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16: Hernias

Sep 10, 2019

That weird lump you found when you were in the shower? Don’t panic. It may be a hernia. Surgeon Dr. Rodney Barker explains why hernias are not that big of a deal but do need surgery. Scot is shocked to learn ER docs don’t know everything, while ER doc Troy learns he may be wrong about the Apple Watch.

Episode Transcript

This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

A Surgeon's Turning Point

Dr. Rodney Barker lives an active life, getting outdoors and hiking with his wife whenever he can, but it wasn't always that way. This surgeon had his own turning point story that came when he first started practicing medicine.

Dr. Barker had been in practice for about 5 years when he had his wake up call. Like many men as they get further along in their career, he began to get very busy. He wasn't working out or eating quite as well as he used to. He had put on some fat and had lost some muscle. He was feeling not as good as he used to.

As a surgeon, Dr. Barker does a lot of standing in his job. As he stopped working out, he soon found himself having trouble staying on his feet all day. He would come home after a day of surgery and feel worn out and sore. He'd lie on the couch in front of the TV until he fell asleep, just to find himself getting up and doing it all over again. He was in a cycle that was significantly impacting his health.

Dr. Barker woke up one of these mornings, took a hard look at himself in the mirror and decided he needed to make a change.

He gets outside whenever he can and tries to work up a sweat at least once a day for 30 minutes. This new focus on his daily activity level has lead to looking better, feeling better, and is helping him stay able-bodied enough to do what he loves as he ages.

Remember, 30 minutes of activity a day can lead to immense health benefits for anyone. "That's all it takes," Barker agrees. You don't need to spend two hours in the gym every day to be fit.

What Is A Hernia?

A hernia is a defect in the muscle layer of the abdominal wall that causes the muscle lining to be thinner than usual. Eventually, that muscle wall weakness may form into a hole that allows organs and tissue inside the abdominal wall to poke out into places they shouldn't be.

Hernias can form anywhere along the abdominal wall, typically from the belly button down. A majority of cases are inguinal hernias that form at the very bottom of the abdomen, leading to a lump in the groin area.

The media will often portray a hernia being caused by someone lifting something heavy, then feeling a pop. That's not quite true. Hernias are caused by many factors. Remember, the hernia itself is a weak spot caused by your genetics. The contents of your abdomen can move through the hole by many means. The act of lifting something heavy, coughing or sneezing, or just going about your daily activities can cause the hernia to form. Some people have a hernia present at birth and don't even realize it until they're older and their muscle tissues begin to weaken.

You Don't Need to Rush to the ER if You Find a Hernia

Troy will often have patients rushing into the ER when they discover a hernia. Patients will feel bump, get scared, and think it's an emergency.

Hernias do not typically a medical crisis. Unless the hernia is incarcerated - meaning the bowel is stuck in the hernia and kinked - there is no need to go to the ER. Incarceration is not subtle. People with an incarcerated hernia they will suffer extremely painful cramping and vomiting. You will know if you need immediate medical attention.

Hernias Will Not Go Away On Their Own

You may have heard that hernias happen when a person is moving something and they hear a pop. While some patients do experience something along those lines, it's not the most common way people find a hernia.

A majority of people will first find their hernia while in the shower. A patient will be washing themselves when they feel a bump that wasn't there before. THe bump may go away when they lie down, then come back when they stand up.

While a hernia is not a condition that requires immediate medical attention, a hernia will never go away on its own. A hernia will need to be treated with surgery, but not immediately. A lot of hernias are asymptomatic, meaning there is no pain or other complications. It's just an annoying lump. These types of hernias can be monitored for a long time before surgical intervention. Dr. Barker has had patients that lived with hernias for ten years before seeking treatment.

When any hernia becomes symptomatic, it will need surgery.

What to Expect with a Hernia Surgery

Hernia surgery is a very simple procedure with a great success rate. Barker does most hernia surgeries laparoscopically, using small tools through a small incision in the stomach..

The procedure itself starts with three small little incisions under the abdominal muscle layer. Dr. Barker will then separate the muscle layers without making any cuts. He then puts the displaced tissue back through the hernia, into the abdomen where it belongs. Finally he places a patch of surgical mesh over the hole to prevent anything from coming back through.

Most of Dr. Barker's patients will be able to go home the same day as the procedure. The recovery is relatively quick, with most people back to their regular activity within ten days to two weeks. In fact, some of Barker's patient heal up even faster. He has run into some of his patients on the slopes skiing less than a week after he's repaired their hernias.

How Can a Person Prevent a Hernia?

Hernias are congenital. People are born with the likelihood of a weak abdominal wall and the potential for a hole to form. But is there anything a person can do to prevent them?

Dr. Barker says that hernias happen to everyone, but anecdotally, he has found that people that stay physically fit are less likely to form hernias. He emphasizes that there is no hard data to back that up, but with his long career of treating hernias he is confident in shape people are less likely to form them. A majority of hernia patients are getting older and forming hernias as they age.

A common misconception is that weightlifters are likely to form a hernia as they strain to lift heavy in the gym. Dr. Barker says this isn't the case. Lifting heavy objects doesn't cause hernias.

Additionally, a hernia is not a reason to stop exercising. Exercise will not make the hernia any worse. As long as the hernia isn't causing any pain or interfering with your daily activity, you can carry on with your life as normal. However, if you do experience any pain at any time with your hernia, you should seek treatment.

Hernia Trusses, Belts, and Briefs: Do they Actually Work?

A hernia truss is a supportive undergarment that tries to keep the protruding tissue in place and relieve discomfort from a hernia. These devices can also be called hernia belts or briefs. If you have a hernia, should you consider using one of these devices?

Trusses were very common just a few decades ago. They could be bought at any drugstore to help men with hernias. Back then, hernia surgery was not as effective or simple as it is today, so patients would turn to whatever relief they could find.

Trusses do not treat the hernia. Only surgery can actually fix the condition. These devices do little more than hold the hernia in place. While these trusses may help some patients with asymptomatic hernias, the only solution available is surgery.

Is Surgical Mesh Safe?

If you've recently stayed up late watching cable TV, you've probably seen an ad about patients experiencing complications from the surgical mesh used during hernia surgery and class action lawsuits against the mesh manufacturers. These ads can raise some serious concerns and may lead patients worry about the safety of using mesh during their hernia surgery.

Dr. Barker uses surgical mesh in his operations and vouches for the mesh's effectiveness. Surgical mesh significantly reduces the chance of the hernia reforming after surgery. According to Barker, there is no research based evidence that modern surgical mesh used in hernia surgery causes post-surgical complications.

Dr. Barker has been treating hernias since before mesh was regularly. He has found that the very low occurrence of patients suffering from chronic pain after surgery is the same now as it was back when hernias were treated without mesh.

If you find an unusual bump in the shower and believe it's a hernia, go get it looked at by a professional. Your physician should be able to diagnose what that lump is and prescribe what your next steps in treatment should be.

Just Going to Leave This Here

On this episode's Just Going to Leave This Here, Scot learns that ER doctors will actually call poison control themselves, The first thing you should do is call poison control. And Troy second guesses himself after learning that an Apple Watch saved a man's life after it sensed a total heart block. On a previous episode he was concerned about the frequent false positives from the device.

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