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Emergency Room? or Wait?


montanapup

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For whatever it's worth, I'm an Emergency Medicine resident....here's my two cents.

 

If the hernia is in your groin, it's either an inguinal or femoral hernia. If it's poking out your navel, it's an umbilical hernia. If it's in the midline, but not your navel, it's a ventral hernia.

 

In terms of seeking emergency care, all that is academic. All that matters is the ability to reduce the hernia. If you've not had any nausea, vomiting, abdominal pain, or change in bowel movements (bloody or tarry black poo), then you don't really have any symptoms suggestive of bowel obstruction or permanent injury.

 

When we evaluate hernias in the emergency department, we determine whether obstructive symptomatology exists (puking, swollen and painful belly) and whether the hernia is easily reducible. If there's no obstruction and the hernia is easily reduced, there's no surgical emergency--we refer the patient to their primary care provider for eventual referral and evaluation by a surgeon. If there's any suspicion of incarceration or strangulation, you stay in the ED until evaluated by a surgeon; strangulated hernias are a surgical emergency and need immediate intervention before the bowel dies.

 

All of this should be taken with a grain of salt; I certainly am not purporting to evaluate you based on discussion on a climbing website. However, if you aren't having any symptoms other than the bulging and it's easily reducible, you might be able to save yourself (and your wallet) an emergency department visit. But, DO NOT WAIT TO BE SEEN IF YOU HAVE ANY SYMPTOMS THAT CONCERN YOU. We're always happy to check people out, even if we ultimately provide reassurance and a referral.

 

Hope this helps.

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I had a hernia recently and my doctor left it up to me to treat right away or put off indefinitely. I didn't initially go to the doctor for a couple of weeks after I first noticed it either. Mine was lower down though and it sounds like mine wasn't as severe of a bulge. In the old days, there really was no treatment for these besides wearing "supportive undergarments". Now you can get the surgery. If you have insurance you will probably want to deal with it ASAP anyway since you can't really climb with it and the sooner you fix it the sooner you will be back. If you don't have insurance, I would sign up for insurance LifeWise right away and then go see a doctor once it is activated. If it is diagnosed before you sign up, they might not cover it. My bill totalled in the vicinity of $6-8,000 (can't remember) in total and I ended up paying around $1,000 of this due to deductibles and co-payment. So it is worth it to sign up for some insurance.

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Thanks everyone,

We're chuckling that everyone has assumed that my hesitation to see a MD has been financial. It's not! I'm well insured. In another career (almost seems like another life) I was a paramedic and I hate going to the ER for something that isn't an emergency. Friday was a Unviersity holiday so my regular MD (at the University clinic) wasn't available.

 

Its not a big bulge - probably the size of my thumbprint - but I'm having to reduced it every hour or so that I'm standing up, so I'm probably going to get eval'ed for surgery. Its a simple outpatient procedure, and will only sit me out for a week.

 

Thanks to everyone who posted here and PM'ed me too.

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  • 3 weeks later...

So, because I promised that since she started it here, I'd finish it here.

 

I had my consult last Tuesday, and my surgeon cleared me for running and skiing, but no heavy lifting, and definetely no climbing. So I got in some of the best powder days ever at Mt. Baker this week. He wanted to wait until after I completed my final exams to operate, but I said, "And miss ice climbing over Christmas? No."

 

So I'm home tonight after spending a rather boring afternoon at the Pacific Rim Outpatient Surgery Center. The good news is that the hernia wasn't so large that it required a teflon patch. But it does feel like I've been punched in the stomach a few times. I should be back up to some speed by next week.

 

Thanks for everyone's advice, help, and humor!

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