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Back in the Swing of Things

AS AN AVID GOLFER and former professional skier, Douglas Sherman, 48, leads a very active life. In addition to his favorite sports, the Snohomish resident works at the Washington Athletic Club. "I fix everything in the building," he says. "I do a lot of heavy lifting. I'm always turning wrenches and lifting ladders."

One day, something went wrong.

"I lifted a couple of televisions that day — one at my house and one at work. I didn't notice that I was hurt until the next day, when I saw a small lump in my abdomen," he recalls.

That lump was an "inguinal" hernia.

A hernia is the bulging of an organ through a tear in a muscle or other internal structure. This allows the organ to move into parts of the body where it doesn't belong. An inguinal hernia, one of the most common types of hernia, occurs when the intestine protrudes through the lower abdominal wall, causing a swelling or lump that can be seen and felt from the outside. In many patients, an inguinal hernia can also be very painful.

Sherman hoped the lump would go away on its own, but it didn't.

"It got progressively worse. I did a lot of reading online to figure out whether it was a hernia, and if it was something that I needed to get taken care of right away. I found out that hernia repair is an elective surgery, so I didn't have it fixed immediately. It wasn't painful, but it was cumbersome. And it wasn't attractive to look at. Also, you don't want to lift more than 15 pounds — otherwise, you're going to see the hernia start growing," he explains.

It was challenging for Sherman to limit his activity, both at work and in his leisure activities. When golfing, he tried wearing a hernia brief, which is similar to a truss (a padded support garment that uses pressure to stabilize the hernia and prevent it from growing), but it was uncomfortable.

"It was really difficult for me to step back and take it easy," Sherman recalls. "I decided that I had to get the hernia taken care of. It was limiting me too much. I was really active before the hernia and wanted to be again."

That's when he found out about the UW Medicine Hernia Center.

Located on the Northwest Hospital campus, the UW Medicine Hernia Center is a dedicated program offering the full range of surgical solutions to repair hernias and relieve associated pain. In addition to common inguinal hernias like Sherman had, the Hernia Center treats complex abdominal wall hernias that require reconstruction, as well as hiatal, umbilical, femoral and ventral hernias.

Sherman called the UW Medicine Hernia Center and made an appointment. "I was impressed that all they do is fix hernias. The doctors do something like 200 repairs a year. I figured I'd be in good hands. I came in and I met with Dr. Wright."

"Hernias are very common — much more common in men than in women. For men, more than 27 percent will develop an inguinal hernia during their lifetime," explains Dr. Andrew Wright, who joined the Hernia Center a few months after it opened in August 2012. "A lot of hernias are actually present at birth. Over time, they stretch out and get larger. Lifting, straining and chronic cough can contribute to a hernia getting worse."

Though many hernias are caused by a combination of genetics and wear and tear on the body, there are a number of risk factors that can be controlled, including obesity, malnutrition, diabetes, smoking and lung disease.

Dr. Wright explained the treatment options to Sherman.

"Back in the old days, people just used to wear a truss or a hernia belt. Nowadays people are more likely to get their hernias repaired with surgery. The earliest hernia operations were done with open surgery, but then came laparoscopic surgery," Dr. Wright says.

Laparoscopic surgery, a minimally-invasive technique, is an abdominal operation performed through very small incisions and aided by a video camera. Its benefits include less pain than open surgery, faster recovery and a lower risk of recurrence of the hernia.

For both open and laparoscopic surgery, a crucial innovation was the development of a light mesh made of polypropylene that is used to patch the hernia opening. It provides a "scaffold" for the body's tissues to grow on, resulting in a higher rate of successful repair. Simply stitching the edges of the hernia together can result in tearing.

Though most hernias only cause bulging or discomfort, Dr. Wright warns that a rare complication called "bowel obstruction" can occur. Part of the small intestine can get trapped or pinched until its blood supply is cut off, or "strangulated." If this happens, emergency care is critical.

"Not all hernias need to be fixed. If it's not causing any pain or discomfort, you don't need to have surgery right away. But if you have pain, especially when lifting, it's time to get it looked at. Once it starts interfering with your lifestyle, you should visit the doctor. Also, if you have a small hernia that starts getting larger very rapidly, it's a good idea to have it checked out," Dr. Wright advises. "Look for a surgeon who does a lot of hernia repairs. The more they do, the better the outcomes they tend to have."

Sherman's surgery — an open procedure — went smoothly. He arrived at 8 o'clock in the morning and was on his way home by noon. "It was quick. The surgery is pretty cut-and-dried," he recalls.

Just a few weeks later, golf was back on his agenda. "Overall it was just a great experience. Since it is an elective surgery, the personal touch that the Hernia Center gives is important," says Sherman. "If I were to give folks advice, I'd say just get the hernia repaired. It's not that big a deal. In the long run, it will affect your life if you don't address it. They just don't repair themselves. If it affects you not only at work, but at play, it's time to get it fixed."

For more information about the UW Medicine Hernia Center, visit nwhospital.org/hernia or call 206.368.3077.

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