Tuesday, May 30, 2006

hiatal hernia : What can you tell me about hiatal hernia?

Q: What can you tell me about hiatal hernia?

A: The diaphragm is a muscular sheet that separates the chest cavity (containing the heart, lungs, esophagus and other organs) from the abdominal cavity (containing the stomach, large and small intestine and other organs). A hiatal hernia refers to the abnormal passage of a portion of the stomach upward into the chest through a hiatus (opening) in the diaphragm.

The vast majority (about 90 percent) of hiatal hernias are of the so-called "sliding" type, in which a portion of the stomach passes upward into the chest through an opening that the esophagus normally passes through on its downward course to the stomach. A sliding hernia tends to move in and out of the thoracic cavity across the diaphragm, although the diaphragm itself is normal.

Sliding hernias are of particular importance because they are associated with gastroesophageal reflux (the passage of acid- containing stomach contents into the esophagus). This causes a burning sensation in the area of the heart and behind the breastbone (sternum), a feeling commonly referred to as "heartburn." However, not all persons with hiatal hernias have reflux; conversely, not all individuals with reflux have sliding hiatal hernias.

The key to treatment of hiatal hernia is to prevent the reflux of gastric acid contents into the esophagus. In most cases, this can be accomplished medically without the need for surgery.

Reflux of gastric contents into the esophagus is greatly enhanced by increased pressure within the abdomen. Consequently, tight belts, pants, corsets and pantyhose should be avoided; an obese patient is strongly encouraged to lose weight. It is important to avoid large meals, not lie down or bend over immediately after eating and refrain from eating for a few hours before bedtime. A person with symptomatic hiatal hernia should sleep with the head of the bed elevated four to six inches (using a wedge under the mattress), so that the force of gravity helps keep stomach acid away from the hernia.

It is best to avoid certain foods (dietary fat, chocolate, peppermint, acidic juices, carbonated beverages and caffeine) as well as tobacco and alcohol.

Antacids (taken in relation to meals and especially at bedtime) are usually quite effective in relieving the symptoms associated with reflux of gastric acid into the esophagus. Drugs that speed up emptying of the stomach or prevent reflux may also be of value.

Some persons with hiatal hernia and reflux have persistent or recurrent symptoms despite adequate medical therapy. In such cases, a surgical procedure may be necessary. The most popular of these is the Nissen fundoplication, in which the surgeon wraps the upper part of the stomach around the esophagus. A success rate of about 95 percent has been reported. Some minor complications such as difficulty swallowing or bloating usually improve over time in most people.

Virgil Williams and Ron Eisenberg are staff physicians at Highland General Hospital in Oakland. Please send questions to them in care of ANG, P.O. Box 10367, Pleasanton, CA 94588. Questions cannot be answered individually; however, some will be discussed in future columns.
Oakland Tribune, Jun 8, 2003
Provided by ProQuest Information and Learning Company. All rights Reserved.

Hiatal Hernia: a leading cause of allergies & chronic illness


In this update to my article on the Hiatal Hernia/Vagus Nerve Disorder Syndrome, (1) I will emphasize two new, related matters. One is a common, but serious additional stomach/esophagus anomaly that may actually be causing some of the problems attributed to the hernia itself. The second matter is a possible causative factor to this whole syndrome that is relatively unknown--the Esophageal Longitudinal Muscle Contraction!

The Lower Esophageal Sphincter, or Schatzki's Ring

As detailed in my earlier article, the Hiatal Hernia Syndrome can (eventually) cause serious illness including respiratory and cardiac symptoms, and appears to be present in most sufferers of food and chemical allergies. (2) But some of these complaints may be caused by the so-called Schatzki's ring, and not the hernia itself. You can have either condition and not the other, or you may have both--as is common. Schatzki's ring is a disorder of the Lower Esophageal Sphincter (LES). The LES acts like a valve between the esophagus and the stomach. Schatzki's ring may be thought of as a hardened, thickened, multi-fold, scar-type tissue. If this ring is present, the LES does not function properly. It may be open when it should be closed--causing reflux (GERD); or it may be closed when it should be open. The latter condition can then lead to food being trapped above the ring. There may be constriction. Trapped food or spasms of the esophagus can then cause serious problems including breathing difficulty (asthma, etc.) and tachycardia and other arrhythmias. The LES (Shatzki's) Ring (as well as an Hiatal Hernia) shows up on X-ray (upper GI series) or during an endoscopy (EGD). Thus it is important to have either test if you have stomach complaints or food or even chemical or electromagnetic sensitivities. As stated in my previous article, once the Vagus nerve is under- or over-excited, the entire body is in great imbalance, and almost any organ can malfunction as many visceral organs are innervated by a branch of the Vagus (Para-sympathetic) Nerve. Also this can make the person sensitive to any environmental factor as well as possibly deplete or weaken the adrenal glands, thyroid or liver.

Some foods are more likely to get trapped (stuck) at the LES Ring, if present. These include breads and fibrous (tough) meats. Dry foods (like bread) can be a problem, but wheat, beef (or other) allergy may also be a factor. (Or this may be a purely mechanical problem, or contain elements of both allergy and mechanical anomalies.) "Steakhouse Syndrome" is the nickname Emergency Room personnel have given this syndrome when people come in with "high" anxiety, or respiratory or cardiac, or cardiac-like symptoms due to trapped food at the Lower Esophageal Sphincter. Steaks and bagels seem to be the worst, but any hard food or even drug or vitamin tablets or capsules can also get stuck! The person likely has some occasional swallowing difficulties. Foods may need to be pureed in advanced cases. Peristalsis is impaired in those with Schatzki's Ring. In the E.R., sometimes an emergency endoscopy and food or tablet removal has to be performed. Endoscopic stretching of the ring is also standardly recommended whenever Schatzki's Ring is found and when the person also has any swallowing difficulty or other complaints described above. This is facilitated by a choice of instruments inserted into the esophagus, including a balloon, telescoping device, or Bougie. Breaking (stretching) the ring is supposed to be a simple, relatively riskless procedure. Many people report great improvement in their health after this. The downside is that many of these people report that it only lasts six months to a year. Some people get it done every year.
Townsend Letter for Doctors and Patients, Jan, 2004 by Steven Rochlitz

Monday, May 29, 2006

hiatal hernia : hiatal hernia

hiatal hernia Definition

A hiatal hernia is an abnormal protrusion of the stomach up through the diaphragm and into the chest cavity.

A hiatal or diaphragmatic hernia is different from abdominal hernias in that it is not visible on the outside of the body. With a hiatal hernia, the stomach bulges upward through the esophageal hiatus (the hole through which the esophagus passes) of the diaphragm. This type of hernia occurs more often in women than in men, and it is treated differently from other types of hernias.

hiatal hernia Causes & symptoms

A hiatal hernia may be caused by obesity, pregnancy, aging, or previous surgery. About 50% of all people with hiatal hernias do not have any symptoms. For those who do have symptoms, they include heartburn, usually 30-60 minutes after a meal, or mid-chest pain due to gastric acid from the stomach being pushed up into the esophagus. The pain and heartburn are usually worse when lying down. Frequent belching and feelings of abdominal fullness may also occur.

hiatal hernia Diagnosis

The diagnosis for a hiatal hernia is based on a person's reported symptoms. The doctor may then order tests to confirm the diagnosis. If a barium swallow is ordered, the person drinks a chalky white barium solution, which will help any protrusion through the diaphragm to show up on the x ray that follows. Currently, a diagnosis of hiatal hernia is more frequently made by endoscopy. This procedure is done by a gastroenterologist (a specialist in digestive diseases). During an endoscopy the person is given an intravenous sedative and a narrow tube is inserted through the mouth and esophagus, into the stomach where the doctor can visualize the hernia. The procedure takes about 30 minutes and may cause some discomfort, but usually no pain. It is done on an outpatient basis.

hiatal hernia Treatment

Dietary and lifestyle adjustments to control a hiatal hernia include:

* Avoiding reclining after meals.
* Avoiding spicy foods, acidic foods, alcohol, and tobacco.
* Eating small, frequent, bland meals to keep pressure on the esophageal sphincter.
* Eating a high-fiber diet.
* Raising the head of the bed several inches with blocks to help both the quality and quantity of sleep.

Visceral manipulation, done by a trained therapist, can help return the stomach to its proper positioning. Deglycyrrhizinated licorice (DGL), helps balance stomach acid by improving the protective substances that line the stomach and intestines and by improving blood supply to these tissues. DGL does not interrupt the normal function of stomach acid.

hiatal hernia Allopathic treatment

There are several types of medications that help to manage the symptoms of a hiatal hernia. Antacids are used to neutralize gastric acid and decrease heartburn. Drugs that reduce the amount of acid produced in the stomach (H2 blockers) are also used. This class of drugs includes famotidine (sold under the name Pepcid), cimetidine (Tagamet), and ranitidine (Zantac). Omeprazole (Prilosec) is not an H2 blocker, but is another drug that suppresses gastric acid secretion and is used for hiatal hernias. Another option may be metoclopramide (Reglan), a drug that increases the tone of the muscle around the esophagus and causes the stomach to empty more quickly.

hiatal hernia Expected results

Hiatal hernias are treated successfully with medication and diet modifications 85% of the time. The prognosis remains excellent even if surgery is required in adults who are otherwise in good health.

hiatal hernia Prevention

Some hernias can be prevented by maintaining a reasonable weight, avoiding heavy lifting and constipation, and following a moderate exercise program to maintain good abdominal muscle tone.
Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

Thursday, May 18, 2006

Sinful Salmon Chowder

Total decadence--so intense, so aromatic, so beautiful in the dish--and downright aphrodisiac with all that fennel. Why complicate it with anything more that salad, bread, and a fruit dessert? Thanks to Jerry Newman for the inspiration. Serve hot as a meal to 4 people.
4 Tablespoons butter
1 large onion, cut into a medium dice
1 large fennel bulb, cut into a medium dice
4 garlic cloves, cut into chunks
12 mushrooms, thickly sliced
4 Tablespoons flour
5 cups fish or seafood stock
1 pound salmon fillets, skin removed (with one smooth slice of a boning knife while you're holding one end of the skin) and cut into bite-size pieces
3 cups heavy cream
salt and pepper to taste
2 Tablespoons cognac
Garnish: minced fennel fronds

Melt the butter in a large saucepan over low heat, stir in the onion, fennel, and garlic, cover, and sweat the vegetables for 5 minutes. Turn up the heat to medium and add the mushrooms, frying them for about 5 more minutes. Then reduce the heat and stir in the flour (adding more butter, if necessary, to dissolve the flour); cook for a minute or two to lose the rawness of the flour. Whisk in the stock, let the soup thicken a bit, then add the salmon pieces, cover, and cook for 5 minutes. Stir in the heavy cream and bring just to a boil. Season to taste with salt and butter. Hold on simmer until ready to serve.

When ready to serve, stir in the cognac, ladle into large bowls, garnish with minced fennel fronds, and guiltily carry to table.


Sunday, May 14, 2006

Make Your AMD-Powered PC the Centerpiece of Your Home Stereo System

An AMD-powered system can be the centerpiece of your home stereo system.

Play your CDs and digital music files through headphones, speakers, or your home stereo system. Download and burn to CD or DVD your favorite songs or full albums. Build a high-capacity digital jukebox, complete with creative playlists and exciting party mixes.

How does AMD64 technology make your digital home stereo better?

AMD Cool’n’Quiet™ technology allows an “always on” PC to be friendlier to the living environment, producing less noise and less heat.
Enhanced Virus Protection* offers built-in anti-virus security advantages.
HyperTransport™ technology delivers out-of-the-ordinary system performance for multimedia.

Copyright 2006 Advanced Micro Devices, Inc.

Monday, May 08, 2006


There are two styles of Roulette Wheels. The "American" wheel which has 36 numbers plus the 0 and the 00. The French or European wheel, has 36 numbers and only a single 0. The latter is found mostly in European and South American casinos and is seldom seen in this The United States. Most players and croupiers believe that the numbers 1 through 35 are arranged on the rim of the wheel in a haphazard manner, except that the red and black numbers alternate. There is nothing haphazard about the arrangement! An attempt has been make to alternate low, high, odd and even numbers, as well as the red and black colors, in such a way that each group of numbers, and each color is spaced out in a mathematically balanced fashion. A perfect mathematical balance is not possible, since the sum of the numbers 1 through 36 is 666, and the 18 odd numbers add to only 342. In order to attain the best possible mathematical balance, roulette manufacturers use the following arrangement: The numbers 0 and 00 are directly opposite each other on the wheel head rim separated on each side by 18 numbers. The 0 pocket is between two black-numbered pockets and the colors alternate in both directions around the wheel, ending in two red pockets, one on each side of the 00. Odd numbers alternate with even numbers. In order to get the best possible distribution of high and low numbers, the sum of each two successive numbers of the same color must equal 37. There are two exceptions, the numbers 9 and 28 and the numbers 10 and 27 which are not the same color, as each pair is made up of a red and black number.


Doc Chey's, the Ultimate Asian Noodle Diner

ORLANDO, FLORIDA—Imagine walking into a dimly lit noodle diner with hip jazz music, flavors of sweet coconut, ginger and garlic drifting in the air and dozens of mini high definition TVs on the walls. No, it's not the set of Star Wars, but Doc Chey's Asian Diner. Doc Chey's Asian Diner opened in Orlando Florida in fall 2005 to the public's delight, introducing Pan-Asian food to the public and bridging culture gaps, one noodle at a time. What is most impressive is not only on the surface but the quality outside mirrors the quality inside each selection on the menu.

The current interest in casual dining is met at Doc Chey's by filling the demand in the Pan-Asian market. I'm an Asian culture explorer of sorts and the favors and style of Doc Chey mirror any cosmopolitan city hip diner. The menu boasts bold traditional favors from China, Japan, and Thailand. The health conscious menu guides you on a taste and sight journey of inviting textures and colorful well seasoned dishes. Salads, soups and entrees such as The Marco Polo harmonize firm shrimp, tomatoes, red peppers, greens, onions, eggplant and udon noodles in a zesty Thai sauce. The dishes are prepared and presented nobly. Calorie counters will be impressed by the selection, taste and health benefits Asian food offers. (This isn't medical advice so please consult your doctor or better yet, bring him/her to the restaurant for their opinion.)

I tried the daily special of Tilapia with Spicy Green Beans and Brown Steamed Rice. The thinly sliced, breaded fish was seasoned lightly and firmly laid on the vegetables, blanketing bright vibrant crisp steamed green beans with fresh minced garlic. The dish looked like a beautiful full moon eclipsing a bright sun. There are selections of green teas available to end the meal in a very satisfying way.

"I like the trendiness of Doc Chey's, the fast service and that it's guilt free healthy eating", said Danny Hernandez, President of A Slice Of New York & Borinquen Restaurant, on Doc Chey's opening day.

Established in 1997, starting as a noodle diner (see history at www.doccheys.com), now it sports seven diners in Atlanta, GA and Asheville, NC. Doc Chey's is a positive force in the restaurant industry that, "affects the quality of life" says COO Dick Rivera of Doc Chey's. Mr. Rivera was COO of Darden Restaurants and of T.G.I .Fridays. Other members of D.C.'s team are CEO/founder Rich Chey and John Metz, Jr. Metz will provide D.C.'s with culinary and operational direction. He is also co-owner of Aqua Blue Restaurant &Bar, Hi Life Kitchen & Cocktails.

Since joining D.C.'s Rivera finds a sense of immediacy in the hands on daily operation at Doc Chey's. He's proud that the customers will be making a good decision in visiting the restaurant. He says also that it seems people are looking for a void in a framented causal dining experience. He doesn't discount his past experience behind the "boardroom table" with the other companies but he is "having the most fun I had in a long time". I'm glad someone is having fun while serving good food.

It's refreshing to see how the ethnically diverse, multi tasking chef and servers and hosts and even the managers seem to flow and harmonize. I strongly encourage you to pick up your favorite chop sticks head to Doc Chey's to sit and relax in a cozy atmosphere of ambient music and good food and be part of something big, at Doc Chey's.

Tuesday, May 02, 2006

She Saves Shell Life by the Seashore

Plenty of people fret over the future of the wolf and the tiger. But who speaks out for the univalve and the bivalve? What about the marsh periwinkle? The banded tulip? The Florida fighting conch and the Atlantic moon snail? Who's willing to put themselves on the line for these mysterious little creatures of the murky brine?

Not many.

Scarlet Colley--"the shell lady"--does, though, down on Texas's South Padre Island. And when people don't care to hear what she has to say, her ultra-broad-shouldered husband, George, all six feet, seven inches of him, is standing right there behind her.

"It's sometimes a good thing," drawls one Texas Parks and Wildlife Department official, "that he's there, too." Scarlet's voice isn't loud--but it is insistent.

Down the Gulf Coast, at the supersalty mouth of the Rio Grande, Scarlet and George decided a few years ago to look for an eco-friendly way to earn a living on the water. Since the region's bird-watching ranks among North America's best, the couple soon got themselves a small pontoon boat with comfy seats for only a few clients and a galley as bright and spiffy as a housewife's kitchen. It was a far cry from the shrimpers' boat George had grown up on.

Next, quicker than the blink of an eye, the couple found themselves booked up by clients seeking a low-key, high-quality birding experience. Always out on the boat, Scarlet began to track the comings and goings of the local life forms. Visiting dolphins soon acquired names, compliments of her vivid imagination. Birds with permanent roosts became the couple's rather more distant but equally delightful acquaintances. From time to time, Scarlet would scoop up an injured animal--an endangered brown pelican covered with oil, for example--and carry it to the rehab center at the Gladys Porter Zoo, an hour's drive away, over the bridge and across the causeway, down to Brownsville.

The Colleys also came to know the people who used the bay for recreational and commercial fishing. But eventually Scarlet started to notice something that bothered her. Some of these folks came to the same spot every day with empty five-gallon buckets.

One day, Scarlet looked inside. "They were collecting live shells," Scarlet says. "Not just one or two, but scads at a time." Not being shy, Scarlet asked why one woman needed so many shells.

"I've been doing this for 10 years," the woman said, "and I know there is no law against it."

by Wendy Williams