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Looking for a Hernia Specialist near North Alabama
Hello all,
I have had groin pain for more than 6 months now, and have been through many doctors and tests all of which have been nonhelpful (doctors) and inconclusive (tests). I will detail history below, but can anyone please recommend a specialist in the area near Huntsville, AL (I can drive to Birmingham, Nashville, Atlanta – I would just as soon fly to Dr. Towfigh if none is available in any of those areas)?
I very much appreciate any help!
Melissa* As a preface, I am an engineer by degree and profession (for 12+ years) who has gone back to school for nursing very recently (and slowly). I have a knowledge base of core classes like anatomy/physiology and whatnot to reference where the pain is occurring, for instance (inguinal region, left side), and I am aware of the capabilities and limitations of imaging options. All imaging was done static (non-provocative), all ultrasound was pretty shallow and was never actually passed over the groin crease or thigh. I had requested ultrasound in those areas and was basically ignored, and requested provocative imaging and the same happened. I think at this point I am honestly just fatigued with the entire set of medical providers in this region, as they each seem to be subscribing to an incredibly powerful repertoire of selective perceptions and buck passing, combined with absolute astonishment when someone wants them to spend more than five minutes total doing an exam. But, I digress.
[b]History (Groin Pain)]
[b]2015 August to December] Intermittent left side groin pain (less than once per day) – described as a ‘pang’
[b]2016 January] Stepping onto left leg causes stab of pain in left groin. Pain is more frequent
[b]2016 April] Pain is consistent daily; seek help from gynecologist
âž” Pelvic exam (internal/external) Hurts when pressure applied
âž” Ultrasound (transvaginal) Minor cyst noted on OPPOSITE side ovary
âž” Recommendation: Aleve (prescription strength) 2x/day, 3 weeks; suggests will likely help if pain is musculoskeletal
âž” 2016 May: Aleve does not help with pain[b]2016 May] Seek help from primary care physician
âž” Blood Test and Urinalysis No findings
âž” Ultrasound (pelvic) No findings
âž” CT Scan (abdominal/pelvic) No findings
âž” Referral to orthopedic surgeon to ‘rule out musculoskeletal causes’[b]2016 June] Appointment with Orthopedic surgeon
âž” Physical Exam (manipulation of legs and hips to attempt to incite pain) Does not increase pain
âž” Physical Exam (external pressure applied to area of pain) Hurts
âž” Suggests based on exam cause is not musculoskeletal, and is likely more superficial than muscle or bone
âž” MRI (left hip) No findings.
âž” ? Uncertain why MRI was ordered of only left hip (midline to edge) and not pelvic region.
âž” Dr’s Aide calls and suggests physical therapy despite doctor ruling out musculoskeletal root cause during exam[b]2016 June]Seek help from general surgeon – unsure how else to get help finding root cause
âž” Gave surgeon entire history up to this point in writing, including references to Dr. Towfigh’s research and media
âž” Surgeon says there is no way inguinal hernia would hurt where I pointed to
âž” Surgeon feels thigh and asks me to cough; says no way there’s a femoral hernia
âž” Suggests physical therapy, weight loss…
âž” Says he will refer me to neurologist (at my insistence)[b]Tests Done]
2016 April: Ultrasound (Transvaginal) – 3cm cyst/R ovary (Gyn)
2016 April: Pregnancy Test – Not pregnant (not ectopic)
2016 May: Urinalysis – No findings
2016 May: Blood Test – No findings
2016 May: Ultrasound, Pelvic – No findings (PCP)
2016 May: CT Scan (Abdominal and Pelvic) – No findings (PCP)
2016 June: MRI Left Hip – No Findings (Ortho)[b]Prior Surgery]
2015 July: Tubal Ligation (laparoscopic, Filshie Clips)Photo attached with diagram of pain location; pain also radiates down inner thigh (burning feeling)
[b]Pain Descriptions]
â— Left inguinal region primarily; radiates to left labia majora, left inner thigh, left abdomen
â— Continuous most days from waking to sleep (and during)
â— Most recently, occasional numb feeling in inner/back thigh
â— Varies in intensity
â— Worse in evening, or after much activity/walking
â— Usually gradually increases; has been sudden (from dull to sharp in seconds, walking in the store)
â— At worst: Affects appetite, sleep, work, home responsibilities cannot walk to car in parking lot without multiple breaks
â— Deep, sore, aching
â— Dull, throbbing (usually when not walking)
â— Warm/Hot, Radiating, Burning (both heat and pain)
â— Sharp, Stabbing, Shooting (usually when walking, though has happened when sitting/sleeping)
â— Pinching, constricting
â— Pressure, bloated?
â— Tender pretty much always[b]Makes Pain Worse (usually)]
â— Walking – specifically when stepping onto left leg, heel hurts worst, though toe still does hurt
â— Standing for prolonged periods
â— Standing, at any point after pain has become bad
â— Bending down
â— Laying on Left Side
â— Being on hands and knees facing down (down dog yoga position)
â— Emptying bladder (less frequently; pain occurs when bladder nears completely empty); also very uncomfortable (moreso than usual) when bladder is full
â— Straining during bowel movement (sometimes)[b]Makes Pain Better (usually)]
â— Straightening all the way out flat on back
â— Sitting (not hunched over)/Leaning Back (decreasing angle between back and thighs)
â— Holding fist at area of pain and applying gentle pressure (this could be psychosomatic – it just hurts so bad I do it anyways)[u]References given to doctor]
◠“In Women, Hernias May be Hidden Agonyâ€, http://www.nytimes.com/2011/05/17/health/17brody.html?_r=0
◠“How Hernias Can Cause Pelvic Painâ€, http://www.pelvicpainrehab.com/uncategorized/3565/herniamaycausepelvicpain/
◠“His and Hers Hernias: Pelvic Pain Culprit Tough to Diagnose in Womenâ€, http://www.huffingtonpost.com/glenndbraunsteinmd/hisandherherniaspelvi_b_950590.html
◠“Hernias in Women: Uncommon, or Unrecognized?â€, http://laparoscopy.blogs.com/laparoscopy_today/LaparoscopyTodayPDFs/Laparoscopy31.pdf pg 8
◠“Hernia Symptom in Womenâ€, http://www.beverlyhillsherniacenter.com/herniasymptomsinwomen.html -
12 Replies
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Looking for a Hernia Specialist near North Alabama
It’s all been a very interesting experience – especially watching the skepticism on the faces of the physical therapists when I explain what I’ve been through (with regards to basically self-diagnosing, then finding Dr. Ramshaw who confirmed). They are all speaking to me like “well, IF it’s a hernia then… but this will help regardless,” which feels really condescending. I’m trying to overlook it, as I am positive their intentions are good (and with the exception of one lady today, nothing they’ve done has caused more pain), but it’s annoying.
The mental health stuff I didn’t really sweat – I’d be seeing my doc and counselor regardless, so having them each sign off on me if it makes Dr. Ramshaw’s office feel better is ok by me haha. I know that they’ve explained anxiety is normal – but for those who already have an anxiety disorder, they want to be sure it’s addressed as best as possible before doing the surgery if that’s an option. I’m just ultimately thankful I didn’t have a need for emergency hernia surgery, as I’ve read those outcomes aren’t always stellar.
On eating – I keep getting recommended to this book “Trim Healthy Mama” which seems like the worst of pseudoscience… It claims “bibilically sound” diet recommendations (argh, the bible recommended a lot of things I’d not recommend today, not to mention I am nonreligious), and seems to have no basis in actual nutrition science. My ‘diet’ has always aimed to be Pollan’s “Eat Food, Not too Much, Mostly Plants”. I fail at it a lot though.
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Looking for a Hernia Specialist near North Alabama
The prehab idea is really interesting. I would think it is fairly normal to have anxiety about surgery and especially anxiety and some frustration (or depression) if you experience chronic pain.
I have read many times that physical therapy, movement, and exercise all generally improve a surgical recovery, as does eating a lot of healthy protein and vegetables.
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Looking for a Hernia Specialist near North Alabama
I had never heard of prehabilitation before I spoke with Dr. Ramshaw but it’s basically a period of a couple (or more) months to get body/mind ready for surgery and the subsequent post-surgical recuperation and rehabilitation. So in my case, because I already suffer from anxiety and depression, I’ll be working extra with my docs/counselor on how to handle the surgery and recuperation anxieties, the reality of being dependent on my roommate and partner for a little while after surgery, and any post-op pain if it happens that the repair doesn’t get rid of it all. I’m also starting to see a physical therapist to work on exercises for things like core strength and pelvic floor muscles to do when I’m not in a ton of pain. They also had recommended massages and seeing a chiropractor if I’m able.
This isn’t their program, but it’s a similar description: http://www.uwhealth.org/news/prehabilitation-how-to-prep-for-post-op-success/46132
And a couple of NIH studies:
(Prehab/length of stay, physical benefits) http://www.ncbi.nlm.nih.gov/pubmed/24439570
(Prehab/psychological) http://www.ncbi.nlm.nih.gov/pubmed/27228096
Obviously the idea of it is still not very common, and there’s no standard program, but the practice of employing prehabilitation seems to be creeping up into cancer care and orthopedic surgery as well.I hope I explained that sufficiently 🙂 I think it’s excellent that they are doing this really – I’d had no idea how huge of an impact a physical debilitation could have on my mental state until I broke my fibula last spring. And if there are any exercises that might help me heal faster, and maybe even could lessen pain in the meanwhile, I’m game.
I will update when I know more 🙂 Take care as well!
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Looking for a Hernia Specialist near North Alabama
Yes, please do post updates as you go along! Whether it is about your condition, any surgeries, and post-op experiences, it is all valuable information and insight. All too often fellow patients disappear after treatment and then their stories are not complete, but surely updates like this could be helpful for other future patients.
Out of curiosity, what is the pre-habilitation?
No need to thank me but you are very welcome anyway! I am glad to hear you had a good experience with Dr Ramshaw, best of luck going forward and you are in great hands! 🙂
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Looking for a Hernia Specialist near North Alabama
Hello Chaunce!
I am so so so incredibly grateful that you took the time to respond to my original post on this topic. My appointment with Dr. Ramshaw yesterday was absolutely brilliant. I have never felt like a medical professional was so attentive, PREPARED (holy bananas, they READ the things I filled out!), and unhurried during any appointment in my life. Most of the appointment was spent speaking to him and his patient care manager, with them answering a ton of questions and explaining a ton about hernias. He also did an exam that lasted less than 45 seconds and was able to feel something (he called it an ‘impulse’ which I guess means movement like bulging?) when I beared down while standing – just with a gloved fingertip over a portion of my left pelvic/groin region. He said that obviously confirmation of existence of (and type of) a hernia would come with laparoscopy, but that it could be sports hernia and possibly also femoral (I think). I just remain completely floored by the competence and capability of their team, especially when I’ve spent hours and hours plus $800+ in the last six months looking for help in Alabama.
In coordination with Dr. Ramshaw and his team I am starting the pre-habilitation process ASAP to hopefully have surgery within the next 6 months.
I know I said it already but thank you – I had already started looking up plane tickets to Beverly Hills just in case no one responded on this board (makes me wonder – of Dr. Towfigh’s patients, who has traveled the farthest for help?), but you showed me there was an option less than 4 hours drive away. I am so grateful to you, Dr. Ramshaw and his team, and especially Dr. Towfigh for her research on the topic of occult hernias and continually trying to bring their existence to the forefront of other docs’ minds. I guess, like usual, here in Alabama we stay about 60 years behind 😉
I will absolutely update as I go along if there is any interest as well.
Take care,
Melissa -
Looking for a Hernia Specialist near North Alabama
How did your appointment go? Any update?
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Looking for a Hernia Specialist near North Alabama
I absolutely will. My initial appointment is July 26; I’m kind of scared to be optimistic but seem to be getting my hopes up regardless. 🙂
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Looking for a Hernia Specialist near North Alabama
Please update us after your consult
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Looking for a Hernia Specialist near North Alabama
That is so scary, and so frustrating – I’m so sorry that you are still having pain… I can’t even imagine how hard that is.
I had a really encouraging experience after contacting Dr. Ramshaw’s office. Without my prompting, they actually referenced Dr. Towfigh’s literature, and I am scheduled for four weeks from now. I just want to say thank you SO much Chaunce for taking the time to make that comment – I have hope for the first time in a lot of months.
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Looking for a Hernia Specialist near North Alabama
The pain that you describe and illustrate is very much like the pain I was suffering with when I started this medical journey almost 4 years ago. I had the same pain radiating to my thigh and labia and around my back. Pain was made worse with standing, bending over, laying on left side and even emptying my bladder. I had all the same negative tests and saw many doctors too. It turned out I had a femoral hernia and had it repaired, but not by one of the experts mentioned on here. I have had problems ever since and 4 subsequent surgeries and am still having pain issues. I have even flown from Virginia to LA to see Dr. David Chen. In my opinion, you should seek out an expert in hernia repair and pain. It is so worth it to get it repaired right the first time. I hope you can get this resolved quickly! I wish you the best.
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Looking for a Hernia Specialist near North Alabama
Oh my goodness, thank you so so much. That is phenomenal. I will contact him ASAP.
I actually have that note above printed out in a folder in my bag that goes with me everywhere; however, in my experience thus far, no doctor has read it. It’s really incredibly frustrating.
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Looking for a Hernia Specialist near North Alabama
Hi rosenrubies,
I’m only a fellow patient but have done a good amount of research in my own journey, so take of this what you will.
Dr Bruce Ramshaw is north of your border in Tennessee and is one of the countries premiere hernia experts and surgeons, he co-authored a book with Dr Towfigh (book is called SAGES Manual of Groin Pain its for surgeons – http://www.springer.com/us/book/9783319215860 )
http://gsm.utmck.edu/surgery/faculty/ramshaw.cfm
Finding a true ‘hernia expert’ can be very difficult in my experience, but you’re near enough to one that it very well may be worth the drive to have a consultation. I would bring your excellent notes you included here as well, I have found the more information you can provide the better.
I am sure you will get some other great recommendations from the wonderful doctors on this forum too. Best of luck with your case, keep us updated on your progress.
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