Dear Dr. Roach: I am a 74-year-old male. I had open heart surgery one year ago. I am currently taking several medicines, all for a year or more. About a month ago I started having very hard stools, and they had become like different size marbles. I have had no changes to my diet. Can a person’s stool indicate a problem? — D.M.
Answer: Yes, a change in a person’s bowel habits can often be a clue that there is a new health problem.
It can mean an issue with the intestines and colon, or a systemic issue, such as low thyroid levels. Changes in diet or medication are probably the most common cause, but changes in physical activity also can cause hard stools. A recent study showed that 25% of people — one person in four! — has had changes in their bowel habits related to the pandemic.
For many people, changes like yours get better as mysteriously as they started. Even so, definitely make an appointment to see your regular doctor. In the meantime, increasing fiber through diet (whole grains and vegetables in particular) and water may be of benefit.
Dear Dr. Roach: We read your column daily, and have read several letters about acid reflux and the long-term use of medications. No one has suggested raising the head of the bed as a solution.
My husband was on prescription-strength Nexium and then rabeprazole for many years until we purchased an adjustable bed. He raised the head about 4 inches; his GERD disappeared and has never returned. He no longer needs meds at all. When we travel, we put a pillow under the head of the mattress, which is a quick and simple solution. We hope others will find this suggestion useful. — H.M.
Answer: I think you are right that doctors rush too quickly to suggest medications to treat acid reflux symptoms, and I am glad you wrote to remind me to go over nonmedication treatments, in addition to raising the head of the bed. Another is to give enough time for the stomach to empty before going to bed.
Bedtime is critical for reflux because of two factors. The first is gravity. If acid gets into the esophagus, it tends to stay there without gravity pulling it back down into the stomach. The second is the swallow reflex. When we are awake, we swallow about once per minute, usually without being aware of it at all. This helps clear any acid that went into the esophagus. While asleep, you only swallow about three times per hour, so the acid can do much more damage.
Two hours — or, better yet, three hours — of time between dinner and bedtime allows the stomach to empty so that there isn’t so much pressure pushing stomach acid backward into the esophagus, where it doesn’t belong.
Diet can make a big difference. Fat tends to worsen reflux, as does caffeine, chocolate and carbonated beverages. Tobacco and alcohol are problematic and should be stopped or at least minimized. Even tight clothing makes GERD worse for some people.
Lifestyle changes can free many people from medications, all of which have the potential for side effects even if they are generally safe.

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 send mail to 628 Virginia Dr., Orlando, FL 32803.
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