DEAR DR. ROACH: I suffer from acid reflux but continue to drink caffeine once a week, on Saturday before noon. I have taken pantoprazole twice a day for a decade. Is there anything you suggest to replace caffeine?

I don’t drink coffee, just caffeinated drinks. I’m an addict. The acid is eroding my upper teeth, which are visibly smaller and occasionally painful. That is why I am desperately asking for help. My medical doctor is concerned about possible throat cancer. Thanks. — G.M.J.

ANSWER: There are two big issues here. The first is the effect of the beverages themselves. Carbonated soft drinks, whether diet or regular, whether caffeinated or not, contain some amount of acid, which can damage the tooth enamel. The only way to stop that is to stop consuming these types of drinks. Even carbonated (seltzer) water is mildly acidic and thus has the potential for harm (though much less so than sugary sodas, which promote decay); plain water is your best bet.

The second issue is the reflux (stomach acid coming up from the stomach). In some people, the acid can even make it to the mouth, which rapidly damages teeth, being a strong acid. This is particularly a problem at night, when there is no help from gravity and there is less swallowing to protect the esophagus and mouth from damage from acid. Caffeine makes reflux worse by weakening the lower esophageal sphincter, the muscular valve structure that prevents stomach contents from coming up.

However, pantoprazole (Protonix) is a proton pump inhibitor, and prevents the stomach from making acid. This partially protects your teeth from decay and, most authorities believe, helps protect against development of cancer associated with severe, longstanding reflux.

DEAR DR. ROACH: There are people who claim that the drugs used to kill death-row prisoners cause pain and suffering. Are there no drugs that can be used that could be considered humane? I’ve heard of operations during which peoples’ hearts are actually stopped, repaired and then started once again, but I’ve never heard that such people remember any suffering during such a procedure. In fact, I would assume that something could be done during any major operation that could result in death without that person feeling any discomfort. — P.C.

ANSWER: In the United States, the question of whether the death penalty is ”cruel and unusual” is a constitutional issue that has been, and continues to be, addressed by the courts. The question of whether it is ethical for a physician to be involved with it is one for physician organizations and for individual physicians to decide for themselves. I agree with my college, the American College of Physicians, that it is never ethical for physicians to participate in state-mandated executions.

This is of importance because those who have the expertise render a patient unconscious, and who would best enable as humane a death as possible in such circumstances, are ethically obliged not to participate. This means that those who are participating lack the highest expertise in using these drugs properly. Moreover, the drug companies who make many of the medications that have been used for execution have refused, on ethical grounds, to sell them for this purpose.

Just this week, my first-year medical students discussed the ethics of this very issue, and one made the argument that if executions are legal and going to proceed, is it not the ethical thing to do to use our medical knowledge to ease suffering? While I understand her argument, I believe physician participation in executions in any form is inherently unethical and antithetical to the physician’s calling.

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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 [email protected] or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.

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