Rx for Readers

Occasional heartburn is generally nothing to worry about, but some people are bothered by heartburn every day.

I am a 54-year-old man who often suffers from heartburn after eating. What can I do? - P.B., Herzliya Judy Siegel-Itzkovich comments: The Mayo Clinic Health Letter discusses this problem. Heartburn is a common digestive response to overindulging in a big meal or eating spicy food. It's also a symptom of gastroesophageal reflux disease (GERD), a condition in which digestive acid flows back (refluxes) into the esophagus that connects the mouth and stomach. Occasional heartburn is generally nothing to worry about, but some people are bothered by heartburn every day. Whether your symptoms are mild or severe, lifestyle changes can help reduce heartburn, but if they are frequent, you must consult your doctor, as reflux increases the risk of esophageal cancer. In general, eat smaller meals, as they reduce pressure on the lower esophageal sphincter. This ring of muscles normally keeps digestive acid in your stomach, helping prevent acid reflux. Fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, tomato-based foods, spicy foods, citrus foods and caffeine can trigger heartburn, so you should avoid them. Tightness around your waist pressures the lower abdomen and the lower esophageal sphincter, so you should loosen your belt. It's best to wait at least three hours after eating before going to bed or lying down. As smoking can increase stomach acid and swallowing air during smoking may also aggravate acid reflux, and for a thousand other reasons, it is advisable to quit the habit. Being overweight is one of the greatest risk factors for heartburn. Elevating the head of your bed about about 10 or 15 centimeters puts gravity to work for you; use bricks or blocks under the feet at the head of your bed, or insert a wedge under your mattress to elevate your body from the waist up. Raising your head with an extra pillow doesn't help. Sleep on your left side; this may help your stomach empty better. Medications can help when lifestyle changes aren't enough, and surgery to tighten the sphincter muscles to prevent reflux also is an option. I am a 93-year-old woman living in a retirement home. Some time ago, I developed a reddening of my right and left soles and toes. At my health fund's department of vascular disease, it was diagnosed as peripheral vascular disease (PVD). In the right foot, I had a medium disturbance and in the left foot, a light disturbance of the small blood vessels. But I was recently diagnosed as having severe disturbance in the right foot and medium disturbance of the left. The doctors recommended balancing risk factors of hypertension and high cholesterol, frequent walking, treatment with aspirin and Losec and checkups every six months. I was told it was likely that my condition would worsen and that I could suffer severe pain, in which case, intravenous injections would be given. In the worst case, my feet would have to be amputated! I am worried that there is no recommendation on how to arrest the further development of the disease. Is there any hope? - H.Y., Haifa Prof. Haim Aner, a senior vascular surgeon at Hadassah University Medical Center in Jerusalem's Ein Kerem, replies: Without examining you, I can't give specific advice. In general, there are possibilities for treatment, depending on your general condition. I and other vascular surgeons have performed balloon catheterization on patients even over the age of 90, inserting a stent to hold open the clogged blood vessel in the legs that prevent an adequate blood supply to the legs. Some of these have succeeded and some have not. Usually, we do not do bypass surgery using another vessel to replaced damaged vessels in the legs of people over 90. You will have to examined to see whether you are suited to balloon catheterization, but it could be that amputation would have to be performed in the end. Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to [email protected], giving your initials, age and residence.