DEAR DR. DONOHUE: Last week on my visit to the doctor, I was having some slight pain in my stomach. When I looked in the mirror, I discovered a small discoloration in the center of my abdomen about the size of a golf ball. My doctor told me I had a hernia. He said I could have surgery if it pains me. I am 75 and 25 pounds overweight. The hernia doesn’t pain me, but I am concerned. It doesn’t protrude when I lie down. What causes a hernia, and what is the best treatment aside from surgery? – J.K.

ANSWER: All hernias are protrusions of an organ or tissues through a defect in the wall that’s supposed to hold those structures in place. In men, the defect is most often in the groin area. The testicles in early life are within the abdomen. As fetal development progresses, they migrate out of the abdomen and into the scrotum. The place where they pass through the abdomen represents a potential weak spot.

In women, the midline of the abdomen is a potential weak spot. Childbirth is one reason for the weakness there. Obesity is another. Twenty-five pounds doesn’t constitute obesity. I don’t think the weight caused your hernia.

Hernias often disappear when a person lies down. The tissues or organs drop back into their usual location.

The only cure for a hernia is surgery. If it’s small and not bothering you, you don’t have to rush to surgery and you might never have to.

DEAR DR. DONOHUE: I read your article about waistlines and visceral fat but don’t understand why a 40-inch waistline doesn’t include height in the formula. My husband is 52, 6 feet 2 inches tall, and weighs 215 pounds. Obviously he has a little extra padding in the middle, but he is well-proportioned. He is very active, and his cholesterol is good. His problem is his military physical, which he takes twice a year. He tops out all the running and fitness testing but gets huge penalties for his 40-inch waistline. Some of his less-healthy and rotund peers score better because they have a 39-inch waist that is not proportional to their 5-feet-6-inch height and their fitness testing is marginal. Sometimes by dieting he squeaks through the waistline requirement, but I feel this is an unnecessary and unhealthy answer. Is he getting a fair shake here? – A.F.

ANSWER: Your point makes sense to me. Guidelines are only rough estimations of health. They’re used to screen large numbers of people and certain cutoffs must be established. Those cutoffs aren’t fair to everyone. Your husband is a case in point.

A waistline of 40 inches (102 cm) or more for a man and of 35 inches (90 cm) for a woman is supposed to put people at a higher risk of having heart disease.

There are many other considerations that go into assessing a person’s potential for heart disease. Physical fitness is one of those considerations, and your husband’s tests indicate he is in good shape. Blood pressure and cholesterol are other indications of heart health.

I calculated your husband’s body mass index, BMI. It’s 27, and that puts him in the overweight category too. However, it’s another guideline that has to be interpreted with a large dose of common sense.

I don’t know if I am an exception to the rule, but I have always found that the military is willing to listen to an appeal of its decisions. Why doesn’t you husband make such an appeal? He has a lot of evidence that he is in top-notch shape.

DEAR DR. DONOHUE: In the fall of 2005, I had a bone scan that showed osteoporosis. I have taken Fosamax and later Evista. I also take calcium and have been exercising. This week I had another scan, and I have gotten worse rather than better. Could this be due to my frequent bowel movements – three or four times a day? – M.G.

ANSWER: It could be. You might have what’s called a malabsorption syndrome, which shows itself as diarrhea or frequent bowel movements. Malabsorption indicates nutrients like calcium are not getting into the blood and to bones. There are many such illnesses, and you should ask your doctor about being checked for them.

DEAR DR. DONOHUE: I am 17 and have worn contact lenses for five years. Last summer I started having problems with my eyes. I think it might be an allergy, because it happens only in the summer. As the day passes, stringy, mucus-like material builds up in my eyes and causes irritation and blurring. I take an allergy medicine. When I went to the doctor and he said it was an infection, but the drops he gave me have done nothing. Please let me know what to do. – J.A.

ANSWER: Stop wearing your contact lenses until there’s a definite diagnosis made and some improvement occurs. You have to go back to the doctor, or you have to see an eye doctor. If this is an infection, the doctor has to identify the causative germ to prescribe the correct antibiotic ointment. Don’t fool around with this. Protracted eye infections can cause permanent eye damage.

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