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April 11, 2020

3 Balls Are Not Better Than 2: Special Guest and General Surgeon Dr. Abikhaled Talks Hernias

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Donna Lee: 

Well hello there! You are listening to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee. And Dr. Mistry is a board certified urologist and I am a board certified co-host. We have with us our partner Dr. Lucas Jacomides. Thank you for coming in.

Dr. Jacomides: 

Thank you. Also, board-certified. Thank you, very much.

Donna Lee: 

That’s right. You are also board certified.

Dr. Jacomides: 

And the board thanks you, too.

Donna Lee: 

You can call us during the week at (512) 238-0762 and email us those questions. They’re amazing and we get them all answered right away. Again, our phone number (512) 238-0762. Armormenshealth@gmail.com is our website. I’m sorry, email: armormenshealth@gmail.com.

Dr. Jacomides: 

It is an email and a website, both.

Donna Lee: 

They are all the same, to make it easy. We have a special guest with us today and I know that you two know each other. Dr Jaccomides, why don’t you introduce our special guest?

Dr. Jacomides: 

Yes sir. With me today is my good friend Dr. John Abikhaled. Welcome John.

Dr. Abikhaled: 

Glad to be here.

Dr. Jacomides: 

Tell us what you do…what don’t you do?

Dr. Abikhaled: 

I’m a general surgeon, so I do a lot of different things, and sometimes people have a hard time getting an idea of what it is we do as general surgeon because it’s such a general term.

Donna Lee: 

It’s so general.

Dr. Jacomides: 

Don’t sell yourself short. You’re a good man. And most importantly, he’s an alumnus of the illustrious Rice University–fighting owls.

Dr. Abikhaled: 

Fighting Owls. Yeah, that’s right.

Donna Lee: 

Y’all are a hoot.

Dr. Jacomides: 

Your wife is a physician as well?

Dr. Abikhaled: 

She is, yeah.

Donna Lee: 

That’s right. Where does she practice again?

Dr. Abikhaled: 

She’s a gynecologist and she practices in Westlake. It’s called Westlake Gynecology.

Dr. Jacomides: 

The name of your practice, John is…?

Dr. Abikhaled: 

Austin Surgeons. We’re in central Austin. I’ve been with the group for about 16 years and have been in practice in Austin for over 20. You know, getting back to your original question, general surgeons, we do a lot of abdominal surgery, but we do other types of surgery, too. So we take care of breast cancer, we do the thyroid gland surgery, and these other little glands called the parathyroid glands that people have never heard of until they have a problem with them.

Donna Lee: 

…until they need to see you.

Dr. Abikhaled: 

We take and we fix hernias, we take out organs you don’t need, we do a lot of surgery termed laparoscopy. And so those are just a sampling of some of the things we cover.

Dr. Jacomides: 

Our worlds cross at parathyroid, because that’s what makes calcium and that’s what makes kidney stones. And it takes, sometimes it’s, patients are very happy when we find that they’ve been after their 5th or 6th stone. You go, “You know, your PTH or parathyroid hormone levels are very, very high. You should go see my good friend John.” Is that, is that one thing you’d like to do or is that one of the other areas you specialize?

Donna Lee: 

Yeah, what’s your favorite?

Dr. Abikhaled: 

Yeah, so I do a lot of parathyroid surgery and thyroid surgery. Those are some of my favorites. And then another area that I really enjoy is doing laparoscopy with what’s known as robotic surgery. The robot is actually a platform that holds our instruments as we do things inside the body through little keyhole incisions. It’s pretty amazing technology and a lot of fun. And then the other thing I do a lot of is I fix a lot of hernias.

Donna Lee: 

And for the guys listening, when do they know to call a general surgeon versus a urologist? Y’all fight that out.

Dr. Jacomides: 

Exactly. What do you, I mean, because most people instinctively and even a lot of primary care doctors, that’s a good question, because they don’t know. They think it’s the stuff “down there.” I don’t even know what you’re talking about, I don’t want to lay a hand on it…go see a urologist. And so then they call and we’d try to dance around and say, no, what you really need is Dr. Abikhaled. You need a general surgeon.

Dr. Abikhaled: 

And so if you’ve gone suddenly from 2 testicles to 3, you may have a hernia that you need to come see me about.

Donna Lee: 

Wow.

Dr. Jacomides: 

Well you could, that’s called the pawn broker sign, by the way. Have you ever seen the sign at a pawn shop? You know it’s called the 3 balls, you know the pawn broker sign. But that could also be used for medicine. But you’re right. If you don’t know, you see one of us and we’ll get you to the right doc.

Donna Lee: 

You see. Now we have more questions, I’m sure.

Dr. Jacomides: 

About pawn shops?

Donna Lee: 

Yes, about pawn shops and the 3rd ball syndrome.

Dr. Jacomides: 

Yeah. 3 balls, not normal…unless you had 4. I mean, that’s better, I guess.

Donna Lee: 

That’s a party.

Dr. Abikhaled: 

My mother-in-law apparently thought men normally had 3 balls, but that’s a different story.

Dr. Jacomides: 

Your mother-in-law. Can we elaborate on that a little bit? No?

Dr. Abikhaled: 

No, no.

Dr. Jacomides: 

Sorry.

Dr. Abikhaled: 

I’ll get in trouble.

Dr. Jacomides: 

Shannon, you’re listening to this. Remember this is entirely unedited. We’ll get that out later. Just kidding. We’re totally going to put that in. So tell us about that workup. A person comes in, a man presumably, with something in his balls. And he thinks that, you know, “I think I have a hernia.” Tell me about the surgery, maybe a little bit about the recovery, and some of the potential risks.

Dr. Abikhaled: 

I’ll start with what a guy might notice if he has developed a groin hernia or an inguinal hernia. That’s one of the most common types of hernias that men will develop and notice. The most typical thing is to look down while you’re taking a shower and you see a bulge in the groin area that wasn’t there before. It’s like a little lump, may feel like a little grape or an egg bulging under the skin. That can protrude on down into the scrotum itself and be right above the testicle or it can be just a little bit higher up, on the very lower part of the abdominal wall. And guys kind of figure that out. They look down, they see a bulge and often they will present us directly without a referral saying, “Yeah, I looked this up on Google and I think I have a hernia.”

Donna Lee: 

How fast does it come on? Like, is it like a tumor where it just takes forever and all of a sudden it’s there? Is it overnight?

Dr. Abikhaled: 

It can be either. What the hernia actually is, is a weakness in the muscle wall there. And it’s not due to being out of shape or having weak muscles. It’s due to a thinning or a separation of layers of muscles. And through that weakness, internal contents of the abdomen will begin to protrude. It can happen very gradually over many years. And I have patients who have had a hernia for many years and just we’re kind of used to it and it never really bothered them. On the other hand, sometimes people will be lifting something or working out at the gym or they’ll cough or sneeze real hard and it’ll just push it out all of a sudden, quite a bit more. And there’s this bulge there that suddenly has appeared that wasn’t there before.

Donna Lee: 

Is it typically really painful?

Dr. Abikhaled: 

Most often it’s actually not painful. It can be sore. If it’s very painful, that’s usually more of an emergency situation and that person may need to go to the emergency room even. Nut often they’re completely pain painless.

Dr. Jacomides: 

I think that’s an important question of when do you have to fix it? I mean, certainly, you know, I did 2 years of general surgery as part of urology training and certainly there are some hernias that absolutely have to be fixed even that day or that night. Tell us about that a little bit.

Dr. Abikhaled: 

If the internal contents is a piece of the intestine that’s bulging through the hernia and it gets caught or what we say “strangulated,” that’s an emergency, because the intestine can get damaged, and that has to be fixed before that damage becomes a serious.

Dr. Jacomides: 

And then if you haven’t had a bowel movement, if things get stuck in there, it’s just the wrong size, of course. And certainly that has to get done fairly urgently as well.

Dr. Abikhaled: 

Sure. It can lead to an obstruction of the bowels. And a person can get sick and start throwing up, things like that.

Dr. Jacomides: 

Not every hernia has to be fixed right away or if at all, if it’s not really bothering him, is what I’m hearing. But if you say, “Okay, I, this is starting to bother me. I don’t like the asymmetry. It’s getting in the way of my Speedos.” What are the ways to fix it? What are the options?

Dr. Abikhaled: 

We can fix it with open surgery, which would mean an incision in that area, just directly over the hernia. Or we can fix it with laparoscopy, where we’re going into the abdominal cavity through little keyhole incisions with a camera, camera and skinny instruments. And we can fix it from the inside that way. And it can depend on the type of the hernia, the size of the hernia, the, and particular characteristics of that patient. And sometimes, it’s preferential to do it one way or the other.

Dr. Jacomides: 

Yeah. And I think the other big question I would have, and I think our listeners would too, is the thought of mesh–you know, people see mesh in our world and urology for incontinence surgeries and pelvic prolapse and immediately start wondering which is the right [inaudible] to call. What are your thoughts about mesh, is this, you don’t hear as much these days about that. Is there something that if someone had mesh before they’re going to be needing to get it out or what are your thoughts?

Dr. Abikhaled: 

There’s been a lot of concern about mesh lately. We get a lot of questions about it. And I think that’s driven by a lawyer commercials that are on late night TV on the cable channels. Mesh was invented decades ago. And went into use because it helps hernia repair in 2 really big ways. Number 1, it was a lot less painful to fix a hernia with mesh. Before we had mesh, we just sutured things together under tension and it hurt a lot to pull tissues together. The 2nd problem was that the failure rate of the hernia repair was pretty high, about 20%, and with mesh our hernia rate is much, much lower, maybe 1% or 2% in for certain types of hernias. So less pain, higher success rate–those are great things. There can be complications with mesh and every patient should understand what those possibilities are and discuss it with their surgeon. But overall if you balance the risks and benefits of using mesh or not using mesh, our experience has taught us that mesh is better.

Dr. Jacomides: 

And then if you do the robotic surgery with mesh, what is their recovery like? They go home same day, I presume?

Dr. Abikhaled: 

Yeah. So, many hernia repairs are day surgeries, in and out, same day, up and around right away. I let my patients begin doing like cardio exercise after 2 weeks and I let people do weights beginning at 4 to 6 weeks after surgery. Many of my patients come back for their post-op visit and required no opiate painkillers at all. We use lots of local anesthetics and other things. They use Tylenol and Advil and avoid opiates completely for many patients. Yeah,

Donna Lee: 

Awesome.

Dr. Jacomides: 

That’s great. Well, that’s great, Dr. Abikhaled, Thank you so much for coming in today, and tell us how we can find you.

Donna Lee: 

Yeah, what’s your website again?

Dr. Abikhaled: 

The website is austinsurgeons.net. You can go online and look us up and find out a lot more about hernias and the other things that we treat.

Donna Lee: 

Awesome. And we’ll put this on our social media so you’ll have that information. If you have any questions for Dr. Abikhaled, you can certainly send them to armormenshealth@gmail.com. Our website is armormenshealth.com. Thank you so much for joining us. That was super informative guys.

Dr. Jacomides: 

Right.

Donna Lee: 

Now guys, now you men know where to go when something hurts down there.

Dr. Jacomides: 

Not every bulge is important, is bad know. You know, but don’t worry.

Dr. Abikhaled: 

Thank you. Glad to be here.

Donna Lee: 

Thank you guys.

: 

The Armor Men’s Help Hour. We’ll be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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