stopping with pantoprazole

[kriswillems]

I thought I had a problem with my heart, but they couldn't find anything on the angiogram (1 year ago).

They found a light irritation of my gullet on a gastroscopy, which made me feel like I have a heart problem (according to the doctor).

I wanted so go back to see a heart specialist because the medicine I took (pantoprazole) didn't help at all. I took it only 2 weeks.

The pain is already there for almost 1 year.

I planned to go back to a heart specialist but my family doctor, who has all medical files, said that I stopped taking pantoprazole much too early and that I should take it for 5 years.

The specialist that prescribed me the medicine never mentioned this.

My family doctor is 100% sure I don't have a heart problem (even though I failed the stress test).

So, I started to take pantoprazole again 2 months ago and have been taking 40mg every day.

I didn't notice the slightest improvement. It felt like I was taking sugar pills - no effect at all.

Now, the supply I took from my home country is empty and I wanted to buy more pantoprazole.

The medicine costs 700B for 14 pills, which is not cheap.

And it was not helping at all, even not after 2 months.

So, I decided to stop with it.

Now after 3 days I have to burp all day and I have a feeling of heartburn.

I never had this kind of problem before, so I guess it's related to stopping taking pantoprazole.

This feeling (heartburn) is different from the feeling that made me start taking the medicine (which felt - to me - like a heart problem).

I found omeprazole in a pharmacy, it's cheap and it's also a proton inhibitor.

Should I take that in stead (20mg per day)?

I don't trust my family doctor anymore and I've decided I'll go to see a heart specialist anyway.

[FBN]

Omeprazole will be adequate; Boots make a generic form which is quite cheap and effective. Taking it for 5 years continuously is not appropriate. The routine is 6 weeks only. If symptoms recur after this period, tests to exclude a helicobacter pylori infection should be done. If positive, a regime of specific antibiotic treatment is usually prescribed with the proton pump inhibitor.

This seeming "rebound" effect of acid secretion and heartburn is experienced by a number of people having taken a proton pump inhibitor; theory is that the effect of the medication is to almost stop all acid secretion, the acid producing cells in the stomach lining either proliferate or become more effective or aggressive in producing acid. There is a basic negative feedback loop in play; acid in the stomach prevents more acid from being produced.

As we discussed before in your previous thread, a visit to a cardiologist remains a good idea but include a test for H. Pylori.

[meatboy]

back in the uk.i was on one of the dearest ZOTON LANSAPROZOLE which as long as i kept taking them[30mg.] i was fine.

since coming to thailand i have been taking 40mg.of omeprazole[miracid] and they have been fine.

and only 45bht.for 14tabs.

lansoprozole cost 1,360bht.for 28tabs.

[Pikiss]

I’ve had mild acid refluxes for years and they have been manageable with proper diet and a weeklong course of pantoprazole every now and then. Earlier this year I had to take a heavy course of antibiotics, which resulted in a full-blown reflux, and gastritis and I had to start 40 mg pantoprazole daily. I’ve been since then reading a lot about reflux and been astonished of how many ways this disease can be symptomatic. Especially in discussion boards some people say that their pain is in the heart but after having all possible tests done most of the cases have proved to be due to reflux (caused by the vagus nerve stimulation?)

I’ve been now on pantoprazole for six months. It took the three first months before the excruciating nightly pains and burning sensation in my stomach and back started to relieve so it really can require a long time to take effect.

The last two months I’ve been on a 20 mg daily dose and still have mild stomach ache at least once a week. I am now gathering up my courage to try to stop taking pantoprazole and see if I can manage. It’s not good to take the medicine indefinitely because as FBN said these proton pump inhibitors prevent your body from producing stomach acid, which is of course needed for your digestive process.

Since you’ve been off the medication for a few days already maybe it’ s good to tough it out and keep on going to see if the symptoms start to relieve. You may want to start taking probiotic products (yogurt and capsules), digestive enzyme tablets with every meal and if needed, a Gaviscon tablet after meal or at bedtime depending on when you feel the heart burn.

[Sheryl]

As FBN said, you need to test for h. pylori.

And, I would indeed suggest you consult a cardiologist,m especially since presumptive treatment for pain of gastric origin has not worked.

[kriswillems]

When they did a gastroscopy they took tissue and I suspect they have analysed it.

I was never said to take antibiotics.

Antibiotics are about the only thing I haven't tried yet.

I have tried pantoprazole.

I have tried aspirin.

I have tried stopping to drink sour drinks and soft drinks.

I have tried cleaning the airco.

I have tried disinfecting the whole room

I have tried changing my sleeping position (using more pillows).

I have tried sleeping in another room.

I have had a stress test (just failed, ST depression between 1 and 2 mm).

I had an angiogram (was perfectly normal)

I had a gastroscopy (found a light irritation of the gullet, lowest grade). They took tissue to analyse in the lab.

I had a standard bloodtest : everything within the borders except HDL and uric acid (slightly outside the normal range)

I had an X-ray of my lungs (1 year ago). It looked normal.

I consulted my family doctor : he's sure it's not a heart problem. He thinks it's my gullet.

I have asked for the opinion of a second heart specialist (only talked) : he thinks it's not a heart problem.

I don't drink or smoke and am 42 years old.

I don't have any pressure or stress related to work.

After so many tests I am seriously beginning to doubt about myself. Still, I am pretty convinced that I wake up around 4AM with pain on my chest every morning (often combined with a numb feeling in one arm). Until 1 year ago I almost never went to a doctor. I don't get enough sleep because of this.

Would it be a stupid thing to try antibiotics ... it's the only thing I haven't tried yet?

I can predict what will happen when I go to the hart specialist: I will fail the stress test, and everything with start over again with no result in the end. But I am going to go anyway. The thing is - I don't want to pay for a second angiogram.

Edited September 13, 2014 by kriswillems

[Sheryl]

Don't just "try" antibiotics. Tretament of h. pylori requires tripe therapy and is not something you want to do if not necessary. There is a fairly simple breath test for h. pylori (urease breath test); get that done. I forget where you live but if in Bangkok, you can arrange it by phone at this place http://www.digestivebkk.com/.

Are you able to get the records of your stress test and angiogram? Would be important to bring these with you when you consult a cardiologist. There is no need to "start everything all over", bring all the prior test results with you and ask for a second opinion. Specifically ask about prinzmetal (variant) angina.

One other point - can you describe the chest pain? While chest pain with arm numbness generally suggests a cardiac origin, a pinched nerve (as can easily occur in sleep positions) can also cause arm numbness and, depending ion its location, possibly some chest discomfort. Which would suggest an altogether different line of inquiry,

[Ace of Pop]

You dont say what exercise you get everyday.

[kriswillems]

That's exactly what the other cardiologist I talked to said. He believes there's a problem with some nerve line. He asked if I ever got an accident. I did, but only my legg was seriously injured.

I have the habit to sleep with one or two arms much higher than my head (not beside my body), stretched out (like you raise your hand in a classroom), which might be causing the problem.... I really don't know.

The feeling that I get in the morning is like a pressure feeling. Like I sleep in a room with closed windows and not enough oxygen. I sweat when I get this feeling.

The feeling usually goes away when I get up. But lately I am also starting to feel some discomfort during daytime.

I can get the results of the stresstest but not of the angiogram.

The problem get's worse when I feel tired, when I worked long hours for a long time, or when I don't get enough sleep for a long time.

The problem seems to slightly improve when I do short and light exercise. Not sure.

I seldom feel extra pain when I exercise, but sometimes the pain is already there (even during daytime) which make exercising difficult/uncomfortable.

I am on overweight and this might be a factor in the problem, but my general condition is not very bad. I get an average score for my age group on the stress test (for maximum heart rate and time I manage to hold on).

Thanks for that link Sheryl.

Edited September 13, 2014 by kriswillems

[Sheryl]

"a pressure feeling. Like I sleep in a room with closed windows and not enough oxygen"

actually sounds like it could be anxiety, do you think that is possible?

Numb arm can easily happen from sleeping in a position that narrows the space where nerves exit the cervical spine, especially if there is already some cervical spondylosis (degeneration of the disks). I get it too. Would not cause the chest discomfort though. Are you sure the two always occur in tandem?

[fforest1]

Well it sounds like you are ok with trying new things so here is another thing you could

try...Serrapeptase

Serrapeptase -will really do major cleaning job on all the junk in your veins and artery's in

your body...I have used it many times..

Fascino sells a brand called Fazen,it come in a pack of 10.When I feel like my insides need a cleaning

I will take all 10 at once.

I don't guarantee this will help but it sure as heck will clean out your body if a good amount is taken

a number of times..

[Ace of Pop]

Try increasing your Potassium Intake. Im no Doctor but as a young man i shared a Flat ,he studied Medicine, me Engineering,we tested each other re Uni Exams. Stress can be something you deny. I advocate as little chemical dependency as possible. You say Uric Acid noted. a pointer towards things Rheumatic.Try finding the root cause before drugging up.

[Sheryl]

P.S. If you haven't already, I suggest you try arranging some pillows/bolsters do that your head and chest are elevated when you sleep. If the discomfort is related to reflux -- a common problem in people who are overweight and likely to flare up when lying down -- this will help.

[kriswillems]

Anxiety would mean it's all in my head, right? After such a long time, and because nothing else helps, I am prepared to believe anything. But I am not sure. Is anxiety related to stress? It could be possible that subconsciously I have some kind of stress because I sometimes miss home... I also had some family related problems, but those problem occurred more recently (6 months ago), after I already had the pain on my chest. Last time I went back to my home country to do the angiogram the problem temporarily disappeared (but it could be a coincidence). Or maybe it's a combination of a gastric problem with anxiety. If it's anxiety it would be the first problem I have with it. Can I somehow do something to take away the "anxiety", if that would be it? Can people with anxiety somehow recognize that they have it?

I've tried more pillows, it didn't seem to help. I will do further experiments with pillows.

The feeling in my arm goes together the feeling on my chest, but it's only there in 70% of the days. I never have only the feeling in my arm and not on my chest. If it was just the feeling in my arm I wouldn't be worried, because it causes no discomfort.

A thing that seems to make the chance on problems higher is eating dinner shortly before sleeping, but I am not 100% sure again.

Edited September 13, 2014 by kriswillems

[meatboy]

P.S. If you haven't already, I suggest you try arranging some pillows/bolsters do that your head and chest are elevated when you sleep. If the discomfort is related to reflux -- a common problem in people who are overweight and likely to flare up when lying down -- this will help.

that is what i had to do[elevate] your bed on a few house bricks.and yes i am overweight.with hiatus hernia.

one for you sheryl i once saw h.pylori on my medical records what is it please.

[Ace of Pop]

Its something that makes you burp more than average.Nothing serious.

[meatboy]

Its something that makes you burp more than average.Nothing serious.

thanks ap.but i dont burp as much as wind comes out the other hole.

[Sheryl]

P.S. If you haven't already, I suggest you try arranging some pillows/bolsters do that your head and chest are elevated when you sleep. If the discomfort is related to reflux -- a common problem in people who are overweight and likely to flare up when lying down -- this will help.

that is what i had to do[elevate] your bed on a few house bricks.and yes i am overweight.with hiatus hernia.

one for you sheryl i once saw h.pylori on my medical records what is it please.

It is a bacteria now known to account for a high proportion of gastric ulcers and gastritis. If present, should be treated. There is a non-invasive breath test for it (urease breath test). It can also be directly tested for when gastroscopy is done.

If you were ever treated for it, you would have been given something like 3 different medications to take daily for 10-14 days, including omeprazole or other PPI plus 2 antibiotics.

After treatment it is important to retest as treatment is nto always successful on the first try. It is a hard bug to knock out. (Mind you, I haven't seen your medical records..for all I know it may have just said r/o h. pylori and the tests have been negative.

[Sheryl]

Anxiety would mean it's all in my head, right? After such a long time, and because nothing else helps, I am prepared to believe anything. But I am not sure. Is anxiety related to stress? It could be possible that subconsciously I have some kind of stress because I sometimes miss home... I also had some family related problems, but those problem occurred more recently (6 months ago), after I already had the pain on my chest. Last time I went back to my home country to do the angiogram the problem temporarily disappeared (but it could be a coincidence). Or maybe it's a combination of a gastric problem with anxiety. If it's anxiety it would be the first problem I have with it. Can I somehow do something to take away the "anxiety", if that would be it? Can people with anxiety somehow recognize that they have it?

I've tried more pillows, it didn't seem to help. I will do further experiments with pillows.

The feeling in my arm goes together the feeling on my chest, but it's only there in 70% of the days. I never have only the feeling in my arm and not on my chest. If it was just the feeling in my arm I wouldn't be worried, because it causes no discomfort.

A thing that seems to make the chance on problems higher is eating dinner shortly before sleeping, but I am not 100% sure again.

That is suggestive of reflux.

For reflux, aside from PPIs which you are already on:

1. Test for h. pylori and treat if present.

2. Do not eat for at least 2 hours before lying down.

3. Lose weight if possible.

4. Elevate your head and upper chest as much as you comfortably can and still be able to sleep. Gravity can be friend or enemy.

If a hiatus hernia is present (often the case) and symptoms are severe and do not respond to the measures above surgical repair is sometimes necessary.

How long ago was you gastroscopy? Do you have the report form it or can you get it?

One other thought - as you say that this is starting to happen during the day it would be useful to see a doctor while you are having the chest pressure and feeling of not being able to breath so they can listen to your lungs. It is possible there is a lung problem (asthma or the like) that is mainly acting up at night. The easiest and least expensive way to check for that is a simple physical examination while you are having symptoms - there will be wheezing heard with the stethoscope. They could also do an EKG at that time, which if the pain is cardiac should show some transient changes.

Anxiety certainly can't be ruled out at this stage but should first rule out the possible physical causes.

[Ace of Pop]

There seems to be a Buzz Word. "Loose Weigh"t.!..! Most posters here are long set in their ways, hence its best to advice as if they are not Children and take a superior stance. It only causes more anxiety.