DEAR DR. DONOHUE: I am 92 years old but still independent – I drive, cook and do necessary house jobs. My biggest problem is achalasia. Food cannot pass down my esophagus and get through the sphincter at its bottom to enter the stomach. Is there anything I can do to avoid the pain and trouble that come with swallowing? – E.M.

ANSWER: The esophagus is a long, muscular tube that runs from the throat to the stomach. Through it, food passes to the stomach. The muscles of the esophagus push food down the tube. At its bottom, right before it joins the stomach, is a circular, strong muscle called the sphincter, which keeps the esophagus closed to protect it against any upward splashing of stomach acid. In achalasia (ACHE-uh-LAY-zhuh), the muscle contractions of the esophagus are weak, so food and drink are not forcefully propelled through it. Furthermore, the sphincter at the bottom of the esophagus stays contracted. It doesn’t relax when food and drink reach it. That’s another reason why swallowing becomes such a chore.

Some achalasia patients find that nitrate medicines relax the sphincter and make swallowing less troublesome. An example of a nitrate is nitroglycerin, the medicine used for the chest pain of angina. Viagra, the medicine for erectile dysfunction, has also been helpful. Botox injections, performed through a scope passed into the esophagus through the mouth, are another standard treatment. Balloons can also be passed into the esophagus and inflated when they reach the sphincter region to open it up. And there are many surgical procedures also available.

Your doctor can tell you if your general health is good enough to tolerate any of these treatments.

READERS: Chronic fatigue syndrome is a common malady of the late 20th century and the 21st century. People who would like information on this syndrome can order the booklet that deals with it and its treatment. To obtain a copy, write to: Dr. Donohue – No. 304, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I am a 54-year-old woman in good health, a nonsmoker and not overweight. I observe a diet and exercise program. I also take a low-dose aspirin daily. It has come to my attention that this regimen could be problematic and perhaps cause a rebound effect should I discontinue the aspirin. And what if I need surgery? I thought I was being proactive and was fending off heart disease and strokes. Have I painted myself into a corner instead? – S.S.

ANSWER: People take aspirin to prevent clots from forming in heart (heart attack) or brain (stroke) arteries. Stopping aspirin doesn’t foster clot formation.

Most operations can be carried out without fear in an aspirin user.

For men and women who have had a stroke or a heart attack, a daily aspirin definitely lessens the risk for having a second stroke or heart attack. This is called secondary prevention.

Primary prevention is aspirin use by people who have not already suffered a heart attack or stroke. People who are at risk of having either are the ones targeted for such treatment. Risks include such things as a family history of strokes or heart attacks at young ages, diabetes, high blood pressure, obesity, high cholesterol and physical inactivity. Men age 40 and older and who have two risk factors benefit from low-dose aspirin. Men age 50 and older and who have one risk factor benefit from low-dose aspirin. Women don’t need primary prevention until age 65. Aspirin protects men better than women from heart attacks and women better than men from strokes.

DEAR DR. DONOHUE: After reading your advice to the woman who had heel pain from plantar fasciitis, I was surprised you didn’t mention orthotics. They solved my heel pain. – M.A.

ANSWER: M.A. and many other readers wrote to suggest orthotics (specially made shoe inserts), heel pads, arch supports and cushioned insoles for the relief of heel pain from plantar fasciitis. The plantar fascia is a sling of tough tissue that runs from the heel to the toes on the bottom of the feet. Inflammation of that tissue is a common cause of heel pain.

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 www.rbmamall.com