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TWS - Surgery, Hernias, and Tabasco

Frank Simon • public
• 2 min read
TWS - Surgery, Hernias, and Tabasco
Photo by Mattia Bericchia / Unsplash

📝 Rx

Hi friends,

Just started my general surgery rotation this past week and it's completely unlike what I thought it would be like. I assumed surgery would be like the Reddit stereotype of crazy hours, pretty intense doctors and generally exhausting days, but it's been the polar opposite. Hours are good, docs are incredibly nice, and the operating room experience has been incredibly fun and engaging overall. To be fair, I'm only on this service for 2 weeks and then switch to a different location, but my entire perspective on general surgery has shifted to a very positive place and I wholly attribute this to my wonderful doctors and staff I've lucked out with.

🩻 Diagnosis of the Week

Inguinal Hernias

What is it:

A hernia in super basic terms is just an opening in the body that has stuff going through it. There are many types, but around 75% of abdominal hernias are inguinal. An inguinal hernia happens when there is either fat or intestine going through an opening in the groin area. Its called "inguinal" because the hernia opening is somewhere right above the inguinal ligament which is right along that "V" line that divides your abdomen and thighs.

If we want to get fancy, inguinal hernias are either "direct" or "indirect."

  • Direct: These go straight through the abdominal wall due to some weakness in the wall lining, and for testing purposes they are "medial to the inferior epigastric artery."
  • Indirect: These sneak in through a normal opening in the abdomen we have called the deep inguinal ring and are "lateral to the inferior epigastric artery." In men the testes go down from the abdomen to the scrotum through this deep inguinal ring opening and in women they have a ligament go through here.

Either way, both are fixed the same way in surgery if they are causing issues, usually with a mesh to close the hole.

Key signs:

  • A bulge in the groin area that increases in size if you stand up or flex your abdomen. The bulge can be "reducible" or "incarcerated."
    • Reducible → The bulge can be pushed back in through the hernia opening and it goes away temporarily.
    • Incarcerated → The bulge cannot be pushed back in through the hernia opening.
  • Abdominal pain with vomiting and nausea if the tissue or intestine going through the hole gets so constricted and stuck that it looses blood flow or blocks digestion.

🤓 Dose of the Week

Now onto the all important topic of Tabasco, which as I've come to find out is made in Avery Island, Louisiana. That's like 2hrs from where I live, so obviously I visited the factory over a weekend to have some Tabasco ice cream and check out the museum. It was genuinely a good trip, you can walk around the factory, eat at their official Tabasco restaurant, and tour their private botanical gardens.

More to the point, nobody I talked to when I got back, native to Louisiana or not, had any idea this place existed. I sent a photo to my group chat and people thought I was in China (lol). It's gotten me thinking about how many unique places are just nearby but we never see them because we focus so much on far away vacations (something I'm very guilty of).

So I did a long search and if you're keen on finding out what's right next door, I'd strongly recommend these websites to start, I've made my own Louisiana bucket list using these:

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