Chaunce1234
Forum Replies Created
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[USER=”1435″]Karen[/USER] Can you share the name of your surgeon? It’s always good to know the names of doctors who are able to diagnose and treat the difficult hernia cases.
How are you feeling now? Any different?
Try to be patient if you had chronic pain prior to surgery. The nerves may have become sensitive from feeling frequent/constant pain, and sometimes it can take a while for that to settle down.
Some other potentially helpful tips for reducing chronic pain:
– Anything you can do that is distracting and/or mentally engaging and challenging will be beneficial to reduce chronic pain over time, as mentally challenging tasks tend to require a lot of focus and thus recruit neurons in the brain. Things like sudoku, math problems, sudoku, challenging puzzles, learning a foreign language, learning computer programming, learning a musical instrument, etc, the more mentally challenging the task the better for this purpose.
– Alpha-lipoic acid and Vitamin C taken every day, as research has shown those can be beneficial in reducing nerve pain over time. Talk to your doctor and surgeon first, make sure these are suitable for you and your current health.
– If you’re in a medical marijuana state, some people report positive experiences with medical marijuana reducing chronic pain, also usually over time. This is an ongoing area of research, so it would also be wise to consult your doctor first.
– Consider working with a therapist who focuses on chronic pain, they can be very helpful
Best of luck and keep us updated on your progress!
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[USER=”1366″]Dave Graham[/USER] best of luck, and keep us updated on your surgery and progress!
It is very understandable to be nervous before surgery, and most surgeons and anesthesiologists are accustomed to basically all patients having anxiety related to any procedure. I would encourage you to share that you are nervous with your care team, as they should be able to help you relax through select medications.
Listen to the doctors advice for the recovery period, listen to your body as well.
Eat as healthy as you can, aim to boost your vegetable and protein intake to expedite the healing process.
It’s also helpful to preemptively get things like Milk of Magnesia (makes having a bowel movement much easier, you do not want to get constipated after any abdominal surgery), ice packs, some healthy easy snacks, pain medication(s), a pillow to press against your wound if you sneeze/cough/toilet, a comfortable bed and/or seating situation, and maybe a few good movies or TV shows you want to catch up on.
Finally, if you feel you had a positive surgical experience afterwards, please share the name of the doctor (and surgery type) on these forums afterwards so that other patients can potentially benefit as well.
Good luck!
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[USER=”2577″]HerniaGuy[/USER] I am sorry you’re going through this.
It is strongly recommended to find a well-versed expert with significant experience in hernia complications, re-do surgeries, and mesh removal. If you had a laparoscopic hernia repair initially that now has complications, you should seek out a laparoscopic hernia expert for further treatment, as they know the anatomy best from that perspective.
The following is a list of doctors who perform complex hernia surgeries laparoscopically, including re-do surgeries and mesh removal, and this may be a helpful starting place for you. This list has been gathered over time from patient reports on these forums and elsewhere, be sure to inquire with the doctors / offices directly:
– Dr Shirin Towfigh in Los Angeles, California
– Dr Peter Billing in Seattle WA
– Dr David Chen at UCLA California
– Dr Igor Belyansky in Annapolis MD
– Dr Brian Jacobs in NYC, New York
– Dr Bruce Ramshaw in Knoxville TN
– Dr Jonathan Yunis in Sarasota FL
There are certainly other well qualified doctors out there for performing laparoscopic mesh removal, and the doctors mentioned may be able to refer you to other resources as well.
Best of luck, and keep us updated on your case, progress, and decision making.
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Yikes. Looking through some of the posted replies on that page from Twitter and the comments are not particularly inspiring.
On a broader note, I suspect some patients that have a bad outcome or chronic pain end up going to a different provider, rather than returning to the original surgeon. Maybe that’s why some of the doctors insist that they’ve never seen chronic pain, or that at 3 weeks all is perfect. That’s a recurring theme we see on these forums anyway. The obvious problem is then that a patient switching doctors will skew outcome statistics to be lower than actuality for chronic pain, and probably recurrence and other complications too. I’m not sure how to get around that data skewing, aside from something like having anonymized patient follow-up surveys done at 6 months, 1 year, 3 years, 5 years, 10 years, probably through mail.
You’d think here in the USA the insurance carriers would be very interested in getting accurate data about pain and complication outcomes, because they could then steer reimbursement to the least problematic (and least expensive) repair methods. Managing chronic pain is very expensive, which is probably why many insurance plans do not cover pain management at all. Well, there’d be nothing expensive to manage if the patient didn’t end up with chronic pain in the first place.
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quote tenreasy:I have lingua hernia on the left side. Noticed it about a 4 months ago as a bulge. My general doctor said I have a hernia and recommended that I do nothing. I am 6’1″, 57 yr old, 165 lbs. No other health issues. Good health. Recently it is bothering me if I walk for a long time. Gets bigger and some discomfort. Frequent gurgling sounds. Saw Dr. Mark Toyama in Chicago and he would do a laproscopic mesh repair using polypropelene material. I am freaked out by reading the horror stories of mesh complications. But it seems like all of the surgeons use mesh. Is it because of the new power of social media that the horror stories are distorting the actual success rate of mesh? I am confused. My other option seems like to see Dr. Tomas in Florida to do the Desarda technique.
Statistically, chronic pain is the biggest risk of inguinal hernia surgery, and you can find many large scale studies that support that as the risk to be concerned about. [USER=”2029″]Good intentions[/USER] makes excellent points that are worth considering.
In the middle of the USA you can also consider reaching out to the following surgeons who are able to perform both mesh and no-mesh repair methods for hernias:
– Dr David Grischkan in Cleveland, Ohio
– Dr Paul Szotek in Indianapolis, IN
– Dr Bruce Ramshaw in Knoxville, TN
– Dr Jonathan Yunis in Sarasota, FL
– Dr Robert Tomas in Fort Meyers, FL
– Shouldice Hospital in Toronto Canada
There are other options elsewhere in the country/world too, but you are correct that most surgeons use mesh.
My personal opinion is to find a surgeon who does a lot of hernia surgeries with successful patient outcomes. If you want a mesh repair, find someone who does a lot of mesh repairs. If you want a no-mesh repair, find someone who does a lot of no-mesh repairs. Practice makes perfect, one would assume.
Good luck and keep us updated on your case and decision making.
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quote drtowfigh:The original Shouldice repair was described with stainless steel suture. Most of us do not use that anymore. At the Shouldice hospital, they still use stainless steel because it’s cheaper—that’s what they told me. They make their own sutures in the back room. I saw their technicians do so. They have a limited stipend provided by the government Lee patient so they have a lot of cost cutting steps. Suture is one of them.
The reason why tissue repairs fail is often because of the quality of the tissue being sewn. Most with inguinal hernias have a collagen deficit. Sewing collagen deficient tissue together is less sturdy than healthy tissue.
Interesting, thank you for this information [USER=”935″]drtowfigh[/USER]
The next obvious question then is; how can patients increase the quality of their own tissue and/or collagen? Does exercise, healthy diet, and weight loss into a healthy BMI range achieve this?
As [USER=”2468″]Baris[/USER] mentions the Shouldice clinic is known to routinely suggest diets and weight loss to patients who are overweight before they will do a surgery, so perhaps there is some validity to a dietary approach. I suppose the question then becomes is if the successful outcome is then dependent on maintaining that weight loss, and if weight gain alone would contribute to recurrence?
In my mind I think of a lean cut of steak versus a marbled fatty steak, I wonder if that is is basically reflective of what the muscle tissues resembles of a lean vs obese patient.
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Dr Meyer and Dr Poor are both very well regarded in athletic circles and responsive as [USER=”2029″]Good intentions[/USER] mentions, I do think the Vincera Institute is usually focused on athletes and movement type injuries, though they certainly do hernia repair as well. I don’t know if they do mesh removal or how often, but it’d be certainly worth investigating and reporting back.
If you’re in the NE USA, you could also consider reaching out to the following hernia experts who have treated patients on these forums for various complex hernia re-do surgeries and other difficult situations like mesh removal and repair:
– Dr Igor Belyansky in Annapolis MD
– Dr Brian Jacobs in NYC, NY
Perhaps reach out to all of the above with a short explanation of your current problem/symptoms and any prior surgery, and ask what experience they have treating a similar situation?
Anyway, best of luck and keep us updated on your case and decision making.
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The Shouldice Clinic in Toronto Canada does almost all of their hernia surgeries open with local anesthesia and mild sedation. I believe the Desarda repair often does the same. I think this is because they want to visually test the repair by making the patient cough before completing the procedure.
I wouldn’t be too concerned about sedation and not being alert, you could always request a lower dose or lower intensity. From reports of people who went to Shouldice, most say they get a pill that makes them either relaxed or sleepy, but still aware and coherent.
Another group you might consider talking to about the general experience, obviously not hernias, are women who gave birth with a c-section, since that is usually done with a local anesthetic / block so the mother is awake for the childs birth.
Anyway, good luck and keep us updated on your case and decision making.
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[USER=”2608″]dog[/USER] [USER=”1391″]UhOh![/USER]
I’d be very curious to hear the official reason from Shouldice as to why they use stainless steel sutures, though I suspect it’s because of biocompatibility, and perhaps the strength contributes to their very high success rates.
My understanding is that many metals (stainless steel, titanium, gold, etc) are highly biocompatible and inert in the human body, which is why they are often chosen for stents, staples, pins, sutures, and other permanent implants or scaffolds.
I do wonder if, over time, plastic sutures or plastic meshes would degrade, perhaps that would contribute to hernia recurrence if that is the case. Who knows?
As for the Desarda repair using absorbable sutures, I suspect it’s because the strip of muscle used in the repair just integrates back into the muscle as part of the healing process. But that would also be an interesting question for a Desarda practitioner to answer.
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I’m sorry to hear you’re going though this. Just out of curiosity, how old are you? Are you active and fit, or sedentary and overweight? Was there any initial event or activity that you can recall near to or when the pain first started? Does taking Advil or an NSAID help the pain?
You might try and request a “dynamic ultrasound with valsava” to check for a hernia at the site of pain, probably even better if you get the ultrasound done while you’re actually in pain. Sometimes the radiologist will do it while you’re laying down in addition to while standing up, because standing will use gravity in addition to the valsava (basically bearing down as if you are trying to poop) to try and demonstrate a hernia. The ultrasound is fairly cheap and insurance shouldn’t fight it, and it’s also usually pretty accurate – assuming the radiologist/tech knows how to do the procedure properly anyway.
Two hernia surgeons in the midwest area that may be helpful resources are:
– Dr David Grischkan in Cleveland, Ohio
– Dr Paul Szotek in Indianapolis, Indiana
Not in the midwest but potentially helpful other resources who are familiar with the ‘hidden hernia’ concept include:
– Dr Brian Jacob in NYC, New York
– Dr Bruce Ramshaw in Knoxville, TN
– Dr Jonathan Yunis in Sarasota, FL
– Dr Igor Belyansky in Annapolis MD
You could also choose to have an online consultation with Dr Shirin Towfigh, she is extremely knowledgable about hidden hernias and hernias in women in particular. If you sent her your MRI / CT images on a disc she would likely review them as part of that process.
Good luck and keep us updated on your case.
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This may be helpful too, I think this pertains to Medicare billing but I am not sure, anyway it lists several phone numbers perhaps one of them is valid for Dr David Johnson
https://npiregistry.cms.hhs.gov/registry/provider-view/1104910306
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I wrote a longer reply but it was flagged as unapproved.
Anyway, it looks like a medical license for Dr David S Johnson is still active so perhaps he has simply relocated elsewhere:
https://search.dca.ca.gov/details/8002/A/88275/08e1c2f68c0a0159e9eadf75738aff47
Do share if you find up to date information, he sounds like a good resource.
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I recall reading a post about Dr David Johnson from a patient who got a Shouldice repair and it went well. Sounds like a valuable resource if he can be tracked down again.
It appears he no longer practices in Palm Springs however, so maybe he moved or is in the process of relocating. Here’s some information I dug up through Google, several locations are listed but who knows if any of them are accurate:
https://www.medicarelist.com/doctor/dr-david-scott-johnson-md-hemet-ca/
https://www.healthgrades.com/physician/dr-david-johnson-ykp59
https://npiregistry.cms.hhs.gov/registry/provider-view/1104910306
This shows his California medical license is still valid, not sure if that means anything:
https://search.dca.ca.gov/details/8002/A/88275/08e1c2f68c0a0159e9eadf75738aff47
Perhaps [USER=”935″]drtowfigh[/USER] or another doctor on these forums can use their own doctor networks to discover where Dr David S Johnson is now practicing?
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quote Jeremy B:I am in the same boat; live in Minnesota, even checked with Mayo clinic, all mesh. I think Grischkan in OH is probably the closest non mesh hernia specialist. I wish someone here could speak to Grischkans results.
I can’t speak from specific experience but you can find a lot of reviews and thoughts of Dr Grischkan around the web. Beyond that, his website says he has repaired something like 20,000 hernias, which is a huge number, I’m not sure if there are many other surgeons with that volume of experience fixing only hernias.
There’s also the Shouldice clinic in Toronto Canada, which is fairly close to the midwestern states as well. Most USA-based insurance probably won’t cover Shouldice, but then again the all-in cost of Shouldice is still often less than deductibles and co-insurance with many insurance plans.
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quote Jjpugsley:Update,
Unable to accept that there was nothing wrong, and with my daughters symptoms not only persisting but increasing, I sent my surgeon Dr Towfigh’ 2014 JAMA article and some newspaper articles on occult hernias. Luckily he had an open mind and called her in for re-examination. He still couldn’t feel anything but admitted, even during the diagnostic laparoscopy, that he was not looking for a hernia. He also said that, with the new information in mind, that her pain was exactly where an inguinal hernia would be. So he went ahead and ordered an MRI!
Unfortunately we’ve had to wait months because manu of the radiologists “ don’t believe this is an acceptable use of the MRI’s time” so they won’t schedule it. Only 1 hospital did, but I have big fears that they may not follow the procedure that would best show this. Her MRI is today, so all my fingers and toes are crossed. Otherwise, I may have to visit Dr Towfigh in person as she is now not able to consistently attend school in her final year due to the pain.Any update on your daughters case?
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This is an interesting thread and it’d be great to detail others experiences.
For me, it was sharp pain and pressure in the inguinal area and the testicle.
I’ve spoken to others who had more of a dull ache or weakness feeling in the groin, so it definitely varies.
I assume the pain can follow just about anywhere the major groin nerves go, depending on what is being pressed or irritated.
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[USER=”2335″]Ddot14[/USER] and [USER=”2678″]Red Oak[/USER]
The following may be helpful leads for both of you seeking a non-mesh hernia repair in the midwestern USA, not quite in either of your states but somewhat close:
– Dr David Grischkan in Cleveland, Ohio
– Dr Paul Szotek in Indianapolis, Indiana
Good luck and keep us updated.
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Based on the videos of surgeries I’ve seen, a lot of the times the “sac material” is basically fat, or intestine that has to be pushed back into the abdomen, so I don’t think it’s considered viable as a reinforcement in either case.
But what you propose as ‘mesh derived from the patients own body’ is basically the gist of the Desarda repair, which uses a piece of muscle from the abdomen, it is relatively new repair and not widely accepted yet though, perhaps more studies are being done.
Overall I strongly agree with your sentiment, surely the holy grail of hernia repair is easily repairing a hernia with a patients own tissue, maybe grown in a lab from stem cells or as a graft or whatever else, that will remodel and grow with the patient perfectly, without any risk of rejection, nerve entrapment, etc. Maybe one day…
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[USER=”2643″]SavingBob[/USER] Thanks for the update about your case. How are you doing now? Any difference in symptoms and pain level since before surgery? Did you have to have another hernia repair after the mesh removal? Was your original mesh put in laparoscopically or open? How did you like Dr Brown overall?
You might want to consider starting a new forum thread to document your case and progress, I am sure it will interest many people who read this site. Thanks again for the update, heal up and be well!
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I posted a reply but it was flagged as spam for some reason.
Anyway, not a doctor, but I think the indirect is more likely to enter the scrotum because it follows where your testicles descended originally, while the direct is less likely. And the third groin hernia variety, the femoral hernia follows the femoral vein to the leg/groin crease.