Advice before I head to Dr. Kang….possible direct hernia
01/03/2023 at 12:51 pm #33341ChuckParticipant
All –I so appreciate all your posts. I am now 4 months out of removal by Dr. Belyanksi –and finally seeing some pain releif. The terrible prostatitis i had has resolved. Thank God I didnt listen to folks telling me to treat prostatitis with long courses of dangerous antibiotics..my good friend and mesh removal brother Nick S –who was also butchered by dangerous laproscopic surgery told me it was the plastic junk and he was right. When i saw Dr. Carvajal —i was so stupid. I had some pain in the inguinal canal area..but it was very minor. He placed his finger on the canal for about two seconds and said I had a small hernia. He didnt palpate or ask for imaging. He just said i had a hernia. Previous ultrasounds had been contradictory –with one saying i had a hernia there and others saying no. Since Carvajal was fixing the left side anyway –i figured it made sense to fix the right. It was part of the reason i got conned into lap surgery to begin with. Fix both sides in one minimally invasive operation—yea right..newbies take note—lap surgery is pure butchery that should be outlawed. After the operation..my op report said i had a small direct hernia on the right. To be honest the pain on the right side vanished…but of course the lap mesh destroyed me in so many other ways. Removal of the mesh resolved many problems —but the pain came back on the right side in the exact same way as it was presurgery…only worse. So my instinct tells me that the direct hernia is back–there is no bulge at all so several surgeons have said they wont do anything–but maybe they didnt palpate correctly…and its only been 4 months. My friend Nick says it could still be surgical trauma and i should wait a year from the removal….that makes some sense…but sure doesnt feel like that. My problem is there are not many good surgeons in the US. Krpata—cold as a stone—wait months pay $$$$$….Jacobs—heralded for his pain mgmt…wait months pay $$$$$. Dr. Towfigh is one of the few that can read an MRI which i understand may be the best way to diagnose my hernia—in addition she has a good reputation for diagnosis and has shown me some compassion personlly. But its very difficult to see her—it takes months—then you can only communicate by email. While i respect Dr Towfigh —my extensive research has caused me to conclude that Dr. Kang is unquestionably the best hernia surgeon in the world. He also seems to be the nicest. In addition…he is ably assisted by Stephen Kwon…who knows more about hernias than most doctors. Stephen told me that he would get me an appointment the NEXT day if i asked—coming from the US???? Can you imagine any of the arrogant US surgeons saying that??? After the horrible doctoring i have received…This email brought tears to my eyes. If i go to see Kang Stephen will be getting a large gratuity. It may sound totally crazy to fly to Korea for a diagnosis…but that is how desperate I have become. I simply cannot take any more chances with lesser surgeons. As i understand it Direct hernias can be quite difficult to fix. Given all the tissue destruction i have sustained from the removal —I need to get it right the next time. Stephen advised that Dr. Kang is so experienced that he does not need dangerous CT scans or MRIs to diagnose hernias…he relies on his vast experience along with his crack ultrasound teams…Can Pinto or Mike M comment on the Good Dr. Kangs diagnostic skills? No matter who diagnoses me —i will still fly to korea to have Kang fix me…i firmly believe anyone going elsewhere is taking a chance with their life. So in a way it makes sense to go korea for a diagnosis too. If its not a hernia…i can still enjoy the country. Any comments or advice appreciated….
01/03/2023 at 4:50 pm #33344
I think the person who went there most recently was Alan @alankeen
I would ask him how he’s doing. He reported bad pain issues after surgery. Somewhat similar to what I experienced after my Shouldice procedure, although his sounded a bit worse, and he had to leave on a wheelchair. He hasn’t posted a recent update, so it will be interesting to find out how he’s doing now.
My only other advice (which I mentioned before) is to avoid surgery unless you get properly diagnosed first.
By the way, don’t assume that it takes months to get an appointment with Dr. Towfigh – check with her office.
01/03/2023 at 7:07 pm #33345ChuckParticipant
Watchful thanks so much…you are the dean of the board…a guy after my heart and fanatical researcher. Hernia diagnosis is tough business. I didnt know this when my POS surgeon Carvajal put his finger on me for two seconds and concluded i had a hernia. Several other surgeons prodded and pushed and could not come to any conclusion…saying that it was a weakness….or that they could dissect the right as part of lap surgery for the left..to know for sure So I really need the best diagnostic doctor. I agree Twofigh is prob one of the best at diagnosis…and she is compassionate –her staff very helpful too. But the wait was long…get the MRI then get in the queu for an email exchange—i am not sure i want to email over this…and if i fly to Cali to see her…why not just go to Kang? . Its prob still worth it but i plan to talk to Dr BElyansky again first…then maybe JAnccyk…both of these guys are caring interested and experienced…the way that Dr. kANG strikes me. I am still interested in the lessons you learned from your surgery…would you go mesh if you had to do it over?
01/04/2023 at 7:05 am #33359AlanParticipant
I’m doing great now, the pain faded quite fast once I got back, it’s very slightly numb around the incisions and a slight tightness on the right side (After walking several miles) but improves each day. I just wish someone warned me about coughing or sneezing, that was an unexpected pain!
I don’t think my pain was typical, the nurses seemed shocked that I couldn’t stand up and walk to the toilet the night of the operation (Everyone else was getting dressed to go home). I assume it was due to having two direct hernias in addition to an indirect on the left side, it was quite swollen across the whole area for several weeks, the pain seemed to fade as the swelling went down.
Stephen said Dr Kang lives and breathes hernia repairs, 6 – 8 repairs a day I think he said he did plus consulting new patients in the afternoon and visiting them the morning after surgery. I would not have been able to do it without Stephen, aside from the obvious translation task he also fast tracked me through the paperwork when arriving and visited me a few times in recovery to see how I was doing.
01/04/2023 at 8:11 am #33361
Thanks for the update, Alan. That’s great that your pain faded fast once you got back, and that the tightness keeps improving.
Where was the pain located? Incision area? Lower down in the scrotal area? I also had severe pain which was supposedly not typical when standing up or walking. This was after a Shouldice procedure, and my pain was in the scrotum, not the incision area. I think that gravity combined with the swelling was causing pressure on some nerves or injured tissue.
It’s really scary when you are in worse shape than others around you after surgery, the nurses are shocked, etc. It causes fear that something went wrong, and that the pain may not resolve on its own. I’m guessing Dr. Kang must have reassured you.
Do you have a hard ridge under the incisions? Any abnormal sensations other than numbness in the incision area? I have a hard ridge. I have some numbness on one side of the incision, and an abnormal sesation on the other side of it when rubbing the skin – feels like raw skin after tearing off a bandage. Must be presthesias from nerve damage, and will hopefully resolve completely with time.
01/04/2023 at 10:59 am #33362AlanParticipant
The pain was across and between the incisions, right side above scrotum has felt tight (reducing daily), I assume that’s due to the inguinal ring on that side being closed up?
The nurses were great, two could speak a bit of English and the others used an app to translate. Dr Kang came to check on me, he didn’t seem too bothered about the pain, he checked touch sensitivity around the area with a pen and said to stay another night.
There’s a hard ridge under both, with I believe is expected for any deep incision? The cuts are extremely clean though, around 3.5cm long and hardly visible now. No other sensations other than slight numbness now.
Did they cut any nerves or move any muscles? I thought that was a requirement for the shouldice method but sounds like they repaired yours by just stitching it up? My main reason for going with Dr Kang was I didn’t want any nerves cut or the cremaster muscle moved\removed.
01/04/2023 at 11:40 am #33366
Thanks, Alan. It’s good that Dr. Kang is very experienced and doesn’t get concerned unnecessarily. It can be tricky to know what is within the normal range of symptoms after the surgery, and what should raise concern.
Yes, the hard ridge in the incision area is normal. My understanding is that it takes a long time for it to soften and go away.
They didn’t completely cut the cremaster and cut the genital nerve branch in my case. They don’t adhere to the original procedure like they did in the past. Also, prolene was used instead of stainless steel for the stitching.
Nerve cutting is a tricky topic. The genital nerve branch is cut in the original Shouldice because the cremaster is completely cut. Supposedly, this reduces recurrence. Also, the genital nerve can sometimes be injured during the procedure because of the traction of the spermatic cord. Other nerves aren’t normally cut in the Shouldice procedure unless they get injured or they’re located in places where they get in the way of the procedure. The nerve anatomy varies from person to person. I don’t know if Dr. Kang has to cut nerves occasionally as well – seems like it’s unavoidable sometimes, but I don’t know for sure.
01/04/2023 at 6:01 pm #33375WatchnwaitinParticipant
Watchful – re the cremaster not being completely cut, does that mean some of it was shaved off instead of being cut? I’ve heard some doctors in the USA don’t cut it but shave about 30% off instead so wonder if that’s what they did for you.
Also, does Shouldice Hospital give you the operative report afterwards explaining what was done?
01/04/2023 at 7:39 pm #33377
I’m not sure how much of it was cut. The surgeon told me they didn’t cut it completely, but it’s not clear from the surgical report. The impression I get from the report is that it was cut completely, but maybe boilerplate language was used.
They give you the report if you request it or if you need it for your insurance claim. Their report isn’t as comprehensive and detailed as some reports I’ve seen from US surgeons.
01/04/2023 at 11:44 pm #33381William BryantParticipant
Thanks both for updates. I was wondering how you were both doing yesterday.
Alan, I think I asked before, but am I right you’re in UK? How much do you think the whole trip cost approximately as cost is a factor for me but seriously considering Dr Kang.
Are you and watchful both improving? It sounds like it.
An older person I know who had a repair in the UK before mesh told me the day he went home from hospital he could hardly walk and though what have they done. He’s perfect now.
Maybe tissue takes a bit longer to recover from.
01/05/2023 at 9:02 am #33382MarkTParticipant
Chuck, I will reiterate my advice, which mirrors what Dr. Towfigh has also suggested: get imaging done (and you absolutely do not need to fly to Korea for that).
No one thinks you are nuts for choosing Dr. Kang…he seems like a solid choice…what may be a bit nuts is going there without a diagnosis. Imagine how you will feel if you book surgery with him, spend money on flights and a hotel, mentally prepare for the surgery and recovery…and then his imaging reveals that there is no hernia.
Get a dynamic MRI done wherever you are and then send it to whichever surgeons you want…Kang, Towfigh, etc. Then, if you indeed have a hernia, you can make your plans to go see Dr. Kang. If you don’t have a hernia, the dynamic MRI will likely also be helpful in diagnosing your problem.
I echo Watchful’s thought that it would not take ‘months’ to consult with Dr. Towfigh. If you get the MRI done, either through her referral or on your own, and it is sent to her, I’m sure she can get back to you fairly quickly.
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