Hacker News Reader

Comment by thaumasiotes | Hacker News Reader

I have an issue which may or may not be a sinus issue:

I have phlegm in my throat, constantly. I need to clear my throat (through voluntary coughing) every few minutes. If I don't do that, the phlegm dries in place and I end up with a restricted airway and difficulty breathing. I can't really sing because my voice will catch on the phlegm.

If you know of anyone with this symptom, or who is familiar with this symptom, please let me know.

So far I've seen an allergist, an ENT, and a gastroenterologist, and the response from each has been "that's not my problem, see someone else". (The ENT did at least stick a camera through my nose and photograph phlegm stuck to the sides of my throat, which gives me a response to the people who say "what if you're just imagining it?")

View on HN

I'm not a doctor, there is an enzyme, bromelain (from pineapple seeds) which may help.. kind of making the phlegm more fluid.

But then, the phlegm could be a defense (mis)reaction to pollution or irritation by stuff you have accumulated in your sinuses - you may try to wash it (saline) and kill it (all bacteria whatever in layers, deep deep in, since years may be still there - kind of your suspended medical history).

Post nasal drip? That doesn't really narrow down the cause though. Could be allergies, deviated septum, viral infection, a whole host of things.

If it is post nasal drip, pseudoephedrine/Sudafed would clear it right up, if only for a few hours. I wouldn't recommend being on that long term, but it is probably worth an experiment.

You didn't say you saw a pulmonologist. I just read about a guy that discovered he had CF at 55 years old.

I haven't seen a pulmonologist. I have had two separate chest X-rays, but that's as far as examination of the lungs in specific has gone.

Have you tried an elimination diet to check whether it could be a reaction to something you're consuming?

I've tried the following things:

- Claritin

- Flonase

- Ranitidine (Zantac)

- Omeprazole

- A diet based around avoiding things that "might" cause heartburn. This list included literally everything I eat; this project had to be abandoned. But for a while there I was basically only eating chicken soup and milk.

- An allergy battery (negative on all tests)

- Nasal irrigation

- Mucinex

Try Pantoprazole.

I had the same issue, and it didn't respond to Inexium (PPI) but cleared up totally with Pantoprazole.

I'm on pantoprazole now. (The Mucinex is also current.) I just hadn't listed it due to classing it with omeprazole.

The ranitidine, omeprazole, and pantoprazole are all intended to treat pain[1] from heartburn, and they've all worked at first and gradually lost effectiveness. (While still being mostly effective, just not totally effective.)

However, going without heartburn pain for weeks at a time has not helped my throat. When this didn't work, the gastroenterologist put a sensor down my throat for a day to record pH levels, and reported the results to me with "good news! You don't have heartburn!"

Of course, I do have heartburn. The response to "in that case, what does it mean that I have this burning chest pain after eating which is immediately relieved by tums?" was "well, some people are more sensitive to acid than others".

(I have many classic symptoms of acid reflux, including minor regurgitation of food after eating, "globus sensation" (feeling of a ball in the throat) when swallowing, and of course burning pain in the chest.)

But I continue the heartburn medication anyway, because heartburn hurts and I independently want to avoid it. :/

[1] Actually, they're intended to suppress the acid itself, not the pain you feel from exposure to it.

Maybe try eliminating the dairy products for a couple weeks just to see? Some people find that they cause phlegm but it varies by individual.

Have you tried the "functional medicine" approach to treating heartburn?

The theory is: instead of "too much stomach acid" being the problem, sometimes it's "too little stomach acid". Age, medications, and infections may all lead to reduced stomach acid production, which leads to unwanted fermentation and impaired digestion of carbohydrates in the stomach, which increases the production of gas, which increases intra-abdominal pressure, which causes the lower esophageal sphincter to malfunction and let the little acid that is left travel up into the esophagus, where it irritates the lining and can cause symptoms like you describe.

Might be worth looking into. A simple way to test this theory would be to get a "Betaine HCL with Pepsin" supplement and take it with meals to see if that helps. Do not try this if you have ulcers or other issues with the integrity of your stomach lining.

I only mention it because this approach cured my persistent heartburn and sore throat issues, after various PPIs worked for a bit and then failed. Conventional medicine is great, but why they continue to recommend PPIs for chronic GERD cases is a mystery to me. The stomach is meant to be acidic - the goal should not be to neutralize the acid.

Good luck!

I'll definitely consider this. It's bothered me for a while that the treatment for the heartburn is acid suppressants, but one of the few things that seems to be helpful is drinking lemonade.

Do you smoke anything? I quit smoking everything because of similar symptoms and it all went away after a month of coughing heavier than when I smoked. Try going “ha!”, “hoah!”, “huh!”. Any help?

No, I don't smoke.

And I've been coughing for three years. :/

[edit:

Sometimes when I cough there is a tearing sensation. If this happens, I generally interpret it as phlegm being dislodged from a place where my coughing wasn't getting it before. I will generally devote a lot of extra effort to coughing at that point. No effect overall, though.

A couple of times I've brought up blood spots after some particularly dedicated coughing.]

Any autoimmune problems? Thick fluids can be a sign of cystic fibrosis and similar non-fun.

None that I'm aware of. Would this be the only manifestation?

probably not but some can kick in later in life too. theres a cheap "sweat salinity" test they give to newborns a doctor can do to rule out a family of such things.

Have you been screened for lung cancer?

I've had two chest X-rays, the second of which was a response to my report that I'd coughed up blood.

Reply on news.ycombinator.com