No need to rush surgery for some

Dear Dr. Roach: I developed visible fat between my naval and my rib cage. My doctor told me that it’s a ventral hernia. I was told surgery is an option but not necessary. I am a female, 75 years old. Should I be concerned? — A.M.

If your doctor is right, you probably have an epigastric hernia, a defect in the abdominal wall. These are more common in men, and are usually small, about 1 cm or so.

Under abdominal pressure, the abdominal contents can poke through the abdominal wall defect. Most often, these do not require surgical correction unless they are symptomatic. At age 75, I wouldn’t be in a rush to get elective surgery unless it’s for a good reason.

There is one other possible condition. It’s called diastasis recti, which isn’t actually a hernia, but might be what your doctor meant. This is a wide separation of the two rectus abdominus muscles.

Dear Dr. Roach: I was gardening when I acquired white blotches on my skin. It seems permanent. It took the pigment over lots of areas on my hands and arms. I am very upset about this. I normally tan nicely. I am elderly. Is there anything I can do? — M.H.

Although an exam would be necessary to confirm, my guess is that you are describing vitiligo. It is unusual, but not impossible to develop at older ages.

The cause for vitiligo is not 100% known, but most experts feel it is probably caused by the immune system attacking melanin-producing cells.

There is no cure for vitiligo. Treatments are moderately effective at regaining some or most of the normal skin color. Topical steroids and phototherapy are probably the most commonly tried.

There are other causes of loss of skin pigment, including some gardening chemicals.

A dermatologist is the best source to discuss the likely cause and treatment.