Cancer Articles (Dr. S.N White)

During the first four to six weeks you should direct attention toward avoiding those activities that can increase intra-abdominal pressure and put excessive strain on the abdominal wall. Thus, take cathartics to avoid constipation and straining with bowel movements. Don't lift heavy objects. To avoid coughing, stop smoking; a coughsuppressing medicine is helpful. Get plenty of rest. You can walk to the movies, be driven about, go visiting and do many other things. You can go on vacation provided you observe these elementary precautions. Relax and enjoy the convalescent period. What kind of anesthesia is used? You can make your choice about this if you have any preference. One method is an initial injection into a vein which will put you to sleep in a few seconds. In certain patients the procedure may be undertaken by deadening the area of incision and operating under local anesthesia.

How often does the hernia come back after it has been fixed? It is not possible to answer that question accurately. It depends on the type of hernia, the condition of the patient generally; and his tissues in particular. The experience of the surgeon also is obviously a factor. In adults, hernias that require only a correction at the ring (so-called indirect hernias) recur in fewer than one instance in ten. However, where the whole base of the area has to be rebuilt (so-called direct inguinal hernias), the long-term recurrence rate can be on the order of two in ten. Can you prevent the hernia from coming back by use of plastic materials for reinforcement? Can you promise that I'll be cured? Plastic materials are sometimes necessary and can help in the recurrent or long-neglected situation. They are required only in about one in one hundred groin hernias. Even in these instances most surgeons prefer to take reinforcing tissue from the patient's thigh rather than to put in...

Only if it is in your best interest. If these hernias are small or of the easily managed type that require only the correction of the ring (inner door), then it is advisable to do both sides. Obviously, if the hernia is large and requires the rebuilding of an entire new wall, one side should not be pulling against the other. One approach is to repair the apparently more complicated hernia first and decide from that. It is not possible to answer this question in advance. If both sides cannot be repaired at the same time, then the other side can generally be operated on seven or eight days later.

This method is rarely used today. It was seldom effective, even though many nonsurgical advocates made great claims for it. Injection treatment was occasionally accompanied by severe and prolonged complications. In my opinion this method has no place in the modern treatment of hernias.  Is there any danger in keeping the hernia aside from that of the intestine getting caught? Can it make me sterile or impotent?  Some hernias grow so large that they start to contain a major part of the intestine or some other organ, and it is then difficult, impossible, or inadvisable to fix them. I've seen men with huge hernias, down to their knees, so large that they could barely walk. Edward Gibbon, the historian, was said to have been virtually riveted to his chair by his large scrotal swelling. No wonder he could write three volumes on the Decline and Fall of the Roman Empire. Other patients with these large hernias become recluses. The hernia of itself does not limit sexual potency o...

In surgery nothing is always or all the time or never. In general, if the hernia produces symptoms or extends into the scrotum, it should be repaired provided the patient is in good condition and has no chronic cough or significant prostatic problem. There are some almost "alls" in this regard. All groin hernias of infancy and childhood should be repaired, and all acute hernial complications should be corrected by surgery. Surgeons generally do not advise hernia repair in the senile, the uncooperative, those with a short life expectancy or those in whom the repair is very likely to be technically impossible or ineffectual. If all people with hernias were operated on, there would be room for little else in the hospital. Certain individuals are willing to bear the inconvenience and potential complications of this correctable problem because they are uninformed, detached, or have the attitude that "I'll wait until it really bothers me." A few individuals with ...

Trusses don't cure hernial protrusions. They do not prevent the hernia from growing. In some instances they cannot effectively prevent the intestine from escaping into the scrotum. A truss can sometimes restrain the bulge of the small "popeye" hernia. But the compression pad can bruise the skin and start an infection in the hair roots. The physician does not ordinarily advise the use of a permanent truss. It often gives the patient a false sense of security. Many patients abandon them after a short time because they don't relieve the pain or restrain the protrusion.

What happens if you don't get a hernia fixed A hernia does not stay confined. With time all hernias increase in size, the bulge becomes more prominent, and symptoms may become worse. Of greater significance is the fact that the content of certain hernias may not be able to be pushed back and the intestine becomes obstructed; this is the acute incarcerated (meaning imprisoned) hernia. Even worse, the intestine may be so pinched off that its blood can no longer circulate and it becomes gangrenous i.e., it dies (called a strangulated hernia for obvious reasons). These last two complications require emergency surgery with a risk far greater than that of the uncomplicated hernia.

Ordinarily all major types of hospital surgical insurance cover the expense entailed in hospitalization for hernia repair. A general insurance company will make an effort to avoid picking up the bill for a compensable hernia that should rightly be assumed by the company responsible for on the job accidents. If a man at work lifts something and experiences groin pain and evidences a hernia that was not present before, it is reasonable to assume that there is a cause and effect relation between the hernia and the job. In such a case the employer's insurance company can be petitioned to assume the expense for the correction of this injury. This contrasts with the sedentary worker who is not aware of an on-thejob incident. In this case his own regular hospital insurance company assumes part of or all the financial responsibility. Most hospital admitting clerks are aware of this and will often ask whether it is possibly a compensation case. Know the answers in advance and express the...

Each side of the lower (groin) end of the abdomen has a potential opening. Each opening can be likened to a double set of doors. The inner door is the internal ring and the outer door is the external ring. Normally the external ring is the size of the examiner's fingertip. When its walls are stretched or lax, it is referred to as a dilated or wide ring. This is of no importance unless abdominal contents go through it in which case there is a true hernia. Presumably a wide ring means that one day it may permit a hernia to occur. There are a lot of "ifs," "maybes" and "we don't know whens" about it. A wide ring requires no treatment and no concern. If you have no symptoms, forget it and have the area examined again if it becomes painful or swollen.

It is a hernia because the bulge increases in size when you strain and it hits against the examining finger when you cough. You yourself can hear a gurgle in the intestine as the lump is pushed back. Note also that it completely disappears when you lie down. The hernia can fall back into the abdomen and may not be obvious ("reduced" is the medical term) especially during the night when you lie down. Some small hernias become apparent only after a day's work, walking or straining, or jumping up and down and exercising. Hernias which have been present for a long time may remain in the scrotum and may not fall back so readily. Many patients learn to manipulate the hernia back with all sorts of hokus-pokus hand movements and contortions of the thighs. But this method accomplishes its purposes. Don't criticize it! However it can be an uncomfortable way to get along. The diagnosis of a groin hernia is usually easy. As a matter of fact, the patient usually makes it himse...