Archive for August 2016

Hernias

About two weeks ago I’m on one end of my mother’s piano trying to horse it up the ramp into the moving truck.  First my back starts to feel not so good.  Then I notice down near my groin isn’t feeling just right either.  I figured I’d just strained something a little.  But now it’s not going away.  When I walk or lift or cough or even stand for a while it starts talking to me down there.  And I think it’s a little swollen or something.

A hernia is the protrusion of an organ through the wall of the cavity that normally contains it. In the case of an inguinal hernia, which this man had, a loop of intestine pushes from the lower abdomen down toward the groin (toward the scrotum in males).

Any young man who has been involved in school sports and has had a sports physical is aware of the “turn your head and cough hard” part of the exam where the doctor checks for an inguinal hernia.  Usually the symptoms are either a bulge along one side of the groin or pain in that same area, or both.  Inguinal hernias make up over 75% of all abdominal hernias and they are almost 10 times more common in males than females.  The rest of abdominal hernias are made up of umbilical hernias (a hernia at the belly button), femoral hernias (slightly lower than the inguinal hernias and almost exclusively found in females), incisional hernias (at the site of past surgeries), and a small number of other less common hernias.

Inguinal hernias are sometimes found at birth and are particularly common in premature babies.  Overall, they occur in about 4% of babies, while umbilical hernias occur in about 17% of newborns.  Inguinal hernias in babies need to be repaired to avoid the 10-20% chance of strangulation – a complication in which the blood supply to the loop of intestine contained in the hernia is cut off causing that part of the intestine to die if surgery is not done right away.

Umbilical hernias in newborns have a more benign outcome with the vast majority closing before age 3 to 5.  If they do not close by this age they can be surgically repaired.

In adults the picture is a little different.  Risk factors for hernias in adults include heavy lifting, overweight and obesity, straining at bowel movements, and chronic cough.  If a new bulge or pain occurs in the groin or abdomen, a physical exam by a doctor can usually diagnose whether a hernia has occurred.  Rarely, imaging is called on to verify or rule out a hernia.

The chance of strangulation is lower in adults.  For this reason, if a hernia is painless some adults choose to take a wait and see approach rather than get surgery right away.  Of course the hernia won’t ever go away without surgery; exercises and trusses and supports don’t repair the defect.

If surgical repair is decided on, the surgeon can give the pros and cons of an open repair vs. laparoscopic (where a scope is used, allowing for smaller incisions and a quicker recovery).  Although it varies, one can usually count on 4-6 weeks of avoiding vigorous physical activity after an open repair, and perhaps half of this time if laparoscopic repair is done.  The surgery itself is usually a day surgery except in complicated cases.

One last common, but somewhat different, hernia is a hiatal hernia.  These can’t be seen from the outside but usually are noticed on an upper GI study or occasionally on an x-ray. A hiatal hernia is where a portion of the stomach pushes up through the diaphragm, usually at the opening through which the esophagus passes.  They are very common occurring in over 60% of individuals over 50 years old.  Ninety percent of them give no real symptoms but about 10% give some increased heartburn, indigestion or upper abdominal discomfort.  If these symptoms occur, an acid blocker such as Prilosec or others is usually helpful.  Very rarely a surgical repair is carried out for an unusually symptomatic case.

But back to the common groin hernias, if you have a tell-tale ache or bulge, you know the drill: see your doc, turn your head and cough.

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Lessons Learned in Haiti

Does anyone have any questions?” I am standing inside an 8 foot by 8 foot corrugated metal shack with a fabric roof in Port-au-Prince, Haiti.  It is stiflingly hot with not a breath of wind.  It’s hard to imagine spending a half hour sweating inside this metal box let alone living there.  But it is the home of a single mom who is resolutely raising her daughter with a little help from her church (whose pastor has asked whether we have any questions) which is in turn helped a bit by an American church.  But there is no mistaking that if there is a hero in this little room it is this uncomplaining resilient mom.

Unable to think of what to ask I just inquire whether the fabric roof keeps off the rain when it comes.  Through the interpreter, the mom responds with soft strength, “We do fine when it rains; we are OK.”  And she smiles with her arm around her daughter’s shoulder.  Honestly my gut instinct is to bow at her feet, to somehow honor her.  Instead I merely tell her it was so very good to meet her, and head back to our vehicle.

Over the next two days we see several hundred Haitian children and adults for a range of medical problems.  Most of them are caused by their environment: parasites from contaminated food and water, anemia and nutritional problems, neck and back problems from the loads carried on their heads, eye irritation from the dust and headaches from the heat.  We give medicines to treat the parasites, knowing that they will be re-infected by the same food and water in a matter of days.  But at least we can knock back the body’s burden of parasites temporarily and allow them to rebound a bit nutritionally.

The chronic problems like diabetes and high blood pressure cannot be adequately addressed.  The numerous blood pressures in the 200’s over 120’s or 130’s that would punch a ticket to the ER in the states, can only be given a short supply of BP meds with the advice to be sure and see another doctor before they run out.  But the odds are hundreds to one against that happening.  There is no access and no money for such things.

And so we put the equivalent of band aids on gaping wounds because it’s all we have, and hope that the brief attention given them brings some bit of comfort.  They are amazingly grateful.  The rest of the team prays with them, gives the children balloon animals that light up their faces and generally tries to minister and encourage.  In the end we hope we have left some small drops of blessing in this ocean of need.

What have we taken back?  A conviction that we need to complain far less and give thanks far more.  We also understand that we cannot fix the whole of Haiti, or even this little section of Port-au-Prince.  Yet, through this church in Haiti that ministers to and knows these families, we, as representatives of our church can minister to twenty orphans and vulnerable children.  They are given help to attend school, eat a good lunch, live within a family setting, and get to know the God in whom they find ultimate hope.  The group facilitating these church to church connections is World Orphans, a ministry that has earned its stripes over many years and has become wise in a type of helping that really helps. This steady life-on-life help and attention over many years, given by those who know and love these children best is where there is hope for at least some in Haiti.

In all this I am reminded of the quote by Edward Everett Hale, “I am only one, but I am one. I cannot do everything, but I can do something. And because I cannot do everything, I will not refuse to do the something that I can do.”  We got to do something for a short time in Haiti.  A Haitian mom, uncomplaining in her small metal shack, continues to do those things she can do every day to see her daughter grow up strong.  In my mind I still bow at her feet.

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