Tissue repair experiences – pain and recovery

[ajm222]

I would also love to hear about how big the lump was after surgery. Mine is about the size of the hernia itself at the moment, a little less than 24 hours after surgery. I know swelling is normal, but how much?

[Good intentions]

Thanks for the links and the quotes Watchful. I don’t really know what to make of them. Glib comments are often the ones that last.

[ajm222]

I’d also kind of be interested in how everyone’s scars turned out. Seems over a couple years most fade largely but it’s a large scar compared to what I had for robotic trocar scars. Also, lots of hair down there and I’d imagine there’s a line where the hair doesn’t grow back. Just curious what experiences you all had with that. I’m sure it’s also parrot surgeon dependent.

[Good intentions]

I wasn’t aware of that. Do you have a reference? I have not seen any stories about his opinions on cutting nerves.

His work on mesh-caused pain seems logical. And it leads to ideas for possible changes in the design of mesh. But, the mesh makers control the product design even though they don’t understand the medical side, and the surgeons control the medical side but don’t understand mesh design. Besides the fact that creating a new pattern of knit knots is cheap and easy to get through the 510(k) process. Doing nothing or very little is the most profitable path at this point in time.

[Watchful]

Apropos Dr. Bendavid – he was very liberal with cutting nerves. Famous for his “no nerve, no pain” approach. Dr. Amid didn’t agree with him on that. Another example of how there is simply no agreement among experts in the field, so what hope do we patients have to make informed choices.

• This reply was modified 1 year, 9 months ago by  Watchful.

[Good intentions]

I hope you don’t mind ajm22 if I add a couple more articles about nerves to your Topic.

Here is a recent one that addresses specific nerves. And also an older one from Dr. Bendavid that addresses the general nerve environment. It’s interesting to contrast the two perspectives. Today’s hernia repair surgeons are trying to find a way to not create chronic pain by avoiding specific nerves, assuming that it’s the nerves that they can see that cause the pain. But Dr. Bendavid’s work proposes that the generally unhealthy environment of the tissue in vicinity of the mesh, in to which new nerves grow, can cause pain.

My chronic pain was both specific, a sharp pain where the original direct hernia was, and non-specific, a general feeling of discomfort and/or pain over the whole of the area in contact with mesh. Most surgeons have problems understanding the second scenario. They will talk about nerves regenerating but don’t seem to really think deeply about what that could mean.

https://link.springer.com/article/10.1007/s10029-019-02070-z

Dr. Bendavid’s work, with co-authors. Dr. Koch is one of them. In HTML and pdf format.

https://www.scirp.org/html/8-2100894_47982.htm

https://file.scirp.org/pdf/IJCM_2014072117033945.pdf

[William Bryant]

Thanks Good Intentions. Don’t suppose anyone knows which surgeons follow these ‘rules’ re leaving nerves.

I think the Germans resect but not sure what that means!

[Good intentions]

Dr. David Chen had some interesting comments about nerves in his presentation about open Lichtenstein. At 7:20 in the video linked below.

It’s interesting that he feels the need to place so much emphasis on protecting the nerves and talks about the wrong way to do it. Suggesting that many surgeons are/were doing it the wrong way. Also good to hear that Dr. Belyansky is open-minded and confident enough to realize that his methods can be improved.

https://youtu.be/nvrpuJs8vuU

[ajm222]

Thanks so much Peter for coming on and sharing your thoughts. I agree about altering the anatomy, which is why I love the minimalist attitude of my surgeon. Avoids cutting nerves at all costs, recommends avoiding surgery altogether unless absolutely necessary, and plans for the simplest procedure unless circumstances demand otherwise. Also comfortable with absorbable sutures if requested.

I did read it takes a couple years for silk to dissolve completely. I also read a couple studies suggesting absorbable sutures work very similar to ‘permanent’ sutures. Statistically very little difference over the long term in terms of recurrences.

As for Dog, at the time he was posting here I did a little research on him and it seems he is or was apparently a successful dog trainer out in LA or something who even appeared on Letterman. And you can find a video of him on the show online, though perhaps he or his account posted that here and that’s how I know. So who really knows. But I do now know several people that have had good results with Dr. Brown. But they had very routine hernia repairs for the most part (though one did have his repair after mesh removal – I’ve spoken with this person privately at length and he’s doing great now). But I take your point. And to someone else’s point above, every super well regarded surgeon in this area has a horror story or three, so you just never know for sure what you’re in for when it comes to surgery.

Thanks again for the advice. I’ve taken a lot from your personal experience in terms of guiding my own decisions.

[PeterC]

Going to chime in on some elements of this conversation.

@GoodIntentions I dont know why I cant tag you but that person you tried referring to – the dog trainer or whatever that kept vouching for Dr. Brown on this website for years and had his sketchy testimonial website/story up – I’m almost certain that person does not exist and his persona was operated by Dr. Brown and/or his staff. AJM you should not use his testimonial for any decision making or indication of how you will do. Literally ignore everything associated with Dr. Brown.

As far as the sutures conversation goes – Dr. Brown assured me he would not use permanent sutures inside of me the day before surgery then proceeded to use Silk Sutures which are said to be permanent if you look it up on google. Through my consultations in the past 2 years I have been told specifically by Dr. Krpata that there is no such thing as a permanent suture (I guess besides metal ones that Shouldice uses) they all eventually dissolve. The silk suture dissolves over a longer period of time and cause more scar tissue to build apparently. I’ve had silk sutures put in by Dr. Brown to suture the conjoint tendon to the shelving portion of the inguinal ligament and every day it feels like I’m walking with rope/barbed wire in that section. It permanently hurts and feels extremely uncomfortable. I do think the sutures are dissolved and the pain comes from scar tissue buildup where the sutures were.

Ajm you are sort of familiar with my story – whatever you do do not let anyone modify your anatomy or create flaps out of tissues. It is not possible to do so without causing a lifetime of impairment and issues and anyone who says otherwise has no idea how the human body works and all of the different forces in play in your abdominal tissues. Everything has a role, its one cohesive unit under tension not independent elements that can be altered without issues.

• This reply was modified 1 year, 9 months ago by  PeterC.

[Watchful]

You’ll be feeling good much sooner than a couple of months other than in the very unlikely case of something going wrong.

Having a great surgeon definitely helps, and that’s the way to go. Stuff still happens even with them, unfortunately. Different patients react differently to the same things. One will be fine, and another will get some bad reaction or rare complication. With some patients, all nerves can be identified and avoided. With others, it’s not so easy. You do maximize your chances of success with the best surgeons, and hopefully with some luck on your side so that the surgeon is in top condition during your surgery, and not tired or distracted.

I don’t know about your surgeon, but I feel that most of the ones I know (including my surgeon) cram too many surgeries into a surgical day. I don’t know how they do it. I certainly wouldn’t be able to do it, and I’m younger than most of them…

[ajm222]

Very true, though I do think he’s going to find it’s going to need a full repair. Just a hunch. Which for him would be a two layer Shouldice. But he’s a great surgeon and should know how to avoid all the major pitfalls. And despite the removal, this should all be healthy and mostly untouched tissue. Will see soon enough. I’m very curious to know what he finds at this point. Hopefully in a couple of months I’ll be feeling good.

[Watchful]

Your procedure sounds relatively minor. It should be an easier and faster recovery than a full Shouldice. When they cut open your groin there’s always risk of impacting some nerve or other issues, but those should be rare when you’re in good hands.

[ajm222]

Thank you for that! Makes sense. I always imagine the first couple of days are definitely painful. As long as there is faulty fast improvement.

I’m in such a weird place. I clearly have something going on, possibly a full recurrent hernia, because of this bulge that gets fairly large after exercise. But for the first time in years I don’t have constant pain and discomfort. So I’m basically signing myself up for going right back into the fire after finally getting some relief. But I know this thing eventually will need to be fixed and I’d like to do it now before it gets worse and more complicated. But as always, there’s also a chance things go sideways.

Anyway, thanks again. That’s exactly the kind of thing I’m looking for. A variety of individual experiences.

[miner]

I had a Shouldice repair done by Dr Reinhorn. First if I ever had another hernia I would go back to him. I didn’t take any pain medication allergic to nsaids and can’t take Tylenol. Didn’t sleep well the first night it was tough to move kinda like a beached whale. Lots of swelling just kept icing it. If your at all constipated figure out how not to be. I think at 8 days I would have been fine going to a game I may have been careful in crowds. My recovery I felt was slow but a steady improvement. It was 8 months ago I still occasionally know I had the surgery.

[ajm222]

Actually it was Boston Hernia

[ajm222]

Is also be interested in your pain levels, Mark

And G and others – any specifics on vitamins and herbs? I did read something from the website of a NY hospital about Arnica Montana. Was surprised they recommended something.

[Andy2023]

thanks Mark for sharing your experience.

when you say that it was challenging getting out of bed or bending, did you need someone else to give you a helping hand getting up or could you still get up by yourself? were you taking both Tylenol and Advil to manage your pain at Shouldice? Medical professional tends to ask a patient to rate his(her) pain on a scale from 1 to 10 with 10 being most severe pain. What would you say that your pain level was in the first few days when trying to get out of bed or bending? thanks

[ajm222]

Thanks, Mark!

So those first few days, was the bending and getting out of bed a combination of pain along with tightness? With the robotic surgeries I had very little pain relatively speaking. I’m guessing with open surgery, because of so much external dissection and muscle and such being cut that contain a lot more nerves, it makes sense that it’s be painful. And the sutures could make it tight.

[MarkT]

I’ve had two Shouldice repairs (one on each side), ~10yrs apart, both a long time ago, with no problems immediately after or since. The first few days afterwards are challenging in terms of getting out of bed, bending, etc…but eight days out was much, much better.

If you have a ‘standard’ surgery and recovery experience, then you should be fine to attend a game. Many people are back at work in that timeframe as long as they aren’t doing anything very physically demanding. You won’t be running up any stairs, but you shouldn’t still be experiencing any major limitations that would prevent you from going. Just give yourself more time and avoid any situations where you might be getting jostled around in a crowd of people.