8 THE STRAITS TIMES NOVEMBER 6 2014

Q I am a 58-year-old man. Forthe past four years, I havehad a hernia on the left sideof my body.

Once in a while, I feel pain but itgoes away after a while.

It bulges out above my groin anddisappears whenever I lie down.

I have diabetes and high bloodpressure. In 2007, I had a heartbypass. I am now under medication.At the moment, my health issuesare under control.

I have seen the specialist threetimes and he has advised me toleave the hernia as it is, given thatit is not giving me any seriousproblems.

But a doctor friend told me thatit has to be operated on.

My concern is how the hernia willaffect me if I were to have theoperation now rather than later.

A A hernia is an abnormalprotrusion or bulge ofabdominal cavity fat. It ariseswhen there is a weakness or

thinning of abdominal wall muscles.Common “weak points” are

around the umbilicus (belly button)and the inguinal (groin) area in men,where the spermatic cord andtesticular blood vessels exit theabdominal wall (deep inguinal ring atthe inguinal canal) and connect tothe testes.

Hernias can occur at birth due tocongenital defects, when the bellybutton or the deep inguinal ring failto close properly.

Most hernias, however, occur laterin life as a result of increasedabdominal pressure that pushes theabdominal content through weakpoints.

Increased abdominal pressure canbe triggered by coughing, strainingduring chronic constipation and whenone has difficulty urinating and afterprolonged strenuous physicalactivities. It can also stem from jobsthat involve certain types of physicalexertion.

Hernias also commonly develop inelderly people, as their muscles areweaker and thinner due to ageing.

WHEN IS SURGERY NEEDED?There are two types of groin hernias– the inguinal and femoral.

An inguinal hernia is moreprevalent among men; a femoralhernia, on the other hand, usuallyoccurs in women.

The most common symptom of ahernia is a groin lump.

It is usually associated withdiscomfort or pain and will growbigger as the condition progresses.

Initially, the hernia will appearwhen one stands or strains, anddisappears upon lying down, just likewhat you are experiencing now.

Subsequently, there may come atime when the lump does notdisappear even when you are lyingdown.

If this is left untreated, the herniacan obstruct the bowels, causingdifficulties in bowel movements.

In serious cases, it can evencompromise the blood supply to thebowels. When this happens, thepatient’s life will be at risk and hewill need to undergo surgery.

Such an operation typicallyinvolves reducing the hernia contentback into the abdominal cavity.

In addition, a synthetic mesh willbe used to support the weakenedabdominal muscle to prevent thehernia from cropping up again.

The procedure can be performedeither through the conventional openmethod or the laparoscopic method,which is minimally invasive.

WATCHFUL WAITINGHowever, not all hernias progress tothe later, more serious stage.

Scientific trials have shown thatthe risk of a hernia progressing to alater stage was 16 per cent after oneyear, 54 per cent at the five-yearmark and 72 per cent after71/2 years.

According to guidelines from theEuropean Hernia Society on treatingadult inguinal hernias, watchfulwaiting is deemed a safe andacceptable option for men whosehernias exhibit minimal or nosymptoms – especially for older menand those who have other healthissues, such as heart problems,kidney failure or liver impairment.

Another non-surgical option is toget an inguinal truss. This is a verytight-fitting garment with paddingover the site of the hernia.

It works by pushing the herniaback into the abdominal cavity. Thehernia will reappear when you takeoff the truss. The garment may beuncomfortable especially in a hotand humid climate like Singapore’s.

All in all, the doctors whom youhave consulted were correct inoffering solid scientific andevidence-based medical advice.

What I would further recommendis for you to get a cardiologist’sassessment of your cardiac risk forundergoing such an operation.

If your risk is low or moderate, youcan either opt for close observationor surgery. But if your cardiac risk isvery high, then close observationwould be recommended.

DR CHAN WENGHOONG,senior consultant,upper gastrointestinaland bariatric surgery,Singapore GeneralHospital

Q I am a 71-year-old woman. When I wakeup in the middle of the night or in themorning, there is a banging noise in myhead.

It sounds like someone is hammering a nail ata constant rhythm. I also hear a snapping soundin my head when I turn my head sharply whiledoing a golf swing.

I was seen by a doctor at a neurosciencedepartment for a facial twitch. The last visit wasseven months ago. He ordered a magneticresonance imaging (MRI) scan. I was dischargedwithout a review of the MRI.

Please advise.

A The noise that you have described could bepulsatile tinnitus which is the perception ofsound when there is actually none present.It could take the form of ringing, clicking,

banging or a multitude of different sounds. When itoccurs in a regular rhythm, it is called pulsatiletinnitus.

There are many causes of tinnitus, includinghearing loss, ear infections, atheroscleroticvessels, intracranial hypertension and tumours.

You also appear to have some facial twitchingwhich is known as a hemifacial spasm.

When you couple both symptoms together, itsuggests some form of neurovascularcompression syndrome.

There are many vessels in the brain and whenthey press on some of the nerves that exit thebrain, the person can experience symptomsassociated to that particular nerve that is beingcompressed.

An example is trigeminal neuralgia, where thetrigeminal nerve (cranial nerve V) is usuallycompressed by the superior cerebellar artery.

This causes a severe pain through thedistribution of the nerve.

Similarly, in your case, the nerves involvedwould likely be the facial and auditory nerves.These two nerves exit the brain and enter the skullin the same areas, and run side by side.

The facial nerve is a motor nerve, controlling themuscles in the face. When it is irritated, it wouldresult in the twitching or spasms you haveexperienced.

And the auditory nerve, if affected, would causea person to suffer from tinnitus or imbalance.

‘CRACKING’ OF SPINEThe snapping sound that you hear when you turnyour head quickly is possibly due to the cervicalspine. It is similar to the cracking of knuckle joints– except that it is happening in the cervical spine.

It is fairly benign and there is no definitiveevidence that excessive cracking of your jointscauses an earlier onset of arthritis.

It is important for you to get a proper diagnosis.

In this respect, an MRI scan of the brain isprobably the safest choice.

You would need to include an MRI angiogram tochart the path of your vessels better. You couldrequest for an MRI of the cervical spine too.

Such tests allow doctors to exclude moresinister causes, such as a tumour or vascularmalformation.

Lastly, you do need a review after your MRI.Request for your previous MRI to be given to youon films or saved in a CD, so that you can show itto a specialist neurosurgeon who I suggest thatyou consult.

DR ROY KOH,consultant neurosurgeon at FeMSurgery @ Alvernia

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Banging noise and snapping sound in her head

I’ve been working mybutt off all my life.

I need to reshape my butt.

Why?

I need to reshape my butt.

butt off all my life.