Why do Proton Pump Inhibitors get used for LPR?

Before the midnight service last week I was sat talking to a relation of one of one of the sides people who was staying over Christmas and had come along to the service. As is often the case we got onto my ongoing medical issues – it often comes up when they find out that I’m usually in the choir and ask why I’m not at whatever service it is we’re attending. This time the conversation was more interesting because the person I was speaking to was from a medical background.

First off she hadn’t heard of laryngopharyngeal reflux, so I explained what my symptoms were and what had been diagnosed, we then got onto the treatment I was on, in this case 30mg of Lansoprazole daily. Although she didn’t say it outright, she seemed somewhat concerned at the fact it had been prescribed, and also how long I had been taking it.

Anyway, after that I’ve had a bit of a look at some of the discussion about the use of Lansoprazole, and Proton Pump Inhibitors in general for the treatment of laryngopharyngeal reflux.

Probably the most interesting is one that comes up in Google pretty easily, a paper written by Christina Reimer and Peter Bytzer of the Department of Medical Gastroenterology, Køge University Hospital, Denmark entitled “Management of laryngopharyngeal reflux with proton pump inhibitors”. The interesting part is when it gets on to reviewing the number of medical trials, in particular the double blind studies, the first paragraph of their summary makes the point pretty clearly:

Data from controlled treatment trials convincingly show that PPI therapy is no more effective than placebo in producing symptom relief in patients suspected of laryngo-pharyngeal reflux disease. Furthermore, neither symptoms, nor laryngoscopic findings or abnormal findings on pH monitoring will predict response to PPI therapy. A reliable diagnostic test for LPR or one that might predict response to a PPI does not exist.

When you actually look at the figures, in some of the trials the placebo group had a greater symptom relief than those on the drugs, and of the studies reviewed only one showed a statistically significant higher rate for the group taking the drug. As the paper says, given these results, why do patients still get put on a PPI as a first course of action?

Certainly that was what happened in my case, and I’ve been on it since September, more than three months. Both my ENT and my GP have very matter-of-factly suggested that I could be on them long term if when I come off them symptoms return – this then was rather interesting when I pointed out to the GP that there is a well known (though not to him it seems) rebound effect from PPI use.

In my case, although it changed what was happening, the Lansoprazole certainly didn’t stop me refluxing, if anything I was refluxing more, and pretty consistently over the past couple of weeks within an hour or so of taking the pill. Since my throat has apparently healed the thought was that it changed the pH of what was refluxing, without actually addressing the underlying problem of what was causing me to reflux. Anyway, the latest run of pills finished over the holiday, and since my ENT has now declared that I am better I’ve tried coming off the Lansoprazole, and thus far I’ve not had any real problems, indeed although there have only been a couple of repeats of the nasty tasting reflux the pill used to induce they have been less than I was getting. It’s just a question now of waiting for my digestive system to recover from the long term effects of the PPI…

Breathing New Life into an EEE PC 4G Surf

ASUS eeePC with Evesham LaptopBack in the mists of 2008, before the rise of the Apple iPhone and iPad, it looked like the future of portable computing belonged to the netbook. Asus were the first into the market with their EeePC, and back then I picked up one of their 4G Surf models. Of course things have changed a lot now, and although there are still a number of manufacturers producing computers in the segment the market has been hit hard by the move to tablet computers.

Back then I quite liked the little computer, the battery life was pretty lousy, and the 800×480 display causes many websites to bring up a horizontal scroll bar. It also lacks any sort of 3G connectivity so it’s very much tied to needing readily accessible wi-fi. What has really stymied it though has been the general lack of support with the software.

The original had an install of Xandros Linux, although you could swap that for Windows XP if you wanted, however a critical factor in the OS alongside the restricted screen resolution was the tiny 4Gb solid state drive. Alongside being mindful of the limited lifespan of such drives in terms of write cycles, the space on the drive is severely limited for most installs. That tended to leave you relying on Asus to keep the OS updated, which they haven’t. Sticking with the official software you’d now be rather behind the latest versions of the OS, which is why there have been a number of attempts to provide a replacement OS.

I’ve had a couple of attempts trying some of the new distributions, but ultimately I’ve not really found them up to scratch, in particular you’d find that whilst some of the software worked on the restricted screen, at other times critical dialogs would have buttons off the edges of the screen. However with all of them there was a general feeling of sluggishness, basically the OS was expecting a faster processor than the old Celeron that powers the little Asus.

However having been playing around with the machine again this holiday I’ve come across another option – Peppermint – a Linux distro based on Ubuntu. One of it’s key features though is it’s designed to be small and resource light, ideal therefore for small comparatively underpowered computers like the EEE PC. It’s worth saying that installation on a small SSD such as the one in the EEE PC is not without it’s problems – the install dialogs are slightly too tall for the screen which is a pain, and also it won’t install straight off the USB drive. To get it to install you have to boot into Peppermint from the USB drive, use alt-F2 to run a command, and type the following:

gksu gedit /usr/lib/ubiquity/plugins/ubi-prepare.py

Then on line 310, change “min_disk_size = size * 2” to “min_disk_size = size * 1.4

EEE PC 4G Running PeppermintThen you need to run the installer using the icon on the desktop. After that though it all works.

You are obviously still limited by the screen resolution, however there are big improvements through the fact that Peppermint uses Chrome as it’s browser rather than the increasingly bloated Firefox. Out of the box the distro is trying to be a network connected OS so it provides links to Google Docs and Google Calendar rather than trying to squeeze office software on. It’s pretty straightforward to install Skype, which makes the little EEE PC a nice little device to use for video Skype calls. However across the board the little Asus feels more swift at doing what is asked of it rather than the sluggish performance I was seeing with other installs.

In fact I was so impressed that I tried the 64-bit version of Peppermint out on another old PC, my Evesham Laptop that has long since been gathering dust under my desk. Sadly although the OS works beautifully on the Evesham, it can’t cope with the dodgy power problems the rather badly assembled Evesham has suffered from – basically the PC gets increasingly hot until a loose connection around the power supply cuts out and the machine shuts down. Something for a hardware engineer to sort out at some point I suspect.

Anyway if you’ve got an old EEEPC around and want a fun little project to resurrect it, I can certainly recommend giving Peppermint OS a go. Whilst it’s not going to be rivalling a modern machine once it’s done, it does give you a perfectly usable little computer at the end.

Health Update

Throat 1I’m just back from a follow up visit to my ENT specialist at the hospital having a check up and getting the results of the biopsy they took during my microlaryngoscopy.

The good news is that the biopsy came up all clear, i.e. benign and not cancerous. He’s also happy that the inflammation is continuing to go down so although I’m still refluxing stuff it’s not the acid that was causing the damage. Next on the agenda is some sessions with a speech therapist as I still get discomfort from my throat when I try to sing so I suspect I’m going to need to work back up to what I was doing before. As before he used an endoscope to check out the state of my throat, and since the speech therapist will need to see what is going on in my throat he took two pictures and gave me a copy, so what you can see here is one of two shots taken during the session. It’s worth noting that the original shots look a lot more pink than what the scanner has produced.

What is interesting is having asked me to sing a note whilst he was looking at my throat he said that I have an asymmetrical voice box – not uncommon apparently. Looking at the picture, front is at the bottom of the picture so the left side of my voice box is on the right of the picture and the right is on the left. Anyway, you can pretty clearly see my right vocal fold, but the left hand one is slightly hidden. When I sang a note the right side apparently moved a lot more than the left with the left remaining largely hidden. Now of course they can’t say whether it was like that before all this started, or whether it’s always been like that, but I guess we’ll find out when I start seeing the speech therapist next year. Aside from that I’m still on the Lansoprazole, although once things settle down that will be tapered down to the 15mg dose and then hopefully to none, but that will be under the care of my GP rather than keeping needing to go back to the hospital.