DEAR DR. GOTT: I was recently diagnosed with achalasia. This all started a year ago when I had trouble swallowing food. One doctor stretched my esophagus, after which I could hardly eat anything, and drinking hot or cold beverages was no good, either. I also had a Botox injection in the lower sphincter of my stomach to relax it. Do you have any suggestions for some relief? I have now lost about 50 pounds and can't afford to lose much more. I'm a 74-year-old female. Please help.

DEAR READER: The esophagus carries food from the mouth to the stomach. Achalasia is a disorder of the lower muscular ring where the esophagus and stomach meet that makes the body less effective in moving food. This occurs in part because the stomach does not relax as it should during the normal course of swallowing, and it is why you received a Botox injection.

Symptoms include weight loss, chest pain that may radiate to the back, neck and arms (similar to a heart attack), difficulty swallowing both solids and liquids, coughing and reflux. Diagnosis is made through esophageal manometry, a test to measure the pressure inside the lower part of the esophagus. A barium esophagogram or an upper GI X-ray will reveal any esophageal enlargement with narrowing at the bottom, as well as the absence of peristalsis (rhythmic smooth muscle contractions that propel food through the digestive tract).

Therapy often consists of either botulinum (Botox) injections to prevent spasms, widening of the lower sphincter or surgery. You have already undergone two of the three common treatment approaches. Perhaps the next step is to speak with your physician regarding surgery, or request a second opinion. Achalasia isn't preventable; however, treatment can go a long way toward reducing complications.

DEAR DR. GOTT: I have been having recurring urinary-tract infections. I've undergone cystoscopy and ultrasound, and even had dye in my kidneys. All looks fine. I've been taking Vesicare. Do you have any suggestions?

DEAR READER: Request a clean-catch urine and sensitivity test, even if one has been done in the past. Any bacteria can be cultured and tested against specific antibiotics to determine which one will be most effective in treating the infection. Then ask your physician about low-dose antibiotics for perhaps as long as six months, or single-dose medication at the start of symptoms.

In the interim, drink 100 percent cranberry juice daily. Drink plenty of water and avoid feminine hygiene sprays and scented douches. If you remain unsuccessful in controlling this unpleasant disorder, request a referral to a urologist.

To provide related information, I am sending you a copy of my Health Report "Bladder and Urinary Tract Infections." Other readers who would like a copy should send a self-addressed stamped No. 10 envelope and a $2 check or money order to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title or print an order form off my Web site at www.AskDrGottMD.com.

Dr. Peter Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook." Copyright 2010, United Feature Syndicate Inc.