♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Welcome, my friends to the Bob and Brad podcast
produced by Bob and Brad,
the two most famous physical therapists
on the internet, in our opinion, of course.
I'm Brad Heineck and I'm exactly one half
of the Bob and Brad crew and here,
oh, Bob and Brad show,
we've got a crew too.
We got, that's another channel by the way.
And we got Chris the pharmacist here.
We're just excited to have him here.
He did a lot of research and he just knows this information
on this topic, which is heartburn, acid reflux
and GERD capital G-E-R-D best relief options.
Whether it's diet,
over the counter or prescription meds, also known as PPI.
I guess we're going to get into that.
You need to know this information.
If you have this or a family member
it's going to be a complete education.
You're going to feel so much better
about how to deal with this.
So Chris, heartburn, acid reflux, GERD, or G-E-R-D.
Are they all the same or is that three different diagnosis?
- They're all the same.
Basically it's that awful feeling you get in your chest,
you just feel like it's kind of burning.
Just doesn't feel right.
You're just uncomfortable, whether it's after you eat
or maybe when you lay down at night
so, your symptoms can come at different times
of the day or at all times of the day.
So, it just kind of depends on how severe your case is.
- So from personal experience, I do want to say one thing
if you have not had acid reflux or this problem
and you're getting chest pain, don't guess and think
that it's, Oh, I've got heartburn because you could be
having a heart attack.
So you've got to get in and get it checked out,
confirm what the problem is.
- Yeah, you want to make sure that you have a pro,
because actually there are the symptoms
and some people are actually, they're indiscernible
to a doctor, even in an ER setting
till they actually do blood work and look
at your (indistinct) and lentils and all the things there.
- So you're saying, they don't know what it is?
- They don't notice till they do some testing.
So, sometimes people can have what they think is heartburn
and it's actually a heart attack.
And some people think they're having a heart attack
and it's only heartburn.
So if it's an emergent situation,
don't just guess I'm going to take a couple
of Toms and see what happens, get taken care of.
- There's another diagnosis as similar symptoms
which I have as costochondritis, which,
has to do with the ribs and the cartilage, in your chest.
But I know I get that pain here, lets say.
I've gone to the emergency room three times.
So I feel confident if I ever get again
that I know it's my costal chondritis, but I'm thinking,
boy I bet you heartburn is similar.
Cause my mother had it in the same location.
- Same nerve plexus, from that standpoint.
So yeah, it's nothing to mess around with guys.
If you don't know, get it checked out by the pros,
I mean those doctors are there to help you, and make sure.
And if it is just heartburn, there's a lot
of things that we can do to help treat people.
- And so, yeah, that's a good news about this,
the more educated you are, the more you can self-treat
or work with your doctor
and have a team effort
that really does that prime way to work.
So you feel part of the team.
What are the stats as far as do most,
is it just an older person thing or?
- Well, it can be I mean as we age basically,
with the stomach, we've got a-
- should we?
- Yeah, I guess we can certainly
- When I was looking this up, I had a-
there was a diagram and this really helped me.
If you think of, here we've got the stomach,
'cause on the left side, right?
So the food goes down, goes over into the stomach,
and then from there into the intestine,
or the rectal duodenum?
- Duodenum, yeah.
- So we've got the stomach.
And here are the food's going down and there's Finster here
and that keeps the food going one direction
if everything is working right, and down in here,
that's why I use red, we've got stomach acid,
and evidently that's pretty potent.
- There is a one molar, one molar has (indistinct) acid.
- Now we're talking chemistry, we've got a pharmacist.
So if you compare that to other
like acidic food, this is... - Much stronger,
- Much stronger, okay.
- Tomato is not going to withstand that.
- So we've got all this acid down here, which is healthy.
We use it to digest, but we want to keep it there.
- Yep. - So with GERD or acid reflux,
somehow this stuff gets up and goes this way.
And that burns, which is why you get the pain here.
- Yes.
- Does that help Liz?
- You're describing it really well.
- I feel like that's my contribution to the video.
(indistinct chatter)
- That's for sure.
So no two ways about it, but yes.
When you get those symptoms, it can happen for, right.
I mean, there's certain foods that can trigger it.
So it's going to be, and it's not everything
in the old days, we used to tell people that,
oh, if you have reflux or GERD,
you gotta go to this bland diet where you're just eating
like white bread and crackers and chicken noodle soup.
- How about milk?
- Milk actually is weakly acidic.
And some people can actually get irritated by it.
Not always, but that's wrong.
So that's the old news.
The good news is, you can eat a lot just about
anything you want, minus garlic, tomatoes,
Citrusy fruits, onions, those types of things.
- I cant eat great food.
- Well, it's one of the only few of heartburn
but there's medicines, we're going to get
to better living through chemistry shortly.
So, but I mean, it's one
of those things that if we can avoid some
of the foods that are triggers,
we can kind of naturally bypass some of this.
A lot of times, we may overeat we have a high fatty meal.
It's just, this little muscle
the sphincter here, can get stretched
and all of a sudden acid
will just kind of leak right through it.
And what you do after dinner?
You kind of lay around, you watch TV.
I mean, you're not necessarily sitting with perfect posture.
If you can sit up right after you eat
for a good hour, I mean, this is going to help
'cause gravity is going to keep things going down
in the right direction.
But if you're in the lazy boy and you're flipping
through channels or you're reading a book,
if this thing is a little bulge
because you maybe had, the old 96
or something to that effect, you can get some seepage
and you're going to get that heartburn.
- 96 (indistinct)
Did you ever see the great outdoors John candy movie?
96 on steak.
- I don't get out much - very big piece of meat.
- I quit watching movies after 86.
Anyways...
- That's about when, it was man.
- I was on the borderline.
So anyways also, so if you lay flat, you're even more prone.
- More prone to probably suffering.
And so there's things that,
people can use bed wedges, prop their bed up.
So there's a lot of non-drug things you can do
but what it comes down to and really the title
of the deal is, the proton pump
inhibitors have really revolutionized
how we treat these types of acids.
- Protons Pump inhibitors.
So they put up a pump in your system?
- Well that's what, basically the easiest way to think
about how we make too much stomach acid.
We have pumps and they're basically in the lining
of our stomach and the X is what kicks off the stomach.
- You don't mean...
- No we're not pumping like a pump
- Surgically putting the pump in there.
Its not like the pump for morphine or for the...
So the pump is just a-
- Hydrogen and potassium.
- And the actual thing that goes out.
That was a little scary for me.
I said the pump and I thought,
what are we going to promote here?
- There is no little robots in us or anything like that?
- I thought they're going to put them in there.
- No, but yeah, ultimately
so it's what our stomachs do to break down food.
So we need that.
It has to, the business ends right here.
This is surface area
gets some of the intestines nutrients go into the body.
I mean, that's the quick and dirty answer
but the reality of it is a lot is going on.
So your body is making a lot
of people that have reflux or even other stomach
kind of conditions that making too much stomach acid
and as a result, so we're getting,
it's seeping out in the wrong direction
we're getting the heartburn, we're getting the discomfort.
So if we take these types of medications
like Omeprazole or pantoprazole, like Prilosec or Protonix
these are drugs that suppress that acid pump.
So your body doesn't make as much acid.
So and realistically, when you take a tablet
within about 20 minutes of taking that
like with Omeprazole specifically
your stomach acid has been reduced by 80%.
So it's a pretty, it's very through.
- So what about, I heard people take Tums.
- Yeah, that's a neutralizer, so it works differently.
That's calcium carbonate.
And so it's kind of like,
so if you've had acid in a little cup
and you threw some Tums in there, it neutralizes it.
So it's not as damaging.
So that works a lot faster
than say a proton pump inhibitor, because,
it takes about five to seven days
for the acid levels for you to proceed.
If you have a lot of reflux
and discomfort there's going on and it takes time,
it's just like any other wound at that point.
So if the mucus is kind of irritated
- So the tissues in the throat or the esophagus
are actually physically...
- Irritated, correct. - Irritated coalisions,
- And they can be, and if untreated, it can go to a myriad
of very serious disease as worse as, as bad as cancer.
So yeah, you can go ulceration
and of ulcers are left untreated.
It can become stomach cancer, esophageal cancer
bleeding verus,
there's a lot of things out there that,
you want to make sure you see your doctor
and you get treatment for this.
- So the first step I'm thinking,
I don't want to take the pills, maybe diet.
Like I know my mother, we had to take citrus
out of her diet and it seemed to help.
And actually she did get, she was taking, I don't remember.
You remember-
- Yep she was on (indistinct)
at one point we switched her out from the (indistinct)
(indistinct)
- I'm supposed to do that, it's my job.
- That's all right.
- I got it written down, yeah, that's exactly right.
So anyways, so, you may be able to modify it
or maybe be able to control it by diet.
If it's a mild case,
- You can, diet and exercise are huge.
- Exercise has something to do with this?
- Well, keeping a healthy body weight.
So 'cause, if we have too much body weight,
we're carrying around the things
that kind of keep everything in place
kind of gets stretched and displaced.
And then, it's all of a sudden,
your stomach's not sitting quite right
and then you can get reflux.
So healthy body weight is important.
- So, we work with our diet a little bit,
and maybe it's not going
you talk to your doctor and it's like a time for meds.
So this means we have to do prescription meds
or is there over the counter meds?
- No, all these drugs are, many of these drugs
are all over the counter as well.
And so that's, one of the problems
that we're facing in this country is,
maybe the over utilization of some of these drugs.
So we have to be careful with that.
The reason that you see a lot of these packages
over the counter, they're only for 14 days.
We only want you to use it for two weeks.
And if your symptoms aren't gone, by that point,
you should be discussing this with your doctor
because we want to make sure
that there's something more serious going on
that could be easily hidden by just simply
taking months and months and months
of over the counter proton pump inhibitors.
- So, yeah, you're just kind of masking.
- You can mask the symptoms.
- And then maybe get a hernia,
- It could be a variety of different things.
But I mean, worst case scenario is let's say
you had some severe erosive esophagitis.
I mean, that esophagus is just raw and irritated.
I mean, sometimes it can be the point where they have to do
special procedures or it could be triggering things
like very bad disease states like cancer.
- So at that point, If you've got that esophagitis,
it's probably going to be painful to swallow.
- It is, but some people are so tough.
I mean, it'd be fun to actually a buddy of mine's
a gastroenterologists
but it'd be fun to have him on here.
But, a lot of these people
just don't even recognize it
and it almost speaks silent in some cases.
some people have tremendous pain.
So it varies from person to person
and condition to condition where along the GI track it is.
So there's a lot of different things,
that go into these factors,
but the medications that we use to help to try
and cut down acid are game-changing.
And so it can be life changing as a result of that
but we still have to be judicious with it
what he is about the shortest amount of time to get you out
because there can be some consequences
of over utilization of some of these medications as well.
- You mean some side effects that take on other problems?
- Yeah, I mean, so, you think about your stomach acid
it's one of your best immune defenders.
So I mean, it helps to protect you against things
like pneumonia and other respiratory infections.
So it actually, even though-
- Because it goes up into the-
- No, it's not even this happy, you just,
it could be on your food or whatever, but it's bacteria.
And it can't stand up to that acid.
Although we do have acids that are bacteria
that do stand up to those acids too, we'll talk about it.
- There's good bacteria?
- There's good bacteria, yep, there's yup.
- That's another video.
- Couple of videos, probably.
so when we have people with symptoms, we have to treat them
and we want to treat them for as what,
usually it takes about three months
to get everything to heal up.
And if you are three months and you're like, I feel great.
I'm not having symptoms at that point,
your doctor may even suggest that maybe you can try
and cut down or try and discontinue the product.
But there's a double-edged sword
with proton pump inhibitors specifically
is that they can cause a rebound in your acid production
for about 14 days after you discontinue a product.
So depending upon the dose level that your doctor
puts you on for your particular condition
some people have to take it up to twice a day.
Some people only take it once a day,
usually like to half that dose
for a couple of weeks and then stop it.
And like I said, recognize
that you will probably have a little bit of rebound reflux.
So you have to kind of muscle through that
or maybe use something like a Tums
or maybe something like a Pepcid,
which is an over the counter supplement
to help to try and cut that down and bridge the gap.
- So the one thing
'cause I think once you see your doctor,
hopefully you're listening to him
you got him as your quarterback or your coach.
But if you're in that phase where
I want to see if I can do this with over the counter meds.
And you said they're typically 14 days.
And then if that doesn't work
then you better-
- Should see your doctor.
- Is there a acceptable and wise way to go in to
get an over counter med
that you could suggest to people to see if they can-
- When people come and see me, we're gonna talk
I'm gonna try and get a gauge
as to how long they've been suffering.
What makes it worse?
We're going to see if it's always after meals.
Is it when they lay down at bedtime?
Is it all day?
- So you're saying like, if I'm a customer, I come in
I have not seen my doctor.
I could go ask the pharmacist, I've got heartburn.
Can you recommend anything?
- Yep, and so we could see how long,
you've been in any of those.
Yeah, it's been like two months
and I've been feeling horrible every time I eat
I just get this horrible pain up here.
It just doesn't feel right.
We can try a couple of different things,
and then I would give them options.
Perhaps it is one, it's a little bit faster acting
than the proton pump inhibitors
but the proton pump inhibitors are more thorough
and they're more effective.
So it depending-
- You can get that over the counter.
- Yeah, they're all over the counter.
These are all over the counter at this point,
this is my arena.
So, but we always say,
"Hey, I'd like you to just try this for about two weeks."
And if this isn't better, or if you see symptoms worsening
while you're doing this, don't mess around with this
and wait for something to happen in a positive direction.
Talk to your doctor because you're going to need the help.
We got to figure out what's going on directly.
And there's ton of incidences, where they go in
and all of a sudden it was a big deal.
- Do you have many people come in for advice like that?
- Yeah, all the time.
So yeah, we want to talk to people.
That's what we're there for.
So hopefully we can give them some temporary help
unless they need more thorough help from their doctors.
- Which is something, we're getting to the end of the video.
But this is something I didn't know.
Cause I've (indistinct) very much
'cause I've been pretty healthy
but I didn't know that you could go-
I just get a lot of my advice from Chris.
I talked to him about something.
He tells me and it's like, I've never had a skin thing.
I said, hi, I got to go to the doctor to get some for this.
And he gave me a little over the counter vice, I got it,
it was gone, it's like, a pharmacist, they work.
I mean, a pharmacist and a doctor
really needs to work hand in hand and they can.
- Oh yeah.
- You can eliminate doctor visits by doing some of it?
- I don't think we can eliminate,
we can help out when it's something simple.
- Well, in my case, it was a simple thing.
It's like, I don't want to go to a doctor because of a rash.
I just need something to put on it.
And you helped me and like this.
This could passively, Oh yeah, stop a doctor visit.
- Yeah, I think the use of over-the-counter medications,
I think is very, very effective
and I think it has its place in therapy.
But again, we have to be careful because I mean,
if we're older, I mean, if they're smokers, I mean,
there's a lot of things that could be triggers
that your doctor really needs to address these things.
And long-term, as we age and we take these things
for long, long periods of time, we found that there
is a higher risk for osteoporosis.
So you might want to maybe be taking a calcium supplement
if you're on it specifically calcium citrate
versus calcium carbonate because the carbonate
needs the acid to break down.
So if you're reducing the acid environment
do you want to use something that's bioavailable.
- Overlap and we don't want to cause
another problem where-
- Exactly.
So, I mean, we have to be mindful, of other things,
like I said, it's, disease, state management too.
We can see and, if you higher risks of
what they call Clostridium difficile
which is another very bad intestinal bug
that when our stomach there is a correlation
with long-term use of these medications.
So we have to be real careful.
And that's why your doctor has to be involved
with your treatment plan.
So coming in and seeing me is nice
and I enjoy it, but a lot of times,
we have to make sure we do the professional punt
and hand it off to the pros.
So whether it's your regular physician
or a gastroenterologist, I mean
these guys are the ones that really know
and they'll turn you back to me
and we'll talk about proton pump inhibitors at length.
Particularly if you ended up
on a prescription to make sure you use it as long enough
what's the best tapering strategy?
If that's end, you should always, when you're talking
with your doctors, what's going to be the end game here.
I mean, am I going to have to take this forever?
And we're finding that about 27% of the people do.
And your doctor has to mitigate those risks for you-
- You're saying almost three-fourths
of the people eventually can get off?
- Can get off.
- So if they're eating well
losing a little bit of weight, watching what they eat
minding the type of things that they eat.
- Maybe get a wedge to sleep on.
- Wedge, to sleep on,
smaller meals multiple times a day sometimes seems
out grazing versus gorging kind of thing.
So there's a lot of things that can be done
that do not require medicine,
but a lot of times they're there for you if you need it.
But just realize
that long-term use does have some consequences.
So we have to be mindful of that.
And you want to work with your doctor,
to do the safest, most effective plan.
See if there is an exit strategy for you.
So we don't have to succumb
to some of these risks that could be associated
with long-term users, medications.
So I'm going to be very, very careful.
- I'm feeling better already.
- All right, well, there you go, no reflux spread.
- Thank you for listening and watching.
I know we'll be back
with another exciting episode with Chris.
- Have a good day guys.