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Your Good Health: Treatment of heartburn, indigestion requires diagnosis

Dear Dr. Roach: What cures heartburn and indigestion?


It’s easier to answer what causes heartburn and indigestion, because treatment depends on the underlying problem. The most common cause of heartburn is gastroesophageal reflux disease. The contents of the stomach, which normally are strongly acidic, go backward into the esophagus, the long, muscular tube that connects the back of the throat with the stomach. The burning sensation is caused by sensory nerves in the esophagus, which is not supposed to have acid and can be damaged by recurrent exposure to it. Not everybody with GERD gets heartburn: Some people have a cough; some people have the sensation of food and acid going all the way into the back of the mouth, but some have less-typical symptoms, including voice changes, difficulty swallowing, excessive salivation, chest pain mimicking angina and nausea.

GERD usually is caused by relative weakness in the lower esophageal sphincter, a muscular valve structure at the bottom of the esophagus. If the pressure in the stomach pushing contents upward is greater than what the valve can prevent, then acid will flow backward into the esophagus.

In addition to GERD, indigestion can be caused by stomach or duodenal (the first part of the small intestine) ulcers, gallstones, inflammation of the stomach, pancreatic disease, side-effects of medications and many other things.

The first step in treating indigestion and heartburn is to make a diagnosis. Often, clinicians will give a trial of medication to treat symptoms. This might be antacids (which work immediately, but wear off quickly); proton pump inhibitors, such as omeprazole (Prilosec); or a class of medications called H2 — for “histamine type 2” — blockers, which include ranitidine (Zantac) and famotidine (Pepcid). Rapid relief of symptoms while on these medications is strong, but imperfect evidence that the symptoms are being caused by a stomach-acid-related problem (GERD, gastritis and stomach ulcers being the most common). Persistent symptoms should trigger a more thorough workup, potentially including an examination of the esophagus, gastrum (stomach) and duodenum. This is done with a type of endoscopy usually called an EGD, or upper endoscopy, as opposed to a lower endoscopy (colonoscopy).

GERD symptoms usually are not cured, since “cure” means permanent relief from symptoms of the condition as well as resolution of the underlying mechanism. The only treatment likely to cure GERD is surgery to increase the ability of the lower esophageal sphincter to resist acid flow. Newer techniques allow this procedure to be done endoscopically. However, people who have had this surgery often develop other symptoms, including bloating and gas from the inability to belch and relieve swallowed air. However, GERD symptoms usually are manageable with lifestyle changes and medications.

Dear Dr. Roach: I am a 73-year-old male and have been diagnosed with pulmonary fibrosis. My doctor wants me to begin a very expensive medication called Esbriet. From what I’ve read, it could cause very serious side-effects. I feel great — no shortness of breath, a little coughing when breathing in cold air or around my cat. I would just like your thoughts on the disease and the medication Esbriet.


I haven’t discussed pulmonary fibrosis since pirfenidone (Esbriet) was approved. Several trials have shown that it improves lung function, exercise ability and disease-free survival in people with mild-to-moderate disease. It can cause a rash, nausea and diarrhea, and it is, as you say, very expensive. However, if you can afford it or have insurance coverage, I recommend pirfenidone.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Your Good Health: Doctor’s talk of ‘lesion’ does not mean ‘cancer’

Dear Dr. Roach: I am having a “push endoscope,” or forced endoscope, tomorrow. They said they found a lesion in a CT scan and want to look into it further. Is “lesion” a fancy name for cancer?


The word “lesion” is a Latin word for “injury.” In medical parlance, it means pretty much anything that is abnormal. While it is true that doctors will use the term “lesion” to describe something that will later turn out to be cancer, “lesions” definitely are not always cancer.

Push endoscopy, also called push enteroscopy, refers to pushing a small endoscope through the stomach further down into the small intestine, so I suspect that your doctors think that whatever abnormality was seen on the CT scan is in the upper small intestine.

Cancer is rare in the small intestine, but unfortunately there are several types that do occur. Carcinoid, now considered a malignant tumour, is the most common.
The enteroscopy will allow your doctor to look at the abnormality and take a biopsy, if appropriate (which I suspect it will be, if a lesion is found).

Some of the possibilities include benign tumours, such as adenomas and lipomas. I also have seen times when a CT scan abnormality has turned out to be nothing at all on endoscopy. Please let me know what is found.

Dear Dr. Roach: What would cause abdominal bloating after meals, with no gas, no pain, no diarrhea and no indigestion? After a big meal, my daughter’s abdomen (she is 46, but this has been going on for many years) looks like she is six months pregnant.


There are many possibilities. The first is air, which many people swallow when eating food.

Most people are not aware that they are doing so, and the amount of air tends to be increased in people who are anxious or who eat rapidly. Most of the gas is eructated (that’s the fancy medical name for “burped”), but much will enter the intestine, where some will be absorbed and some passed later.

The name for abdominal enlargement after eating is “distension.”

Irritable bowel syndrome is a common cause of distension, but it normally is associated with some degree of abdominal discomfort and a bloating sensation. It’s thought that swallowed air and gas produced by colonic bacteria combine with non-co-ordinated movement of the abdominal muscles to produce the visible abdominal distension. The vast majority of people with irritable bowel syndrome have diarrhea or constipation.

Poor absorption of food, such as from celiac disease or lactose intolerance, can cause abdominal distension, though diarrhea is common.

Small-intestine bacterial overgrowth also may cause distension, but again I would expect accompanying diarrhea or gas.

There are other, less common causes, and a gastroenterologist certainly would be able to review the possibilities and discuss treatment with your daughter. However, since this has been going on for many years, and it doesn’t seem to be causing her many (if any) symptoms, I am not sure an evaluation is mandatory. Still, some possibilities, such as celiac, are worth knowing about, since there may be subtle symptoms she has learned to live with that might be improved with dietary modification.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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Skier found ‘in good health’ after overnight ordeal – Aspen Daily News

A backcountry skier reported missing on Saturday near Marble emerged “in good health” on Sunday afternoon, after reportedly touring for miles until 1 a.m. to stay warm Saturday night then bedding down under a space blanket.

Greg Berry of Boulder told a Pitkin County Sheriff’s deputy that he went for what was intended to be short tour late morning on Saturday, but became lost and disoriented. The experienced backcountry skier was staying in the Crystal River Valley with some friends celebrating a birthday and wanted to get some exercise, telling his companions that he would “stay safe and stay below treeline,” said Alex Burchetta, director of operations for the Pitkin County Sheriff’s Office.

When Berry did not return later in the day, the friends did some searching of their own and then contacted authorities. Though Marble, high in the Crystal River Valley, is most easily accessed from Pitkin County, it is in fact in Gunnison County. Still, the Pitkin County Sheriff’s Office and Mountain Rescue Aspen (MRA) often assist with Gunnison County operations in the Elk Mountains.

Authorities in the Roaring Fork Valley were notified of the missing skier around 9 p.m. Saturday, and a team of five MRA volunteers, supported by others at the C.B. Cameron Rescue Center in Aspen, deployed at first light Sunday. They were joined by searchers from West Elk Mountain Rescue in Paonia and Crested Butte Search and Rescue, who made the four-hour drive required in winter to reach this side of the Elks.

The teams searched the popular backcountry skiing zone accessed via the Quarry Road in Marble until 3 p.m. but could not locate Berry. As they were debriefing at the trailhead, the rescuers were informed that Berry had turned up near Paonia Reservoir on Highway 133, which is located on the other side of McClure Pass and the Ragged Mountains from Marble. He had hitchhiked from there into Paonia, where he contacted his friends to let them know he was OK. 

Burchetta said Berry told another deputy that after he realized he was lost, he determined to keep moving on his alpine touring gear, presumably in an attempt to stay warm. He kept at it until about 1 a.m., when his headlamp died. Berry took shelter under a space blanket he was carrying until the sun came up, then continued with the tour.

Temperatures in the high country near Marble dropped into the teens Saturday night and early Sunday morning, as a winter storm enveloped the area. It grew even colder on Sunday as at least a foot of snow accumulated.

Berry, who works for a Front Range wealth management firm, could not be reached on Monday. Officials with the various rescue agencies involved said they were unsure what route Berry took in his travels.

A Gunnison County Sheriff’s Office press briefing stated that Berry was “in good health” upon his exit from the backcountry on Sunday.

A note on the Mountain Rescue Aspen Facebook page Monday stated that 17 team members, between searchers in the field and support staff at the rescue center, aided in the effort.

“Anytime someone makes it out alive, with or without our help, we are happy with the outcome,” the online post said.

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Why living by the sea is good for your mental health

Why living by the sea is good for your mental health
Even in the winter, there’s nothing like a brisk walk by the sea (Picture: Getty)

The first couple of months of the year can be tough for some people.

It’s a time of contemplation and change, reflection on the previous year and new resolutions for the one ahead.

Plus, the skies are mainly grey and it’s pretty cold.

I personally feel very grateful to live by the sea, as I know that being it really helps my mental health.

And it seem the experts agree – here’s why.

Sea air helps you sleep better

Dr Natasha Bijlani, a consultant psychiatrist at the Priory’s Roehampton Hospital in south west London, says:

‘Sea air is good for sleep because it is generally cleaner and fresher air, with higher levels of oxygen which can improve sleep.

‘The sound of waves can be very soothing to the brain. If you relax, this can help clear the mind, lower stress levels and strengthen your immune system.’

The sound of the sea seems to be particularly evocative in how people feel.

If you close your eyes and listen to the sea, you could be in Cornwall or the Caribbean – it doesn’t seem to matter.

Those who have fond memories of seaside holidays are likely to associate the environment with feeling rested and happy.

The sea can also induce a feeling of awe, and its constancy can help you ‘de-stress’.

When you look at the sea, it sometimes helps with ‘not sweating the small stuff’ – the vastness of an ocean offers perspective.

You’re more likely to exercise


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Why sleep is key to good health

Nick gave me a Fitbit for Christmas (yes, it was on my list!). One of the things it measures is your sleep pattern and looking at mine each morning has been interesting.

I generally have good sleep “hygiene” (quiet, dark, cool, no distractions, early to bed) yet I sometimes feel far from refreshed when I wake … and not only when the cat decides to sit on my chest purring loudly at 3am about 2cm from my nose.

The Fitbit breaks down the time between going to bed and getting up into four areas: being awake, being in REM (rapid eye movement/dreaming) sleep, light sleep and deep sleep.

So last night, for example, I was in bed for nine hours yet according to the app I only got around 7.5hrs sleep because 15 per cent of that time I was awake, 13 per cent in REM, 63 per cent in light sleep and 9 per cent in deep sleep.

It has been identified that sleep cycles last around ninety minutes during which we move into, through and out of various stages of sleep. When we wake up after a full cycle we will feel refreshed but if we get woken up in certain parts of that cycle we will feel disoriented and out of sync.

Research in relation to activity in the brain when we sleep has detailed what happens during REM and non-REM sleep. Volunteers have been observed dreaming through brain scanning and results indicate physiological changes happen in and to our body and brain as we slip into the various stages of sleep.

Sleep is vital to our overall wellbeing. It allows the sift, sort and store of data and experiences, which can only be achieved when the external stimulus of our environment is tuned out. Some suggest that, through dreaming, the brain is applying what it’s learned to predict how we might react in future by attempting to fit aspects of our experience into scenarios (wild, wacky or wonderful) that help us to map out future possibilities based on our emotions, desires and motivation.

Certainly, research indicates that dreams are necessary for our mental, emotional and physical health and that not being allowed to dream causes increased tension and overall stress. Although they can feel troubling at times, dreams are symbolic – their meaning is for us to contemplate and interpret, and uncover the patterns presented and the messages they offer.

Although we often focus on exercise, what we are eating and drinking and overall lifestyle as part of a healthier approach, if we’re not getting a good night’s sleep at the end of each day a lot of the other good work is minimised.

So, it’s time to check /improve your sleep “hygiene” to improve your quality of sleep and help your brain and body get the well-deserved and restorative rest it needs to do its work effectively.

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What does it *really* mean to be in “excellent” health?

The determination last week of President Trump in “excellent’ health by his doctor really struck a nerve for you. Can you share a bit about why, as an MD, you find the results of his physical exam so unsettling?

I think they revealed the troubling idea that, in this country, we have a disease care system—we don’t really have a health care system.

There’s this idea that health is the absence of disease. We see health and disease as black or white, but it’s not binary. Just because you don’t have a disease does not mean you are healthy. There’s a huge gray area between the two, and all of us are somewhere on that spectrum. So for many people, even though their blood tests are “normal,” they may not be feeling as energetic as they should be, they have aches and pains, their digestion is off, they are not as mentally sharp, and possibly they’re overweight. True health is a feeling of vitality and emotional and psychological wellbeing. It’s way beyond just the absence of disease.

In this country, we have a disease care system—we don’t really have a health care system.

According to the White House doctors, President Trump is currently “healthy”—that’s to say, free of disease—and they predict he’ll remain that way for the rest of this term, and likely the next one. What do you think?

I have never seen him as a patient so I can’t comment directly on his health, but what I can say is that anyone with abdominal obesity is unlikely to be healthy. Abdominal obesity—when there is excessive fat around the stomach and abdomen—is known to have negative impacts on health. It is a major source of inflammation, and inflammation is likely the most important risk factor for heart disease, cancer, Alzheimer’s, and other serious diseases.

In addition, anyone who only sleeps for four or five hours a night is also unlikely to be in “excellent” health. Multiple studies have shown that sleep deprivation over time is associated with a lowered immune function and all sorts of diseases, including an increased risk of cancer, stroke, diabetes, and Alzheimer’s disease. And besides the risk of multiple diseases, we now know there is a cleaning system in the brain called the glymphatic system that only works when you sleep. It works like an overnight cleaning crew that clears toxic waste proteins that accumulate between brain cells during the day. So if you don’t get enough sleep, your brain suffers. Basically, if you don’t take the trash out, it’s going to accumulate into quite a mess! And, when the “trash” we’re talking about are toxins in the brain, it can cause all sorts of problems with the way your brain functions. Over time, it’s going to cause hazy thinking and confusion.

And finally, I have a hard time perceiving someone who eats junk food and does not exercise as healthy.  Unhealthy eating alone is a risk factor for depleting your immune system and triggering it to go haywire. Even if someone does not smoke or drink, this definitely does not cancel all the other bad habits out.

[For a medical professional] to say President Trump is in “excellent” health and will remain so for the duration of his presidency is outrageous—and it’s also irresponsible, because it’s tacitly telling people there are no consequences for having such an unhealthy lifestyle, when nothing could be farther from the truth.

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There’s a Long History of Presidential Health Being a Well-Kept Secret

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Saunas Are A Hot Trend, And They Might Even Help Your Health

Is it the heat that makes you healthier? Or the chance to chill?

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Is it the heat that makes you healthier? Or the chance to chill?

bortonia/Getty Images

It’s not even a month into winter, and the cold temperatures have already crushed my spirits. Bundling up every time I leave the house, unexpected school snow days, a sidewalk obstacle course of frozen dog poop: I’m over it. I find myself dreaming of not just spring but warmth in any form. So a sauna is sounding particularly good about now. And besides the respite from the cold, there are a host of claimed health benefits from regular sessions.

And indeed, research has shown an association between certain positive health outcomes and regular sauna use. A 2015 study covering more than 2,300 middle-aged men in Finland found the more frequently a man took a sauna, the lower his risk of fatal heart disease and early death. The same group of researchers has also reported an association between regular sauna use and a lower risk of high blood pressure, and between moderate to heavy use of saunas and a lower risk of dementia, among other benefits.

One caveat, besides the fact that the subjects were all men, is that saunas are so ingrained in the culture in Finland that it’s hard to find anyone who doesn’t use them. So there’s no control group that used them not at all — only those who used them more or less frequently.

And with this type of study, it’s not possible to know whether it’s the sauna itself or some related factor, like the ability to afford time for frequent RR, that is bringing the benefit. As Rita Redberg, a cardiologist at UCSF Medical Center, wrote in a JAMA Internal Medicine editor’s note accompanying the 2015 study, “We do not know why the men who took saunas more frequently had greater longevity (whether it is the time spent in the hot room, the relaxation time, the leisure of a life that allows for more relaxation time or the camaraderie of the sauna).”

Tanjaniina Laukkanen, an author of those studies and a researcher at the University of Eastern Finland, tells Shots in an email that the team believes both heat and relaxation are important factors. Heart rate increases with full-body heat exposure. That helps improve cardiac output.

Saunas also seem to improve the function of the blood vessels. Christopher Minson, a professor of human physiology at the University of Oregon, studies the effects of heat — in his case, hot water immersion — on the human body. He says that like exercise, heat is a global stressor, with likely a host of beneficial mechanisms throughout the body. He’s researching heat therapy for people who are unable to get the full benefits of exercise, such as people with spinal cord injuries.

This comparison to exercise doesn’t mean you should skip working out if you’re physically able to do it. Another study from Laukkanen’s team suggests that there are some independent effects of cardiovascular exercise and sauna use, and that the men who were in good aerobic shape and frequently hit the sauna had better cardiovascular outcomes than those who only fit one of those categories.

So should we all be taking a regular sauna? Redberg’s 2015 editor’s note said that “clearly time in the sauna is time well spent.” She elaborated in a recent email to Shots, saying that that study and subsequent ones show an association between sauna use and some positive health outcomes such as lower blood pressure and possible relief from musculoskeletal pain and headaches. Saunas are among the relaxing and stress-relieving activities she recommends to patients, including massage, yoga and Pilates. She also recommends physical activity, especially walking.

Of course, there are cautions. People who faint or who have low blood pressure might want to be careful, or at least drink a lot of water before and after, which is good advice for all sauna-goers. If you have unstable heart disease, you should be cautious and consult a doctor first.

And what about the infrared saunas that are trendy now?

How To Make Disease Prevention An Easier Sell

While traditional saunas heat up the surrounding air to about 185 degrees, which in turn heats you, infrared saunas (also called far-infrared saunas) only reach about 140 degrees, according to a 2009 review of evidence on infrared saunas and cardiovascular health. But the infrared rays penetrate more deeply into the body, which means you start sweating at a lower temperature than in a traditional sauna. That produces a lighter demand on the cardiovascular system, similar to moderate walking, according to the review, and so might benefit people who are sedentary for medical reasons. It’s also good for people who like the idea of a sauna, but find the high heat unpleasant.

The review, which covered nine studies, found “limited moderate evidence” for improvement in blood pressure and symptoms of congestive heart failure with infrared saunas, and some limited evidence for improvement in chronic pain. Infrared saunas are also a part of waon therapy, used in Japan, which consists of 15-minute stints in the heat followed by 30 minutes of reclined rest, wrapped in a towel. (Sign me up!) Evidence suggests waon therapy can benefit people with heart failure.

Laukkanen says her group’s work can’t be applied directly to infrared saunas, and that more studies are needed to suss out their longer-term benefits. Whatever kind appeals to you, just don’t think that you are “sweating out toxins” to the benefit of your health (a frequent marketing claim). Toxin removal is chiefly the job of the kidneys and liver, not your sweat.

Katherine Hobson is a freelance health and science writer based in Brooklyn, N.Y. She’s on Twitter: @katherinehobson.

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Eagles Injury Report: Birds In Good Health For NFC Championship Game

By Kevin McGuire

With one game separating the Philadelphia Eagles from a trip to the Super Bowl, having all hands on deck can be essential. Fortunately for the Eagles, nearly every available player on the active roster will be ready to play on Sunday against the Minnesota Vikings in the NFC Championship Game. If anything, the Eagles may be a bit shallow with linebacker depth if the injury report has been any indication this week.

Dannell Ellerbe was the only Eagles player to miss practice on Wednesday. A hamstring continues to slow Ellerbe down a bit, just as it did a week ago. He was limited in practice last week and that continues to be the case this week, with the Eagles preparing for the conference championship. There may be a tad more caution in play here with the medical staff and coaches because of the importance of having players in the best health possible this weekend. Ellerbe was limited in practice on Thursday and is considered questionable for Sunday evening.

Ellerbe has been the starting middle linebacker for the Eagles, so his absence would be a concern for the team if he cannot be on the field or is limited in game action. Ellerbe did play last week in the Divisional Round against the Atlanta Falcons, and he recorded a pair of tackles in the 15-10 victory.

Najee Goode may be the most likely replacement for Ellerbe any time he is not on the field. That is in part because another backup linebacker, Kamu Grugler-Hill, was limited in Thursday’s practice as well. Working through an ankle injury, Grugler-Hill is also listed as questionable for this weekend.

The primary backup to Mychal Kendricks may be just a ding on the depth chart, but having two linebackers listed as questionable could present some matchup concerns for Jim Schwartz, because the Vikings could find a way to find some cracks in the middle of the defense and open up opportunities for short gains to turn into long plays.

The only other Eagles player appearing on the injury report heading into the NFC Championship Game is rookie cornerback Sidney Jones, which is to be expected. Jones made his NFL debut in the final game of the regular season after coming off a torn ACL injury, only to suffer a hamstring in the regular season finale against the Dallas Cowboys. That left Jones limited in practice all of last week before taking on the Falcons. This week, Jones is still on the injury report with a hamstring, but he has been a full participant in practices. It is probably still unlikely Jones will play any significant role on the field on Sunday given his hamstring status and the fact this would be just his third NFL game. The stakes are too high to put too much faith in a rookie with that extremely limited amount of experience a week after seeing what poor rookie secondary play can do against the Minnesota Vikings. Jone should only be used in a worst-case scenario situation.


  • LB Kamu Grugler-Hill (ankle)
  • LB Dannell Ellerbe (hamstring)


  • CB Sidney Jones (hamstring)

Kevin McGuire is a Philadelphia area sports writer and college football editor for The Comeback and host of the No 2-Minute Warning PodcastFollow McGuire on Twitter and like him on Facebook.

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Your Good Health: Adult whooping cough difficult to diagnose

Dear Dr. Roach: I have an adult son with serious medical issues. Because of a persistent cough, he saw his internist four times, as well as a pulmonologist. Blood tests and X-rays were negative. His diagnoses over time included: a bad cold, allergies and sleep apnea. During those months, he was prescribed several antibiotics and steroids, as well as other medications.

Soon I, too, began having cold symptoms — running nose, sneezing, coughing, exhaustion — then increased choking from mucus. I tried natural treatments, to no avail. One night my cough changed in both sound and severity. My throat was slightly sore and my glands a bit swollen: I knew the diagnosis.

In the morning, I went to the doctor and said: “I have adult whooping cough.” He agreed. I was put on doxycycline for four weeks. My son is finally on a similar medication. Loss of time, job income, fear of suffocation — all so terrible to experience.

How long is this contagious? When we are better, should we take a booster shot for pertussis (whooping cough)? Do people realize how dangerous this is for babies? I’ve been told their pertussis vaccine is only 70 per cent effective. How long are vaccinations and booster shots effective? Please fully explain whooping cough in adults. I believe it’s being misdiagnosed much too often! Thank you.

L.S., R.N.

Whooping cough is caused by the bacterium Bordatella pertussis and is a very contagious illness. In adults, it causes nonspecific symptoms, including cough, which can be severe (the “whoop” inspiration that makes this condition recognizable in children usually is absent in adults). I’d agree with you that this infection is frequently not diagnosed.

The infection typically begins seven to 10 days after exposure (colds and the flu have much shorter incubation periods). The first phase (called the catarrhal phase) lasts one to two weeks and seems like a cold: feeling unwell, runny nose, mild cough. Eye redness and tearing are common, but it is seldom recognized as pertussis.

The second phase is the paroxysmal phase, and is characterized by severe cough. The cough is forceful, has several spasms in a single exhalation, and can lead to vomiting, fainting or loss of urine. This phase lasts up to three months.

The convalescent phase lasts a week or two, during which symptoms gradually decrease. People are most infectious in the catarrhal phase and the first two weeks of the paroxysmal phase. This is the time when antibiotics also are most likely to be effective.

However, antibiotics still may reduce infectivity to others, so health-care workers and people working with small children should be treated as soon as the condition is suspected. Azithromycin is the usual treatment.

Neither natural infection nor vaccination leads to lifelong immunity. It is hard to make the diagnosis; obtaining a correct specimen is hard, and many physicians fail to consider the diagnosis. It’s important to know whether there is an outbreak in the area; many public health departments send that information by email.

Adults should have a booster vaccine, the TDaP, and pregnant women should have a booster with each pregnancy.

More information is available from the U.S. Centers for Disease Control and Prevention website at

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to

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