Scrip for Nitroglycerin (not cardio)

[Unregistered]

I have been having trouble with GERD and have been seeing my doc. We have tried acid reducers (nexium, omeprazole) to no avail. I had my esophogus/stomach scoped and the results were clean, no evidence of scarring or inflamation, all biopsies came back negative.

My doc thinks that I might be having spasms in my esophogus. As a diagnostic test he would like me to take a nitro pill when I am having symptoms. I explained that I was a pilot, and feared that the scrip for nitro could jeapordize my 3rd class medical. He hand wrote the scrip rather than put it in the system electronically so there is no record if I don't get it filled, and advised me to find out if it is ok or not before filling.

So would this cause a problem when I go to get my nex 3rd class?

Thanks in advance

 

[bbchien]

Yes it'll be a bit of touble, especially when the doctor writes a note that says you were prescribed Occasional NTG a a diagnostic maneuver to distinguish coronary disease from Esophageal disease.

The AME will likely call the county medical society to see if this guy is actually a doctor. You see, we use NTG to determine if it's CORONARY disease.

Go ask him directly for a treadmill, do not stop, do not pass GO. Go directly and get reaffirmed, or if it shows coronary ischemia it'll save your life.

 

[Gary F]

Nitroglycerin has been proven to be useless as a diagnostic tool for coronary disease. The main reason is that it can relieve the pain of esophageal spasm and may not relieve angina. Depending on the circumstances it might be a good idea to get some type of stress test to assess episodes of chest discomfort. A simple treadmill test might suffice.

 

[Unregistered]

I should state that we have talked about possible cardiac diagnoses, however my doc does not think there is any reason to suspect cardiac problems. I am fairly young, in shape, exercise regularly (4-7 hour mtn bike rides on weekends). Of course I understand that being young and in shape does not preclude having cardiac issues.

The discomfort is definately in my esophogus and is followed the next day by a burning sensation and sore throat. At the onset of symptoms the discomfort/spasm feelings occour higher in my throat and work thier way down.

As I have said, my Doc and I have talked about possible cardio issues and at this point he has ruled it out. One of the other diagnostic tests we discussed was a barium swallow. He also gave me a scrip for a single dose of a "GI cocktail" (I think that is what he called it) that is essentially lidocane in Maloxx. The next step after these couple of tests is a referall to a GI doc. Essentially we are trying to rule out GERD and see if it is a hiatel hernia or an esophagal spasm.

From Bruce's response, I guess I am going to go ahead and decline to fill the scrip for the nitro.

If after all that you think I should still do a treadmill test, I will definately talk to my doctor about that. If I did the treadmill how much grief/paperwork should I anticipate for my next medical? (Note: if recomended, I will do the treadmill test regardless of the consequences to my medical, can't fly if I am not alive!) What, if anything, should I have my doctor record etc during the test that might help?

Again, thanks for your time!

 

[Gary F]

I should state that we have talked about possible cardiac diagnoses, however my doc does not think there is any reason to suspect cardiac problems. I am fairly young, in shape, exercise regularly (4-7 hour mtn bike rides on weekends). Of course I understand that being young and in shape does not preclude having cardiac issues.

The discomfort is definately in my esophogus and is followed the next day by a burning sensation and sore throat. At the onset of symptoms the discomfort/spasm feelings occour higher in my throat and work thier way down.

As I have said, my Doc and I have talked about possible cardio issues and at this point he has ruled it out. One of the other diagnostic tests we discussed was a barium swallow. He also gave me a scrip for a single dose of a "GI cocktail" (I think that is what he called it) that is essentially lidocane in Maloxx. The next step after these couple of tests is a referall to a GI doc. Essentially we are trying to rule out GERD and see if it is a hiatel hernia or an esophagal spasm.

From Bruce's response, I guess I am going to go ahead and decline to fill the scrip for the nitro.

If after all that you think I should still do a treadmill test, I will definately talk to my doctor about that. If I did the treadmill how much grief/paperwork should I anticipate for my next medical? (Note: if recomended, I will do the treadmill test regardless of the consequences to my medical, can't fly if I am not alive!) What, if anything, should I have my doctor record etc during the test that might help?

Again, thanks for your time!

Don't forget that this forum is for general medical information and not a medical evaluation.
If somebody who has had episodes of chest discomfort can exercise vigorously without chest discomfort then a stress test may not be needed depending on age and other risk factors. The point is that many patients (and sometimes doctors) have falsely attributed cardiac chest discomfort to GI problems. Stress tests have limitations including the possibility of a false positive or false negative test.

 

[Jeanie]

Are the spasms coincident with any kind of food? or just happen any ol time? You might consider looking at the affect also of what you eat or drink to see if there is a relationship....