Dear Dr. Donohue: Will you write about hiatal hernia? I have had this for a long time. What are the cause and the treatment? — Anon.
A: I have to start with some anatomy. The esophagus is the muscular tube through which food passes. It runs from the throat to the stomach. To reach the stomach, it must pass through the diaphragm, a large, horizontal muscle that separates the chest cavity from the abdominal cavity. Fortunately, nature arranged for a hole in the diaphragm through which the esophagus can connect with the stomach. That hole is called a hiatus. A hiatal hernia is an upward bulge of the stomach through the hiatus and into the chest cavity.
Sometimes, but not always, a hiatal hernia is responsible for the regurgitation of stomach acid and digestive juices into the esophagus. When that happens, a person suffers from heartburn. The official name for heartburn is GERD, gastroesophageal reflux disease. Hiatal hernia isn’t a synonym for heartburn as it is often used. It’s only one cause of heartburn. And, to repeat, it doesn’t always lead to heartburn.
When a hiatal hernia produces no symptoms, no treatment is needed. When it brings on heartburn, heartburn is treated with a change of diet and a change of a few lifestyle practices; sometimes medicines is the therapy taken. Don’t eat any foods that trigger heartburn: chocolate, peppermint, citrus fruits, fatty foods, tomatoes and colas. Don’t lie down after eating. Put 6-inch blocks under the posts at the head of the bed to keep stomach juices in the stomach while sleeping. Many medicines can suppress the production of stomach acid. Prilosec, Prevacid, Nexium and Aciphex are a few of their names.
Should medicines fail to control heartburn in a person with hiatal hernia, surgical correction of it will.
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The booklet on GERD explains this condition in detail. Readers can obtain a copy by writing: Dr. Donohue — No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.
Dear Dr. Donohue: I have Baker’s cysts, one behind each knee for more than six months. I went to the emergency room, but no one knew what to do. After coming home, one ruptured — very painful. A young intern told me I had a Baker’s cyst and sent me to an orthopedic surgeon, who gave me a cortisone shot in one knee. Why don’t they remove the cyst? — L.M.
A: A Baker’s cyst is actually a bursa that’s filled with fluid. Bursas are shock absorbers that reduce friction when tendons rub against bones. The behind-the-knee bursa gets its fluid from the knee joint via a one-way tunnel. This kind of swollen bursa often indicates a knee problem — arthritis, torn cartilage, etc. The knee problem has to be identified and taken care of so the bursa doesn’t repeatedly fill with fluid.
A doctor can drain fluid from the bursa with a needle and syringe and then inject cortisone into it. That works for a while, but often fluid returns. Ask the orthopedic surgeon if you do have knee damage that can be fixed. That’s the ultimate solution. Fluid-filled bursas also can be removed if they keep recurring.
Dear Dr. Donohue: Will you please explain the difference between pneumonia and walking pneumonia? Which is more serious? — M.V.
A: Pneumonia is lung inflammation. Usually, it results from an infection of bacteria or viruses. Not always. Poison gas and toxic fumes also cause pneumonia.
Walking pneumonia applies to pneumonia caused by mycoplasma (MIKE-oh-PLAS-muh), a very small bacterium. Quite often, mycoplasma pneumonia is a self-limited infection that is not life-threatening. People with this kind of lung infection frequently are able to be up and about — walking around. That’s where the name comes from.
Walking pneumonia usually is less serious than bacterial or viral pneumonia.
Frankly, it’s a term not regularly used these days.
Dr. Paul Donohue writes for North America Syndicate. Send letters to Box 536475, Orlando, FL 32853-6475.