Received on December 4, 2016

The original message below was delivered several weeks ago to my PCP stating “to: All Staff at Tri-Valley:”  I did this to allow everyone, including the doctors and nurses at Tri-Valley, to read and hopefully obtain more knowledge on a particular condition.  My only hope is that your office does the same.  Once you read my letter, I’m sure you’ll realize why I did not call to make my annual appointment follow-up. The reason being is because I consider myself now “totally cured!”  You will understand how and why after reading below:

I would like to add an update to my current medical records. First of all, I would like to inform Tri-Valley that I am no longer taking ANY of my meds that were related to my Allergy/Asthma diagnosis (inhalers, nasal sprays, Montelukast, Benzonatate, etc.).  I have been taking those meds off and on since 2004.

When I was vacationing in Hilton Head this past March, the pollen was so severe that I got a bad sinus infection. Actually, I was not sure if it was an abscess tooth or not so I went to my dentist the following week to get an x-ray which determined it was my sinuses. Since then, I did not stop coughing, not even with all the allergy/asthma meds taken daily! My daughter kept bugging me to visit an Allergist rather than go back and see my Pulmonary doctor, so I did. Finally in July 2016, I saw an Allergist at the Pavilion in Doylestown Hospital. You should have records of this as well. I had to stop taking all my meds (except my thyroid med) so they could perform a complete allergy testing series. Guess what I found  I am allergic to? Nothing! With that, the doctor suggested I might have Silent Reflux, not Acid Reflux as I do not ever experience heartburn. Reflux disease is affecting more and more people these days particularly due to our diet. In turn, I told the doctor that I wanted another second opinion by an E.N.T.  She agreed.  I asked if she knew of any reputable doctors in the area and I was referred to Dr. Berger of BergerHenry ENT Specialty Group.

Within 2 weeks I was seen by Dr. Berger.  After discussions regarding all my symptoms, he then did a small procedure scoping through my nasal passage past my voice box and esophagus.  He also diagnosed me with Silent Reflux.  Since then, I have been following a restricted diet by not eating anything acidic such as citrus fruits, no chocolate, no garlic, no onions, absolutely no tomatoes, very lean red meat, no carbonated drinks, and no alcohol.  This can make one pretty upset but considering what I have been dealing with for more than a decade, I knew I could stick to this diet regimen. My previous diagnosis can only be treated with meds and it never really goes away as there is no cure.

Silent Reflux not only can be treated; it can be cured as well!  It all depends on the patient and how they go about taking care of themselves. I was so strict on my 2-week detox that I also lost 8 pounds. Once in a while now, I might have food/beverage, etc. that has some acidic content but do not have much.  Basically when I shop the grocery stores, I only make purchases around the perimeter. I now avoid boxed foods and any processed goods that have acidic, fructose syrup, bleached flour, and any ingredients that can affect reflux.  It is also a good generalization to follow if one just wants to lose some weight!

Now the good news! …….

Not only have I lost weight and feel much better about myself, but my COUGH has basically stopped! I sleep better at night and then wake up more refreshed than I have in years! Upon my initial visit with Dr. Berger and given a diagnosis of Silent Reflux, the only meds he prescribed were Omeprazole DR 40mg twice daily before meals and Ranitidine 300mg at bedtime. I have another follow-up with Dr. Berger in October to see how I am doing. He will probably look through another scope of my throat for comparisons and then most likely, he will decrease the meds. Once my esophagus is healed, I can then slowly introduce myself to some foods I love best and see how it goes.  Dr. Berger did state that for some, healing is almost instant yet for others, it can take a year or longer depending on its severity.

When I was informed that I was probably misdiagnosed, I am not putting any blame on my Pulmonary doctor. He treated me according to all the symptoms I had. The only question that I might have for him is, “What were my results on all the breathing tests I did at every visit?”  If I did well which I believe I did, then he should have questioned himself that maybe it is something else I might have! I was never told results of my breathing tests. Some information I did find on websites is the fact that individuals with asthma have issues with exhaling, not inhaling; individuals with reflux have issues with inhaling, not exhaling!

No wonder I coughed so much going from building to building, room to room, in and out of air conditioning, the seasonal air outside, etc.!  It is the changing of all different airs and scents etc., not allergies!  After my visit with Dr. Berger, I then took it upon myself to do further investigations on this Silent Reflux diagnosis. I now have a few books regarding chronic cough, reflux, and Dropping Acid, The Reflux Diet Cookbook & Cure by Jamie Koufman, MD (Voice Institute of New York), and Jordan Stern, MD. This book really opened my eyes! Common Symptoms of Reflux are: hoarseness, chronic cough, choking episodes (heavy phlegm buildup), trouble swallowing, a lump in the throat, chronic throat clearing, postnasal drip, heartburn, asthma (just like those who have allergies/asthma). Most of the time, a doctor makes the diagnosis of GERD. I even have that in my chart at Tri-Valley. The difference between having Silent Reflux and Acid Reflux is that people with Silent Reflux, also called laryngopharyngeal reflux (LPR), do not have heartburn. That is me! The explanation for this, is that refluxed material does not stay in the esophagus long enough to irritate that organ however, even if a little bit of stomach juices come up into the throat, symptoms occur. The throat and voice box are much more sensitive to irritation and damage from reflux than the esophagus. This is when I get extreme hoarseness and coughing. According to Dr. Jamie Koufman, pepsin is the culprit, not acid. Pepsin is what does most of the esophageal and throat damage caused by reflux, but pepsin requires acid for its activation. Pepsin is an enzyme released in the stomach to break down food protein into peptides. With reflux, the inflamed tissue has pepsin on it and in it. That is why acidic foods and beverages cause trouble! In my further research, I also found that alkaline water helps get rid of pepsin buildup as well. The enzyme pepsin is what causes most reflux. Since alkaline water has a higher pH level than other waters, it can help neutralize stomach acid and relieve symptoms. In a study conducted by Dr Jamie Koufman and Nikki Johnston PhD, they found that alkaline water inactivated pepsin. It was found that pepsin will still activate when water with a pH of 7.4 was consumed. This study concluded that alkaline water with a pH of 8.8+ permanently inactivated the pepsin and therefore consumption may have therapeutic benefits for patients with reflux disease.  I have been drinking Alkaline water (and only this) for about a week with a pH level of 9.5 and 10 (highest available). It is more expensive than spring water but this is all worth it to me for what I have put up with (healthwise) and especially the high expenses in the past years for my allergy/asthma meds and testing! I hope this adds to the curing of my condition and if it does, I plan to pass on all that I have learned about Silent Reflux!


Honestly! For the past few weeks and as of today’s date, I haven’t had ANY coughing episodes, no post nasal drip, no phlegm buildup issues in my throat, no hoarseness, or any symptoms related to allergy/asthma or reflux!!!   Also, I am no longer taking Ranitidine or Omeprazole.  What this comes down to, is I can only hope that staff, including the specialists, take all this into consideration when someone they know (or are under treatment) with the symptoms of allergy/asthma to think twice.  It just might be a reflux condition rather than allergies and/or asthma, and if so, it can be cured!

Lastly, if I had never been seen by Dr. Alan Berger, I would still be in the same condition as before coughing all the time 24/7.   Dr. Berger is definitely a specialized ENT and takes the time to listen to his patients thoroughly, gets to know their lifestyle, is very caring and treats you with dignity and understanding. He gave me a plan to follow and I did so accordingly. Immediately after my first visit, I took it upon myself to further investigate Silent Reflux via websites and was pleasantly surprised with more information on this diagnosis. I found great recipes to cover all meal courses and also beverages that are quite tasty!  I later shared my findings with Dr. Berger and he was very pleased to know how much I care about my own health, and also stated I should share this with others.  I plan to do so on websites asking for testimonials pertaining to individuals who agonize with Reflux.

Thank you for reading this. Have a great day!

Denise P.