DEAR DR. DONOHUE: I have read your column for many years, but I haven’t seen anything about stomach flu. Will you write about it? Someone in my family of seven gets it every year, even in the summer. Does the flu shot protect you from it? – H.H.

ANSWER: At one time, I conducted a crusade to erase the term “stomach (or intestinal) flu” from the English language. I didn’t get very far, so I gave up on it. Real flu – influenza – is a respiratory illness, not an intestinal illness. The flu shot provides protection only against true flu, not “stomach” flu.

Four viruses are the usual culprits of stomach flu, and, for adults, the one that leads the pack is norovirus. Vomiting, diarrhea, fever and often headache are the main symptoms. It comes on suddenly, about one or two days after the virus enters the body. The sickness lasts only one to three days. A slight increase in number of cases occurs in the winter, but it comes in all seasons. Norovirus infections usually spare infants. Older people have the worst symptoms, and they are the ones who can die from an infection, but death is rare. This is the illness that sweeps through cruise ships and can infect an entire nursing home. It’s also common in military settings and sports teams. The virus is passed in contaminated food and water, and it can live for long times on inanimate objects – another possible source of transmission.

No medicines kill the norovirus. Replacing fluid lost through diarrhea is the most important aspect of treatment. A homemade replacement solution is a mixture of half a teaspoon of salt, half a teaspoon of baking soda (sodium bicarbonate) and four tablespoons of sugar in a quart (about one liter) of water. Commercial fluid replacements also are available, and drinks like Gatorade are suitable for infections that are not prostrating. Bismuth subsalicylate (Pepto-Bismol) controls diarrhea.

Many bacterial illnesses, like Salmonella, also lead to diarrhea, but that’s a subject for another day.

Immunity to norovirus is not long-lasting, so second infections occur.

DEAR DR. DONOHUE: Swallowing became a real problem for me. Food would get stuck on its way to my stomach. I tried all sorts of over-the-counter medicines, but nothing worked. I saw a gastroenterologist, who put a scope down my swallowing tube. He discovered that there was a constricting ring of tissue at the bottom of it. How did I get it? He opened it with a balloon. Can it come back? – C.W.

ANSWER: You’re talking about a Schatzki (SHOT-ski) ring. It is as you say – a fold of tissue encircling the lowermost part of the esophagus, and it does cause food to hang up there.

How did you get it? Some theorize that reflux of stomach acid into the esophagus explains why it developed. Acid reflux is a fancy way of saying heartburn. However, people can have reflux and a Schatzki ring but not have any heartburn symptoms. Meat and large pieces of bread are the foods most likely to get stuck.

Stretching the ring with a balloon or other device usually fixes the problem. However, it can come back, and it often does. Because recurrence is common, many doctors put their patients on medicines that suppress stomach acid production.

DEAR DR. DONOHUE: I need some basic facts about the pulse. First, what’s considered a normal rate? I have trouble finding my pulse. I feel all over my wrist, but it’s hard for me to detect. Is there some other place where I can feel it better? – C.M.

ANSWER: The pulse rate and the rate of the heartbeat are one and the same. When the heart beats, it ejects blood into arteries. The force of that ejection runs down all artery walls and is the pulse beat. A normal pulse (or heart rate) is 60 to 100 beats a minute.

You feel the pulse on the thumb side of the wrist. Maybe you’re pressing too hard and obliterating it. If you can’t find it there, you can feel it in the neck, slightly below the angle of the jaw. Or you can put your hand over your heart and count the heartbeats.

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.

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