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On Sat, 24 Sep 2005 12:17:00 -0400, K@.not wrote:
>I know someone with an inguinal hernia. It is very visible,
>but isn't binding yet and hasn't started down into the
>scrotum. He can't afford surgery, and doesn't have
>insurance. He must be active in order to work. He has
>heard that a truss is not a good thing, but wouldn't that
>be better than nothing? He says it's slowly getting larger,
>so wouldn't a truss at least slow growth down significantly
>by keeping the weight of the intestine from constanty
>pushing and ripping the torn muscle?
>
>If he can figure out how to get surgery somehow, would
>the muscle grow back together? If so, why wouldn't it
>grow back together by itself if a truss were worn to keep
>the intestine from pushing the tear apart? Would it try
>to grow back, and then get torn, and then try again, and
>get torn again...etc?
>
>What about trying to let a student practice on him? Are
>there medical students who would want to do surgery
>like that for the practice? If so, how to find out about
>that?
>
>Thanks for any help or advice!
Some admonitions for the fellow that should do no
harm:
(1) Lose weight. Any reduction in abdominal visceral
fat (central adiposity) will help to slow further progress
of an inguinal hernia, direct or indirect.
(2) Exercise. Building up the abdominal muscles can
be effective both in slowing further progress of the
hernia *and* will increase the strength and viability of
the fascia and muscle with which the operating surgeon
will have to work. "Piss-poor protoplasm" makes for
bad surgical results.
(3) Increase dietary vegetable fiber intake and, if
necessary, make use of stool softeners (surfactant
"wetting" agents like sodium docusate) to increase
the bulk and frequency of bowel movements while
reducing stool obduracy. If the individual strains at
stool, he will increase intraabdominal pressure and
that tends to speed the progress of herniation.
(4) If he smokes, get him to quit smoking. This not
only will improve overall health, but it will also improve
wound healing postoperatively and reduce chances
of intra-operative respiratory and cardiac complica-
tions.
A truss is of little or no value, and I do not recommend
it. If your friend is willing to do a decent job of "prepping"
himself for surgery, I suspect that any teaching hospital's
general surgery service would be happy to take him on
through the outpatient clinic. Surgical residents (not
students!) generally welcome uncomplicated inguinal
hernia cases in order to fulfill their requirements for
board eligibility. Just make sure that the chief resident
is one of the guys scrubbing in on the case, and that
you get it done within the first six months of the calendar
year.
The new guys come on the service in July, and you
*really* don't want to come in for elective surgery
in the summer months.
------------------------
Health care is too expensive, so the Clinton administration
is putting a high-powered corporate lawyer in charge of making
it cheaper. (This is what I always do when I want to spend less
money - hire a lawyer from Yale.) If you think health care is
expensive now, wait until you see what it costs when it's free.
-- P.J. O'Rourke, "The Liberty Manifesto" (1993)
(http://www.cato.org/speeches/sp-orourke.html)
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