Friday, July 7, 2017

#14 A Sacrifice to the Goddess Hernia

Hello readers! I have had the worst writer's block. I have tried every literary laxative in the book (legal ones, that is), and still, I strain to write. But, here is a new one at last.

Dear Dr. Tumoriffic,

I have something bulging in my groin that I can't push back in. Should I come to see you right away, go the emergency room, wait until after my vacation to Newark?

Mr. Bulgepants

Dear Mr. Bulgepants,

Quick answer:
If your hernia is painful, or if it is difficult to push back in, you need to see your primary care doctor or a surgeon right away. If you cannot push it back in, go to the emergency room.

Long answer:
It really depends on what that bulge is. This is a family-friendly blog, so there are some kinds of groin bulge I simply refuse to discuss. However, I will assume that is not where you're going with this. In that case, it sounds like a hernia.

Hernias are one of the oldest diagnosable health conditions. They were known to doctors as far back as ancient Egypt. Hippocrates bestowed the name 'hernia' on the condition in honor of the goddess Hernia, who was the goddess of buds or shoots. Unlike Athena, who burst forth wholly formed from Zeus' head (in the mother of all hangovers), Hernia burst forth from Zeus' left groin during a weight-lifting contest with Atlas.*

A hernia is the extrusion of one part of the body through the tissue containing it. The ones we usually talk about involve the intestines pushing through fascia, the leathery tissue that wraps nearly all of the body and keeps what belongs inside inside. Hernias are extremely common, affecting nearly a quarter of all men at some point over their lifetimes and about 3% of women.

Examples of these kinds of hernia include the ventral (front) hernia, in which the abdominal fascia splits down the middle, and the intestines bulge out, creating a tall, narrow bump in from the middle of the abdomen. Many older men have these, and you can see them if you look for them at the beach. These are usually harmless, though disfiguring.

Another common one is the unmbilical hernia, in which the little weakness of the fascia created by the belly button expands to let out a bump of gut.

Finally, there is the inguinal hernia. Inguinal hernias form because of original sin. Specifically, during fetal development, the testicle must migrate from outside of the abdomen so that it can travel upwards to form most of the male brain. Wait. There is something wrong about that. What I meant is that the gonads are formed in the abdominal cavity.** If the fetus is male, if all goes normally, the gonads migrate out of the abdominal cavity and into the scrotum through a tube of fascia about 4 inches long called the inguinal canal.***

An increase in abdominal pressure from, for instance, trying to lift something heavy like a planet, may push the bowels through the opening of the inguinal canal and even into the scrotum, leading some men to become inappropriately proud of their new anatomy.****

Hernias can be harmless. If it doesn't hurt, and you can easily push the herniated tissue back where it belongs. It can be something to do if you're bored. Some people get them repaired at this stage. That's perfectly reasonable, but usually not necessary.

However, if the herniated tissue becomes stuck (the technical term is 'incarcerated'), it's an emergency. The blood supply to the tissue may be blocked, and the tissue will die very quickly.  The gut is filled with bacteria that are usually quite friendly, but if a piece of gut dies, those bacteria escape into the rest of your body, and you can die in hours.

A hernia can usually be repaired with a very quick procedure. Depending on the type of procedure, patients can often go home within 6-24 hours. They usually can return to light exercise in 1-21 days but have to refrain from heavy exercise (like wrestling a minotaur) for 2-6 weeks.

So, to repeat:
If your hernia is painful, or if it is difficult to push back in, you need to see your primary care doctor or a surgeon right away. If you cannot push it back in, go to the emergency room.

Be well,

Dr. Tumoriffic

PS: Bonus questions:
1.What should you do if you have a hernia that is painful or is difficult to push back in?
2. What should you do if you have a hernia that you cannot push back in?
3. What color is an orange? -Groucho Marx

* Some of the preceding paragraph is actually true.

* Never let your dentist fill your abdominal cavity.

* The inguinal canal is named for the canal that runs through the isthmus of Corinth.  Ancient Greeks who didn't like Corinth referred to the Canal of Corinth as the Inguinal Canal.

* There is an old tale handed down through the generations of doctors in my family. A patient had come into the emergency room with an inguinal hernia so bad that it looked like he had enormous testicles. He was so proud, he wanted to show it to everyone.

This dog is content.

No comments:

Post a Comment