Hiatal Hernia Turns Traumatic

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DEAR DR. DONOHUE: Our experience with my husband’s hiatal hernia was traumatic. He was 69 and in excellent health. After a day of working in the yard, we sat down to supper and within three minutes he was incapacitated with chest pain. He was taken to the hospital and was given nitroglycerin for the pain. The pain subsided as quickly as it came. It took two months to discover the real problem: His stomach was in his chest cavity and had crowded his heart and lungs. Surgery was scheduled. Before the scheduled date, the pain returned and he had to have emergency surgery. Please let people with a hiatal hernia know about this. — M.H.

ANSWER: People have been led to believe that a hiatal hernia is the same as GERD, gastroesophageal reflux — heartburn; it isn’t. They are two different conditions. A hiatal hernia is a bulging of the stomach through a gap in the diaphragm muscle, the muscle that separates the chest cavity from the abdominal cavity. The gap is the hiatus, and through it, the esophagus can pass from the chest into the abdomen to join the stomach.

GERD can happen to people with a hiatal hernia, and it can happen to people without a hiatal hernia. Your husband’s problem was a somewhat rare complication of a hiatal hernia. The upward bulge of his stomach, the portion in the chest, twisted and cut off its own blood supply. That’s what caused his pain. The first time, the hernia untwisted spontaneously and the pain left. The second time, the twist didn’t untwist, and emergency surgery was required.

This process is called strangulation and is a very serious affair. Thankfully, it happens only to a very few. You’ve provided a chance for people to learn what a hiatal hernia is, what a strangulated hiatal hernia is and what GERD is. We’re all glad that things worked out well for your husband.

The booklet on hiatal hernia, acid reflux and heartburn focuses primarily on the common heartburn problem and its treatment. Readers wanting more information can obtain a copy by writing: Dr. Donohue — No. 501W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have two granddaughters who bite their fingernails. Is there anything that stops this awful habit? — B.S.

ANSWER: What prompts people — children and adults — to bite their nails is often unexplainable. Stress, boredom, imitation of other nail-biters and relief of anxiety are offered as explanations for the habit, but proof is lacking for a cause in most cases. Close to 60 percent of 10-year-olds bite their nails. As children grow older, the number of nail-biters lessens.

Doing nothing about it is often the best policy. If the child wants to stop, then there are ways to help him or her break the habit. When children are at home, Band-Aids over the fingers remind them not to bite. Chewing sugarless gum makes nail-biting less convenient. Readers are welcome to give us their solutions.

DEAR DR. DONOHUE: How serious is bipolar disorder? Can you control it yourself? Is the brain lacking some element? — L.R.

ANSWER: Bipolar is a disorder in which people experience spells of deep depression alternating with spells of great energy and unbridled enthusiasm. It’s an emotional teeter-totter. In the high-energy phase, people feel invincible, are constantly on the go, can do with little sleep, have grandiose and unreasonable plans and are overly sociable. They become impulsive and make hasty and poor decisions. Sometimes they hallucinate, seeing things not present and hearing things not spoken. In the depressed phase, the opposite holds. People become reclusive, feel that all is hopeless, don’t want to get out of bed and are reluctant to interact with others. Those extremes are the two poles of bipolar disorder.

Yes, it is a serious illness. It can disrupt a person’s life.

Brain chemistry is involved, but the exact mechanisms are not completely understood. Genes have a major role too. Bipolar disorder runs in families.

People cannot control these mood swings by themselves. They will have times when the extremes of the two poles are not present but, predictably, the highs and lows return.

Medicines are most helpful in restoring stability to people’s lives. Lithium is a medicine with proven good results. There are others.

DEAR DR. DONOHUE: Please explain the proper care of a person who contracts shingles. Is it contagious? My doctor didn’t want me in his office. Other doctors say it’s not contagious.

I received the drug Famvir at the start. Now I take Lyrica and Percocet. I am miserable. How long is recovery? I have a mild case. I pity anyone with a difficult case. — E.B.

ANSWER: When the shingles rash is brand-new and consists of many small, fluid-filled blisters, virus is present in those blisters. It is theoretically possible for an adult or a child who has never come in contact with chickenpox to catch chickenpox, not shingles, from the blister fluid. The possibility is slight, but it does exist. Most adults — more than 90 percent — have been exposed to chickenpox, so adults are not in great danger. Newborn and young infants, before they’ve received the chickenpox vaccine, are at a little greater risk.

You do realize that shingles is the reawakened chickenpox virus that lives in the body from the time of infection to the time of death.

You don’t have shingles now. You have the dreadful shingles complication — postherpetic neuralgia. It’s pain coming from the nerve that the shingles virus traveled down on its journey to the skin. You are getting the appropriate medicines. The pain is usually gone in months, but it can linger for years.

The shingles vaccine was developed to prevent shingles and postherpetic neuralgia.

The shingles booklet describes this illness and its treatment in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 1201W, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Canada with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

©2008 North America Synd., Inc. All Rights Reserved

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