DEAR DR. DONOHUE: Several months ago I went to an ear, nose and throat doctor about a sore throat that came on every night after going to bed. He said it was caused by acid reflux and told me to take Prilosec for a month. It works fine, but the package info is disturbing. It says to take it for 14 days and then wait before taking any more. The doctor tells me to keep taking it as long as it’s working so well. What should I do? – L.C.

ANSWER: Prilosec suppresses the stomach’s production of acid. It’s a popular acid-reflux (GERD, heartburn) medicine. Readers will be surprised you take it to stop nightly sore throats. Acid reflux can have unusual symptoms – sore throat being one. Stomach acid can trickle upward into the throat and irritate it.

The instructions for Prilosec say to use it only for 14 days and then wait four months before starting another 14-day course. But read the instructions again. They also say to use it in this way unless you have been directed otherwise by a doctor. You have been directed to use it otherwise.

One reason for limiting its constant use has to do with the absorption of vitamin B-12. Stomach acid is necessary to absorb that vitamin from food. However, people who use Prilosec or medicines closely related to it for prolonged periods have not been shown to be at great risk for developing a B-12 deficiency.

Secondly, high doses and prolonged use of the medicine lead to tumors in some lab animals. Tumors have not been found in humans.

Many doctors have their heartburn patients take the medicine indefinitely. You can do so too.

Or, if you are willing to experiment, you can stop the medicine and see what happens. You might not develop sore throats. If you do, start it again.

The heartburn booklet discuss the symptoms and treatment of this common malady. Readers can order a copy by writing: Dr. Donohue – No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Please advise me on taking Actonel versus Fosamax for osteoporosis. I started taking Fosamax about five years ago and obtained very good results. Now my insurance company has switched me to Actonel to save members money. I would like your opinion on making this change. – P.N.

ANSWER: Fosamax (alendronate) was the first member of this drug family to appear on the market, in 1995. It stops bone breakdown by putting the breaks on cells that chip away at bone.

Actonel (risedronate) is a close relative of Fosamax. It was marketed in 1998, and its action is similar to the action of Fosamax. It has many satisfied users.

I can find only one study that showed Fosamax as being slightly more effective than Actonel, but that information hasn’t been duplicated in other head-to-head comparisons. Doctors sing the praises of both drugs.

I wouldn’t hesitate to make the switch if your insurer demands it be made on the basis of cost savings. If you do go ahead and change, your doctor can check the health of your bones after a few months of use, and then you’ll have proof that it’s working for you.

Will pharmacists help me out here? Am I wrong in calculating that the difference in a year’s supply of Fosamax versus a year’s supply of Actonel is only $45?

DEAR DR. DONOHUE: African-Americans seem to have a greater incidence of certain diseases than their white counterparts. Why? – R.P.

ANSWER: There are differences in susceptibility to many illnesses among all ethnic groups. African-Americans suffer more severe high blood pressure at younger ages than do whites. Partly that has to do with socio-economic factors. Partly it has to do with physiological differences. African-Americans are more sensitive to salt than are whites, and they have decreased activity of certain kidney substances that dilate arteries and lower blood pressure.

DEAR DR. DONOHUE: I have a bifascicular block. In 1995, my doctor indicated that my ECG reflected a right bundle branch block. A few years ago he indicated that I now have a bifascicular block. He did not suggest any further tests. Please comment on a bifascicular block and how serious it is. – K.M.

ANSWER: The fascicles, also known as bundles, are cables of special tissue that run through the heart muscle and function as its electrical power lines. There’s a right and left fascicle (bundle). The left splits into two smaller cables, the anterior and posterior. The fascicles transmit the electric current generated by the heart’s natural pacemaker to the ventricles, the heart’s lower pumping chambers. When the signal reaches the ventricles, a heart contraction occurs – a heartbeat.

A block is a short circuit in one of the fascicles. Your right bundle branch block delays the arrival of the electrical signal to the right ventricle. It still pumps, but the signal has to take a detour to get to the ventricle. Most often a right bundle branch block doesn’t pose a significant health risk.

Now one of your smaller left bundle cables has a block in it. You have a short circuit in two places – a bifascicular block. Even with two cables blocked, the electrical signal makes its way to both lower heart chambers, and their pumping action is not impeded. A bifascicular block in a person who has no symptoms and whose heart appears to be otherwise healthy does not compromise health, either.

In a few people, a bifascicular block progresses to a complete heart block. In that situation, the electrical signal doesn’t make it to the ventricles. They go on pumping but at a very slow rate, and an artificial pacemaker must be installed to speed up the heartbeat.

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.