DEAR DR. DONOHUE: I have bad heartburn that is controlled with medicine. I would like to know for how long it is safe to take these medicines. I would like to learn about nonmedicine options. – H.L.

Heartburn is officially called gastroesophageal reflux disease – GERD. With GERD, stomach digestive juices and stomach acid spout up into the esophagus like a geyser erupting. The esophagus doesn’t have the protective lining that the stomach has, and it cannot cope with those juices. The result is heartburn.

Medicines are usually very effective in controlling GERD. Patients can take them for three months and then begin to reduce the dose. The day soon arrives when they are taking no medicine. If these people are lucky, symptoms don’t return. That happens only to about 20 percent. The others have to resume medicine to control GERD. Many people must take it for protracted periods of time.

If you want to try taming GERD without medicine, more power to you. Eat slowly. Gulpers are prone to have heartburn. Eat smaller portions at every meal. If need be, increase the number of meals but keep portions small. Chew gum for 30 minutes after eating. Gum stimulates saliva production, and saliva is Nature’s own antacid.

Surgical procedures are a way to avoid medicine-taking. There are quite of few of them, so I can mention only a couple. One surgery is done with a laparoscope, a viewing instrument inserted into the abdomen through a small incision. The surgeon also inserts instruments through another small incision and can tighten the muscle at the juncture of esophagus with stomach. That muscle is a sphincter, and sphincters act as doors. When closed, nothing gets through and nothing backs up. With GERD, the sphincter is lax.

Another procedure is to shore up the sphincter with a device that is a miniature sewing machine. This device is passed through the mouth and down the esophagus until it is positioned at the sphincter site. The machine tightens up the sphincter with sutures – an inside job.

The heartburn pamphlet details the options for treating heartburn and hiatal hernias. 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./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: In your article on bad breath, you mentioned TriOral. I can’t find it in any drugstore near me. How can I get it? – M.P.

TriOral is a mouthwash that kills mouth bacteria involved with the production of bad breath. It contains zinc chloride and sodium chlorite (not chloride, as in table salt). The manufacturer is Triumph Pharmaceuticals in St. Louis, Mo., and ringing up 1-800-492-7040 will connect you to the company. You do not need a prescription. The product actually comes in many forms; mouthwash is only one of them.

Triumph has a Web site,, with more information.

DEAR DR. DONOHUE: We have our own well for all the water we use, including drinking. My brother-in-law says we are poisoning ourselves because well water contains arsenic. All our neighbors have their own wells, and they don’t seem to be dying. Is the arsenic thing for real? – D.T.

Arsenic is all around us. It’s in rocks, soil and water. It’s also a byproduct of some manufacturing processes.

The United States has set an allowable limit of 50 micrograms of arsenic in 1 liter (1 quart) of water. That is a very tiny amount. To play it ultrasafe, a new regulation is going to be put into effect in 2006. It will allow only 10 micrograms of arsenic in 1 liter of water.

In the mid-1990s a large number of people in India and Bangladesh suffered arsenic poisoning from contaminated drinking water. That hasn’t happened here and is unlikely to do so.

Your brother-in-law could have been reading too many mystery novels. Arsenic poisoning was a favored method of killing in those novels of bygone years.

DEAR DR. DONOHUE: Last summer I was stung by a bee or a wasp. My arm swelled, and I began to feel woozy. I never passed out, but my husband took me to the emergency room, where they gave me fluids by vein and injections of antihistamines. I am afraid of a repeat incident this summer. Could a second sting kill me? – H.B.

In North America, about 50 deaths occur annually from insect stings. Having had one serious reaction to a sting puts a person at risk of a repeat dangerous reaction. “Serious” here means the sting provoked nausea, vomiting, trouble breathing or a drop in blood pressure. That kind of reaction is called anaphylaxis (AN-uh-fill-AX-us). Anaphylactic reactions can cause death.

Your reaction, while an exaggerated response, does not appear to have been an anaphylactic reaction. However, obtain a copy of the emergency doctor’s assessment of what happened. If you had an anaphylactic reaction, it will be clearly stated.

Anyone who has suffered an anaphylactic reaction should consult an allergist. Allergy shots can desensitize people to insect venom. The process takes time, so it is best to get started well before the stinging season arrives.

Such people should also make provisions to have quick access to an emergency kit. The kits contain adrenaline in a pre-filled syringe that can easily be self-administered. Adrenaline is an antidote to a serious sting reaction.

If the copy of your emergency record does not indicate anaphylaxis, you should still make provisions for avoiding stings for your own comfort. When outside, wear long-sleeved blouses and long pants. Don’t wear brightly colored clothes, and don’t use perfume. Bees and other insects will mistake you for a flower.

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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