Seeking Guidance on Managing Grade 3 Esophagitis
Hello everyone! I'm not looking for direct medical advice, but I would appreciate some direction on what steps to take next. I'm a 42-year-old woman, standing at 5'5" and weighing 160 lbs, residing in Texas. I have a history of managing type 2 diabetes (currently with an A1C level of 5.1) as well as depression and anxiety. My current medications include a weekly dose of 2.5mg Mounjaro (which is gradually being reduced to every 10 days), 20mg of Vybriid daily for depression, 10mg of Dayvigo for sleep, and 40mg of pantoprazole paired with 4mg of cyproheptadine daily for reflux issues. I also use 8mg of Zofran as needed for nausea and .5mg of Xanax for anxiety. Additionally, I’m mindful of my diet, steering clear of foods known to exacerbate my reflux. I've dealt with a sensitive stomach my entire life, often experiencing nausea under stressful circumstances. For instance, during high school, I would vomit whenever I was away from home or encountered any anxiety-provoking situation. It was a struggle that I became accustomed to over the years. About four years ago, while exploring the option of weight loss surgery, tests revealed that I have a hiatal hernia and grade 3 esophagitis. Ultimately, I chose not to undergo the surgery and continued to navigate my life as a person prone to vomiting in response to stress. During sessions with my psychiatrist, I've mentioned how anxiety appears to be my main trigger for these issues. However, she wanted to rule out any physiological factors before proceeding further. I had my first gastroenterology appointment in January; however, I didn't find the doctor particularly engaging or thorough. She simply glanced at the EGD results I'd provided, prescribed pantoprazole and cyproheptadine, and told me to reach out for refills when needed. While I understand that reflux is a concern, I had previously tried different medications like omeprazole and Prevacid without finding relief. The gastroenterologist suggested a gastric emptying test, but I feel it's not necessary right now given my current Mounjaro treatment. I am contemplating seeking a second opinion from another GI specialist, as I believe an adjustment in my medication regimen might be all that’s needed. I was troubled by her lack of communication about alternative factors, such as the potential impact of my hernia. She assessed the hernia as small, stating that it could have been addressed if I had opted for weight loss surgery. As for my symptoms, I still vomit at least once a week, which leads me to consider if an updated EGD would provide clarity, especially since it’s been four years since my last one. My insurance has reached its deductible for the year, making this the perfect time to consider any procedures that could help ease my symptoms before the year concludes. I'm not particularly keen on surgical options, yet if hernia repair is a viable avenue, I would be willing to explore it for a chance at more normal living. However, it may just boil down to a necessary medication adjustment. My aim is to go into my next GI appointment with a clearer understanding of both simple and more aggressive treatment options. Being a nurse, although not in the GI field, I’ve researched online but haven’t found satisfactory answers, so I'm open to hearing your suggestions!
Answers (1)
3/31/2025, 12:01:03 AM
OpenHealth AI
Thank you for sharing your situation in detail. It's clear that you're navigating some complex health issues with your grade 3 esophagitis, anxiety, and related symptoms. Let’s break this down into manageable steps for you to consider as you prepare for your next gastroenterology appointment.
Key Points:
- Symptoms and Management: You are experiencing ongoing vomiting and gastrointestinal discomfort likely related to both your esophagitis and anxiety.
- Medication Adjustments: Potential adjustments in your current treatment could be beneficial.
- Second Opinion: Seeking a second opinion from a new gastroenterologist might provide you with clearer options.
Explanation:
Grade 3 esophagitis indicates significant inflammation of the esophagus, which can cause symptoms like pain, vomiting, and difficulty swallowing. Given your current regimen of medications, it seems crucial to explore if further adjustments in treatment could alleviate your symptoms. Stress and anxiety can significantly impact gastrointestinal health; hence addressing these concurrently may also help.
Actionable Steps:
- Seek a Second Opinion: Start by identifying a new gastroenterologist who has good reviews regarding patient engagement and thoroughness. It’s essential to feel comfortable with your doctor.
- Compile Your Medical History: Gather and summarize all relevant medical information, including:
- Your history with medications (like pantoprazole and others).
- Past test results, including EGD and any imaging from your hiatal hernia.
- Document your ongoing symptoms (like the frequency and triggers for vomiting).
- Prepare Questions for the Appointment: Consider asking about:
- Alternative medication options outside of pantoprazole, especially if prior medications didn’t work.
- Non-surgical interventions that could alleviate symptoms from your esophagitis or hernia.
- The necessity and timing for a gastric emptying test in the context of your current treatment.
- Explore Stress Management Techniques: Since anxiety plays a significant role in your symptoms, consider implementing practices such as mindfulness, relaxation techniques, or therapy specifically targeted at managing stress and anxiety levels to see if it impacts your gastrointestinal symptoms positively.
- Consider Lifestyle Adjustments: Continue being mindful of foods that might exacerbate your reflux, stay well-hydrated, and try to eat smaller, more frequent meals to alleviate pressure on your gastrointestinal system.
Remember, you are advocating for your health, and that is very important. Having these steps structured and ready to discuss will empower you during your next appointment. If you have any more specific concerns or questions, feel free to ask.
Related Questions
Persistent Pain in Right Shoulder and Arm After Lifting
Hello, everyone! I’m a 23-year-old male and have been engaged in weightlifting for several years now. Recently, I’ve been struggling with ongoing discomfort in my right shoulder and arm, which I haven’t been able to accurately identify. The pain manifests during particular movements, especially with lateral raises or when my arm is raised to shoulder level while rotating my wrist. Certain pressing and pulling activities can also provoke this discomfort. Rather than feeling sharp, it’s a deep, nagging sensation that sometimes seems localized in the front area of the shoulder or at the biceps tendon, and at other times it feels more like it’s situated between the shoulder and upper arm. Fortunately, there’s no numbness or tingling involved. This issue began while I was working out. I decided to take a break for around two months, but when I returned, the pain persisted. After consulting a physician, I was diagnosed with bicipital tendinitis. Since then, I’ve reduced my upper-body workouts, completely steering clear of shoulder exercises and heavy lifting, and have begun a gentle rehabilitation regimen focusing on external rotations, pendulum movements, and scapular exercises. Despite adhering to this routine for about a week, I haven’t experienced any noticeable improvement. Is it typical for this type of tendon injury to require an extended period for recovery? At what point should I consider diagnostic imaging, such as an ultrasound or MRI? Additionally, are there frequent rehabilitation errors that might impede the healing process? I appreciate your insights in advance!
Understanding EEG Results for My 22-Month-Old Son: Insights Needed
Could someone help clarify this for me? My son, who is just 22 months old, hasn’t started walking yet, becomes tired easily, and has been experiencing behavioral outbursts. He had a febrile seizure in February 2025, followed by another unexplained seizure in April 2025, which led us to consult a neurologist. Since he was 3 months old, he has been receiving therapy from a physical therapist for torticollis. At birth, he spent five days in the NICU due to issues with meconium aspiration. A recent MRI showed normal results, and he also had a follow-up EEG after one conducted in July 2025. The results from this recent EEG were abnormal for a pediatric patient in awake, drowsy, and sleeping states. Notably, there were brief episodes of left frontotemporal delta slowing, which occurred mainly when he was awake and drowsy. There were no signs of epileptiform activity detected. In contrast, the EEG performed back on July 3, 2025, was deemed normal for both awake and drowsy states, again with no evidence of epileptiform irregularities, although it did not capture any sleep data. This examination was prompted by the child's existing history of febrile seizures. Importantly, he is not currently on any anti-seizure medications. The EEG procedure used standard electrode placements per the 10-20 system, conducted a single-lead EKG, and included continuous video monitoring. During the analysis, the background activity was symmetric, indicating some anterior-posterior (AP) organization, with a dominant rhythm of 50-80 microvolts at 7 Hz. His drowsy state was marked by a reduced amount of eye blink activity, less breathing motion interference, and a generalized slowing in theta/delta frequencies. Stage II sleep exhibited spindles and vertex waves patterns. Additionally, there were intermittent bursts of 250-300 microvolts in the left frontotemporal region with semi-rhythmic activity of 2-4 Hz, mostly observed during wakefulness and drowsiness. No definitive epileptiform discharge was noted. Photic stimulation during the test did not elicit a strong response, and hyperventilation was not conducted during this session.
Understanding Atrial Fibrillation and Thyroid Issues: Variability in Cardioversion Decisions
Hello everyone, I’m reaching out for guidance regarding my mother’s current health situation, and I’d greatly appreciate any shared experiences or thoughts. **My mother's background:** - **Age**: 55 years - **Weight**: Recently dropped to 116 kg from 118 kg in just two days, likely due to diuretics. - **Health history**: Previously an underactive thyroid, undiagnosed and untreated, now presenting as overactive. - **Medications**: Currently taking thyroid medication and a beta-blocker (Rapiblock). **Current health status:** My mother has been hospitalized since Tuesday, experiencing **atrial fibrillation with heart rates exceeding 200** beats per minute due to her thyroid's hyperactivity. - The plan for cardioversion was initially settled on Tuesday. However, the following day, the medical team advised postponing it until her thyroid levels could be stabilized, believing that her heart rate would return to normal once her thyroid condition was managed. - Her **obesity** precludes her from undergoing a transthoracic echocardiogram, and due to her thyroid concerns, she cannot handle contrast dye (this has been a consistent issue for over four years). Therefore, the only feasible option was a **transesophageal echocardiogram (TEE)**, which has yet to be performed. - She has been prescribed various medications including beta-blockers and thyroid treatments in the past. - On Friday, a doctor proposed proceeding with cardioversion; however, the attending senior physician objected. - Today (Saturday), another clinician has expressed a desire to move forward with cardioversion, having initiated a new medication, as the senior physician is unavailable. - **Communication has been unclear**, as we were notified of developments by a nurse rather than the physician in charge, causing confusion and anxiety. - Currently, only a **chest X-ray** is scheduled, and the TEE remains unaddressed. **My inquiries are as follows:** 1. Is it common for medical professionals to have varying opinions and frequently revise medication or treatment plans like cardioversion? 2. Is it safe to conduct cardioversion in the absence of a TEE? I presumed that this was a standard procedure to exclude the presence of blood clots. 3. Is it usual practice to have only a chest X-ray prior to moving ahead with cardioversion? 4. How typical is it for patients or their families to not be directly informed about treatment changes and learn about them through nursing staff instead? I recognize that this cannot substitute for professional medical advice. I’m simply trying to discern whether these circumstances are typical or if we should express our concerns more assertively with the healthcare facility. Thank you for your insights!
28-Year-Old Male Experiencing Scalp Sensations Post-Amitriptyline Treatment
I am a 28-year-old man in generally good health, without any cardiac concerns. Approximately a month ago, I encountered intense pain localized to one side of my head, which was unresponsive to paracetamol. However, a single dose of a migraine treatment provided substantial relief. Following that, I began a regimen of amitriptyline, starting at a nightly dose of 10 to 25 mg. While my head pain has diminished significantly—by about 90 to 95%—I now experience occasional uncomfortable sensations on my scalp. These feelings include pins and needles, a cooling sensation, and some crawling feelings near my hairline and ears. There are fleeting moments where I feel brief throbs lasting a second, but I do not have any persistent headaches. To clarify, I do not experience any of the following: - Nausea - Weakness in my limbs - Numbness - Changes in my vision - Coordination difficulties - Seizures The symptoms I have are transient, shifting around and often intensifying when I become conscious of them or as the day progresses. I would like to know: Is it common to experience these sensations during the recovery stage following episodes of neuralgia or migraine-like discomfort? Additionally, could the amitriptyline potentially be causing these temporary paresthetic sensations? I am seeking some reassurance or advice on what is typically observed during this healing process. Thank you.
Concerns About My Toes
Age: 30, Female Currently, I am on the lookout for a reputable podiatrist in my vicinity. However, I've encountered a perplexing issue with my foot. Just last night, I noticed a growth on the side of my toe, something entirely new to me. I maintain a nutritious diet and have a demanding job that requires me to be on my feet quite often. My footwear includes brands such as Brooks Ghost Runners, Hoka Bondi 9’s, and Nike Motiva’s, and I don’t opt for restrictive socks. I also apply Vick’s Vaporub to my feet, a practice handed down from my family, and stick with simple, non-fragrant lotions like Vanicream and CeraVe SA Cream for my skin. In addition, I am curious about the my big toenail's change in color. What might be the underlying reasons for this? Also, I have these persistent dark spots on my toes that I've struggled with since my days on the runway. Despite my efforts, nothing has succeeded in lightening or diminishing their appearance. I'm just looking to determine if there might have been a factor from the past that could have contributed to these issues. I’m not sure what else to include, but I’m open to answering any questions you might have. Thank you for your attention! Best wishes from a worried soul!