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Forum Name: Surgery Topics

Question: How is a hernia diagnosed?


 ravenous_wolf - Sun Oct 12, 2008 10:02 pm

Over three weeks ago I had a severe pain in my left hip, lower left back, and lower left stomach which prevented me from sleeping. I went to my doctor who quickly looked me over but didn't send me for any tests. He simply said that such back pain would probably go away but he did give me a prescription to Ambien CR which greatly helped me sleep (I have lots of monetary problems, stress about getting laid off, etc.).

The back pain went away but there is still a sharp pain around the lower left part of my stomach up to my left hip and there is small lump/bump protruding in the middle of my rib cage. The lump/bump doesn't hurt but the pain is directly beneath it, like below my rib cage.

With the back pain gone, there is still a lot of stiffness in the back and I just don't feel normal from my upper left hip to the left part of my stomach.

I plan on going back to my doctor and ask him to perform an x-ray or an MRI but I wanted to know how a hernia is diagnosed? That is just my first impression of what this could be.
 John Kenyon, CNA - Mon Oct 13, 2008 9:31 pm

User avatar Hello -

An unusual location for a hernia, but far from impossible. There are several ways hernias can be diagnosed, depending on the location (or suspected location). The most common one is by direct palpation (the doctor can often tell what is protruding and where, just by probing it with his fingertips). Even if that makes it obvious, it then needs to be precisely located by one of several imaging techniques, depending on just what appears to be herniated. A CT scan with contrast, if it is suspected to be a loop of intestine, is a common way to get a good picture of exactly what's happend. Sometimes an MRI can also help, since it will visualize soft tissue more exactly. A simple x-ray is sometimes all that's needed. It all depends on the initial impression.

From the location of what does sound like a possible hernia, the pain could easily radiate to the other affected areas.

Hopefully you can prod your doctor to examine this more thoroughly or, failing at that, get a consult with a gastroenterologist or internist.

Best of luck to you. Hope this is helpful. Please follow up with us here.
 ravenous_wolf - Thu Oct 16, 2008 9:33 pm

UPDATE:

Doctor examined me again. He said that whatever was protruding from my rib cage was not a hernia but just a bone. I had surgery there over twenty years ago for a collapse lung and the doctor said that although it looked a bit unusual, it wasn't a hernia. And there was no pain to it.

He also examined me more closely again on my lower left side. He touched me where I felt pain but he didn't think it was a hernia. It hurts from my belly button all the way to my side but he didn't think it was any kind of hernia.

At first, he wanted a colonoscopy done but then he opted for an MRI first for this upcoming Monday.

Mr Kenyon, I know that you don't want to needlessly frighten me but what could the other possibilities be?

It just feels like there is a hand gripping me from inside, like from my belly button to my side. I was hoping that it was a hernia becuase that is common but now I am just wondering what it could be. They did a urine test and I came up fine so it is not infection. Any insight would be greatly appreciated and a kind thanks for your previous response.
 John Kenyon, CNA - Fri Oct 17, 2008 2:49 pm

User avatar Hi again -

Well at least it's not a hernia, so that's one thing to scratch off the list. Another one of those crazy coincidences that seem to happen all the time.

So what else could it be? There are a number of things, ranging from the very innocent to the relatively serious, but the law of averages says it is probably something on the lower end of the scary scale. That doesn't mean it couldn't be something further up the scale, only that the odds are against it. My main reason for equivocating about this isn't to avoid scaring you, since if I thought there was a distinct pattern that suggested something really bad I'd want you to know so you'd be motivated to get it fixed. The problem is there are a lot of possibilities, most of which, as I said, fall toward the lower end of seriousness. Even so, simple things can become complicated over time. One of the (admittedly vague) plusses is that most cancers don't announce themselves with pain. Usually there are other, even more disturbing symptoms that come first, which is why so often a malignancy is missed til it's advanced: unlike most things, cancer tends to start out quietly. On the other hand, you could have a gynecological problem, anything from an ovarian cyst (which is usually a fairly benign, though often pretty inconvenient problem) to a spastic colon, to a muscular injury without herniation, to fibroids, endometriosis, a foreign body (very unlikely, but let's try and cover some ground here), to a pinched nerve that's radiating to distal areas, which can be very confusing to the diagnostic process sometimes. While it is possible the symptoms you're having could signal something serious (meaning, I believe, "life-threatening") I honestly don't feel it sounds much like one of those possibilities but more like one of the things I've listed above. There are a good many other things, relatively innocent, which could be causing this also, but these are some of the things you'll need to have ruled out -- or in. Once this is done, the appropriate treatment can be instituted. It may take a good and dogged diagnostician to figure it out, but that's hardly too much to ask.

I'm glad it's not a hernia, because although those are usually not especially dangerous in and of themselves, they can develop serious complications at times, usually if not corrected in a timely way. Any of the other conditions I mentioned could conceivably require surgical treatment (the "annoying" part) but are not, in and of themselves, terribly serious. Pain, discomfort and worry, however, are often serious enough to disrupt one's enjoyment of life. That's reason enough to get to the bottom of this.

Keep after the doctors until this mystery is solved and the problem is managed. I don't think it's especially dangerous, based on the overall impression, but that's only one concern. You deserve relief from the problem, whatever it is.

I hope this helps somewhat. Sometimes the presentation is just too vague or there are too many possibilities, to point at something from a distance and say "Ah ha!" However, a peristent patient is a good match with a persistent doctor. Please keep us updated. I think it very likely you're in no immediate danger, but the only thing that's going to make this OK is to know exactly what's going on. Push for answers. As more facts come to light please don't hesitate to let us know.

My best to you. Please stay in touch.
 ravenous_wolf - Sat Oct 18, 2008 5:31 pm

MY TRIP TO THE EMERGENCY ROOM

Friday was quite a day for me because my employer was moving upstairs just one floor. However, since almost everybody got laid off, there is hardly a staff anymore (my managers are now out of state). And that Friday I was by myself so I put in a big effort to get the last of the stuff done.

By the time I got home I was exhausted but my wife was running out the door with our two boys to spend the night at her parent's place. That left me with the seven month old and she was cranky. It took a huge effort to get her to finally get to sleep. Then my wife comes home and has lots of groceries to unload so I help unload it.

It is already 9:15PM but not only was I exhausted, I felt that I pullled a muscle too many. I just felt so irregular by 9:45 I told my wife that I was going to the emergency room of a nearby hospital. However, their staff doesn't get to examine me until like 3:00AM. I could hardly walk and I felt a burning sensation of where that hernia so I thought that it must be internal bleeding. Anyway, the reason that I wanted to go was that I felt that sore spot on my side was going to explode and I also felt that there things inside of me snapping.

And I just felt I couldn't wait until Monday for the lab that my primary care physcian was sending me to for a CT scan. And then there was a SNAFU with my insurance and they denied the CT scan so I figured that it would take another day before my doctor and the insurance company sort it out. So I felt that I would wait until Tuesday or so to find out what was wrong with especially since I felt so weird.

The hospital runs a urine, blood test, and eventually the CT scan with that solution going through my body. I was bracing for the worst news.

And then by 7:45AM in the morning a nurse comes into the exam room to give me the results of everything.

I am perfectly fine!!!

The blood, urine, and CT scan showed that EVERYTHING was normal or within range of where it should be. In fact, the nurse was almost of the perception that I was wasting his and the hospital's time (although he didn't directly say that).

Now I am a typical male who is terrified to go to the doctor and I am afraid of medicine. In fact, it took so much courage to check myself into the emergency room and I only did it because I have three screaming kids ages four and under and I wanted to around for them when they grow up.

I am not a hypochondriac or into a lot of drama.

In fact, I don't know what happpened.

According the test results, EVERYTHING is normal. And they have absolutely no clue to why I am experiencing pain because all that results show that everything is normal. As for myself, I cannot refute science. If the results show that it is normal, then I have to assume that the pain that I am experiencing is imaginary.

My only clue may be a month ago when all this started, I made a conscious attempt to avoid anything on the left side of my body figuring that I would make this condition worse. Perhaps in thirty days, there was a lot of atrophy on the left side of my body because of how paranoid I was.

I am not some kind of freak that made this up but I have to accept the findings of science. So today I put more effort into my day (but not as much as Friday) and I am going to keep adding more effort so that the left side of my body is as worked out as my right side (but I won't overdo it like I did this past Friday).

The bottom line is that there is nothing wrong with me. The test results show that I am a normal person. At first I have to admit that I was more disappointed than relieved because the pain I have is so real. However, I am obligated to assume that it is in my head instead of being real.

This is a pretty big shock to me because I am so afraid of doctors and hospitals so getting stuck with needles and tested is not something I do for fun.

So anyway, this is the best possible outcome for me even though I am embarassed. I appreciate your time and effort in responding to my questions. Even though it is weird, that is the best possible outcome for me.
 John Kenyon, CNA - Sun Oct 19, 2008 7:21 pm

User avatar Well that was a frustrating trip! I'm honestly sorry they didn't find something -- even if it were something stupid -- so you'd have something to hang your hat on. The pain you feel is real. You may have had anything worrisome ruled out, and that's good news, needless to say, but that pain is still there. It may be something so odd and essentially wrong that there is no assignable cause, but that doesn't make it unreal. Hopefully it will slowly (or maybe quickly) resolve and then it can be laid to rest. But don't kick yourself for having done the prudent, reasonable thing. It's a shame it took so long and you came away feeling silly You shouldn't feel that way, but I certainly understand.

It is the best possible outcome, and for that we can all be grateful (especially you). Now the pain, serving no purpose, needs to go away. If it won't, then you'll need to have that managed. It may be, for some strange reason, an inflamed nerve or something equally innocent. Simple analgesics hopefully would help control it til it's run its course.

So I'm really glad to hear you're fine, but share your frustration. Thanks for the follow up. Enjoy your good health, minus the inexplicable pain.
 ravenous_wolf - Sun Dec 14, 2008 12:08 am

UPDATE - I HAVE BEEN DIAGNOSED

Shortly after my trip to the emergency room, a lot of things happened; some unrelated. My eyeglasses broke and the lenses were put in the wrong place; I have a lazy eye so years of aligning my eye went up in smoke so my eyes looked warped. I also started slurring a bit of my speech. I also had a bit of a limp when I walked. And then like my left side of my body was different. There was a bit of a burning sensation on my left elbow and there felt like something was grabbing me underneath my left rib cage.

And after I went to my in-laws Halloween party (almost 40 people were there), a few people told my mother-in-law and my wife if I had suffered a stroke.

In early November, my wife told me to go to the emergency room and get a CT scan of my head. At first, I didn't want to go because I had to prepare for a presentation at work and the customer was flying in to see it. I needed to work long hours and the weekend so I could be ready to present it but my wife was adament about it so I went and got checked out. What happened next was a month of hell.

I was immediately admitted to the hospital and spent a week there where I was poked and prodded and eventually given a spinal tap. The CT scan showed spots in my head and in my back. I had lots of test run and so much blood was taken of me.

Overall, the prime suspect was MS but the hospital tried to rule out other stuff like Lupus and Lyme disease. About the last test was the spinal tap and it had to be given twice because the first person who administered it was not able to get enough fluid out of me (it hurt like hell). And it took about three weeks to get the results from that but I was released shortly after the spinal tap.

In the meantime, my wife set up an appointment with one of the top neurologists in town who saw the test results (except the spinal tap) and strongly felt that I had MS. She gave me a strong anti-inflammatory (in an IV, about a gram a day for three days). Afterwards, she recommened that I stay in a rehab hospital for physical therapy and occupational medicine. My big concern was if I was ever going to go work again and drive my car again. Needless to say, I was scared. That second hospital, I stayed for just over a week. I was a mess because my balance was warped and my limp worsened. But I was different than the other patients. They wanted me in wheelchair but I refused. Instead, I used a walker. Several days aferwards, another therapists gave me a cane to use and I used it until I was released. I realized that a big part of this was emotional. My first shower there was a mess because I used the walker for it. However, as I got more confident, I didn't use anything. I eventually improved there was released after staying there for just over a week.

I saw the neurologist again and by then, the spinal tap results were ready which my wife picked them up and took them to the specialist. She confirmed that it was indeed MS so next week I will have to begin a regimen of injecting a medication every other day.

It was probably a "flare-up" at that time (I had one bowel and bladder accident and other stuff). For work, my employer was generous and understanding but the customer flew in to review my unfinished work. However, the meeting with the neurologist, the second time, I had my hair cut, I shaved, and wore nice slacks and a good shirt. She said that appearance-wise, I had greatly improved so she wrote a note releasing me back to work (next Monday) and to drive. It had been about 30 days of agony and fear but I am greatly improving. I don't use a cane or a walker now and I feel that my walk is greatly improving. I practiced driving this Saturday (my dad was with me).

I am totally ignorant about MS so any recommendations of web sites and literature will be greatly appreciated. I am still in shock. About four years ago, I went to a neurologist about a tingling sensation in my hands but he didn't listen to half of what I said. He thought that it was a vitamin defiency and believed that this would go away on its own. And since I am a technical writer, I thought that this could have been Carpal Tunnel Syndrome so I never took it to the next level of examination. I hope those years of delay didn't cause more harm. I am happy that I can go back to work and drive but I need to learn more about this disease.
 John Kenyon, CNA - Sun Dec 14, 2008 12:53 pm

User avatar What an incredible story! What a long, strange trip, too. What an ordeal for you. We started in October wondering about a hernia and here we are some months later with you having (finally) been diagnosed with MS. As I said early on, any sort of solid diagnosis would give you something to hang your hat on. At least now you know. And while I doubt the missed opportunity of four years ago has contributed to the advancement of the disease, it would have been great if that doctor had tried to rule out the more perplexing and serious things then, as you'd now be four years ahead of the program. But that is the past, and MS is often far from obvious.

Your story demonstrates very vividly how infuriatingly difficult it can be to diagnose MS. Managing it is often far less complex than figuring out it's present. MS and lupus are probably two of the most commonly missed or misdiagnosed diseases for this reason.

Your story is also a tremendous testimony to not quitting -- all along the way. You will most likely do exteremely well because of your innate determination to keep going. The other really bothersome thing about MS is the way it can flare up only to virtually disappear later, then show up again with some new and different symptom. The fact that you now know you have it will help you and your doctor together narrow down any future problems to MS or Not MS.

There are a number of helpful and supportive sources for sufferers of MS, but I think a great starting place would be the web site of the National MS Society, which offers a lot of basic information for patients and those close to them. The site can be found here: http://www.nationalmssociety.org/index.aspx

The society also publishes MS Magazine, a good source for keeping up with the latest advances in treatment and management of the disease. as well as lots of supportive stories, often from well-known people who are not well known to have MS.

Thanks so much for this incredible update. Many people will see this post and many of those will be inspired by your determination. This will be just one of the many silver linings to an obviously painful ordeal for you. Please stay in touch with us here at The Doctors Lounge and keep us informed of your progress.

I wish you all the best. You are an inspiration to us all.

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