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Which heartburn treatment is best?
Dec. 26,
2012 |
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Dr. Paul Donohue
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DEAR DR. DONOHUE: I need help with acid reflux. I have battled it for seven years, and until recently I have used Prilosec, but it has stopped working for me. I tried AcipHex and Protonix but didn't feel well when taking them. Now I'm on Prevacid. Is it OK to take indefinitely? I wonder about Nexium. My doctor told me to take any acid reducer that works. What do you consider the best long-term medicine? – F.H.
ANSWER: Acid reflux, heartburn and GERD (gastroesophageal reflux disease) are different names for the same thing – the upward splashing of stomach acid and digestive juices into the esophagus, the long tube that brings food from the throat to the stomach. The esophagus can't handle those corrosive juices, and the result is burning pain.
Can you identify any food or drink that brings on your symptoms? If you can, eliminate it. Potential troublemakers are fatty foods, fried foods, spearmint, peppermint, chocolate, tomatoes, citrus fruit and caffeine.
You prevent nighttime heartburn by putting 6-inch blocks under the bedposts at the head of your bed. In that position, gravity keeps stomach acid in the stomach. Weight reduction almost always lessens symptoms.
I like your doctor's approach. Use the cheapest medicine that keeps you free of pain. Antacids often can fit the bill: Tums, Rolaids, Mylanta, Maalox and the many others. The most effective medicines are those called proton pump inhibitors: Dexilant, Nexium, Prevacid, Prilosec, Protonix and AcipHex, some of which are available without a prescription. They practically turn off acid production.
Some doctors like to have their patients stop use after a year to see if symptoms remit. If they do, so much the better. Less expensive are Tagamet, Pepcid, Zantac and Axid, which cut back on acid production and are obtainable without prescription.
One downside of indefinite use of proton pump inhibitors is the possibility of vitamin B-12 deficiency. Acid is needed to absorb it. The same goes for iron, calcium and magnesium.
The booklet on heartburn (GERD) explains this common condition in great detail, along with its treatments. Readers can obtain a copy by writing: 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.
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DEAR DR. DONOHUE: My wife is a healthy 66-year-old woman. The problem is that she wakes up at night, screams for a second and then goes back to sleep. The following day, sometimes she remembers, but sometimes not.
This has been going on for two to three years. She uses no medicines. What could this be? – J.V.
ANSWER: It could be what's called sleep terror. It's more often seen in childhood, but occasionally adults have it. You describe it perfectly. The person suddenly wakens and screams in what appears to be panic. Then she or he returns to sleep. Most have no memory of the event the following day, and don't recall a frightening dream. If this doesn't interfere with her normal functioning, she doesn't need to pursue it.
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DEAR DR. DONOHUE: Our 37-year-old daughter lives in Denver. She took her younger sister skiing where the altitude was 11,800 feet. Our younger daughter lives in Toronto, where the altitude is 250 feet. She felt discomfort or worse at the higher level.
Is it safe for an unacclimatized person to travel to such an altitude abruptly? How best should one treat altitude sickness? Are there potentially any serious or lasting effects of altitude sickness? – P and H.M.
ANSWER: At high altitudes the pressure of oxygen in the atmosphere drops, so less gets into the blood. Most healthy people can tolerate altitudes of 5,000 feet (1,500 meters) to 8,000 feet (2,400 meters) without difficulty. Older people and people with heart and lung disease might become short of breath at such heights.
An unacclimatized person, trying to function at 8,000 feet (2,400 meters) or more, can run into trouble if the person doesn't make the ascent slowly. Above 8,000 feet, people should not ascend more than 1,000 feet a day without returning to a lower altitude to sleep.
They can continue to go higher if they descend 1,000 feet each night to sleep. They will know they are pushing too fast if a moderate amount of activity leaves them breathless and bushed.
Acute mountain sickness, a formidable illness, occurs to unacclimatized people in the first six to 24 hours at a given height. People become short of breath, dizzy, have a dry cough and are nauseated. They often have a headache.
High-altitude pulmonary edema, an even more serious illness and an emergency, fills the lungs with fluid. People cough, and the cough's mucus is pink or bloody. These people have to be taken quickly to a lower altitude, and personnel experienced in the treatment of this condition have to manage definitive treatment.
People who fully recover from either usually don't have permanent damage. They are vulnerable to a second episode, however.
Your daughter can protect herself on her next visit by slowly ascending and by taking Diamox. It's a mild diuretic that affords good protection against altitude sickness.
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DEAR DR. DONOHUE: I have developed an unquenchable thirst, which makes me drink water all the time. As a result, I have to spend a lot of time in the bathroom urinating. Can a person drink too much water? - –A.C.
ANSWER: A person can drink too much water, but that's a very rare situation. A more likely explanation of what's happening to you is diabetes.
Excessive thirst, drinking water nonstop to satisfy the thirst and the resulting need to urinate frequently are signs of diabetes. You must see a doctor soon.
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DEAR DR. DONOHUE: Can you get ringworm from eating too much candy? Is there any relationship between not keeping the body clean and ringworm? I have been told that both can cause it. – Z.C.
ANSWER: Neither causes it. Ringworm is a fungal infection. The infection can spring up on the head, the body, the hands or the feet (athlete's foot). The fungus is picked up from someone else or from inanimate objects like the floor of a shower room.
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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.
(c) 2012 North America Synd., Inc.
All Rights Reserved
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