Surgery available for heartburn if medicines fail

DEAR DR. DONOHUE: My husband has gastric reflux very bad. He had tried many procedures and all the pills, but they don’t work for him. He is now on Nexium. Can surgery be done? — F.S.

ANSWER: GERD — gastroesophageal reflux disease, popularly called heartburn — is the upward shooting of digestive juices and acid from the stomach into the esophagus, where it leads to pain. Your husband may have tried these maneuvers, but I’ll mention them for others. Elevating the head of the bed by putting 6- or 8-inch blocks under the bedposts keeps stomach juices in the stomach during the night. If he smokes, he has to stop. He needs to eliminate fried and fatty foods, citrus fruits and juices, tomatoes and tomato products, onions, garlic, caffeinated beverages, chocolates, mints and spicy foods. In place of three large meals, smaller and more-frequent meals can cut down reflux.

Nexium is one of the five proton pump inhibitors, the most powerful suppressors of acid production. When these medicines fail to control reflux, then other conditions ought to be considered. If other conditions can’t be found, then surgery could be the answer.

The Nissen fundoplication is one of the standard operations for GERD. The topmost part of the stomach is snugly wrapped around the lowermost part of the esophagus to create a barrier to the upward spurting of stomach juices. The operation often can be done with the aid of a scope passed through a small incision in the abdominal skin and another small incision for the necessary instruments.

Another procedure is done with an endoscope, a scope passed through the mouth into the esophagus. It comes with a device that encircles the lower esophagus with a few stitches to tighten it and prevent acid reflux from the stomach. This procedure is the Bard EndoCinch procedure.

The heartburn booklet describes this common malady in detail and outlines its treatments. To order a copy, write: 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: I am 65 years old and have been taking calcium and vitamin D for many years. I also take a 250 mg tablet of magnesium daily to help with the constipating effects of calcium. My doctor originally put me on it to control high blood pressure. Will the magnesium lead to dependence and slow natural bowel action? — D.K.

ANSWER: Magnesium is an important but seldom-discussed mineral. It aids in the production of DNA, RNA, proteins and hormones. It’s a major component of bones, and strengthens them, along with calcium. It is used for the severe hypertension that sometimes occurs in pregnancy. Does it lower your blood pressure? The recommended daily amount for adult females, 31 years old and older, is 320 mg, and for males of the same ages, 420 mg.

Magnesium hydroxide often is used as a laxative and as an antacid. It’s milk of magnesia. The Phillips company markets magnesium hydroxide as Phillips Milk of Magnesia.

Your dose of magnesium hasn’t hurt you and is not likely to interfere with bowel motility.

DEAR DR. DONOHUE: My beloved niece recently passed away at age 54 from thrombotic thrombocytopenic purpura. She was hospitalized for seven months and received many blood cleansings. What happens to the body with this illness? How could a healthy woman contract it? — A.M.

ANSWER: Thrombotic thrombocytopenic purpura encompasses many serious health problems: anemia, a decrease in blood platelets (the clotting cells), kidney failure, fever and neurological signs. Neurological signs are things like disorientation, paralysis, seizures and the inability to speak. The immune system makes antibodies that lead to all these dire consequences. Plasma exchange (blood cleansing) clears blood of those antibodies and returns it to the patient along with fresh frozen plasma. Plasma is the liquid part of blood, the part from which blood cells have been removed. I can’t explain why she didn’t respond. It happens. I am sorry for her, and for you.

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.