DEAR DR. DONOHUE: I have been diagnosed with a hiatal hernia. My doctor said it will not fix itself. I have to manage it by not eating before bedtime, elevating the head of my bed and taking antacids. The doctor said that laparoscopic surgery is an option. I am wondering if I should have the surgery. Can you tell me about it and if it’s worth it? – S.C.

ANSWER: Your doctor is right. A hiatal hernia won’t fix itself; no hernia will. The question is: Does it need fixing? A horizontal muscle – the diaphragm – separates the chest from the abdomen. The esophagus – the swallowing tube – must pass through a hole in it to reach the stomach. A protrusion of the upper part of the stomach through that hole into the chest is a hiatal hernia.

Many people go through life with a hiatal hernia and never know they have one. It causes them no symptoms. Others develop GERD – gastroesophageal reflux disease – commonly known as heartburn. Stomach acid spurts into the esophagus. Apparently you have GERD. You’ve adopted some of the steps to control it.

If elevating the head of your bed, not eating before bedtime and taking antacids control your heartburn symptoms, you don’t need surgery. If you do have symptoms, then you need to take additional steps. Don’t eat foods that aggravate GERD: fatty foods, tomatoes and tomato products, citrus fruits, alcohol, coffee, tea, chocolate and peppermint. Don’t wear constricting garments around your stomach, like a tight belt. If those steps don’t control your GERD, then you can take medicines that greatly lower stomach-acid production. Prilosec and Nexium are examples.

If all fails, then think of surgery. It can be done through small incisions with a scope. The topmost part of the stomach is wrapped around the esophagus to create a barrier to the reflux of stomach acid. Procedures also can be done with a scope that is passed into the esophagus through the mouth. With those procedures, people go home the same day.

The booklet on hiatal hernia and GERD explains this common problem 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./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: I have worked night shift for almost 28 years (10 p.m. to 6:30 a.m.). I have heard that working the night shift for long time periods can shorten the life span by 10 percent. Have you seen or heard any studies that substantiate this? – D.S.

ANSWER: I haven’t seen such studies. A 10 percent shortening of life seems like an awfully long time – seven or eight years.

I have seen studies that show night-shift work affects people’s health. It’s called “shift work sleep disorder.” Some people on the night shift cannot reset their body’s inner clock and never get adequate sleep. That can affect heart function, promote weight gain, lead to ulcers, impair memory and affect job performance. Chronically sleep-deprived people are prone to accidents in their cars and elsewhere.

If people are able to get their inner clock adjusted to the time change, they don’t suffer these complications.

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