Also known as plain ole "heartburn" this is pain you wish you never met! Left unchecked, the person with reflux will eventually, usually about oh 0200 hours or thereabouts, show up at the nearest emergency room. In the dark ages (LOL), we would prop the poor person's head up on the emergency room table, take their vital signs and start an intravenous drip of Normal Saline and an EKG of course, first thing...then wait. The physician would come out of the sleep room (I worked night shift in rural hospitals a LOT) ruffling the hair on his head, yawning and ask, "Well girls, what do you think?" This is the scenario for heartburn of course. That's pain. It may make you THINK you are having a heart attack but you are not. Heart attack pain makes a person (Usually) go very still and quiet, as if by hiding

the reaper won't notice them.

Macabre, I apologize. Nurses have a weird sense at times, of what is actually proper in polite society.

So if there was no increased blood pressure, no change in skin tone or temperature (shallow, grey and sweaty), no nausea and no abnormal EKG, PVC’s, elevated T waves, increased heart rate, and that button in your brain, that red one, that’s the one, it says “In case of PANIC, PUSH” its quiet and not pulsing red angrily, well, then we'd tell the doctor "He (or she) needs a cocktail to make sure."

Ah that grasshopper, I often wish I had the ingredients for that famous, two o’clock in the nearest emergency room cocktail. Let's see if this ole nurse can remember all the ingredients...you guys may have to help me on this one.

1. Viscous Lidocaine

2. Mylanta

3. Pepto Bismol

4. Donnatal

5. Take 30 ml of each, pour it all up in a plastic cup, get the person to drink it and wait.

Takes about twenty minutes; if its heartburn the screaming stops; always a good thing in an emergency room of a rural hospital with half a dozen to a dozen real patients down the hall.

I know, I know, time is of the essence, first thirty minutes of a heart attack are the most critical, you are supposed to read the EKG!!! Ship your patient to cath lab! Do lab work! Look important! I thought you were some high falluting twenty some odd old veteran of nursing here! What are you thinking!?

It’s one of those things they neglect to tell you in nursing school. You may actually get one day in a small hospital during school! Wow live it up! Well the real world is different, a lot. Imagine this:

You are on HWY 93, fifty miles in one direction is Kalispell Regional and fifty miles in the other direction is Missoula general Hospital.The plce is staffed with fur young nurses but you have med surg patients down one hall, maybe a newborn and Mother, and twelve to twenty geriatric patients dwn anothr hall. So when thoe emergency doors burst open and you hear moaning or worse? Televiion it is not. It is January in the banana belt, lol. It is cold. The roads are clear, the snowplows and their drivers are really great guys. However, you have one ambulance and they are NOT paramedics. Plus it’s snowing, which is good, a heat wave in the Rockies yippee, at least it’s between 22 and 32 degrees Fahrenheit, but visibility is limited. Your patient is not in any acute danger at this moment; remember the “vital signs and signs of impending in case of panic push, heart attack?” No sweating, no EKG changes, no anxiety, shortness of breath or elevated blood pressure and a much quieter patient.

So much for the diagnosis, poor patient all that pain and then to be told  by the physcan "Here, go to the W store or its equivalent and buy a proton pump inhibitor." This type of medication decreases the amount of acid in your gastrointestinal tract (OK, your stomach). It is used to treat a number of illnesses including GERD, Barretts Esophagus, stress ulcers and ordinary dyspepsia. There is not a lot of definitive work that shows that proton pump inhibitors are actually any better at healing the stomach lining and the esophagus but I absolutely will tell you when I go a week without one, I believe being impaled by gravity over a sharpened stake would be preferable compared to the reflux pain! At least I know my pill of choice, omeprazole (prilosec) is going to work. I don’t have to take it every day but if I go without for a week, it takes three weeks to get back to feeling normal.

Baby Girl knows exactly how to fix me of course, she is 26 you know, would you like to borrow her?

Lol, sorta.

The thing is she is absolutely correct. She has listened to all of my nursing lectures, she remembers.

· Eat small frequent meals,

· drink plenty of water,

· improve your posture,

· exercise regularly; walking is the best exercise,

· and if there is a specific type of food that makes it worse then avoid it.

· There you go, cured!

I wish. The problem is the harm has been going on for a long time, 56 years of time actually. I have never been able to just get up and eat. I detest water. If it will not get past my nose, it s not going into my mouth. I don’t get hungry until the end of the day; even then, I don’t like to eat a lot of food at one time. Add to all of that I am a nurse. That means (all student nurses do not read this next part)

I drink coffee, any kind, any temperature, at any time I can find the time to slosh it into my cleverly hidden, cleaned every time before I put it away, cup. Other than that, from one task to another, usually without a bathroom break, forget actual food break, I am on my feet from nine to twelve hours a day.

OK, all student nurses may start reading again.

Since I was, let me put this delicately, a bit older when the baby girl (who is still up for grab in case any of you NEED an adult in training?) was born; that means I have been a nurse a little while (cough). Therefore, I take a lot of prilosec. I should buy stock, probably, except that I do not actually approve. Does that make sense? I take it and I take it and all the time I’m worried to pieces about the long term affects of proton pump inhibitors. The first part is to understand what the pill does. It dissolves, like, duh, and by the very last part of the acid production in your stomach, that’s when the prilosec does its thing. It blocks that last stage of acid production, great little idea, eh?

Except that takes away the hydrochloric acid and that takes away your vitamin B12 and calcium. Are you a female of the age that the cute flying nun is addressing? Right, me too. So a broken hip is the risk. Take this wonderful little pill for 1-4 years and your risk of breaking a hip increases 1.2 to 1.6 times that of persons without GERD. The one adverse affect that really worries me is Clostridium Difficile. C Diff is a nasty infection, caused by being the last bacteria on the block. The proton pump inhibitor eventually does a great job of clearing out all the bacteria in your intestinal system. All but C Diff. UGH. Enough of that.

There are no special signs and symptoms associated with Barrett’s esophagus. Men are more likely to get it than women, the age is usually over 50, and the number one predisposing factor is GERD has been going on for a long time before Barretts occurs. It is usually diagnosed by upper endoscopy and it is recommended that anyone over the age of 40 who has GERD also have a yearly endoscopy. What the physician is looking for are cell changes in the lining of the esophagus. This change is called intestinal metaplasia, because the tissue that replaces the normal esophageal tissue LOOKS like that of the tissue in your intestines. That’s as far as it goes, usually. For a very small percent of persons with Barretts, less than one percent a year develops esophageal cancer. So, monitor and take your physicians advice and always always take your medications to keep the stomach acid at bay. The risk of a broken hip versus the risk of esophageal cancer…makes buying stock in omeprazole sound rather enticing doesn’t it?

Along with the upper GI series (endoscopy) that your physician recommends biopsies are also taken to check the cells. If a condition known as dysplasia develops sometimes, the physician will remove the Barrett cells and this fools your body into replacing those cells with normal esophageal cells! How cool is that? This, young student nurses and all you guys out there reading this, was NOT AN OPTION when this writer was…OK OK never mind. It is important though, because so many new and wonderful ways to treat this seemingly innocuous disease are being discovered all the time! I wait for the day when the doctor takes out his palm pilot, runs it down my torso, gives me a pill and I grow a new kidney or a new esophagus! Thank you Bones, oh pardon my over familiarity, Dr.Leonard McCoy!

Until then, whether you have GERD or Barretts Esophagus remember:

1. See your physician regularly.

2. Take all your medications with you, in their bottles, with you to all your physician appointments

3. Do Not Fear the Upper GI Series, you will be sedated, you will be just fine, your nurses will be right there.

4. Take all your medication exactly as the physician orders.

5. Remember that if one works three will work better is a LIE !!!!! It will MAKE YOU SICKER !!!! Not to mention it gets you into big trouble with mean nurse kratchets of the world and we are MANY!

6. Last but not least, my adult in training is a being sent to teach me how to be more mature, how to follow my own nursing advice, how to keep going no matter how many times I fail and I cannot live without her near me and her Dad. Besides, she is such a good cook :)