DEAR DR. DONOHUE: My 31-year-old son-in-law is 6 feet tall, weighs 185 pounds and is in good physical condition. His concern is triglycerides. His measure more than 600. His cholesterol is just a bit high. He eats very healthily, with little fast food. He drinks only diet soda and skim milk. He uses sugar substitutes in his coffee. He eats much Indian food. Any help is appreciated. – B.W.

ANSWER: Total cholesterol, LDL cholesterol (the bad kind) and HDL cholesterol (the good kind) have star billing when it comes to artery hardening and heart disease. The spotlight has begun to shine on triglycerides, and now they are sharing billing with cholesterol.

Triglycerides are fats. The whitish, yellowish stuff you see in a cut of meat is triglycerides. Guidelines tell us that a triglyceride level below 150 mg/dL (1.7 mmol/L) is ideal; levels between 150 and 199 (1.7-2.2) are borderline bad; levels from 200 to 499 (2.2-5.6) are bad, and anything over 500 (5.6) is very bad. Your son-in-law is in the “very bad” category.

For overweight people, weight loss is the first step in bringing down triglycerides. This doesn’t apply to your son-in-law. He should severely limit rapidly absorbed carbohydrates, like sugar. They raise triglycerides. He also should cut back on red meat and full-fat dairy products. He has to steer clear of trans fats, found in some commercially prepared foods, particularly baked goods and many fast-food deep-fried items. He has to limit alcohol. Your son-in-law is doing all this, but his levels still are too high.

Three hours of weekly exercise can lower triglycerides. If this doesn’t get the job done, then he should consider the medicine route. Niacin and gemfibrozil can bring down the triglyceride reading.

Diabetes, a low output of thyroid hormone, kidney disease and some medicines like beta blockers and thiazide diuretics raise triglyceride levels.

Very high triglyceride levels can inflame the pancreas – pancreatitis. Your son-in-law is at the threshold of that complication.

DEAR DR. DONOHUE: In 2004, I had a scope put down my throat and into my stomach. The doctor said I had a hiatal hernia and signs of acid reflux. He put me on Prilosec. It stops my heartburn very well. I have been on it ever since. If I miss two doses, the heartburn returns. Is it safe to take this medicine for long periods of time? – L.K.

ANSWER: Prilosec (omeprazole), Aciphex, Protonix, Nexium and Prevacid are proton-pump inhibitors, the strongest medicines for decreasing stomach acid production. The manufacturers of these medicines suggest a four-to-eight-week course of medicine. The medicines don’t cure heartburn. They suppress it as long as a person takes them. So what’s a person to do when heartburn returns after a course of therapy? Another kind of medicine, like Zantac, can be used. Common antacids often work. Avoiding foods that stimulate acid production is another way to control symptoms.

However, if acid reflux is severe, then the proton-pump medicines are the best. Evidence suggests that long-term use might make a person more apt to have a hip fracture. That danger can be partially offset by taking calcium and vitamin D. Many people remain on these medicines for extended periods. You have to make this decision for yourself.

DEAR DR. DONOHUE: I have a fungus infection on my left foot and toes. What causes it? How do I get rid of it? – L.D.

ANSWER: A fungus causes it. Fungi are germs that are a bit larger than bacteria. Fungi thrive in warm, moist places. Keep your feet dry. Wear sandals when you can. Change socks twice a day. Have two pairs of shoes, and alternate their use. You can find numerous medicines for athlete’s foot (which is what you have) at the counters of all drugstores. Lotrimin AF, Micatin, Absorbine and Tinactin are a few names. If those medicines fail, the oral medicine griseofulvin usually can do in the fungus.

DEAR DR. DONOHUE: I am one of those men who is not helped by Viagra. I want to continue with an active sex life, even though I am 77 years old. I’ve been contemplating getting one of those penile implant devices. How do they work? What kind of doctor do I see? – B.F.

ANSWER: One such device consists of two distensible cylinders implanted in the penis. A fluid reservoir is inserted under a groin muscle. And finally, a small, inconspicuous pump is placed in the scrotum. All three components are connected. For an erection, a man manipulates the pump, which propels fluid into the penile cylinders.

Semi-rigid rods are another kind of device that produce a more or less constant erection that does not interfere with the passage of urine and that is not visible. The device can be bent upward or downward.

A urologist is the doctor you want to consult for more details.

Have you seen your family doctor? You really should. Erectile dysfunction often is a sign of clogged arteries. If the penile arteries are clogged, then arteries to the heart and brain also might be clogged. That’s something that needs to be investigated.

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.