Different types of Hernias

Our new team member at Surgical Artistry, Hannah, did some studying regarding hernias, and this is what she wrote:

Dr. Lee and Dr. Wu operating together on a hernia.

Different Types of Hernias

Inguinal Hernias– The most common type of hernia. They occur in the inguinal canal. Inguinal hernias develop when abdominal tissue such as intestine or omentum, protrudes through a weak spot in the abdominal muscles and fascia. They do not improve on their own and can lead to life threatening complications.

Ventral Hernias– This is a hernia that appears at the site of a previous surgery incision. These can appear weeks, months, or even years after surgery and can be very small or very large and complex. If this hernia widens, it can be very difficult to repair. These have a high recurrence rate.

Femoral Hernias– Like the inguinal hernia, femoral hernias also appear in the groin area. These are common in women, but can also appear in men. These are usually the result of a pregnancy, or childbirth. A weakness in the lower groin allows the intestinal sac to drop into the femoral canal. Early repair is strongly advised for this type of hernia, as severe complications such as incarceration and strangulation are common.

Umbilical Hernias– Occur near or on the bellybutton or naval, which has a natural weakness from the blood vessels of the umbilical cord. In adults, umbilical hernias often do not resolve and will progressively worsen over time. This type of hernia is often caused by abdominal pressure due to being overweight, excessive coughing, or pregnancy.

Epigastric Hernia– These occur due to a weakness, gap, or opening in the muscles or tendons of the upper abdominal wall, on a line between the breast bone and the naval or umbilicus.

Hiatal Hernias– These are slightly different from other hernias because they are a weakness or opening in the diaphragm, which is the muscle that separates the chest cavity from the abdominal cavity. These hernias cause reflux of acid from the stomach into the esophagus, which can lead to heartburn, pain, and erosion of the esophagus.

Spigelian Hernia– A rare type of hernia in the spigelian fascia, lateral to the rectus abdominis muscles.

Obturator Hernia– A rare type of hernia that occurs in the pelvic floor. Much more common in women, especially elderly women. It is said that obturator hernias can be caused by pregnancy, which leads to lax pelvis muscles.

Other Hernia Terms

Strangulated – Squeezing the blood supply

Incarcerated- The hernia is not reducible

Reducible- The hernia can be pushed back without surgery

Summary of my nutrition talk to runners

  • Use weight as a guide to hydration

–I’m ok with 1 lb weight loss after running

  • Hydrate with water and/or fluids with some salt in it like coconut water or apple juice.

–And Yes, you can be on a liquid diet while running, you do not need to eat solids while running

  • Some people are heavy salt sweaters.
  • I’m ok with running on fasted state (empty) but well hydrated for up to 1 hour
  • Everyone is different and nutrition is complex, and talking about nutrition is akin to religion or politics. It’s not always one size fits all, and even as our own personal health changes, our diet needs changes. So it’s not one size fits all at all times.
  • The world of nutrition research is complicated by people with agendas.
  • I choose for my own health, plants and the associated carbohydrates with whole plants: legumes, grains, potatoes, rice, fruits.
  • I choose blender over juicer for fiber. We all need lots of fiber.
  • B12 is made by anaerobic bacteria. We need B12.
  • All plants have protein even rice.
  • Just a fun fact: 1 calorie of broccoli has more protein than 1 calorie of steak.
  • Yes, athletes need more protein, but they also need for calories. By naturally eating more calories, we will naturally make up for it in protein.
  • We were made to eat plants more so than cats. Cats have protein taste receptors on their tongues but they can’t taste carbohydrates.

Nutrition lecture for runners was given 2/11/17 at Doctors Hospital in Manteca, California.

Most doctors don’t get a Nutrition course?

Let me explain why:

But we get courses in the groundwork that explains nutrition: BIOCHEMISTRY

I was in medical school 20 years ago

I got my MD degree about 20 years ago, and we did have a fundamental course in nutrition but it wasn’t a heavy weight course as I remembered it, but important enough for me to feel that at least I could say that I’m one of the few doctors maybe?? that got a nutrition course.

Biochemistry is the mother of Nutrition

I know a lot of nutrition focused doctors around the world frequently quote that most doctors don’t get a nutrition course. That is probably true, however, it’s not the whole truth. Because, all doctors I know get several courses on BIOCHEMISTRY which is the MOTHER of Nutrition. Biochemistry is the groundwork for which helps us understand how our bodies work and how our bodies interact with nutrition. And there’s biochemistry of what happens when things go wrong like CANCER.  If nutrition were a course, it would be bundled into biochemistry. We all studied the biochemistry of humans, animals, bacteria, viruses, and plants. I think back when we were in medical school, I have a feeling that the very smart doctors who were in charge of our medical education probably felt that nutrition was somehow influenced too strongly by businesses and probably felt it wise to just teach us the basics of how to evaluate nutritional claims. Now that’s wiser than cramming down our throats some information that would change from time to time as we search for the truth. I believe that search swings like a pendulum around what is the truth or the “best practice.” So we’ll go from one wild extreme to the other and back and forth sometimes.

Smart doctor colleagues love biochemistry

Many smart doctors I know even have degrees in Biochemistry such as my wife, Dr. Tammy Wu – plastic surgeon, and Dr. Monica Wood – orthopedic hand surgeon.

As doctors and medical professionals, we should all embrace our biochemistry roots and apply it to nutrition

I have had a renewed interest in Nutrition and have had this interest for the past 7-8 years as I decided to transition myself to a vegan diet. But most of that interest comes from our skills in evaluating medical studies – which is a skill I was supposed to learn in medical school, and balancing that with the understanding and reviewing of the subject of biochemistry – which is the chemistry of life. I believe that my other physician colleagues in Modesto and in the world have similar interests especially as we come more and more to the conclusion that some of the best medicines come from nature. Even BOTOX comes from nature.

Modesto Kybella coming soon – is here as of July 7th, 2015

Update: Kybella is available at Surgical Artistry as of July 7th, 2015.

Visit my Kybella FAQ page.


I’ve been getting a few buzzing questions about Kybella for the neck.  It’s a form of mesotherapy for the adipose tissue in the neck area.  I’ve told patients that I’m waiting for a few things which include getting excellent education and training on the product and waiting to see about complications.  There is much to learn from others when a new product comes out.  I frequently think of these new items as a watchful waiting type of process.

I’ll have updates on Kybella coming soon for our Modesto practice.  Stay tuned!

Here’s a website from the FDA regarding Kybella.

Calvin Lee, MD
Modesto Surgeon with needles and injections.

What is Plastic Surgery?

Plastic Surgery De-mystified

By Tammy Wu, MD

Plastic surgery is such a common term that when one hears it, one knows what someone is talking about. But more likely than not, people will equate the term “plastic surgery” with “cosmetic surgery”. Due to the recent popularity of media coverage as well as shows portraying lives of plastic surgeons and some plastic surgeries (ie. Nip Tuck, Dr. 90210, etc), and shows that “give away” plastic surgery, such as The Swan, plastic surgery is no longer “hush hush”, as it was in the past, but is in the very forefront of everyone’s television and/or internet.

But what IS Plastic Surgery? What does it entail? Who performs them? How is it different from Cosmetic Surgery, or is it?

These are the questions that I will address in this article.

The word “plastic” in plastic surgery came from the Greek word, “plastikos”, which means “to give form or to mold”. Hence the specialty of plastic surgery encompasses the field of Cosmetic Surgery, but also Reconstructive Surgery. As a plastic surgeon, I was trained on doing both reconstructive as well as cosmetic surgeries. In fact, if one were to read the history on cosmetic surgery, one will find that many cosmetic surgeries have their origins in reconstructive surgery. Many discoveries for either new ways or methods for cosmetic surgery came from the field of reconstructive surgery. Therefore, it makes sense then that a surgeon who is well versed in reconstructive surgery would also be well-trained in the field of cosmetic surgery.

What then is Reconstructive Surgery? How is it different from Cosmetic Surgery?

Reconstructive Surgery, in general, is surgery that is performed on abnormal structures to improve function or appearance. The abnormal structure may have been a structure that someone was born with, termed “congenital”, or due to acquired causes or external events, such as trauma, infection, tumor, or other disease processes.  Some examples of congenital structures that plastic surgeons perform to reconstruct, or correct the deformity, include cleft lip and palate, hemangioma formation or other blood vessel malformations, or limb abnormalities, such as absence of a thumb.

Some examples of trauma reconstruction would be soft tissue or bony injuries from car accidents or boating accidents, falls, dog bites, as well as burn care and burn reconstructions. Then there are also the reconstructive surgeries that are performed to restore a structure either deformed or taken away by cancer, such as breast reconstruction for breast cancer, facial reconstruction due to cancers of the head and neck, or limb reconstruction due to limb cancers such as sarcomas. Many of these reconstructive surgeries sometimes will involve microsurgery, which is the usage of a microscope, in order to perform very fine detailed work to optimize the outcome of the surgery.

As you can see, just the field of Reconstructive Surgery is quite extensive.

What is Cosmetic Surgery then?  Cosmetic surgery is surgery that is performed to reshape normal structures to improve appearance.  Therefore, most if not all cosmetic surgeries are elective in nature, meaning that one does not have to have the surgery, because the structure or body part that one does not like, is not necessarily abnormal or nonfunctional; but one wishes to improve upon its appearance. That is also why when a surgery is considered “cosmetic” in nature, insurance companies do not cover or pay for them. The range of cosmetic procedures is extensive as well. They include areas of non-invasive topical treatments to less invasive treatments such as Botox ®, fillers, medium-level chemical peels, to invasive procedures that require anesthesia in order for the procedure or surgery to be performed comfortably for the patient.  The cosmetic surgeries may involve any body part from head to toe. From the head (hair transplantation), to the face (eyelid lift and face/neck lifts), to the chest (breast augmentation /lift in women and gynecomastia treatment in men), to the abdomen (tummy tuck, liposuction), to the thighs (thigh lift, liposuction, etc.), and shaping of calves with contouring liposuction or other modalities of treatment. Thus, it does seem that the possibilities are almost endless.

So, is it true then, that when one starts down the road of plastic surgery, one can’t stop? This is an issue which shoulders the responsibility on both the patient and the surgeon, to ensure that  the patient does not become a cosmetic surgery “junkie”. However, there are certainly situations in which multiple surgeries are planned for the safety of the patient. For example, when one has lost a massive amount of weight (, ie, > 100 lbs), one may be left with a lot of loose skin all over. Due to the extensiveness of some of these body contouring procedures to remove the excess skin, it is necessary to divide up the surgeries and do them in multiple stages, so that we can minimize the perioperative risks and optimize the patient’s safety.

In the next article on Plastic Surgery, De-mystified, I will discuss in more detail some of these reconstructive and cosmetic surgeries.