Dr. Keith Roach

DEAR DR. ROACH: I am a 74-year-old woman who is active and healthy. I recently had an endoscopy, and the findings were a hiatal hernia of about 5 centimeters with some inflammation. I have been having almost daily acid reflux episodes.
The gastroenterologist put me on a regimen of 40 mg of omeprazole for six weeks. It worked perfectly for me, and I had no stomach pain or acid reflux. When the regimen was done, the doctor said I shouldn’t take it daily. But if I really wanted to take it, he said I should use the over-the-counter (OTC) form of 20 mg every other day. (This worked perfectly for me when I tried it.) He also said that I should treat any future acid problems with Pepcid or get surgery for the hernia.
At my regular medical visits, my regular doctor said it was okay to take the low-dose, OTC omeprazole. Can you give me another opinion about this? — G.P.
ANSWER: The diaphragm is a large muscle that separates the chest from the abdomen, and important structures have to go through it. So, there is a hole in the diaphragm called the hiatus. A hiatal hernia is a weakness in the hiatus where the esophagus passes through, allowing the stomach (and sometimes other contents of the abdomen) to pass into the chest cavity.
The major symptom of a hiatal hernia is acid reflux, which is stomach acid that goes backward into the esophagus. So, the treatment for a symptomatic hiatal hernia is also the treatment for acid reflux.
Your gastroenterologist found inflammation, so he gave you a course of antacid treatment that was long enough to allow the inflammation to heal. You shouldn’t need so much medicine to prevent future problems. Your gastroenterologist is appropriately concerned about the long-term side effects of proton-pump inhibitors like omeprazole. In my opinion, he correctly gave you the options of a low-dose PPI, a different kind of medicine called an H2 blocker (Pepcid), or surgery.
Of these options, the safest is Pepcid or similar medicines, so I also normally recommend it as my first choice. If my patient continues to have unacceptable symptoms, then I will recommend a low-dose PPI. Surgery is done most frequently in people who don’t get relief from medications and sometimes in young people with severe symptoms to prevent a lifetime of medication.
DEAR DR. ROACH: I’m interested in having my ears candled. I have heard some good things about it, but I’ve never heard a medical professional recommend it. What are your thoughts on ear candling? — B.M.
ANSWER: Ear candling is a technique to remove excess ear wax. Some have suggested that it might help other conditions, like Meniere’s disease or temporomandibular joint disorders. There are even more outlandish claims of what it can do.
Please do not believe these incorrect statements and do not try it. There are clear dangers, including being burned from melting wax, driving wax deeper into your ear, and puncturing your eardrum. Two house fires were caused by ear candling, and one was fatal. There is no benefit and clear potential for harm.
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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 ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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