LASERS FOR HERNIA REPAIR
Question: I expect to need surgery for a hernia. Is the new laser technique better than a conventional operation?
Answer: Not necessarily. When part of the intestine “herniates” through the muscles of the abdominal wall, a surgeon must reposition the herniated segment and reinforce the weakened muscle. But the incision is the same whether the surgeon uses a scalpel or a laser. Both procedures are performed under local anesthesia on an outpatient basis. Some surgeons use lasers to “weld” the wall of the abdomen shut; but that weak bond still has to be reinforced by sutures, and the method won’t make you heal any faster.
Question: My 48-year-old husband’s doctor recommends surgical repair for an umbilical rupture. But it’s not causing any discomfort now, and other doctors never noticed it. Is surgery really necessary?
Answer: Perhaps not. An umbilical (belly button) rupture, or hernia, is caused by weakness or separation of the abdominal muscle fibers near the navel. When you stand, cough, or strain, the hernia becomes apparent: A portion of the intestine pushes through the muscle and appears as a bulge under the skin. Most of the time, the intestine can be put back into place if the person lies down and gently presses against the bulge. Such hernias are usually congenital but may not be detected until middle age.
Surgery can prevent “strangulation”—impaired blood flow to a trapped portion of intestine—but strangulation isn’t likely anyway. If your husband remains free of pain and the bulge doesn’t bother him, he may be able to do without an operation. However, if pain develops, he should return to his physician and reconsider surgery.
Question: How often do adults need to have a tetanus shot?
Answer: All adults should receive a tetanus-diphtheria toxoid booster every 10 years. If an injury that might lead to tetanus occurs more than five years after the last shot, another booster should be given. (The next shot would then be given 10 years from that date.)
JUST ONE SHOT FOR PNEUMONIA?
Question: You’ve said that people 65 and older should receive pneumococcal vaccine just once. But some doctors have told me they recommend the shot every five years. I had one six years ago when I was 71. Should I get another?
Answer: Healthy older people generally need only one dose of pneumococcal vaccine. (However, a single revaccination with the “23-valent” vaccine is worth considering if you previously received the older, “14-valent” type of pneumococcal vaccine.) But if you have a medical condition such as heart, kidney, liver, or lung disease, diabetes, Hodgkin’s disease, cerebrospinal fluid leaks, an immune-system disorder, or sickle-cell anemia, you could be susceptible to complications from pneumonia. Anyone in those risk groups should get a shot every six years.
Question: I’ve heard so many opinions, pro and con, about flu shots. Who should get a flu shot? How effective is it? When is the best time to get one?
Answer: Anyone who can tolerate a flu shot should consider getting one before the influenza season begins. That’s especially important for these high-risk groups:
• People age 50 or over.
• People with chronic lung or heart disorders, including children with asthma.
• Adults and children who, during the preceding year, needed regular medical care or hospitalization for a chronic disease: diabetes, kidney disorders, sickle-cell disease, or suppressed immune systems (including HIV/AIDS).
• Children and teenagers 6 months to 18 years who are on long-term aspirin therapy.
• People who live with or care for a person at high risk. A flu shot takes about two weeks to provide protection and lasts about six months. But the injection does not provide full immunity in all cases. It’s about 90 percent effective in young healthy people, and 70 percent effective in elderly, high-risk people—for the strains of influenza included in the vaccine. If an unexpected strain of flu pops up during the flu season, the vaccine may not work at all.
Generally, October is the best time for a flu shot, but any time between September and February is better than not at all. Travelers abroad, however, should consider a flu shot whatever the month. They may risk exposure to the virus at any time of year.
CAN YOU TOLERATE A FLU SHOT?
Question: You say that “anyone who can tolerate a flu shot” should consider getting one. Exactly who can’t tolerate a flu shot?
Answer: People allergic to eggs, which are used to make the influenza vaccine, should not receive the shot. And people with an acute illness, such as a respiratory, gastrointestinal, or urinary-tract infection, should wait until they recover. Pregnant women should delay a flu shot until after the first trimester, unless they are at high risk.
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