ASK THE GP: Is surgery the only way to fix my hernia? Dr Martin Scurr answers your health questions
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I was diagnosed two years ago with a hiatus hernia, and now it is causing problems, with reflux so bad it disturbs my sleep. I’m sick of taking tablets.
My GP — who has referred me to hospital — told me I may be offered surgery, but that this means having your chest cut open. What do you advise I do?
Anne O’Donoghue, Ealing, West London.
A hiatus hernia occurs when part of the stomach protrudes up through the diaphragm via the opening usually occupied by the oesophagus (gullet).
It is extremely common — it’s estimated that a third of people over the age of 50 have one (though younger people can have them, too, as a result of pregnancy or obesity, for instance).
In my view, surgery is an attractive option, when compared with a lifelong prescription of medication (file photo)
The herniation puts pressure on the gullet and stomach, which can, in turn, lead to symptoms such as heartburn, acid reflux, wheezing and burping.
Any heartburn can be treated with acid suppressants. Typically, this will be a proton pump inhibitor (PPI) — such as omeprazole or lansoprazole — which cuts acid production in the stomach.
However, this will do little for the recurrent regurgitation that you are experiencing.
In my view, surgery is an attractive option, when compared with a lifelong prescription of medication. While PPIs can help, and generally are well tolerated, they have been linked to longer-term effects, such as an increased risk of infection and possible raised risk of osteoporosis.
Also, surgery is not necessarily as invasive as you have been told. These days, a laparoscopic (keyhole) operation is performed, which does not require opening the chest.
The most common technique is now what is known as a Nissen fundoplication. This involves tightening the valve (sphincter) at the bottom of the oesophagus, as well as closing the opening, so that the stomach cannot protrude up.
A review of 12 trials has shown that doing this via keyhole led to a 65 per cent reduction in complication rates, compared with open surgery.
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The surgery itself requires around three days in hospital.
Another approach, called the Belsey operation, which does involve a chest incision, is reserved for unusual cases (for example, where patients are very overweight) and is now rarely offered.
It must be acknowledged that a proportion of patients — around 10 per cent — does require heartburn medication following successful surgery, to prevent recurrent heartburn, though the issue of regurgitation will have been abolished.
I hope that your consultation with the specialist is supportive and that they are in agreement with what I have outlined here. There is certainly reason for optimism.
Earlier this year, I was diagnosed with multiple pulmonary embolisms, for which I am being treated. In my circumstances, would you advise air travel?
John Slater, by email.
The answer to your question is ‘yes’, but with certain provisos.
Undoubtedly, your treatment will involve prescription of what are often called anticoagulants (and more commonly known as ‘blood thinners’), and these will be giving you a high degree of protection.
A pulmonary embolism is essentially a blood clot in the lung.
Clots can arise for all sorts of reasons — for example, recent surgery, prolonged immobilisation (such as on a long flight), heart failure, obesity, pregnancy or advancing age.
Earlier this year, I was diagnosed with multiple pulmonary embolisms, for which I am being treated. In my circumstances, would you advise air travel? (file photo)
These all encourage blood to pool in the deep veins in the legs and pelvis and a clot to form — what we refer to as a deep vein thrombosis, or DVT.
If a lump of clotted blood breaks away, lodges in the lungs and blocks the fine blood vessels, this impairs the ability of the lungs to oxygenate the blood, which can be life-threatening.
It is likely that your diagnosis followed symptoms such as chest pain, breathlessness or a cough, or you may even have collapsed.
Write to Dr Scurr
To contact Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email [email protected] — including contact details.
Dr Scurr cannot enter into personal correspondence.
His replies cannot apply to individual cases and should be taken in a general context.
Always consult your own GP with any health worries.
Anticoagulants will have been commenced immediately.
This medication does not dissolve the blood clots, but prevents new ones from forming. The clot itself will normally disperse naturally.
Anticoagulants are prescribed for at least three months — and possibly indefinitely.
If you are still taking them, then you are protected if travelling by air, although you’d be advised to wear compression stockings for added protection, as well as remaining hydrated and walking down the aisle of the aircraft every two hours. Compression stockings — available without prescription from most good pharmacies —work by squeezing the superficial veins in the legs, increasing blood flow through the deep veins and reducing the pooling of blood.
I have had patients about to undergo very long-distance flights (six to 12 hours) requesting sleeping tablets to help them during the journey — however, I would vigorously recommend against this, as sleeping in a seat on an aircraft, with the legs downwards for hours on end, is asking for trouble, even in otherwise healthy individuals.
It’s vital to keep the blood flowing through the veins of the legs by constantly using those muscles.
If you are no longer taking the anticoagulants and are embarking on a long-haul, or even short-haul, flight, then talk to your GP about having a single injection of the blood-thinner heparin.
This provides a temporary period of anticoagulation and can be self-administered. It should be repeated before the return flight.
Check with your medical adviser, but my view is that if you are currently taking oral anticoagulation, then there is no need to worry.
In my view: Medical terms must not be simplified for patients
When I saw that modern slang is to be adopted on NHS websites to make them easier to understand, I got so hot under the collar that superheated dihydrogen monoxide — or what we technical types call steam — came out of my ears.
For those of you who missed it, the Department of Health has decided to trade certain traditional terms for more informal language, in an effort to make its public websites more understandable.
So, for example, ‘urine’ is to be replaced with ‘pee’, ‘faeces’ with ‘poo’, ‘nausea’ with ‘feeling sick’, and so on.
At first, I thought it was an early April Fools’ joke. But no — the decision, fostered by NHS UK Standards, is based upon top-level research conducted by graduate-level civil servants. And yet it totally goes against what many doctors know only too well — that most patients find it embarrassing to talk about bodily functions and actually feel more at ease using formal terms.
And yes, of course, language evolves, but so does slang. Slang is as diverse as the society in which we live.
However, the everyday terms used in healthcare are based upon science and evidence — and that requires technical, non-negotiable terminology.
As doctors, nurses and health workers, we have always had to translate and explain from time to time — and I imagine we will continue to do so. With so much within the NHS in need of urgent reform, to me this seems to be an unnecessary distraction.
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