What is a hernia?

[Music]

Narrator 1: It’s a northwest lifestyle weekend on KOMO news. IRG’s health talk continues.

Narrator 2: Next up we have Dr. Steven Counter, a general surgeon for The Polyclinic. We’re talking about hernias. And uh, I mean just the word hernia doesn’t connote a really good feeling, does it?

[laughs]

Shannon O’Kelley: I hear you cringing a little bit.

Narrator 2: Yeah a little cringe, yeah.

Shannon O’Kelley: Yeah it’s a topic we haven’t talked about yet but-

Narrator 2: No!

Shannon O’Kelley: It’s a health topic that a lot of people are going to experience. Particularly, for some reason, men seem to have a lot of these inguinal hernias and Dr. Counter’s going to address that with us and educate all of us. 

Narrator 2: Interesting to hear what he has to say. Dr. Steven Counter and Shannon O’Kelley on IRG Physical and Hand Therapy’s Health Talk. 

Shannon O’Kelley: Dr. Counter, welcome! Welcome to Health Talk, how are you doing today?

Dr. Steven Counter: I’m well, thanks.

Shannon O’Kelley: Well I’m glad you’re here because we’re going to talk about hernias but before we get into hernias, which by the way is a topic that we haven’t touched on this show, so uh it’s new for us and you’re going to give us all the information on it, but uh tell us about your practice and kind of how your day works and your area of interest and how you got interested as a general surgeon maybe.

Dr. Steven Counter: Great thanks, so I’m a general surgeon at The Polyclinic and uh I like tell my friends that I’m an ambulatory out-patient surgeon uh-

[laughs]

Shannon O’Kelley: There you go!

Dr. Steven Counter: Uh and that confuses them. Uh but what it means is I do a lot of outpatient surgery where patients are going home within an hour of waking up from anesthetic uh we do most of our surgery at First Hill Surgery Center and that’s about 80 percent of my practice. Uh, about 20 percent of my practice then is the more classic in-patient hospital work uh where people may stay several days in the hospital. 

Shannon O’Kelley: Tell me about your interest in general surgery and your training. 

Dr. Steven Counter: I trained here in Seattle at Swedish Hospital, I’ve been at The Polyclinic for now almost 20 years uh I developed my interest in hernia surgery really when laparoscopy became much more popular, uh into the late 90’s, that’s where I trained uh in that era and so I’ve been able to incorporate that into my practice. 

Shannon O’Kelley: Okay, so let’s talk about hernias. Anatomically tell us what’s going on there.

Dr. Steven Counter: Yeah so hernias- most people think of hernias I think of groin hernias or inguinal hernias uh most commonly seen in males, uh but, uh in the United States there were somewhere around 500,000 hernias repaired last year so it’s not just in the inguinal region. There are belly button hernias um, anyone who has an “outie” belly button has a hernia uh we have hernias in incisions and uh of course people who have had an colostomy or an ileostomy, that’s a different type of hernia but hernias are very, very common. 

Shannon O’Kelley: So, the word hernia, maybe you can describe it, what does it actually mean, is it just a bulge of tissue, I mean I- I- that’s um fairly limited, but tell us what hernia means.

Dr. Steven Counter: I think that’s accurate, you know, uh- a hernia is a hole in your abdominal wall through which something is bulging. And if you go on the internet you see a lot of books you’ll always see a loop of bowel in there but in fact that’s not really what we see. We more often see fatty hernias, small amounts of tissue and of course the bigger hernias can involve organs or even bowel um but that’s not usually what we see in our ambulatory practice. It’s mostly a bulge that people notice maybe a little bit of discomfort. Uh oftentimes people are concerned about cancer uh tumors, and they see their primary care doctor and our primary care docs are really uh very in tune to hernias and you know so I’ll fix over 200 hernias in a year. It’s that common in my practice. 

Shannon O’Kelley: So tell us about the cause, is this one of those things you-you describe it as a rupture in your abdominal wall, I mean you’re lifting twisting, turning, is it a traumatic event, is it over time? Do you have inherent weakness there? What’s going on?

Dr. Steven Counter: Well, so the Hollywood version of course is always the old guy out chopping wood, you know?

[laughs]

Shannon O’Kelley: Right, right. That’s me by the way!

Dr. Steven Counter: Yeah, right, but so uh it’s all ages. So we have pediatric hernias, um that are really the congenital weakness that uh most boys, but also little girls can have in their inguinal region. Um and then there’s incisional hernias that we see related to previous surgeries. Far and away the majority, though, are still inguinal hernias.

[laughs]

Dr. Steven Counter: I see uh great athletes, I see um people between the ages of 30 and 60 I think is most of my patients. Most of them are active but not always is their hernia associated with an activity. 

Narrator 2: Back with Dr. Steven Counter and Shannon O’Kelley right after this timeout on KOMO.

Shannon O’Kelley: Dr. Counter thank you again for joining us here on Health Talk and thank you for talking about hernias for the first time, you did a great job setting it up, anatomically describing it. But I guess our listeners want to know, how do we finally end up with you- what’s that sequence or that continuing of care if you will?

Dr. Steven Counter: Yeah most of my patients come through our primary care doctors, they’ll have um gone in with a complaint or a concern about a bulge usually in the groin, uh their primary care doctor will say yeah I think it’s a hernia go see Dr. Counter, and uh when I see them, they ambulatory patients. They are well, they come from work, um and we do, you know standard exam- turn your head and cough, that’s a very common uh scenario and uh one or both sides, about 30 percent of patients will actually have hernias on both sides.

Shannon O’Kelley: So let me ask you a question really quick, because I mean the old- I mean I have a lot of guys ask me this question, you know the old turn your head and cough test, right? So let’s talk about that. So what you’re doing is you’re palpating up in that area where there’s normal weakness- if the weakness is going to occur it’s going to be there and when you cough, do you feel a little bulge? Is that what you’re looking for?

Dr. Steven Counter: Yeah, visually see a bulge and also feel a bulge or significant impulse um sometimes when they cough it will recreate their pain or their discomfort that initially concerned them um and that’s diagnostically uh about 95 percent accurate. So we don’t need a lot of other tests. So usually you can just see the hernia surgeon and he’ll say yeah you got a hernia and oh by the way you have one on the other side, too. 

Shannon O’Kelley: Wow, okay. Is that common to have them on both sides?

Dr. Steven Counter: Yeah about 30 percent of patients will in fact get one on the other side at some point not always at their first presentation so it may be 5 or 10 years later perhaps. 

Shannon O’Kelley: So, someone comes in and you- as a surgeon you’re going to say well yep this needs to be repaired, I mean I guess the question is do they all need to be repaired or are there some you let go or how do you judge that?

Dr. Steven Counter: Yeah, the-the-the uh a lot of literature now on watchful waiting of hernias that are basically asymptomatic, that is to say yeah there’s a small bulge there but it doesn’t affect their life or their job and we’ll watch. I’ll-I’ll be honest, though, that most guys come in with a bulge, um they’re worried about it and usually within 3 to 6 months we’re repairing their hernias uh they do get symptomatic uh they’re concerned about it, maybe they’re traveling, uh job requires them, uh to have it fixed, uh so those are the common scenarios for going ahead and-and uh fixing the hernias.

Shannon O’Kelley: And tell us about the repair, the actual operation.

Dr. Steven Counter: My preference for most patients that are healthy and active is a laparoscopic repair where we implant a piece of mesh, use small incisions under general anesthesia, again in an outpatient setting where within an hour of surgery they’re uh on their way home recovering. Usually within a week they’re back to working, within 2 to 3 weeks can be even back to playing golf or tennis or pretty normal activity uh assuming that they’re pain free and recovered uneventfully. 

Shannon O’Kelley: So that’s pretty amazing this is one of these minimally invasive surgeries we’re talking about, through the scope, uh-uh and-and the recovery’s pretty quick and I imagine there’s just biologics, it just takes time to- there’s some scarring and some healing to take place?

Dr. Steven Counter: Well everyone has an inflammatory response. And that’s a time related phenomenon. You can’t make that go faster but by making small incisions, they’re on a lot less pain medicine, they’re back to work sooner, they’re driving sooner, many of my patients just take Tylenol. 

Shannon O’Kelley: As we wrap this up, it’s an easy procedure from the standpoint of in today’s world, minimally invasive, recovery time’s pretty quick and you said about 6 weeks you’re back to almost all activity? 

Dr. Steven Counter: Even sooner than that for the majority of patients. It’s really uh quite amazing to have guys out telling me about their golf game 2 weeks after their hernia surgery. 

Shannon O’Kelley: That’s great. Again thank you for your time and information that’s why I love Health Talk is I always learn something- I learned a ton from you. 

Dr. Steven Counter: My pleasure. 

Narrator 2: Look at the topic I don’t think any of us love talking about but hernias as you mentioned Shannon we had not addressed before and we try to talk about everything on this show we’re happy Dr. Counter gave us uh a little bit more insight into that.