Ask the doctor: Should I try this new 15 heartburn cure
20:24 GMT, 16 July 2012
20:24 GMT, 16 July 2012
For many years I’ve suffered from acid reflux, which triggers painful heartburn. My GP prescribed Nexium, which is meant to prevent acid being released, but this has had limited success. I recently received a junk email from the U.S. recommending a ‘natural’ cure which costs around 15. This may be a waste of money, however my problem is gradually getting worse and I am keen to give anything a try. Could you advise
David Rabone, by email
Matters of the heart: Don't use a natural remedy to cure heart burn
How very frustrating for you. But let me first reassure you that your situation isn’t unique and that there are other options available.
At least one in ten patients with your condition does not respond to the powerful acid-suppressing medicine Nexium. But before describing why this occurs, and offering some suggestions that might help, I want to explain the nature of the condition.
Gastro-oesophageal reflux — often called acid reflux — is thought to be caused by a weakness in the valve between the oesophagus (also called the gullet) and the stomach.
The valve is meant to prevent the contents of the stomach splashing up the gullet, but in some people it does not seal properly, and the acidic contents slosh back, causing irritation and pain.
Some people suffer to such a degree that the acid gets into the throat, causing hoarseness and a sore throat or a cough.
Furthermore, some people develop chemical burns on the lining of the gullet — also known as an ulcer.
While this does heal, if damage recurs over a long period, it can cause scarring and the gullet may narrow. This can trigger further pain or a sense of blockage on swallowing. In extreme cases, surgery may be necessary to widen the gullet.
In some cases, this damage can also cause normal cells that line the lower part of the gullet to be replaced by ones that have a small chance of transforming into cancer cells.
The condition is called Barrett’s oesophagus and is diagnosed with endoscopy — a flexible tube about the diameter of a pencil is passed through the mouth, under local anaesthetic or mild sedation, and used to inspect the gullet and take a tissue sample.
Those diagnosed with Barrett’s are advised to have their gullet lining checked by endoscopy every two or three years.
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His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.
These complications make effective
treatment of heartburn essential. One possible reason for the failure of
your treatment is if the Nexium is not being taken 30 minutes before
breakfast and 30 minutes before the evening meal: the drug must be fully
absorbed to ensure regular acid suppression.
It could also be that the burning
discomfort you’re experiencing is not due just to acid reflux, but part
of a bigger picture of irritable bowel syndrome. This is called
Finally, there is non-acid reflux and
bile acid reflux — different problems with similar symptoms. In non-acid
reflux, the gullet is overly sensitive to chemicals in food, and
becomes sore and irritated when stomach contents reflux.
In the second condition, bile (which
is released by the liver and helps digest fats) backflows from the
intestine into the stomach and even up into the gullet, causing pain.
As for the ‘natural remedy’ you have been recommended, there is no such thing, and what is on offer here is quackery.
Instead, further medical
investigations are needed. Endoscopy may be required, as well as 24‑hour
acidity and pressure monitoring. This would involve a thin catheter or
capsule inserted through your nostril and into your gullet.
You then go about your normal business
of eating, sleeping and working while the device collects information
that is then analysed once the catheter or capsule is removed.
However, the first step is requesting
referral to a specialist. Once this is achieved, you will be on the road
to receiving a firm diagnosis. The best of luck.
Around 18 months ago I started suffering numbness and pins and needles in my hands at night. Usually the outer parts of my hands — the little fingers and ring fingers — are affected. The feeling wakes me in the night, but if I shake my hands and rub them, it disappears. I do not sleep on my side, so I do not think that the cause is pressure.
Mrs Paula Taiano, Sittingbourne, Kent
This can be a frightening syndrome. Often patients with these symptoms come to me fearing they have a circulatory problem or a neurological illness such as a brain tumour or multiple sclerosis.
But please be assured that what you have is not serious, and is called nerve compression syndrome. This occurs when nerves get pinched — in your case, I’d suggest it’s the elbow that’s affected.
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VIEW FULL ARCHIVE
The ulnar nerve, which runs from the shoulder down to the little finger, tracks around the back of the elbow and the funny bone. It supplies the little and ring fingers, part of the middle finger and the border of the hand on that side.
It can be irritated or squeezed in the channel where it passes around the elbow, and tingling and numbness will be the consequence.
This squeezing is more likely to happen when the channel is tight and narrow, which occurs when you sleep with your elbows bent.
When you wake, straighten your arms and shake your hands and the alarming sensation will melt away.
However, the symptoms might also be partially caused by compression of a nerve at the wrist joint, which supplies the thumb, index and part of the middle finger, as well as much of the palm.
The source of your trouble can be diagnosed using a nerve conduction study in which tiny electrical impulses are passed through electrodes stuck on to the hand. The test, which takes 15 minutes to an hour, can detect which nerve is affected. In severe cases the trapped nerve can be relieved with an operation, but it is rarely necessary.
Once the diagnosis is confirmed, patients often find it preferable to tolerate and live with the symptoms.
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Don't be patient: Being on a long waiting list for treatment can be costly for your health (posed by models)
The then Labour government had pledged to tackle the shortage in NHS beds by closing pay beds — effectively pushing those who’d previously been private patients into NHS beds.
The problem with this policy was that pay beds weren’t the source of the shortages. The real cause, as my father endlessly hammered home, was that healthcare was being silently rationed via the waiting list.
The NHS had not long passed its 21st birthday, and there was a dawning realisation that the cake was of limited size, with only so much to go round. Subtle strategies were evolving to make sure that somehow people were not over-claiming on the bounty of free healthcare, and so the waiting list was born.
All too soon the electorate found this unacceptable. As medicine has become more and more expensive with advancing technologies, the pressure has become ever greater to introduce better-disguised mechanisms of rationing.
Last week, it was reported that a patient in Kent with acute gallbladder infection due to gallstones (cholecystitis) wasn’t being given surgery to remove the diseased organ as they should have been. (Once gallstones start to play up, they continue to do so, with recurrent infections or pain due to gallstone colic.)
Yet in Kent the rule now is that you may not be referred until you have had at least two episodes of cholecystitis. Is this fair No. Is this safe Certainly not.
But it’s not just Kent that is making these subtle rationing decisions. More than 90 per cent of primary care trusts impose limits on referrals for procedures they deem ‘non-urgent’.
However, urgency is entirely a matter of opinion. Even my father’s fellow quango member, the ‘idealistic socialist’ Ray Buckton, from the trade union ASLEF, had to have treatment in the private sector (paid for by the late Robert Maxwell) when rationing meant he couldn’t get what he wanted on the NHS. We all have our weaknesses and sometimes cannot practise what we preach.
Free healthcare at the point of delivery is a splendid aim when the delivery is not rationed by cunning administrators.
It can take weeks to get over an attack of gallbladder infection, and it is a third-world level of care to expect someone to go through it all twice to earn the right to an operation that will cure them. So when you hear about rationing and poor service, shout about it from the rooftops and write to your MP.