DEAR DR. ROACH: My adult son recently has been diagnosed with achalasia, after many months of being misdiagnosed. He has suffered unbelievable pain and difficulty eating or drinking. At first he thought he was having a heart attack. Fortunately, that was ruled out. He is going to a prominent gastroenterologist, who made the diagnosis and has been treating him. He had the balloon procedure, which was not successful. He then had a Botox procedure. This relieved him somewhat. However, he has still had some painful episodes. What can you tell us about this illness? Will he eventually be cured? — S.G.

ANSWER: Achalasia (awk-uh-LAY-shuh) is a swallowing problem caused by degeneration in the nerve cells in the esophagus, the muscular tube that carries food to the stomach. Nobody knows why it happens, but it might be autoimmune or related to a viral infection. Because the nerve cells no longer work properly, the esophagus cannot empty, and food stays in the bottom of the esophagus, causing a “stuck” feeling, which indeed can resemble the symptoms of heart disease. Both solids and liquids are affected.

Achalasia may be diagnosed with several different types of tests, including X-rays, barium swallow, endoscopy and esophageal manometry (measuring pressures inside the esophagus). It’s important to get the right diagnosis, since other conditions, especially cancer of the esophagus, may look like achalasia.

The usual first treatment is to widen the opening at the bottom of the esophagus, the lower esophageal sphincter. Sometimes it takes several attempts to work, but it does work for about 60 percent of people. Botulinum toxin (Botox), which prevents muscle contraction, is effective up to 90 percent of the time, but it needs to be repeated since the effect of the toxin is temporary.

Surgery is the most definitive treatment, and it provides long-term relief for about 85 percent of people 10 years after treatment. There isn’t a cure, but most people get relief from one of these treatments.

DEAR DR. ROACH: I am a 55-year-old post-menopausal woman. I understand that at this age, the vagina lining and anatomy change for the worse. I am not enjoying intercourse with my husband due to a constant burning feeling in the vulva and cervix, which is becoming painful. I have tried using a variety of lubricants, but they all seem to have an ingredient that causes more burning to the skin in that area. It feels like I am applying salt or vinegar. The lubricants I use do not have glycerin, but they still sting. What other ingredients might cause this burning? What brand name do you suggest for sensitive skin, like mine? — N.I.

ANSWER: Some women have bad responses to paraben, fragrances and alcohol. Some women do well with silicone-based lubricants, but others find them to be more irritating; also, they can’t be used with condoms. Astroglide makes a sensitive-skin formulation that doesn’t have any of the common irritants. Hydra Smooth is another good brand for women with very sensitive skin.

If you can’t find a product that works for you, you might ask your doctor about estrogen cream. Most post-menopausal women have some atrophy (thinning) of the lining of the vagina, and estrogen cream probably is the safest way to treat this common condition.

DEAR DR. ROACH: My microwave is peeling paint on the inside top of the oven. It was suggested that I use masking tape or a special paint on it. — G.V.E.

ANSWER: Don’t use masking tape; it can release chemicals if it gets hot. You can remove all the peeling paint, and repaint with special microwave-oven paint.

READERS: The booklet on restless leg syndrome and nighttime cramps offers more tips. Readers can obtain a copy by writing: Dr. Roach — No. 306, 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.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Health newsletters may be ordered from www.rbmamall.com.

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