The Pharmacist Answers Podcast Cynthia Hendrix

Avenleigh wants to know what is in our vitamins and why do we take them, so she asks the pharmacist!

Laryngitis Laryngitis, known as inflammation of the larynx, is the most common cause of hoarseness and voice loss.  It is very common in viral infections, such as a cold, flu, or adenovirus.  Acute laryngitis is caused by an illness, while chronic laryngitis may be a secondary symptom of another problem like acid reflux, smoking, or severe thrush.
There is a lot of advice that goes around about what can "cure" laryngitis or get rid of hoarseness.  Hydration is always key.  Some of the other advice is more anecdotal.  But above all, whatever you do for a hoarse voice, DO NOT WHISPER!
Laryngopharyngeal Reflux Disease (LPRD) LRPD is a condition where stomach acid refluxes into and burns the vocal cords.  It may or may not accompany GERD.  It causes intermittent to chronic hoarseness, swallowing troubles, throat pain, or a constant sensation that something is stuck in your throat.
Misuse and Overuse Misuse of your voice is defined as the inefficient use of your voice.  It may stem from poor posture, poor breath support, or poor hydration.  Overuse of your voice is defined as excessively loud or prolonged use of your voice.
Lesions Vocal cord lesions are benign growths on the vocal cords that interfere with normal vibration. These can result from repeatedly prolonged periods of misuse or overuse.  They will cause chronic hoarseness or sporadic voice-silencing.  They come in three varieties and are all treatable:  nodules, polyps, and cysts.
Nodules require vocal rest and voice therapy and training to help make sure they don't happen again.  Polyps and cysts require micro-surgery where the growth is removed, and then rest and therapy and training will follow.
Hemorrhage If you have a sudden loss of voice after yelling, then it is possible a hemorrhage occurred.  A hemorrhage is when blood vessels in the surface of the vocal cord burst and fill it with blood.  COMPLETE REST is required until the blood is reabsorbed by the body.
Paresis and Paralysis Paresis is the fancy word for weakness.  Vocal weakness can occur during a viral infection or after neck or throat surgery.  It can be temporary and strength will return on its own after a recovery period, or it can be permanent.  Prolonged or permanent vocal weakness can be improved somewhat through therapy and training.
Paralysis, on the other hand, is neurologically based, whether damage happened in the area of the brain that controls the voice and supporting structures, or the nerves in and around the larynx are damaged.  This can also be temporary or permanent and is generally one-sided.
Symptoms of a weakened or paralyzed vocal cord include noisy breathing - like something is hanging in the way of the air flow.  And breathy talking - like when someone is trying to use their "sexy" voice and there's more air making noise than vocal vibrations.  There is a surgical repair process that involves taking the working vocal fold and stretching it over so when it activates, it will still come in contact with the unmoving vocal fold.
Callbacks Voice
Thrush - Mouth Issues
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Notes coming soon!

Gag Reflex Basics The official name of your gag reflex is the pharyngeal reflex or laryngeal spasm.  Trigger points for the gag reflex can be found on the roof of the mouth, back of the tongue, in the tonsil area, the uvula, and the back of the throat.  The purpose of this reflex is to prevent objects from entering the throat that did not first progress through the normal swallowing process.  It also helps prevent choking.
Gag Reflex Progress When the reflex is triggered, the soft palate raises to close off the nasal passage.  Then the pharyngeal muscles contract on both sides to try and force whatever made it too far down back up into the mouth.  If the input is strong enough, it can also trigger vomiting (this is how vomiting is induced in eating disorders such a bulimia).
Do you Gag? One in three people lacks a gag reflex, which means rather large things can enter their throats without triggering a reflex.  This is possibly how sword-swallowing got its start.
The other side of this coin is someone with a hypersensitive gag.  They can have trouble swallowing large pills and large bites of food.  Dentist visits and even neckties can trigger this unpleasant reflex.  It can be a part of a larger issue, such as Sensory Processing Disorder or Autism.  Or it can be a preconditioned issue due to a previous experience.  In either case, speech or occupational therapy can be done and will include desensitizing areas of the mouth to touch.
Other Protective Reflexes The Reflexive Pharyngeal Swallow is a triggered swallow that clears the pharynx of residue.  The glottis will close and allow the pharynx to move stuff to the digestive tract.  This is a protective mechanism to keep stuff out of the airways. Phayngoglottal Closure Reflex happens when the glottis closes inside the larynx without the continuation of a swallow. Phango-Upper Esophageal Sphincter Contractile Reflex occurs during any type of reflux from the stomach.  While some stomach contents may make it past the lower esophageal sphincter, so the upper one prevents it reaching into the throat and mouth. Bottom Line All of these reflexes are protective to prevent choking or improper ingesting of things.  They can be damaged to different degrees during head trauma or stroke.  But surprisingly, smoking causes the most damage to the protective reflexes on the pharynx.
Callbacks Swallowing
Mouth Parts
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Bad Breath Basics Halitosis, aka bad breath, can have many causes.  Some bad breath you can prevent with the choices you make, but some bad breath can be a sign of a more serious issue or disease.
Oral Health You should brush your teeth for at least 2 minutes twice a day, including the surface of your tongue, then rinse your mouth with an antibacterial mouthwash.  Follow one of your brushing sessions with a good flossing.  This allows you to get any food debris and bacteria build-up out of the way on a daily basis.
You should see your dentist twice a year for a deep cleaning and a check-up on your overall oral health.  Your dentist will be able to help you with bad breath issues that may stem from more complicated issues like cavities, gum disease, poorly-fitting dentures, or thrush.
Dry mouth, whether due to your natural biology, medication side effects, or mouth-breathing, can lead to bad breath due to the imbalance of bacteria growth.
Your Choices Smoking and other tobacco products can make your breath smell bad even when you are not actively using it.
The foods you eat also affect the status of your breath.  The compounds that cause eaten and digested foods to smell contain sulfur-based compounds.  These include broccoli, cabbage, brussel sprouts, onions and garlic, coffee, and fish.  The funny thing about these smelly compounds is that they can actually make your WHOLE BODY smell (including your breath as well as other exiting air) until they have passed all the way out of your body! 
Diseases Infections, such as bronchitis, pneumonia, and sinusitis, can lead to distinctive bad breath.  Postnasal drip can lead to bad breath as well.  Pharyngeal diverticula that trap old food bits can make your breath smell, as well as tonsil stones that are calcified debris trapped by the tonsils.  Bad breath can also be indicative of acid reflux or GERD.
Certain diseases that have telltale breath smells include diabetes, liver disease, and kidney disease. 
People with diabetes are at risk of a medical emergency known as Diabetic Ketoacidosis, in which a lack of insulin renders the body's cells unable to use the available sugar.  The body starts burning fatty acids for energy and the waste product is ketones.  Ketones cause the body to become very acidic.  This leads to a rapid transfer of water (extracellular fluid rushes into the blood to try and neutralize and dilute the ketones and then the kidneys rapidly try to flush out the acidic fluid through the urine) which can lead to fatal dehydration.  Clinicians are taught that people experiencing ketoacidosis may have fruity-smelling breath or breath that smells like acetone or nail polish remover.
People with liver disease may have breath that smells musty or like a mildewing basement.  And people with kidney disease may have breath that smells fishy or like urine or ammonia.  Ammonia is a typical by-product that is released in urine.  Someone with kidney disease may not be able to filter out the ammonia compounds effectively.  Therefore, the ammonia compounds will circulate in the blood.
Call Back Brush your tongue - Tastebuds
Tonsil stones - Tonsils
Pharyngeal diverticula - Dysphagia
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Dysphagia Basics Having difficulty swallowing or the inability to swallow is known as dysphagia.
Symptoms of dysphagia include:
Pain while swallowing The sensation of food stuck in the throat or chest Drooling Hoarseness Regurgitation Reflux Unexpected weight loss Choking, coughing, or gagging when swallowing Taking tiny bites Dysphagia by Phase There are several conditions that can affect each phase of the swallowing process.
Oral Phase Dysphagia during the oral phase, or voluntary phase, can be caused by neurological conditions like Multiple Sclerosis, Muscular Dystrophy, advanced Parkinson's.  Brain damage caused by trauma or stroke can also cause trouble swallowing in adults.
Dysphagia in Kids Babies start out nursing or feeding through a bottle and their swallowing mechanism is reversed.  A reverse swallow is when the tongue is thrust forward or out of the mouth to open the throat and allow food or drink down the esophagus.  As children learn to eat solid food and drink from a cup, the swallowing procedure changes. Children can also have trouble swallowing, but the root causes are completely different.  Premature birth, low birth weight, cleft lip or palate, and tongue or lip ties can lead to swallowing issues if not corrected with therapy.  These issues can cause swallowing issues with the reverse mechanism as well as make it difficult to convert to a regular swallow.  Children with low muscle tone are also more likely to stick with the reverse swallow because it is easier.
Pharyngeal Phase Pharyngeal diverticula are pouches that form in the mucous membrane above the esophagus.  These pouches can collect food particles that don't get swallowed.  This can cause bad breath, as well as coughing, and constant throat-clearing because it feels like something is stuck in the throat.
Esophageal Phase There are several swallowing issues that stem from the esophagus and esophageal phase.
Achalasia is an issue where the sphincter that opens into the stomach doesn't relax to allow food to pass through.  This can cause pressure in the chest and may possibly lead to regurgitation if it persists. Diffuse spasms happen when the peristalsis rhythm of the esophagus muscles is poorly coordinated. Stricture is also known as a narrowed esophagus.  It can be a result of injury and scarring from GERD. An esophageal ring is when a thin area of the lower esophagus is narrowed.  This is also a result of scar tissue from chronic GERD.  The scar tissue from acid damage tends to be less flexible which can cause pain. Eosinophilic esophagitis is the overpopulation of eosinophils in the esophageal lining due to food allergies.  Eosinophils are a type of white blood cells that show up in very specific situations - parasitic infections, cancer, or allergies. Dysphagia Risk The risk of dysphagia increases with age, mostly because the risk of the conditions that cause dysphagia increases with age as well.  And while dysphagia can be very uncomfortable, the biggest concern is with the risk of aspiration, or breathing food or drink into the lungs, that leads to pneumonia.
Call Back Swallowing
Muscle Tone discussion - Accordion in Your Brain
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