Dekalb Surgical Associates

12/04/2025

“I lifted something heavy and felt a painful groin bulge that went away. Is that a hernia?”

Very likely. What you describe—a sudden bulge in the groin with discomfort after straining that then slips back in and the pain eases—is classic for a reducible inguinal hernia. A hernia is a weakness in the abdominal wall that lets tissue push out when pressure rises (lifting, coughing, standing), and slide back when you lie down or relax.

Is this an emergency? Not if the bulge went away and you’re feeling mostly fine. It is urgent if a bulge becomes stuck out and is painful, firm, or discolored, or if you have nausea/vomiting, fever, or belly swelling. In that case, lie down, try gentle steady pressure or ice for a few minutes—if it won’t reduce, go to the ER.

What to do next
• Schedule an exam. We can usually confirm the diagnosis while you’re standing and coughing. An ultrasound is sometimes helpful if the bulge is shy. If you have had this sort of episode which caused a lot of pain briefly, we would typically want to confirm the diagnosis and then recommend you plan for an elective repair of the hernia.

• Activities now: You don’t need blanket restrictions just because a hernia exists. Do your usual activities as tolerated; let discomfort be your guide. If routine life starts causing bothersome symptoms, that’s a good reason to plan repair so you can return to everything you enjoy without guarding.

Treatment choices
• Watchful waiting might be considered if symptoms are mild (for men).
• Surgical repair is recommended when pain or limitations creep in. Options include open repair (can be done with local anesthesia and light sedation, avoiding general anesthesia) or laparoscopic repair (often best for both sides at once but typically uses general anesthesia). We’ll tailor this to your goals.

Note: In women, we lean more toward repair sooner because femoral hernias are more common.

Bottom line: Your story sounds like a hernia. It’s not an emergency if it reduces and you feel okay, but let’s examine it and plan the approach that fits your priorities.

11/18/2025

What's Behind the Estrogen Black Box Warning Removal?

Just last week, the FDA made a major announcement regarding a black box warning on estrogen products. The black box warning has to do with increased risk of breast cancer for anyone using these products. This warning dates back about 20 years, and the FDA, with RFK Jr. in support, has retracted the alleged increase in breast cancer risk.

I thought it would be worthwhile to review the data which dates back over decades. It can be overwhelming, and a brief article perhaps won't do justice to the entire subject. But hopefully, I can capsulize some salient points for you.

I will start with the take home points:
This announcement is most helpful for women who have had a hysterectomy and have no history of breast cancer. This group should consider taking an estrogen supplement beginning with onset of menopausal symptoms, without fear of increasing their risk for breast cancer.

If you have a history of breast cancer, estrogen usage still comes with some risk, so still best to avoid, except for vaginal estrogen products for treatment of vaginal dryness and related symptoms.
If you have an intact uterus, there’s not too much in this news for you. If you have menopausal symptoms, you can take estrogen with progesterone, but there is a slight increase in breast cancer risk.

Brief History of Estrogen Supplements

Estrogen was first isolated in the 1920s and then was able to be extracted from the urine of horses for commercial production of estrogen as replacement therapy. It was first used for treatment of menopausal symptoms in the 1930s. Conjugated estrogens were sold as Premarin in the 1940s (and is still widely prescribed) and enjoyed widespread use in the 1950s. It was often prescribed indefinitely following menopause, with the presumption that it would extend youthfulness and femininity.

It was not until the 1970s that it became apparent that use of estrogen over time increased the risk for developing endometrial cancer. This risk, of course, was not an issue in women who had undergone a hysterectomy. For those with an intact uterus, it was reported that adding a small dose of progesterone to the estrogen eliminated the risk. And still today, if estrogen is used for menopausal symptoms in a woman with an intact uterus, the recommendation is to take estrogen with added progesterone. This is an important point that seems to have been lost in the publicity surrounding this recent announcement. Women with an intact uterus should not be taking estrogen by itself, rather estrogen combined with progesterone.

Estrogen enjoyed a very good reputation for all sorts of benefits through the 1970s and 1980s: for the relief of menopausal symptoms (most notably hot flashes and night sweats, vaginal dryness, and mood swings); the maintenance of bone density to prevent osteoporosis; and presumed improvement in cardiovascular risks. However, in parallel with the findings of increased risk for endometrial cancer, some early studies raised concerns about increased breast cancer risk as well.

Data Leading to Black Box Warning

These concerns led to several very large studies (the Nurses' Health Study, the Women’s Health Initiative Study (WHI), and the Million Women Study), designed to prove, if possible, one way or the other, whether hormone replacement therapy increased the risk of breast cancer and whether it decreased the risk for cardiovascular disease. Results reported at about the 5-year mark showed an increased risk for the development of breast cancer in women who were on estrogen, and in women who were taking combined estrogen and progesterone. Furthermore, there was reported an increase in cardiovascular risk as well. These landmark studies were the premise for adding the black box warning regarding increased breast cancer risk to virtually all estrogen products in the early 2000s.

Over the past twenty years, longer-term follow-up has found that what appeared to be an increased risk for breast cancer early on goes away if you follow these women over a longer time frame, and importantly, there appears to be no increased risk for dying of breast cancer. But it is important to be aware that taking both estrogen and progesterone, particularly over prolonged periods (e.g., ten years or more), definitely has an associated increased risk for breast cancer. Also, regarding cardiovascular risks, though more “events” might occur early on, there is no increased risk for death from cardiovascular disease.

As is often the case, published studies often have conflicting or nuanced results, and one really must dig into the data to come to trustworthy conclusions. I will try to summarize the conclusions I have come to in my review.

Summary Points

1) Estrogen comes in a wide variety of formulations and of varying compounds, and one cannot attribute the same risks and benefits to each one. The safest product is vaginal estrogen applied specifically for symptoms of vaginal dryness and dyspareunia (painful in*******se). There is no increased risk for breast or other cancer with these products. Its use is still not recommended in women who have a history of breast cancer, although it may be safe in those women as well.

2) The purported increased breast cancer risk attributed to estrogen was clearly overblown with the black box warnings added to all products 25 years ago. Estrogen by itself for menopausal symptoms appears to be safe. Furthermore, more recent reports have even found a decreased breast cancer risk with unopposed estrogen. For women who have had a hysterectomy and no history of breast cancer, I think there is compelling data to take estrogen, especially if menopausal symptoms are present. Benefits appear to far outweigh any risks in most women.

3) For women with an intact uterus, taking estrogen by itself is not an option due to the increased risk for endometrial cancer. For the general population, annual incidence of endometrial cancer is 28 per 100,000 women per year. Use of unopposed estrogen appears to double the incidence. This would mean that instead of 280 cases of endometrial cancer per 100,000 women over 10 years, there would be 560 cases. That added risk is just too high to consider this option.

4) For women taking estrogen with progesterone, the estimated increased incidence of breast cancer is between 8 and 18 cases per 100,000 women over 10 years. The general population has a breast cancer incidence of ~280 cases per 100,000 women over 10 years. So for women taking estrogen with progesterone, which is the only option for women with an intact uterus, the number of women with breast cancer would increase from ~280 to ~ 292 per 100,000 women over 10 years. I think most women and physicians would consider this an acceptable risk if there was strong enough reason to prescribe it, ie, significant menopausal symptoms.

11/07/2025

“Do I really have to avoid heavy lifting for 6–8 weeks after hernia surgery?”

Short answer: not necessarily. Restrictions vary by surgeon and by the specifics of your repair, but my guidance is activity as tolerated—even in the first week.

Our rule of thumb:
If it doesn’t hurt too much, it’s probably okay. That includes walking, stairs, driving, and even lifting. Pain is your body’s built-in governor; it limits you before you can harm the repair. We sometimes tell patients: if someone tried to “prove” they could disrupt a well-done repair, they’d find it nearly impossible—the pain would stop them first.

What to do early on (days 1–7):
• Walk frequently and climb stairs as needed.
• Drive when you’re off narcotic pain meds and feel safe reacting quickly.
• Lift everyday items; increase gradually, guided by comfort.
What to avoid for 4–6 weeks:
• Bicycling in traffic (quick twists/braking can be risky while sore).
• Ladders (falls and sudden core strain are the real enemy).
• Any activity that causes sharp, escalating pain at the repair site.
Why this works:
Modern repairs are strong from the start. The main risk isn’t the act of lifting—it’s overriding your pain signal or taking a fall. Let discomfort be your speed limit and you’ll naturally progress without setbacks.

When stricter limits may apply:
Large or recurrent hernias, complex reconstructions, or significant medical issues may warrant a slower ramp. Always follow the specific plan you and your surgeon agreed on.

Bottom line:
You don’t need a blanket “no lifting for 6–8 weeks.” Move early, add activity as it’s comfortable, avoid higher-risk situations like traffic biking and ladders for a few weeks, and let pain be your guide. If something feels wrong—worsening pain, swelling, redness, fever—contact your surgeon.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

Send a message to learn more

11/03/2025

“I have hernias on both sides, but only one bothers me. What’s my best option?”

Great question—and there isn’t a one-size-fits-all answer. Here are the practical choices and how to think about them:

1) Watchful waiting (for older men with mild symptoms).
If the discomfort is occasional and not limiting, it’s reasonable to monitor both hernias. Many men choose this for months or years and decide on surgery only if pain increases. Seek urgent care if a bulge becomes painful, stuck, or firm. (Note: because women have a higher risk of femoral hernias, we usually don’t recommend watchful waiting for women.)

2) Fix the symptomatic side only.
An open repair through a small groin incision can target just the side that bothers you and can often be done with local anesthesia and light sedation (no full general anesthesia). This is appealing if avoiding general anesthesia is a priority or if you want the shortest, most focused procedure now.

3) Repair both sides in one operation.
If you want to “one-and-done” it, a laparoscopic (or robotic) repair treats both sides through the same tiny incisions. This typically requires general anesthesia and can offer a smooth early recovery—especially helpful if you’re active or your job is physical.

An open approach can still be used to repair bilateral hernias, using 2 separate incisions, so one can still avoid general anesthesia if desired in this situation. Some surgeons recommend staged repairs, one side, then waiting some weeks before repairing the other if done open, but we are comfortable repairing both at the same time.

How to decide
• Your priorities: Avoid general anesthesia? Prefer to fix both at once? Need a quick return to work?
• Hernia details: Size, reducibility, side(s) involved, and prior repairs.
• Health history: Previous abdominal/pelvic surgery, medications, and overall fitness.

Bottom line: All three paths are reasonable. If you want to avoid general anesthesia and only one side hurts, open repair of the symptomatic side is a strong option. If you’d like both fixed now with minimal incisions, laparoscopic repair makes sense, or “open”, to avoid general anesthesia. Let’s review your exam and goals together and choose the plan that best fits you.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

Send a message to learn more

10/29/2025

“Can you fix my hernia without mesh?”

Short answer: sometimes, yes—but it depends on the type and size of your hernia and your goals for recovery.

What “mesh” means.
Mesh is a medical patch used to reinforce the abdominal wall. For many adult hernias—especially larger inguinal (groin) or umbilical hernias—mesh repair lowers the risk of the hernia coming back. Most people do well with mesh, but some prefer to avoid it.

Non-mesh (tissue) repairs.
There are time-tested techniques—(some of them are named after a surgeon who first described them) like Shouldice, Bassini, or Desarda for inguinal hernias—that use your own tissue to close and reinforce the defect with sutures. These are typically done through a small open incision and can often be performed with local anesthesia and light sedation (no full general anesthesia). For small, first-time hernias in patients with healthy tissue, this can be a very reasonable option.

Trade-offs to consider.
• Recurrence: Non-mesh repairs can have a higher chance of the hernia returning, particularly for larger defects or heavy-lifting lifestyles. For ventral hernias (those in the midline of the abdomen) we would typically discourage a non mesh repair, because of such a high risk for recurrence.
• Recovery: Early discomfort is similar. Return to light activity is usually quick in both, with gradual increases over a few weeks.
• Anesthesia & scars: Open tissue repair can avoid general anesthesia and uses one small incision; laparoscopic mesh repairs use several tiny incisions but typically require general anesthesia.
• Hernia type: Very small umbilical hernias may be closed with sutures alone; larger ones usually benefit from mesh to stay durable.

Bottom line: If avoiding mesh—or avoiding general anesthesia—is a top priority, tell your surgeon. We’ll examine the hernia, review your medical history, discuss your work and activity goals, and offer a personalized recommendation. In many cases you do have a non-mesh option; in others, mesh offers the best long-term durability. The right choice is the one that fits your priorities and anatomy.

Send a message to learn more

09/11/2025

Mount Vernon Anatomy: Surgery & Salad students went hands-on with robotic surgery at Intuitive Surgical, observing live procedures, practicing on simulators, and connecting classroom learning to the future of medicine.

08/14/2025

Got a hernia but avoiding surgery?

"I Have a Hernia but Don’t Want Surgery. Is It Okay Just to Use a Truss?"

A truss (support belt) can make you more comfortable—but it won’t fix the problem.
⛔ The hernia is still there.
⚠️ It can get worse.
🚨 In rare cases, it can become an emergency.
👉 In this post, learn:
• When a truss can help
• The signs you need urgent care
• Why surgery is the only permanent fix
📌 Your comfort matters—but so does your safety.

A hernia happens when part of an organ—often the intestine—pushes through a weak spot in the muscle wall. This can cause a bulge, discomfort, or pain. Many people wonder if they can avoid surgery by using a truss or hernia belt.
A truss is a supportive garment that holds gentle pressure over the hernia to help keep it in place. It can make you more comfortable and may help you do daily activities without pain. However, a truss does not fix the hernia. The weak spot in the muscle is still there, and the hernia can come back out as soon as the truss is removed.
In most cases, surgery is the only permanent way to repair a hernia. Without surgery, the hernia may grow larger over time and cause more symptoms. The biggest risk is that the intestine can become trapped (incarcerated) or have its blood supply cut off (strangulated). This is a medical emergency and needs immediate surgery. Warning signs include sudden severe pain, redness over the bulge, nausea, vomiting, or inability to pass stool or gas.
If you are not ready for surgery, using a truss can be a short-term option, especially if your hernia is small and not causing major problems. But you should talk to your doctor to make sure it’s safe for your type of hernia. When you ARE ready for surgery, check out our website to see your options. We’ve got you covered!
Bottom line: A truss can help with comfort, but it’s not a cure. The safest long-term solution is surgical repair before complications happen.

Send a message to learn more

03/03/2025

As of March 1st, our office has moved to the Montreal Medical Center, Suite 303, 1462 Montreal Rd, Tucker GA 30084. Still the same doctors and staff, at a more convenient location, just off Lawrenceville Highway inside I-285. There is lots of convenient free parking behind the building. We look forward to seeing you there soon!

Send a message to learn more

02/28/2025

Our phones are back up!! They are on answering service but you can leave a message! Thank you for your patience!

02/28/2025

Our phones are currently out or order. We are working on the issue. Hopefully they will be back up soon! We apologize for any inconvenience.

09/12/2024

The Effect of GLP-1 Drugs on the Stomach (Gastroparesis) and Risks for Surgery

What are GLP-1 Drugs?

GLP-1 drugs are medications often used to help people with diabetes or those trying to lose weight. These medications work by controlling blood sugar, slowing down digestion, and helping you feel full longer. Some common GLP-1 drugs include Ozempic, Trulicity, and Wegovy. These drugs are being prescribed much more frequently in the past few years.

What is Gastroparesis?

Gastroparesis means that your stomach empties food more slowly than normal. This can happen when the muscles in the stomach don’t work properly. GLP-1 drugs can cause this to happen because they are designed to slow digestion. For most people, this effect helps with weight loss and blood sugar control.

Why is This a Problem for Surgery?

When you have surgery, doctors want your stomach to be empty. This is because food in the stomach can cause complications like aspiration, which is when food or liquid accidentally gets into your lungs during anesthesia. Aspiration can be dangerous, leading to serious breathing problems or infections like pneumonia.
Since GLP-1 drugs slow down how fast your stomach empties, there is a risk that food may still be in your stomach during surgery, even if you haven’t eaten for several hours. This raises the risk of aspiration and other complications.

What Should You Do Before Surgery?

If you are taking a GLP-1 drug and have surgery scheduled, it’s important to talk to your doctor. Your doctor might tell you to stop taking the medication for a full week before surgery to give your stomach time to empty completely. Always follow your doctor’s instructions and let the surgical team know about any medications you are taking.

In Summary

GLP-1 drugs can be very helpful for managing diabetes and weight loss, but they also slow down your digestion. If you are going to have surgery, make sure to discuss your medications with your doctor to avoid any risks during the procedure. This way, you can help ensure a safe and smooth surgery.

06/21/2024