Hiatal hernia allows organs into chest

Dear Dr. Roach: My father was recently diagnosed with a type 4 hiatal hernia. His doctor said that 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.

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, your father 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?

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.