Doctors should cover all bases

Dear Dr. Gott: I have a hiatal hernia and have suffered from chest pain for many years. I have had two endoscopies and have been properly diagnosed with acid reflux. Prilosec helped to reduce the frequency and severity of my chest pain but did not eliminate it. I have had EKGs and a session with a Holter monitor, and neither indicated the heart as a source of the problem.

Early in the morning of Jan. 8, the pain was so severe that I ended up in the ER. They did all the usual things, ruling out the heart and the esophagus as the source of the problem. Finally, I was given an ultrasound that disclosed gallstones. I had laparoscopic surgery to remove my gallbladder 18 days later. Since then, the pain in my chest has almost completely vanished.

The point of this epistle is that I modestly suggest that in the case of intractable chest pain, the other organs in the vicinity be checked for abnormalities. That is what finally brought me success and relief.

Dear Reader: And right you are. We doctors sometimes tend to find one abnormality and then sit on our laurels, disregarding other possibilities. Your “epistle” is particularly appropriate, because it reinforces what we learned in medical school: Cover all the bases.

The diagnosis of the causes of chest pain can be a challenge. Once we have ruled out the more “serious” factors (heart, lungs and intestine), we may tend to sit tight, forgetting that the gallbladder is a common culprit. The diagnosis of gallstones is easy, safe and painless: an ultrasound test. But first the physician has to consider them in the differential diagnosis.

Thanks for writing.

To give you related information, I am sending you a copy of my Health Report “Hiatal Hernia.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: In a recent column, you stated that pregnant women and those people with documented folic acid deficiency should take 400 milligrams of folate supplement a day. I believe that this is about 1,000 times the recommended dosage of 400 micrograms of the vitamin. I believe that my local newspaper probably erred but, if not, your readers should be alerted to the error.

Dear Reader: I cannot blame your newspaper for the mistake; I take full responsibility. Doses of folic acid are, as you pointed out, on the order of micrograms, not milligrams. I take responsibility for the typo and ask my readers to forgive my glitch. It was careless.