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Ask Dr. Gott 3/12
Surgery is last option
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    DEAR DR. GOTT: I am a 70-year-old male who does not smoke or drink alcohol. I am about 65 pounds overweight but am otherwise in relatively good health. However, I have what I believe is a gastrointestinal problem and hope you can help me.
    For the last 15 or 20 years, I start coughing or choking during or immediately after eating or drinking. Often, I regurgitate what appears to be mucus and/or food. These spells can last for several minutes and sometimes occur when drinking water, brushing my teeth or simply rising from a reclined position.
    I have seen several doctors and have had numerous tests, including stool analyses, blood tests, barium X-rays, a sigmoidoscopy, a colonoscopy and an endoscopy. The only abnormal findings were a hiatal hernia and evidence that my stomach produces more-than-normal amounts of acid. Anti-acid medication does not provide any relief and upsets my stomach. I am willing to have the required surgery to correct the hiatal hernia, but no one can assure me that it will solve my problem. I am also told there is a chance it can return.
    I am at my wits' end and don't know what else to do.
    DEAR READER: Your symptoms certainly suggest the presence of a hiatal hernia. This simply means that your stomach, at times, protrudes through the diaphragm up into the esophagus. The diaphragm is a muscle that separates the stomach, intestines, etc., from the lungs, heart, etc. It is also what causes hiccups. Often, a hiatal hernia does not cause symptoms but can be accompanied by excessive stomach acid and gastroesophageal reflux disease. GERD occurs when the stomach overproduces acid that then backwashes into the esophagus, causing indigestion. Some people also experience coughing as a symptom.
    You appear to have exhausted the over-the-counter and prescription medications. You do not mention whether you have tried diet and lifestyle changes, such as raising the head of your bed 3 to 4 inches. If not, I recommend you try this as well as eliminating high-acid foods such as citrus fruit and tomatoes from your diet.
    As a last resort, you can try surgery. However, as you know, there is no assurance that this will work. I can tell you that for some it works wonderfully and for others it appears to have no affect.
    If this fails, perhaps an appointment with a neurologist is appropriate. There is a slim possibility that your problem stems from your body's inability to transmit appropriate messages from your brain to the nerves and muscles that control swallowing. This is very unlikely but should be looked into if all else fails. Good luck and let me know how this turns out.
    To give you related information, I am sending you a copy of my Health Report "Hiatal Hernia, Acid Reflux and Indigestion."
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