DEAR DR. DONOHUE: A couple of months ago, while eating breakfast, I came down with terrible stomach pain. Then I started to throw up. My wife took me to the hospital. They told me I was having a gallbladder attack, and they admitted me for surgery.

I am completely better now, but I have some questions I’d like you to answer. How do I digest food without a gallbladder? What causes gallstones? Can’t gallstones be dissolved with medicines? — H.M.

ANSWER: Most gallstones are cholesterol gallstones, and the cholesterol comes from the liver. The liver also makes bile, a digestive juice. Cholesterol enters the bile, and bile is then stored in the gallbladder, a little storage container on the underside of the liver. If the cholesterol concentration of the bile is high, cholesterol crystals in the bile clump and settle to the bottom of the gallbladder. Crystals aggregate to form a stone. The stone or stones block the exit of bile out of the gallbladder and into the intestine, where it aids in digestion. A blocked gallbladder is painful.

Risks for stone formation include obesity, being a woman, taking the birth control pill, having a family history of gallstones and crash dieting. How greatly the diet influences stone formation is open to question. However, diets high in sweets, sugar and fats seem to play a role.

Medicines can dissolve gallstones. The stones have to be small, and the medicine has to be taken for months to years. Frequently, stones form once again when the medicine is stopped.

Bile helps in the digestion of fats. When a fatty meal enters the small intestine, the gallbladder contracts and sends a jet of bile into the intestine. People without a gallbladder can still digest food quite well. Their bile drips into the intestine on a more or less constant basis.

DEAR DR. DONOHUE: My son chews tobacco. That’s bad enough, but he also swallows the juice. He has a wonderful wife and two teenage boys. We have tried to talk to him, but to no avail. We hope you print something to state the consequences of this habit that will scare him into quitting. — M.B.

ANSWER: I’ll do my scary best. Chewing tobacco and snuff are called smokeless tobacco. Snuff is finely ground tobacco placed between the lip and gums or snuffed into the nose. Chewing tobacco is more coarsely ground and is tucked between the gum and cheek.

More than 2,000 chemicals are in tobacco and its juices. Your son absorbs them through the lining of his mouth. Swallowing the juice (yuck!) allows more chemicals to be absorbed in his stomach and digestive tract. His blood levels of nicotine are high.

He puts himself in danger of cancer of the mouth and throat and tongue. He’s eroding his teeth. High blood nicotine levels lead to artery hardening and heart disease.

He’s not subjecting his lungs to cigarette smoke, so he doesn’t run the risk of lung cancer or chronic obstructive pulmonary disease — one good point.

Smokeless tobacco in any form is not a great idea.

DEAR DR. DONOHUE: I had my first ever complete physical examination. It included blood and urine tests and an EKG.

The EKG showed premature atrial beats. The doctor never said a word to me about them. What do they mean? Are they trouble? I am 37. — G.K.

ANSWER: Premature atrial beats are extra heartbeats originating in the upper heart chambers, the atria.

They’re not an indication of serious heart disease. They need no treatment, especially when a person is completely unaware of them. Numerous premature beats might be felt as palpitations. Sometimes numerous beats have to be suppressed. Yours can be forgotten.

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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