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future of inguinal repair and PT
I am curious why there isn’t more pre-surgery (inguinal hernia) pelvis/posture analysis as well as PT aftercare? I realize there is a wide range of possibilities with the surgery and patient responses but it seems like there should be more. In my mind, this accomplishes a couple of things, especially with a surgery that has a high number of known complications.
1) It gives patients emotional/cognitive support.
2) Pre-tests could identify biomechanical/morphological issues that could be problematic during recovery and maybe worked on in advance of the surgery.
3) PT aftercare could help gauge a patients recovery better as well as provide better guided feedback.
#3 was especially surprising for me after my surgery. Every time I talked to doctors I was told to sit and wait longer and the pain will just resolve. If I went in for just about any other surgery for a moving part, ie shoulder, knee, hip, foot, etc, then there would be PT afterwards.
Perhaps I should have looked longer for someone who advocated for more involvement in my care but I did do some research and my post care treatment didn’t seem unusual from other recommendations – two weeks off of work and don’t lift over 10 lbs for 6 weeks and walk and exercise as the pain permits.
Is it a matter of doctor preference or maybe no there is no existing PT protocol for hernia repair? Do other abdominal procedures experience the same rate of complications as inguinal hernia repair? Do insurances not want to cover additional care accepting that 10-20% complication rate is fine in their cost-benefit analysis?
I realize there are too many questions here to answer and I know there is no single answer but, in hindsight, these are some of my surprises. Things seemed pretty hands-off after a major surgery.
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22 Replies
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future of inguinal repair and PT
How are you doing now? Have you continued on a physical therapy regimen? Does stretching help? Have you tried other treatments to address your pain? How have you progressed?
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future of inguinal repair and PT
quote :Honesty is a hard thing to come by these days, especially by surgeons who have a conflict of interest. To make money they have to perform surgery but sometimes it may not be in your best interest. How sad.Not all surgeons are like this. For example when I met Dr. Goodyear last year, he was doing 3 or 4 surgeries a day and at this age, I do not think he needs to work at all but he does. He can retire very happily. From what I see in the insurance statement they paid him very minimum amount for surgery whereas hospital got more dough (for nothing). This is the main reason not all surgeons are the same.
I met a local surgeon but that guy was scratching his head and beard when I asked him the material the mesh is made of. Mind you, this local surgeon was referred to me by an office colleague. I did not like to put my sensitive area in a surgeon’s hands who does not even know what the mesh is made up of! But just reading the details of Dr. Goodyear I went straight to him after talking on the phone. I met him for 15 min before surgery, had it fixed in 1 hour and walked out. Yes the local surgeon said I can walk out too but you can see how much he knows even after you talk to him for 30 min.
BTW how did you decide which surgeon to go to? Referrals from friends? Did you check about his rating? Talked to anyone about that surgeon? All I can tell you is, surgeon usually may NOT be at fault. After an alien material is put in body (which is a gaurded and closed environment) NOBODY on the face of earth can tell you how YOUR BODY reacts to it. All they can do is, “majority of people is doing good, so should you.” It is a generic conclusion. Thats why they say “Each case is different.” How do you know surgeon messed it up? How do you know what is happening in your body? Find details and fix your problem aand then with all results you have the right to throw dust on anyone you like. Till then I would not conclude so easily.
Yes there are people who do surgeries for money but the one I met is NOT the one who does for money. Thats 100% sure.
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future of inguinal repair and PT
Groundfaller
I sense a lot of disgust and negative thinking in you. Beleive me I can think (and usuaully do) worse than you but over the years (due to age?) I decided that negative thinking is taking me nowhere. You, IMHO are concentrating on the problem. Instead, shift your idea to find a solution. Yes the surgery was done and no matter how hard you try you will never be the same like when you were 17 years old. That fact you must accept. Life is NEVER smooth to ANYONE. It always and regularly throws curveballs that hit us hard where it hurts most. But if all you want to do is to rue about what already happened, you are —- in the words of Joel Osteen (Caution: I am not preaching, I am not a christian but just like Joel)“You are pulling up the chair, with popcorn and recollecting all the movie that happened before again and again and making yourself miserable.”
From your posts we all know how bad your condition is. YES it is bad BUT If you want to get better, you must stop rueing and ACT. Find a way. Is money your problem? Is pain your problem? Talk to the doctor who you trust, explain about the money problem and make a payment arrangement or do something. Posting here, and on NHPI and everywhere on internet is NOT a solution for you. It may help others but what about you? Or even ask for money from public help/local church/cloud funding/even your bank for a loan or whatever it takes. People are usually helpful and pitch in.
I have gone through much worse but ultimately you are the one in hole and have to find a way to get out. If you are interested to stay in the hole with popcorn, chair and watch the old movie repeatedly, go ahead. It is your life. In the words of a famous monk, “If you want to be happy nobody can make you unhappy and if you want to be unhappy, nobody can make you happy.” But please recognize that after a couple of repeated posts from you people get bored and will stop commenting or helping.
Decide to be happy, find a solution, fix it and move on. And move on you must. May be after all this you can write a book that will help a million people. Think about that. Best of luck
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future of inguinal repair and PT
Hi, Don’t give up hope. There are ways to help your healing. Your surgery is done so now focus on healing. Try Reiki, go to see a DO (Osteopath) to work on ways to heal, try yoga. I think you can regain your physical activity. Believe that your body can heal and it will. Best of luck! Just think the hard part is behind you!
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future of inguinal repair and PT
I was really hoping for better results. I am feeling incredibly depressed. I am just shy of one year now from when I had my surgery and things are markedly worse than before the surgery. I have been to many doctors and health care professionals in different disciplines and there is nothing they can do. I have grown tired of the blank looks and the mystified responses. I don’t trust doctors any more.
I opted for having my inguinal hernia repaired for ‘quality of life’ reasons and now I profoundly regret it. General practitioners, surgeons, urologists, and physical therapists have all seen me and decided they can’t/don’t want to help.
I caution anyone considering this surgery. I know statistically there are more successes than failures but that hardly matters if you are one of the people who ends up with chronic complications. The doctors are almost running from the exam room to escape a conversation they don’t want to have. They don’t know how to manage these problems. Know that you can potentially be that person they dont want to work with and it is not a small percentage of patients. It is not a fraction of a percent. It is not even in the single digits. The number of people with chronic pain is a percentage in at least the teens and some suggest it may be as high as 30 percent. That is a lot of people and if you get this surgery you can be one of them. I don’t say this as a scare tactic. I say this because I am living it. I say it because I wish people would have been more honest with me. Honesty is a hard thing to come by these days, especially by surgeons who have a conflict of interest. To make money they have to perform surgery but sometimes it may not be in your best interest. How sad.
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future of inguinal repair and PT
For those considering surgery, I would strongly suggest, if you are in a situation to wait a little bit (even though I dont advocate waiting until it gets worse), find a PT that can help you work on some issues ahead of time.
Ironically, the exercise that is proving most beneficial to me is the one that most stay away form after hernia surgery – squats. I am talking no weight squats that focus entirely on form; driving the hips back, chest out and head up, with an even press through both legs. It is incredibly hard giving the years I spent not moving right because of the hernia. It is a total adjustment but I also found relief when done right. I have also found a lot of relief from clamshell exercises, bridges (when I can do them right), and anything that activates the glutes. That is my personal weakness but I wish I had some direction ahead of time. I am now trying desperately to fix my bad mechanics between episodes of inflammation and pain from bad mechanics. No bueno.
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future of inguinal repair and PT
[quote] WasInTN]
The well known, excellently caring and super humane Dr. James Goodyear of North Penn Hernia Institute. Google for more details about him. Every patient gave him a rating of 5/5 and even my insurance (BCBS) gave a rating of 5/5. I give him a rating of 10/5.
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future of inguinal repair and PT
Fantastic discussion by all.
We really truly need a defined physical therapy regimen for pre- and post-hernia repair patients. I’m so glad do many of you have brought up this topic. At the Shouldice clinic in Toronto, where everyone has a 48 hour stay after their inguinal hernia repair, they are asked to ride stationary bikes those two days. There are bikes all over their campus. They also have pool tables, encouraging bending and other movements.
I strongly believe that all abdominal and inguinal operations, not just hernia repairs, should be followed by a strengthening regimen–just like orthopedic surgery. We just don’t have any hard evidence to support any specific regimen. It’s not been in the culture of general surgeons.
I would love to work with any therapist, patient, and surgeon who is interested in helping devise a regimen, and then test its efficacy.
WasInTN: very informative posts. Please name your surgeon here so that others may seek him for similar excellent care.
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future of inguinal repair and PT
Thanks again RJ. I appreciate the supportive comments.
The last 1-2 of weeks have produced some good results in my physical therapy. I am not out of the weeds yet by a long shot but it is a promising sign. I have added some new exercises and I am seeing a combination of them being really helpful. It is starting to feel like with continued daily work and a careful, gradual increase I might feel normalish again. Here’s to hope.
I think you are spot on with the pain threshold and movement triggers. I am starting to learn those limits but I am also incorporating small approximations of what I used to do. In time I hope to be able to slowly add to that. I am going to give this a solid, thoughtful effort.
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future of inguinal repair and PT
@groundfaller, I’ve had no experience with tumeric but I do take fish oil supplements, which have an anti-inflammatory effect and are good for you anyway. It doesn’t have the immediate impact of something like a pharmaceutical NSAID, but it does seem to help over time. It’s another thing to consider, usually well tolerated too. Also, from personal experience, after a particularly annoying pain ‘flare up’ or whatever you’d like to call it, using ice on the location of discomfort can help considerably, as can a hot water bottle on nearby muscles – these may just be distracting with other strong sensations, who knows, but it can offer some relief.
My personal advice is to find a way to participate in your active pursuits anyway, even if in a new way, at a reduced pace, or a different intensity level. If that’s who you are and what brings you joy, it will help your mental health and self esteem, which is equally as important as physical health. Find the pain threshold or movement triggers and avoid them as best you can. It sounds like you’re working on this with the physical therapist, which I think is an excellent decision.
It is fairly clear to me that hernias and whatever other related issues pertain to the anatomy are obviously far more complex than people (and perhaps some doctors) may realize.
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future of inguinal repair and PT
Yeah, lots of questions and comments there and I will just speak to the gist of it. Hernia repair is a major surgery with the potential for major complications. I knew that going into it. I have lived a very healthy life and wasn’t emotionally or psychologically prepared for those complications. I still believe my problem is the result of a biomechanical imbalance that came from living with a hernia for many years and being very active and doing very heavy labor. Bodies have a way to adept their movement to things that just aren’t right and that is what mine did. Now I have a pelvis and supporting muscles that want to behave one way out of habit and the repair “expects” it to do something different, hence the swelling and discomfort. If you rub two things together long enough you get friction. The exercises produce good results but I am very congnizant of my movement when I do them. The trick now is training my mind and body to move again in a way that respects the repair without having to be so focused on moving that I can’t concentrate on anything else.
As for comments about surgeons, I have three:
1 – Choose the most experienced surgeon you can. Simply put, you should expect the best.
2 – Choose a surgeon that you feel like you can talk to and one who doesn’t quickly glance over potential complications. Should complications arise, you need someone you can talk to.
3 – And this should probably be first, if you discover a hernia early on which is not problematic, be very careful if “watchful waiting” is recommended. Hernias do not heal on their own. If you do heavy manual labor and/or you have an active lifestyle, it is almost guarenteed to get worse. That means a bigger repair with the potential for more problems. I was in my mid 30’s when mine was found, felt healthy, and when the doctor said, “this can wait,” I didn’t hesitate to wait. I didn’t want to be cut open. Of all the things I have tried to make excuses for, I truly believe this was my biggest mistake – waiting!
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future of inguinal repair and PT
groundfaller
Quick dumba$$ question to you. (Excuse my ignorance)1. Before surgery did you find details of how good is your surgeon? What are the surgeon’s ratings? Patient reviews? How many specific hernia surgeries did he do? (Not ventral, and other hernias but the type you had). Is he a general surgeon who does hernias, cuts, bones and all those? I would not go to a general surgeon who claims he can ALSO DO hernia surgeries.
2. Did/do you have any allergies for mesh material (I do not have any allergies so I assume mesh would not cause me any).
3. Did you feel like superman immediately after surgery and started your rigorous biking/exercize less than 2 or 3 weeks after surgery?IMAO (A = arrogant) surgery *IS* surgery. It is like wearing eye glasses. You can see well after wearing glasses but it will NEVER be the same like not having to wear one. A famous surgeon once told me – once the body loses the natural thing, it can be fixed but will NEVER be the same. Even now though I have no pains I do not lift heavy stuff. Those days are gone. I do not want to risk getting hernia on my other side since who knows, what may cause it. The proven thing I know is, I had hernia and weak pelvic floor and it is in my family genes. So be it and I accept it. I had my superman days when I was in 20s and 30s. I am good for my age and can run, jog and do other things but will NEVER be the one I used to be in my 20s. Period.
Lastly I want to mention this. Even the surgeon who did work on your hernia cannot be faulted, if he did the job. For two reasons are 1) nobody can give you a gurantee of how the mesh would behave once inserted. It is completely different from person to person. Did your mesh migrate? Did it have a hole? My surgeon said there is less than 1% chance for recurrence on surgery side but there is 18% chance for hernia on the other side (non-surgical side). If you go to a mesh removal surgeon he may or may not agree that mesh was causing the problem because there are so many factors involved – allergies, mesh material, migration, shrinking, your own body reactions to an outside material, you name it. It is hard to pinpoint one thing.
Unfortunately there is no foolproof method to diagnose a hernia before surgery and problems after surgery. Thats the bane of all this.
Before concluding, have you considered resting the surgery area for over 6 months to see how the recovery happens? I understand that outdoor activities are great for you and may be a necessity but does rest help? You can probably start a note on daily basis of what activities cause pain, what does not and how the day to day rest/activities are helping/troubling.
And did you talk to your original surgeon again and what does he say now? If he says it is all in your head, he really did not know what hernia surgery is. That much everyone can say.
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future of inguinal repair and PT
Thanks for the reply WasinTN and thanks for sharing your story. I think the more information that is available for future patients so they can make good decisions the better. I am glad you found a good surgeon.
I did have the surgery over 10 months ago and I am still having complications. My lengthy rants above are just ways for me to seek advice, vent, look for support, or whatever.
Future hernia surgery patients…choose wisely! It’s the best advice out there. Again thanks WasinTN.
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future of inguinal repair and PT
Groundfaller
From the posts here I could not grasp if you already had surgery or planning to have. I have to admit I did not read it fully but will share my experience here.Around 2007 I found that I had inguinal hernia on right side and my PCP said I should be careful – not dangerous at that time but it can grow. I ignored his advice. During my 2013 overseas trip I had no pain but before flying my PCP again said I should be careful. As dumb as Lloyd Christmas in ‘dumb and dumber’ movie I ignored it again. Back in the USA I jogged, ran and even played Basketball. I noticed a bulge then in the area just above the base of penis and below the belly button. It was painful. However hard I tried to hold it, caress it or do whatever , the pain remained. If I had to use slightest force during my bowel movements, it was like hell. This was till July 2014. By then hernia was dictating my life on what I should eat, if I should walk, and whether I can talk louder or laugh heartily. No kidding. I felt miserable.
I went to two local surgeons and both confirmed it was hernia on a scale of 5/10, 10 being the stragulated case that needed ER. The second surgeon appeared keen to cut my sensitive area and ready to operate but when I asked questions about what material the mesh is made of etc he was scratching his head. When he walked his pants had no belt and I did not feel he was good enough to touch my sensitive areas. I wanted someone who could speak with authority on what he planned to do. I choose a famous surgeon far way from my home and went to him. Glad I went to him. He saw me at 9 AM and surgery was over by 12 NOON and I walked out (yes walked out) with my family at 1 PM. Two weeks of home stay and walking regularly and I was back to work. Post surgery the surgeon advised me to keep walking. I kept walking whenever possible – including at midnight when I woke up.
After surgery my digestion improved, my hernia pains are gone and I am hale and hearty. The surgeon did a super job with just a 3″ cut. Now after 5 months I have some hardness at the cut area since scar tissue is still healing and I found that it heals differently in different people. I have some itch when I walk/run but no restrictions. I am good.
I also did exercizes before going to the surgeon assuming that I can avoid the surgery. Nah, it does not work. Not for me. There are some stories on Internet that somebody got cured without surgery and all but I do not beleive them anymore because the hernia is a defect already in the pelvic floor and should be corrected – surgically. By eating less, stopping breakfast and all those things will not cure the already formed defect. Body cannot obviously repair itself in some case. this is not something a broken bone which can probably repair itself.
As for diagnosis, there is really no foolproof method to find you have a hernia. The fingers of the best surgeon when placed under your pubic area and when you cough he can find that. Having said that he can find does not mean he will say surgery is an urgent thing for you. If anyone with hernia wants to postpone surgery I understand that part but from my experience I can tell you that it was waste of time to postpone surgery. The hernia will only grow. It is the intestine coming down the weakened layer of your tissue.
I also wanted to do a Desarda method in FL but backed off because hernia is our genes. My dad had it and never had surgery and my brother had it and got surgery. So without mesh if I had surgery probably my genes would have made the hernia re-appear. No good. I did not want to take a risk of recurrence.
In the end, you are RIGHT. The skill of surgeon matters a LOT. That was the reason I choose this surgeon. He did hundreds of surgeries and is doing them on daily basis even now. He uses an innovative method of mesh. Super friendly guy and excellent surgeon.
I can go on and on. BTW I am not a medical professional. So all this is my personal bragging ONLY.
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future of inguinal repair and PT
Thanks again for the feedback RJ. I spent most of December on a regular dose of NSAIDS although my body never really responds to them in terms of pain and it is hard to tell if I get any reduction in inflammation. For the first 2/3 of the month I was taking ibuprofen regularly and then I switched to sodium naproxen to see if there would be any more improvement. I didn’t notice much. About 2 weeks ago I decided to switch to tumeric capsules with bromelain. I generally don’t turn to herbal/supplemental remedies too often but at this point I am desperate, so what the hell.
Regarding the physical therapy progress I was doing pretty good until today. Recently I even managed to add in two 5-10 mile flat bike rides the week before. Things didn’t feel 100 percent but they felt ok. Monday I tried a 10 mile bike ride home from work which didn’t bother me and on Tues I went shopping in an outdoor mall where I was on my feet for more than an hour. Sadly the pain and swelling began to return today and I have been very frustrated. I will return to just my physical therapy for activities again and see if I can reduce the pain once more.
These relapses are taking a big toll on my self-esteem. The prospect of ever seriously climbing and biking is dwindling pretty fast. If I had any notion a year ago that this would be my circumstance I would have never opted for the surgery. That pain was somewhat manageable then. I know I complain about my hobbies being the big sacrifice but the scary part is the loss of ability in my daily living, ie home repairs and the belief that i can put in a hard day of work.
Keeping my fingers crossed.
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future of inguinal repair and PT
For full disclosure I have yet to have hernia surgery so this may differ from your situation – nonetheless, before a hernia diagnosis was made I have had a notable amount of pain reduction success using anti-inflammatory medication. Ibuprofen or aleve are good, but what helped most significantly was a 30-day course of prescription NSAID called Meloxicam which notably reduced regional inflammation and groin pain. That was some months ago but the effects have been long lasting, presumably from the anti-inflammatory effect of a sustained dose of powerful NSAID. Obviously you’d want to consult with a doctor (and you’d need an RX for the latter anyway), but if you tolerate NSAIDs well it’s something to consider while you work through physical therapy.
Keep it up, and keep us updated on your progress.
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future of inguinal repair and PT
So after almost 2 weeks of physical therapy, I have noticed an improvement in the pain. That is a quick response and I consider it very promising. The pain has not yet resolved of course but the improvement is significant and I expect the recovery to require a lot of time. Nevertheless, I am more optimistic than I was a month ago and I wanted to share a few thoughts just in case someone finds it valuable for their situation.
First of all, I still believe that the lingering problems I am experiencing are the result of a bio-mechanical problem. My logic is as follows: I spent many years with a hernia including ~4 years of watchful waiting but with no symptoms which were disruptive to my active lifestyle. One thing I did notice over time though was that my movement was favoring the side with the hernia. I wouldn’t sit as flat when riding my bike or when standing I noticed myself always leaning more to one side. I did also notice minor lower back aches on the side with the hernia and my hip joint would occasionally go in and out of joint in an audible fashion.
My theory for my pain is that once the prosthetic mesh was placed inside me, and I had a large inguinal hernia according the surgical report, it was done so with the expectation that my pelvis and hip joint was moving in a normal fashion but because of years of improper movement from the hernia, I was “twisted’ out of proper posture. It has been especially noticeable when standing in place or when squatting to lift where I am not engaging my glutes correctly and therefore exhibiting a sacroiliac joint dysfunction.
The second theory I have for my pain – and this is insight which comes from noticing what does and doesn’t feel good from the PT exercises – is that when performing the exercises or for that matter any other normal daily movement, I am not breathing deeply. I also feel like that habit might have developed over time as deep abdominal breathing may have started to irritate the hernia.
The above is all pure speculation on my part based on how my body is responding to activities and the history of my hernia development/treatment. My PT routine is a very simple set of core exercises which include a series of leg lifts in each direction, clamshells, planks, and kegels (a theraband has been added to many of these for more resistance). I have also noticed the most relief from pain comes from when I do glute exercises and when I do simple planks and focus on deep, full breathing that allows my diaphragm to expand. This observation leads me to believe I had a specific area of weakness that hopefully if addressed and continued over time, I will continue to see more relief in my pain. I have carefully selected and added a couple more exercises which include push-ups and a face done prone glute exercise that seems to really activate that muscle group. When done properly, these exercise seem to benefit my situation. My day starts off better and if I find at the end of my work day I am experiencing pain then a few of the exercises such as the clamshells, take the pressure off the surgical site where the pain originates.
I certainly am nowhere near my ability to go on 30 mile expert level mountain bike rides like I could a year ago but I am hoping with with some carefully directed exercise routines I will be able to enjoy biking again.
Again this is entirely my own experience and I am far from pain free but it is meant as food for thought for anyone desperate to resolve their own pain.
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future of inguinal repair and PT
Linda, it sounds like you have a very good handle on things as well as a good head for making decisions. I am especially glad to hear that you have found a surgeon that comes well recommended. I wish you the best and hope that if you have the surgery that it is a speedy recovery. Let us know.
Troy
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future of inguinal repair and PT
Hi Again,
Thanks for your support. I have seen three surgeons. The third one was recommended by Dr. Towfigh and when I went for my appt. she recalled that Dr. Towfigh was sending someone her way. She is a female surgeon interested in hernia surgery on females as well as males. It is male dominated as hernias in women are not as common. So I have that on my side. She was kind of rushed during my appt. (But did step out to see a patient and then stepped back in to finish answering my questions. So she went out of her way on a very busy day.) The other two surgeons were not as rushed, but they mostly do repairs on men. So she is a hernia specialist and very busy which is a good sign. I see her again after my run of PT and I am hoping I don’t feel rushed. I have so many questions that I feel like I must be a bother at times…but I want to feel confident with my decision to have the repair. And like you said about repairing a small hernia being the best approach, I also read the same thing. The outcome could be better in a smaller hernia.I hope you find activities that allow you to regain who you are. I am active too. In 2009 I tore my meniscus and opted to not have surgery because it is a 50-50 chance that it would heal right. So I had to change my activities. No more running, no Zumba–no pounding. So I bike ride and speed walk. I have downhill skied (half days) without a problem. I also hike. So my theory is that you and your body can accommodate the injury. Change is hard… I hope you can find healthy alternatives to stay active and get fresh air.
Glad that this site exists…great info and support. Hang in there.
Linda -
future of inguinal repair and PT
I think this is a very fair question. Presumably Physical Therapy for hernia repair has some effect on outcome and return to normal activities just like it would with any other surgery, some evidence for which is seen with professional athletes. If you’re a sports fan, you’ll undoubtedly notice that many pro athletes are sidelined during the season for various hernias (usually inguinal and sports hernia it seems, from what I understand the repair is often similar involving a groin mesh overlay despite the two hernia types being very different), yet they’re often back at it in 6-8 weeks. That’s rather amazing, so what’s their routine and how soon does it start?
Here are three recent examples of pro athletes having hernias repaired, it’s a regular news story in sports:
There certainly must be some protocol that is used in pro sports to quickly rehab groin hernia surgery for a rapid return to the field that could be simplified for the wider public, so what is it? Perhaps surgery type matters as well? It seems most pro athletes have laparoscopic repair.
Anyway, as an active person myself with a hernia that has yet to be repaired, I’m certainly curious. This is something I’m sure many others would be interested in as well.
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