DEAR DR. DONOHUE: I had a vertical-banded gastroplasty more than 20 years ago. Since then, I estimate that I have vomited 1,500 times a year. I stopped eating in the evenings to stop the GERD I experience, but I have developed a persistent cough at night and have small bits of food come up in my throat almost every night. I start out sleeping in bed, but end up finishing the night in a chair. I take Prilosec for the GERD. Can you recommend anything or the kind of physician to see? – T.N.

ANSWER: A vertical-banded gastroplasty is the kind of weight-loss surgery that makes a small pouch out of the stomach. After the surgery, the stomach holds only about an ounce (30 ml) of food. Normally it can hold more than 10 times that volume.

You have two problems: GERD – gastroesophageal reflux (heartburn) – and vomiting. They might both be related to the surgery, but let’s handle them separately.

For the reflux of stomach acid into the esophagus and throat, put 6-inch blocks under the bedposts at the head of your bed, so gravity keeps food in your stomach at night. You might need a larger dose of Prilosec – a medicine that turns off acid production – or you might need a different medicine in that family of drugs. Limit or eliminate fatty foods, caffeine, chocolate, alcohol, mints and orange juice.

The vomiting can be a consequence of the kind of surgery you had. Smaller, more frequent meals might be an answer. If they aren’t, you need to see a gastroenterologist. You should also see a surgeon who has experience in this kind of surgery. The surgeon might suggest that you have a revision of your original surgery to stop this nocturnal vomiting.

DEAR DR. DONOHUE: Will you discuss malignant otitis externa? I have it.

I had an earache for three weeks. I used eardrops that I got over the counter. They didn’t work, and the pain became horrible. My family doctor sent me to an ear, nose and throat doctor the same day he saw me. The ENT doctor is the one who made the diagnosis and has me on antibiotics. He said I might have to be hospitalized and have surgery. What makes this earache so special? – D.W.

ANSWER: Malignant otitis externa is the worst earache imaginable. Most often it’s caused by a bacterium with the name Pseudomonas (SUE-doe-MOAN-us), a particularly nasty germ that’s difficult to treat because it has a natural resistance to many antibiotics.

This kind of ear infection can spread to structures adjacent to the ear, including bones of the skull. Oral antibiotics taken for a long time can sometimes eradicate the infection. If they don’t, then the doctor has to remove dead tissue associated with the infection.

Intravenous antibiotics, in these instances, are almost mandatory so the antibiotics achieve high blood levels and penetrate the site of infection.

Do you have diabetes? Diabetics are susceptible to this kind of infection.

DEAR DR. DONOHUE: Many years ago, when I was in high school, aspirin was measured in grains. One tablet had five grains of aspirin. My science teacher always said that for aspirin to be effective, you had to take one grain of aspirin for each 10 pounds of body weight. If you didn’t, the aspirin would do you no good.

Today, aspirin is in milligrams. I wonder what the dosage should be in milligrams and how grains compare with milligrams. – C.D.

ANSWER: Grains are units in a system of weights and measures called the apothecary system. It’s a system not used much these days; the metric system has supplanted it. One grain equals 65 milligrams. A standard adult aspirin has 325 mg (5 grains).

The rule you learned of one grain for every 10 pounds has been repealed. The amount of aspirin depends on the reason for its use. A dose as small as 81 mg (low-dose aspirin or baby aspirin) can keep platelets from sticking to each other and forming clots in arteries. It’s the dose often chosen to prevent heart attacks and strokes.

For pain relief, two adult aspirin (650 mg, 10 grains) every four hours is sufficient for most people.

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. Readers may also order health newsletters from

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