DEAR DR. DONOHUE: My sister has a very serious drinking problem, and no amount of therapy has helped so far. She has been an alcoholic for more than 20 years. I understand that some type of prescription medicine will cause her to be repulsed by the taste of alcohol. Could you tell me what that medicine is? – K.H.

Your sister will make no headway with any kind of alcoholism therapy unless she herself wants to stop drinking.

Quite often, a silent problem makes people turn to alcohol as a way of self-treatment. An example is depression. If such a condition can be unearthed and treated, that often ends the alcohol attraction.

No medicines cure alcoholism. Drugs can sometimes help an alcoholic stay firm in the resolve not to drink, but that is the extent of their power.

Disulfiram (Antabuse) has been an adjunct in treating alcoholism for many years. It interferes with the way the liver detoxifies alcohol. As a result, an intermediate product, acetaldehyde, builds up in the blood. If a person on Antabuse slips and takes an alcoholic drink, the blood level of acetaldehyde rises and results in profound nausea, vomiting and diarrhea. It makes the face flush and the person feel most miserable. It’s a way for recovering alcoholics to reinforce their resolve not to drink. The downside is that people can stop taking the drug if they decide to jump off the wagon.

Naltrexone is another drug used as a reinforcement to remain sober. It dulls the alluring reward that alcoholics get from drinking.

A third drug, topiramate (Topamax), was marketed to control seizures. It was found to dampen people’s craving for alcohol, so it too has been used as a helper in keeping people free from alcohol.

The most important factor is your sister’s wish to conquer her addiction.

DEAR DR. DONOHUE: What kind of a diet should a person with acid reflux (hiatal hernia) have? Are salads harmful? What kind of medicine should be taken? – W.R.

People with acid reflux – the upward spouting of gastric acid into the esophagus – have to be their own judges of what their diet should be. Acid reflux is heartburn. Heartburn diets are an idiosyncratic thing; foods that trouble one person do not trouble another.

Foods on most heartburn sufferers’ lists include fatty foods, fried foods, chocolate, peppermint, tomato-based foods, spicy foods, citrus fruits, caffeine, alcohol and carbonated beverages.

Eating smaller meals keeps pressure in the stomach low, and that prevents acid reflux.

Salads aren’t harmful unless a particular ingredient or a particular dressing brings on heartburn for you.

Many medicines are effective. Simple antacids fill the bill for some people. For others, Zantac, Pepcid, Prilosec and Nexium (the purple pill that fills so much TV advertising time) are only a few of the many medicines that can control acid reflux. The best one for you is the cheapest one that relieves symptoms. Finding that medicine can take a little time.

DEAR DR. DONOHUE: I developed horrible vaginal pain that forced me to see my gynecologist on an emergency basis. The doctor drained an infected gland full of pus. How did I get this infection? From my husband? – K.L.

I assume you had an infected Bartholin gland. There are two of them located at the vaginal entrance. They provide the vagina with lubrication.

How these glands become infected is often a matter that is never solved. They just do. It is unlikely that you got the infection from your husband.

The most important facet of treatment for an infected Bartholin gland is draining from it the pus that distends the gland and causes the pain. Antibiotics are necessary, but they are on the second rung of the treatment ladder.

DEAR DR. DONOHUE: I am 71 years old, and my doctor still insists that I get mammograms. None of my friends, also my age, get them. Is there a time when a woman can stop? – W.B.

Experts disagree about this, but let me give you what seems to be the majority opinion.

The facts are as follows. The incidence of breast cancer increases with age right up to the year of a woman’s death. About half of all new breast cancers, in the course of a year, happen to women older than 65. It’s true that at older ages breast cancer is not as fast-growing as it is in younger women, but it does grow, and it still can spread and be lethal.

Second, the life expectancy of a woman at age 70 is more than 15 years. That means that a cancer that first begins at age 70 has a chance to grow and spread well before a woman’s anticipated time of death.

If a woman is in reasonably good health and if she has a life expectancy of at least three to five years, then age should not be used as a criterion for discontinuing mammograms.

Every woman should assess the need of mammograms with her doctor. I happen to agree with your doctor.

Breast cancer is every woman’s fear. The breast cancer pamphlet can place that fear in correct perspective. Readers who would like a copy can write to: Dr. Donohue – No. 1101, 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: Are clove cigarettes safe? I switched from regular cigarettes to the clove kind to prevent lung cancer. Did I make the right move? – T.H.

You made a halfway-right move. Read the label on the package of cigarettes. The content of many clove cigarettes is 60 percent regular tobacco. That’s less than a 100 percent tobacco product, but it does not promise you freedom from lung cancer or emphysema or chronic bronchitis.

I don’t know if there have been any studies on pure clove cigarettes. It stands to reason that introducing anything other than air into your lungs is not a great idea.

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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