DEAR DR. DONOHUE: I have a bad hernia in my right groin. At times it sticks out like a baseball, and it’s hard to push back in. It’s getting worse. What can I do for it? I am 88 and in good health. I passed a heart exam for hernia surgery, but doctors I have contacted won’t do anything for me. – E.M.

ANSWER: From the lowermost ribs to the top of the pelvis bone, the abdominal wall is a sheet of muscle that holds all the abdominal organs and tissues in place. A hernia is a hole in that wall through which organs and tissues poke out.

In men, groin hernias are common because of the path the testicles take to reach the scrotum. In fetal life, they are high in the abdomen, but as development progresses, they migrate downward into the scrotum. Their pathway involves a hole in the groin region of the abdominal wall. That hole remains a potential weak spot throughout life.

If a hernia bulge can be easily pushed back into the abdomen, the hernia doesn’t require immediate attention. If the hernia can’t be pushed back, it’s said to be “incarcerated” and might progress to the stage where its blood supply is cut off. That’s a “strangulated” hernia, and it’s an emergency.

A truss – a belt with a soft pad that covers the hernia – can keep it from popping out, but it is not a cure. Surgery is the only cure. You’re having enough trouble with your hernia to have surgery. If you can’t find a local surgeon willing to do the job, then there must be a large medical center or a medical school in your state where surgeons will repair the hernia. You have had a heart check and have been declared fit to withstand surgery. Even if a general anesthetic – one where you are put to sleep – is out of the question, many hernias can be fixed with local anesthesia – numbing only the operative site and keeping you awake but free of pain during the procedure.

DEAR DR. DONOHUE: Will you address the topic of acoustic neuroma?

About 25 years ago, I began to lose hearing in my left ear. I was 45 then. My hearing in that ear got progressively worse, and it had a constant ringing noise. My doctor told me this was just a case of deafness and nothing could be done for it.

Then I had trouble with balance. I worked in construction, and this put me in danger of falling. After three years of putting up with this situation, I finally saw a doctor who made the diagnosis of an acoustic neuroma and referred me to a specialist, who removed the tumor.

I am sure there are others out there who would benefit from my story. – R.F.

ANSWER: I am sure there are people out there who will benefit from it too.

An acoustic neuroma is a benign tumor that wraps around the hearing nerve. It’s benign in the sense that it doesn’t spread. It is not benign as far as what it causes. It leads to one-sided deafness, and often, tinnitus – ear noise – follows on the heels of deafness. It can bring on dizziness and a loss of equilibrium.

Now, with MRI scans, the diagnosis of acoustic neuroma isn’t the challenge it was 25 years ago. Early discovery and removal of the tumor can preserve hearing in the affected ear.

DEAR DR. DONOHUE: With the bombardment of nutritional information, I have become a reader of all food labels. On a few labels I have noticed a warning that there is phenylalanine in the food. What does that mean for me? – J.D.

ANSWER: Some infants are born with a condition called PKU, phenylketonuria (FEE-nil-KEY-tone-YOUR-ee-ah). They don’t have the enzyme that converts the amino acid phenylalanine into other substances. The blood level of this amino acid rises. As a consequence, brain development greatly slows, which leads to mental retardation.

If the diagnosis is made soon after birth, a diet that excludes phenylalanine permits normal brain growth. Screening for PKU is routinely done on all newborns. Affected children usually stay on the diet for the rest of their lives.

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. Readers may also order health newsletters from www.rbmamall.com

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