Hiatal hernia should be addressed


DEAR DR. ROACH: Two months after having neck surgery under general anesthesia, I find that I have a partially collapsed lung. A CT scan showed “subsegmental atelectasis.” It also showed that I have a hiatal hernia, and that my stomach is in my chest. What can I do about it? -- Anon.

ANSWER: “Atelectasis” (Greek for “imperfect extension”) means that an area of the lung is not properly inflated, so it is not helping exchange gasses. This is a universal finding after surgery, where the normal breathing pattern is interrupted. We use a device called an incentive spirometer (one common model has three balls that can be lifted up with a deep inhalation) to help reinflate all the areas of the lung after surgery.

Two months is a long time after surgery to still have atelectasis. It sounds to me, in your case, that the lung can’t completely inflate because your stomach is compressing part of it. The hole in the diaphragm (the muscle that separates the chest from the abdomen, and which is the primary muscle of breathing) where the esophagus passes through is called the diaphragmatic hiatus. In some people, that hole is large enough that part of the stomach can go through the diaphragmatic hiatus and into the chest. This is a hiatal hernia.

There’s only so much room in the chest, so the stomach’s presence there certainly will collapse part of the lung. The reason this may need to be corrected is not because of the lung -- most people have tremendous lung reserves and will do fine without one or two lobes of the lung, or even an entire lung; rather, the stomach can bleed or twist inside the chest, and that’s an emergency. You need to talk to your surgeon or regular doctor about the hiatal hernia.

DEAR DR. ROACH: I read your recent column on how brand and generic drugs regulate the amount of medicine in a tablet. Why do thyroid cancer patients need such careful control of their medicines? -- A.P.

ANSWER: Thyroid cancer patients do need to be very careful. Most experts keep the thyroid level just at the very high end of the normal range, so that the TSH level stays low. TSH stimulates the thyroid and may stimulate any remaining but dormant cancer cells. So, it’s really important to watch this carefully, as a frankly high thyroid level increases the risk of heart rhythm disturbances, among other problems.

DEAR DR. ROACH: You wrote a column on urine having no medical benefit or purpose. When I was in boot camp for the military (1964), they collected our urine every morning in a large bag in a container. When we asked the purpose of this, they said it was used in medications. Any truth to this? If not, do you know the purpose of collecting the morning urine? -- W.R.B.

ANSWER: You have me stumped. I know that in the 1940s, when penicillin was first available, it was much easier to purify the penicillin that was excreted unchanged in the urine than it was to extract it from the Penicillium mold. However, that was not an issue by 1964. I tried to look this up, but found nothing. I know a lot of veterans read this column, and I am curious if someone has an answer.

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