[Alephy]

@drtowfigh The definition of success is what I have been wondering about (in fact many others have as well) i.e. does this include follow up for potential problems? Since joining in this forum I am inclined to say that most of the times it does not…I guess this is the question for many who consider hernia surgery i.e. whether they can follow the data or not, or the average medical advice; naively I would personally say no:(

[Alephy]

I am not sure that this “not sneezing” advice makes sense! On the one hand they (the experts, not the pseudo ones) seem to agree that you can do sports with an hernia; on the other some (probably the same pseudo doctors) claim sneezing is bad for your hernia. Any activity puts some pressure on your body, and so also the hernia: I would argue though that for that to have an impact the hernia needs to be massive! The body is stronger than we may think, even with an hernia.
At the very least I never noticed any pain or discomfort with mine, and I am super allergic so I sneeze all the time:(
If you do feel your hernia when sneezing, I am wondering that it may still not mean that it is necessarily getting bigger or more problematic?

And if the idea is it is bad in that long term after many years of sneezing, I would argue that you can counter that with….sports:)

[Alephy]

I thought I would chime in, as I have some experience on the divergent opinions of doctors:)

What moves somebody to become a doctor? I think only a minority is doing it for ethical reasons…why did Dr. House become a doctor?:) incidentally, I would never let him look at me, as if it goes well all is fine, while if it goes bad you are most definitely on your own! I was once told by a medical student I knew that to be a doctor requires a good dose of callousness, and I guess you see this around…

It has been commented here on why a doctor in a hospital would go private and open their own practice: when this happens though business considerations also kick in i.e. it is their job, whether they are good or bad at it (and it is always easy to blame an external factor for their failure)

Unfortunately Hernias are in the tiny spot where there are lots of them, the system wants to pay as little as possible, they are for the most part not life threatening, and the area is small and with lots of structure around that is essential in many different ways (it is clock work): if you removed any of these components things would be immediately better…so I don’t think comparing hernias to other (more successful?) procedures is necessarily correct.

I wonder why we don’t see centres with a guaranteed followup up to x years, clearly written communication guidelines, as well as guidelines when problems arise: as an example, if chronic pain occurs, the center could offer expertise without extra charging, or contact an expert on behalf of the patient, agree to remain at disposal for any questions until the problem is resolved, agree following up with extra diagnosis prescriptions (mri etc). These days one center is focused on this aspect, another on that one, and if you have a hard situation that requires different expertise you are bounced back and forth.

And of course (and in Europe we are getting there I think) a centralised secure database for medical information, so that at least one doesn’t have to wait to receive the documents from doctor A, in roder to discuss the case with doctor B… (I was hit and annoyed by this in Switzerland!)

ps: Personally I would also make independent medical researchers (preferably public employees) run surveys, follow ups, and assessments of best practices/materials etc. Many research articles are biased by conflict of interests, and often the methodologies used are also dubious.

[Alephy]

@DrBrown this is another interesting point. On the one hand there are no articles from the 1980s of chronic pain and hernia repairs, on the other some doctors (I think I also remember Dr. Towfigh mentioning this at one point) think that in the past chronic pain was assumed as normal, and this is why it was not reported/published. It is also mentioned in recent papers that compare mesh vs non mesh, that the rate of chronic pain is the same in both (with a few years follow up I guess), although I would expect a lower rate than in the 1980s because of better surgical procedures?

So which is which?? I find it interesting that a patient cannot be given simple facts e.g.

if you do mesh, you have ~x% chance of complications + possible problems in tot years

if you do pure tissue repair, you have ~y% chance of complications + possible problems in tot years

(as mentioned by many, recurrence should enter the discussion but not be the focus of it)

[Alephy]

Hi Colin,

Personally I found your post very interesting, you described your personal experience with the two surgeries, which is what people have been doing here since the very beginning. No one is saying that they are showing scientific results out of one’s experience, for that there are medical articles (which are not submitted to this forum for review as far as I know:)

[Alephy]

Thanks a lot for the upcoming event! I have a question: some have said in the forum that push ups are “bad” when one has an hernia; is it true?

[Alephy]

I guess it all depends on what you (like to) do and how…
Did you have surgery and if so did it fix the problem so that you could go back to the gym?

From my side I had at one point small but fastidious pain and some cramps, but all these symptoms disappeared when (hear this) I stopped drinking espresso coffe and opted for normal coffe instead (I am still not sure if the espresso machine had a mould problem actually, va savoir). At the moment the hernia seems the same size as before, and I have at times a feeling of weakness; for the rest I do exercise as before when it comes to solo training (I have always used elastic bands and body movement, no weights though); I have not had yet a real martial arts sparring session because of lockdowns/covid

[Alephy]

I saw the video too, and I think many people found it interesting, as it seems to confirm that exercising with an hernia is fine and even recommended (despite some believing that it would make things worse).

As for the surgery, I have been told by some surgeons that one should get surgery sooner rather than later, as (they claimed) watchful waiting is not recommended anymore, and that it is better to have surgery now that one is pain free and without complications (the idea is that one will eventually have to have surgery period).
They also mentioned that with time the (inguinal) hernia becomes bigger (I am not sure I agree with this statement actually, at least it is not always so), and so the more one waits, the less likely a tissue only repair will succeed: apart form the fact that some surgeons don’t see a problem with tissue repair and the hernia size, I found crazy that one surgeon considered my hernia already too big, and another one (a specialist, and a good one actually) found it quite small (he still suggested surgery in few weeks though, and with mesh).

ps: having spoken to some doctors in Swiss hospitals, I think they would still be able to perform e.g. a Shouldice in case of an emergency. In Switzerland there are even some hernia experts that offer tissue only regularly (e.g. in the Basel area).

ps2: I read somewhere that during the COVID pandemic hospitals saw fewer hernia emergency surgeries, to the point that the article asked what happened to the “missing” patients, which makes me think that the so called emergency surgeries are probably inflated and that the number of truly necessary surgeries is smaller

ps3: I wouldn’t be surprised if some patients got an hernia but managed to cope well, with the hernia even shrinking thanks to lifestyle changes that might just improve collagen quality (never read any such evidence on this though, it is just my thought/rambling)

[Alephy]

@drkang Thanks for your answer, which I think touched on all the points/questions that were raised, and in a very precise manner!

[Alephy]

Thanks for this video, very informative! I was wondering, as hernias e.g. inguinal hernias are mostly caused by collagen depletion (or poor quality tissue), is or will there be a way perhaps in the future to “reverse” the trend and make the body regrow healthier tissue? Might in this case (some?) hernias get smaller/reduce?

[Alephy]

Reading “..Mesh is now the subject of intense global scrutiny after reports of serious long term effects from material that has twisted, moved, disintegrated, or caused severe allergic reactions.” makes me wonder: if the pelvic mesh caused allergic reactions, shouldn’t one conclude that the same problem would be potentially present for a hernia repair? (I understood the different meshes are made of the same material?)

In any case the fact that a surgeon can put a mesh in but not know how to take it out as something is supposed to be permanent, is in itself a major flaw of thinking (personally I don’t consider a hernia surgeon who cannot take the mesh out a hernia expert)…

[Alephy]

I think in general it is crucial that any new method be published and discussed with peers, as it is the only Scientific way. This has also another big advantage: any new valid methodology can then be picked up by other doctors and offered in other places; remember, the number of hernia cases is in the hundreds of thousands if not millions worldwide eery year! I think the Shouldice clinic also often has surgeons visiting the center to learn the technique (if I am not mistaken) which makes sense to me…One surgeon can help many patients, but one surgeon’s procedure can help 100 times more…

On the Scientific method, I find it appalling how new mesh implants are funnelled into the market without any real long term testing, just because they are “similar” to already existing products…

[Alephy]

Hi Josh,

The back pain can be caused by the muscles unbalance as well as a fascia problem (the fascia is always affected in one way or another when having surgery).
I am wondering, is the pain you experience in the groin like a shooting electric current? (forgive my bad analogy)
Is the back pain in the form of spasms? (these can be truly painful, I had this level once and ended up at the ER)

[Alephy]

@drkang Thank you for your post. It would be great if your data could reach as many doctors so that your method/procedure would be available in other countries too.

I wanted to ask you an unrelated question. Many doctors say that in the old days when treating hernias without a mesh the patients often had to stay in bed for several days, which led to other complications. They also argue that the pain level was severe, and that many weeks (5 or more) had to pass before the patient could go back to work or start again with any physical activity.
These days however it seems non mesh pure tissue repair is performed in day hospital (or max one night in hospital): of the two one, either what the doctors are saying of the “old days” is not accurate, or the surgical procedures/ anesthesiology in the last 20/30 years have improved so much that today’s pure tissue repair is anyway very different from what it was like before? But I was also under the impression that the Shouldice clinic has not changed much in the way they do things (they have been doing it since the 1940s?), so I am really confused by the statements above that I have read from many doctors…

Thanks again!

[Alephy]

I think common sense often goes a long way in solving a problem. Addressing the pain from mesh as seen by the brain sounds like propping a three pillar building with another bigger one next to it, rather than adding the extra pillar instead.

As for the doctors being under pressure and often criticised by the patients, I think part of this would be solved by at the very least acknowledging that hernia surgery while common is also at higher risk of complications than normally explained/sold to the patient (this point is the one that most angers me actually)…

[Alephy]

This is actually a question a patient should ask the surgeon before mesh surgery i.e. if problems arise, will you be able to remove the mesh, and if not do you have a plan to tackle the problems? (referral to a colleague etc)…

[Alephy]

I think some surgeons will always “complain” that they had to use mesh because the patient had waited too long and the hernia was too big, it is the usual dismissal for a pure tissue repair (I have seen this myself i.e. a specialist saying my hernia was small, and another this-time-mesh surgeon saying at the same time that it was too big for a pure tissue repair).
I may agree that a bigger hernia may be more problematic to treat surgically (I let the doctors comment on that), but I am still uncertain about early surgery vs watchful waiting, especially when there are no symptoms: the reason behind is that a pure tissue repair is also not risk free (how low must it be for one to decide for the surgery?)

[Alephy]

I was also interested in this device, as according to their studies it promotes the growth of healthy tissue (not scar tissue that is), because allegedly the 3d mesh moves freely: I don’t think I read this w.r.t any other mesh device out there, which would be a major selling point…

While it is true that the inventor of the device also conducted the studies in animals for its efficacy, I also read that he had a legal dispute with the manufacturer, which was resolved with the two sides parting ways….
I would be interested to read a long term follow up of the patients that received the device…I think these days it is used mostly in India if I am not mistaken…

I have read about the many problems of the past 3d devices, but at the same time the hernia is a 3d problem in many ways, so I am not surprised that a 3d approach is still considered….

[Alephy]

I seem to remember in the video that Dr. Jacob mentions WW as a valid alternative. It is interesting that doctors do not agree on this, and that the official guidelines do not recommend it; but then again it is considered a valid option also in the UK…

At one point I definitely thought that those against WW were mostly the mesh only surgeons somehow (at the very least some of them do give the impression of being in for a as high a volume of surgeries as possible)…

BTW this is also why just going to a hernia specialist and trusting the person is not enough i.e. different experts might recommend different treatments, with different impacts: this is true for WW and in general for the potential surgery complications (my biggest complaint is that these are often not even mentioned or they are just played down!)

[Alephy]

Good luck with your surgery! Do you know which procedure will be used?
If I may ask, how expensive is it in Germany? Will the UK NHS refund you?