Joey Wahler (Host): They're a common condition, especially in men. So, we're discussing hernias. Our guest is Dr. Deborah J. Fox-McClary, a dual board-certified surgeon specializing in general surgery and colon and rectal surgery. This is WickCare Talks, the podcast from Wickenburg Community Hospital and Clinics, dedicated to helping our community lead healthier, more active lives.

In each episode, we connect you with trusted health experts sharing valuable insights on a wide range of topics, from managing chronic conditions to simple tips for everyday wellness. We're here to provide practical information to support you on your health journey. So, please be sure to follow us so you never miss an episode. Thanks so much for being with us this time. I'm Joey Wahler. Hi there, Doctor. Welcome

Debora J. Fox-McClary, MD: Good morning, Mr. Wahler. How are you?

Host: Oh, please. Mister is unnecessary for you and anyone else that graduated medical school and well beyond that for that matter, but I appreciate the politeness, Doc. So first, for those unfamiliar, we've obviously all heard the term, but in a nutshell, what do we mean by hernia? And just how common is a hernia issue, especially among men?

Debora J. Fox-McClary, MD: So a hernia, as I will often tell my patients, is a very common issue. They occur in part because of weaknesses in our body. Humorously, I will tell people that, in some way, shape, or form, if we were walking on all fours, some of the most common hernias wouldn't even occur. But because we're upright and standing, we are subject to failure of the lower part of our abdominal wall. And in fact, 98% of all hernias appear to be in the groin regions. Now, between men and women, men are much more likely to get those because of the formation of that area while they're in the womb. So, it is something that they're predestined to. There is some family predisposition to it.

So when I speak to patients in the office, I will talk to them, our abdomen is a big chest area. It's an area that you can store all your internal organs and your lungs, and that abdomen, the wall of it is made up in layers. So, the most important layer from the standpoint of a hernia is something called fascia. And fascia is the innermost layer. It's a leather-like thick material. It wraps around all of the muscles that we work out when we're at the gym. And that fascia holds those muscles together.

Now, the hernias we get are in the fascia in between the muscles. One of the weakest areas that we have then is down low on either side of the pubic bone, and that is the most common site of what we call a groin hernia or an inguinal hernia.

Host: And then, there are actually different types of hernia in addition to that, right?

Debora J. Fox-McClary, MD: Absolutely. We can see hernias in all parts of the body. Common ones that patients have heard about are the hiatal hernia, which is a weakness where your stomach comes into the abdomen. When we operate on people and we make a surgical incision, you can get a hernia along the incision area.

A very common hernia that we see in patients is an umbilical hernia. Right where your belly button is, is the last place on your body to close when you're forming in your mother's womb and where the umbilical cord is. And so, that, again, is a very common place that we see hernias form.

Host: And so, what are the typical symptoms of a hernia that people should watch out for?

Debora J. Fox-McClary, MD: The number one symptom of a groin hernia actually, for most of the patients who talk to me about it is they'll be in the shower, and they look down to wash themselves, and there's a bulge sticking out from that area that shouldn't be there. Not one of our normal organs, but actually in the area of the right or the left groin.

Commonly, they're not painful. They're just a bulge, and they feel a little bit like a bubble coming out. Patients who examine these will find that commonly they can push the bulge back in. And then, if they cough or something, the bulge comes back out again. Now, occasionally people will have pain from hernias, but we do like to try to see people before they get to the point where they're having pain from the hernia.

Host: And speaking of which, Doc, I know from personal experience, if you let that bump go too long and any pain that may be associated with it, eventually, that weakened area is going to succumb increasingly, am I right, to where that bump is going to start poking through more and more, and the pain is going to increase to where there's no doubt you need to get it taken care of, right?

Debora J. Fox-McClary, MD: You know, so absolutely. And again, if you have a small hernia and you have other things going on in your life, we tell people live with it, but get it fixed before it gets you into big trouble. Again, the groin hernia is the most common, and you can imagine a situation where if we walked on all fours, that there's not as much pressure there. But of course, people would think you were insane if you walked on all fours.

Host: I believe you're correct, Doctor. And so speaking of which, when you talk about if we were to walk on all fours, hernia likely wouldn't be an issue. That's because often, am I right, hernias are caused by overexertion from essentially putting too much pressure on that area, often because, especially in the case of men, you're lifting too much, whether it's something acute like taking something out of the trunk or off the floor without using the right balance and posture, right? And bending the knees, et cetera. As well as maybe something that just develops over time, like, you know, doing too much lifting in the gym and eventually it catches up with you, right? So, it's really a matter of we are standing upright, but our body can only handle so much in terms of that kind of exertion. Am I right?

Debora J. Fox-McClary, MD: I agree. Some of it is heavy lifting. And I do see these in people who lift as part of their work or their hobbies. And occasionally, I'll have a patient who comes in here who says, "Oh, I was cleaning the garage and I lifted a box and I felt a twinge down in the groin area. And then, when I looked there was a new hernia there."

So, sometimes I see that. We do see, though, that there is a tendency for predisposition in families. So, if your father or mother had groin hernias, you're more likely to develop one over the course of your lifetime. And there also is a risk factor of obesity in driving hernias. So, if you're overly obese where you have a lot of pressure outwards in the abdomen and you're doing just regular lifting or house cleaning chores or such, then you can still develop a hernia because that obesity puts pressure outwards on that area of the hernia and can give you a higher risk of getting a hernia.

So, a common example of this, not from obesity but from pregnancy, we'll see thin young women who had no history of a hernia and then they have a pregnancy. And at the end of the pregnancy, they now have a hernia at the belly button. And that is because that during the pregnancy, all the other organs are being pushed aside, but the outward pressure, we think, drives the formation of the hernia.

Host: And obviously, there's not much that can be done to prevent a hernia in that situation. But other than pregnancy, any specific exercises or physical routines that should be avoided or emphasized to reduce hernia risk or that could make a hernia worse? How are we moving our body that's either contributing to or how should we move it to prevent?

Debora J. Fox-McClary, MD: I think that's a really good question. At least in my patient populations, when I see people and if they have a small hernia and it's not giving them any type of symptoms, in other words, it's just a bubble, they push it in, they cough, it comes back out, I actually tell them, "Just do your normal activities and live your normal life."

But when you have a free couple of weeks, we need to fix this so it doesn't continue to be problematic." Now, when I see a patient who tells me, "Well, my hernia, if I lift something, it'll come out and it gets stuck and it, and it's really hard for me to get it back in," I tell them, "Well, then you can't lift anything until we get it fixed."

After a surgery, it's common in the first few weeks we tell people, "Don't do any heavy lifting because we have a fresh hernia repair, and we don't want you to stress it." But at some point, we actually do want you to resume an exercise activity, begin doing some lifting again, because that actually can improve the healing of the hernia repair site.

Host: Absolutely. So for those suspecting they might have a hernia, what should they do and how does someone like yourself go about diagnosing it and, of course, eventually treating it, which we'll ask you about in a moment. How about what to do if you think you have one and how someone like yourself would in fact confirm that?

Debora J. Fox-McClary, MD: Well, I recommend making an appointment. And you can oftentimes start with a primary care doctor, but many insurances allow you to directly make an appointment with a surgeon who will commonly examine the area that you're concerned about. But also, we'll check the opposite groin to make sure there's not one that you don't yet know is there. They'll also check the belly button area, and they may check some other sites depending on your history for hernias. Once I've examined a patient, there's many times I can tell the patient, "Yes, you have a groin hernia. I don't need any more X-ray studies on you. Let's get you scheduled to fix this."

There are other hernias, ones along surgical incisions, where we will then recommend instead of going straight to surgery, actually getting a CT scan first. I liken the CT scan to being a roadmap. So, it lets me see what the terrain looks like, how big the hernia is, and are there any other hernias. And it helps me both to counsel my patient and to plan for surgical repair of the area.

Host: And, Doc, am I right? It's still the so-called mesh method that's most common in terms of surgically repairing a hernia, and that's kind of akin to the old school patch that you would either sew or iron onto a hole on a pair of jeans, right? Only it's a lot stronger and it lasts a lot longer, usually for your whole life, right?

Debora J. Fox-McClary, MD: I love this analogy, that I might have to steal that in counseling patients in the future. So, yes, we use mesh commonly. I have a piece of mesh I'd like to show, if that's okay with you. And this was actually a piece we were going to use on a patient. And unfortunately, it slipped from somebody's hand, and so it can no longer be used in a patient.

But I have a piece of it here. And a common analogy I tell my patients is it almost has the consistency of screen door wire, the mesh that we have in our screen doors. But this is made out of polypropylene, and we've been using polypropylene for years. And we know polypropylene, it leaves the body alone. The body's not too concerned about polypropylene. And so, now, in particular, like in a groin hernia, we would use a piece that's only a little tiny piece of this big portion that I have here. And you could almost see in the analogy of some of the homes we have here in Arizona, where we have stucco. A lot of that stucco is around chicken wire, which provides strength to this. And so, the body is the same way. It heals through the small holes in the mesh, and it will create a much stronger repair than our body can make on its own. In fact, when we were in the 1980s and 1990s when I was in training, we were still doing groin hernia repairs without mesh at that point. And we were seeing sometimes upwards of a 30% or 40% recurrence rate.

And as I thought about it in my mind at the time and still today, is that you have a weak part of the body. And if I take two weak pieces and pull them together with stitches, now I just have a weaker area. So, we like to use the mesh around the repair site to let the body grow through, and it becomes much, much stronger.

In subsequent studies by our research scientists and such, what we see now is that if a hernia repair fails and the hernia comes back, we never see the hernia go right through the mesh. What we see is the hernia go around the edges of the mesh. So, we know the mesh makes a big difference in how people heal. It makes it much more likely to have long-term success with the repair and have it last the rest of the patient's life.

Host: Wow. Interesting. I did not know that last point. So in other words, the mesh will hold up longer typically than our own body will. Couple other questions for you, doc. First, after surgery, what's the recovery timetable and experience like once you get that mesh put in there to patch things up, so to speak? How long before you're up and at them again?

Debora J. Fox-McClary, MD: It depends. We have different techniques for fixing hernias. So again, if you think of a hole in your car tire, for example, one of the ways that we do the repairs would be akin to us putting a patch on the tire from the outside of the tire. When we do that, all of the pressure of the hole is against that patch. And when we do a repair that way, what we call an onlay repair, we will tell people, "You can't lift anything for six weeks. You can't go to the gym for six weeks. You can walk around, but you need to take it extremely easy so you don't disrupt my repair."

The modern repairs are different, though. What we're doing now with the laparoscopic methods and with the robotic methods is we're going inside of the patient's abdomen with a little bit of air, and we actually go in behind where the hole is. And we put the piece of mesh on the backside. It would be akin to repairing your tire from the inside. And now, if I do something like that on a patient, that patient almost right away can start lifting heavy things again, because that would be incredibly difficult for the patient to push stuff through.

Now, even in that setting, I tell patients I do want them to be active. I want them to go to the gym. I do want them to go to work. But I want them to use common sense, which is not as common as we think it is. So, I will tell often my male patients, "This is not the week or two to reorganize your garage. This is not the week or two to plan to help somebody move to a new place. You need to take it easy." But when we think with the mesh repairs that we're doing from behind the hole, that we have a lot better chance that they're going to succeed over the long run.

Host: And in talking about some of those advancements, you actually answered in advance what was going to be my last question about what might be new and different about the treatment of hernia as well. Well, folks, we trust you are now more familiar with hernia and its repair. Doctor, interesting stuff really, because I think most people that have not had a hernia or that don't know of anyone that has probably don't know any of that stuff that you just told us. Keep up all your great work. Thanks so much again.

Debora J. Fox-McClary, MD: Thank you very much for your time. And, again, I would just say to the listeners, if you have a question, please make an appointment. We have surgeons at the clinic most days of the week. And other than the cost of the clinic appointment, you get a good education and you're not required to do anything. We just want to meet with you and we can talk more.

Host: And along those lines, Doc, we should probably tell people just for the record as well that if you get a hernia, it ain't going away on its own ever, is it? It's kind of like going to the dentist. You can put it off, but they're going to see you in there sooner or later.

Debora J. Fox-McClary, MD: Well, and that's the problem because it's through that fascia which we don't work out. When we go to the gym, you're working your muscles but not your fascia. So, if you try to go to the gym and work out, the hole just will become larger. So, you're right. It doesn't go away on its own and the best thing is to see somebody. I might not say to somebody that you have to do it tomorrow, but at least you know what we need to do and you can plan your life for a time that fits best with your schedule.

Host: Absolutely. Great advice indeed. And for more information, please visit wickhosp.com/wickcaretalks. We hope today's discussion has provided you with valuable insights to support your well-being. Remember, every step you take is a step toward a healthier life. To ensure you don't miss future episodes, please follow us on your favorite podcast platform. If you found this episode helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of WickCare Talks.