Dr. J’s Own Hernia
Tagged: watchful waiting
05/10/2021 at 2:19 am #29100
Dr. Jacob, mesh surgeon, candidly spoke of his having and living with an IH on Hernia Talk Live, for which I thank @aj9000 for bringing the vid segment forward and of course Dr. Towfigh. Told with aplomb, his story gives me much hope about dealing with one. 🙂
At the beach he strained something in his groin but he just knew his hernia was unaffected despite two weeks of physical discomfort. Two things gave rise to his aplomb–the belief that most physical exercise is well tolerated by herniae and that mesh can handle any sized one. So watchful waiting is a reasonable stance, if indeed he is doing that. I believe that is only if assuming mesh surgery.
I have some questions though. How long can you play this game of chicken? He seems to say that pain is the guide; if painless, then there is little worry (e.g. strangulation). But isn’t there an ideal hernia condition for successful surgery? Wouldn’t a pea-sized one be better handled than one like a grapefruit? Is strangulation most of time immediate–an emergency, or do people usually get some lead time about it?
05/10/2021 at 3:26 am #29101
I saw the video too, and I think many people found it interesting, as it seems to confirm that exercising with an hernia is fine and even recommended (despite some believing that it would make things worse).
As for the surgery, I have been told by some surgeons that one should get surgery sooner rather than later, as (they claimed) watchful waiting is not recommended anymore, and that it is better to have surgery now that one is pain free and without complications (the idea is that one will eventually have to have surgery period).
They also mentioned that with time the (inguinal) hernia becomes bigger (I am not sure I agree with this statement actually, at least it is not always so), and so the more one waits, the less likely a tissue only repair will succeed: apart form the fact that some surgeons don’t see a problem with tissue repair and the hernia size, I found crazy that one surgeon considered my hernia already too big, and another one (a specialist, and a good one actually) found it quite small (he still suggested surgery in few weeks though, and with mesh).
ps: having spoken to some doctors in Swiss hospitals, I think they would still be able to perform e.g. a Shouldice in case of an emergency. In Switzerland there are even some hernia experts that offer tissue only regularly (e.g. in the Basel area).
ps2: I read somewhere that during the COVID pandemic hospitals saw fewer hernia emergency surgeries, to the point that the article asked what happened to the “missing” patients, which makes me think that the so called emergency surgeries are probably inflated and that the number of truly necessary surgeries is smaller
ps3: I wouldn’t be surprised if some patients got an hernia but managed to cope well, with the hernia even shrinking thanks to lifestyle changes that might just improve collagen quality (never read any such evidence on this though, it is just my thought/rambling)
05/10/2021 at 5:03 am #29103
@alephy, interesting! Do you happen to know if you’re doomed if a recurrence? I thought I did all the things right but still failed.
>>>as (they claimed) watchful waiting is not recommended anymore.
By that you probably know that the UK health system is built on WW. What they said doesn’t make sense anymore. 😀 The first time, an internist told me not to wait. Interestinqly, he is quite old; maybe younger doctors have a WW mindset.
>>They also mentioned that with time the (inguinal) hernia becomes bigger.
The fly in the ointment, huh. It seems likely, maybe more than likely, but I haven’t seen any info that delves much into it. Have you?
>>…my hernia already too big, and another one (a specialist, and a good one
>>>actually) found it quite small (he still suggested surgery in few weeks
>>though, and with mesh).
Hmm, fishy. The first time, a doc looked at my MRI and calculated the size of my hernia. His matched what another had said. And these matched what sizes I have seen used in research studies using size a variable. So from that it seems there’s a standard scale for size.
>>>during the COVID pandemic hospitals saw fewer hernia emergency surgeries,
>>>to the point that the article asked what happened to the “missing”
Maybe because there was no hospital space for them? Unless a person gets a serious illness they will never know what really happens inside medical care.:D
>>>ps3: I wouldn’t be surprised if some patients got an hernia but managed
>>> to cope well, with the hernia even shrinking thanks to lifestyle
There is something to that. I’m unsure about shrinkage but I suppose if a person brought their physical activity to a minimum, the hernia would likely become less problematic maybe even submerge if a reducible one. Would like to hear more about it.
05/10/2021 at 6:54 am #29104drtowfighKeymaster
Watchful waiting is appropriate for a lot of patients with a symptomatic or minimally symptomatic inguinal hernias. I recommend it all the time.
I also recommend that they consider repair if the hernia is starting to get larger. All hernias have the potential to increase in size over time. But they don’t all get bigger rapidly. The process may take years or be never.
Exercising will not increase the hernia. In fact, it may decrease the perceived size or reduce the symptoms, making watchful waiting even a better choice.
We will discuss all of this Tuesday on HerniaTalk LIVE Q&A.
05/10/2021 at 8:07 am #29106
The idea of being able to exercise with a hernia seems so surreal to me. My inguinal hernia is smaller than a golf ball but causes an intense level of discomfort associated with it when it protrudes at all so I’ve always acted to prevent that by wearing a truss. This certainly isn’t a perfect solution so even with a truss I wouldn’t be able to exercise. My hernia first presented after working out in the gym as I was a bodybuilder and immediately drastically changed my life. In my circumstance I knew watchful waiting wasn’t a good fit for me. It’s strange to me that others must not feel it quite the same as myself to be able to remain active.
05/10/2021 at 9:14 am #29109
I guess it all depends on what you (like to) do and how…
Did you have surgery and if so did it fix the problem so that you could go back to the gym?
From my side I had at one point small but fastidious pain and some cramps, but all these symptoms disappeared when (hear this) I stopped drinking espresso coffe and opted for normal coffe instead (I am still not sure if the espresso machine had a mould problem actually, va savoir). At the moment the hernia seems the same size as before, and I have at times a feeling of weakness; for the rest I do exercise as before when it comes to solo training (I have always used elastic bands and body movement, no weights though); I have not had yet a real martial arts sparring session because of lockdowns/covid
05/10/2021 at 10:05 am #29114
Booked in for surgery on the 7th of June with Dr Lorenz in Germany after a UK surgeon referred me as he wasn’t confident enough in tissue repair. I certainly hope to be able to get back to the gym after I’ve recovered. That said even if I could just go for long walks without major discomfort it would be a life changing improvement.
05/10/2021 at 10:46 am #29116
Good luck with your surgery! Do you know which procedure will be used?
If I may ask, how expensive is it in Germany? Will the UK NHS refund you?
05/10/2021 at 11:09 am #29118
I don’t know what procedure will be used which is a relief for me as it’s because he can perform multiple types of repair (including Shouldice and Desarda). He will tailor his approach to me and my specific hernia.
Here are his stats if you’re interested from tissue repairs:
“We follow up our patients normally until one year and we can report that we have a very low recurrence rate of lower than 0.5% and a pain rate of lower than 1.5%. Younger patients below 50 years are normally ideal for a pure tissue repair. After a short break of normally 4 to maximum 6 weeks after surgery you do normally any sport as you like. ”
The costs are incredible, the London surgeon was going to charge £4200 for a Desarda repair with 1 night stay in hospital. In Germany it’s going to cost £2,081.34 for the surgery (includes everything) and £103 per night in a private hospital room or £77 in a shared room. Accounting for flights, hotel and even choosing to stay 3 nights in hospital it’s still cheaper and the hospital looks incredible.
On the NHS, in my case it’s not going to be funded by them at all. I believe you can get them to partially fund it but in my case I’m dying to get this surgery done quick. I have terrible health anxiety so I’ve prolonged waiting far longer than I should have and the longer the lead up to the surgery after I made up my mind the worse it was going to be.
My opinion on private hernia surgery in the UK is that I see no reason anyone should get it done. It’s cheaper in Germany and the experts are located there hence my London surgeon referred me to them.
05/10/2021 at 9:27 am #29110Good intentionsParticipant
This would or will be a fascinating story, from a psychological perspective. Dr. Jacob is aware of the damage that mesh can do and the pain that it can cause, as a surgeon who removes mesh. He must also be aware of the general recommendation that watchful waiting is a waste of time, and could be life-threatening due to incarceration. He seems intelligent and able to determine the pros and cons of complex decisions. He is a major proponent of mesh repairs, very similar to Dr. Felix, who had his own hernia repaired with mesh.
As a person with the financial means to choose the safest route of pure tissue first, then mesh if pure tissue fails, I wonder if he will place his faith in the technology he has been benefiting from, and just go directly to the mainstream mesh repair.
I hope that he shares the details of his hernia journey as it progresses. It is not clear why he is waiting, he must have an opinion about the best possible repair method, as an expert in the field.
05/10/2021 at 10:52 am #29117
I seem to remember in the video that Dr. Jacob mentions WW as a valid alternative. It is interesting that doctors do not agree on this, and that the official guidelines do not recommend it; but then again it is considered a valid option also in the UK…
At one point I definitely thought that those against WW were mostly the mesh only surgeons somehow (at the very least some of them do give the impression of being in for a as high a volume of surgeries as possible)…
BTW this is also why just going to a hernia specialist and trusting the person is not enough i.e. different experts might recommend different treatments, with different impacts: this is true for WW and in general for the potential surgery complications (my biggest complaint is that these are often not even mentioned or they are just played down!)
05/10/2021 at 9:51 am #29112Good intentionsParticipant
The internal conflict, possibly even fear, for Dr. Jacob must be incredible. Here is a video showing a TAPP removal of mesh by Dr. Jacob. The video ends at about 4:30 but the audio continues. There is no follow-up information about how the patient did in the long run. This might partially explain the watchful waiting.
I feel like I am “piling on” but this situation is one in which a well-respected expert is forced to truly and objectively (hopefully) face the same fears and results that his patients do. At the least, he will gain a true understanding of what a mesh repair feels like along with an awareness of what happens n the long run.
05/10/2021 at 7:08 pm #29119
@Goodintentions always brings a keen eye to things here at HT. By my own medical experience I have come to appreciate him and others here more and more. It cannot be denied that “something out there” in mesh practice worldwide has brought harm to certain patients. Multiple accounts show relief has been in short supply aggrevated by some unhearing medical doctors. Such will invariably be invited by hernia topics so we need patience at such time. To @Dr. Jacob, I want to thank him for his candidness but also greatly thank him for doing mesh removal. Good Intentions recently pointed out how the field is being thinned out of removal specialists. He seems a patient person in Dr. T’s video, which must greatly account for his choice of field.:) We need more hearing and patient docs like him. We thank him much for sharing here at HT!
@Good Intentions is incisive in his comment, one that would be vitally revealing in any field: how close is theory and practice? As indelicate as it may appear, the question is pertinent but will likely remain unanswered for some time to come, I suppose. It’s the kind of question that would be foremost in the guide I proposed be made collectively here at HT but I guess went unnoticed.:D I’m unsure though that the last video clip reveals a WW connection as the patient said his pain was present before his hernia surgery. It would take some doing to unravel pre and post pain.
Congrats to @scarletville for his find. Good luck to you and thanks for the great intel you provided. Remember to report how things work out, wonderfully we hope. Before then, it would help to hear your experience with a truss. You said it was helpful. Give us more about that. @Alephy, the coffee connections seems a real one. You had some cramps likely brought on by the strong brew. You though seem to be doing well with WW. I’d be interested in hearing more.
05/17/2021 at 5:23 am #29159
I’d like to thank scarletville also for that information. I’ve really been struggling to find a hernia specialist in the U.K. who doesn’t just use mesh for everything. I’ve recently been diagnosed with an umbilical hernia and have just had a ct scan to check for others which may be causing me discomfort so this might be a very good option for me also.
05/17/2021 at 8:09 am #29160
Mark if it’s really important to you that you get the surgery done in the UK I believe Dr. Andreas Koch does some surgeries in London as well as Germany. I would consider contacting him. As I said though if price does matter the surgeons and facilities are better in Germany at a much better price. Ulrike Muschaweck definitely does surgeries in London but I think the other options are more preferable for your case.
05/18/2021 at 6:57 am #29163
It would be nice get any surgery done in the U.K. but we don’t seem to have too many options here. I’m not the most travelled so I am a bit apprehensive about the foreign language,flights, booking hotels and finding my way around Germany etc! I would look at that as short term stress though. Getting the best treatment is the most important thing. Cost also being important.
Hopefully I can get a definitive diagnosis from the NHS then I can make contact with 3+Chirugen where I believe Dr Lorenz is and go from there.
I may be fortunate enough to just have the umbilical hernia which could mean a suture repair in this country is an option if I can find a good surgeon.
I wish you the best of luck with your surgery. I think you’ve really stacked the odds in your favour. Things usually work out well when you do that.
05/18/2021 at 4:38 pm #29165
Fingers crossed for both of us, after my operation on the 7th of June I’ll be making a post on here about my experience which might help you decide. Also my surgery is at a different hospital Dr Lorenz does surgeries at which looks considerably nicer: https://www.havelklinik.de/behandlung/zentrum-fuer-allgemeine-chirurgie
05/18/2021 at 11:30 pm #29167
Thanks for the link. It’s much appreciated. Makes me wish I paid more attention in German at school!
I look forward to reading about a good experience and outcome for you.
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