[Chaunce1234]

Where did you get a non-mesh repair done? Do you mind sharing the name of the surgeon?

Often you hear 3-6 weeks for healing time with a hernia repair, but you should contact the doctor if you are concerned.

[Chaunce1234]

I posted a lengthy reply but it got lost or flagged for some reason. Anyway, I’ll try to dump a quick short version:

– Have you had any imaging to confirm there is not a recurrence or some other obvious issue going that may be causing pain?

– Have you been to a pain management clinic? Tried nerve block injections?

– TENS Unit can be effective for some people, it’s a little electrical stimulator you put on the site of pain, they’re about $40 on Amazon

– If ibuprofen works to some extent, and your health is generally agreeable to it, you may want to try a stronger prescription NSAID like mobic or diclofenac for 30+ day course

– Medical marijuana, if you’re in a state that supports it, it’s worth a shot, many people report success and there is a lot of ongoing research to support this

– Alpha-lipoic acid is demonstrated to reduce neuropathic pain over time, may be worth a try

– Vitamin C is also demonstrated to reduce neuropathic pain over time, also might be worth a try

– Opioids have potential side effects, they are effective at treating pain but really best thought of as a last resort

– Targeted physical therapy may be helpful

– Working with a pain therapist or pain clinic can be helpful

– Mentally challenging activities can be beneficial over time as they recruit new neurons to learn, something like learning new languages, learning a musical instrument, sudoku, crossword-puzzles, chess, programming, math, etc

Anyway, keep us updated on what you try, what works, etc. Good luck.

[Chaunce1234]

Glad to hear you’re doing well! Keep us updated on your progress and how you’re feeling as you heal up.

[Chaunce1234]

Some of my posts are being flagged or not posting so perhaps they occasionally mix-up, and some of them were crossed with other posts? Could be a glitch in the forum? Long ago I had another username (Chaunce12?) but the password was lost when they changed the forum. But alas no, I am not a doctor… though sometimes I feel like my knowledge level on certain topics is approaching that of some doctors… ha.

Anyway, I agree and have found the same thing regarding images, and heard many similar stories. Many doctors don’t read the images as they can be fairly complex, they often just read the paper report. Sometimes nowadays the radiologist is off-site or even outsourced to another country entirely, which is quite removed from the patient and it makes you wonder if anything gets lost in that process… thus whenever possible, try to have a specialist look at the actual images, as they may see things the radiologist didn’t, or that aren’t mentioned in the report itself.

[Chaunce1234]

Assuming you’ve already been checked for hernia recurrence? Have you had an MRI or any other imaging to see if anything obvious is to blame? How long ago did you have surgery and when did the pain begin? Have you tried a nerve block injection?

– As far as lidocaine patches, many can be obtained from drug stores and are certainly worth a try. If you try them out, let us know how it goes.

– TENS unit might be worth a try, you can order one on Amazon for about $40. Basically you put little pads on or around an area of pain and the TENS unit pulses little electrical currents through, which in theory disrupts pain signals. Some people report success with them.

– If ibuprofen works slightly, have you tried naproxen? And if your health permits, you might want to discuss an extended 30+ day course of another strong prescription NSAID like mobic or diclofenac with your doctor

– Prescription opioids often work very well for pain, but mass media / political hysteria about street drug addiction is harming legitimate patients. But they do have side effects, can become habit forming, and there’s a risk of rebound pain as well. These should be considered a last resort.

– Alpha-lipoic Acid. There is research to support it as helping neuropathic pain after several weeks:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272801/

– Vitamin C. It’s not a pain killer, but it has demonstrable efficacy with helping to treat chronic pain over time. Will it resolve the pain completely? Doubt it, but it could help. Here is some data:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5391567/

– Medical marijuana. Controversial and with some societal stigma, but there is evidence that it is effective for many people. If you’re in a state that allows medical marijuana, it is worth investigating and considering. There is a fair amount of emerging research to support this as well:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4666747/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3243008/

– Targeted physical therapy may help as well

– Working with a pain therapist or pain management clinic can be very helpful

– Engaging in new mentally challenging activities can be helpful indirectly, as it recruits neurons to learn something new. Learning a new language, learning a musical instrument, crocheting, programming, sudoku, crossword-puzzles, painting or drawing, etc.

Anyway, keep us up to date on your progress, what you try, what works and what doesn’t, and how you’re doing.

[Chaunce1234]

I’m a fellow patient, not a doctor. But…

– Ultrasound of groin with valsava, at the location of pain can often be very helpful in diagnosing hernias or recurrences.

– MRI of the pelvis (sometimes with valsava too) can also often reveal hernias or other potential causes of pain.

Does anything in particular help, or make the pain worse? Have you visited a pain clinic? Have you had nerve blocks or any other similar treatment before?

Where are you located? Perhaps someone on this forum can recommend a few hernia experts near you.

Best of luck, keep us updated on your case and progress.

[Chaunce1234]

Speaking from experience, you can often have 2 different people read the exact same CT and report 2 different things. My understanding is that inguinal hernias and/or fat in inguinal canal (lipoma etc) are fairly common and so sometimes they’re just ignored. Also, a lot of clinicians will just read the CT paper report and not look at the scan themselves, since reading radiology is complex and a field in and of itself. Yet another reason why specialists can be helpful.

Perhaps focus on your specific symptoms, and then go from there. Where do you have pain? What makes the pain better or worse (if anything)? Are the symptoms consistent with an inguinal hernia or something else? What did Dr Naim suggest regarding your symptoms?

You could always get an ultrasound with valsava on the groin, it’s usually a fairly cheap procedure and can also help to diagnose otherwise difficult to detect hernias.

Good luck and keep us updated on your case and decision making.

[Chaunce1234]

What surgery did you have? How are you doing so far?

As far as my experience goes, you’ll typically be given an antibiotic in the IV before/during surgery and that is sufficient unless there is some evidence of infection post-op, but perhaps everywhere is different.

[Chaunce1234]

Can you be more specific about the symptoms you are experiencing? What and where is the pain? Is it at the incision or elsewhere? Did you have the pain immediately after the surgery, or did the pain onset occur later? Was the original hernia painful before you had it repaired? Have you been checked for a hernia recurrence? Does anything help the pain, or make it worse?

You may want to visit a pain management clinic if you have not done so already, as there are less invasive things to try. For example, nerve block injections, radiofrequency nerve ablation, extended NSAID courses, various medications, etc. Some people also have success with physical therapy, myofascial release, etc

Best of luck. Keep us up to date on your case and progress.

[Chaunce1234]

Dr Procter offers good advice.

Just out of curiosity, what did Shouldice tell your husband about his symptoms and the hernia they found?

[Chaunce1234]

This has happened to me before too. I suspect it is an anti-spam measure that is automatically flagging posts with links.

[Chaunce1234]

I would second Good Intentions idea of contacting an expert with experience in various causes of groin and pelvic pain. Vincera and Dr Meyers office is a great choice, and they may review your imaging studies. They are considered experts at sorting out various pelvic, abdominal, and groin issues, and have a team to address a wide range of issues.

There are several doctors on these forums that also review images sent in to them for hernias, including Dr Procter, Dr Szotek, and Dr Towfigh. Whether or not there are fees involved I am not sure.

For ruling in/out a hernia, it may be helpful to have an ultrasound with valsava on the painful region.The valsava straining is often needed to show smaller hernias, and if you are going that route it’s important to have an ultrasound tech or radiologist that has done it before specifically to search for hernias.

Best of luck and keep us updated on your progress.

[Chaunce1234]

I am sorry you are going through this. Perhaps you should seek out a second or third opinion with a surgeon who has specific experience with hernia repair, hernia repair complications, groin pain, and related issues. This is a complex topic and unfortunately there are fewer experts out there than you might imagine there would be.

Out of curiosity, are you male or female? Was your hernia symptomatic before the operation, and if so, how? Are/were you physically active, an athlete? Assuming it is compatible with your health, have you tried taking an extended course of anti-inflammatory like naproxen, mobic, ibuprofen? Have you been to a pain clinic or had any nerve blocks or similar procedures done? Do any specific activities make the pain better or worse?

Where are you located? Perhaps members on this forum can offer some nearby experienced doctors that may be helpful.

Best of luck, and keep us updated on your case and progress.

[Chaunce1234]

I wrote a longer reply but it was held for moderation, hopefully this shortened version will go through.

Anyway, you will want to seek out a specialist with experience specifically in mesh removal for the type of hernia repair you originally had (open vs laparoscopic), then discuss your specific case with them.

Here are a few potential leads on the west coast, you may need to travel unfortunately:

– Dr Peter S Billing in Edmonds WA

– Dr Andrew Wright at UW Seattle (unclear about mesh removal experience, contact office for more details)

– Dr Robert Martindale at OHSU Oregon

– Dr Shirin Towfigh in LA California (she runs these forums)

– Dr David Chen at UCLA California

– Dr William Brown in Fremont California

There are others elsewhere in the country too if location does not matter to you.

It may be helpful when presenting the case to doctors to bring your original operative report, medical records, details about original surgery, list and description of specific troubling symptoms, list of what helps and what makes it worse. Having important elements in bullet points can help them scan data, that’s just my observation from being a fellow patient.

Best of luck, and keep us updated on your case and decision making.

[Chaunce1234]

@jerseattlewa I am sorry you’re going through this. Out of curiosity, do your symptoms respond to regular anti-inflammatories like Ibuprofen or Naproxen? Or is an anti-biotic like cipro the only thing that brings relief?

Removal of mesh is a complex operation that requires significant experience and knowledge of the complex groin anatomy. You will want to seek out a doctor who has specific experience removing the type of mesh you had implanted, preferably using the same method you had the surgeon done from the original operation (ie; laparascopic removal for laparoscopic mesh repair, open removal for open mesh repair).

You may need to travel because it is a highly specialized procedure.

Some names that I have seen repeatedly in your general region (Washington / Oregon), and that have been reported on these forums that could be helpful include:

– Dr Peter S Billing in Edmonds, WA, apparently has some experience with mesh removal as reported by these forums and elsewhere online

https://www.evivamd.com/about-eviva/meet-our-physicians-providers/peter-s-billing

– Dr Andrew Wright at University of Washington Seattle, as head of the UW hernia center presumably has some experience on this matter but you should call to verify

http://www.uwmedicine.org/bios/andrew-wright

– Dr Robert Martindale at OHSU in Oregon, a patient on these forums reported having her problematic mesh removed and the original hernia repaired without mesh

https://www.ohsu.edu/providers/robert-g-martindale/332DF38FFB324681949B3E75BD3B492B

Elsewhere on the west coast are the following options in California:

– Dr Shirin Towfigh in Los Angeles, has extensive experience with mesh removal (she runs these forums)

http://www.beverlyhillsherniacenter.com/

– Dr David Chen at UCLA in Los Angeles, California, performs mesh removal and has a lot of experience

https://www.uclahealth.org/david-chen

– Dr William Brown in Fremont, California, has performed open repair mesh removal

http://www.sportshernia.com/

Elsewhere in the country, known surgeons with mesh removal experience include:

– Dr Bruce Ramshaw in Tennessee

– Dr Jonathan Yunis in Florida

– Dr Kevin Petersen in Nevada, for removal of open repair mesh

– Dr Robert Tomas in Florida, for removal of open repair mesh

– Dr Brian Jacobs in NYC

There are perhaps others as well that I am forgetting, if anyone knows of any do chime in.

Best of luck and keep us updated on your case.

[Chaunce1234]

[USER=”2369″]oqhpeoi2495[/USER], I have sent you a message requesting the name of the surgeon you had for the non-mesh repair. If you didn’t get the message, please send the non-mesh surgeons name to me.

Thanks in advance, and please keep us updated on your progress!

[Chaunce1234]

It sounds like you’ve made great progress for a week out of surgery and had an excellent surgeon, so I would be happy and not worry, particularly given that you’ve had a stellar outcome thus far.

Data shows the non-mesh repair to be excellent when performed by an expert on the appropriate patient profile (fit, not obese). Several of the most well-known groin injury and hernia surgeons in the professional sports world routinely perform the non-mesh procedure on professional athletes and other fit patients, presumably for a reason. Also, the Shouldice hospital performs almost exclusively non-mesh repairs and has a 1% recurrence rate and remarkably low chronic pain incidence. So expertise matters, particularly given the complex nature of the surgery in a very complex region of the body.

Can you share some additional details about your case? What were your symptoms like prior to surgery? Did you have pain, a bulge, anything remarkable? If you were symptomatic beforehand, are the symptoms changed or resolved now post-surgery?

Please do share the name of your surgeon and their location. It is increasingly difficult to find non-mesh hernia experts, thus sharing this information can be valuable to other patients seeking similar surgical options.

Best of luck and keep us up to date on your case and progress.

[Chaunce1234]

Your best bet is to see an expert for proper hernia diagnosis. As for hernia surgeons in the UK, there are many but you will likely have a harder time finding non-mesh repair, as is usual nowadays since fewer surgeons are trained on the techniques. A few potential leads:

The Gilmore Groin and Hernia Clinic I believe performs all hernia repair types, but you must inquire directly with them. They are in London.

http://www.thegilmoregroinandherniaclinic.co.uk/

Dr Ulrike Mushawek from Munich Germany is also occasionally performs surgery in UK at “WELLINGTON HOSPITAL’s PLATIN MEDICAL CENTRE (PMC)” according to her website. She is particularly well known in sports and athletic circles and performs many hernia repairs on professional athletes. She mostly does non-mesh repair, however.

https://www.leistenbruch.de/english.html

Peter Jones of The South East England Hernia Clinic also apparently performs Shouldice hernia repairs in the UK, and might be reached at 01622 695533 if that contact information is up to date.

Surely there are many other regional experts in the UK, but that might offer some starting points. Best of luck to you, and keep us updated on your case and decision making.

[Chaunce1234]

This is a critically important discussion and topic that seems largely ignored by industry and the medical community, to the detriment of both patients and doctors.

Anyway, here’s a new interesting large scale study (22,000 groin hernia patients) demonstrating a 15% chronic pain rate after mesh hernia repair.

http://onlinelibrary.wiley.com/doi/1…bjs.10652/full

15% of patients having life altering chronic pain after a “routine” procedure is incredibly high, why is this not considered an urgent problem that needs immediate mitigation by the medical community?

The paper you reference from Dr Bendavid of Shouldice is noteworthy, and he has other interesting papers that have been published on the topic as well. Personally I am just shocked and disappointed that the non-mesh repairs are largely not even taught anymore, and are becoming extinct despite plenty of evidence suggesting they can be equally as good if not better than mesh, particularly for some patient groups, with fewer potential severe side effects.

[Chaunce1234]

quote kevin-pa:

Thank you Jnomesh. I hope Dr. Jacobs was able to help you.

I think he takes out-of-network insurance, but that can get pretty pricey also. Also, if I buy private insurance through blue cross/blue shield, all of the plans do not include out of network.

Dr. Jacobs also takes cash according to their website. I am lucky in the fact that I have some money saved up, and I would honestly pay whatever it takes to have this done correctly. But does anybody know roughly what we are talking about with a “cash” surgery? $15,000? $30,000? More?

thanks again.

Take this with a huge grain of salt because this could be outdated or otherwise inaccurate information, but based on what I’ve read elsewhere

– Shouldice Clinic in Toronto Canada is about $7,000 USD, including procedure, all meals and three days in their hospital

– A sports hernia repaired in Philadelphia is about $14,000

– A Desarda repair in Florida is about $5,000

– A sports hernia repaired in Munich Germany is about $7,000 (or 5000 euros)

– A standard laparoscopic repair at a standard US hospital is about $30,000

The best way thing to do is call a clinic and ask for the total quote, for the entire procedure and standard followup, for cash payment of the particular surgery you are seeking.

Generally speaking, an open repair will be cheaper than a laparoscopic repair. Add in the robotic lap repairs, or any complex surgeries, re-dos, etc, and price surely goes higher as well. You will see some very high quotes and billing details out there if you look for them.

Bottom line; it’s expensive.