DEAR DR. DONOHUE: I am soon having surgery for my hiatal hernia. Two doctors have told me that it is severe enough to have this done. I have reflux coming into my throat and have taken Nexium for several years now.

I am worried about the effects of surgery. How long does it really take to recover? What other side effects will I have to live with? I have read that gas and flatulence are common consequences. On the flip side, I might not have to take medication anymore, and that would be great. – J.K.

ANSWER: Hiatal hernia and gastroesophageal reflux – GERD (heartburn) – are not the same thing. A hiatal hernia is an upward bulging of the stomach through the diaphragm muscle – the horizontal muscle that separates the chest from the abdomen. The esophagus – the swallowing tube – passes through a hole in the diaphragm to reach the stomach. That’s where the stomach can push its way into the chest. GERD is the upward spurting of stomach acid into the esophagus. It often happens to people with a hiatal hernia, but it can happen to people who don’t have the hernia. You have both hiatal hernia and GERD.

Surgery is the answer for people with symptoms of GERD that medicines cannot control. One popular operation is the Nissen fundoplication. The surgeon wraps a collar of tissue around the top of the stomach to prevent acid from shooting into the esophagus. Surgery eliminates symptoms in 90 percent of patients.

Recovery from surgery begins the day after having had it. People feel chipper in a few days to a week, and they’re doing just about everything they ever did by six weeks. I haven’t heard anyone complain of gas after the operation. Of course, as with any surgery, things can go wrong, but they don’t often do so after this operation.

Sometimes the surgery can be done through small incisions with the help of a scope. Recovery from laparoscopic surgery, as this is called, is even faster.

The booklet on hiatal hernia, GERD and heartburn covers symptoms and treatment for these common conditions. Readers can order 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: Several years ago, I went to an orthopedist for severe knee pain. He said that I should lose weight, strengthen the muscles around my knee and give up high-impact sports. I stopped playing basketball, but I continued to play tennis.

For two years I hobbled around on my painful left knee. The pain eventually went away; however, I now limp when I walk. My wife and friends ask me when I am going to get rid of my limp. They say it makes me look older than 61.

Recently I went to a different orthopedist and had another MRI. He said the MRI showed I definitely have a torn meniscus. He also said the inflammation has gone out of the joint, and that’s why it no longer hurts.

Even though the knee pain is gone, I would like to get rid of my limp. Do you recommend that I have the meniscus repaired now, or leave well enough alone? – J.G.

ANSWER: I’d recommend that you have the meniscus repaired if the orthopedic doctor says it’s causing the limp. It could be. The meniscus is a C-shaped cartilage disc that cushions the joint. If it’s torn and the torn part projects upward, it can interfere with knee bending and can cause the knee to lock and you to limp.

Scope repair of a torn meniscus is not traumatic and doesn’t require a long convalescence. If your doctor is for the procedure, so am I.

DEAR DR. DONOHUE: I would like to know why some people pick their nose. I work with a person who goes at it all the time. Why? – M.R.

ANSWER: I don’t have an answer for you. I know, by observation, that it’s a universal activity that must bring a sense of accomplishment to the practitioners.

DEAR DR. DONOHUE: Many months ago I wrote to you about protein in the urine. Will you please address the subject? I am a 59-year-old female and have had diabetes for two years. I try to control things with diet. So far, I have not had to take medicine. My last hemoglobin A1C was 5.7, and my fasting blood sugar is 117 mg/dL (6.5 mmol/L). My urine has protein in it. Are my kidneys in danger? I take Diovan for high blood pressure. Is there a better high blood pressure medicine for urine protein? – K.V.

ANSWER: Urine should be protein-free. The kidney has millions of tiny sieves that strain the blood. Waste products pass through the sieves into the urine. Substances essential to health remain the blood. Proteins are one of those essential substances. They’re too large to pass through the fine filters of kidney sieves. When protein is found in the urine, the logical assumption is that holes have developed in the kidney sieves.

Diabetes can give rise to kidney damage, allowing proteins to pass into urine. Your diabetes is not at all bad. Your hemoglobin A1C indicates excellent blood sugars for the past months. Your fasting blood sugar is also good. Diabetes is not a likely cause of your urinary protein. High blood pressure is another cause of kidney damage and proteinuria, as this finding is called. I assume your blood pressure is under equally good control. You don’t need to change your medicine.

Often the first step taken after finding protein in one urine specimen is obtaining a 24-hour collection of urine. That gives a much better estimate of kidney damage. Innocent conditions can lead to proteinuria. Standing during the day causes some people to have proteinuria. You might have that.

Ask your doctor if you need to have a 24-hour urine collection. Without that value, it’s hard to judge the significance of protein in one specimen. Your blood tests must not have indicated any kidney troubles, or the doctor would have pursued this further. Blood tests that gauge kidney function are BUN and creatinine.

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