DEAR DR. DONOHUE: I have a hiatal hernia, and I am taking medicine to control it. I used to take Tums, and they worked pretty well for me. It’s only because I mentioned it to my doctor that I am now on prescription medicine. I don’t like the idea of taking drugs. Couldn’t I have continued with my Tums? – W.A.

Give me a minute to clear up a misunderstanding, and I’ll give you an answer.

A hiatal hernia is an upward bulge of the stomach into the chest cavity. It’s an anatomical problem. Heartburn – a symptom almost everyone has experienced – is the spouting upward of stomach acid and digestive juices into the esophagus. The esophagus is not equipped to handle those corrosive juices. It lacks the stomach’s protective lining. Consequently, digestive juices in the esophagus cause the disagreeable sensation of heartburn.

People with hiatal hernias often also experience heartburn, but people without hiatal hernias can still suffer heartburn. The two – hiatal hernia and heartburn – are not always synonyms. The official name for heartburn is GERD – gastroesophageal reflux disease. The Tums were helping your heartburn, not your hiatal hernia.

If a person has infrequent episodes of heartburn, then dealing with GERD without prescription medicines is acceptable. Antacids are one aspect of self-treatment. Putting 6-inch blocks under the bedposts at the head of the bed is another. That keeps stomach juices in the stomach during the night, a time when GERD is at its most active. Making a few diet changes helps. Fatty foods, fried foods, chocolate, caffeine, alcohol, peppermint, onions and citrus fruits can precipitate an attack of GERD.

Many GERD patients have frequent episodes of heartburn. When that is the case, taking medicines that suppress acid production provides reliable relief and prevents changes in the esophagus that can set the stage for serious complications. After two years of treatment, your doctor might allow you to taper the dose of medicine and eventually get off it if heartburn does not return.

The new pamphlet on hiatal hernia and GERD answers most questions on this condition, its treatment and its complications. Readers can obtain a copy by writing: Dr. Donohue – No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I drink eight glasses of water every day because I was under the impression that it was healthy and that it flushed poisons out of the body. I am told this is hogwash. Have I been drinking all that water without any good reason? – M.M.

The eight-glasses-of-water-a-day law has been repealed. It is one of those rules that creep into medical folklore without much evidence to back them up.

Five or six glasses of fluids, not just water, are all that is needed. Caffeinated beverages qualify as fluid replacement beverages. They do make people urinate a bit more, but not so much that it prevents them from contributing to the daily fluid intake. Thirst was said not to be a good indication of water need. That’s another law that has been discarded. It is a good indication to drink fluids – but it is not a good indicator of need for fluid when exercising on hot days.

Compulsive water drinking does not flush “poisons” out of the body. But it is not a harmful practice, either.

DEAR DR. DONOHUE: My first grandchild might have to undergo surgery for hydronephrosis. My daughter tells me it has something to do with the kidney, but she is not too sure what that something is. My husband and I have never heard of it. Please write something about it. – D.M.

Hydronephrosis is a distention of a kidney with too much urine because there is a blockage in the drainage system between the kidney and the urinary bladder. The plugged kidney swells with urine. If the condition is only a temporary problem, then surgery is not indicated, and it will go away on its own. If it is a permanent problem, as it often is, then surgery has to correct the anatomical quirk that’s stopping the flow of urine from the kidney to the bladder.

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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