Do I really need an 操作／手術 for my hernia?

Published: 02:26 BST, 23 October 2012 | Updated: 02:26 BST, 23 October 2012

After 苦しむing from heartburn I was 診断するd with a hiatus hernia.

Unfortunately, I have an intolerance to ant i-酸性の 医薬 and have now been 申し込む／申し出d an 操作／手術 to 直す／買収する，八百長をする my hernia and cure my heartburn, called a fundoplication 手続き.

Could you tell me something about it?

My 外科医 has told me it doesn’t work for everyone. I am 60.

Margaret Docherty, by email.

I have an intolerance to anti-酸性の 医薬 and have now been 申し込む／申し出d an 操作／手術 to 直す／買収する，八百長をする my hernia

Hernias are a very ありふれた 条件, and are defined as the protrusion of any structure in the 団体／死体 through its coverings.

Most people think of them as occurring in the groin, where the intestine 押し進めるs through weak muscles.

A hiatus hernia, however, is when part of the stomach has bulged up through the diaphragm.

This is the 禁止（する）d of muscle that divides the chest from the abdomen.

同様に as helping us to breathe by 製図／抽選 空気／公表する into the 肺s, it helps clos e the 開始 between the stomach and the oesophagus (the gullet), 妨げるing stomach 酸性の splashing up into it.

The gullet passes through the diaphragm; the stomach sits below. But in a hiatus hernia, muscle 証拠不十分 in the diaphragm 許すs the upper part of the stomach to move through it.

In most people this 条件 is ‘silent’, 原因（となる）ing few symptoms. They may even be unaware of it.

But in others there is 苦痛 予定 to the stomach 酸性の travelling up the gullet, as the 弁 between the stomach and gullet is no longer 存在 調印（する）d tightly by the diaphragm.

I assume you’ve been 申し込む／申し出d an 操作／手術 as you’ve been troubled with symptoms from 酸性の reflux, and have an intolerance to the 一般的に-used 酸性の suppressant 薬／医学s such as omeprazole.

This 手続き is called Nissen fundoplication, after Dr Rudolph Nissen who first 成し遂げるd it in 1955.

Today it is 普通は a keyhole 手続き. The 外科医 包むs the upper part of the stomach around the lowest part of the gullet ― this is called plication ― and stitches it 永久的に in place.

This helps 強化する the 弁 between the gullet and the stomach.

The gap in the diaphragm through which the stomach was protruding is also 狭くするd and 修理d by stitching.

The 操作／手術 is 安全な and 効果的な, and although you have been 警告するd that some 患者s do not 達成する 完全にする 決意／決議 of their symptoms, 熟考する／考慮するs show that even after ten years, 89 per cent of 患者s are symptom-解放する／自由な.

After the 操作／手術, most 患者s have some degree of difficulty with swallowing, and it is necessary to eat a light, soft diet for some weeks as your stomach and gullet 傷をいやす／和解させる.

Occasionally it is necessary for the 患者 to を受ける a stretching 手続き of the passage through the 修理d area, and this is carried out under anaesthetic.

I send you my 安心: it is most likely you will be 満足させるd with the 結果, and 達成する 救済 of? your symptoms.

For 20 半端物 years I have taking thyroxine, after 存在 診断するd with an underactive 甲状腺.

I am having terrible problems with my 負わせる, 予定 to my metabolism 存在 slow, and started taking kelp, as I read this 増加するs 甲状腺 levels.

However, my 甲状腺 levels are now too high and my do ctor has 減ずるd my level of thyroxine (she does not know I am taking kelp).

Would it be healthier to stop thyroxine and just use kelp?

I feel I cannot ask my GP, as she may tell me to forget the kelp.

Marianne Bainbridge, by email.

I understand that you feel taking a natural 補足（する）, and 供給（する）ing your 病んでいる 甲状腺 with a booster, must be a より望ましい way of 扱う／治療するing your 条件 ― and I have much sympathy with that.

Unfortunately, I must advise you to stop taking the kelp, as it may 証明する dangerous to your health, 特に your heart.

An underactive 甲状腺, or hypothyroidism, is a 比較して ありふれた 条件, 影響する／感情ing around one in 50 women and one in 1,000 men.

It occurs when the 甲状腺 （分泌する為の）腺 does not produce enough 甲状腺 hormone, thyroxine.

The hormone’s 役割 is to 支配（する）／統制する 非常に／多数の 過程s in the 団体／死体, and 欠陥／不足 leads to 非常に／多数の symptoms 含むing sensitivity to 冷淡な, constipation, 負わせる 伸び（る） and fluid retention, 疲労，（軍の）雑役, 乾燥した，日照りの 肌 and 不景気.

取って代わるing it with a daily tablet is all that is 要求するd to 回復する normal health and longevity, and a 年一回の 血 実験（する） is needed to check levels.

The kelp has 上げるd your thyroxine levels 予定 to its high content of iodine. This 自然に-occurring mineral is 必須の for the 生産／産物 of thyroxine, and so 上げるs levels of the hormone. It is 設立する in 貝類と甲殻類 and 海草, cow’s milk and some cereals and 穀物s.

However, while you need to 上げる your thyroxine, 超過 甲状腺 hormone is as harmful as a 欠陥／不足 ― the most serious 可能性のある result 存在 atrial fibrillation, an 不正行為 of the heart rhythm that can 原因（となる） dangerous circulatory problems.

This is 明確に something to be 避けるd.

その上に, the 影響 of giving iodine 補足（する）s to people with 異常な 甲状腺 （分泌する為の）腺s is 予測できない, and depends on the underlying 病気 in each individual.

Because of this, it is best to 選ぶ for a stable 治療 and 差し控える from taking the kelp.

I understand your 失望, but it is far more important for your 団体／死体 to receive a constant and 正規の／正選手 level of thyroxine, and a daily dose of synthetic 交替／補充 is the safest and most practical way to 達成する this.

ーに関して／ーの点でs of the 負わせる 伸び（る）, speak to your GP, as she may be able to 申し込む／申し出 負わせる loss advice, or 言及する you to a dietitian. But whatever you do, do not stop the thyroxine in favour of kelp.

The 利益 of that is unreliable and is an illusion.

By the way?.?.?.?

患者s need care, not a Facebook friend

Why is it that if you want to see a hairdresser or 財政上の 助言者, all you have to do is phone and 調書をとる／予約する an 任命, but if you need to see a GP, you must phone at 8.15am 正確に／まさに and after 圧力（をかける）ing redial 12 times you 結局 find there are no 任命s left for that day?

This question was 提起する／ポーズをとるd at the 年次の 会合 of the 王室の College of General Practitioners last week by Anna Dixon, director of 政策 at the King’s 基金.

Since for 合法的な 推論する／理由s no 臨床の advice can ever be given 経由で Facebook and Twitter, I wondered what 正確に／まさに is communicated?

She was explaining to GPs the need for general practice to transform from a cottage 産業 to something more modern.

There is no 疑問 that 存在 ‘modern’ is something GPs think about.

Later in the 会議／協議会, the chairman of the 王室の College, Professor Clare Gerada, spoke enthusiastically about her use of Facebook and Twitter, which 高めるs good communications with 患者s, we were told ― though since for 合法的な 推論する／理由s no 臨床の advice can ever be given in that way, I wondered what 正確に／まさに is communicated?

One comment from the 床に打ち倒す （機の）カム from a GP who 述べるd himself as a Luddite, ignorant of the use of such マスコミ, though he pointed out that he has no hesitation in giving his 患者s his email 演説（する）／住所 and 動きやすい number.

We were all then asked to raise a 手渡す if we did this ― out of many hundreds of GPs, just three of us did so.

All? of which tells us something about communication in general practice today.

For 存在 modern is meaningless unless 患者s 利益.

Professor Gerada was later bemoaning the use of the word ‘burnout’ in discussions she’s had with 同僚s struggling to 対処する with their 臨床の work and 抱擁する 容積／容量s of red tape. Indeed, the word is on the tip of many tongues.

But then every 接触する I have with the profession is infused with glib phraseology which gives an illusion of doctors 存在 ‘on message’ ― yet if I hear the words ‘reflective practice’ once more (an 試みる／企てる to show we are thinking about what we do and learning from problems) I will probably need resuscitation 同様に as re-training.

Not once in my four days at the 会議／協議会 in Glasgow did I hear the words vocation or 義務.

If they are no longer considered to be part of our かかわり合い to 患者s and the world of 薬／医学, then I think we should be told and I’ll 辞職する.

And Anna Dixon should probably realise that what she really needs and deserves as a 患者 is for general practice to return to 存在 a cottage 産業, albeit 援助（する） ed and supported by the IT 革命.

We should be 辛勝する／優位ing backwards to a world of care and service, with より小数の 患者s on a 外科’s 名簿（に載せる）／表（にあげる）, so 緩和 圧力 on 任命s ― not racing 今後s into a world of Facebook? and Twitter.