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Femoral "reoccurance" after Shouldice repair?
Hoping for an opinion from Dr. Towfigh
In May 2016 I was diagnosed with bilateral inguinal hernias. I live in Alberta, Canada and after much research made the decision to go to Shouldice in Toronto for non-mesh repairs. They scheduled me for only one side as there was a bulge confirmed by both a doctor and ultrasound. The one on my right side had no bulge (not doctor confirmed at the time) but did show up on the ultrasound. Upon signing in and getting my checkup a doctor at Shouldice confirmed the presence of one on the right too and they fit me into the schedule to have both done. There, they do one surgery and then there’s a day inbetween and then you have your other hernia fixed. The first hernia was fixed by a senior doctor of over 20 years. The second on the other hand, was given to a junior doctor who had only been there a year and a half and was still under supervision when repairing my right side. All was okay but I did notice a dent in the top of my right incision which one of the doctors said was normal swelling upon discharge. (The dent is still there and mildly painful when pushed on, it feels like he sewed my skin into my musvle) So I was generally active during recovery but weary to start weight lifting again as I was 4 to 6 times a week before my hernia diagnosis. So I waited 3 months to start weight training again (October 2016). Everything was going well for about two weeks until my 3rd set of 15 deadlifts (light/medium weight). I got to the 11th rep on my 3rd set and I felt a stabbing shot of pain through my right repair. I placed the weight on the floor and tried to stand erect. I couldn’t without gasping due to nerve pain. I knew something was wrong. I called Shouldice several times over the next month or so and got the same answer “is there a bulge? No. Well it sounds like muscle strain.” The nerve pain subsided after a week but the aching never did (varying degrees of pain of 1 to 6 on pain scale until now, 2 years after my repair).
My doctor did a pap and pelvic exam last year (about 6 months post injury) and tried to feel my ovaries (he is exceptionally brutal in the force he used). He pushed up with his fingers from the inside and down on my abdomen with the palm of the other hand. I was then told I was done and to get dressed and I can go. When I got up to get dressed I could barely walk out of the room from the familiar nerve pain I had when I initially injured my repair. I couldn’t move my legs or straighten my body after bending over without a gasping shrill. The nerve pain subsided days after, just like the initial injury.
Recently, I just caught a cold for the first time in years and I was coughing and sneezing a lot. I feel bulging in my right crease of my leg every time I cough or strain now. So I went to see my doctor who referred me to a general surgeon who ordered an ultrasound. I thought for sure I would get my suspicions of a femoral hernia confirmed and I would fly back to shouldice or get lap done. Nope. There was a bulging of my femoral vein (I believe it said in the report) but the general surgeon felt the bulging I feel by pushing on both sides to feel the difference. He recommended not having surgery as there was no hernia found and fear of making nerves worse. I was relieved to hear that but then I started getting really sad. I know what I feel. I have stopped working out which really was a passion of mine because of pain and fear and now I have to keep living this way? Recently, having intercourse with my husband makes I feel like something is bulging out of my right side and is very uncomfortable. Even using a tampon feels strange. Is there a better test for diagnosing small femoral hernias? What do I do? I feel helpless and defeated. Do I ask for an MRI? If I get it diagnosed I doubt Shouldice would repair me again because they go by bulges, not images. If they can’t feel it or see it, no surgery for you! Do I just have to live like this? A dull, heavy, dragging ache with occasional nerve pain. I want my life back!
On a seperate note, maybe related or unrelated I had a strange case of ascending paresthia in April 2017 (6 months post injury to repair) starting in my feet and ascending to my face within 3 hours. I was checked for a stroke, given an MRI without contrast, saw a neurologist, given another MRI with contrast of my head and cervical spine to check for MS. Nerve conduction study. And urinary urgency off and on for months with no cause found. Blood was tested for an amazing amount of things over 5 times and even 24 hour urine test for diabetes insipidus. Nothing came back with answers. I still have tingling down my spinal cord, down the back of my thighs, all the way down to my toes and also in my tongue. Its not that bad, doesn’t hurth and has become normal to me. I dont notice it unless I think about it. Is it possible that there is an infection after the tearing? I’m grasping at straws for answers.
Jill
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5 Replies
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quote Julliac:Chaunce,
Thank you for your reply. I was never checked out by anyone at Shouldice post surgery to clarify. Toronto is a 4 hour flight away from me in Alberta. I talked to 3 surgeons over the phone shortly after my injury to discuss what I was experiencing (3 months after my surgery). Its now 2 years post surgery and I still ache. I just had an ultrasound to find a femoral “reoccurance” (they deem it a reoccurance because you are 15 times more likely to get a femoral hernia after sutured inguinal repair due to upward traction). The two doctors I saw here in Alberta said that ultrasounds are quite unreliable for diagnosing small femoral hernias.
Anyways, I never did ache during the first 3 months (other than the first 2 weeks of course). I have not tried anything to manage pain. I avoid heavy lifting as I’m terrified to hurt myself again. Nerve pain is no joke. But I miss my strength/body and realize now that I am allowing this fear to dictate my activity. Yes I ache to varying degrees (mild to moderate) but it’s not debilitating/severe. You’ve given me a lot to think about or try. I hate the thought of medication, that would be a last resort for me. I guess I should check with physio and massage and see if that could help. Thanks a million for the reply. Your knowledge is truly appreciated.Jill
Interesting, thanks for the clarification, I was under the impression you had already a physical exam post-surgery by a hernia surgeon. If you have not done so by a hernia surgeon, that would probably be a good idea.
Was your recent ultrasound done with valsava? Essentially you take a big breath and then bear down as if you are trying to defecate while they are scanning the impacted groin region, it’s a little awkward but it can be very effective at showing small hernias. If you didn’t have that type of groin ultrasound done, you may want to specifically request it.
I can very much understand your hesitancy to take any medication, but keep in mind an NSAID course is temporary and usually well tolerated. The aim is for an extended course of a strong NSAID, typically a prescription level anti-inflammatory, taken daily for a month or two straight. Only do this under a doctors guidance and assuming your general health can accommodate NSAID usage. The idea behind this is to consistently reduce any regional inflammation, which is often related to the pain.
Nerve block injections to target the site / nerve branches involved in the pain are also temporary and worth a consideration. These can be very effective for some people who have constant pain or an irritated nerve. Often it’s not just a numbing agent but sometimes a steroid / anti-inflammatory agent as well. If the first one is fairly effective, the shots are often repeated a handful of times every week or every other week, particularly if pain notably diminishes with each block.
Finally, groin / abdominal / pelvic / hip rehab with targeted physical therapy / massage, aimed at rebuilding muscle strength and flexibility while loosening scar tissue, is certainly a valid consideration. If you happen to follow pro-sports, you will find that just about every professional athlete who has groin surgery (for a hernia or another groin injury) seems to go through extensive rehab protocols aimed at improving flexibility and movement in the groin post-surgery.
Anyway, I’m not a doctor so be sure to review all of this with your own physician to create a plan of action. Best of luck and keep us updated on how you proceed and any progress.
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Chaunce,
Thank you for your reply. I was never checked out by anyone at Shouldice post surgery to clarify. Toronto is a 4 hour flight away from me in Alberta. I talked to 3 surgeons over the phone shortly after my injury to discuss what I was experiencing (3 months after my surgery). Its now 2 years post surgery and I still ache. I just had an ultrasound to find a femoral “reoccurance” (they deem it a reoccurance because you are 15 times more likely to get a femoral hernia after sutured inguinal repair due to upward traction). The two doctors I saw here in Alberta said that ultrasounds are quite unreliable for diagnosing small femoral hernias.
Anyways, I never did ache during the first 3 months (other than the first 2 weeks of course). I have not tried anything to manage pain. I avoid heavy lifting as I’m terrified to hurt myself again. Nerve pain is no joke. But I miss my strength/body and realize now that I am allowing this fear to dictate my activity. Yes I ache to varying degrees (mild to moderate) but it’s not debilitating/severe. You’ve given me a lot to think about or try. I hate the thought of medication, that would be a last resort for me. I guess I should check with physio and massage and see if that could help. Thanks a million for the reply. Your knowledge is truly appreciated.Jill
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Ultrasound is usually fairly accurate to show a hernia or not, so if you had an ultrasound done on the impacted groin and it came back negative, and you had three different surgeons review your case, then you can probably assume you do not have another hernia.
I’m not a doctor, but it is certainly possible that you have some lingering nerve irritation, scar tissue, or some other remnant pain issue that can be a side effect of surgery. The groin is highly innervated with wildly complex anatomy, and hernia surgery is diving right into that very delicate area.
Have you done anything to treat the symptoms? Nerve blocks? Extended strong NSAID course (if your doctor approves / health permitting)? Any other anti-inflammatory efforts? Targeted physical therapy? Mayofascial release? Targeted massage to break up the scar tissue? Heat and ice? All of those may be worth exploring, as many people report improvements.
You might also want to find exercises for recovering after a sports hernia surgery because the injury and surgery area is very similar (inguinal / groin) and so are the rehabbing exercises to rebuild strength, loosen scar tissue, and regain mobility. You sound like you’re fairly active so you’re probably familiar with the concepts of this already. For example, I found this on YouTube but there are many others: https://www.youtube.com/watch?v=p3I0mKxuQGU
Other things that can potentially help with nerve type-pain over time include: alpha lipoic acid taken daily, vitamin C taken daily, medical marijuana, and engaging in mentally engaging and/or challenging tasks (complex math, learning a foreign language, puzzles, playing music, creating art, etc). Endurance sports can also be very beneficial but that can obviously be challenging or impossible if you’re in pain.
It sounds like you’ve had a fairly thorough workup, which is good to rule in/out other potential issues, and Shouldice is pretty much the gold standard for optimal hernia repair so that combined with the various surgeons checking you out I would imagine the chances are pretty good that you don’t have a recurrence.
With all that said, of course it’s always possible (but perhaps less likely?) that there is a recurrence or a new hernia that is being missed. Dr Towfigh has done some research on this topic and has an MRI protocol, usually a high resolution MRI with valsava, to try and appreciate the rare ‘hidden hernia’ that can be difficult to diagnose despite causing pain. Here is her paper on that topic: https://jamanetwork.com/journals/jamasurgery/fullarticle/1893806 and https://www.researchgate.net/publication/264989952_Role_of_Imaging_in_the_Diagnosis_of_Occult_Hernias
Good luck and keep us updated on your case and progress.
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I talked to 3 different surgeons and all of them offered the same response. “It’s impossible that you damaged your repair. The chance of that is 1%. It sounds like muscle strain. Is there a bulge? No….well then no hernia”. I’m constantly aching to varying degrees. I haven’t gone back to shouldice as it’s a 4 hour plane ride across the country. I haven’t called in over a year. Maybe it’s time to get some thoughts or direction from them. Thank you so much for replying. It’s nice to know someone took the time to read my story. Much appreciated.
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When you talked to Shouldice did you get beyond the front desk or did you talk to a surgeon? Preferably the highly experienced one. At big institutions there is often a basic set of questions that are asked for screening purposes, by the support staff. You’d think the doctor with 20+ years would have offered more.
I’m not sure that Dr. Towfigh is very active on reading the daily posts. But I think that she does check her messages. You can click on her name in any of her posts and there will be an option to send a message. You can also contact her practice, via the link on the “Hernia Surgeons” page.
Good luck. Keep pressing forward.
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