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#003 Purpose of the Doctor Evka platform

Does your baby or toddler have ANY of these "reflux-y" symptoms? 

1.  Feeding concerns

2.  Vomiting

3.  "Too much" crying

4.  Poor growth

Treatment differs based upon the diagnosis, but what if you are not certain of the appropriate diagnosis? Is it possible for a caregiver to find the appropriate guidance?

Absolutely!

You want to feel empowered and validated.  Maybe that means that the medical team doesn't dismiss you when you say that you're concerned about how your child... Maybe that means that you get told, "We believe you, and here's how we can help."  

But you keep being told that your young child  "has reflux" and "this is all normal" when your intuition tells you otherwise.   But it takes forever to see the appropriate doctor. But when your child gets an evaluation, it is followed by a lot of "we don't know exactly why" or "we don't have a good solution". But even if you do get a diagnosis, you are left with a lot of questions...

You have no idea what to do next or who you can trust.

Hi!  I'm Doctor Evka.

I’m a board-certified family physician, a life coach, and a mother who worried about her young child's "reflux-y" symptoms : crying, feeding challenges, vomiting, "poor growth", etc. Yet very few individuals believed the extent of the problem or knew how to really help!  

I started the Doctor Evka platform when I realized there is an enormous gap in knowledge and resources not only on that different medical diagnoses that have "reflux-y" symptoms but also in how caregivers and their young children get the appropriate help. 

Because of my medical experience, my book knowledge, my various certifications, and my day-to-day experience, I grew to have an actionable knowledge base.  Then I became a life coach to boot!  With what we implemented, my child is almost like a different person, and I have so much more of my life back.  

Let me help!

On the Doctor Evka platform, you will find important  topics clarified.  As a physician and a mom who gets it, I give you the tools to take on your child's "reflux"  related challenges: feeding concerns, vomiting, crying, and "poor growth".  I also turn them into actionable steps that you can start taking today to improve the situation.  To gain powerful understanding of your child, obtain more control over the situation, and get more of your life back, check out my Doctor Evka VLOG or PODCAST.  If you're ready to go all in - and get further results -  then check out of my BOOKS or  PROGRAMS.

JOIN THE COMMUNITY OF CAREGIVERS TO YOUNG CHILDREN PURSUING ACTIONABLE  KNOWLEDGE AND A SENSE OF CONTROL OVER THEIR CONCERNS

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#002 What can be mistaken for acid reflux?

Many children though to have reflux may actually have something else going on.  This is especially true if we are discussing pathological reflux.  We are not talking about those children who spit up every once in a while  If a young child has vomiting,  excessive crying, and weight changes, we are not talking about run-of-the-mill reflux.  We are talking about something else, and I want to spend this episode discussing that. What are some of these mimickers of reflux?  

On the Doctor Evka website, in the "about" section, you will find the wording, "Click here to get a list of diagnoses that might mimic reflux."  That list is huge.   I will link to it here.

Some of the medical conditions on that list include non IgE-mediated food allergies, FPIES, eosinophilic esophagitis, various motility disorders, cyclic vomiting syndrome, etc.  When people attribute young children's symptoms to these other medical conditions, are they disregarding these other diseases?   

Such disregard can happen when it comes to diagnoses.  Did you know that the youngest children for a given grade level are at high risk of being diagnoses with attention deficit hyperactivity disorder or ADHD?  This is compared to children in the same grade who are older.  If a third grader is born November, for instance, that person is more likely to be diagnosed with ADHD compared to a third grader who is born in July.  Both children are at the same grade level, but the younger child might naturally be a bit more immature.  When you are told by the school that your younger child might need to be evaluated for ADHD, perhaps what the school is actually describing is a case of immaturity.

In the same way, parents might be told that their children have reflux.  In fact, it is a common diagnosis that is often given in the first six months of age. Not even necessarily by doctors but also by other members of the general public!   Some children who cry a lot, have feeding challenges, vomit, or have changes in their growth curve may be prescribed medication for reflux.  Even if doctors don't prescribe it, perhaps a friend tells them, "Give your child a medication for reflux; you can even buy these medications without a prescription." 

Yet a couple of good, randomized studies suggest that there is no benefit to the treatment of reflux in young children with acid suppressors.    If you give these children histamine blockers or proton pump inhibitors to treat the symptoms of reflux, the children might not get any better. 

There's a free course about one of the treatments of reflux with some of these acid suppressors on my website - DoctorEvka.com.  I'll link to it here.  

The free course is worth taking if you ask me.  

Why then is it that some caregivers swear by acid suppressors? Why do they say that they gave their children acid suppressors, and their symptoms seemed to get much better.  Were they lying?  I don't think so.  I believe them.

Part of the reason why some children improve with acid suppressors is not because these children have reflux.  It could be because these acid suppressors treat other medical conditions - not just reflux.  In some cases, they are actually of benefit. Again, I discuss this in my free training.  

In the interim, I want you to understand that acid suppressors do not treat run-of-the-mill reflux as defined in my prior episode.  (That's the episode in numeric order that comes right before this one.)  In fact, there are risks to acid suppressors. For instance, some acid suppressors - like proton pump inhibitors - actually carry a significant risk with them. Children whose stomach acid is lowered may be at increased risk of developing lower respiratory tract infections like pneumonia.  Stomach acid works as a line of defence against infections.  When the stomach's contents become less acidic, a child's may become more vulnerable to infections.

One of my goals on the Doctor Evka platform is to give you a better sense of what exactly your child has.  Is it just run-of-the-mill reflux?  Is it something else?  To learn more about how you can figure this out, I can link you to the following section.

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#001 What is Reflux

Baby Sam was hungry, but at a few weeks of age, he started to reject both the breast and the bottle. He would appear irritable, and his mother thought he was hungry because it had been a while since he last fed.  She would hold Sam in her arms and introduce him to either formula or breast milk.  Sam would put the nipple in his mouth, suck for a short period of time, arch his back,  turn away, and scream.   After a period of time, he would return to the nipple, suck for a short period of time, and scream again.  Feeding took forever because this is how the feeding behavior looked.

In the meantime, Sam's mother became increasingly upset.  She did not know why baby Sam was rejecting food.  She took Sam to see either the pediatrician or the family medicine physician as either of them can see children.  His mother became increasingly upset because Sam seemed to refuse to feed.

Sam's doctor thought that perhaps his symptoms were that of silent reflux.  He prescribed an acid suppressing medication.  Guess what happened?  Although in many cases I am sure that these acid suppressive medication could have at least some benefit, his symptoms did not seem to get any better. You see, acid reflux seems to be a common diagnosis these days.  However, when given acid suppressing medication, some children's feeding does not get better.  Why is that?  

This conversation will span two different episodes.  (See the end of this post for a link to the second episode.)   In addition, this podcast is part of my new free training on histamine blockers.  I will link to it here.  The free training will tell you a whole lot more than this episode can, and I highly recommend that you take it.  


Our questions about reflux are as follows.  First, what is reflux?  Second, why do we often say that children with vomiting, feeding challenges, or a lot of crying have reflux?  I am going to spend the rest of this post discussing what reflux is, and then the next episode will be about its role in these symptoms. (The link to the next post will be at the end of this article.) 

It's often said that many young children develop reflux, but reflux - in and of itself - is overly diagnosed.  Most babies and some toddlers have reflux.  Then why it is that when young children have feeding challenges, vomiting, or excessive crying, the culprit is often thought to be reflux?  It almost seems as if we are medicalizing normalcy.  Today I wanted to discuss what reflux is. 

If you look up the definition of reflux in the dictionary, you might come across the following definition:  Reflux is the flow of fluid through a tube in the opposite direction to how it is meant to go.   There is a physical reason why backwards flow can happen in babies.  

You can think of the digestive tract as one hollow tube filled with muscles.  The stomach is an enlarged portion of that hollow tube, and the stomach has a ton of muscles.  When we eat, food goes into the mouth, down another portion of this digestive tube, through a ring of muscles, and into the stomach.  For many older children and adults, the ring of muscles keeps this upper portion of the digestive tube separate from the stomach.  (One upper portion of the digestive tract is called an esophagus.)  

The stomach has strong muscles.  These muscles do what many muscles do; they contract and relax.   The stomach also produces acid.  Thanks to the action of this ring of muscle, this acid does not often wind up in the tube connecting the mouth to the stomach (i.e, in the esophagus).  If the ring of muscle cannot quite do its job, however, then as stomach muscles contract and relax, acidic stomach juice may get into this tube.   

Think of the stomach like a stomp rocket.  I'm going to tell you how to make a quick one.  Take an aluminum juice pouch; part of the packaging usually includes a straw surrounded by a plastic wrapper.   Make a small ball out of the plastic wrapper. Attach one ends of the straw to the juice pouch.  Tape it in place.  Attach the other end of the juice pouch to the small ball.   Now stomp on the juice box filled with juice.  The small ball should fly out from the other side of the straw.  In fact, if the straw is not securely fastened to the juice box or the stomp is strong enough, perhaps the straw and some juice will fly out as well.

The stomach does a similar stomping action.  The goal of this stomping is to propel food further down the digestive tract.  Its goal is not to have the food move backwards and up and out of the mouth.  However,  if the muscle connecting the stomach to the tube above it cannot properly close, stomach contents might fly up into the mouth.   

In reflux, stomach contents flow back up the tube from which they previously came. This reverse flow is known as reflux.  It is common in very young children because the muscles connecting the upper parts of the digestive tract to the stomach are not perfect.  It takes time for them to learn how to effectively close shut when the stomach is trying to stomp - or pump - food further down the digestive tract.   

Symptoms of reflux in babies include wet burps or hiccups as well as spit up.  Fluid winds up oozing out of the mouth.  This is a "normal" process.  What I find interesting is that young children's symptoms such as vomiting, failure to grow, and excess crying are often attributed to reflux.  If most babies have reflux, then why don't most babies also have  vomiting, failure to grow, and excess crying?  Perhaps there is something else going on, and we will explore that in the next episode.  


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#066 WHAT TO DO WITH EPINEPHRINE (EPIPEN) DURING AN ALLERGIC REACTION

Let us say that your child is in the middle of an IgE-mediated allergic reaction to a trigger food. What do you do with the epinephrine?

Now, you might be asking me, "Hey, Doctor Evka!  How do I know that I am administering the epinephrine correctly, and how do I know when to administer it?"   These are two very good questions.

Let's say that you go up to your friend who also has an epinephrine autoinjector for her child.  You ask her, "How do I get this auto-injector to work?"  She answer, "Here!  Let me show you."  She pulls out her auto-injector and realizes that hers looks very different from yours. She's really not sure how to get yours to work.

The cool thing about epinephrine autoinjectors is that they all work in basically the same way.  Push the autoinjector firmly against your child's outer thigh, and it should automatically do its job most of the time.  Despite this, though, it's good to know exactly how your device works.  To figure this out, either schedule a visit with the prescribing doctor for soon and / or call the manufacturer.  They will likely be able to direct you to a series of videos that can help show you exactly how to use your device.

Now the question becomes one of when to use the medication. Most doctors recommend that you air on the side of caution.  It's better to give the epinephrine even when you don't think that it might be needed than not to give it.  That's because studies have shown that you want to stop an IgE-mediated food allergy right in its tracts before it becomes more serious.  You hear of young children who have died from their reaction to specific trigger foods, and you hear their parents' biggest regrets - not giving the epinephrine soon enough.

When do you know that it's time for your child to get epinephrine? You already know that the child has food allergies.  The doctor has prescribed epinephrine.  You might not even know what the child ate, but your child has shortness of breath, a weak pulse, hives, trouble swallowing, or skin swelling. Your child coughs repeatedly. They start to talk funny as their voice sounds different. They seem generally off. Their skin develops raised, red rashes.  They pee or poop, and it's not in the toilet.  It's during the allergic reaction.  

If you see an allergic reaction starting to happen, it's best to stop it in its tracks.  You're going to do that through the use of epinephrine.  You are not going to be able to stop the reaction in its tracks if you just use Benadryl, diphenhydramine, an antihistamine, another histamine 1 blocker.  Those medications do not help with the child's heart rate or blood pressure, but the epinephrine does. 

All right! That's enough for now.    Any questions?  

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#065 EPINEPHRINE (EPIPEN) INSTRUCTIONS FOR USE DURING A FOOD ALLERGY

 the pharmacist gave you epinephrine that the doctor had prescribed for your child?  The epinephrine came into a brown little bag.  You opened up the bag and looked at the medication.  You saw two medications in the bag - two epinephrine auto injectors in the bag. It's like you got a two-for-the-price-of-one deal.  How come?  Why did the pharmacist give you two of them?  Was one supposed to be meant for the car while another one for home? 

No!  The goal is for the child to have both auto-injectors with them at all times.   How come?  Let's look at this from a practical standpoint.  I'll give you four reasons why epinephrine medication come in sets of two auto-injections and no, one of them is not that the insurance company feels sorry for you and wants to give you a "free deal".  

First, if your child doesn't have the medication next to them, how are  they going to be able use it?   You have to bring the medication with you wherever you go.  Easier said than done especially for someone who forgets their cell phone or their car keys in random places! Easier said than done for someone who misplaces their items!  Remembering to bring the epinephrine doses with you might you to put both the medications and a key finder in the same bag.  I would recommended a well-insulated bag as the medication doesn't work as well at extreme temperatures.  Store the epinephrine at room temperature - not in your car on a hot summer day or in the cold refrigerator.   

Second, what if one of the epinephrine auto-injectors fails, and you are dealing with a life or death situation?   You better hope that you have a second epinephrine next to you that is properly functioning.

Third, you should call 911 after giving the epinephrine.  Even after giving the epinephrine, you may still be dealing with a life threatening situation.  When you call 911, an ambulance is supposed to come and take your child to the hospital, but there's a little problem with some of the ambulances.  Not all ambulances carry epinephrine.  In that case, you'll be glad that you had an extra epinephrine with you. (By the way, when you call 911, let them know that your child is having an allergic reaction, and you would like an ambulance that carries epinephrine to appear at the scene.) 

Fourth, what if the first injection of epinephrine doesn't work as well as you would like?  What if you  inject the first epinephrine and five to ten minutes later, your child still has difficulty breathing and hives that keep on spreading over the body?   There are many situations where you wind up having to give both doses of epinephrine.  Going into a reaction, you don't know how many epinephrine injections you'll have to go through.  You'll find out once the reaction is over but not before. 

All right!  Back to my story... You look at the brown bag that that has the prescription of epinephrine within it.  In which form do you think the actual epinephrine medication comes?  Is it a or b?    Does it come as a - a liquid solution - or as b - a solid pill?  If you answer a, then you're correct.  Almost all epinephrine comes as a liquid solution.  The trick is that you need to get this liquid solution into the muscles in the outer thigh.   You can't just rub the solution onto the thigh. That will put the solution on the surface of the skin, but it won't get it into muscles.  To get the solution into muscles, you need to inject it into there.  

There are a few ways that you can get this liquid epinephrine solution into the muscles.  First, you can buy a needle and a syringe. You can draw out the correct amount of epinephrine from the vial and then inject it into the muscle.  That's the old fashioned way but some families still use this method because it can be cheaper. Buying epinephrine solution in a jar along with a syringe and needles can be much cheaper than getting epinephrine that's already prepackaged and ready to be injected.    

Nowadays, most people get epinephrine inside of an autoinjector because it's easier, and many people have some kind of insurance that helps pay for it.  The autoinjector is medical device that has a needle on one end.  It holds a particular dose of epinephrine medication so there's no need to try to figure out the correct amount to give to the child.  Plus, the device can inject epinephrine directly into the muscles in your child's outer thigh even if your child is wearing stockings, jeans, or pants.  You just press hard on the device once you have it up against the outer thigh, and the device should be able to deliver the dose right into the muscles in the thigh.

Talking about auto-injectors, let's say that you go up to your friend whose child also has food allergies and ask to see their epinephrine autoinjector.  That autoinjector may look quite different from yours. The same dose of epinephrine medication comes in different auto-injector forms. These auto-injectors act to get the epinephrine into the body, and they can look cylindrical, round, or even flat-ish.  They can have needles that retract or that do not where the child is more likely to be stabbed by the needle.  You have to be careful with those!  

To learn how to inject epinephrine,  check out the next blog post (#061). 

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#064 EPINEPHRINE SIDE EFFECTS WHEN YOUR CHILD HAS FOOD ALLERGIES

Let's start with an experiment.  Go to the supermarket and buy a soft drink with a lot of caffeine in it.  Also buy sugar and an energy drink.  Now go back home.  Mix all of these together.  Make sure that you include loads and loads of sugar.  Swirl the soft drink, the energy drink, and the sugar.  Make sure that the mixture is thick because of how much sugar it has.  Now drink that.  It's all food; right? People  eat sugar and drink soft drinks and energy drinks every day. Nothing unusual about that.  Right? 

OK... Don't do it.  You'll feel sick if you do it.  Your heart will go really fast; you will feel chest palpitations.   In fact, you might get chest pain.  You might feel restless.  You might have nausea.   You might vomit.  This feeling can last for hours.  It might land you in the emergency room if you feel really sick.  Not fun!

If you by chance decide to do this - which I don't recommend - then you will know how it feels to take epinephrine.   This is the feeling that some people get when they take epinephrine!  Only differences? What I describe that you do won't save your life.  Epinephrine will save your life if you are in the middle of a severe allergic reaction. Plus the effects of epinephrine won't last for hours like taking this crazy drink concoction might.  The half life of epinephrine is minutes. The crazy concoction I had you create will last in your body for minutes and not hours.  You will likely feel much sicker for much longer with this sugar / caffeinated soft drink / energy drink concoction than you will be if you take epinephrine.   Why are some of us more comfortable making a drink concoction like this as opposed to taking a medication?   Epinephrine can save your or your child's life.  Let's discuss epinephrine. 

Let's say that you just went to your doctor's office because your child has repeated episodes of an allergy-type rash or difficulty breathing each time that they eat a specific food. You think that it's food allergies, and you ask the doctor, "What do I do?"  The doctor then prescribes epinephrine.  You are sent on your way.  You go to a drive-thru at the pharmacy and do not talk to the pharmacist.  What now?  You have this prescription for epinephrine, but what do you do with it?

This episode is about the ins-and-outs of this medication - epinephrine.  Remember that I focus on the parents of children with limited diets.  What is one cause of limited diets?  Food allergies!   I need to discuss this information with you because epinephrine or an EpiPen are often prescribed, and people can be scared of this medicine.  I wanted to discuss the medication epinephrine in order to help calm down a person's fear.

To learn more, check out the next blog post (#059). 

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#063 WHAT BODY MECHANISMS CONTRIBUTE TO VOMITING?

There are many reasons why the body might vomit.  There are different pathways to the same result.  Let me talk about two of those pathways.  

One pathway is that of the body noticing a "toxin" such as  a food allergen.  In response to this "toxin", the body makes chemicals such as serotonin, and these chemicals eventually arrive at a trigger zone in the brain.  At this trigger zone, the brain recognizes that it needs to get the person to vomit.   These chemical messengers elicit the vomiting response.  

Now let's talk about the second pathway to the same result of vomiting.  The second pathway has to do with a direct nerve connection between an irritated digestive tract and the vomiting centers of the brain.  We just talked about it a few moments ago. 

In other words,  there are multiple pathways to the same result - vomit.  In fact, in many conditions, both pathways are present.  If you have a child who has repeated episodes of FPIES and often vomits, their esophagus might eventually get irritated.  If you have a child whose esophagus becomes too acidic because of gastroesophageal reflux disease, then the esophagus might also get irritated.  If you have a child who has an allergic condition like eosinophilic esophagitis, then the esophagus might also get irritated.  Irritate the esophagus enough, and a person might vomit.

Does this give you a better explanation of why I believe that reflux and food allergies including FPIES are not related in some ways.  In other ways, they are related.  When you look at a child who is vomiting, you might think that all vomiting comes from the same place.  It doesn't.   There are multiple pathways to the same result of vomiting.  Each disease might follow only one of the pathways or more than one of the pathways.  It really depends.  If you want to improve the frequency of vomiting, you need to both figure out the disease and also figure out which vomiting pathways are being activated. 

Back to my story of little Peter.  He just kept on vomiting.  The mother took him to see his doctor, and the doctor prescribed some histamine 1 blocker to Peter.  Despite the medication, Peter continued to have multiple episodes of vomit.  Why?

I'll give you two potential explanations.  First, Peter could be vomiting because of something that has nothing to do with how much acid is in his stomach or esophagus.  His vomiting might have nothing to do with irritation in his esophagus.  It could be due to his age and the sphincter between the stomach and the esophagus being loose.  It could be due to food allergies or some other medical condition.  Second, histamine 1 blockers do not treat vomiting in the short term.  They might decrease the amount of  acid in the esophagus or in the stomach, but it can take a while for irritated esophaguses to heal.  It might not happen overnight.  Histamine 1 blockers work more under the principal that if stomach acid is causing pain in the esophagus, perhaps by decrease the amount of acid in the stomach, there will be less pain.  

Eventually, Peter's mother took him back to the doctor and discussed how the histamine 1 blocker medication was not helping with the stomach pain.  They had another discussion, and eventually over time with other changes, Peter did start to have less vomiting episodes.  That's such a complicated topic that there's no time to discuss it during today's episode.

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#062 REFLUX (HEARTBURN) AND VOMITING

 What causes vomiting with reflux?

That's a great question, and I will give you two ways that vomiting happens with reflux.  There are other ways, but these are two of the common ones.  Neither of these reasons has much to do with serotonin.  

First, in very young children, vomiting happens because their stomach acts like a stomp rocket.  I bring up the subject of a stomp rocket because I recently made one.   I'll try to describe what the final product looked like, but if you are unfamiliar with a stomp rocket, at this point, I'd urge you to use your computer or your phone and find an image of one.  This toy consists of a hollow tube that is attached to an air pump. When I stomp on the air pump, air fills the hollow tube.  The air pushes against the tube until it pops off. The rocket launches.   In my case, in addition to having the hollow tube as part of my stomp rocket, I also curled up a small piece of paper into a ball.   I put the ball into the hollow tube of my stomp rocket. When I stomped on the air pump, air filled the hollow tube that had the ball of paper.  Both the hollow tube and the ball of paper launched into the air. 

Now, there are two ways that I can hold a hollow tube attached to the air pump.   In the first way, I can hold one end of the hollow tube on the ground.  Air cannot escape from the end of the hollow tube that is firmly held to the ground.  The ground is acting like a sort of sphincter to prevent air from going that way.  This is how a stomach works when the sphincter connecting the stomach to the esophagus is closed shut.  Food can't go back up into the esophagus and eventually out of the mouth.  This sphincter allows the food to move in one direction - further down the digestive tract into the intestines.

Now let's say that I hold the stomp rocket in a different way.  I pick up the hollow tube so that one end is no longer on the ground.  Both ends of the hollow tube are now in the air.  Now let's say that I stomp on the air pump really hard.  Air can go both ways in the stomp rocket. If I have small balls of paper inside the hollow tube, the balls can go in either direction. Both sides of the hollow tube are in the air.

It's a similar concept with young children and babies who have reflux.  Their sphincters that would prevent food from going up into the tube connected to the mouth are loose.  They're not firmly attached to the "ground". When their stomachs do their jobs as  "air pumps", food goes both ways:  either further down the digestive tract into the intestines or further up the esophageal tube and perhaps even straight out of the mouth.  Got it?  It takes babies a while for this sphincter to become stronger.  It takes a while before the stomp rocket known as the stomach has one end firmly attached to the ground - allowing food to go in only one direction.    This is a mechanical issue that's tied to physics.  It's not due to how serotonin affects certain structures around the brain that trigger vomiting.

That is reason number one for how young children vomit, and it has to do with physics, stomp rockets, and loose sphincters.  A loose sphincter between the stomach and the esophagus! This is something that happens to just about every baby.  Just about every baby has a loose sphincter that connects the stomach to the tube that goes up to the mouth.  Sometimes doctors assign a name to vomiting that happens with a lose sphincter. They call it reflux, but it's not really a disease unless it's more severe. 

More severe reflux is known as gastroesophageal reflux disease.  It's a condition where a lot of stomach acid flows back into the tube connecting the mouth and the stomach.  It flows back so much that the tube gets an "acid burn".   It gets irritated from all of that extra acid.  

Now, let's talk about this irritation of the esophagus - the tube connecting the mouth and the stomach.  If this tube is irritated enough, then the sphincter might not work really well.  When the stomach does its air pump job, food might go both ways - not just further down the digestive tract.  It might also go straight from the stomach into the esophagus and eventually perhaps up and out of the mouth.  You have to think that when the esophagus is irritated, sometimes the sphincter is irritated too.  Not always!  

In addition,  the moist tissue that lines the inside of the esophagus - the tube connecting the mouth and the stomach - can get irritated. It has nerve endings.  When it's irritated enough, it acts like a young child might act if really irritated.  The child might tell a parent about the mean thing that another child did.  The child might want the parent to retaliate on their behalf.  In the same way, the tube connecting the mouth and the stomach might say, "You know!  I'm feeling really irritated and crabby.  Let me lash out and tell my parent to hurt this child."  The nerves in the stomach tell the brain, "Make the body vomit."  Like a very complaint mother who allows her child to get everything that they want, the brain listens to the child.  The body vomits.  All thanks to the irritated esophagus and the direct nerve pathway between the digestive tract and the brain!


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#061 HOW REFLUX AND FOOD ALLERGIES LIKE FPIES ARE RELATED

Today, I came across an online post that was written by a mother of a child with food allergies.  She wrote, "Many doctors have now told me that FPIES and reflux are not related.  I don't believe it.  Are there resources with proof out there?"  In response, I told her, "You are both right.  This is such a complex topic that I can't answer it by writing a Facebook post.  Instead, can I do a podcast about it?"  Hence this podcast episode was born.  Now, if the mom of this podcast is listening or if you find it helpful, please, rate my podcast. Give it five stars for good measure!  Good ratings on a podcast allow it to be seen by more people and allow me to help more people.

Back to the topic at hand... I understand where the doctors are coming from when they say, "No!  FPIES and reflux are not related." They might have only 10 to 15 minutes to see you in the office, and the actual answer is way more complex.  They just don't have the time to go over all of it in great detail.  Yes, the doctors are right that FPIES and reflux in some ways when they say that these two conditions are not related.  However, they would be even more right if they said, "Food allergies including FPIES and reflux are not related in some ways, but they also are related in other ones." That's an even more accurate statement, but explaining the reasons for it would take a long time!  More than the length of a podcast episode but at least here you'll get a partially complete answer!

In this episode, I'm first going to go over some of the similarities between reflux and food allergies.

One of the first similarities is food moving in reverse through the digestive tract.  It's kind of like skydiving. The airplane is on its way up from the ground, and you jump out of the perfectly good airplane to go fly way back down to the ground. When you vomit, food that was on its way further down the digestive tract goes straight back from where it came!  Up and out of the mouth!   However, vomiting food is much less fun than skydiving ! 

According to the Mayo Clinic, one of the symptoms of reflux is "regurgitation of food or sour liquid."  In other words, one of the symptoms of reflux is food being brought back up from the stomach into the mouth.   How about one of the symptoms of food allergies? It's the same thing.   Without food being ejected from the stomach... without vomiting... you cannot be diagnosed with acute FPIES or acute  food protein-induced enterocolitis syndrome.  In fact, vomiting can be a sign of multiple types of food allergies - not just FPIES. People with classic IgE-mediated food allergies can also vomit. 

Remember little Peter whose mom took him to see the doctor for recurrent episodes of vomiting?  The doctor heard the phrase "distressing vomiting" or "little kid vomiting that is bothering the mother" and thought, "Hmm....  what's one of the common diagnoses that can do this?  I need something that I can treat more easily before I do a complex workup... Oh... I got it... Reflux!  Why don't we see if this is gastroesophageal reflux and prescribe a histamine 1 blocker for Peter?   Let's see what happens if we do this."

The problem is that histamine 1 blockers do not stop vomiting. Instead, they might make vomiting less painful on the esophagus. However, they do not stop vomiting.  Now you might be asking yourself, "If histamine 1 blockers do not stop vomiting, what does?"  

The answer here is that it depends upon the reason for the vomiting. It's not all about the reflux. There are many reasons why young children vomit, and you need to try to figure out the root cause so that you can then develop the appropriate treatment plan.  

Take FPIES, for instance.  It's a condition can be diagnosed when a person vomits approximately 1 to 4 hours after eating a trigger food and has a set of other symptoms including paleness to the skin and  fatigue.  The amount of time can vary as can the other symptoms.   In FPIES, vomiting happens after the immune system recognizes a specific food as being foreign to the body.  The immune system says, "I'm going to do something to get rid of this trigger food.  I'm going to make sure that the digestive tract releases a lot of serotonin". Cells in the digestive tract then release a chemical messengers including serotonin as well as some other ones.  (The jobs of these chemical messengers is to trigger the vomiting reflex.) When there's too much serotonin or another one of these chemical messengers during an allergic reaction, vomiting happens.  You treat an acute FPIES reaction by giving odansetron.  It blocks the effects of serotonin.  The vomiting in FPIES happens partly because of changes in serotonin levels. 

How about with reflux?  What causes vomiting with reflux?

That's a great question, and I will give you more information about it in the next blog post (#057).  


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#060 WHAT IS BEHIND THE VOMIT WHEN REFLUX MEDICATIONS ARE NOT WORKING

Little Peter stared at the vomit pooled beneath him.  His outfit was stained with liquid stomach contents.  Sweat dripped down his brow as it passed through his brown hair.  There was formula in its liquid form as well as cracker, still mostly intact.  It covered his shirt. Peter's mother held him tightly in her arms.  She kept him upright in hopes that the vomit would not go down the wrong way.  It was a sight to behold.  Her clothes were soaked to.  On her hair were pieces of undigested food, and her eyeglasses were covered in a thin brown mist.   She wiped the last of the vomit off Peter's lips and then cleaned her face as well with another towel.   Then the torrent of vomit came again.  This time, it seemed even more forceful than the last.  More vomit on their clothes!  More  vomit on their bodies!  More vomit on the floor! The stench of vomit filled the air with a pungent odor.   Peter's mom thought, "Oh no! There it is once again."

This time, Peter's mother had a plan.  When the whole ordeal was over and both of them were washed and in new clothes, she picked up the phone. She looked through her list of contact numbers until she found just the right one.  There it was.  The number that she really wanted!  The phone number of Peter's family doctor who worked alongside pediatricians in the same medical office.  All of them seeing children!

She dialed the phone number and explained again what happened. Little Peter had vomited once more, and they needed to be seen for a medical visit.  Perhaps there was something that the doctor could do to help them.   Lately, there seemed to be a lot of episodes of vomiting.  The receptionist on the other side of the phone line told her, "Tuesday!  You can have an appointment with the doctor on Tuesday".    Tuesday?  Just a day way! 

The next day, Peter and his mother found themselves at the doctor's office.  They sat down in one of the office exam rooms and waited patiently for the doctor to come.  When the doctor came into the room, Peter's mom stated, "My son has been vomiting a lot."   The doctor and Peter's mom had a back and forth conversation in which the doctor eventually diagnosed Peter with reflux, and Peter was sent home with a prescription for a histamine 1 blocker.  

Mom couldn't wait to get to the pharmacy. She couldn't wait for Peter's frequent episodes of vomiting to the end. She hoped that the medication -  a type of histamine 1 blocker - would do the trick, and Peter would feel so much better.   No more frequent episodes of vomiting was the hope.  Peter's mom certainly hoped that this would be the miracle drug.

What happened?  That day, after Peter took his medicine, he continued to vomit.  The next day, despite the medicine, the vomiting continued just as frequently as it did before.  Peter's mom thought, "Was it the wrong dose?  Was it the wrong prescription?" She couldn't figure out why Peter continued to vomit so much. 

This is the topic of the next few blog post (#056 and #057).  When you have a young child who is vomiting, what does that mean?  How do we know if it is reflux?  What if it is something else?  How do we go about figuring this out, and what are the similarities and differences between some of the different causes of vomiting in young children?  For instance, what are the similarities and differences between reflux and food allergies including FPIES?


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