[plague diaries] today I learned!

[kaberett]

I have been intermittently mentioning Issues With Reflux. When last heard from, in early September, I was... working my way up to doing something about it? Working my way up to Doing Something about it.

At the end of September, I got officially bumped up from 20mg omeprazole to 40 mg omeprazole, having merrily done this unsupervised for the week I was at Admin: the LRP, and established that I miraculously did not have symptoms. At that point the conclusion was, okay, bump me up to 40 mg, with the intention of dropping me back down to 20 mg somewhere in the vicinity of four weeks after surgery, with onward referral for endoscopy if that didn't... work.

Then, obviously, surgery was... postponed.

And then! On Monday afternoon I hit the point of "no, this is bad enough I need to go back to the sodding GP", and yesterday morning I filled out an eConsult, and yesterday afternoon I was informed I had been booked a phone appointment for... today. Which, er, is much sooner than I was expecting.

... and it was amazing. I had an absolutely classic Let The Doctors Do Their Damn Job moment: GP expressed Some Concerned Frustration that it was Bizarre that the increased dose had initially worked and then stopped, and hit the point of going "When exactly did you start noticing symptoms again?"

So I told him that it was a few days ago![1] Four or five? And I couldn't think of anything I'd changed -- I was still cutting way back on chilli, still not consuming alcohol, etc etc etc -- the only thing I could even vaguely think of on that timescale, I said, offhandedly, was that I was recovering from my first confirmed case of COVID but couldn't imagine that was relevant --

....... I think I remember reading something about that, says the GP. Let me just go check with Doctor Google...

(Yes. Verbatim. I was DELIGHTED.)

And: BINGO. Apparently there's a study that found increased acidity (lower pH) in the stomach post-COVID infection, getting back to normal for about 98% of people it shows up in around 6-8 weeks post-infection. Higher acidity is, shockingly, associated with more by way of pain and discomfort and General Symptoms.[2]

In the context of I Contain Multitudes, and all the ways our immune systems interact with our biota, and the fact that "hypochlorhydria" ("low stomach acid") lets SARS-CoV-2 pass through the stomach Still Intact, I am now vaguely wondering about the extent to which this constitutes An Immune Response, but I should really attempt to not fall down that particular rabbit hole, at least not tonight...

(Next steps: bump the omeprazole dose up again for a week to try to get things under control; referral for endoscopy being made; please go get these bloods done ASAP because they'll want to see the results. No idea on wait times. And all of this after I'd said "oh! okay then, I'm totally happy to leave it for now and come back in the new year if it's still a problem!" so, like, I'd like to keep this one, thanks, I like this GP.)

[1] In fact I double-checked my notebook after the appointment and discovered that I first noted An Unpleasant And Unwelcome Resurgence Of Reflux on.... 07/10/2024.

[2] So far I've failed to track down the paper -- I think the journal was "BMU" and it was published probably around 2021? But I was absolutely getting Stats, Clearly From An Abstract quoted at me...

Comments

[shanaqui]

Speaking of microbiota, there's some stuff out there about how eating a lot of fermented food can reduce the symptoms of acid reflux (I don't think anything I read suggests it affects the causes, but it can be protective re: Barrett's oesophagus and such, IIRC), and anecdotally, it feels like this is true for me. I'm on 40mg/day of esomeprazole right now (omeprazole does diddly-squat for me, lansoprazole likewise, and yet esomeprazole is great, goodness knows why) but normally I can be on 20mg/day and even think about dropping it, after about 10 months of paying great attention to at very least consuming a live yoghurt once per day.

I have been much more fascinated about this than anyone around me, ahaha. I really need to poke Lisa to get our ginger bug started, for fermenting our own ginger beer.

[kaberett]

Most of the bread we eat is sourdough and I do indeed also eat lots of live yoghurt! But hey I have an onward referral and hopefully it will settle...

[shanaqui]

Mmm, sourdough is a good idea too... 🤔

[ursamajor]

... as this has just become highly relevant for me, bloody pandemic, thank you for the note to keep an eye out for such over the next few weeks! I hope your tummy troubles stop bugging you soon.

[kaberett]

Ooft, good luck <3

[cesy]

Hooray for a helpful GP!

[vass]

Oh, well done that GP!

And what can't COVID fuck up?

[lunabee34]

Oh wow. That's. Wow.

[prettyarbitrary]

Oh, you are spot on about immune response, I can save you the research. Things that trigger inflammation can trigger acid reflux flares--probably for precisely the reason you note here. My acid reflux gets set off along with inflammation I experience from getting sick (not only from COVID), my allergies and other causes. If you are someone who has periods, then sometimes the back half of the cycle will also do it, or at least make flare-ups more likely. This is all documented in research, but it doesn't always make it into the brain of any given doctor.

Also as a note on omeprazole, just in case you find it's less effective than you wanted/expected, or loses effectiveness: I found out the hard way that omeprazole sometimes loses effectiveness or you can even develop an active intolerance for it, which often manifestes in the form of--oh the irony--triggering acid reflux. Apparently this is also a known thing. If this does happen, it's fine, there are SO many options for drugs to manage acid reflux.

A few other tricks for taking the edge off of flare-ups, even though you probably already know these since you've clearly done your reading, but hey just in case:
Eating smaller meals, more frequently. Fiber--veggies can be particularly good at calming the beast. Rice and bread. Avocadoes are actually mildly alkaline so can help neutralize excess acid.
And it feels almost kind of dumb, but sleeping propped up into a partial sitting position with pillows or raising the head of your bed with some risers or books beneath the feet can help, at least in the short term.

[kaberett]

Hee, thank you re research!

I've previously been on omeprazole long-term (like, over five years) so I do at least have some evidence there to draw on! And I did not know that about avocados, so thank you again :-)