Watchful waiting

[roger555]

I just want to add that to me the first and most important thing is to find out what caused your hernia and stop doing that. The second thing is to do things that will help like wearing a belt and doing the right exercises and avoid exercises or doing other things like your posture and sleeping position that aggravate your hernia. Kang surgery is my third option.

[roger555]

18 years ago I had three hernias (inguinal on both sides and one two below and to the right of my navel). There were no lumps, just pain. I got them from sleeping on my side in an abdominal stretch position for about a year. Then I went back to sleeping in a fetal position and the pain went away in four months.

Now 18 years later I got an inguinal hernia on the right. I think I got it after doing some stretching before going on a stationary bike. The ultrasound showes just fat no bowel poking through with no tear but pain after standing for a few minutes, sometimes burning and pulling sensations. I got some improvements from doing some exercises and wearing a hernia belt I made myself. I think I found some other exercise that will help.

The only surgery I will be willing to do is the Kang’s repair. But at this time I cannot travel. Just by reading Dr Kang’s website it’ s clear to me that he is first of all interested in the best outcome for the patient unlike most other surgeons who just fix the hernia with no consideration of what problems they can cause.

I am going to concentrate on strenghtening my abdominals and core which I think will help prevent and cure hernias.

[kevin-pa]

For what it’s worth, I’ve been waiting 5 years. You can search this forum and I asked the same questions in 2017 when I did a bunch of lifting and first got diagnosed.

Has it gotten worse? It’s hard to say. Not really. I’m mostly a-symptomatic with the exception of long days on my feet. But I’ll also go months without really feeling anything even while working hard, and then out of the blue have 2 weeks of moderate pain just walking around the house. I’ve learned it follows no pattern and cant explain it. I’ve had the surgery booked twice, and canceled it both times. Mainly for the fear of chronic pain or more constant pain than what I have now. It’s the unknown. The truth is 90% of the time I barely even know I have a hernia so I say bk way am I ever getting that surgery. But then when it kills me I curse myself and say I’m calling the surgeon tomorrow. So in my experience, this has worked for me with minimal change to my lifestyle. I still hike, jog, walk my dog, lift weights occasionally, etc. I’ve just learned to listen to my body and know my limits and what tends to cause pain/discomfort. I’ve gone back and forth a thousand times on surgery but I know myself too well and I won’t get it until it truly forces me to.

[Mike M]

@Jack

Thanks Jack! Shouldice Hospital (from what I read with reviews, other patients) is a very good option if you get one of the premier doctors at that location. It is my understanding you cannot choose. You might want to consider Dr. Yunis in Sarasota, FL or Dr. Grischkan in Cleveland, OH if you are still considering Shouldice.

I am sure you already know but there are other risks not associated with Shouldice, Dr. Kang, open tissue no mesh procedure, etc. that are present with laparoscopically performed procedures too. There is some valid debate that the chronic pain results are similar as well as reoccurrences.

Biggest thing imho with any procedure is choosing the best doctor you and your insurance can afford. As you have probably already read from the forum feedback that makes the biggest difference over anything else. If I was doing lapa I would consider Drtowfigh or someone at the Cleveland Clinic. You will be able to find a lot of good options if you go that route too.

[Jack]

Congratulations on making a decision Mike, hats off to you for traveling to Korea for your health, and best wishes for a good operation and speedy recovery with Dr Kang.

I’m 50 and fit/active. I’m wary of mesh, like most on this board it seems, and have investigated Shouldice Hospital. My hernias are bilateral, which with Shouldice seems like a lot of cutting, and two chances at pain, that’s the only reason I’m considering getting it done laparoscopically.

[Mike M]

@Jack

I am traveling in the next few days to have surgery with Dr. Kang in South Korea. http://gibbeum.com/main/main.php . He explains his procedure in the other threads but essentially it is similar to Bassini / Shouldice for direct hernias with smaller incision and a less “traumatic” procedure than Shouldice with equal or better results reported. Less tension too. Indirect Hernia the closest type of procedure would be the Marcy but it is not really a Marcy repair. All his procedures are known as his own Dr. Kang procedure.

If I did not discover Dr. Kang I would have reluctantly still been in the phase of “watchful waiting” with the Shouldice procedure and Dr. Grischkan being my #2. choice. I felt 100% comfortable with Dr. Grischkan but the Shouldice procedure is more involved but still with really good results.

I would never consider any other type of repair at my age other than an open tissue repair without mesh. I would only consider mesh as an option if I was 65+ or a couch potato. That isn’t to say mesh repairs are bad just not my preference. It is strictly a personal opinion based on what I have researched that it would not be in my best interest at my age. I am not a doctor so get a few opinions from actual doctors and testimonials from patients before you make up your mind imho.

If it means anything though – I never travel for anything other than traveling to another state for family vacation, occasional work obligations (I own a few companies and have to unfortunately), and recently this year for the Superbowl. I am not a travel person at all. Whatever is the opposite of travel person is me. Also having worked with medical professionals in my career (as a non-medical professional) at the highest level I am one of the most cynical people on the planet as it pertains to doctors.

tldr; Dr. Kang is the man.

[Jack]

Good points Mike M, especially the walking on eggshells part.

Out of curiosity which type of procedure do you think you’ll get?

[Mike M]

So here is my thought process coupled with my experiences.

– Watchful waiting is probably bad imho. –

#1. It almost certainly will progress unless you limit your lifestyle. In my particular case it went from undetectable to hmmmm something is moving there slightly to pop oh I now have “moderate symptoms” all because of coughing from a minor cold. Obviously every case is different but recognize that it is a possibility it could progress quicker than you expect.

#2. Fixing it sooner usually results in a better outcome with less aggressive surgery being needed.

#3. There are MANY other serious symptoms that can occur and even potential damage other than just the “strangulation scenario” if it progresses. Nerve damage, cut off circulation to other “sensitive” areas vessels down there, tension, etc.

#4. It can progress to a serious point (even without strangulation) where other options you had for repair are no longer an option.

#5. Do you really want to be beholden to your hernia, walking on eggs shells, and ultimately on pins and needles trying to “manage” your hernia for an indeterminate amount of time? You have zero symptoms *now*. Understand that this can change unexpectedly and in a flash.

I took the “watchful waiting” stance at the beginning of Feb thinking it was no big deal. Hernia went from zero symptoms to moderate in a flash then back down to near zero symptoms. I wasn’t even doing anything out of the ordinary either and not even lifting weights.

You know what “watchful waiting” means to me?

The time it takes for me to do the necessary due diligence to find a doctor, procedure, staff, and hospital that best fits my needs.

[Jack]

I’ve seen a few docs say if it’s not bothering you you can wait. And Fitzgibbons has published studies showing strangulation risk is extremely low but most watchful waiting people eventually get the surgery as the hernia becomes more painful as the years go by. I’ve been very anxious, as I’m sure people on the board can relate, as there is a not trivial chance of pain or complications. I think I’m going to keep a journal of how it feels, ie how much it hurts or interferes and maybe that can guide me, rather than looking down and seeing the noticeable bump and assuming it needs to be fixed soon.

[Alephy]

I think one question you should ask yourself is if you can still do all you used to do, or all that you want to do, with the understanding that the hernia is maybe now preventing you from doing it…

Many doctors will tell you that watchful waiting is not recommended anymore; however Dr. Towfigh has endorsed it (when symptoms free).

Other than that, you can do physical activity with an hernia, weight lifting etc…

[William Bryant]

I’m in a similar situation. Mine is not too symptomatic fortunately. I’ve waited 7 months now approximately. I think the best advice is when it interferes severely with what you want to do, pain/discomfort are too great,then you’ll know.

Some people prefer to have surgery when it’s smaller and they are younger. There would be logic in that but still no guarantee you won’t be left with pain or have a recurrence. Surgery isn’t as plain sailing as is made out, sorry to say.

Personally I wish to avoid mesh if I can. Doctors often prefer mesh as you probably know.

To get non mesh you may have to pay which is another factor.

Read some more on the forum and take a bit of time deciding. Best of luck.