Popularly known as heartburn, the Greek word pyrosis is the burning sensation in the pit of the stomach behind the breast bone, which some people experience with or without ingestion of spicy foods or alcoholic beverages, especially when they are lying flat in bed.

This symptom may be due to GER or the actual GERD. GER, or gastro-esophageal reflux, as the words suggest, is a situation where the normal acids and enzymes in the stomach flows back up into the esophagus (food pipe), which, under normal condition, should never happen.

GERD is the acronym for Gastro-Esophageal Reflux Disease. An anatomical lower esophageal sphincter (a valve) is present at the end of the esophagus (swallowing tube), which prevents the normal hydrochloric acid and other digestive juices produced in the stomach from refluxing (backing up) into the esophagus. While the stomach can tolerate this acid, the esophagus lining is very sensitive and gets easily "burned" by these acid and juices. In some people, this sphincter tone loosens up and becomes incompetent, allowing upward flow of these "chemicals" into the esophagus. When GE Reflux happens more than twice a week, it means the person already has GERD. This condition is also seen among infants and children.

WHAT CAUSES GERD?

Nobody knows. The etiology has not been determined. Hiatal Hernia may be a factor. The diaphragm is a tent-like muscular dome that divides the chest from the abdomen into two separate compartments. At the center of the dome is an opening (hiatus) that allows the esophagus in the chest to go through to connect to the stomach, which is in the abdomen under the diaphragm. When the hiatus becomes abnormally large, part of the stomach in the abdominal cavity goes up to the chest cavity (termed hiatial hernia), and this renders the esophageal sphincter incompetent, allowing reflux.

Other factors that aggravate GERD are smoking, ingestion of alcoholic beverage, citrus fruits, chocolate, coffee, fatty and fried foods, garlic, onion, spicy foods, mint flavoring, tomato-based foods like pizza, chili and spaghetti. Pregnancy and overweight are also contributing factors.

SYMPTOMS OF GERD

Common symptoms and signs are burning sensation in the pit of the stomach under the breast tip, sore throat, frequent burping with acidic (sour or bitter) aftertaste, persistent hiccups, stomach discomfort/fullness, nausea, or even vomiting. Chronic cases may even have upper GI bleeding (black tarry stools) and anemia. Majority of cases are among children under age 12 with GERD, and in some adults too, GERD may be present without any of those symptoms above, and instead, may only have dry cough, difficulty swallowing, or symptoms of asthma. Prompt consultation with your physician is prudent when any of these signs or symptoms appear.

AMONG INFANTS/CHILDREN

In general, infants with GER appear healthy and happy, although they may spit up or vomit often. They usually outgrow their GE Reflux by their first birthday. If not, the condition may be GERD. Usual symptoms among infants are irritability and/or arching of the back (during or immediately after feeding), refusal to feed, which could lead to loss of weight and poor growth, frequent regurgitation, coughing, upper respiratory infection, laryngitis, wheezing, asthma or pneumonia. Some of these symptoms are also see among children with GERD. Urgent medical care is mandatory among these infants and children.

WHY IS ACID REFLUX BAD?

The stomach mucosa (lining) which normally produces the digestive acid can tolerate this acid well, but not the esophagus. Constant reflux of stomach acid into the esophagus, if allowed to continue untreated, can cause frequent burning chest or stomach pain, chronic cough, bad breath, and esophageal stricture (scarring and narrowing), making the food pipe too narrow for food to pass through. In some cases, the chronic esophagitis can even cause ulcers and bleeding. Some patients develop Barrett's metaplasia, where the cells in the inner lining of the esophagus take on abnormal shape and color, and, over time, this becomes cancer.

MINIMIZING REFLUX

The recommended management includes: quitting cigarettes and avoiding alcoholic beverages, avoiding spicy foods and those items listed above, eating small meals, waiting for about three hours after eating before lying down, wearing loose-fitting clothes for sleeping, raising the head of the bed about eight inches (with blocks under the bed posts, adding pillows may not work as they move out of place), and religiously taking the medications prescribed by the physician.

MEDICATIONS

The various medications for GERD are grouped into Antacids (Maalox, Mylanta, Rolaids, Tums, Alka-2 etc) neutralizing acids, foaming agents (Gaviscon), coating the stomach for protection, H2 Blockers (Tagamet, Pepcid AC, Axid AR, Zantac 75) blocks acid production, proton pump inhibitors (Protonix, Prilosec, Prevacid, Aciphex, Nexium), more effective than H2 blockers, and Prokinetics (Recholine, Reglan), which helps strengthen the sphincter, improves muscle action in the GI tract and makes the stomach empty faster. Some of them are more effective when used in combination.

THE NEED FOR SURGERY

When lifestyle changes and drugs do not work, surgery may be considered, either to treat a bleeding ulcer, esophageal stricture, or hiatal hernia. For this type of hernia, Nissen Fundoplication is the commonly performed operation. The upper part of the stomach is wrapped around lower end of the esophagus, thus strengthening the sphincter, making it competent, and preventing reflux. The Nissen could also be done thru laparoscopy. Lap Gastric Banding (LAGB), using adjustable band inserted thru laparoscopy for sliding hiatal hernia, has been found to be effective in helping in the management of GERD.

How successful is the surgery for GERD? Quite successful. Ten-year follow-up studies, some even longer, show that up to 90 percent of the patients are rendered asymptomatic (symptom-free), doing well, provided the changes in lifestyle recommended above are strictly followed, including daily physical exercises.

The US-FDA approved Enteryx "implant" for GERD patients who wish to avoid surgery, has been recalled and no longer used due to reported injuries and deaths in some patients from the polymer/solvent injection, which was supposed to reinforce and help the competency of the esophageal sphincter.*

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• The mortality rate has been found to be around 19 deaths in 100,000

Liposuction is the most common cosmetic procedure performed in the United States today. Medically termed lipoplasty, it is a surgical procedure for removal of fats under the skin using a suction equipment through small incisions.

This is a short procedure performed usually in the office by a plastic surgeon, and was first introduced about 30 years ago. Like most plastic surgeries, liposuction is a purely elective procedure, one performed not to save lives or treat diseases, but "to achieve beauty."

THE CASE

The accepted medical standard mortality rate (risk of dying) in elective surgeries is one death in 100,000 cases. However, in liposuction, the mortality rate has been found to be around 19 deaths in 100,000, or 19 times riskier than what is acceptable. This was reported by the American Society of Aesthetic and Plastic Surgeons (ASAPS) and published in the Plastic and reconstructive Surgery journal. This is even higher than the death rate for motor vehicle accidents in the United States.

This death rate is, indeed, too high a price to pay for vanity' sake, and for an effect that is not permanent or lasting and a condition that is expected to, or could, recur even within months among individuals not disciplined enough to diet properly and exercise daily after the liposuction.

The standard acceptable surgical mortality rate in major operations is usually around one to three percent. While even coronary (heart) bypass surgeries today can attain a one percent post-op rate, or 99 percent death-free result, well within the set acceptable standard post-op death rate, and in some series, the death rate was even zero in 100 consecutive bypass cases done, liposuction is, to this date, still unable to achieve the industry acceptable mortality rate of one out of 100,000 patients for this elective procedure.

The risk in major surgery cases naturally varies according to accompanying co-morbidities (other diseases present), such as high blood pressure, diabetes, pulmonary disease, thyroid disease, etc. if any. Patients for liposuction, on the other hand, are usually healthy individuals, only seeking for aesthetic improvement in their physical appearance.

NOT FOR OBESITY

Liposuction is not a treatment, much less a cure, for obesity. Most, if not all, plastic surgeons consider obesity as a contraindication for liposuction. The treatment for obesity is mainly reduction diet and daily exercises under a programmed regimen.

Liposuction is being used to contour the chin, neck, cheeks, breasts, upper arms, abdomen, buttocks, hips, thighs, knees, calves and ankles. Because of patient expectation, some have been disappointed in spite of good surgical results. Plastic surgeons report that most patients like how they look afterwards.

Liposuction will not remove cellulite (dimpled skin). Daily exercises could help improve the looks of the areas involved by firming the muscles underneath.

Liposuction candidates must meet the following minimum criteria: good physical and medical health, normal weight, psychologically healthy, bothered by pockets of fats that remain after dieting and exercise program. And of course, they must have enough money to pay for the procedure, which may need to be done repeatedly as time passes by.

RISKS AND POSSIBLE COMPLICATIONS

These include reaction to medications, problem with breathing during the procedure, bleeding, infection, thrombus (blood clots), pulmonary embolus (clots to the lungs), and fat embolus (pieces of fats go to the blood stream and then to other vital organs), which could be fatal. The higher risk appears to be associated with the use of general anesthesia.

A HEALTHY LIFESTYLE

Cosmetic surgery has mesmerized our bulging-sagging-wrinkling-aging population as a crutch while we search for the elusive fountain of youth.

To me, the procedure is un-physiologic, useless in the long run, and not safe enough, to say the least. It is against our body physiology, because it is natural to develop more fats when we eat more calories than we expend with our physical activities.

Resort to healthy diet and exercise before these bulges occur instead of allowing them to form and then resort to a surgical procedure to remove them.

Living a healthy lifestyle is much less expensive, more physiologic, safer, and wiser, and more effective for health and maximal longevity.

Are we willing to risk, or even lose, our life with liposuction just to look a little less fat and prettier temporarily? Are we really that obsessed in dying to look good?*

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HEALTH@HEART
By Philip S. Chua, MD, FACS, FPCS

"Show me a man with an attitude and I will show you one abandoned by his friends and scorned by strangers he irritated and riled."

Here are some quotes of wisdom I have come across which are inspiring philosophical parachutes in life for those who, like many of us, sometimes find themselves falling towards the pit of discouragement and despair. With the proper attitude, these sage proverbs lift our spirit by allowing us to view and accept the trials and tribulations in this world in their most positive and best light. Indeed, all of us need a psychological boost, an inspiration, every now and then. Here are some:

Anthony J. D'Angelo, in The College Blue Book, said "Wherever you go, no matter what the weather, always bring your own sunshine." To quote Oscar Wilde, "If you don't get everything you want, think of the things you don't get that you don't want."

Voltaire expressed it beautifully when he stated, "Life is like a shipwreck, but we must not forget to sing in the lifeboats." An ancient Persian saying puts a great perspective on our daily aches and pains in life, "I had the blues because I had no shoes until upon the street, I met a man who had no feet." And as some of us may curse some bad days we encounter and wish they never came. Cavett Robert offers these poignant words: "If you don't think every day is a good day, just try missing one."

Indeed, every day is a good day, although others are better, and others not as good. But each day is a gift. Not waking up to another day is a deadly waste, but not appreciating another day as we open our eyes each morning in our journey through life is a tragedy. How each of us greets the day depends greatly on our attitude. Indeed, attitude impacts our health, our life, and our everyday happiness and success. A person with a chip on his shoulder, with a negative attitude or pessimistic view of life, will obviously be miserable most of the time. And the opposite is true, as Annette Goodheart brilliantly points out: "Just because you're miserable doesn't mean you can't enjoy life."

Happiness is basically an attitude. Gaining inner peace is an attitude. We have that God-given power to feel what we want to feel. And we can even psyche ourselves. I do.

When I wake up each morning, I thank God for another wonderful day. And I tell my mind ahead of time that it will be another good day. It may not be a perfect day, but a good, pleasurable and productive one, a day I could enjoy being with my family, doing my computer works, writing my column to help inform, educate and entertain people, challenging our fellowmen to open their heart to Gawad Kalinga to help our poor fellowmen languishing in abject poverty in the Philippines and around the world, promoting the moral crusade of the Filipino United Network (USA) and other advocacy groups in our campaign for good governance in our home country, or to simply complement someone, inspire somebody, do open heart surgery, or just touch a heart, plant a tree, and enjoy the sunset and the beauty of the universe.

In a world where global peace is still a dream, a world beset with an economic crisis, with terrorism, with greed and corruption, with energy, food and water shortage, global warming and its devastating side-effects or typhoons, earthquakes and flooding, a good attitude, in the midst of all these disasters, is one of our best weapons against helplessness, despair and depression.

With all these complex problems confronting us, we often find ourselves in the gutter of hopelessness, wherefrom, Oscar Wilde suggests, we can look up at the heavens and "see the stars." Indeed, a positive attitude, a happy outlook in life, especially these days, can help us tremendously in conquering our fears, insecurities, and dilemmas. After all, "defeat is not bitter unless you swallow it," as Joe Clark states. To this, I will add my own: "No one can succeed in life who does not have the courage to fail"; and, "The greatest risk in life is in not taking any risk at all."

Someone said, "You cannot adjust the direction of the wind, but you can adjust your sail."

And all this leads me to quote a very popular soothing prayer that you may know, one that I say almost every day of my life, immediately following the expression of my thanks to the Almighty: "God, grant me the Serenity to accept the things I cannot change; Courage to change the things I can; and the Wisdom to know the difference."

My faith in God, my acceptance and submission to His will, eliminates more than 75 percent of my worries day in and day out. I do not dwell on things I cannot change and allow fear and despair to paralyze my life. Worrying about things outside of my control is a waste of my time and expensive emotion that takes a toll on my mental and physical health. The things beyond my power I leave to God, and in doing so, I free my mind of a lot of unhealthy baggage.

But, of course, we should not simply leave everything to God. We must do our share. He promises to help those who help themselves. While we cannot cure the cancer of poverty in our country, we, as individuals, who are more blessed, can at least open our heart to help the homeless and the hungry, and gain that sense of satisfaction and inner peace. As I have stated a few times in the past, let us not wait for surgery to open our heart. Let our good attitude and compassion for our fellowmen reign.

As I live my life each day, I remind myself of an ancient proverb that says, "To everyone is given the key to heaven; the same key opens the gates to hell." It's indeed a matter of personal choice. And that choice inevitably depends on our attitude in life. Some people believe their fate is predestined, and that they can't do anything about it. Others, inspired by good attitude and a positive frame of mind, design, create, and charter their own destiny.

Finally, I strongly believe that leaving this world after this life is not a tragedy. Dying without significance, without making a difference, without leaving behind a good legacy, is.

Let's all develop a good attitude to help us enjoy life. It's a potent prescription for health and happiness.*

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