Watchful waiting?

Hernia Discussion Forums Hernia Discussion Watchful waiting?

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    • #12125
      Alephy
      Participant

      Hi All,

      Did anyone opt for a watchful waiting, while being able to lead an otherwise normal life? What is your experience? Did you have to follow a specific diet?how often would you go check with your doctor?

      Thanks again!

      Cheers,

      Alex

    • #20686
      Casimir
      Participant

      I did for 3 years and desperately wish I had continued to do so. No special diet — except fiber, and staying fit / cardio. No heavy lifting. Had regular checkups. You can’t go back if something doesn’t go “right” and the odds are surprising bad that something will go wrong. It will literally ruin your life. No exaggeration.

    • #20701
      Alephy
      Participant

      Did you have a mesh repair in the end? what went wrong if I may ask?

      Another reason I am thinking to wait is that in say another 5 to 7 years things might have improved enough to offset the (at the moment high) risk for complications…also I am 49 and going towards 60 I might have less expectations with regard to being able to have a very physically active life (at the moment I am still kicking with martial arts…which may have caused the problem, go figure)

    • #20769
      Alephy
      Participant

      Did you get surgery with mesh in the end?(which type of mesh/surgery if I may ask?) what made you decide? pain/discomfort? how did you cope for three years> did it refrain you from doing sports?

    • #20777
      Katherine
      Member

      I had a hernia form in 1996 (small one on the right). It never bothered me until December of 2018 when I did some core exercises recommended by a PT. From 1996 to 2012, I did anything I wanted (2012 was the year of a disastrous back surgery). I lifted in the gym, was a runner, etc. It never, ever bothered me. I think the reason it got worse in 2018 was I was older an my collagen was just much weaker (may also have something to do with an autoimmune issue following surgery). Anyway, no special diet, no special life circumstances, never saw a doctor after 1996 to have it checked until it worsened in 2018.. If I were you, I’d watch and wait until it bothers you.

    • #20778
      Good intentions
      Participant
      quote Alephy:

      Did you have a mesh repair in the end? what went wrong if I may ask?

      cshelter has posted quite a bit about his situation. You can click on his name while you’re logged in and see all of his past posts. Good luck. [USER=”3125″]Alephy[/USER]

      https://www.herniatalk.com/member/3118-cshelter

      By the way, if you’ve researched this far you should keep going, in to more detail about the different types of mesh. “Mesh” is a very vague catch-all term used to cover everything from absorbable materials to permanent synthetic polymers. In the early days the “mesh” was made of metal. It is a lot of work and difficult to understand but even most doctors just use whatever mesh their purchasing agents have made a deal for. “Mesh” is a product, sold just like any other commercially available product, with sales people and marketing professionals behind every one of them.

      Here is a list of many examples of “mesh”. https://www.herniatalk.com/13873-types-of-mesh-and-their-manufacturers

    • #20779
      Alephy
      Participant

      Well it was almost without symptoms but since the last week or so I have a low level pain and discomfort…I have stopped training as a precaution but in the long term I am not sure just waiting is a viable option (I even had a slight nausea which went away quickly luckily, had it not I would have rushed to ER), unless all the pain goes away all of a sudden….did you also have a small bulge? mine is hard to see (only stretching the skin)..
      In any case I will see a specialist this Wednesday (instead of waiting for the ct scan and the visit with the surgeon at the end of Feb)…for me it is important to be able to continue exercise physically so at the very least I want the all clear for that…the urticaria condition also complicates my surgery as far as mesh is concerned…as soon as I know what type of hernia I have I will have to decide…

    • #20810
      Alephy
      Participant

      When do you think one should seek surgery instead of waiting? where do you draw the line?(apart from extreme pain, symptoms of strangulation etc)….some pain is acceptable or one should get surgery immediately then?

    • #20814
      drtowfigh
      Keymaster

      The amount of pain and acceptance of symptoms varies per patient.

    • #20822
      UhOh!
      Member

      I’ve opted for it thus far and continue to do so. As far as things I’ve had to change:

      -No more deadlifts in the gym (but can still squat heavy without issue)
      -No pull-ups or climbing in ways that stretch out the whole body
      -Use hand to hold hernia in when coughing/sneezing

      Occasionally, the bulge will enlarge a bit more than usual (typically when I have upper respiratory tract infection) but it doesn’t seem to do so for more than a day. Pain is rare, and if it happens feels like a mild muscle ache (not nearly as bad as when I pull an actual muscle).

      Part of why I’ve felt comfortable waiting is that I, too, had an ultrasound and it showed only fatty tissue in the sac. Had it been intestine, I might have thought more carefully about a repair sooner.

      There are two things that would make me consider a repair, besides the obvious strangulation (and I’m guessing one will happen eventually, at some point):

      1. Significant increase in size.

      2. Local availability of a surgeon performing a pure tissue repair involving minimal cutting/sewing (closest seems to be Dr. Grischkan in OH).

    • #20832
      Alephy
      Participant

      [USER=”1391″]UhOh![/USER] do you have a direct or indirect hernia? The US report in my case also mentions fat and small intestine…fat from the small intestine? How good is the US in differentiating the type of inguinal hernia btw?

      ” pure tissue repair involving minimal cutting/sewing “: does this include Shouldice in your opinion? from what I have read the Shouldice procedure is quite “heavy”

    • #20833
      Alephy
      Participant

      [USER=”2029″]Good intentions[/USER] Thanks I have gone through the post on available meshes…one day I will try and ponder on what clicks in doctors brains that makes them see A but NOT see B (long term pain), it cannot just be money…

    • #20845
      pinto
      Member

      Alex,

      I highly recommend that you forget watchful waiting. Any worsening of your condition is very unlikely to be reversed. The worse the condition, the less successful repair will be. Most troubling is if you ever need emergency surgery when you are very unlikely to even know the surgeon let alone choose a method or competent surgeon. (I talked with enough general surgeons that convinced me about the latter point.)
      Good luck.

    • #20849
      Alephy
      Participant

      Yes I agree with you. I will be seeing some doctor(s) next week, and have already contacted some others in Europe…at the very least I have some options (all of them expensive to a certain degree)…I have also a scheduled ct scan and surgery discussion end of February but if I find the right surgeon before I might go for it and not wait….definitely the discomfort has increased, and although the odds of an emergency are in my favour, I just want it controlled so I can eventually go back to my previous physical activity…also I have had onsets of back pain which I think are related to the hernia somehow..

    • #20854
      UhOh!
      Member
      quote Alephy:

      [USER=”1391″]UhOh![/USER] do you have a direct or indirect hernia? The US report in my case also mentions fat and small intestine…fat from the small intestine? How good is the US in differentiating the type of inguinal hernia btw?

      ” pure tissue repair involving minimal cutting/sewing “: does this include Shouldice in your opinion? from what I have read the Shouldice procedure is quite “heavy”

      I’m honestly not sure, the US report didn’t indicate. I’ve always assumed direct because of how it “behaves” (seems to bulge “away” from scrotum, always quick to go “in” when I lie down and come back “out” when I stand, easy to manually reduce whether sitting, laying or standing), but that’s hardly a medical diagnosis.

      US did indicate the size of the hernia defect in centimeters, which I took as an indication that it was direct, but again, that’s not exactly a medical opinion…

    • #20861
      pinto
      Member

      My own dentist needed emergency IH repair. I assume a dentist has infinitely more access to a local medical community and medical awareness than many of us. He likely did some watchful waiting. Alex, you are moving in the right direction. Make sure you feel right with your ultimate decision. Good luck.

    • #21759
      Alephy
      Participant

      Well, here I am re-evaluating watchful waiting…it seems it is not so easy to get 1) a non mesh surgeon and/or 2) one that is covered by my insurance.
      I have been told that the smaller the hernia the better for a non mesh repair: I wish I had been told that one can indeed get a non mesh repair without the surgeon ultimately deciding for a mesh during surgery..

      So basically I don’t see the point in getting a mesh now unless it is really an emergency, in which case they will most certainly use a mesh anyway…

      The question is: do doctors see or have a feeling how things will change in say 10 years from now?

      How much of the long term problems related to the mesh goes down to the skill of the surgeon do you think?
      (one site in the UK stated that all the problems with mesh are due to the surgeon not being skilled enough…which goes against my understanding of what could go wrong with the design of the implant itself.material etc etc)

    • #21760
      Kablooey
      Participant

      Alephy,

      When I discovered that I had a hernia and was researching my options and learned that Polyproplyene Mesh is not entirely inert as it is often claimed and degrades through oxidation regardless of the “skill” of the surgeon it seemed like a no-brainer to me as a 43 year old who potentially may be around for a few more years to choose a non-mesh approach. I was very fortunate that my “Top Tier” health insurance plan in the US offered thru my employer had a rather high deductible requiring me to pay nearly the same amount as flying abroad and paying for the procedure out of my own pocket. When considering this and the fact that if I were to go with laparoscopic/mesh which was recommended by a top NYC surgeon and had a problem… It would be so much more expensive finding a surgeon to fix it and the consequences could be so devastating: permanent erectile dysfunction? I couldn’t imagine having something in me that may eventually fail and cause complications in a few years or possibly 30 years down the line. Where as the worst case scenario with the non-mesh option would be to have it done again free of charge. Yes, it would be wonderful if every hospital across America offered these procedures but we should be so grateful that there are already more than a handful who can and the wealth of information that is available thru this forum! -Best Regards

    • #21761
      Momof4
      Participant

      Alephy,
      The statement on the UK site is false! While surgeon technique and skill definitely contribute to success it certainly isn’t the only factor when mesh causes problems or fails. I know Dr. Towfigh has said the percentage is small, but some people react to the mesh itself. You can have an allergic reaction or foreign body response (which may be dose dependent). I have had lots of problems with 2 different types of mesh and my surgeries were with top hernia specialists so I’m fairly sure it wasn’t the surgeon. Seems we are finding out that mesh is not inert and does not always behave as predicted. Wish I had known this before I was implanted by a local surgeon, a surgery that was considered “no big deal” was the start of a long nightmare for me. I’m still working with doctors to find a solution that will get me back to “normal”, whatever that is! Haha

    • #21772
      Alephy
      Participant

      I agree with you @Momof4…I really find it disconcerting that so many docs report wrong facts or numbers….what’s wrong with stating what is known and letting the patient know the possible risks? This is incidentally why patients with problems after surgery get angry,at least from what I read here…the other really annoying thing is that some doctors get angry as soon as you start asking too many questions!
      Btw about the watchful waiting:one doc told me it’s fine to wait,another that it’s not recommended anymore, yet another that I can certainly wait few months…all this while happily taking my money

    • #21803
      drtowfigh
      Keymaster

      Watchful waiting has been studied prospectively for up to 10 years. The risk of needing emergency surgery was 0.18% per year. That’s a very low number, and thus watchful waiting is considered safe in men with asymptomatic or minimally symptomatic inguinal hernias.

    • #21808
      Colt
      Participant

      Doc, I wonder are there any new inguinal hernia meshes on the horizon in next few years
      That are going to be more acceptable to the human body rather than the ones currently in market,
      Another question if a tissue repair fails,(shouldice) can you do another tissue repair or at that point to fix hernia would you have to definitely go back to mesh
      To repair, just curious

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