Sleep med can weaken stomach valve

Dear Dr. Roach: Iaman 80-year-old female and have been on 10 mg Elavil for 30 years to help me sleep. I have been having reflux problems from time to time for quite a while. I have been diagnosed with LPR (laryngopharyngeal reflux). I have read that there could be a connection between Elavil and weakened sphincter. If I am able to wean myself off Elavil, could the muscle strengthen, or once it is weakened is the damage done?

Anon.

Answer: Laryngopharyngeal reflux is when stomach acid comes all the way up the esophagus into the pharynx. It’s a type of severe gastric reflux, and can damage important structures, including the vocal cords and airway. Treatment is the same as it is for gastro-esophageal reflux disease, including lifestyle modification and antacid drugs.

Amitriptyline (Elavil) is an antidepressant that is frequently used to improve sleep or in people with chronic pain. Stopping the Elavil, even after decades, could certainly improve the symptoms. You can talk to your doctor about other options for sleep during a trial off the Elavil.

Dear Dr. Roach: My husband and I went to dinner with another couple. Three days later the man called to inform us he tested positive for COVID. The next day my husband tested positive as well. Symptoms were relatively mild, and he recovered quickly. We both received two vaccines and two boosters. How did I not contract COVID? Do I have natural immunity?

C.R.

Answer: “Natural immunity” means that a person has gotten the disease and is protected from getting that disease again. This happens with many viral diseases.

Vaccine-based immunity is about 97%. In the case of COVID-19, it seems that natural immunity from a previous infection is NOT long-lasting with COVID-19, and a person can get COVID-19 again and again.

Until a vaccine is developed that provides longlasting protection, we are left with periodic vaccination, which dramatically reduces the risk of severe disease.