[Alephy]

I used to say this: martial arts got me few injuries, but most definitely made me avoid few others…the same goes with exercising: you sure will not twist your ankle while on the couch, but you might suffer from high blood pressure…

In one sentence, we were made to move…

[Alephy]

I look at this as the triad of hell! You have the area (e.g. the groin) that is tricky from the anatomy and functionality point of view (it is a very key area if you are an athlete), you have the huge numbers of patients (huge volume) , and you have the business and involvement of big corporations!

Remove any of these three components, and I would think the problem would somehow get resolved….

[Alephy]

I think there is a misunderstanding on what a cure means….personally I think of that as “reduction of symptoms”. As an example in the past people were pushed into surgery whenever a meniscus problem was diagnosed: it has since been found that at 4 years the symptoms of those who had surgery and those who had PR were similar/identical, suggesting that PT be the preferred first approach to the problem. You do not “heal” from a meniscus injury, and nor do you heal with surgery (when they remove a piece of it): you can however improve your symptoms to the point of going back to what you activity was….this is also true for athletes and laymen alike.

The key to recovery (which is a better word than cure) is to diligently train your muscles (all of them). In the hernia case, training and taking care of the core muscles will likely make things better, perhaps reduce the hernia, and make it more tolerable when you go back to your daily activities (even @drtowfigh mentioned this as often her first suggestion to patients in one of her videos, if I am not mistaken). The area will never be the same as before, with or without surgery (unless some gene therapy reprograms the tissues so that they go back to the quality level they had before, which I assume will eventually be THE real cure), but you can “improve” your whole body to tackle the problem.

Basically while the local problem will remain to a degree for ever, and locally you will be worse than before, overall your whole body may actually progress beyond your previous abilities thanks to the exercise, know how in taking care of your body, and possibly different approach to training and sports.

Those who focus on the local problem, and want to sort it out to go back to their previous life, live in a different reality: the only path to recovery with or without surgery in my opinion requires exercise, and I would say after the injury you must do your exercising diligently and religiously, and for the rest of your life (I am talking about active/sportive people, just so we are clear)

I have been watching my hernia for about two years, and I train by myself few times a week. I have not gone back to full martial arts routine (mostly because of COVID) but I will soon do: will I be able to? I don’t know, but it will sure be interesting to try and find a way to adapt…

One day I might have surgery, but if that happens I will go under knife with a lot more knowledge about the procedures and my body than if I had tried to fix the local hernia alone…

[Alephy]

I forgot to mention that I have also a feeling that a successful story with mesh could end up being not so after x years, and this also should be factored in…

[Alephy]

I am a bit puzzled by the definition of success after a mesh surgery…

There are many types of mesh, different materials, procedures, the anatomy of certain areas varies a lot, surgeons have different skills etc: it seems to me there are just too many variables!

But most importantly, depending on the person’s age, lifestyle etc, the same set of values for the variables above can lead to different outcomes: an older person might consider the procedure successful , while a younger athletic one will face problems due to the sports and physical activities performed…

ps: notice that I am not even mentioning the recurrence rate

[Alephy]

@spinotza I guess what you just mentioned depicts a different picture….if you go for surgery do you already know which type? mesh vs non mesh? in the UK?

[Alephy]

@Jack2021 Yes I was told the same by the better half of the doctors I saw, and I agree with it.

At the very least doing the things you were doing before will help you understand your limits given the new situation (and as we all age, these limits were never really fixed, even before the hernia).

[Alephy]

I think as far as cutting the nerve is concerned, you may want to read other posts…one person from the UK has had sever issues after a similar surgery…I am not sure for the average person but for an athlete it may have strong implications….

[Alephy]

My takeaway from this is that the Chief Surgeon was probably taught proper anatomy when he or she was a student, and learnt to properly discern the tissues/nerves etc in the area.

The younger surgeons were probably taught a simplified curriculum with the idea that using mesh would not require more….

What will happen in the years to come?

[Alephy]

@andrew1982 thanks! Has she been following up your case, or you are with another doctor now?

[Alephy]

@andrew1982 If I may ask, where did you get the surgery? In Germany? Under Muschaweck herself or with another doctor? In case ping me privately if there is a privacy issue with my questions…

I ask as at one point I also considered that procedure…

[Alephy]

@drtowfigh Thanks for the video, it was really interesting!

Did I understand correctly that when the absorbable mesh is placed below the muscle the recurrence rate is around 12%? It was also mentioned that depending on the technique the recurrence rate with absorbable meshes can vary dramatically, which prompts my question:
I have often heard doctors say that biological meshes don’t work, but I have failed to see articles detailing clear numbers to this conclusion; in the video the recurrence rate (depending on the technique) is said to vary between 12% and 30%. So has something changed in the technique or mesh quality to account for this discrepancy?
On the one hand it is said that the absorbable meshes just don’t work, and on the other a recurrence rate of 12% to 30% is mentioned: is the 30% upper limit the complete failure argument? (I got the one behind the 80% recurrent rate in case of an incisional hernia, if I remember correctly)

The lower limit, 12%, seems close the synthetic mesh performance to me, which would warrant (costs aside) the use of these meshes.

In answer to the patient’s poll I can say this:

I would be ok with a risk of recurrence up to 30%, as I am inclined to the idea that a hernia surgery might have to be done again in the future. The caveat here is when i.e. if a new surgery will be required down the road in say 10 years or more, it would be still acceptable to me, considering also the possible advancements in technique, materials etc. Should a surgery be required few years after the first one, I would still consider it as a risk worth taking, re-assessing though my options for the second surgery…

My answer is based on my age, lifestyle and expectations for the years to come: I am not in my 20s, and I am not looking at professional competition in a particular sports (the poll should include the age and lifestyle factor in my opinion).

I really liked the idea of an absorbable mesh combined with a tissue only repair, however I have only heard about this possibility in this forum and in the video, which makes me think that this would be difficult to get from an average surgeon (at least in Europe).

Last but not least, offering any alternative to the synthetic mesh (whatever that is) in case of urticaria, allergies etc sounds like a must to me, as a risk prevention measure…

Thanks again for all the info!

[Alephy]

I also had a small abdominal hernia (fat protruding) in the late 90s, operated in 2003. As it was small no mesh was used, and I was back to my routine after 4 to 6 weeks. I think inguinal hernias are probably a different beast altogether, as the location is a lot trickier.

You mention adjusting one’s life style to the hernia: from what I have gathered here this will continue to be the case even after the surgery (for the inguinal hernias at least), as most people tend to adjust to try and avoid recurrences, or the mesh complications (minor or big that they may be) warrant them to do so.
I have also read stories of people going back to contact sports after few weeks from a mesh repair and not even feeling anymore that they had surgery, and there are also examples of professional athletes in the same category: personally I don’t think this is the majority of the cases.

If I started having limiting pain I would definitely have surgery. As for choosing a doctor, this is easier said than done, as I think I would have to travel for that (I very mush wish covid will be behind us if or when that happens).

[Alephy]

I am also on watchful waiting, right inguinal hernia, direct or indirect I am not 100% sure, since end of 2019. I can only see mine when stretching the skin (was told it is small, but who knows?). It is almost non symptomatic (I can feel it at times when exercising a lot, I am 50 and do internal martial arts ie nothing heavy).
I have seen doctors who clearly had not my interest at heart, as they repeated the same lines that you usually hear from surgeons who want to operate on you, that is: it will get bigger, watchful waiting is not recommended anymore, there is a risk it incarcerates and can be fatal, the mesh is inert and whenever there are problems it is because the surgeon was not an hernia expert. One even said that the hernia on the right will cause one on the left, while telling me how good the Bard meshes are, and that I would be back to sports in days…

As per why they would not consider tissue only repairs: oh but those have 50% rate of recurrence, and you will have to stay put for months, and it is not the golden standard….and of course they don’t know how to do them anyway anymore….

When I asked about absorbable meshes I was told (also here on the forum) that their recurrence rate is high (could not find this result in the literature) and that it is only used in special circumstances…

I sometimes think I am good at stumbling into the wrong people’s office….

[Alephy]

@drkang Thanks for the info! Does this method work also for small hernias?

I did as you suggested and I could hardly notice any bulging (in a mirror), but then again even when standing the bulge can only be seen when stretching the skin (and no, I am not fat, I am quite in shape:).

All the exams I did ie two ultrasounds and a CT scan, said I have a direct one. All doctors agreed, except one, who instead said she thought it was definitely indirect (but she did not see the CT scan result)…

[Alephy]

I wonder, no doctor could diagnose whether the hernia is direct vs indirect? no ultrasound could discern that?

As for me all the doctors I saw told me they were 100% sure it is direct, except one, who thinks it is indirect. And I also had two US which also reported a direct hernia…

[Alephy]

Well I guess sneezing is a personal thing too, but I think bjj exerts a lot more pressure than any sneezing I can recall (by a lot) 🙂 or at least this is my experience. Incidentally also non grappling martial arts which involve the abdomen (kind of internal) often produce a lot of pressure when against an opponent (also my little experience here:)

[Alephy]

Sorry I meant always PT=Physical Therapy

[Alephy]

@spinotza Just so I understand, do you have any pain because of your hernia? Is running the one thing in life that makes a difference for you? If the answer to both questions is no, then I would totally agree with @good-intentions ….

[Alephy]

@william-bryant I am a supporter of watchful waiting.

None of the doctors I have seen mentioned this option as a possibility, all referring to the official guidelines that do not support it, with the reasoning that an hernia will only get worse and that sooner or later surgery will be necessary, and better sooner than later. I do NOT agree with this way of thinking!

Why?
1) if the hernia has no effect on your lifestyle, the risks associated to doing nothing are minimal (I am talking about an inguinal hernia, for other types this is not necessarily true!)
2) few more years of waiting might bring in other options/techniques/technologies which might benefit you
(again depending on the type of hernia)
3) no surgery will rewind the clock, even if you are an elite athlete, so the idea to do it so you get back to your old yourself is an illusion: you can however get into being somebody different, sometimes in fact thanks to the injury (few people have mentioned that the hernia prompted a lifestyle change which was beneficial, this can go even further in my opinion)

And most importantly,
4) a very high percentage of the people who got inguinal hernia surgery (will) have discomfort, on par to much worse than before the surgery, so it is a very substantial risk! (other types of hernias have a different background and associated risks and might warrant a rethinking of your approach to the problem)

My post however wanted to focus on the dishonesty of many doctors, who either ignore the risks or simply report false information: this is what makes me angry!

I think it is hard to find doctors who will give you a fair assessment of your hernia, in terms of options, outlook etc. The response will always be a mixture of personal believes, old info, bias towards a procedure/technique, limited skill set etc. And you better get your know how in order, so as to spot the “experts” with lots of conference badges, who will take your money, go in and leave you right after with your problems (the body violation feeling afterwards must be mentally challenging)

My 2 cents

• This reply was modified 3 years, 2 months ago by  Alephy.