Bill Klaproth (Host): This is Columbus Community Hospital HealthCast. I'm Bill Klaproth. In this episode, we talk with Dr. Jacob Oran, general surgeon at Columbus Community Hospital, as we talk about common abdominal problems and how they're treated today. We're going to go over hernia repair and minimally invasive options, gallbladder disease and gallstones, colon health and colorectal cancer screening, appendicitis, and abdominal pain evaluation. We'll also briefly cover reflux or GERD and the surgical treatment options that can help people feel better and get back to their lives. Dr. Oran, welcome.

Jacob Oran, MD: Thanks for having me, Bill. Glad to be here.

Host: Great to talk with you today. So, let's start with this, Dr. Oran. What are the most common abdominal problems you see in the clinic and ER? Things like hernias, gallbladder attacks, appendicitis, colon issues, maybe even reflux. How serious are those things really?

Jacob Oran, MD: Yeah. So, each one's going to have its own level of severity depending upon how old the person is and how long it's been going on. As far as acuity, meaning, you know, how quickly do you need to act on these things, typically, we'll put appendicitis high on that list. Hernias can be if there's an intestinal blockage. Those are going to be high on that list. And then, gallbladders are a close second. Now, anything, reflux or, you know, let's just say like stomach ulcer related, that's going to typically be a little bit lower. It depends on if that person has a bleeding ulcer, and that could fall into that abdominal pain acid category. And it really just depends on, again, age. But some of these things can progress to sepsis, and that's why appendicitis gets higher up on that list.

Host: Yeah. That's definitely something we don't want. So, let's touch on hernia just a little bit more. What are the warning signs that a bulge in the groin or belly button has become urgent or dangerous? And what happens if someone keeps putting it off?

Jacob Oran, MD: You were spot on with the belly button or the groin. And so, if there is a bulge that is new, and it's really firm and tender to the touch, or maybe the skin color over the top of it has changed, typically, that person's also going to be feeling ill. That's an emergency. Otherwise, if that bulge has been there a long time and it's just soft and squishy, maybe some intermittent twinges of pain or, you know, some people will kind of mess with these things, because of the feel of it. And that's just going to be more of an elective thing. So, definitely, changes in the pain characteristics, how firm it is, and the skin color in that area, and an overall feeling of, you know, just not feeling well or even nausea. Those are going to be concerning signs for some type of intestinal problem.

Host: Well, that's really interesting. You mentioned if it's new, firm, tender to the touch, color discoloration, that's kind of a warning sign right there. So, that is really good to know. So when someone comes in with abdominal pain, what are the main steps you take to figure out whether it's a hernia problem, gallbladder disease, appendicitis, maybe a colon issue, maybe even reflux? How do you determine what's going on? Because aren't these symptoms kind of the same for a lot of these things? How do you do that?

Jacob Oran, MD: Yeah, good question. A lot of times, it's done by the emergency department physicians. And so, you know, I put myself in their shoes, you know, or you're teaching a student or a resident how to differentiate these things, you know, the location on the abdomen is going to be very helpful. If you look at the abdomen as just one big thing, that's not going to be helpful.

So, we typically will break it into four quadrants. You know, right upper, left upper, right lower, left lower. And then, if they have localizing pain in one of those areas, then you're going to be able to narrow that down. So, that's one of the first steps, is it in a particular area? If somebody's having new pain and it's all over their entire abdomen, that tends to be a sign of badness, whether it's appendix, gallbladder, colon, small intestine, stomach. That can be a sign of a perforation where there's, you know, leakage of fluid outside of the bowel. And then, it's just causing irritation to the whole abdomen. So, diffuse abdominal pain tends to be really concerning.

So, the first thing is localizing it if it is localized. And then, you know, just knowing your anatomy and starting there. And so, that's where CT scans can be really helpful because you can look at the whole thing.

Host: Absolutely. So, you said when someone comes in with effusive abdominal pain, that's really a warning sign then. That's kind of the red flag, right? That really gets you concerned.

Jacob Oran, MD: That tends to be the kind of the, "Oh, no."

Host: Right.

Jacob Oran, MD: You know, "We need to call help right away on this one."

Host: Yeah. But that makes a lot of sense what you said. You look at the location on the abdomen. And then, you kind of divide it into four quadrants, and you're able to narrow it down then. And then, you said you're also able to use CT scans, which is very helpful. So, say, you find something, there's a CT scan and you're like, "Something's not right here."

When someone does need surgery then, if it gets to that point for, let's say, a hernia or gallbladder or colon issue, appendicitis, reflux, et cetera, what are the key members of the care team from primary care to surgeons, anesthesiologists, GI specialists, nurses? How do you all work together to attack the problem?

Jacob Oran, MD: So, most common things when I'm on call typically that come up as far as calling people in, you know, say a weekend, is going to be appendicitis, it's going to be gallbladder or, you know, cholecystitis. Those are going to be the two most common. And it should come from me, that initial phone call, and I'm going to call our house supervisor. And then, our house supervisor will call in the OR staff, which is a scrub technician, circulating nurse, and a recovery nurse.

So, there's three there. And then, our anesthesia provider. So on, especially on the weekends, you know, that's going to be the bare minimum is those four plus myself. And then, before surgery, it's going to be the ER nurse that's getting the patient ready. And if they're really sick, the house supervisor will typically help so that there's two nurses in there getting that person ready for surgery.

Host: Well, it's great to understand the care team available at Columbus Community Hospital and how you all work together. So, that's why I was curious of how that works, and I'm sure people want to know as well, "Who's all going to be treating me for this?" And I know many people are probably scared of abdominal surgery, certainly if it's imminent, if there's an emergency and has to be done.

But even for some hernias that you say might not be an emergency situation, it's been growing over time, and people might put off hernia surgery even though they're miserable potentially or at risk because they're like, "I don't want to go through this, so I'd rather put it off." What fears do you hear most often, and how do you address them honestly without downplaying the risks?

Jacob Oran, MD: I think one of the biggest fears is just the surgery as a whole, knowing that you have to go to sleep. So, that was a big concern on my patient this weekend who needed gallbladder surgery. They were really worried about the anesthesia. And then, the next big concern that I see is, you know, "How is this going to affect my life for the next however long? Is it one week? Is it six months? So, being able to counsel people on the duration of the recovery, which sometimes I do beforehand." It just depends on, you know, you have to take each individual, and treat them that way, Because some people don't care, and some people it's a really big deal. Financial issues, unfortunately, is a big concern, and that's out of my hand.

You know, I tell everybody, no matter who your surgeon is in Columbus, California, New York City, the surgeon fee, which is the only thing that we charge, is the same. That's dictated by the government. You can look it up online. You want your gallbladder out, it's the same no matter where you are.

The hospital fees, that's different, and that's out of my hand. As we all know, insurance is tricky. And then, from a surgical standpoint, what I do specifically is I always like to draw pictures. I think most of the time, my pictures help calm people down because if they say, "You need your gallbladder out," a lot of people would be like, "I don't even know what a gallbladder is." And so then, the picture can show them what a gallbladder is, can show it in relation to other organs. So then, I can talk about the surgery, but also the risks. And then, you know, what is life going to be like without a gallbladder? What is life going to be like without an appendix? And I can draw it for them. And then, there's a very select few that would say, "I wish you didn't do that." But I would say that's like one in 100, because sometimes ignorance is bliss. Just fix it, Doc, you know? But pictures is like my go-to. So if you ask anybody in my office, we've got extra sketchpads that they bought specifically for me, because I like to draw those things out. Same thing with hernia repairs or colon surgery.

Host: I love the drawing of the picture. If you asked me, Dr. Oran, where my gallbladder is, I would not be able to tell you. So, you drawing a picture and saying, "Hey, Bill. Here's what this is. Here's where it's at. Here's what I'm going to do," that communication alone would make me feel better. So, I'm sure your patients feel that same way when you communicate with them like that on a level where they really understand what's going to happen to them. I bet that really does help put them at ease.

Jacob Oran, MD: Yeah. And I don't want to, like, dumb down what I do, but some of the things that we do for these particular incidents is very straightforward. It's almost just like a plumbing on the body, maybe, you know, the doorknob on your house fell off, all right? So, you got to fix it. You know, it's like, well, for some people they'd be like, "Okay, I can put a doorknob on." And other people would be like, "I have no idea." And I think that's what the picture does. It's like, "Hey, you know, it's kind of simple, but you definitely want somebody who knows what they're doing."

Host: Yeah. No, that makes sense. And I love that you do that. So, let me ask you this. Are there realistic lifestyle changes like diet, weight loss, exercise, even things like watching how you lift things or managing constipation that can reduce the risk of getting a hernia, gallstones, severe reflux, colon problems, things like that in the first place? Are there lifestyle changes we can make to try to avoid those things?

Jacob Oran, MD: A little bit. For sure, preventative measures. So if you just talk appendicitis, no, that's just going to be random, whether you're two or 72. The older you are, the less likely you are to get appendicitis. So, that one, there's not going to be any preventative measure for. Gallbladder-wise, if you were born a male, you have a much lower chance. It's about three to one, four to one, women that'll have their gallbladder out compared to men. So obviously, that's not preventative. So, we know there's a big component with probably estrogen and pregnancy related. So again, out of a lot of females' control.

But the one thing would be obesity. So, maintaining a healthy body weight. That's going to help decrease the risk of colon cancer. That's going to help decrease your risk of reflux, and decrease your risk of gallstones as a whole. As you can imagine, you know, if there's just more fatty tissue in the abdomen and it's pushing on stuff, then that'll kind of just push everywhere. And in particular, it'll push on the stomach.

And so, that definitely is one of the main risk factors for acid reflux is around abdomen. Other preventative measures, you know, not a lot. Some of these things are genetics. And then, hernia-wise, typically, most belly button hernias are something that people are born with. And this is where the tables turn as far as groin hernias go. It's about three or four to one guys will get groin hernias compared to a female.

And then, as far as preventative, honestly, smoking cessation is the most important for hernias. So, don't smoke, or if you do, stop smoking. That's one of the biggest risk factors for hernia development outside of obesity.

Host: That's really interesting. So obviously, as you said, managing your weight, smoking cessation, those are all really, really important. So Dr. Oran, if you had to boil it down to say maybe three top, don't ignore this. When you see this, do not ignore warning signs for abdominal pain or bowel changes or reflux. What would those three things be that someone would want to seek urgent or same-week medical care?

Jacob Oran, MD: Urgently, you know, or same week, it's going to be pain that is getting progressively worse. And not just over—"Oh, it's a little bit worse a week later." This is going to be within the same 24-hour or 48-hour period where it's going from fairly significant to severe. And then, anytime there's associated fever, nausea, vomiting. Those are going to be the big ones. Because honestly, on a normal day, people should not have any abdominal pain. Maybe the slightest abdominal pain, from some gas, but abdominal pain should not be a daily thing.

Host: Absolutely. So really, important to know. So, thank you for that. So, pain that's progressively getting worse, fever, nausea, vomiting. And if those things are getting worse and not better, that's kind of the warning sign that, "Hey, it's time to call the doc." Is that right?

Jacob Oran, MD: Yeah. In 24, 48 hours, if you're going past 48 hours and you've had that pain that whole time, everything's worse for you as an individual. It makes surgery more difficult. If it was the appendix, it's probably ruptured. If it's the gallbladder, it's probably necrotic and dying. And so, the risks for everything go up. And I tell all my patients when they come in at an appropriate time, "This is great. I'm sorry you have to have surgery. But this is going to be real straightforward. It's going to be easy for you, it's going to be easy for me."

Host: So, the earlier you get in, the better outcomes generally as well. So, that just makes sense and is good advice for anybody.

Jacob Oran, MD: Yeah. And, you know, the anxiety with, you know, knowing, because ignorance is bliss. I mean, I get it. You know, I've had health problems myself, and I'm sure I've put them off in the past.

Host: Right. Well, great advice. This has really been fascinating and informative. Thank you so much, Dr. Oran. We appreciate your time today. Thank you again.

Jacob Oran, MD: My pleasure. Thanks for having me.

Host: And once again, that is Dr. Jacob Oran. For more information and resources, just visit columbusgeneralsurgery.com. Once again, just go check them out on the web, columbusgeneralsurgery.com.

And if you found this podcast helpful, please share it on your social channels and check out the full podcast library. It's full of great information for you. Check it out for topics of interest to you. This is Columbus Community Hospital HealthCast. Thanks for listening.