DEAR DR. DONOHUE: I am a 64-year-old woman, and I have been on Nexium for two years for heartburn. During that time, I have had two broken hips. My doctor says there is no connection between Nexium and my broken hips. I have tried to get off Nexium, but each time I stop, I become sick. I replaced Nexium with Prilosec, but it didn’t work. The fourth time I tried to quit, I ended up in the hospital for four days. Is there any way I can be free of this medicine? – A.H.

Nexium (esomeprazole) belongs to the family of drugs called proton pump inhibitors, the most potent suppressors of stomach acid production. Other members are Prevacid (lansoprazole), Prilosec (omeprazole), AcipHex (rabeprazole) and Protonix (pantoprazole). These drugs pose a small risk of contributing to hip fractures when they’re used for prolonged periods in high doses. The mechanism isn’t known for sure, but it might be due to the decreased absorption of some calcium compounds because of decreased acid production. Acid facilitates the absorption of some forms of calcium. It sounds like you really need this medicine to function, so you should be sure you’re getting enough vitamin D, and perhaps change to calcium citrate. It requires less stomach acid for absorption.

Have you tried another family of drugs that lower acid production but not quite to the level proton pump inhibitors do? Those medicines are Tagamet, Pepcid, Axid and Zantac, all over-the-counter medicines.

You have to take approaches to stomach-acid control that aren’t medicine. Avoid heartburn trigger foods: onions, garlic, caffeine, colas, peppermint, spearmint, alcohol, chocolate, fried and fatty foods, citrus and tomato sauces. Don’t wear constricting clothes, which encourage the spurting of stomach acid into the esophagus. Tight belts are one example. Eat smaller meals, but eat more often. After eating, don’t lie down for 30 minutes. Try to stay standing or walking or washing dishes during that time. Place 6-inch blocks under your bed’s head posts to keep stomach acid in your stomach during the night.

If all this fails, you might want to consider surgical procedures that tighten the lower esophagus and prevent acid from reaching that organ.

DEAR DR. DONOHUE: My problem is passing out when I laugh. It happens when I laugh fairly hard, and it’s more than just getting a little lightheaded. I fall asleep most every time I sit down, and I have to take a nap at lunch every day. I just turned 39. My wife thinks this is not normal. – K.R.

It’s not normal. It’s suggestive of narcolepsy, the irresistible compulsion to fall asleep at inappropriate times and places. One of the other signs of narcolepsy is cataplexy, a sudden loss of muscle tone without loss of consciousness. It can be as minor as involuntary dropping of the jaw to as major as collapsing on the floor. Strong emotions like laughing provoke cataplexy. Cataplexy might be what you mean by passing out.

Discuss this with your family doctor. Medicines like modafinil often can control narcolepsy.

DEAR DR. DONOHUE: I always heard that one must fast before being tested for cholesterol. My doctor always told me to do so. At my last visit, he had his nurse draw my blood for a cholesterol check. I told him I had not fasted, but he said it didn’t matter. Have things changed? – D.S.

You don’t have to fast for an accurate cholesterol reading. However, you do have to fast, preferably for 12 to 14 hours, for an accurate triglyceride reading. Triglycerides often are checked along with cholesterol.

A new trend is developing for triglycerides. Many now feel that a more accurate picture of triglycerides is obtained by not fasting before blood is drawn. Whether this technique wins universal approval is something we’ll have to wait to see.

DEAR DR. DONOHUE: I am a male with a problem that occurs every two or three months. I have had it for the past 30 years. I get severe rectal pain that lasts only a few minutes. I was surprised to find out it has a name, proctalgia (prok-TALE-juh) fugax (FEW-jacks). Is there any hope of finding an answer to it? – A.K.

The presumed cause is a spasm of rectal muscles. Some find relief by sitting on a clenched fist. Since it is fleeting and happens infrequently, medicines have little time to get to work before it has run its course. You’ve put up with it for 30 years, so it might be wise to forgo any medicines so that you don’t run the chance of suffering side effects from them.

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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