[drtowfigh]

What to tell the ultra sound technician

An ultrasound looking for an inguinal or groin hernia should be ordered specifically as a “dynamic hernia ultrasound.”

The patient should be asked to stand, lie flat, cough, push belly out, rotate hip out, and walk around if necessary. Ie, if a hernia is not visualizable at the groin, then much time needs to be spent to actively force out a hernia, using Gravity and pushing out (bearing down) movements. Videos should be taken of the area and reviewed. Also, in women especially, the femoral region should also be reviewed as should any scars in the area, such as from a Cesarean section.

Ultrasounds are best performed by a skilled radiologist. But, nowadays, that is hard to find. I have one in my town who does it and he is very excellent at it. Most of the time, however, it is done by a technologist and then the still pictures and maybe some video clips are sent to the radiologist to review, without any patient interaction. This, the quality of the images and interpretation are very technician-dependent. As a result, I see a lot of falsely negative ultrasounds in my practice.

If an ultrasound is “negative” and there is high clinica suspicion for a hernia, then another imaging tool should be pursued.

[drtowfigh]

Passing gas causes some pain relief

Some patients who have groin hernias or abdominal wall hernias note worsening of pain symptoms with meals and prior to a bowel movement. They may feel relief after a bowel movement. However, there are also patients who have constipation and strain to have a bowel movement. Thus the pain after bowel movement lingers.

In short, these symptoms are not necessarily specific to a hernia.

[drtowfigh]

Serious Concerns about my five year old daughter.

I reached out to Dr Todd Ponsky. He is a renowned pediatric surgeon who is also a hernia specialist. He would like to help you and he feels the situation may be more serious than a hernia. Please contact his office for guidance.

Good luck and please let us know final results.

[drtowfigh]

Hernia question

Jessica, let us know how you are doing.

[drtowfigh]

Dr. Daniel Vargo @ University of Utah feedback

Dr. Vargo is highly respected in the surgery and hernia surgery world, among surgeons. He does seem to be referred quite a large number of complex abdominal hernias, so if that is your problem, it is good to have it evaluated by a surgeon with a lot of experience in it.

In consultation, I would specifically ask Dr. Vargo’s recommendations, what options you have, the expected recovery, and what you can do now to optimize your current situation to reduce your risk for perioperative complications and improve your outcome.

[drtowfigh]

Looking for recommended hernia experts in Oregon?

For small inguinal hernia, low BMI (thin patient) and low risk hernia (not recurrent, not smoker, not laborer), then I agree with you: lightweight mesh is definitely preferred.
I suspect most laparoscopic surgeons who are high volume would agree with me.
Consider the following skilled laparoscopic surgeons in Portland:
Dr. Sean Orenstein
Dr. Kevin Reavis
Dr. Paul Hansen

Please let them know you were referred by HerniaTalk.com

[drtowfigh]

Serious Concerns about my five year old daughter.

Thank you for reaching out.

Although this is primarily an adult-focused hernia discussion panel, it seems that many of your child’s symptoms can be translatable to an adult and so I will try to address them here, with the caveat that I am not a pediatric specialist and so many specifically pediatric problems may not be addressed by me.

That said, I will reach out to my pediatric colleagues to ask them to post on this thread as well, to seek their opinions.

With regard to the symptoms, dark stool or black jelly blood in stool is highly concerning for bleeding in the intestine. This may occur with bleeding problems of the intestine and these are almost always painless. They can also occur if there is any pinching of the intestine that is severe, causing intestinal injury that is more than just bruising. The most common cause of this is an abdominal wall or inguinal hernia. If your daughter has this, she must be intermittently incarcerating and even partially strangulating her intestinal contents. This causes pain, obstruction, vomiting, and in severe cases intestinal ischemia which then translates into bleeding of the mucosa of the intestine and thereby dark stool or black jelly like blood in the stool. Another option would be an internal hernia, which is a hernia in between intestines . A similar process can happen.

Ultrasound or MRI may be able to diagnose this, but only if there are symptoms at the time of the procedure, as she may be intermittently incarcerating in a hernia. If there is no direct evidence of hernia, then there may be indirect evidence, such as inflammation or proximal dilation of intestine at the site of obstruction.

If these tests are all normal, and your daughter is very symptomatic, is in the hospital a lot, and/or cannot gain weight or grow adequately, then elective surgery is warranted, with the risk that it may not show anything.

Areas

[drtowfigh]

Trying to Get A Hernia Diagnosis

1) no rush to get the umbilical (belly button) hernia repair done. It is not an emergent or even urgent problem unless she has problems with pain, vomiting, the hernia content getting stuck.
2) the only connection between her umbilical hernia and inguinal hernias is she may have a genetic predisposition toward developing hernias. Otherwise tone does not cause the other. Also, perhaps she has other risk factors for developing hernias, such as obesity, nicotine use, chronic constipation, cough, straining, repetitive lifting of heavy objects.
3) PT does not cause hernias.
4) mixed connective tissue disorders are among the genetic family of diseases which may predispose patients to hernias. Commonly collagen vascular disorders are associated with hernias. These include Ehlers Danlos syndrome, Marfan’s syndrome. Lupus, scleroderma, and rheumatoid arthritis are less associated with hernia, but there is a weak link.

Thank you for your positive comments about this Forum. Please let there know about it.

[drtowfigh]

Mom had hysterectomy, now hernia issues.

As long as she is done with chemotherapy and any radiation therapy and her nutrition is adequate, she should be a good candidate for hernia repair.

Perhaps patients on this forum can chime in on their experience after abdominal wall repair with mesh.

[drtowfigh]

Hawaii Speciaists?

Not sure if there are any hernia specialists in Hawaii.
Try Dr Nishida. He has a lot of hernia experience.

[drtowfigh]

Hernia question

Just call the surgeon’s office and let them know you were referred through HerniaTalk discussion board. And that the surgeon is aware of the referral.
If your insurance plan mandates a referral from your primary physician, the doctor’s office will let you know.

[drtowfigh]

Hernia question

Hi and thanks for submitting to Herniatalk.

First, congratulations for taking charge of your health. I agree with you that you need a surgeon who listens and understands women. It is not okay to just take medications for pain. There is a cause for your pains and perhaps your surgeon can help figure it out and cure you of it. Also, nerve pain does not usually just happen. In many cases, especially among women, such pain is from a hernia. You need not have a bulge to have a symptomatic hernia. CTs are generally falsely negative in showing these small hernias. This was proven in my most recent publication where we showed that a negative CT was wrong most of the time and 10 out of 11 CT scans were proven wrong by an MRI.

Here are some colleagues in Iowa who have shown interest to see you and evaluate you:
– Dr Matt Morgan in Pella
– Dr Luis Garcia in U of Iowa
– Dr Michael Burchett in Bettendorf

I recommend a dynamic hernia ultrasound if any imaging is requested. If that does not show a hernia, then move on to an MRI pelvis with Valsalva.

Link to article: http://archsurg.jamanetwork.com/mobile/article.aspx?articleid=1893806

[drtowfigh]

Should I have a hernia re-done?

A. I don’t recommend that you mix two procedures together. Deal with the acute problem of your pain first. Once you are pain free, then deal with the elective asymptomatic hernia. And let the surgeon choose the technique.
B. If it’s a nerve issue and nerve blocks alone are not helpful, surgery can help. If it’s a pure nerve issue and you have no pain from anything else, then yes the nerve can be surgically addressed without disrupting the repair.

[drtowfigh]

concern of Hernia Repair an Lookin for 2nd opinion

Perhaps you can provide more detail. Where was the hernia? How was it repaired? Attach a picture of it helps

[drtowfigh]

Chronic pain and recurring Hernias

Congrats!

[drtowfigh]

Need help in diagnosing hidden hernia

Any updates on your status?

[drtowfigh]

Chronic Hernia Pain – Where to turn now?

At the Lichtenstein Hernia Institute at UCLA, Dr David Chen is the main surgeon who can evaluate you. Dr Andrea Nicol is the main pain management specialist and she has a lot of experience with patients who have chronic pain after hernia repair.

Of course, I am also at your disposal. Similar to Dr Chen, a large proportion of my patients (unfortunately) suffer from chronic pain. I have system to help determine the cause of pain (mesh, nerve, recurrence, infection) and an excellent team to tailor a treatment plan of care.

Besides us two, there are few other choices available on the Wedt Coast.

Also,, if you are a patient in the Kaiser Permanente system, Dr Talar Tejirian at the Hollywood campus is focusing on developing a similar program in the KP system to better care for patients with chronic pain after hernia repair. My current fellow in training will be joining her in July, so that should add to their expertise in the field.

[drtowfigh]

Should I have a hernia re-done?

I agree with Dr Goldstein.

Details of your pain, where it is, the quality of it, etc, and a physical exam will help determine why you have the pain.
If the pain comes and goes with certain activities and has been doing so since surgery, it is possible that a stitch or a scar tissue or the mesh may be tugging on a nerve with those specific movements. Local nerve blocks may be diagnostic and possibly therapeutic. Your surgeon or a knowledgable skilled pain management physician can help start that work up. Often redo surgery is not necessary. At times surgical nerve transection may be necessary.
If you had no pain until recently, then a hernia recurrence should be considered. If it is not felt on examination, then imaging via dynamic MRI with Valsalva should help.

[drtowfigh]

Need help in diagnosing hidden hernia

Yes. Absolutely. Please do.
And Dr Brunt is aware.

[drtowfigh]

hernia specialist in New Hampshire

Hmmmm. Certainly your symptoms are not typical. Dr Adrales is a superb hernia surgeon so I trust that she’s right about your hernia. But you may want to play it safe and make sure you don’t also have a hip problem. That involves a hip series xray followed by an examination and evaluation by an orthopedic surgeon with possible need for an MR arthrogram of your hip.