DEAR DR. DONOHUE: I have had heartburn for a number of years. I take Maalox for it, but it doesn't always work. What will happen if I don't get this taken care of? Is this the same thing as having a hiatal hernia? How is it best treated? -- R.M.
ANSWER: Heartburn results from stomach acid bubbling up into the esophagus, the long tube that stretches from the back of the throat to the stomach and through which food passes on its way to the stomach. At its juncture with the stomach, the esophagus has a door, the lower esophageal sphincter. It's not actually a door. It's a muscular valve that slams shut after food passes through it. People with heartburn (GERD -- gastroesophageal reflux) have a door that doesn't tightly close, so stomach acid spurts upward through it into the esophagus.
Have you tried avoiding chocolate, peppermint, alcohol, caffeine, fried and fatty foods, orange juice and tomatoes? Doing so will help. Weight loss, if needed, and not wearing anything that constricts the stomach, like a tight belt, also keeps stomach acid in the stomach. Slow eating helps control heartburn because it doesn't distend the stomach the way gulping food does. Putting blocks under the posts at the head of the bed keeps acid in the stomach during the night, when heartburn is often at its worst.
If the above doesn't free you from heartburn, over-the-counter medicines that decrease acid production might. Zantac, Pepcid and Tagamet are examples. Prilosec, another over-the-counter drug, just about eliminates acid production. There are stronger doses of these medicines available with a prescription.
A hiatal hernia is a bulge of the stomach through the diaphragm muscle into the chest cavity. It can bring on heartburn, but it is not the only cause of it. Not all patients with a hiatal hernia have heartburn. The above advice applies to people with a hiatal hernia who also have heartburn. If medicines fail people with hiatal hernia , there are a number of surgical procedures that can help them.
The heartburn booklet offers more advice to those who suffer from this common disorder. People can order a copy by writing: Dr. Donohue -- No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order for $4.50 U.S./$6.50 Can. with the recipient's printed name and address. Please allow four weeks for delivery.
DEAR DR. DONOHUE: My grandfather just had two toes removed because of gangrene. He has had diabetes for many years, and I presume that was the cause. Is this the same gangrene that comes from war wounds? If so, how are the two related? -- J.Z.
ANSWER: Gangrene is tissue death. Your grandfather's gangrene came from a poor blood supply to his toes, and that most likely was a complication of his diabetes. Diabetes often impairs circulation.
Gangrene that comes from wounds contaminated with soil or other material is caused by a bacterium with the name clostridium. It's widespread in nature.
Clostridium causes an infection, and its gangrene is gas gangrene. It turns a wound black, the color of all gangrenous tissues. Muscles under the wound become beefy red until they eventually turn black. Gas bubbles form, produced by the germs' metabolism.
Treatment is removal of dead tissue, as it is for all gangrene, regardless of cause. In the case of gas gangrene, antibiotics -- generally penicillin -- are also administered. Sometimes putting patients with this infection into chambers with oxygen under pressure is part of treatment. Oxygen kills the clostridium organism.
DEAR DR. DONOHUE: My wife and I, both in our late 70s, enjoy a glass of wine with dinner. On weekends, we sometimes have a cocktail before dinner or later in the evening. Is this too much alcohol for people of our age? -- B.P.
ANSWER: Most men, even at your age, can safely have two alcoholic drinks a day. A drink is 12 ounces of beer, 5 ounces of wine or 1.5 ounces of 80-proof alcohol. A woman should limit herself to one drink a day.
Your wife can indulge in the extra cocktail on weekends without fear.
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