DEAR DR. ROACH: My father was recently diagnosed with a type 4 hiatal hernia. His doctor said that this can be very serious and he may need to have surgery to correct the problem. He's 85 years old. Can you shed some light on this situation? -- J.S.
ANSWER: There is a hole in the diaphragm for the esophagus to go through. By far the most common type of hiatal hernia, type 1, is simply a larger than normal hole in the diaphragm, allowing the stomach to slide up into the chest. Most people can manage their hiatal hernia medically, and only those with symptoms that cannot be controlled with lifestyle changes and medication are considered for surgery.
I have never seen a type 4 hiatal hernia, in which the defect is so large that the stomach AND other abdominal organs -- such as the colon, spleen, pancreas, or small intestine -- are present in the chest cavity. The complications of a type 4 hiatal hernia include bleeding, twisting of the organs, obstruction of the intestines and compromise of lung function.
Your father has likely had this condition his whole life, unless it is a complication from previous attempt at surgery. At age 85, he is not likely to develop one of those complications that would necessitate emergency surgery. It would be an unusual situation for your father to be recommended for surgery at his age.
DEAR DR. ROACH: I read your recent article in response to someone about what to avoid to prevent kidney stones. One of the suggestions was to avoid cranberry juice.
I take cranberry whole fruit powder (Vaccinium macrocarpon) in a probiotic to prevent UTIs. Does this active ingredient in cranberry whole fruit powder in tablet form make me susceptible to kidney stones? I really hope not. -- L.D.
ANSWER: Cranberries and cranberry juice contain oxalates, which will increase the risk of a calcium oxalate stone in people who are predisposed to form stones. Some evidence shows that drinking more cranberry juice increases stone risk, and a study looking at cranberry tablets showed an increase in oxalate in the urine. So, I recommend against cranberry juice and supplements in people who have a history of oxalate kidney stones.
Cranberry products are often recommended to prevent urinary tract infections, as you are doing. Cranberries contain one or more substances that prevent bacteria from sticking onto the walls of the bladder, and thus might reduce urine infections. The evidence is suggestive that cranberry juice is helpful, but that's not universally accepted.
Vaccinium, by the way, is a plant genus with hundreds of species, known since antiquity, and has nothing to do with vaccines. The word "vaccine" comes from the Latin word for "cow" and reflects the historical use of cowpox to prevent the deadly disease smallpox.
DR. ROACH WRITES: A recent column on recurrent testicular swelling caused a surgeon to write me about the possibility of a communicating hydrocele due to an indirect inguinal hernia. This causes peritoneal fluid from the abdomen to go into the testicle. If this is the case, the hernia will need to be repaired to keep the hydrocele from reforming. I thank Dr. B.H.H. for writing.