Our Frequently Asked Questions were developed in response to the most common patient questions about health problems. If you have a question that we haven't included, you may want to check the reference areas for additional information, speak to your doctor, or send us an e-mail at: email@drmckernan.com

Heartburn, Hiatal Hernias, and Esophageal Reflux Disease 

• Q: What Causes Heartburn?
  A: Heartburn is caused by smoking, caffeine, alcohol and certain foods or drinks. It may occur or get worse after eating, especially a large meal, or lying down. Although many people who suffer from heartburn also have a hiatal hernia, heartburn is not caused by a hernia. While heartburn is typically not serious, the burning feeling that persons experience with heartburn, when accompanied by a sour-tasting fluid the the throat and difficulty in swallowing can be more serious. Its often caused by a health problem called gastro-esophageal reflux disease or GERD.
  Heartburn pain can also be mistaken for a heart attack. Usually heartburn pain is not associated with any physical activity and doesn't worsen with an increase in activity. Often the symptoms are the same and are hard to tell apart.
  
  
• Q: What Does Heartburn Feel Like?
  A: Heartburn is a burning feeling or pain in the chest, usually felt behind the breastbone. It sometimes moves upward to the neck and throat. It may last several hours.
  
  
• Q: What is GERD or Gastroesophageal Reflux Disease?
  A: It is a common health problem that physicians feel is caused by a hiatal hernia or when the lower esophageal sphincter or LES which is the opening to your stomach doesn't work well enough to hold food and fluids in the stomach and allows food and stomach juices and acids to wash back into the esophagus.
  
  
• Q: What Causes GERD?
  A: Factors such as aging, over-eating, coughing, vomiting, obesity, lying down, bending forward, lifting heavy objects, straining or pregnancy can bring on the disorder.
  
  
• Q: What Is A Hernia?
  A: Hernia occurs when part of an internal organ protrudes through an abnormal opening in the abdominal cavity. A hernia can result from a weakness of the abdominal wall due to a birth or congenital malformation, a trauma, aging or increased pressure.
  
  
• Q: What Causes A Hernia?
  A: Factors such as obesity, straining, heavy lifting or pregnancy can exert enough pressure on the abdominal cavity to cause a hernia.
  
  
• Q: What Are the Symptoms Of a Hernia?
  A: The most common symptom is a lump in the lower abdomen or a feeling of fullness. Most people find the fullness disappears if they lie down. This is due to the retraction of the hernia inside the abdominal wall. A catching pain when lifting or straining is also quite common. In addition, after standing all day, many find the pain becomes sharper or experience a continuous dull ache due to the increased pressure on the hernia.
  
  
• Q: I Have Chronic Hoarseness and Don't Smoke. Can This be Related to Reflux?
  A:Yes. You will need tests to determine for sure, but this is a common symptom in many patients who are unaware they have gastroesophageal reflux disease.
  
  
• Q: How Are Heartburn and GERD Treated?
  A: Doctors usually recommend trying lifestyle and dietary changes to treat both of these disorders. Avoiding certain foods and beverages such as citrus drinks, tomato products, peppermint, chocolate, fatty foods, coffee, alcohol, and spicy foods often helps. Also decreasing the amount you're eating or eating several hours before bedtime, dieting if you're overweight, getting more exercise, elevating the head of the bed 6-8 inches and quitting smoking also help many people.
  Over-the-counter medications, such as antacids brings some relief if not used long-term or abused. Doctors also prescribe other medications including H2 blocks to reduce acid secretions in the stomach, an acid pump to inhibit an acid-producing enzyme and motility drugs that quicken the emptying of the stomach after eating or drinking.
  
  
• Q: Is It A Serious Medical Problem?
  A: It can be. Sometimes GERD can have serious side effects or complications. Bleeding or ulcers can occur in the esophagus or the esophagus may narrow or stricture if it is scarred. When this happens it limits eating and swallowing. Also since the symptoms of GERD are so similar to those of a heart attack, many people do not recognize this serious health problem and pass it off as an attack of heartburn or their GERD.
  
  
• Q: What About Surgery To Treat My GERD?
  A: Some people may need or elect to have surgery because their reflux disease is severe or it isn't responding to medications and lifestyle changes. Surgical treatments for this disorder have been very successful in treating it.
  Today surgery can often be done using a less invasive method with quicker recovery and less pain. This surgery is done utilizing an instrument called a laparoscope and does not involve making a large incision into the stomach through muscles and tissue. Doctors use the laparoscope to look into the stomach and esophagus and pass other instruments through very small incisions in the stomach/esophagus to perform the surgery.
  
  
• Q: How Does the Doctor Determine If I Have Reflux?
  A: The doctor will perform a physical exam, have you complete a patient history questionnaire and speak with you about your symptoms. He/She will ask specific questions about your condition and then probably recommend that you have a series of medical tests, such as an esophageal manometry, esophageal endoscopy, diagnostic ultrasound, and barium upper GI test to provide him/her with additional information about how well your esophagus is functioning and how you are digesting foods. He/she then will determine if you have reflux.
  
  
• Q: How Can A Doctor Determine If A Hernia or a Damaged LES is Causing Reflux?
  A: Your doctor will perform a physical exam, talk with you about your symptoms, gather other information from your patient questionnaire and perform a series of medical test to determine what is causing the problem. These test would include: an esophageal manometry, esophageal endoscopy, diagnostic ultrasound, and barium upper GI test to provide him/her with additional information about how well your esophagus is functioning and how you are digesting foods.
  
  
• Q: My Gastroenterologist Has Not Recommended Surgery. I'm Tired of Taking These Expensive Medicines and Still Not Being Able to Eat What I Want. What Can I Do?
  A: Seeking answers from a surgeon is easy. You are not going to be pressured into surgery. Surgery is a more definite answer for some people. Results are statistically proven. Medications are no longer required in 90% of the cases where people have surgery to treat this disease. Many patients also go back to eating whatever they want within two-three weeks. Surgery certainly isn't for everyone, but increasing the quality of your life is a choice only you can make.
  
  
• Q: What Is The Treatment For a Hernia?
  A: If its determined that a hernia is causing your reflux disease, your doctor will often prescribe over-the-counter medications initially, such as antacids to bring some relief, if not used long-term or abused. Doctors also prescribe other medications including H2 blocks to reduce acid secretions in the stomach, an acid pump to inhibit an acid-producing enzyme and motility drugs that quicken the emptying of the stomach after eating or drinking. Since these medications cannot eliminate the hernia, they frequently are not long-lasting. If the symptoms continue, often surgery is recommended.
  
  
• Q: I Have Asthma and Have Wheezing at Night. Sometimes I Sleep in a Recliner for Comfort. I Also Often Have an Unusual "Taste" in My Mouth? What is This?
  A: Asthma sufferers have a high incidence of gastroesophageal reflux disease. The chronic reflux actually increased the asthma problem. In addition, medications prescribed for asthma actually increase reflux symptoms by relaxing the lower esophageal sphincter. Diagnostic tests can confirm this problem, and once it is surgically treated, you may significantly reduce your "asthma," which really is a complication of the reflux.
  
  
• Q: Will Surgery To Repair My Hernia or LES Hurt?
  A: Today surgical techniques are available that cause much less pain and discomfort than ever before. Fortunately, hernias and weakened LES are conditions that can be treated with this new technology. In fact, use of these new techniques has been so successful with hernia repairs, that most persons are only out of work for 7 to 10 days and are eating and functioning normally in three weeks. During the surgery, you will be given an anesthetic to insure you have no discomfort. After surgery, other medications will be available should be experience some slight discomfort. Most patients do not require extensive medication to avoid pain and discomfort following this surgery.
  Laparoscopic surgery may be used to repair the hernia or weakness/tear in the wall of the abdomen. This surgery is performed through several small incisions and specialized surgical instruments. It has less pain, a quicker recovery and lower risk of infection that the more traditional approach to surgery.
  
  
• Q: How Much Does This Surgery Cost?
  A: Costs for medical care vary throughout the United States and the world. In Atlanta, the cost for the physicians care for this procedure is about $3600. Hospital charges are $8000-$10000, and the Anesthesiologist's charges are $800-$1200. Since the surgery can vary slightly from person to person, its difficult to give an exact fee for the procedure.
  
  
• Q: How Long Will I Be In the Hospital For Surgery?
  A: You'll come to the hospital or outpatient surgery center on the day of surgery. You'll have your surgery, and recover usually for several hours before going home. Most persons are able to have the surgery as an outpatient and leave within 23 hours from the time they come for surgery.
  
  
• Q: Is This Surgery Covered by Insurance?
  A: Most insurance companies do cover this surgery; you'll need to check with yours to see if it is covered.
  
  
• Q: Dr. McKernan is Not Listed on My Health Plan Provider List. Is There Anything I Can Do?
  A: Dr. McKernan is a leader in the surgical endoscopy field. You may want to contact your provider to compare statistics from his background with those on your plan. In many cases, your carrier will approve an out-of-plan physician when the facts are outlined. When it comes to quality and surgical intervention, never settle for "no" as an answer.
  
  
• Q: How Long Does Surgery For A Hernia or LES Repair Take?
  A: About an hour to an hour and one half; the time can differ slightly from person to person. Dr. McKernan has performed over 700 cases and his average surgical time is 81 minutes, with 95% of patient leaving for home the morning after surgery.
  
  
• Q: Will I Have to Follow A Special Diet After Surgery?
  A: Yes, just for about 3-4 weeks. We recommend you eat fruits and vegetables, chicken and fish if you chew it well, gelatin, soup and broth. We recommend that you avoid red meat, orange juice, spicy foods, carbonated drinks, raw fruits and vegetables. You will feel full quickly after meals. It is better to eat small meals more frequently during the day than to try to eat too much. When you feel full, you need to stop eating immediately. You may experience gas initially after surgery. Usually products such as Gas-X, Digel or other simethicone preparations will bring relief.
  Some patients experience spasms after the surgery as their body heals. Slowing down while eating and taking smaller bites usually controls the problem. Over-the-counter pain relievers can also be used if needed.

Inguinal Hernia

• Q: What Is An Inguinal Hernia?
  A: Inguinal hernias are protrusions of soft tissue, such as a portion of the intestine, through a weak spot in a muscle, usually in the abdominal wall. Inguinal hernias occur where the abdomen meets the thigh in the groin region. Since hernias are weaknesses or tears in the wall of the abdomen, sometimes they are referred to as ruptures.
  
  
• Q: What Causes Inguinal Hernias?
  A: They typically occur two ways: first, by wear and tear over time and secondly from a weakness in the abdominal wall that is present at birth.
  
  
• Q: How Can I Tell If I Have An Inguinal Hernia?
  A: Hernias produce different symptoms or feelings. Sometimes you'll notice a protrusion in your groin area between the pubis and the top of the leg or feel pain when you strain during urination or a bowel movement or when you lift a heavy object. The pain can be sharp and immediate. Other times you'll just feel a dull aching sensation, a vague feeling of fullness, nausea or constipation; these feelings typically get worse toward the end of the day or after standing for long periods of time and may disappear when you lie down.
  
  
• Q: Are Inguinal Hernias A Serious Medical Problem?
  A: They can be. If the hernia can be pushed back into the abdominal cavity, it is referred to as a reducible hernia, which while not an immediate health threat, will require surgery to disappear. If it cannot be pushed back, it is called nonreducible. This is a condition that may lead to dangerous complications such as the obstruction of the flow of the intestinal contents or intestinal blood supply (strangulation), leading to tissue death. Intestinal obstruction produces nausea, vomiting, loss of appetite, and abdominal pain and usually requires immediate surgery. A strangulated hernia is very painful and requires immediate surgery.
  
  
• Q: Who Is Likely To Have This Medical Problem?
  A: Every year, more than half a million American men, almost one in twenty, will have a hernia that needs surgery. And while the number of women who have problematic inguinal hernias is much less, they are on the rise. Typically men are about 10 times more likely to get an inguinal hernia than women. Men are more susceptible to this type of hernia because of a residual weakness along the path (inguinal canal) where the testicles descended into the scrotum prior to birth.
  
  
• Q: What Does A Medical Evaluation of My Inguinal Hernia Include?
  A: You'll have a physical exam with a doctor, complete a medical history questionnaire and talk with the doctor about your symptoms.
  
  
• Q: How Is An Inguinal Hernia Treated?
  A: Various lifestyle and medical treatments often can help. Since hernias are caused by obesity, a serious program of weight control is recommended, especially if your weight is centered in the abdomen. Eating more fiber often helps reduce straining of the bowels. Getting more exercise, avoid standing for long periods of time and learning proper lifting techniques can strengthen the back areas or eliminate strain on the hernia. Since smoking often causes straining when coughing, it is also recommended that you stop.
  Doctors may also recommend that you wear a truss or supportive wrap to reduce pain and further damage. Since these approaches do not completely get rid of the hernia, often many people elect to have surgery to get rid of it.
  
  
• Q: What Is The Surgery For an Inguinal Hernia Like?
  A: Today surgical techniques are available that cause much less pain and discomfort than ever before. Fortunately, hernias are conditions that can be treated with this new technology. In fact, use of these new techniques has been so successful with hernia repairs, that most persons are only out of work for 7 to 10 days and are eating and functioning normally in three weeks.
  This surgery is done utilizing an instrument called a laparoscope and does not involve make a large incision into the abdominal cavity through muscles and tissue. Doctors use the laparoscope to look into the abdomen and pass other instruments through very small incisions in the abdomen to perform the surgery.
  
  
• Q: If I Have Surgery To Treat This, Can it Come Back?
  A: Yes, in some patients inguinal hernias return. However, it is very infrequent. Recurrency rates for Dr. McKernan's patients are less than 3%; national rates are 10% or greater.
  
  
• Q: Is This Procedure Covered by Insurance?
  A: Most insurance companies do cover this surgery; you'll need to check with yours to see if it is covered.
  
  
• Q: How Long Does This Surgery Take?
  A: Between 30 minutes and two hours depending on the nature of the hernia. The length of surgery will vary slightly from person to person. Dr. McKernan's average surgical time is approximately 64 minutes.