STAY WELL & SPARKLE: Gwo Gwen

You probably don’t remember a fearless, roadside preacher better known as Bouzai. He ministered in the light of portable lamp, hence his nickname. He was short. He was fat. He was full of fire. He turned many to righteousness, especially in the villages.

“There was a man named Moses,” He bellowed.

“La tay ni uh nom yo tay ka kiya Moses,” His interpreter shouted in turn.

“And Moses sowed his seed…” Rev. Bouzai continued.

“Ehpi Moses coud gwen li…”

The villagers were horrified! One has to appreciate the context of our local Patois to understand mistranslation of the words sow and seed, cut and testicle. In their mind, that Mr. Moses must have been a really messed-up man to do such a thing to himself?! After all, man!

Gwo gwen means enlarged testicle. Actually, in hernias, testicle size remains normal and unchanged. However, bowel dropping into the scrotum or testicle sac gives the confusing appearance of gwo gwen.

David declared in Psalms 139, “You formed my inward parts; you knitted me together in my mother’s womb.” For whatever reason, that knitting together is not always perfect, and congenital abnormalities do occur. Hernias are more common in males because there is a passage that the testicle drops through while the fetus is developing. This processus vaginalis is supposed to close by birth, but if it does not, babies can be born with hernias. Most surgeons prefer to wait until the baby has grown at least a year before operating.

Have you seen children with big navels? People used to think the exclusive cause was children being poor malayway, neglected, hungry, and crying all the time. Well, that’s just a congenital umbilical hernia. Socio-economic status has little to do with it apart from the fact that the poor are less likely to recognize the problem and seek surgical correction. Hernias occur most commonly in the groin (inguinal) but can also be epigastric, (the area above the navel) or incisional, at an old abdominal operation. Pregnant women may develop hernias because of the pressure on the belly wall, most often femoral, near the groin.

Throughout life, that underlying weakness or defect in the muscle wall may allow guts to push through. The result is a bulge, which can be painful. In patients with poor access to medical care, or who are terrified of doctors and hospitals, that sac can literally get bigger than a beach-ball and even extend below the knees.

I had an obese patient come to me in such a condition. For decades his penis was invisible, retracted at the base of a deep tunnel in that big, big, big paytan mound of flesh that had grow around and over it. When he did #1, the liquid bubbled out of that hole and he would catch it in a urinal. He lived alone with no one to encourage him to take care of himself. Needless to say his sex life was non-existent.

I knew better than to tackle that on my own. I referred him to the top hernia expert at Ohio State University where a team of surgeons operated on him. The expert later told me my patient spent a month in intensive care and almost died. But thanks be to God, his life was changed for the better. With our excellent district clinic system and efficient community nurses, I cannot imagine anyone in Dominica ever letting things get that extreme.

Unlike medical conditions like the common cold, a hernia does not get better or goes away on its own. It can only get worse, gradually or quickly. Heavy lifting itself does not cause the hernia, but can make an unrecognized hernia ‘pop’ and suddenly get bigger. Some senior citizens go through all their life of hard work only to develop a hernia after an episode of intense coughing from the flu or emphysema. Other causes in the aged include an enlarged prostate and straining at the stool from chronic constipation. In the old days people wore trusses, special pads on jock-straps or attached inside the underwear to keep the hernia in place. These were not very effective and hernia sufferers often succumbed to life-threatening complications discussed later.

Many people endure hernias for years. At an early stage, it may pop out and go back in by itself (spontaneously reducible). Later on, it has to be pushed back in (manually reducible). At this point some patients play with it like some party trick. “Hey, let me show you that!”  It’s soft and squishy and oftentimes not painful at all. Size does not always equal pain. If you have ever known someone with a hernia, you may have wondered how come some small ones can be quite disabling, while some large ones may not be bothersome at all.

Unfortunately, hernias can progress to irreducible or incarcerated, and eventually, to strangulated. In this case the bowel not only gets stuck, but also twisted and swollen. No bowel contents can pass through. The belly rapidly becomes distended and exquisitely painful – a surgical emergency. A nasogastric tube must be passed into the stomach to decompress it. Only surgery can prevent the bowel from turning to gangrene, causing a raging sepsis and ultimate demise.

Various kinds of innovative patches have been developed to reinforce hernia repair. Even today, however, there is no technology better than a well-trained surgeon to securely hand-sew back these tissues together. A small percentage of hernias do recur. Mostly, it is because people cannot resist getting back to their usual activities before the month or so of recovery time ordered by the doctor. Just bear in mind that each time a hernia recurs, it becomes more difficult to repair. Fortunately, in Dominica today, the vast majority of hernias are easily diagnosed and routinely taken care of once and for all.

Dr. Sam Christian is a US-trained surgeon who runs the Urgent Care on 137 Bath Road, Roseau. He is author of the faith and fitness book, Mannafast Miracle and can be reached at 613-8345 or[email protected]