DEAR DR. DONOHUE: I have a small, soft bulge in my right groin. No pain is involved. I think it might be a hernia.

I am active and 43. I don’t do any really heavy work. If it is a hernia, I can’t afford time off from my job right now. Is immediate surgery demanded? How long would I be off work? Is there any danger in putting surgery off? — L.K.

ANSWER: The abdominal “wall” is composed of muscles and ligaments that keep the abdominal organs in place. It extends from the ribs to the pelvic bones. A hernia is a bulge in that wall; it’s a weak spot. The covering of the abdominal organs protrudes through the weak spot. Men have more groin hernias than women because, during fetal life, the testes start out inside the abdomen and migrate into the scrotum. Their migratory path leaves a weak spot in the groin, the site for a hernia.

The only true cure for a hernia is surgery. However, repair doesn’t have to be immediate. Many people go through life with a hernia without having it fixed. If the bulge is large or painful, it needs quick attention. Hernias can become incarcerated or strangulated. Incarcerated means that the bulge can be pushed back into the abdomen. Strangulated means the blood supply to the hernia is cut off, and it produces severe pain. It has to be fixed immediately. These hernia complications are rare events.

Your question about time of recuperation depends on the kind of surgery done. Some surgeons repair a hernia with a laparoscope, a telescopelike device inserted under the abdominal wall for viewing. Instruments are similarly passed through small incisions. Laparoscopic surgery is less painful than standard surgery, and recuperation is a bit faster. Recurrences of the hernia, however, occur slightly more often with this procedure.

If you have a sedentary job, you should be back at work in 10 days. Manual labor requires longer recuperation. The doctor instructs patients not to lift loads greater than 25 pounds from four to six weeks after the operation.

DEAR DR. DONOHUE: What is meningitis? How do you catch it? How is it treated? How often does it cause death? — E.H.

ANSWER: Meningitis is an infection of the meninges, the three coverings of the brain and spinal cord. The infection comes from bacteria or viruses. Signs of bacterial meningitis are headache, stiff neck, high temperature, delirium, and, if not treated, coma and death.

Viral meningitis for the most part, but not always, has less florid but similar symptoms.

The most important test for meningitis is microscopic examination of the spinal fluid to find the cause.

Bacterial meningitis can be passed to others through droplets of oral secretions coming from an infected person or from a carrier who has no signs of illness. Viral meningitis is transferred in a number of ways. Mosquitoes are involved in some cases.

Antibiotics are the treatment for bacterial meningitis. Only a few medicines are effective for viral meningitis. When treated early, death from meningitis is rare.

DEAR DR. DONOHUE: Do humans ever catch heartworm from their dogs? I have my dog treated to prevent it and got to wondering about this. — L.V.

ANSWER: Dog heartworms are due to the parasite called dirofilaria and are passed to the dog from infected mosquitoes. Mosquitoes can pass the parasite to humans, but it never completely matures in humans. It can form a lung granuloma, a heap of dead cells that is about the size of a coin. Such granulomas are infrequent causes of illness.

Dogs do not pass the illness to humans.

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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