♪ 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.
