DEAR DR. DONOHUE: Our experience with my husband’s hiatal hernia was traumatic. He was 69 and in excellent health. After a day of working in the yard, we sat down to supper and within three minutes he was incapacitated with chest pain. He was taken to the hospital and was given nitroglycerin for the pain. The pain subsided as quickly as it came. It took two months to discover the real problem: His stomach was in his chest cavity and had crowded his heart and lungs. Surgery was scheduled. Before the scheduled date, the pain returned and he had to have emergency surgery. Please let people with a hiatal hernia know about this. – M.H.

ANSWER: People have been led to believe that a hiatal hernia is the same as GERD, gastroesophageal reflux – heartburn; it isn’t. They are two different conditions. A hiatal hernia is a bulging of the stomach through a gap in the diaphragm muscle, the muscle that separates the chest cavity from the abdominal cavity. The gap is the hiatus, and through it, the esophagus can pass from the chest into the abdomen to join the stomach.

GERD can happen to people with a hiatal hernia, and it can happen to people without a hiatal hernia. Your husband’s problem was a somewhat rare complication of a hiatal hernia. The upward bulge of his stomach, the portion in the chest, twisted and cut off its own blood supply. That’s what caused his pain. The first time, the hernia untwisted spontaneously and the pain left. The second time, the twist didn’t untwist, and emergency surgery was required.

This process is called strangulation and is a very serious affair. Thankfully, it happens only to a very few. You’ve provided a chance for people to learn what a hiatal hernia is, what a strangulated hiatal hernia is and what GERD is. We’re all glad that things worked out well for your husband.

The booklet on hiatal hernia, acid reflux and heartburn focuses primarily on the common heartburn problem and its treatment. Readers wanting more information on heartburn 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 $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My husband belches so loudly and so often that it’s a major embarrassment to me. I don’t like to eat out with him. I don’t like to eat in with him, either. He says he can’t help it. Is that so? Can you suggest something for him? I will be eternally grateful if you can. – M.C.

ANSWER: Your husband can turn down the volume of his belches without too much effort.

He might even control their frequency with a few simple changes. Air swallowing is the cause of belching. The belcher is usually unaware that he or she is swallowing air. Becoming conscious of that is a great step toward controlling it. He should eat slowly, and each mouthful should be relatively small. He has to drink slowly too, not gulp. He must stay away from carbonated beverages.

If he’s a gum chewer, tell him to stop. Gum chewing brings air into the stomach.

Drugstores have a variety of preparations containing simethicone. It’s said to break up air and gas bubbles in the stomach. He can give one a try. Names of a few of these products are Phazyme, Mylanta Gas, and Gas-X.

DEAR DR. DONOHUE: I have gotten in the habit of taking Tylenol before seeing my dentist. I have a phobia about needles, and seeing the dentist come at me with a syringe puts me in a cold sweat. I have it in my mind that the jab will be painful. Taking the Tylenol works for me. Is there anything wrong with doing this? – R.C.

ANSWER: There’s nothing wrong with taking a Tylenol before seeing the dentist. If it gets you through what you imagine might be painful, three cheers for Tylenol.

DEAR DR. DONOHUE: I am a 43-year-old male. I have been running 5 kilometer (3.5 miles) since the late 1980s with consistent times in the 19- to 29-minute range. Three years ago, my times started improving each year. I now run in the 18:00 to 18:30 minute range, yet I haven’t changed my exercising or eating habits. I am curious if you ever heard of something like this or could explain why it happened. – M.S.

ANSWER: I can’t explain it, M.S. I don’t want to try. Why look a gift horse in the mouth? Be happy that this has happened. Would you look for an explanation if you won the lottery?

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.