the community through organizations such as Allied Arts, United Way, the Oklahoma City Philharmonic and Museum of Art, Ronald McDonald House Charities of OKC, Toby Keith Foundation, Positive Tomorrows and more.

The post Not a Cold. Not the Flu. It’s Cedar Fever! Who Knew? appeared first on Oklahoma Allergy and Asthma Clinic.

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