There are a few things connected to this week's Ribfest in Warren that are certain.
There will be plenty of great barbecue consumed.
There will be plenty of beer consumed.
There will be plenty of heartburn.
Very few of us haven't over-indulged and paid the price of what physicians call gastro-esophageal reflux.
It happens; and for most of us, a couple antacids swallowed with the vow "I'll never do that again" is all it takes to reduce the discomfort and finally make us forget all about that vow. After all, how often do you get a chance to indulge yourself in barbecue like this?
However, there are those among us for which gastro-esophageal reflux is more than just a passing occurrence. Those are the victims of perhaps the most apt sounding acronym in medicine: GERD, or gastro-esophageal reflux disorder.
For them, heartburn and indigestion are chronic and sometimes acute to the point of mimicking events such as heart attacks, asthma attacks and ulcers.
Dr. Monica Juszczyk, a specialist in internal medicine at Warren General Hospital, said that if GERD is severe and left unabated for the long-term, the esophagus can become damaged and the chances of esophageal cancer are increased.
"Simplified, it's when the stomach contents back up into the esophagus," she said. And with those contents are stomach acids that can damage and scar tissue not intended to hold them.
Juszczyk said GERD is more frequently seen in the obese population and in adults, but children can also experience the problem.
Anyone who watches even a little television will recall advertisements for prescription and non-prescription remedies for acid reflux, from the simple minty-chalky tablets many people reach for not long after Thanksgiving dinner, to the stuff only a doctor can prescribe.
For mild and occasional cases of heartburn, Juszczyk said, a couple Tums or Rolaids will do the trick. But if they become a regular part of your diet, there is probably something more going on. And if that's the case, eating handfuls of over-the-counter chalk may be masking a potentially serious medical problem.
"A lot of this depends on the foods we eat and our lifestyles," Juszczyk said, noting that in many cases modifying diet and lifestyle will take care of the problem.
That might include reducing the intake of fatty foods, soft drinks, sometimes tomato sauce, and avoiding overeating.
"Refrain from lying down after eating food; try not to eat too much," she said. "Don't eat right before bed. Cut down on alcohol consumption."
"Stop smoking." Smoking? In addition to delivering its own acids, smoking reduces the among of saliva the body produces, and saliva is an acid neutralizer.
"Lifestyle modification is number one," Juszczyk said, "working on weight loss, not eating late at night or two to three hours before bed. Try more frequent small meals. Cut alcohol, red wine, orange juice and colas."
"Sometimes we tell people to use a wedge under the head when they sleep," she noted as a way to elevate the esophagus and allow gravity to keep stomach contents where they belong.
"If that's not enough, medications such as antacids, Maalox, Mylanta can help symptoms, but not repair the damage to the esophagus," she said.
Next come the prescription drugs, like Zantac, Nexium and Prilosec, usually prescribed when a physician determines that the problem is not only severe, but chronic, and there is danger of tissue damage, usually detected by a gastroscopic examination.
"You can't stay on those drugs forever," Juszczyk noted. Each of them has its own set of side-effects. There is a danger of long-term reduction of gastric acid and a propensity for gastritis. They can lead to a change in the lining of the stomach and a reduction in calcium absorption.
"Too often and too quickly people jump to medication," she said, noting that a change in lifestyle can often be very effective.
It is not unusual for infants to suffer from GERD during the first year of life. Usually, it's not cause for worry, but if children are complaining of pain or nausea, an examination to check for inflammation and an interview by a physician are in order.
So, the advice for the Ribfest: If you're considering that second rack, keep this old adage in mind - moderation in all things.