Do you think you have a hernia?
What are hernias?
The hernias we address in this http://DoctorsExpressHartsdale.com Medical Minute are inguinal, or groin, hernias. More common in men than women, an inguinal hernia can occur when part of the small intestine protrudes through a weakness or tear in the area between your abdomen and your thigh- or your groin. It's possible for anyone to get an inguinal hernia, but it is more commonly found in males.

Hernias form a bulge and can be accompanied by pain. Men have an approximate 26% lifetime risk of having hernia at some point in their life, where as women have a much lower chance of one- only about 3% of women will experience a hernia at some point in their life. There are other types of hernias, such as abdominal, or "hiatal" hernias but groin hernias outnumber abdominal hernias by about 3 to 1.

What causes a hernia?
The cause of a hernia is not always known, but hernias are often the result of weak spots in the abdominal wall. Weaknesses can be due to congenital defects (present at birth) or formed later in life. Some risk factors for inguinal hernia include:
• fluid or pressure in the abdomen
• heavy lifting
• straining during urination or bowel movements
• obesity
• chronic cough
• pregnancy

Hernias often form in people with weakened abdominal muscles or in those who do a lot of heavy lifting or straining, which is why we see it quite often in young men. Physiology plays a part: men have testicles and scrotum which descend through the inguinal canal-much larger in men than in women. That is part of the reason men tend to be more susceptible to hernias than women.

Symptoms of hernia

Symptoms of inguinal hernia usually include a bulge in the groin area and pain, pressure, or aching at the bulge—especially when lifting, bending, or coughing. These symptoms usually subside during rest periods. Men may also experience swelling around the testicles.


Screening and Diagnosis of Hernias
If you are having abdominal pain or pelvic bulge and pain, you want to see physician, and he or she will do an exam. They will use their finger, to see if you have a bulge in your scrotum or on your groin and they'll see if its reducible or not. If the exam doesn't give them the answer, they can then perform an ultrasound, an inexpensive test that can tell you the same day whether a hernia is present.


What to do if you think you have a hernia
Most of the time hernias do not cause problems. People often live with hernias their entire life without them becoming aggravated or painful. When they do cause pain though, there is concern that complications may have arisen. Most common hernias are what we call reducible; you can take your finger or you can lie down in bed and due to the effects of gravity, the bulge in the groin will actually disappear, which means the intestinal contents actually go back into the abdominal cavity or to the correct location. If it's not reducible by lying down or using a finger or having a physician trying to reduce it, then there are concerns about complications such as strangulation, or incarceration occurring. If those concerns are there, then you need to see a surgeon, and there may be a need for surgery.

How to Treat a Hernia
As stated earlier, hernias can often be watched for years without being treated. If however, they are causing pain, we generally refer you to a surgeon who can do a very simple laparoscopic surgery.

If you suspect a hernia, but have not been diagnosed, you should see your doctor, and of course, we are happy to see you here at Doctors Express

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This patient presented to the ER for umbilical pain and had a history of umbilical hernia. He was concerned about the possibility of incarceration of the hernia.

In this video we explain how the clinical exam helps to differentiate a simple painful hernia from an incarcerated one.

***Thanks to the patient for sharing his history and exam with YouTube world***

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Shane Shapiro, M.D., orthopedic physician at Mayo Clinic in Florida, performs a bone marrow aspiration and concentration for BMAC/stem cell injection into arthritic knees. This procedure is part of a Mayo Clinic IRB approved, FDA monitored clinical research trial which can be searched on at http://ClinicalTrials.gov.

Mayo Clinic and the Mayo Center for Regenerative Biotherapeutics is studying biologically based non-surgical treatments for osteoarthritis. One such treatment is the harvesting of the patient's own stem cells from their bone marrow.

"In our procedure we draw cellular rich bone marrow from both sides of the pelvis. We then filter the resulting product and concentrate the stem cells and their corresponding growth factors. Using an ultrasound to image the knee joint, we are then able to precisely inject the cells into the arthritic knee. We are currently demonstrating that this procedure is safe and can relieve pain. We also hope to be able to slow the progression of the degenerative joint disease and perhaps one day regrow cartilage in the arthritic joint."

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Hear Dr. Shapiro discus this procedure in detail here: http://youtu.be/8Djpsc66hKI

Learn more about the Mayo Clinic Center for Regenerative Biotherapeutics here: http://goo.gl/rnRdtU
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Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

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How to start a peripheral IV in the dorsum of the hand: clinical nursing skill technique.

Starting an IV (intravenous catheter) can be an intimidating experience for nurses, especially nursing students and new nurses. However, nurses will perform IV insertions often, so this is an important nursing skill to learn.

Before starting an IV, always follow the protocols of your facility, as well as manufacturer's instructions for any supplies used.

In this video, Nurse Sarah demonstrates how to start a peripheral IV in the dorsum of the hand. Prior to inserting the IV, you'll want to do the following:

-Gather supplies
-Perform hand hygiene
-Prepare supplies (including priming the saline flush, removing air from extension tubing, opening packages, completing labels, and any other steps required by your facility.
-Locate a suitable vein
-Perform hand hygiene
-Don gloves


If the patient has a lot of hair, you might want to use clippers to trim the hairs prior to starting the IV. You may also apply a tourniquet to help veins move near the surface of the skin.


Next, you'll want to clean the site using the cleaner that came in the IV start kit, such as ChloraPrep.


Once the site has dried completely, you can insert the IV. Stabilize the vein with your non-dominant hand, and insert the IV's needle into the vein, watching carefully for blood return (or a blood flash) in the chamber. Advance the IV around 2mm more to ensure the plastic cannula is in the vein, then thread the cannula into the vein and press the needle safety button.

Notes: https://www.registerednursern.....com/how-to-start-an-
IV Video Series: https://www.youtube.com/watch?v=MbG_1-_mnoo&list=PLQrdx7rRsKfXr6kruqEpIovf66sxo0gxh



This video also demonstrates how to flush the IV using the push-pause method, how to secure the IV using the Tegaderm dressing that came with the IV start kit, considerations of the different cap types and the clamp sequence, and more.



For more information, watch the complete tutorial.

#nurse #nursing #iv #startiv #ivtherapy



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Watch this clinical examination video to learn how to diagnose inguinal related groin pain.

This video clip is part of the FIFA Diploma in Football Medicine and the FIFA Medical Network. To enrol or to find our more click on the following link http://www.fifamedicalnetwork.com

The Diploma is a free online course designed to help clinicians learn how to diagnose and manage common football-related injuries and illnesses. There are a total of 42 modules created by football medicine experts. Visit a single page, complete individual modules or finish the entire course.

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