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Last year I was diagnosed with a hernia near the navel. My GP referred me to a specialist who refused to operate because I have a gap from my navel to my chest caused by exercising too early after having children. I was advised to contact my GP if I heard gurgling noises. Is the gap dangerous?

Carol Ratcliffe, Derbyshire.

A hernia occurs when an organ pushes through the muscle that contains it – in your case, something in your abdomen comes through a gap in the abdominal wall.

It sounds like the gap between the rectus abdominis is on either side of the abdomen. Stretching during pregnancy and also if you are overweight can open a gap. This is known as the divariation of the rectus.

That little lump you say you found last year is the result of abdominal contents – likely a loop of intestine or part of the web called a fat membrane – seeping through the space.

It sounds like the gap between the rectus abdominis is on either side of the abdomen

This type of hernia is usually painless, and the bulge often flattens out when the abdominal muscles relax – for example, when you lie down. In some cases, however, the knot does not flatten – this is known as an entrained hernia and it appears to be what you are describing.

Occasionally, these hernias can twist and cut their own blood supply. When a loop of intestine is trapped, it blocks the intestine, causing acute pain and loud bowel noises. This requires quick surgical treatment, which is why you need to watch out for gurgling noises.

I think it is likely that you will need to repair this hernia as it sounds like it is incarcerated. Talk to your GP to see if another referral for surgery is advisable.

I’m 78 and I can’t remember a day that I didn’t have a headache. I have been prescribed numerous medications and had a brain scan which was fine. My GP found that I have migraines.

Rosemary Dining, Worthing, W. Sussex.

Chronic migraines – defined as moderate to severe migraines for at least 15 days a month – is debilitating.

The condition is common in people who have had the occasional migraines earlier in life.

Rare migraines can occur due to factors such as genetics, a history of head injuries, significant stress (e.g.

Many people also suffer from nausea, sleep disorders and an aversion to light, sounds or smells.

You say in your lengthy letter that your doctor tried common preventive medications such as pain relievers, antidepressants, and anti-inflammatory drugs that frustratingly didn’t work.

Rare migraines can occur due to factors such as genetics, a history of head injuries, significant stress (e.g.

Treatment usually focuses on prevention – not least because taking pain relievers for ten to 15 days a month or more can cause drug overuse headaches. You will have tried different drugs for two to three months at a time.

There are many first-line drugs, such as the beta blocker propranolol – which is believed to stabilize blood vessels in the brain so they’re less likely to overstretch – and topiramate, an anticonvulsant that can reduce the activity of nerve cells in the brain-related with migraines. There is also the antidepressant amitriptyline, which increases levels of the pain-regulating brain chemical serotonin.

I suggest talking to your GP to see a neurologist who specializes in migraines. They will be able to arrange second line treatments for you.

These include botulinum toxin injections and anti-CGRP injections, which block chemicals responsible for pain signals, as well as other antidepressants.

The neurologist may also suggest cognitive behavior therapy to control your response to migraines and hopefully reduce its effects.

And it’s worth considering over-the-counter supplements like riboflavin (vitamin B2) and coenzyme Q10. Both have been shown to reduce the frequency and severity of migraine headaches.

Email to Dr. Scurr on [email protected] Dr. Scurr cannot conduct personal correspondence. Answers should be given in a general context: if you have any health problems, contact your GP.

From my point of view: Personal family doctor visits save lives

As the mail pointed out, the migration of personal consultations in connection with too few general practitioners can be risky, especially for elderly and vulnerable patients.

I am thinking of my mother, a frail 92-year-old with type 2 diabetes. They should have regular blood tests and exams to check for peripheral neuropathy, some type of nerve damage, and other diabetes complications.

But for a recent blood test, she was told to go unaccompanied for Covid to a hospital nine miles from her home. How is she supposed to move around the huge building unaided while using a walker? The circumstances were similar for her eye check. Many in their position just wouldn’t leave.

A new study found that 11 percent of type 2 diabetics also had depression, which more than doubled their risk of heart, brain, kidney, and nervous system damage.

Therefore, it is important for GPs to see patients to be screened for depressive illness as part of their regular treatment – but this is even less likely now as we are moving away from in-person GP care.