Chaunce123
Forum Replies Created
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Inguinal Hernia Tenderness
If you have a known hernia that is bothering you more and becoming larger you should probably get it looked at by a surgeon. They can do an exam which should give you a better idea of your options.
I’m not a doctor but that is my 2 cents.
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No mesh hernia surgeon in Iowa?
MO,
I have researched this pretty heavily for the west coast which is in another thread on this forum and came up with others elsewhere in the USA, but I don’t know of any no-mesh surgeons in Iowa. You can always try to call the offices of surgeons and ask if they do the repair type you are looking for, but in my experience only about 50% of the desk staff are aware of specifics and they have to put a request to the doctor and then call you back. Anyway, if you can travel there are some options in your general region, but it’d still be a bit of a trip away.
Shouldice Hospital in Toronto Canada are experts in no mesh hernia repair.
In Cleveland Ohio is Dr Grischkan who does a Shouldice repair as well.
There are probably others in the midwest too, I think the “McVay repair” originated in the midwest. The no-mesh repair is getting increasingly difficult to find in the USA and the standards by which surgeons will perform a no-mesh surgery tend to depend on the surgeons experience plus the patient. For example, I know that Shouldice requires a healthy BMI measurement and they regularly will prescribe weight loss to people before they will perform the surgery.
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Fat in Inguinal Canal vs Hernia vs Cord Lipoma?
Does a laparoscopic repair fix the canal fat or a cord lipoma?
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Diagnostic laparoscopy as the definitive means of hernia detection?
I don’t know for sure, but I think if you have the TEP surgery you always get a mesh to support it?
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Finding no-mesh inguinal hernia surgeons on west coast?
Are there specific types of auto-immune disorders that increase the mesh risk? Or is it any auto-immune problem at all? Even something simple like hay fever, celiac, or psoriasis? Or is it worse auto-immune disorder like lupus, RA and MS?
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Continued proliferation of Millikan tension-free plug and patch repair?
UhOh, maybe consider a road trip to Canada and to Shouldice?
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Referrals
sands, I’m only a patient who has done a lot of research in my own journey so don’t take this as medical advice or opinion.
With that disclaimer, I have consistently seen many positive reviews and reports about Dr. Grischkan in Ohio and he does open repairs of mesh or no mesh depending on case and patient preference. I do not think he does a laparoscopic repair though, so if you want that option you may need to look elsewhere.
Best of luck, good health.
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Looking for a Hernia Specialist near North Alabama
Hi rosenrubies,
I’m only a fellow patient but have done a good amount of research in my own journey, so take of this what you will.
Dr Bruce Ramshaw is north of your border in Tennessee and is one of the countries premiere hernia experts and surgeons, he co-authored a book with Dr Towfigh (book is called SAGES Manual of Groin Pain its for surgeons – http://www.springer.com/us/book/9783319215860 )
http://gsm.utmck.edu/surgery/faculty/ramshaw.cfm
Finding a true ‘hernia expert’ can be very difficult in my experience, but you’re near enough to one that it very well may be worth the drive to have a consultation. I would bring your excellent notes you included here as well, I have found the more information you can provide the better.
I am sure you will get some other great recommendations from the wonderful doctors on this forum too. Best of luck with your case, keep us updated on your progress.
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Diagnostic laparoscopy as the definitive means of hernia detection?
These are great replies and very informative, thank you Dr. Goldstein and Dr. Szotek.
A follow up question — What happens if a peritoneum laparoscopy is performed and no hernia is found? Does that ever happen? Are other problems ever seen in that approach which warrant fixing?
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4 years of hip/groin pain. Help!
Getting a dynamic ultrasound study with valsava is pretty easy and it may be helpful, sometimes clinics also do them standing up with valsava, but I think the key thing is not just coughing but actually bearing down. That may be something worth pursuing.
Dr Chen and Dr Towfigh are both hernia experts in Los Angeles that see a lot of the challenging cases like ones you’ll find on this forum, it could be worth making an office visit with either (or both) of them.
If you have a core muscle or pelvic muscle injury that is being overlooked you could always venture across the country to Vincera Institute in Philadelphia, it’s quite a trek but they handle many pro athletes in the US.
Anyway, good luck and keep us posted.
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Hard to Detect Femoral Hernia Advice. Please Help!
ALevitt,
I’m just a fellow patient, but I do know that Dr Towfigh has co-authored a book with a Dr Brian Jacob who resides in NYC from Mount Sinai so they may have some other degree of collaboration as well. Their book is the “SAGES Manual of Groin Pain” http://www.springer.com/us/book/9783319215860
Additionally, Dr Goldstein regularly answers questions on these very forums and is extremely knowledgable, I think he is located upstate.
Anyway, those may be two early leads to go on, but certainly in a great city like NYC there will be other experts available as well.
Hopefully that is helpful for the interim, best of luck to you and your wife.
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4 years of hip/groin pain. Help!
Dr Goldstein,
This may be a silly question, but for the 80% better / 5% worse / 15% same numbers … Is that 5% worse risk basically the true chronic pain risk associated with any hernia repair? Is there anything that generally raises or lowers that risk chance?
Thank you
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4 years of hip/groin pain. Help!
wes878, can you elaborate on your symptoms? Can you pinpoint a specific pain location or is it generalized in the area?
I am merely a patient, but I do know two things: sports hernia is routinely misdiagnosed, and small inguinal hernias can go undiagnosed and are often overlooked in radiology as well. Groin issues in general can be very difficult to track down, so you want to work with someone well experienced as the wonderfully helpful doctors here have suggested.
Some thoughts, from a fellow patient …
– Was your groin ultrasound with valsava? That may be helpful for a hernia diagnosis
– Have you had nerve block injection or otherwise? Some clinics use nerve block as a diagnostic method (shoot into hip joint for checking hip pathology, etc), some clinics also use Platelet Rich Plasma (PRP) injections into soft tissue injuries with good result
– Where in the country are you located?
These resources are a bit in the thick of things with imaging studies for diagnostic purposes, but it may be helpful for both your own use and a doctor you may be working with …
http://sportsmedicineimaging.com/topics/sports-hernia/
http://sportsmedicineimaging.com/topics/pubic-instabilty/
Good luck, good health, and keep us updated on your progress and findings!
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Physiomesh Recall… Should I be concerned?
You can (and perhaps should) ask the surgeon what mesh type or repair type they will be performing. I personally would always ask this question, I am a curious patient and like to be involved in decision making (whether doctors appreciate this or not, I am not sure 😆 )
If there is a recalled mesh and you are going to have surgery, you can request that the recalled product will not be used.
If you currently have recalled mesh installed in your body, and it is not bothering you, you may have nothing to worry about, but you could reach out to your surgeon anyway to ask questions.
Either way, seek out a specialist for the procedure you are looking for. That is my recommendation.
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Fat in Inguinal Canal vs Hernia vs Cord Lipoma?
UhOh, this is based on personal experience, I am not not a doctor so take this info with that knowledge:
– I believe the advantage to knowing contents is mostly about surgical recommendations (timeline, mainly), and for diagnostics pertaining to the more unusual or ambiguous cases. Patient symptoms matter, as does the patient presentation. Most hernias of the groin are obvious, there is little ambiguity about them existing, and the precise contents are often irrelevant if the hernia is asymptomatic, minimally symptomatic, or the procedure is elective. It may impact a watch and wait vs repair recommendation, but if you’re going to have it repaired anyway it probably does not matter whether there’s fat or bowel in there. The sac contents are figured out definitively during surgery, either way, and as far as I know, the repair is usually the same too.
– Sometimes an Ultrasound can determine the size of a defect, and sometimes ultrasound can determine the contents as well
– CT and MRI can also sometimes determine what is contained within a hernia defect, because fat, inflammation, intestine, etc, look differently on imaging studies.
Both of those say “sometimes” because it may depend on who is reading and interpreting the radiology images. I personally have had mixed opinions about the exact same radiology, so the “sometimes” is pertinent to less-than-obvious cases.
Clear as mud, from a patient perspective anyway … right? :blink: 😆 😆 😆
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Symptoms of possible internal hernia
Hi WesternWilson,
For full disclosure, I am not a doctor and I am only a patient who has battled some GI issues and abdominal pain, so take this info with a grain of salt. With that said, there are a lot of opportunities for investigation:
– You should work with a Gastroenterologist, find one who is open to investigating things a bit and is perhaps recommended by peers, colleagues, the community, etc
– Contrast CT, possibly dual contrast of oral solution plus an injection for maximum visibility of potential pathology
– Stool guaiac test can be informative
– Stool culture can turn up unusual pathogens, bacteria, etc
– Upper endoscopy is a good idea (Anecdotal, but I have a friend who had all sorts of upper GI issues, vomiting, etc, turned out he had a hiatal hernia)
– Colonsocopy is something a GI doc will likely recommend
Turning up to the ER for that type of problem can be hit or miss for diagnosis, but if it gets acute or severe you should absolutely do it. With that said, generally speaking it’s better to work with a good physician on an outpatient clinical basis.
Some general tips for managing nausea and GI issues, from personal experience:
– Keep a general food diary and try different types of food to see what makes symptoms better or worse (slow motility diet can be helpful to some, bad for others, high fiber, certain vegetables, etc)
– Avoid complex foods and garbage foods (spicey foods, excess sugar, fast food, highly processed junk, junk food, etc)
– Ginger tea can be amazing for GI upset, get true ginger tea where the bags are filled with dried ginger flakes
– Similar, a high quality Ginger Ale like Reeds Extra Ginger Brew can be great for GI upset and nausea too – again make sure it has real ginger in it, not the corn syrup junk
– Sometimes probiotics can be helpful, high quality probiotics like Kefir are generally recommended, some swear by kombucha, avoid the high sugar yogurt candy type products
Most importantly, work with a good GI doctor. Depending on where you are in the country that can be easy or difficult, but if you’re in a tiny town it may be a good idea to look for a bigger city.
Good luck, and stay positive!
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Alternatives to mesh
Under what circumstances would these alternative / biological / dissolvable meshes be appropriate for a patient?
Is there any way to find ongoing trials for these alternative products for inguinal hernia cases?
Are these alternative remodeled mesh options better choices than a traditional bassini tissue repair?
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Pain Diary
21tomlinson, hang in there. I know you’re having a tough time right now. If your pain right now is severe and causing serious despair, you should go to the ER – they can help and offer immediate support.
Maybe today you can leave a voicemail at some of the office clinics of the providers offered here. Otherwise maybe call them first thing tomorrow morning and arrange an appointment for ASAP.
I would highly encourage you to go to a new pain management specialist if the current treatment protocol is not working. There are many things to try to manage pain and to help. To me it sounds very clear that your current provider is not understanding the severity of your condition, and to me that says you need to find someone who does understand and is willing to try new things.
Don’t give up, don’t feel hopeless, you can fight through this. Keep trying things until you find something that helps.
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Finding no-mesh inguinal hernia surgeons on west coast?
Dr Earle, thanks, those are certainly good points that are all worth considering. It seems like long-term follow up is missing for many procedures in the USA which is unfortunate. Maybe something as simple as having follow-up surveys to patients at 6 months, 1 year, 5 years, 10 years, 20 years to checkup and poll outcomes would be a good idea.
For me personally, I am just more comfortable with the idea of letting my own tissue heal together than having a permanent mesh which can’t be removed if it became problematic. If it was easily removable without major side effects, I would probably opt to try the mesh repair and see if it helped my situation. Hopefully researchers and device companies are working on this stuff.
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Pain Diary
21tomlinson, I am sorry you are going through this suffering. There is always hope, don’t give up!
I hope this is not out of line, but there are some nontraditional treatments out there for chronic pain that perhaps are worth exploring or looking into. I am not a doctor so you would want to discuss these options with your care provider.
One is called ketamine therapy, which I believe is a low dose anesthetic. There are clinics around the country which perform this, and there is some evidence that it can be effective for otherwise difficult pain management. It looks like there are ongoing studies about this, but here are some links and some supporting research if you are interested.
http://www.ketamineclinics.com/ketamine-treatments/pain-treatment/
http://www.californiapainmedicinecenter.com
http://www.ncbi.nlm.nih.gov/pubmed/18266808
http://www.ncbi.nlm.nih.gov/pubmed/23432384
Another is pelvic rehab physical therapy, which is a bit harder to find for males, but there are some positive outcomes that can be reported for pain syndromes for both male and females with the rehab therapy.
http://www.pelvicpainrehab.com/locations/
https://pelvicguru.com/2016/02/13/find-a-pelvic-health-professional/
Finally, and this is by far the most controversial so please don’t take offense to this, but ongoing research supports certain types of medical marijuana as potentially beneficial for chronic pain. If you go this route, please seek out a qualified knowledgable doctor and not a hippy on the street corner, as it appears the type of marijuana matters, as do other factors.
http://jama.jamanetwork.com/article.aspx?articleid=2338266
https://www.nabp.net/events/assets/Carter_Aggarwal.pdf
https://www.cdph.ca.gov/programs/MMP/Pages/default.aspx
There is also something called a TENS unit, which I think uses electricity to disrupt pain signals, but I think you’d need to work with a doctor to have it target the proper regions.
Perhaps some of this information will be helpful to you (or to others in similar situations). Do your best to stay positive, and don’t give up!