The Shadow
DEAR DR. DONOHUE: The advice you gave about heartburn overlooked something that changed my life forever and cost my wife hers. She was treated for GERD for many years. She was otherwise in excellent health and a trainer at Gold’s Gym. Following a “heartburn” attack resulting in throwing up blood, she was admitted to a hospital where the diagnosis of inoperable stomach cancer was made. She died in four weeks at age 55.
She never underwent an endoscopy. I have talked to others who had a similar experience. GERD sufferers should request an endoscopy. — A.S.
ANSWER: I don’t have words to express the sympathy I feel for you and your family. I’m sure that similar sad tales occur throughout the world. About 10,500 people die of stomach cancer yearly in the U.S. It’s curable when caught early. It rarely is if discovered late. Early symptoms are vague. A feeling of fullness after eating small portions of food is one clue. So is stomach pain. The pain of GERD, gastrointestinal reflux disease, is heartburn pain, the condition for which your wife was being treated.
Should all with GERD have a scope exam of their stomach so a diagnosis like cancer is not missed? Most experts feel that a trial of heartburn medicines, when GERD is suspected by its symptoms, is sufficient, and a good response to treatment provides more evidence that the diagnosis is correct. These doctors would suggest a scope exam if GERD symptoms don’t respond to treatment.
Alarms ought to ring if a person complains of pain on swallowing, an unexplained loss of weight, recurrent vomiting, and bleeding from the digestive tract. A family history of stomach cancer sounds the alarm again. These clues indicate a problem more serious than GERD and prompt a scope examination.
Your story has influenced me to be more liberal with suggesting a scope exam for people with less than an airtight case for GERD.
DEAR DR. DONOHUE: I have a hiatal hernia just below my breastbone. Would that keep my bowels from moving properly? Would antacids cause this? I am 70 years old. — J.
ANSWER: We need a picture so others understand a hiatal hernia.
The diaphragm is a large muscle that lies horizontally between the chest cavity and the abdominal cavity. It’s the chief breathing muscle. When we take a breath in, the diaphragm descends lower into the abdomen. That creates negative pressure in the chest, and air rushes into the lungs.
The esophagus, the swallowing tube, runs from the throat to the stomach. It reaches the stomach through a hiatus — a gap — in the diaphragm. When the stomach bulges upward through that gap and into the chest, a person has a hiatal hernia.
Many with a hiatal hernia have no symptoms. Some suffer from heartburn. A hiatal hernia, however, does not affect the bowels.
Some antacids, on the other hand, can be constipating. If that’s what you mean by bowels not moving properly, it is a possibility. Make a change in the antacid you’re using.
DEAR DR. DONOHUE: What exactly is artery hardening? I used to hear that word all the time. I don’t hear it used so much lately. — J.V.
ANSWER: The most common kind of artery hardening is officially called arteriosclerosis, “arterio” for “artery,” “sclerosis” for “hardening.” And the most common kind of arteriosclerosis is atherosclerosis, hardening due to the buildup of cholesterol, fats, white blood cells and other materials.
The buildup is plaque. It can block arteries and cut off blood supply to the heart and brain.
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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.
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