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UNDERSTANDING HERNIASBY: DR. PAUL CONTE

AUGUST 2021

MY BACKGROUND

▪ Began career as a synthetic organic chemist at Epitope in Portland, Oregon

▪ Completed residency and fellowship at UW Madison

▪ Began practicing clinical medicine in 2001, opened office in West Des Moines in 2004.

▪ Became interested in medical-legal work and reviewing complex workers compensation cases (licensed in Iowa and Nebraska)

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OUTLINE FOR TODAY

▪ What is a hernia?

▪ What causes a hernia?

▪ Symptoms

▪ Types of hernias

▪ When to seek medical attention

▪ Work-related hernias and evaluating MMI

▪ Common comorbidities

▪ When to consider surgery and recovery time

WHAT IS A HERNIA? ▪ Your belly has walls of muscle (some get to

call it their 6-pack) that support posture, help us move and hold our organs in place.

▪ An opening in the muscle or tissue can create a “weak” spot where an organ begins to push through – creating a bulge.

▪ Once this happens, hernias rarely “go away” ▪ A person can live with a hernia pain

free▪ OR, sometimes the hernia can cause

emergency situations

It is always best to have a hernia evaluated

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HERNIAS: ONE OF THE OLDEST MEDICAL CONDITIONS▪ First recording is from the Age of Antiquity

▪ At that time, many hernias were “treated” with trusses.

▪ Trusses are still used by people today if they don’t want to undergo surgery or are too high-risk for surgery.

▪ Not particularly comfortable to wear.

WHAT CAUSES A HERNIA

▪ A combination of muscle weakness and strain causes a hernia

▪ Hernias can occur quickly – or develop over time

Common causes of muscle weakness, include:Congenital defect

AgeChronic coughing

Damage from surgery or injuryPregnancy

ConstipationSudden weight gainLifting heavy objects

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SYMPTOMS: WHEN TO SEEK MEDICAL ATTENTION▪ Typically, you see a bulge or lump in your

belly or groin.

▪ Sometimes, you only see the bulge when you laugh, cough, or strain, like when you lift a heavy object.

▪ Often, you can press it back into place.

▪ People seek medical attention when:▪ The bulge gets bigger over time.▪ It starts to change the way they feel when

they eat▪ Pain, pressure, or a dull ache around the

bulge▪ Pain when lifting objects

PATIENTS SEEK MEDICAL ATTENTION AT DIFFERENT TIMES

▪ Sudden straining/movement causes sharp pain or “ripping” sound

▪ A bulge appears somewhere in the abdomen that hadn’t been there before

▪ There has been a small hernia with either no pain or ignored symptoms –and, now, a sudden movement has caused concern because of pain

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TYPES OF HERNIAS• Inguinal and

Ventral (front of the abdomen) are the most common work-related hernias.

WHEN CAN A HERNIA BE WORK-RELATED? ▪ The patient relates the hernia directly to

an episode at work▪ Job is strenuous▪ Job requires frequent lifting ▪ The person has not noticed a bulge or

pain before the episode at work

▪ The person has had a hernia but never had pain▪ Patient doesn’t know exactly what

happened▪ Original bulge is getting bigger or

pain has developed

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THE ROLE OF THE DOCTOR FOR WORK-RELATED HERNIAS

• Priority for the physician: the health and safety of the patient

• For work-related hernias, we typically work with the employer

• Often, our practice serves as an IME (independent medical exam) – working with employer and/or lawyer to provide medical opinion.

COMMON COMORBIDITIES SEEN WITH HERNIAS

▪ Obesity

▪ Diabetes

▪ High Blood Pressure

▪ Deconditioning

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EVALUATING MAXIMAL MEDICAL IMPROVEMENT• Two month follow up after surgery• Evaluate based on AMA Guides 5th Edition• Rare for a patient to still have issues

• Can re-evaluate in another month or two

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ONCE YOU HAVE SURGERY –POST SURGICAL RECOVERY PROTOCOL• All patients are off work for one week• If low physical demand, patient may return to job with no restrictions.• High physical demand jobs:

• May return to work on LIGHT duty at 1-2 weeks• Must be off daily pain medications before returning to work• Patient should wear athletic support or compression

shorts daily while up• Light duty for variable amount of time based on job

demands• Usually 4-6 weeks of light duty

• If no light duty available, patients can return to full duty in 4-6 weeks.

SOURCES: Guides to the Evaluation of Permanent Impairment. 2000, 5th edition.

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QUESTIONS?DR. PAUL CONTE, MD FACS515-225-7001

4949 WESTOWN PARKWAY SUITE 100WEST DES MOINES IA, 50266

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