DEAR DR. DONOHUE: My doctor suggests I have surgery for my hiatal hernia. Medicines haven’t helped me. I saw the recommended surgeon, and he wants to do this with a laparoscope. Is that standard? I don’t fancy having surgery in the first place, and in the second place, being a guinea pig doesn’t make me happy. – H.C.

ANSWER: You’re not going to be a guinea pig. Laparoscopic surgery for hiatal hernia has been around for many years. It’s not experimental.

A few words about hiatal hernia are in order. People automatically associate hiatal hernia with heartburn, but the two are not the same. A hiatal hernia is an upward bulge of the stomach through a gap in the diaphragm, the large, horizontal muscle that separates the chest cavity from the abdominal cavity. Some people with hiatal hernia suffer from heartburn, but not all. And not all people with heartburn have hiatal hernia.

Surgery for hiatal hernia usually is considered when medicines fail to control heartburn symptoms. Since the arrival of drugs that are such effective suppressors of stomach acid – Nexium, Prevacid, Prilosec, Protonix and Aciphex – the need for surgery has declined, but there remains a group whose only hope for relief from acid reflux is surgery.

A popular surgical procedure involves snugly wrapping the top part of the stomach around the lowermost part of the esophagus to prevent stomach acid from splashing up into the esophagus. This surgery can be done with a laparoscope – a viewing instrument that looks a bit like a slender telescope. The scope and the instruments to correct the hiatal hernia are passed into the abdomen through small incisions. Convalescence after laparoscopic surgery is, therefore, faster than after standard surgery. Not all patients are candidates for it, but if I were given a chance to have it, I wouldn’t hesitate for a minute.

DEAR DR. DONOHUE: Spring is not my favorite season. I am miserable every day. From April through late June my nose itches and runs, my eyes itch and I sneeze constantly. Hay fever, right? I can’t take antihistamines. I have tried and they make me so sleepy I can’t work. Do you have any suggestions? – D.J.

ANSWER: If your symptoms are making your life miserable, why not consult an allergist? The allergist can test you for the things you’re allergic to and can prepare a serum to desensitize you to those allergens. It might be too late to start this season, but an allergist will know which allergy medicines are best suited for you.

If you want to treat yourself, take a second chance with antihistamines. The newer ones are not as sedating as the older ones. Have you tried Claritin, Allegra, Clarinex or Zyrtec? They shouldn’t make you a zombie.

Have you tried nose sprays to control your itchy, runny nose? Astelin nasal spray is an antihistamine that often can turn off the nasal spigot and nasal itch.

If it doesn’t work, then you can step up to nasal sprays that have a cortisone drug in them. Beconase AQ, Flonase and Nasalide are three such products. People tend to shy away from cortisone medicines because of their side effects. The cortisone in these nasal sprays isn’t completely absorbed, so side effects are few.

Your hay fever is of such magnitude that you’d be best off consulting a specialist for it.

DEAR DR. DONOHUE: I had sex, and I had not taken my birth-control pills that day or the day before. I called my doctor, and he prescribed pills to prevent pregnancy in a situation like this.

I have been worried ever since. How effective are these pills? I cannot become pregnant now. – N.O.

ANSWER: I assume you’re talking about Plan B, the name of the pills used for emergency birth control. One pill is taken within 72 hours of intercourse, and the second pill is taken 12 hours later.

Plan B prevents pregnancy 89 percent of the time.

Are you aware that every sexual act does not result in pregnancy? The expected rate of pregnancy from one unprotected sexual act is only 8 percent.

DEAR DR. DONOHUE: Eight years ago my husband was said to have Alzheimer’s disease. A few years later, the diagnosis was changed to Parkinson’s disease. Now the diagnosis is progressive supranuclear palsy. What is that? His speech is hard to understand, and his walking is bad. How does it end up? – B.C.

ANSWER: Quite a few illnesses can look like Parkinson’s disease or Alzheimer’s disease, especially in their early stages. These illnesses share with each other an attack on brain centers that produce similar signs. However, each also affects brain centers not stricken by the others, and that gives each of these illnesses distinctive features.

An unsteady walk with frequent falls is a sign common to both progressive supranuclear palsy and Parkinson’s disease, because the brain area that governs walking is affected in both illnesses. Some distinctive signs of PSP are a soft, monotone, barely understandable speech; forgetfulness; irritability; and decreased blinking, which leads to dry eyes. Swallowing can become a formidable task. One of PSP’s most distinguishing features is the inability to turn the eyes downward and, later in the illness, to turn them upward. Loss of eye movement makes reading impossible and adds to the patients’ instability.

Many patients eventually have to use a wheelchair.

The Society for Progressive Supranuclear Palsy is ready to help patients and their families with reams of information and with support. You can reach the society at 800-457-4777 (in Canada, 866-457-4777) or on the Web at www.psp.org.

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