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Advancing Care - October 2022

hernia

That ache in your belly: Is it a hernia?

You spent the weekend moving and lifting heavy boxes, and now your abdomen hurts. Could that pain in your belly or groin be a sign of a hernia? Jonathan Blancaflor, MD, a surgeon with Lawrence + Memorial Hospital and Yale Medicine, describes the signs and symptoms and shares details about a free screening on Oct. 16 if you think you have a hernia.

A hernia is when an organ pushes through a weak spot in body tissue. It can develop between the muscles of the abdominal wall, the groin or the diaphragm causing a noticeable bulge along with pain – and it can be dangerous, said Dr. Blancaflor. “A hernia can be a serious issue because you can have a piece of bowel or intestine pushing through, which can lead to an obstruction or infection that requires emergency surgery,” he said.

Symptoms of an abdominal or groin hernia may include:

  • A bulge or lump you can see or feel in the abdomen or groin
  • Bulge that is more noticeable or uncomfortable at the end of a long day, when you have been on your feet
  • Aching pain or a feeling of pressure in the area
  • A tugging sensation in the groin
  • Pain or discomfort that gets worse with activities that put a strain on the abdomen, such as lifting, pushing, running, coughing or bearing down during bowel movements

Symptoms of a hiatal or diaphragmatic hernia may include:

  • Discomfort with large meals and a feeling of being full very easily
  • Acid reflux or heartburn
  • Chest pain
  • Episodic chest pain with meals, associated with difficulty swallowing and vomiting

It is important to call your doctor if you suspect you have a hernia. Wait too long and you could face a trip to the emergency room. A doctor typically can see or feel a bulge from a hernia during a physical exam, but some cases might require a CT scan, ultrasound or other imaging to diagnose the condition accurately.

If you think you may have a hernia, a free screening is available on Sunday, Oct. 16 from 9 am – noon at Lawrence + Memorial Hospital, 365 Montauk Ave., New London. Walk-ins are welcome; however, advance registration is recommended by calling 800-562-2537 or scheduling an appointment online.  Attendees will be evaluated for hernias by L+M surgeons and any appropriate follow-up care can be scheduled if needed.

The screening features interactive demonstrations of the hospital’s advanced da Vinci surgical robot, which surgeons use to perform same-day, minimally invasive hernia surgery. “The da Vinci Xi robot is the very latest and best available technology. It has opened new doors and given our Digestive Health team and patients new treatment options for even complex hernia repairs,” said Dr. Blancaflor. “We can do all of that right here at L + M Hospital.”

Advantages of robotic surgery include three-dimensional images of the inside of the abdomen (as opposed to the two-dimensional in laparoscopic surgery), smaller scars and less pain. After the procedure is completed, the surgeon closes the small abdominal incisions with a stitch or two or with surgical tape.

“Robotic surgery for hernia repair provides our patients a much faster, greatly improved recovery period,” Dr. Blancaflor said. “Patients can return to work and get back to recreational activities sooner with a lot less pain when compared to open surgery."

Lawrence + Memorial Hospital offers comprehensive digestive health services to diagnose, treat and help people manage a wide range of gastrointestinal symptoms and conditions, including all kinds of hernias. For more information about L+M’s Digestive Health services, call 860-443-3147.

Don’t get blindsided by dry eye syndrome

You’ve likely seen the commercials and you may have experienced the symptoms yourself: The gritty, itching, burning, achy symptoms of dry eye syndrome are real, and so is the battle. Have you tried virtually every over-the-counter product available? It may be time for a new plan of attack for chronic dry eye.

Dry eye, also known as dysfunctional tear syndrome, is a very common disorder that can be debilitating. The condition tends to develop with advancing age – between 10 - 30 percent of people over 50 are affected by it.  The most common symptoms of dry eye are irritation, redness and burning. Excessive tearing, in response to the lack of lubrication, can also be a sign of dry eye, as can discomfort wearing contact lenses.

“Some people have the sensation that something is scratching or that something is stuck in their eye,” said Anita Hwang, MD, an ophthalmologist with Lawrence + Memorial Hospital and Yale Medicine who sees patients in Waterford. “Dry eye is usually easily diagnosed by its symptoms, and the cause can usually be determined during a thorough eye exam by an ophthalmologist, without the need for invasive tests.”

What causes dry eye?

A host of things can cause dry eye, including diseases such as hypertension and diabetes; immune disorders, such as rheumatoid arthritis and lupus; and medications such as antihistamines, beta-blockers, diuretics, anti-Parkinson’s drugs and chemotherapy.

Dry eye can also be seasonal. During the winter when the heat is on, the humidity levels are much lower and the air is much drier. If people have very dry heat in their house and don’t have a humidifier, oftentimes, their eyes can dry out quite quickly. Seasonal allergies can also result in itching and irritation that leads to dry eyes, and medications to treat allergy symptoms can also have the same effect.

And for some working in front of a computer screen (or using other electronic devices) for long periods of time can also contribute to the symptoms. “When we are focused on a screen, we tend to blink less, which dries out the eyes,” Dr. Hwang said.

Treating dry eye

The treatment for dry eye depends on the cause of the condition. There are two main types of dry eye: One is called aqueous tear-deficiency, in which tears are not sufficiently produced to lubricate the eyes; the more common form is an evaporative type in which tears are produced but evaporate too quickly.

If you are producing tears but they are evaporating too quickly, warm compresses and Omega-3 fatty acid supplements may provide some relief.

Over-the-counter artificial tears can help if you are not producing enough tears. However, if you are using the artificial tears three to four times a day and you are still symptomatic, talk to your eye doctor about a prescription-strength medication option.

“People who tend to use artificial tears four times per day or more to keep their eyes comfortable may also want to switch to a preservative-free variety, because the preservatives can become irritating to the eye,” said Dr. Hwang. She cautions patients against using drops that promise to “get the red out” because regular use of these drops can make the problem worse.

Dr. Hwang also recommends eye-gel ointments at bedtime. “The nighttime ointments last longer than drops – but don’t use them if you typically get up to use the bathroom during the night because they will make your vision blurry and it isn’t safe,” she said.

If dry weather or indoor conditions are causing dry eye, using a humidifier — especially while running central heating or air conditioning — may help.

For dry eyes caused by too much time spent in front of a computer screen, Dr. Hwang suggests the “20-20-20” rule: after 20 minutes of focused work, move your gaze and look 20 feet away for 20 seconds.

Surgical options

If the at-home remedies don’t work, more invasive treatments may be necessary because severe dry eye can cause damage to the cornea (the transparent “window” at the front of the eye).

Punctal plugs are one option; these tiny devices are placed in the tear ducts to block the drainage canal, so that the tears stay around the eye. “We can block the tear-draining ducts so that the patient’s own tears are kept in the eye longer before they drain out, and that keeps the eyes better lubricated,” Dr. Hwang said.

Drainage ducts can be blocked by either using cautery (an agent used to sear tissue) or by inserting tiny silicone plugs into some of the ducts. Both procedures are done in the office. (Cautery is a permanent solution, but the plugs can be removed.)

Another option for treating severe dry eye is a scleral lens device, which is special contact lens that does not touch the cornea. Instead, the scleral lens rests on the conjunctiva (the white part of the eye) and rises above the cornea. Fluid is placed in the chamber above the cornea, allowing a layer of soothing fluid to rest on the cornea, bathing the area.

Future looks bright

Surgical options are uncommon – less than 1 percent of patients require surgery. Most of the time, dry eye syndrome can be controlled with medications.

“There is no cure for dry eye, but there are multiple therapies that we can use to control it and give patients a good quality of life,” said Dr. Hwang.

Screening is key to detect breast cancer

Breast cancer is the second most common cancer in American women after skin cancer – but millions of women are surviving the disease, thanks in part to regular screening, early detection and improvements in treatment. October is Breast Cancer Awareness Month, when women are encouraged to learn about the importance of early detection and how to reduce the risk of breast cancer.

“Compared to 15 or 20 years ago, the proportion of early-stage breast cancers we are seeing in our clinics is significantly higher. We can directly attribute this to the improvements in screening technologies, in mammography, tomosynthesis, breast MRI, breast ultrasound and computer-assisted detection methods over the last decade,” said Meena Moran, MD, chief of Breast Radiation Oncology for the Smilow Cancer Network. “Another major factor attributing to earlier detection over the last two decades is the overall increased awareness of breast cancer and the importance of screening in the general population.”

Medical oncologist Robert Legare, MD, medical director, Smilow Cancer Hospital Care Center at Westerly and Waterford, agreed and cited promising cancer therapies on the horizon.

“When I think of the next 10 to 20 years and how oncology treatment is evolving, our affiliation with Yale Cancer Center is tremendously exciting,” Dr. Legare said. “We are able to ensure our patients have easier access to cutting-edge clinical trials, immunotherapies, genetic counseling, second-opinion consultations, nutrition counseling, survivorship guidance and more at our Smilow Cancer Hospital Care Centers in Waterford and Westerly.”

When should you be screened?

The earlier cancer is detected, the better. Early detection improves the chances that treatment will be effective. The goal is to find cancers before they cause symptoms. We join the ACS, American College of Radiology, American College of Obstetrics and Gynecology in recommending that women of average risk who are 40 years and older should receive annual screening mammograms. Women who are at an increased lifetime risk of breast cancer may consider screening before age 40.

What constitutes increased risk? Women who have strong family history, known genetic mutations that are associated with breast cancer, and/or received chest radiation for other cancer or conditions between the ages of 10 –30. If you have any of these risk factors, talk to your healthcare providers about when and how to screen for breast cancer.

Schedule your mammogram online

An annual mammogram is an important, proactive way women can take care of their health. Mammograms are the best tests doctors have to find breast cancer early-- sometimes up to three years before a lump is felt.

Mammography is a type of imaging that uses low-dose X-ray to examine breast tissue. There are two types of mammograms:

  • Screening mammography is recommended each year to examine breast tissue and check for breast abnormalities.
  • Diagnostic mammography may be recommended to further examine an area of concern, lump or follow-up after a screening mammography.

Breast tomosynthesis, also called 3-D mammography, is used in a screening or diagnostic mammography. This allows the radiologist to view the breast in thin "slices" rather than as a whole, which improves the detection of lesions and reduces the need for additional views of the breast.

Yale New Haven Health offers screening mammography at 15 locations across Connecticut and one location in Rhode Island. No referral is needed at most locations if you are 40 years and older and have not had a mammogram in the last year.

Schedule your mammogram appointment online now

The Smilow Cancer Hospital Care Centers in Waterford and Westerly provide access to expert cancer care and treatment to patients and families in southeastern Connecticut, southwestern Rhode Island and the surrounding communities, including Fishers Island, New York. Learn more about the services offered at each location:

Smilow Cancer Hospital Care Center – Waterford

Smilow Cancer Hospital Care Center – Westerly

Laboratory services are open

Did your doctor order a test? We’re open for services. When your physician orders blood work, we make it easy with blood draw stations conveniently located in your community. A physician requisition form is required. All major insurance plans are accepted. Our blood draw stations honor requisitions from other labs. Please call 1-800-305-3278 for a list of locations near you. If you need help figuring out if lab services are covered by your insurance, call 1-888-542-2925 Monday – Friday from 8 am – 4:30 pm.

Find a Doc at L+M or WH

Are you looking for a physician? Call 833-346-3637 or visit our website’s Find a Doctor feature for information on physician specialties, office hours and locations as well as insurance plans accepted. Many of our physician practices offer telehealth video visits for your convenience.

Billing questions?

Yale New Haven Health offers financial counseling to patients and families. Spanish-speaking counselors are also available. To make an appointment with a financial counselor, call 855-547-4584.