DEAR DR. DONOHUE: I have been suffering from GERD for 19 years. Stomach acid stays in my throat. I have tried all kinds of medicines, but they make things worse. I have had acid tests with a tube in my throat that indicated an acid rise when I step out of bed. Why on an empty stomach? My sphincter muscle doesn’t work. I had a procedure called EndoCinch; it didn’t work. I spoke to a surgeon about laparoscopic surgery. Do you feel surgery would benefit me? — L.T.
A: You’d be hard-pressed to find a single person who hasn’t had at least one episode of GERD — gastroesophageal reflux disease, or heartburn, in common language. It’s often felt on an empty stomach. Food initially neutralizes stomach acid, but some foods do increase acid production shortly after they hit the stomach.
GERD is like Old Faithful, except instead of water, it is a geyser of stomach acid, which shoots up into the esophagus because of a lax sphincter (SFINK-tur) muscle. The sphincter, if working, would shut and prevent the upward spurt of acid. Sometimes, as in your case, stomach acid can rise as high as the throat and mouth to cause hoarseness, cough or an awful taste sensation.
Have you tried the nonmedicine approaches that can sometimes control GERD? Chocolate, peppermint, spearmint, coffee (including decaf), other caffeinecontaining foods and drinks, citrus fruits, tomato products, highfat foods, garlic, onions and spicy foods often make it worse. Sixinch blocks under the bedposts at the head of the bed keep stomach acid in the stomach during sleep. Weight loss, if needed, is another way to stop stomach acid from spurting up. Small meals, slowly chewed, help. Smoking and alcohol aggravate GERD.
If nothing works, surgery is a definite option. The Nissan fundoplication is successful 90 percent of the time. It can be done with a scope. The upper part of the stomach is wrapped around the lower esophagus to create a barrier to acid reflux. A number of procedures, like your EndoCinch, can be done through a gastroscope — a scope passed into the esophagus through the mouth. The long-term results of these procedures aren’t as wellknown.
DEAR DR. DONOHUE: I had two biopsies on my nose, and the diagnosis is basal cell cancer. It has been suggested that I have plastic surgery to fill the hole caused by the biopsies. I don’t understand basal cell cancer. Does it spread? Will it go deeper? How does plastic surgery stop it from growing? — P.G.
A: Basal cell skin cancer is the most common kind of skin cancer. More than 800,000 new cases of it are discovered yearly in the U.S. and Canada. Since the sun’s ultraviolet rays are responsible for most cases, it appears in places exposed to the sun: the nose, the ears, the face, the scalp, the neck and the backs of the hands. It begins as a pearly-white bump that turns into a sore. The sore may heal, but it always comes back. A persisting or recurring sore is a sign of trouble.
Basal cell cancers don’t spread, but they can bore deep down into underlying muscle, cartilage and even bone to create major disfigurements. If all cancer cells have been removed, the basal cell doesn’t return.
Plastic surgeons are trained to repair large skin gaps like the one you have in your nose. I don’t know if all the cancer cells have been removed. If they haven’t, the plastic surgeon can do that job too. They aren’t the only ones who treat basal cell cancers. Dermatologists have the training to do so, too.
c. North America Syndicate
