Getting A Handle On Heartburn

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DEAR DR. DONOHUE: After an endoscopy, the doctor told me I have a hiatal hernia. He said nothing could be done for it and that I will have to live with it the rest of my life. He gave me no medicines or advice. I am anxious about this and would appreciate any info you can give me. — Anon.

ANSWER: The swallowing tube — the esophagus — begins at the throat, travels down the chest and finally ends by attaching to the stomach. To reach the stomach, it must go through an opening in the diaphragm, the muscle that separates the chest from the abdominal cavity. That opening is the hiatus. A hiatal hernia is a bulging of part of the stomach through the hiatus and into the chest cavity. Many times, a hiatal hernia causes no symptoms and needs no treatment.

At other times, a hiatal hernia produces GERD — gastroesophageal reflux — an upward spurting of acid and digestive juices from the stomach into the esophagus. That brings on heartburn, a common problem with many treatments. People without such a hernia also develop GERD.

Here are some tips to handle heartburn. Lose weight, if need be. Don’t eat within three hours of going to bed. Elevate the head of your bed using blocks that are 6 to 8 inches tall and placed under the bedposts. This keeps stomach juices in the stomach while you sleep. Sleep on your left side for the same reason. Don’t wear constricting garments around the abdomen or too tight a belt. Take antacids as needed — Tums, Rolaids, Mylanta and Maalox. Eliminate any food that gives you heartburn. Usual offenders are citrus fruits, tomatoes, onions, spicy foods, fatty and fried foods, chocolate, carbonated beverages, mints and caffeinated drinks.

If these steps don’t solve the heartburn problem, try medicines called acid blockers: Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine) and Axid (nizatidine). In low doses, all of these can be purchased without a prescription.

The next step is medicines that turn off acid production. Prilosec (omeprazole) doesn’t require a prescription. The prescription drugs are Prevacid, Nexium, Aciphex, Protonix and Dexilant.

If necessary, surgical procedures can correct hiatal hernias.

The booklet on hiatal hernias explains this common condition in detail. To obtain a copy, write: Dr. Donohue — No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My barber, Vinnie, said my eyebrows were receding and that is an indication of thyroid problems. I write to see what your take is on this. I would like to establish fact from fiction. — P.D.

ANSWER: Vinnie is somewhat near the truth by saying hair loss is a possible consequence of both an underactive and overactive thyroid gland. However, the loss is usually on the scalp, when and if it does occur. Loss only of eyebrow hair isn’t a symptom of thyroid disease. And hair loss from the scalp is not the only sign that things are wrong with the thyroid. Other signs must be present, too.

DEAR DR. DONOHUE: Please address Meniere’s disease in your column. I am 88, a female and in good general health. I do not smoke or drink alcohol. I weigh 125 pounds and am 5 feet 1 inch tall. My diet consists mostly of health foods. — G.R.

ANSWER: Vertigo (dizziness), ear noises (tinnitus) and fluctuating hearing loss are the three signs of Meniere’s (men-YAIRS) disease. Vertigo comes in spells lasting 20 minutes or more, and they leave the person off balance for several days. Tinnitus can be ringing, roaring, hissing or other sounds that come and go but eventually stay permanently. The same happens with episodes of hearing loss. It becomes a permanent problem in time. All these signs are due to a buildup of fluid in the inner ear, the place where hearing and balance take place.

Treatment of Meniere’s focuses on ridding the inner ear of the fluid buildup. A strict low-salt diet goes a long way in reducing symptoms. The reason is that salt brings on fluid retention. Restricting caffeine and alcohol also helps. Diuretics — water pills — might be needed to get rid of the fluid.

A hearing aid usually overcomes deafness.

Dizzy spells are accompanied by nausea and vomiting. Antivert and Phenergan relieve all three.

Should these measures fail, more-heroic efforts are called into play. One is an injection in the ear of the antibiotic gentamicin, which destroys the ear’s balance organ and eliminates dizziness. Another approach is the Meniett device, a little gadget that creates pressure pulses that are transmitted to the inner ear. The pulses pump fluid out. A doctor has to make a small hole in the eardrum so the pressure waves can make their way to the inner ear.

An ear, nose and throat doctor can evaluate you and determine if you are a candidate for these treatments or for other treatments I haven’t discussed.

The booklet on vertigo discusses its many causes and treatments. Readers can obtain a copy by writing: Dr. Donohue — No. 801W, Box 536475. Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have a pain that starts near my elbow and shoots down my arm to the little finger. It doesn’t happen all the time. I don’t know what brings it on. It just appears to happen for no reason. What could this be? — E.J.

ANSWER: I’m sure you’ve heard of carpal tunnel syndrome. It’s due to a compression of a wrist nerve as it passes through a tunnel of ligaments and bones on its way to the hand and fingers.

You describe something similar, compression of the ulnar nerve at the elbow. This nerve supplies the little finger and the adjacent side of the ring finger. Compression of the nerve causes the kind of symptoms you have. You can try a simple treatment, an elbow splint. Your wear it at night, and the elbow should be bent about 60 degrees. Give it a week. If the pain doesn’t leave, you should have an exam. Other conditions can cause the same kind of pain.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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