CAN'T BREATHE? SUSPECT VOCAL CORD DYSFUNCTION!

WE ARE NOT ALONE: A new (informal) Vocal Cord Dysfunction Support Group has formed, for VCD patients, and other concerned people, like family, friends, medical people, and others. 

See web-page 7 & link (Z) on the links webpage, for information about a new self-help group for VCD patients in Germany.

I want to thank the many kind and knowledgable people at National Jewish Medical and Research Center (in Denver, CO) for quickly and accurately diagnosing VCD in my husband and in myself (within the same day we each arrived there!). I also want to thank National Jewish for hosting their first VCD Conference for medical professionals on July 20-21, 2001, their second VCD Conference, held July 18-19, 2003, and their third VCD Conference, held July 19-20, 2007. (See web-page 8)

I also want to thank Jean Howe, formerly the head Speech Therapist at National Jewish Medical & Research Center, who gave me the tools (speech therapy, encouragement, and who told me to ask my Nat'l Jewish doctor to prescribe a flutter valve, which helped me tremendously to control my coughing and to bring up phlegm during that stage of bronchitis) to control the VCD. (Note: The FLUTTER VALVE is an excellent tool, but is not for everyone, e.g. not for those with "unstable tracheas", etc., and it has to be prescribed by a doctor. Read about a "flutter valve", in the bronchitis section of webpage 5.)

Thanks also to Rosalind Dudden, the very patient and helpful librarian, at National Jewish Medical & Research Center, who helped me to first find medical literature about VCD, in the spring of 2001. Her help, gave me useful information about VCD, that helped me to create this website, back in June, 2001. (I've just scratched the surface...)

Thanks also to the physicians and nurses and others at National Jewish Medical & Research Center, and elsewhere, who shared their thoughts about VCD with me, and who gave me support to start the (very informal) VCD Support Group. It was in literature sent to me by the National Spasmodic Dysphonia Association (NSDA) that I saw (and adopted) the sentence, "We are not alone."

Thanks to the unknown young man who heard me talking on the phone to my husband about sinus problems, at the Tattered Cover Bookstore (in Denver, about 1999), and who rushed over to me, and said, 'Excuse me, but you MUST READ the book Sinus Survival by Dr. Robert Ivker!' He was right!

Thanks to all who helped enable me to create and improve this website, especially Peter, who patiently transformed my emails to him into web pages, etc.! Also, See the extremely helpful References on webpage 9, and, on the "links" webpage, and the additional references scattered throughout the website.
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It was not easy for my husband and me to get our VCD correctly diagnosed:

In 1998, my husband went to several Emergency Rooms, where no doctor had any idea of what he really had. He was misdiagnosed as possibly having asthma, or midlife crisis, or panic attacks. Finally, after about a week of frequent, frightening VCD attacks (he turned blue, and his oxygen levels dropped below normal), a Pulmonologist (lung specialist doctor) suspected VCD, and recommended that my husband go to National Jewish Medical & Research Center, in Denver, Colorado (see webpage 7), where he was quickly diagnosed with VCD, that same day, in 1998. 

After being taught the special speech & breathing therapy (see webpage 4), by a Nat'l Jewish SLP/Speech & Language Pathologist, and after being told to work on improving his sinus condition, he and I began the tedious but necessary work of figuring out all (or most of) my husband’s underlying causes of his VCD. 

Doing this helped me to discover some SINUS TIPS, and some GASTRIC REFLUX TIPS, (see Appendix A & B, below, on this webpage 10), which resulted in my husband quickly conquering his VCD, in 1998.
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In 2000, I first had VCD attacks, during a severe case of viral bronchitis. After many misdiagnoses at Emergency Rooms, I also went to Nat’l Jewish, and was quickly diagnosed with VCD, that same day. VCD is not “catching”, but, it is common. Each person’s list of VCD causes is unique to that person. Using the SINUS TIPS, and the GASTRIC REFLUX TIPS, helped me to also quickly conquer my VCD, in 2000.
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After we both conquered the VCD (no more VCD attacks for years), I created this free VCD website, in 2001, to help others of all ages, whose VCD hasn’t yet been diagnosed. No one should suffer one minute longer than necessary, with this frightening and sometimes dangerous ailment! 

I receive no financial help, and I researched and continue to update the website, myself.

If you would like to speak by phone, or send me an email, I would be happy to try to help you or whoever has the VCD, to conquer it, as quickly and as easily as possible. I do not charge a fee for this help—

However, if you feel that speaking or emailing to me, was very helpful to you, I would appreciate a donation, in an amount of your choice, if you can, to help cover my costs of spending time helping VCD patients, and, for updating the website.

You can telephone me at 970-726-4440. My email is fsds@rkymtnhi.com (see “email”, below). If I am away from the computer, and cannot answer your email, you can call me, and leave a message. (First, be safe, and get emergency medical help, for any breathing problems! See webpage 4.)

Also, if anyone sees errors that need correcting, or has suggestions for improving this website, and/or wants information added to this web site, please e-mail me (See email, below.) 

BELOW: Please read:
Appendix A (Some SINUS TIPS),
Appendix B (Some GASTRIC REFLUX TIPS, without acid blockers),
Appendix C (Some TIPS about INFANT GERD & COLIC),
Appendix D (Some ERGONOMICS TIPS),
Appendix E (NEW!-July, 2007): (Some GLUTEN-FREE, MILK-FREE TIPS),
Appendix F (NEW!- July, 2007): (Some TOTAL DIARY TIPS): 

P.S. I have not found any books about VCD. Any writers out there?

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APPENDIX A:

Some SINUS TIPS: 

Please check with your doctor, before trying these "tips", to be sure that they are safe for you to try, in your particular situation. If any of the tips don't agree with you, stop doing them, and contact your doctor.

SOME  "SINUS SURVIVAL" THINGS WE DO, that we learned from the excellent book: SINUS SURVIVAL, by Dr. Robert Ivker, D.O.  See webpage 9, (References), in this VCD website. These "tips" also help with ALLERGIES! 

PLEASE READ THE BOOK "SINUS SURVIVAL", by Dr. Ivker!, for MORE GOOD IDEAS!!!

(1) NASAL IRRIGATIONS (for children able & old enough to do these, and for adults): THIS IS DONE WITHOUT ANY CHOKING, AND WITHOUT SNIFFING THE LIQUID UP THE NOSE! We do  these once or twice a day, when we feel the need. When I first did them, I needed to do them 4x/day. We try to avoid doing them within 1 hour of bedtime (or lying down), because some of the irrigation fluid drains out later on, and we prefer to be awake and not lying down (when possible), to gently blow the residual warm salt-water out of each nostril. Keep tissues (unscented) handy.

  (a) First, we each bought a NETI-POT, an 8 ounce (mine holds 10 oz. when full to the brim) little ceramic teapot without a cover, from a health food store. Some people who do Yoga use neti-pots (hence the East-Indian name NETI-POT). This avoids potential latex allergy from rubber bulb syringes! Also, this is a gentle gravity method, with no dangerous high water pressure. And no electricity is needed! And if a person has arthritis in a hand or in fingers, no painful squeezing of a plastic bottle is needed--just gently hold the "neti-pot" in one hand.

Clean the brand new neti-pot, before using it, by using ONE drop of an unscented "free & clear" hand dishwashing detergent (buy from a health food store), adding hot water, and then rinse away all the detergent, several times with plain hot water.

Then, pre-heat the neti-pot, by rinsing the neti-pot again in warm to hot water.

  (b) We put about a level half a teaspoon (1/2 teaspoon) (no more than this) of plain (non-iodized) salt (sodium chloride, NaCl, avoiding additives) into a neti-pot: When completely full to the brim, my ceramic neti pot can hold about 10 oz. of liquid. If your neti-pot holds less than 10 oz. of liquid, use less than 1/2 teaspoon of plain salt. We prefer PLAIN, ADDITIVE-FREE, NON-IODIZED sea-salt (from health food store). Definitely avoid iodized salt, because the iodine (actually "iodide ions") would burn/harm the delicate nasal tissues inside the nose! If necessary, use between 1/4 teaspoon and a level half (1/2) a teaspoon of the plain NON-iodized salt, in an 8 to 10 oz. capacity neti pot. 

  (c) We then add a little hot water (non-chlorinated, non-fluoridated) and stir, to dissolve the salt. Avoid tap water that is chlorinated, because the chlorine is very irritating to the nose. We use well water or bottled spring water (no chlorine, no fluoride). Distilled water is OK, for the nasal irrigation, but we do not drink distilled water, which can leach minerals (like calcium) out of the bones, contributing to osteoporosis. Avoid using water that had a water softener used on it.

  (d) Then I add a little cold water, and stir, to make the salt water warm, not hot. (We experimented, until we found the most comfortable degree of warm temperature—tepid/lukewarm.).

  (f)  I stand in front of a sink. Then, I lean my upper body FORWARD, over the sink, and tilt my head slightly to the right (looking towards the right), so my RIGHT nostril is a bit higher up than the left nostril. I wear a bathrobe, because this can be a little messy (but it is worth it!!! The sinus relief is wonderful!!!, like lessening post nasal drip, lessening stuffed nose, lessening phlegm, soothing and healing sore & dry throat, promotes sinus drainage, preventing and treating the common cold, etc.).

If it feels like fluid is getting into one or both ears, try keeping the head less tilted (sideways), so that one nostril is just A TINY BIT higher than the other one. But still lean FORWARD over the sink, to prevent the fluid from going down towards the throat.

If it is hard on my back to lean forward, I put a folded towel on the edge of the sink, put my left fore-arm on towel, to support my back, and then I lean forward over the sink.

  (g)  Holding the neti pot in my right hand, I put the neti-pot spout INTO my RIGHT (upper) nostril, and gently, slowly, pour about about half of the 8-12 oz. neti-pot) (it is a guestimate)  of the warm salt water into my right nostril--keeping my mouth open (breathing only through my mouth). The fluid pours or drips out of… my LEFT (lower) nostril! (into the sink). IT TOOK A LITTLE PRACTICE TO KEEP THE FLUID FROM GOING  INTO MY THROAT, BUT I QUICKLY LEARNED BY PRACTICE! LEANING FORWARD, OVER THE SINK, HELPS ME TO KEEP THE FLUID FROM GOING DOWN MY THROAT.
    During this nasal irrigation, I must breathe only through my open mouth. (I can talk, if necessary, but usually I do not). 

  (h)  Then, I gently blow both nostrils (blowing out the warm salt water, out of both nostrils at the same time), and then, I lean FORWARD, over the sink again, slightly tilting my head to the left (looking towards the left), so my LEFT nostril is a bit higher than my right nostril. Then, I put the neti-pot spout INTO my left (upper) nostril, and gently, slowly, pour the rest of the remaining warm salt water) into my (upper) left nostril, letting it pour or drip out of the right (lower) nostril, into the sink. I hear a slight gurgling sound from the neti-pot, when it's empty.

  (i) Then, I gently blow both nostrils (blowing out the warm salt water, out of both nostrils at the same time). Then, I carefully bend over, somewhat, (sitting or standing) and gently blow each nostril, one at a time, several times, while head is low (alternating--left, right, left, right). Then, I stand up, or sit upright, and again, gently blow each nostril, separately, alternating nostrils, several times.

  (j)  Finally, I wash out the neti-pot, using hot water. Occasionally I will use 1 drop of UNSCENTED gentle, health-food-store dish detergent (unscented soap is probably OK too), and then thoroughly rinse the neti-pot with hot water, and let it air-dry upside down on a paper towel, in a dish drainer. 

  (k)  After a little practice, each nasal irrigation now takes only a couple of minutes to do! This neti-pot method uses gentle gravity, (possibly safer and more comfortable than some other methods). My husband and I actually look forward to doing these nasal irrigations, because they are so helpful, soothing, and healing! 

Nasal irrigations promote controlled sinus drainage, which happens right after each nasal irrigation, instead of when sleeping! After each nasal irrigation, gently blow the nose, one nostril at a time, (right, left, right, left, etc.), to get rid of the irritating sinus drainage material, that is ready to come out, after each nasal irrigation. See (i), above.

Additional benefits: Nasal irrigations wash away pollen, pet dander, bacteria, viruses, dusts, etc.! (prevents & treats colds, and lessens allergy problems) 

(2)  WE MOISTEN (HUMIDIFY) THE AIR AT NIGHT in the bedroom, while sleeping, USING A VICKS (or any good brand) HOT WATER (warm mist/steam) VAPORIZER—NO MEDICINE, JUST WATER & A LITTLE SALT TO GET THE warm mist VAPORIZER GOING. (HOT water seems to prevent mold, in our vaporizer.). Use cold water to fill the vaporizer's "reservoir", up to the "fill" line. The warm mist vaporizer then boils the water, to produce steam. The salt stays behind, in the reservoir, helping electric current to flow in the water between two electrodes, and this electric current heats some water, which boils, coming out as steam. Steam is invisible at first, until it hits cooler air, which condenses the water vapor, creating tiny hot water droplets--a cloud (This visible cloud is also called steam).

This has very much helped to moisten, soothe, and heal our noses, throats, and sinuses. The higher humidity prevents throat from drying out, even if mouth breathing while sleeping. Dry air used to make throat feel sore & hurt. Dry air caused worse VCD! The WARM MIST VAPORIZER prevents & treats this problem. GREATLY HELPFUL FOR VCD PATIENTS WHOSE AIR IS VERY DRY! 

We put the warm mist vaporizer about 7 feet away from our noses, but directed towards our noses. (If vaporizer is too close, like right next to the face, lungs can get irritated from too much moisture, and in some people, such as asthmatics, etc., this could cause bronchospasms!).

We avoid cool mist humidifiers, because they may breed molds. A pharmacist warned me to avoid sonic cool mist humidifers, because he said these can put tiny irritating or toxic particles into the moisture droplets, which then get inhaled.

Even if you live in a high humidity area, if your indoor heat or air conditioning dries out the air, try using a warm mist vaporizer.

If a warm mist vaporizer isn't available, put some water in bathtub and leave bathroom door open to allow evaporation of water. Or, put some water in a bucket or pail, and put bottom end of big towel into the water, with top of towel held up above pail by some means. Towel "wicks" water up, allowing evaporation to put moisture (water vapor) into air.

(3)  WE USED AN AIR CLEANER mainly AT NIGHT. We bought a negative ion generator because it was noiseless and less expensive than a HEPA filter. John Bower writes in his book "The Healthy House", that some very sensitive people are bothered by fumes or particles from the resins (glues) in HEPA air filters, that hold the filter together. Also HEPA air cleaners create a breeze, and make a sound.

We used to put it on, in the living room, at bedtime. When we tried it in the bedroom, it gave off too many negative ions (too drying, too irritating, caused insomnia).

By keeping it in the living room, just outside the bedroom, just the right number of negative ions drifted into the bedroom, cleaning the air nicely, preventing stuffed nose. We only operated this air cleaner in a room that is next to (adjacent to) the room that we were in.

We kept the negative ion generator away from metal, and we didn't touch it while it is on, and we kept it away from grounded (3 prong) electrical plugs, because I was told that MUCH OZONE could be produced if it is close to metal, or if it is touched, or if it is close to grounded electrical plugs (like next to a lamp that uses a grounded plug). Ozone, in large amounts, is toxic, drying, irritating, and bad for asthmatics, too. Ozone is an asthma trigger, and may be a VCD trigger. Ozone is bad for people, except when created in small amounts by nature, like from occasional lightning bolts outdoors, etc., or, when ozone is high up in the atmosphere. In nature, the ozone gets quickly diluted by winds, outdoors. And, thunderstorms are not continuous!

AVOID AIR CLEANERS THAT SAY THEY ARE OZONE TYPES. In his book, The Healthy House, John Bower writes that even negative ion generators may produce a very small amount of ozone, but in very tiny, acceptable amounts., The only time I ever smelled ozone from our neg. ion generator, was when I touched it for more than a couple of seconds.

(4)  I use a Breathe-Rite nasal strip while sleeping, to help keep my nose un-stuffed, and to lessen snoring. CAUTION: Packaging of this product contains natural rubber latex which may cause allergic reactions. IF YOU MIGHT HAVE A LATEX ALLERGY, DO NOT USE THESE BREATHE RITE NASAL STRIPS! One can call the company at 1-800/858-NOSE(6673) to ask if the Breathe-Rites contain any other ingredients that one might be allergic to.

(5) Read the book, THE HEALTHY HOUSEby John Bower, to get ideas about how to greatly improve your air quality, at home, at school, & at work. Indoor air pollution causes sinus problems. OPEN YOUR WINDOWS to let in fresh air, if outside air is good quality. AVOID BREATHING IN TOXIC CHEMICALS, MOLDS, & IRRITATING DUSTS. See examples on web-page 5, about Environmental & Occupational Health, Sick Building Syndrome, Building Related Illness, Toxic Molds, etc.

(6) These SINUS TIPS, along with some GASTRIC REFLUX TIPS (see below), and improving AIR QUALITY, can often greatly lessen (or eliminate) both VCD attacks, and similar Upper Airway Dysfunction, (areas near the vocal cords squeezing shut/closing up/moving together & down), attacks! (like Laryngochalasia, etc. See web-pages 5, 3, 4, 9, and links web-page, of this website.

These SINUS TIPS (& GASTRIC REFLUX TIPS & IMPROVING AIR QUALITY) can also be helpful for people with asthma, voice problems, COUGHING PROBLEMS, etc.

(7) Before trying these "tips", please check with your doctor first, to be sure that these tips are OK (safe) for you to try, in your particular case.

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APPENDIX B:

Some GASTRIC REFLUX TIPS (without acid blockers): These tips include some ways to help gently heal the stomach, esophagus, throat, etc., and, these tips may help people to discover and remove many UNDERLYING CAUSES of their gastric reflux. Please also see a GASTROENTEROLOGIST, and an ENT/Ear, nose & throat doctor, and an ALLERGIST, & any other specialist doctors necessary, to help you find all your CAUSES of your reflux, etc.

Please check with your doctor, first, before trying these tips to be sure they are safe, in your particular situation. And, ask child's doctor & pharmacist about adjusting dosages down (tiny fraction of adult dosage), for children, and only if safe for the child. 

GER=Gastro-Esophageal Reflux. (Gastro=stomach. Esophagus=food tube.)

LPR= Laryngeal-Pharyngeal Reflux. (Larynx=voice box, containing the 2 vocal cords, just behind the "Adam's Apple". Pharynx=throat, above the larynx. The larynx is above the trachea/windpipe.)

Reflux=corrosive stomach material (can be acidic, or alkaline/bile, or enzymes, or neutral, or a combination) that backs up into the esophagus (food tube), causing any of these problems (at least): VCD/Vocal Cord Dysfunction/Laryngospasm attacks, cough, voice problems, asthma, globus (feeling of lump in throat), constant need to clear throat, much extra throat mucus, worsening of sinus condition, sore throat, laryngitis, voice problems, pre-cancerous conditions of throat &/or esophagus, etc. Heartburn may or may not be a symptom of reflux. Reflux can be intermittent (not happening all the time).

Also read about an out of stomach type of reflux, called HGM/heterotopic gastric mucosa (one type is called "inlet patch"), on webpage 5, in reflux sections.

SOME GER/LPR CONTROL THINGS WE DO, that we learned from the excellent book: STOMACH AILMENTS AND DIGESTIVE DISTURBANCES, by Michael T. Murray, N.D. See webpage 9, References, and, also see GER/LPR info on webpage 5, and on LINKS webpage, in this VCD website.

PLEASE READ THIS GREAT BOOK. It may possibly be bought on-line, from Michael T. Murray’s website.

Some of the following we learned from people &/or other books, &/or other good websites about voice, GER, etc.

(1) DGL (De-Glycyrrhizinated Licorice) CHEWABLE TABLETS. Each DGL tablet has 380 mg of DGL. (mg=milligrams). DGL was one of our main methods of controlling the GER/LPR. We used Enzymatic Therapy brand DGL, shortly (about 20 minutes) before ALL meals (breakfast, lunch, supper, and snacks). The DGL was said to NOT cause high blood pressure (hypertension), and was said to NOT cause fluid retention/edema, because a bad (steroidal) part of whole/crude licorice has been supposedly removed, leaving the DGL.

However, I am trying to find out what percentage (or amount by weight) of residual steroid-like "glycyrrhizins" may remain in various DGL products.

PREGNANT &/OR NUSING MOTHERS SHOULD AVOID DGL. People with any medical conditions &/or who are taking steroids, &/or who shouldn't take steroids, should check with their doctors first, before trying DGL. (e.g. high blood pressure, diabetes, thyroid conditions, asthma, etc.)

Also see note about gout, below:

Chewable DGL tablets are available at most health food stores, and at good pharmacies. DGL capsules are said to not be effective, unless they are opened, mixed with a bit of water (like a teaspoonful) or mixed with a bite of food, and the DGL could be briefly chewed, to mix with saliva. Note: The Enzymatic Therapy brand of DGL contains the amino acid glycine. Glycine can worsen gout (a type of arthritis). Some other brands of DGL, such as Jarrow, are without glycine, for those having gout.

The DGL tablet(s) must be chewed, to briefly mix with saliva, to be effective. If a DGL tablet is too dry (which could cause a cough), put a few drops of water on the tablet, and then chew it up. Chew DGL tablet(s) for a few seconds, to briefly mix with saliva, shortly before (about 20 minutes before) EVERY meal, and if necessary, between meals (Read label directions). Chewing the DGL tablets for TOO long a time, may cause a burning sensation on the tongue & in the mouth. (I do not know if this is from the DGL, or from another ingredient).

The DGL seems to not only promote healing of throat, esophagus and stomach, but also seems to help prevent OUR reflux* (resulting in no more globus/lump in throat sensation, no more constant throat clearing, excess mucous, excess phlegm, no more NIGHT-TIME VCD/Vocal Cord Dysfunction/Laryngospams attacks, no more laryngitis, etc. for us).

*But, if we ever eat foods that don't agree with us, we can still get reflux! So please keep a food diary. And see MORE IDEAS below, too.

We like the taste of the plain, fructose-free, DGL CHEWABLE tablets, but for those who hate the taste, try mixing a crushed DGL tablet with a tiny bit of mashed organic banana, and then chew, briefly, to mix with saliva. Avoid any DGL that contains mint or chocolate. (Mint and Chocolate—in all forms, can cause gastric reflux episodes. AVOID MINT & CHOCOLATE!!. These can weaken the LES/lower esophageal sphincter, but I don't know why mint & chocolate do this.)

Deglycyrrhizinated Licorice is pronounced: Dee-gl-eye-sir-rise-in-eh-ted Licorice.

(2) We use Thayers brand of SLIPPERY ELM Throat Lozenges when we feel the need. (Soothing, coating, healing, nourishing). Slippery Elm (inner bark from certain elm trees) also comes in teabag form, or in bulk, etc. as an herbal supplement. Avoid if allergic to elm trees.

(3) We drink the occasional small glass of CARROT JUICE (organic, fresh) which soothes, coats, heals the digestive tract, is nourishing, and stimulates the immune system, with beta-carotene, soothing and coating PECTIN (a type of fiber), and other good nutrients. Carrot soup, cooked carrots are also good. Beta-carotene is heat resistant. Beta-carotene later is turned into Vitamin A inside us. Do not overdo on carrot juice. If your skin turns orange, drink less carrot juice. Avoid beta-carotene pills -- too potent (can harm the liver, if one has liver problems). Sometimes, carrot cake, using brown rice flour (gluten-free), instead of wheat flour, may be more accepted by children than carrot juice. Carrot soup (milk-free) can be delicious. If carrots don't agree with a person, try other vegetables such as yams, sweet potatoes, squash, watercress, etc.

(4) People can elevate the head of the bed a few inches, by putting 6 inch to 8 inch thick BLOCKS, ON THE FLOOR,--then lift up the the head end of the bed, and put what used to touch the floor, up and onto these blocks. This creates an incline (slant/tilt), where the head is 6 to 8 inches higher than the feet (mattress is still a straight line, not bent). This helps some people, but not all people. (Check with a pediatric Gastro-enterologist, about raising the head end of a bed of a child, or a crib of an infant). Also, see (16) about a special GERD PILLOW, for adults.

Using many pillows is not the best way to elevate the head, because it puts people into a kind of sitting position, leading to squeezing/pressure around the waist. This can promote more reflux episodes. (Lying on one's left side, if comfortable, may decrease reflux).

(5) We try NOT TO BEND OVER too often, and we try to AVOID STRAINING (Valsalva maneuver). We AVOID LIFTING HEAVY objects. (No weight lifting!) (at least until after no more reflux symptoms for 3 months). Sit without any pressure on the abdomen or stomach (knees lower than hips). Avoid running (shakes up the stomach), temporarily. Avoid gymnastics, etc., temporarily. Avoid all strenuous exercise, for at least 2 weeks. Easy walking is best, until fully recovered.

 (a) If CONSTIPATION is causing any straining, see Ref.15,18,23,24,25 on webpage 9 for ideas about gently treating constipation, including eating whole grains (preferably gluten-free, if one has a gluten intolerance), not white grains (de-natured ones), etc.  For us, exercise, increased water intake, acidophilus/bifidus, digestive enzymes, avoiding junk food, improved diet, chewing slowly (takes will power!), eating when not under stress or angry, etc., eating raisins, prunes, etc., all are helpful. Food sensitivities can cause constipation. Avoid foods that you are or may be sensitive to. See more about this, below. 

(6) NO MORE TIGHT pants, belt, corset,--AVOID TIGHT CLOTHING, around waist, like tight elastic around waist, etc. Undo the top buttons or zippers, and wear shirts outside of pants or skirts, instead of tucked into waist.

(7) Keep a FOOD DIARY for a week or two, to find which foods, beverages, ingredients, snacks, etc.,  may cause your reflux. Then, avoid these foods, etc.,  at least temporarily (for 2 weeks or longer):

a) Avoid junk foods, and avoid soda pop.

b) Some people need to avoid acidic foods, temporarily (2 weeks), such as citrus fruits (oranges, orange juice, lemons, lemonade, grapefruit, lime, tangerine), tomatoes (juice, soup, in pasta sauce, in salad, salsa, pizza, etc.), vinegar (in salad dressing, etc.). Try pineapple & grape juice, instead.

It is good to avoid acid foods, temporarily, if one has an ulcer. These gastric reflux tips methods often can help to heal ulcers. (See a doctor, if you might have an ulcer). 

c) Some need to eat acidic foods, if the stomach is not producing any (or enough) acid.  Some people need betaine hydrochloride supplements, which becomes HCl/hydrochloric acid, or, some use vinegar (acetic acid) in salads, or mixed with water, while others need to avoid eating acid foods, temporarily (see "b"). Each person is unique. 

d) We avoid all artificial sweeteners. People with diabetes can read the helpful book Reversing Diabetes, by Dr. Julian Whitaker, M.D.

Diet soda pop contains the harmful artificial sweetener Aspartame (Equal/Nutrasweet), which can cause WEIGHT GAIN, HEADACHES, UPSET STOMACH, BLURRED VISION, BLINDNESS, TWITCHING, SEIZURES, BRAIN TUMORS, HYPERACTIVITY, MOOD SWINGS, ETC. Also, soda pop often has strong acids, plus other harmful artificial ingredients. Plain water, gentle herb teas, certain fruit juices (diluted with water, to prevent dehydration), brown-rice-milk, etc. are healthier substitutes for soda pops.

e) We try to avoid all ADDITIVES, including artificial ingredients (flavorings, colorings, etc.), even "natural" additives (flavorings, colors, etc.) and fake fats (like Olean, Olestra, etc.), because some of these can greatly hurt the digestive system, and prevent absorption of vital nutrients, such as fat-soluble vitamins (A, D, E, K) from foods. Fake fats also prevent digestion and absorption of needed fats & oils, used to repair myelin nerve cell sheaths (made of fatty material, mostly cholesterol). Hormones are also made of mostly cholesterol.

f) Avoid no-fat, or extremely low fat diets. Fats & oils (organic olive oil, organic sesame oil, organic butter in small amounts, organic nuts, etc.) are needed to produce hormones, and to produce myelin sheaths for certain nerve cells. Diets too low in fats & oils, can cause neurological (nerve) damage, and hormonal imbalances. But, don't overdo on fats & oils. For example, if "fish oils" might aggravate your GERD, avoid fish oils, and instead, eat fatty fish like salmon, etc.

g) Avoid cow's milk, cow's milk products (cheese, ice cream, yogurt, etc.) for at least 2 weeks (a month is better). See (8) below, about this.

h) Avoid glutenous foods for at least one month. See (8) below, about this:

(8) FOOD (protein) ALLERGIES & FOOD (protein) SENSITIVITIES & FOOD (non-protein) INTOLERANCES can cause or worsen gastric reflux! My husband has found that Avoiding cow's MILK PRODUCTS helps him feel less congested, with less mucus in throat. Milk and milk products (like cheese, including pizza, etc.) can cause gastric reflux episodes. Brown-Rice Milk (look for gluten-free, or make your own) can substitute for milk (but not for babies!). Rice Dream (a brand of rice milk) has some gluten in it, from barley. Avoid Rice Dream, if you might be gluten sensitive. 

GLUTEN is a protein-like substance, that is in wheat (includes spelt, kamut, bulgur, semolina, farina, wheatina), rye, triticale (a hybrid of wheat & rye), and barley.

Oats are controversial, and American doctors say that oats should be avoided at this time, by gluten sensitive people, for these reasons: Oats are often "cross-contaminated" with gluten, at packaging plants, &/or, even when gluten-free, some people are sensitive to oat proteins.

Buckwheat and Millet are controversial, and may contain gluten from cross contamination by glutenous grains at the factory. Both buckwheat and millet, may contain proteins that some are sensitive to. It may be best to avoid both, at least at first. Read labels to avoid hidden gluten, in some soy sauces, gravies, etc. Avoid grain alcohols, grain vinegars, beer (barley malt), "malt", "starch" or "maltodextrin" from unknown sources, etc. 

People with gluten sensitivity (Celiac Disease, & other types of gluten sensitivity, including neurological types, etc.) need to avoid all foods, drinks, medicines, etc. containing gluten. And, avoid body & hair care products, dish detergents, glue on envelopes, glue on stamps, licorice candy (often has wheat flour--glutenous), etc., that may contain gluten. When going gluten-free, avoid previously used cast iron cookware, used wooden utensils, used wooden cutting boards, teflon/non-stick cookware (all of these may retain previous gluten). Buy a new toaster, and use only gluten-free foods in the toaster (like brown rice bread).

BROWN RICE (organic) is gluten-free. Corn is gluten free, but some are sensitive to corn proteins, so avoid corn products, at least temporarily. There are (gluten-free) brown rice pastas (like spaghetti, etc.) available at health food stores (one brand is Tinkyada) that taste just as good as glutenous pastas.
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Celiac Disease may be found in at least about 1 out of 100 people, and even more often, in those with ancestors from any of these areas: Ireland, England, Wales, Scotland, Scandinavian countries, Italy, Northern Africa, the Middle East, Northern Europe in general, etc. And, gluten sensitivity, in general, which includes non-Celiac types of gluten sensitivity, may even be found in as many as 1 out of 3 people, anywhere.

I very rarely eat milk products, like yogurt, cheese, whipped cream, but I do take some ACIDOPHILUS/BIFIDUS, daily, which is mixed with goat milk powder. So, at these times, I take LACTASE ENZYMES, to digest (break down into easily absorbed small molecules) the milk-sugar called LACTOSE. Many people (due to heredity &/or disease, or just naturally) have Lactose intolerance, where the small intestine's microscopic finger-like projections called "villi", do not secrete the lactase enzyme. Result is that the milk-sugar (lactose) travels further down the small intestine than it should. Then, bad bacteria eat the lactose, giving off lots of gas (the gases are by-products of the bad bacteria’s own digestion process), and this causes folks to get bloated, gassy, have diarrhea, and cramping. I use Lactaid brand lactase enzymes, and it helps, for me. Ordering direct from them can save money.

Some people may be ALLERGIC to milk proteins. 

Or people can be SENSITIVE to MILK PROTEINS (like casein, whey, etc.). Milk protein sensitivities are different from a "lactose intolerance". BOTH CAN CAUSE REFLUX, LEADING TO VCD!

Cow's milk protein sensitivities can cause "auto-immune" reactions, such as reflux, etc. But, milk sugar (lactose) intolerance, doesn't cause an auto-immune reaction.

NEW INFO: (June, 2007): Milk proteins, if one is sensitive to them, can sometimes cause villi damage in the small intestine, that is very similar to Celiac Disease!

Even though food sensitivities are not technically the same as food intolerances, many people use the words food sensitivites and food intolerances, interchangably. However, food protein sensitivities do involve the immune system (different antibodies are made--IgA & IgG, in the large intestine/colon), compared with food allergies(IgE antibodies are made), while food intolerances do not involve the immune system (no antibodies made). 

FOOD protein ALLERGIES & FOOD protein SENSITIVITIES & FOOD non-protein INTOLERANCES all can cause or worsen gastric reflux! Food protein sensitivities &/or food non-protein intolerances may cause delayed effects (even hours or days later), when certain foods are eaten. Food protein allergies usually cause more immediate (allergic) reactions to the "allergenic" food that was eaten.

To find out whether you may have certain food protein allergies, food protein sensitivities, food non-protein intolerances, etc., look at link "AA", at the bottom of the links webpage, at http://cantbreathesuspectvcd.com/links.html . This is a link to "EnteroLab", a laboratory that was created by an experienced Gastroenterologist, Dr. Kenneth Fine, MD, in Dallas, Texas, and which does special recently developed analytical tests (looking for elevated numbers of certain antibodies) on stool samples. These non-invasive tests can very accurately/reliably tell you certain foods that you may have a problem with the proteins of (like egg protein, or casein--a cow's milk protein, or gluten, etc.). The link is:
http://www.finerhealth.com

In fact, Dr. Fine writes that his newly patented special stool tests often give more accurate results than invasive intestinal biopisies, and blood tests! Avoid eating any foods that you may be allergic, sensitive, or intolerant to. Also avoid herbal extracts prepared in "grain" alcohol, & homeopathic remedies in "grain" alcohol, etc.  Some may need to only temporarily avoid certain foods (like corn, soy, cow's milk, etc.). Some may need to permanantly avoid certain foods (like foods that contain gluten). 

Gluten sensitivity can lead to autoimmune problems anywhere in the body, including: digestive tract (Celiac Disease &/or gastric reflux, indigestion, mal-absorption, etc.), the pancreas (affecting digestion, &/or causing diabetes, etc.), the thyroid gland, skin, nervous system (seizures), joints (arthritis), etc.

For more advice & support, about trying to eat gluten-free & milk-protein-free, please see Appendix E, below.

(9)  We try to DRINK MORE WATER (drink more water, if safe, in your case), to prevent chronic dehydration. We like hard (nicely mineralized, but, not carbonated) well or spring water.

We do not drink distilled water (soft water, no minerals), because it can leach minerals out of our bones, possibly contributing  to osteoporosis. We avoid water softeners (chemicals) because they can be toxic, and because good minerals help keep us healthy. People with KIDNEY PROBLEMS &/or GLAUCOMA, etc. should ask their docs how much water is safe to drink, since too much water can be dangerous for them! (But, dehydration can cause problems also.) 

We also avoid water filters that contain silver in the filters, because silver is a toxic heavy metal. When necessary, we use a solid carbon sink-top water filter, instead. Some reverse-osmosis water filters remove too many good minerals, making the water too much like distilled water. (See Ref.18,20,23, on webpage 9)

(10) We use "PROBIOTICS" such as ACIDOPHILUS/BIFIDUS (edible beneficial bacteria which keep bad YEASTS away, such as Candida Albicans, formerly called Monilia). ACIDOPHILUS/BIFIDUS also can eat or control some bad bacteria, and some viruses. The ACIDOPHILUS &/or BIFIDUS are also called PRO-BIOTICS and are beneficial intestinal flora/bacteria (mainly for the large intestine). We keep the jars refrigerated, but not too cold. These are available at health food stores & pharmacies. (See Ref.14,15,23,24,25, on webpage 9).

The ETHICAL NUTRIENTS company makes a very gentle, yet very effective, pro-biotics formula, ("DAIRY-FREE, MAXI-BIFIDUS") that is a milk-free (called dairy-free) powder, made of Bifidus infantum, with only rice maltodextrin as an additive ("said" to be gluten-free, but the label doesn't say "gluten-free"). This can be used by infants, nursing mothers, children, & adults. Follow label directions. Keep refrigerated. This is a simple (yet effective) probiotic formula.

Good health food stores have many choices available, and usually can order whatever you ask for, if your choice is not immediately available. 

Various Acidophilus/bifidus PROBIOTICS can re-populate the large intestine, with good bacteria, after antibiotics &/or steroids, etc. have killed off these good bacteria!

NEW INFO! (9/07): BROAD SPECTRUM ANTIBIOTICS  and/or ACID BLOCKERS, can cause people to sometimes develop a very harmful, dangerous, sometimes fatal, bacterial infection in the "gut" (colon/large intestine)--sometimes in the small intestine too, called CLOSTRIDIUM DIFFICILE (abbreviated C. diff.).

Stool sample testing (see your doctor) can tell you if you have C. difficile or not.  Symptoms of C. difficile, often include diarrhea, sometimes abdominal cramping, very bad odor of diarrhea, and sometimes an orange color of stool, sometimes a jelly-like consistency, pus, mucus, blood in stool.

See these links to articles, for info about treating stubborn Clostridium difficile intestinal infections, by using both (either with or without some other antibiotics):

--probiotics (beneficial) bacteria (Acidophilus/Bifidus) and,

--a "friendly" (usually non-pathogenic) probiotic live yeast (related to Brewer's/Baker's yeast) called Saccharomyces boulardii (pronounced: sack-uh-row-MY-seas, boo-LARD-ee). This "friendly" yeast is not the yeast infection called Candida albicans.

But, people who have very low immune function, or who are in an ICU/intensive care unit, &/or who have a "central line" for intravenous feedings, &/or who have a NG/naso-gastric tube, need to be closely monitored, to be sure they don't get infected by this beneficial yeast, itself. See an informative article at this link:

http://www.postgradmed.com/issues/2002/11_02/joyce3.htm

Ann Marie Joyce, MD; David L. Burns, MD (2 gastroenterologists in Massachusetts)

VOL 112 / NO 5 / NOVEMBER 2002 / POSTGRADUATE MEDICINE,

"....Altered bowel flora increases susceptibility to recurrent C difficile infection. Thus, another approach to therapy is to use probiotics to repopulate or restore colonic bacteria as an adjunct to antibiotic therapy (16) (table 3). Saccharomyces boulardii is a [usually] nonpathogenic* yeast that releases a protein that interferes with the binding of toxin A to its receptor (17). The administration of S boulardii has been shown to be effective both on its own and in combination with metronidazole or vancomycin in patients with recurrent C difficile infection...."

*(check with doctor first, if have very depressed immune system, or if have a central venous line, or if using a naso-gastric tube---such people are at higher risk of getting a "fungemia"--fungus infection in the blood, from this live yeast.)

See more info about C. difficile, including a very helpful website/forum, on webpage 5, in gastric reflux sections.  It is the C. Difficile Support Group, at this link: http://cdiffsupport.com/phpBB/index.php

A landmark, groundbreaking medical journal article by 3 pioneering gastroenterologists in Duluth, Minnesota, tells how putting healthy donor stool (both donor & stool are pre-tested) into a nasogastric tube, to deliver healthy stool bacteria, into the "antrum" of stomach, has been curing over 95% of recurrent C. diff. patients, by re-populating the small and large intestines with good stool bacteria (bacteriodes), that had been destroyed by taking antibiotics, and these good bacteriodes kill C. diff. bacteria and their spores! Here's a (new, as of 1/08) link to the article (older link got changed):

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Some of us have to continue eating the acidophilus/bifidus (daily, or from time to time), but the results seem worth the effort to us. 

Some probiotic bacteria (like milk-free preparations) have FOS's (fructo oligo saccharides) added to their probiotic formulas, to feed the beneficial bacteria, but, some people have noticed worse indigestion, leading to worse reflux, because some bad bacteria ALSO were feeding on the FOS's. I avoid FOS's.

Yogurt and buttermilk contain similar beneficial bacteria, but are milk products, so see (8) above, about milk products.

(11) We use DIGESTIVE ENZYMES. My husband likes Acid-Ease by Prevail, which contains Slippery Elm (inner bark), Marshmallow Root, Gamma-Oryzanol (from Rice Bran Oil), and the plant enzymes Amylase (digests starch), Lipase II (digests fat), and Cellulase I (digests cellulose from plant cell walls). The Acid-Ease does not contain Protease, because PROTEASE (a protein digesting enzyme) can be very irritating to ulcer/GER folks.

The Acid-Ease is NOT an acid blocker. It is not an antacid. It soothes, coats, nourishes, and promotes healing. Its enzymes help with leaky gut syndrome.

I use Total Enzymes (which does have Protease, a protein digesting enzyme) by Nutri-West, a company that sells only to health practitioners (Chiropracters, Physicians, and others), who can order, at cost, by calling 1-307-358-5066. One of the enzymes in Total Enzymes ("malt diastase") may be glutenous. Avoid this product, if you may have a gluten sensitivity.

Digestive enzymes are NOT FOR EVERYBODY, but are helpful for MANY people.

12) ACID BLOCKERS CAN HAVE DANGEROUS (harmful) SIDE EFFECTS: Some examples are:

Acid must be present in the stomach, in order for the stomach to make a substance called Intrinsic Factor. Intrinsic factor must be present with Vitamin B 12, in the stomach, for absorption of Vitamin B 12 to happen, in the ileum (last part of the small intestine), I believe.

Acid blockers therefore prevent absorption of Vitamin B 12. Malabsorption (lack of absorption) of Vitamin B 12, causes NERVE DAMAGE (pain, numbness, pins & needles sensation, etc.) in the peripheral nerves (outside the brain & spinal cord). This is called PERIPHERAL NEUROPATHY. For details about this problem, ask "Rose" at a good Peripheral Neuropathy forum at http://neurotalk.psychcentral.com/forumdisplay.php?s=&daysprune=-1&f=20

If Vitamin B 12 continues to NOT be absorbed, there can also be NERVE DAMAGE to the Central nervous system (brain & spinal cord).

ALSO, the minerals calcium, iron, zinc, other minerals, and important trace minerals, etc. cannot be properly absorbed, when there is no hydrochloric acid in the stomach (due to taking acid blockers, or for other reasons, etc.).

AND, protein does not start to get properly digested (broken down--eventually into amino acids), in the stomach, when there is no acid in the stomach.

Acid blockers can pre-dispose a person to getting a Clostridium difficile intestinal infection! See (10) above, for more about this C. difficile.

Doctors and pharmacists can advise about VERY gradual (slow) tapering down (weaning) schedules (when and if safe) for the acid blockers, if you see good results from trying some of these "tips", etc., for about 2 weeks (with your doctor's supervision). Some acid blockers, when stopped too quickly, can cause rebound acid secretion in the stomach, resulting in excess hydrochloric acid secretion. The REBOUND ACID SECRETION often causes worse GERD symptoms!

ALSO, SOME FORMS OF REFLUX ARE NOT ACID REFLUX, but are ALKALINE REFLUX, (bile is alkaline). Besides refluxed stomach acid (HCl/hydrochloric acid), Pepsin (an acidic proteolytic/protein digesting, enzyme) &/or bile (alkaline) can irritate & damage: the esophagus, throat, vocal cords, & lungs. Acid blockers may not stop alkaline (or neutral) types of reflux!

(13) Do not drink ICY COLD DRINKS, and AVOID VERY HOT DRINKS. Use room temperature drinks, or slightly cool, or warm, but not boiling hot. Extremely cold or hot liquids can irritate the stomach, which is bad for ulcers and can cause gastric reflux episodes.

Some people are addicted to chewing ice. Compulsive ice chewing/eating is called Pagophagia, and is one type of "pica" (compulsive eating of non-foods, or ice). Pagophagia can be caused by an iron deficiency anemia, which can be caused by poor diet, mal-absorption due to acid blockers &/or gluten intolerance etc., internal bleeding, pregnancy, various medical conditions, worms, etc. Pagophagia may also be related to eating disorders (like anorexia or bulimia, etc.) &/or OCD (obsessive compulsive disorders). Teeth can crack &/or voice problems in singers may result from this habit. Some foods are naturally rich in iron. Eating these foods can prevent constipation and stomach problems that some iron supplements cause.

(14) If using beta agonists (like Aluterol) &/or steroids (like Prednisone, etc.) for ASTHMA, learn Buteyko breathing methods. If the Buteyko helps, then work with asthma doctor, to hopefully lessen these asthma meds, both of which can worsen reflux. See webpage 5, --asthma & medications sections, for more about this. Also, see Reference 30, on webpage 9, for info about Buteyko.

(15) Ask physical therapists, chiropractors, osteopaths, etc. if they know any safe adjustments that might lessen GER/LPR, if you wish.

(16) Read (by Dr. Jamie A. Koufman, M.D.--an experienced VOICE DOCTOR/Laryngologist) PATIENT INFORMATION SHEET ON REFLUX by Center for Voice Disorders of Wake Forest University, in Winston-Salem, North Carolina. Here’s a link (may not work now, since Dr. Koufman is now in NYC): http://www.bgsm.edu/voice/pt_info.html  Dr. Koufman was a pioneer in showing the connection between stomach reflux (can be acid reflux OR alkaline reflux) and breathing problems!

(17) Some have found a special (large) GERD pillow helpful for preventing GERD episodes while sleeping and while lying down. Here is a link to the Prop up pillow website:  http://www.propuppillow.com

(18) Hiatal Hernia might worsen gastric reflux, so check with your gastroenterologist doctor, about possibly trying the following non-surgical treatment for mild hiatal hernia:

(19) Avoid harmful chemical air pollution, which can aggravate gastric reflux. See webpage 5 of this VCD website for more information about this.

(20) Some patients have been greatly helped by holistic NUTRITIONISTS, who can give advice about improving the diet, taking nutritional supplements, and avoiding certain irritating or allergenic foods. 

(21) Using the above methods has almost completely freed my husband of needing to use Tums, and seems to be nicely controlling his and my GER/LPR. We have never used acid blockers.

(22) Using the above methods, in addition to the SINUS SURVIVAL tips, has helped us to prevent VCD attacks, and COUGHING problems, in us.

(23) Please check with your doctor, in advance, to be sure that it is OK for you to try these tips, in your particular case. 

a) Please get monitored by your doctor, to be sure that no more damage to the throat, esophagus, stomach, vocal cords, lungs, etc. is happening, from possible SILENT gastric reflux.

b) Pregnant or nursing ladies should check with their doctors, before trying any of these tips.

c) Check with your doctor and pharmacist, to be sure that there would be no harmful interactions between any of your medications, diet that you may be on, and any herbs, foods, etc. mentioned in these tips.

d) Check with your doctor, to be sure that these tips would not interact badly with any medical condition(s) you may have.

These tips help my husband and me (adults). Some of these tips may be OK for children, and others may not be OK for children. Check with your doctor! Babies with gastric reflux need DIFFERENT treatments (see Appendix C, below), not these tips (except for raising the head end of the crib, if your doctor says it is OK to do this, etc.). Check with your doctor! 

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APPENDIX C:

Some TIPS about INFANT GERD & COLIC:

Check these ideas out with the doctor who is seeing and helping your infant or child, before trying the ideas. The sources of these ideas will be listed at the end. And, see a Pediatric GASTROENTEROLOGIST, and a Pediatric ENT/Ear, nose & throat doctor, and a Pediatric ALLERGIST, ETC., to help you find all underlying CAUSES of your child's reflux, etc.

(1) Fresh breast milk from the mother when possible, as long as mother eats VERY HEALTHY FOODS, and eats in comfort, and not in a rush, not when angry or upset, and mother avoids foods that the baby may be SENSITIVE TO. La Leche knows about breastmilk banks, if nursing is not possible.

(2) FOOD SENSITIVITIES, FOOD ALLERGIES, & FOOD INTOLERANCES can often cause or worsen GERD! 

a) Nursing mothers and infants should avoid drinking cow's milk, which has more casein (milk protein) in it, than goat's milk has. The baby may be sensitive to the milk protein called casein. Nursing mothers should also avoid eating cheese, ice cream, whipped cream, yogurt, buttermilk, kefir, etc. if these were made from cow's milk. Nursing mothers can (with doctor permission) drink catnip tea, fennel seed tea, etc. which would go into the breast milk, often relieving colic. Babies and nursing mothers should AVOID cow's MILK & cow's milk products (Some say that an autoimmune reaction to cow's milk proteins can cause juvenile onset diabetes. Cow's milk can also cause colic, GERD, etc.)

b) Raw, fresh, organic GOAT MILK (if your doctor says it is OK), from someone you know, who takes very good care of the goats, so the milk is safe, is sometimes better tolerated than cow's milk.

c) Some babies have GLUTEN SENSITIVITY (like CELIAC DISEASE &/or other types of GLUTEN SENSITIVITIES), and must avoid gluten completely, in their food, and in milk from the nursing mother. Nursing mothers can try a gluten-free diet for a few weeks to see if this helps, and make sure the baby is not eating or drinking anything that contains GLUTEN.

Nursing mothers and babies can avoid the following glutenous foods: WHEAT, RYE, OATS, BARLEY, BUCKWHEAT, ETC. See Appendix B, above, for much more about gluten intolerance.

BROWN RICE (organic is best) and CORN are gluten-free, but many are sensitive to corn proteins, so temporarily avoid all corn products, including corn-syrup (a sweetener). READ LABELS CAREFULLY! 

Also, try to avoid cross contamination, where gluten accidentally comes into contact with non-glutenous foods (at a food processing plant, at food stores--like from bulk bins using the same scooper, in the home, etc.)

Millet agrees with some Celiac Disease patients, but is not tolerated by other Celiac Disease patients. Temporarily, avoid millet.

For some Gluten Sensitive/Celiac Disease, etc. patients (babies included) it is best to AVOID ALL GRAINS TEMPORARILY, and then try organic brown rice, later on. Recent data shows that Celiac Disease is found in at least about 1 out of 120 people (not rare at all!). If the baby has ancestors from Ireland, England, Scotland, Wales, Italy, Scandinavian countries, Northern Africa, Northern Europe in general, there is even a higher (genetic) chance of having Gluten Sensitivity/Celiac Disease, etc. And, gluten sensitivity (Celiac Disease &/or other types of gluten sensitivity) may exist in as many as 1 out of 3 people! 

Untreated Celiac Disease or any type of untreated gluten sensitivity can cause or worsen GERD. The treatment for Gluten Sensitivity/Celiac Disease is a gluten-free diet, plus GF (gluten-free) nutritional supplements (vitamins, minerals, etc.) prescribed by the doctor, or found by parents, with the doctor's OK.

d) Discuss with your pediatrician, whether soy &/or corn products are OK or not for the baby. Soy &/or corn may be OK for some babies, but some other babies are sensitive to soy proteins &/or corn proteins, and should avoid soy &/or corn products. If sensitive to corn or soy, eating such foods can cause reflux.

e) To find out some foods your baby may be sensitive to, please see link "AA", at the bottom of http://cantbreathesuspectvcd.com/links.html . This "AA", is a link to Dr. Kenneth Fine's (MD) "EnteroLab", which does special stool testing (analysis), recently patented. This is often more accurate (and is non-invasive), than intestinal biopsies (which are invasive). Link "AA" is http://www.finerhealth.com

f) If the baby may be lactose (milk-sugar) intolerant, ask the pediatric doc about possibly pre-treating breast milk or goat milk with lactase enzymes to pre-digest (break down) the lactose (milk-sugar).

g) Avoid all artificial ingredients. Avoid so-called "natural" colors, flavors, sweeteners, etc. Read labels carefully.

(3) If the baby has ever taken antibiotics, the baby may need to have (drink) BENEFICIAL (good) EDIBLE BACTERIA (called PRO-BIOTICS) to replace the good bacteria in the large intestine, that were killed off by the antibiotics. 

The ETHICAL NUTRIENTS  company sells an INFANT/NURSING MOTHER formula of BIFIDUS INFANTUM probiotics, called DAIRY-FREE, MAXI-BIFIDUS, that has only rice maltodextrin (said to be gluten-free, but the label doesn't say gluten-free) mixed with the Bifidus infantum powder. This is a milk-free preparation, and can be very helpful to treat or prevent yeast infections (like Candida albicans/thrush, etc.) in a baby that took anti-biotics. Look in the refrigerated section of good health food stores. Check with your pediatric doc, and follow label directions carefully. The store can order it, if not immediately available. Bifidus is related to Acidophilus. A milk-free probiotic is a good substitute for cow's milk probiotic foods like yogurt, buttermilk, kefir, etc., which may cause GERD, due to sensitivity to milk sugar or milk proteins in cow's milk.

Avoid FOS's (fructo oligo saccharides), which may, in some cases, cause worse reflux, when the FOS's are eaten by bad bacteria in the intestines. See Appendix B, above.

(4) Avoid tight diapers, which can cause a gastric reflux episode. Keep diapers loose.

(5) Avoid any pressure on the abdomen or stomach area of the baby, including the sitting position. Either hold baby upright, after each feeding, or have the crib tilted/slanted at a 30 degree angle, with head end higher (elevated) than feet. Some doctors feel that having the baby in bed with mother can help also, so that the baby feels more secure, and mother can see quickly, if the baby is having any BREATHING problems, DUE TO A GASTRIC REFLUX EPISODE. Quickly recognizing and treating breathing difficulties, can help to prevent SIDS (Sudden Infant Death Syndrome), caused by an infant GERD episode. Ask your baby doctor (pediatrician &/or pediatric pulmonologist/lung doctor &/or pediatric GI/Gastro-intestinal doctor), about this.

(a) Keep head of baby higher than feet, by putting blocks a few inches thick, under the head end of the crib, making the crib tilt/slant, at a 30 degree angle, with head end higher than feet.

(6) Check with your baby doctor about which positions are safest for the baby, when lying down. Some say that sleeping on the left side may reduce reflux. Some people think that lying on the abdomen can put a baby at risk for SIDS (Sudden Infant Death Syndrome). There is disagreement about what are safe positions.

(7)For reflux &/or colic: Two books (see sources) recommend using tiny amounts of the herb Slippery Elm inner bark powder, which can be mixed with good quality well or spring water (avoid distilled water, because it has no minerals at all in it), or with breastmilk or with goat milk. Slippery Elm is soothing, coating, healing, and nourishing, AS LONG AS THE BABY IS NOT ALLERGIC TO ELM TREES. (Check with the doctor first).

These books also recommend Marshmallow root powder (mixed with water or safe milk), if baby is not allergic to this herb. (Ask doctor first).

These books also recommend making a weak tea out of the SEEDS of FENNEL, or DILL, or CARAWAY, or, a mild CATNIP (herb/leaf) tea. This weak tea can be taken by the baby AND/OR the nursing mother. (Ask doctor first, about trying each of these alone, and then maybe a combination).

(8) One website (see sources) had a father recommend a very TINY amount of the spice ginger, mixed with water or safe milk, for his baby that had GERD (Gastro-Esophageal Reflux Disease).

(9) Keep baby away from any CIGARETTE SMOKE. Second-hand smoke can cause a GERD episode in a baby!

(10) It can be VERY HELPFUL to KEEP IN PHYSICAL CONTACT with the baby, ESPECIALLY WHEN FEEDING (NURSING, ETC.), which is reassuring to the baby, and promotes better digestion.

See the sources below, for more information:

(A) The Wise Woman Herbal Childbearing Year, by Susun S. Weed (1986). Ash Tree Publishing, Woodstock, New York

(B) Back To Eden, by Jethro Kloss (1939), Loma Linda, California

(C) Prescription for Nutritional Healing, by James F. Balch, MD and Phyllis A. Balch, CNC (Nutritionist) (1997), Avery Publishing Group, Garden City Park, New York

(D) Reflux Digest-Spring 2000, at http://www.reflux.org/reflux/paghomfa.nsf/Pages/digest4-1.htm

The present name (2002) of this parents' support group is : PAGER (Pediatric/Adolescent Gastroesophageal Reflux Association), and their website has a parents forum, at http://www.reflux.org

(E) Conservative Therapy, The Best Way to Deal With A Baby With GERD, by Tatiana Bidikov, MD (But, DO NOT PUT BABY ON ABDOMEN, UNLESS YOUR DOCTOR SAYS IT IS SAFE!! Some doctors think baby lying on the abdomen could cause SUDDEN INFANT DEATH SYNDROME (SIDS). ASK ABOUT PUTTING BABY ON HIS OR HER SIDE, AND WHICH SIDE IS BETTER, if OK with your pediatrition.)
http://www.ccmeds.org/bidikovtgerd.html

(F) Go to the forums called Gluten Sensitivity/Celiac Disease forum, & Peripheral Neuropathy forum, both at http://neurotalk.psychcentral.com/index.php and write a message to a mom "JCC/Cara" who knows much about Gluten Sensitivity and Celiac Disease. Look for topics/threads by "jcc/Cara" about FOOD SENSITIVITIES CAUSING MALABSORPTION. Read JCC's links to websites of Dr. Fine, who is an EXPERT at diagnosing and treating Celiac Disease, and other food protein sensitivities & food non-protein intolerances that can lead to INFANT GERD. Links to additional good gluten-intolerance forums, are http://www.celiac.com and http://www.forums.delphiforums.com/celiac Also, see (G) below.

(G) "EnteroLab", a laboratory in Houston, Texas, created by an experienced Gastroenterologist, Dr. Kenneth Fine, MD, does special stool tests (you send in a stool sample from your child), to accurately tell you some foods your child may be allergic to, sensitive to, or intolerant of. Then, avoiding these foods can often greatly help to lessen gastric reflux! Check with your child's doctor. Dr. Fine's website is at http://www.finerhealth.com . Also, see (F) above. 

(H) National Vaccination Information Center (NVIC) has an informative website about the risks & dangers of vaccinations, including SIDS (Sudden Infant Death Syndrome). Their website is at http://www.909shot.com

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I mention brand names of some things that we have used and like, or that others have recommended to us. However, we get no money and no compensation from the companies mentioned.

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APPENDIX D:

Some COMPUTER ERGONOMICS (body position) TIPS. These tips can prevent neck muscle tension, thereby decreasing VCD:

1) Fold down the plastic flaps that are on underside of keyboard. Put computer keyboard ON LAP, not on desk.  This allows upper arms to relax, hanging down at sides, by gravity. This can prevent (or treat) Thoracic Outlet Syndrome (TOS). Some symptoms of TOS can be any of these (at least): neck muscle tension, arms might feel heavy, or painful, or numb, or pins & needles in arms, unusual, unpleasant "alarm" feeling can sometimes wash over upper torso in front &/or over the upper back, etc. 

With keyboard on lap, you won't need wrist rests. 

Most find it helpful to use an office chair that doesn't have arm rests, or, where arm rests can rotate back, out of the way of arms. 

To prevent keyboard from sliding forward, off the lap, brace right part of front edge of keyboard against front of a desk drawer, where desk drawers are located to the right of right knee. Front edge of keyboard is closer to knees than to belly. It also helps, to wear pants or skirt that are not too smoothe in texture. 

From shoulders down to elbows, should be a vertical line (or close to vertical--just about "plumb"). From elbows to fingers, should be a slightly descending line (elbows a little higher than hands). Wrists should not be noticeably bent. You pivot lower arms from elbows. 

It helps to learn how to "touch type", on your keyboard. Position the keyboard (left/right) so that hands are symmetrical, in "ready" position for typing.

2) Be sure monitor is not too high or too low, to prevent neck strain. Notice where your natural gaze lands, on the monitor. A normal gaze descends (drops) slightly, from eyes, to whatever object the gaze falls on (monitor).

If your natural gaze falls very close to the bottom of the monitor screen, the monitor may be too high, and may need to be lowered.

If your gaze falls very close to the top of the monitor screen, the monitor may be too low, and may need to be raised up higher.

If your gaze falls somewhere in the middle of the monitor screen, your monitor is OK where it is.

3) Use computer glasses (tri-focal length power, no stronger than +1.00, or preferably +0.75), or, buy magnifier clip ons to clip onto your eye-glasses. Power of clip-ons should be at most +1.00, or if possible, +0.75 

Optometrists sell computer glasses, and magnifier clip-ons (some other type businesses also sell magnifying clip-ons). 

If computer glasses (or clip-ons) are not used, when sitting at the computer, neck strain (from craning neck, trying to see monitor better) could cause larynx to move out of normal position, causing stress on vocal cords, pre-disposing one to having VCD.

Avoid contact lenses. 

If you don't need glasses, you can buy non-prescription magnifying glasses, having a power of +1.00 or +0.75, to be your computer glasses, or, buy magnifying clip-ons, to put over plain glass eyeglasses, or, have computer glasses made for you by an optometrist.

4) Find a Speech Pathologist who knows how to do and teach MANUAL LARYNGEAL MUSCLE TENSION REDUCTION TECHNIQUES, if needed. Nelson Roy, in Salt Lake City, Utah, teaches this to Speech Pathlogists, and others.

5) Tilt seat of office chair (part you sit on) slightly downward in front (part of seat closer to knees, than to belly), to relieve pressure under thighs, and to preserve the lumbar curve of the back. 

6) See if office chair seat is too low or too high. Your feet should comfortably be flat on floor, somewhat forward of a plumb line down from knees. Don't tuck feet under chair. Avoid crossing legs.

7) See a good Occupational Therapist (OT), preferably one who knows & uses Feldenkrais Method, and other ergonomic tips.

8) Don't sit still. Move body (with Feldenkrais movements), stretch, etc., while sitting in office chair. Get up often and walk around.

9) When driving, try holding steering wheel lower down, and try not to hold on too tightly. Some find pillow support for arms to be helpful. See a good Thoracic Outlet Syndrome (TOS) forum, for more ergonomic advice, at http://neurotalk.psychcentral.com/forumdisplay.php?s=&daysprune=&f=24

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APPENDIX E:

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