drtowfigh
Forum Replies Created
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Possible femoral hernia
Yes! And thanks for your post.
First, my research had shown that CT scan is very unhelpful for small or hidden hernias in the groin. Ultrasound and MRI is better. So the fact that CT scan was negative despite your symptoms means 1) it was not read specifically to look for hernias. 2) the hernia is too small to see on CT. When symptoms are suggestive and CT is negative for hernia, I recommend MRI.
Femoral hernias can present with pain radiating down the from of the upper thigh. Sometimes it can also radiate up and out to hip and lower back. They are often too small to be felt on exam. So, symptoms are important to determine the plan of care. Pain is often activity related, with pain while sitting for a long time, sneezing, standing on your feet.
I recommend MRI pelvis, without contrast. I have developed a hernia protocol which includes Valsalva and dynamic images to accentuate very small hernias. In my experience, women are more likely to have small or hidden hernias and they can be very painful.
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pain in my right groin going around my back
Let us know how it goes with Dr Jacob.
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pain in my right groin going around my back
Dr. Jacobs has read all that you have posted on HerniaTalk.com and his recommendations come based on the information you provided, discussion with me, and his significant experience.
I defer to you and the surgeon you choose to treat you to have a discussion about what is ailing you and how it can be treated. That said, if you wish to have a cure, and surgery is the cure for your ailment, then you must mentally prepare yourself to make that decision. It is a decision you must make alongside your surgeon.
I am truly shocked with the number of repeat imaging studies and other procedures you have had in a very short time. Thus, my hesitation that another study is being ordered, when a prior study has already answered the question. Besides, you should save your resources for actual treatment by a specialist, rather than performing studies which may not be necessary.
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pain in my right groin going around my back
Please explain why you are afraid of laparoscopy and what you believe laparoscopy entails.
Laparoscopy is your best option if he believes you have examination findings suggestive of a structural problem.
As I explained before: I do not recommend more imaging. But to answer your other question: no, no contrast is indicated for the MRI. And yes, MRI pelvis will show your appendix.
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pain in my right groin going around my back
I do not recommend more imaging.
Colonoscopy does not cause hernias. Not do I believe it is causing your groin pain, though I don’t have the privilege to examine you.
I recommend you see Dr Jacob and take him all your studies. He is aware of your post. Let his office know you were referred by me and you have posted on herniatalk.com. -
pain in my right groin going around my back
What insurance do you have?
Most hernia specialists have limited insurance carriers and/or are out of network.
Dr George Ferzli is another gifted surgeon in NY who may be of help.
You can also consider searching for doctors on the americanherniasociety.org. Website.
If you cannot find one, I strongly recommend you invest in a hernia specialist. I am shocked that you have had such a runaround of care and waste of resources to date, wth expensive tests and procedures and exposure to radiation. -
pain in my right groin going around my back
You really need to see an expert that is skilled in handling chronic groin pain and can also correctly interpret imaging studies. I would be happy to see you if you wish to come to Los Angeles.
In NYC, I recommend Dr. Brian Jacob.
I do not recommend more imaging. That seems like no added value.
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pain in my right groin going around my back
You really need to see an expert that is skilled in handling chronic groin pain and can also correctly interpret imaging studies. I would be happy to see you if you wish to come to Los Angeles.
In NYC, I recommend Dr. Brian Jacob.
I do not recommend more imaging. That seems like no added value.
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pain in my right groin going around my back
You already answered your own question: you have right groin pain radiating to your back and imaging showed an inguinal hernia. The hernia does not go away.
We have looked at all patients referred to me and reviewed their radiology images ourselves. The reliability of general radiologists accurately interpreting a CT or MRI for inguinal (groin) hernia is not as high as you would expect. The results of our study is being presented to the radiology society of North America, so hopefully they will find it of interest. My point is: if a radiologic study is interpreted as negative, but the clinical symptoms are suggestive of hernia, then either the study is misinterpreted or you need a more sensitive study, such as MRI.
But in your case, you already have a diagnosis. You need to find a surgeon who is a “believer”, as I call them, to repair your hernia.
Also, be open to a non-mesh hernia repair.
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Trying to Get A Hernia Diagnosis
Excellent.
Spread the word about our discussion forum. Glad could be of help. -
RUNNER w/ extreme hip/pelvic pain,possible hernia?
Tearing the along the groin crease is most suggestive of a hip labral tear. MRI hip with arthrogram (contrast injection) should identify this problem. Also, see a hip specialist. Other problems include femoral acetabulum impingement syndrome (FAI). These can all be worked up by a skilled orthopedic surgeon.
To definitely rule out a hernia, CT may not be adequate. MRI pelvis, without contrast, with Valsalva (push out on belly) is most sensitive imaging study for this.
I hope this is helpful!
Best of luck. -
Trying to Get A Hernia Diagnosis
1. Narcotics do not help with hernia pain. I recommend ice and naproxen (Aleve) for all my patients.
2. The amount of pain is related to the type of repair, technique, and rarely to the size of the inguinal hernia itself.
What type of repair did she have?
Also, days 2-4 are usually worst, and then every day should be better. Please check with her surgeon, but I recommend that my patients be up and about, walking, cycling active immediately. Getting the groin moving is very helpful in the recovery. -
Chronic Pain after Hernia Surgery in April 2011
Great. Please keep us updated. And if you’re happy with your surgeon, please provide names so other locals can also get help.
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Trying to Get A Hernia Diagnosis
Yes. A letter is the best way to share your experience with that doctor.
So glad to hear of the successful operation. -
Clinical Data on Small Abdominal Wall Hernias
I believe most surgeons would perform a simple primary suture repair for such a small epigastric hernia. If it can be reached from the umbilicus (belly button), then the incision can be hidden in there.
Most surgeons place mesh for most umbilical or epigastric hernias, nationally. And studies show that mesh repair is always superior to non-mesh for this problem, in terms of recurrence. However, the smaller the hernia, the less the superiority of mesh in reducing recurrence. In my practice, I do not routinely place mesh if these hernias are under 2cm.
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Clinical Data on Small Abdominal Wall Hernias
First, let me assure you that almost all databases that I am aware of and publications that I have seen and those that I also perform include patient demographics, e.g., gender, height/weight. The height/weight are often reported as body mass index (kg/m2). That is pretty standard.
That said, you are correct: there is no formula where you can plug in your own info and it will spit out the risks and benefits tailored to your needs. Medicine is not a perfect science by any means. You may find me the same exact findings in a different patient and perform the same exact operation and the outcome may be different. Every patient is truly different. Now, statistically, the risk/benefit may be the same, but the outcome per patient will be different.
Dr. Bruce Ramshaw is a whiz in this concept of “complex systems” and has been able to show that implanting the same mesh in two different people, for example, can have drastically different outcomes at the mesh and cellular level.
Hopefully, one day, we can tailor each patient’s care to their own specific needs and body’s interactions, maybe even by genetic evaluation. Today, we cannot do that. Most of us who are interested in this topic, however, do have our own database and do publish. Also, if you go to the americanherniasociety.org website, they have a database that many surgeons also participate in, called the AHSQC. You can find out which surgeons near you participate. Lastly, there are other national databased with the American College of Surgeons, NSQIP, etc., that some surgeons participate in.
With regard to your 4mm hernia: if you are symptomatic, then I recommend repair. I also do not recommend mesh implantation for such a small hernia.
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Trying to Get A Hernia Diagnosis
Aha! You are now addressing one of my life goals: raising awareness of hernias among women.
My gut feeling is you are absolutely right. Though, nationally, 7 male groin hernias are repaired for every 1 female hernia, my impression is that many more women have groin hernias than are being diagnosed and treated. It reminds me of the situation of heart disease among women.In my experience, inguinal hernias are under diagnosed among women because:
1. Many doctors don’t believe women can get inguinal hernias
2. Hernias tend to be smaller in women so they are not easy to find on examination (ie, hidden hernias)
3. Hernia symptoms are different among women than men. Women get pain with their menses, it may radiate to their back or into their vagina or down their leg.
4. Many cannot imagine that a small hernia can cause so much pain.
5. Women’s pelvic anatomy is complicated by presence of ovaries, uterus, possible endometriosis.
6. There is virtually no prospective clinical trial research done on inguinal hernias that includes women.I am working hard to publish my results and educate the world about women and the concept of hidden hernias. Just this past Monday, I turned in another research publication sharing the specific questions and exam findings that can diagnose a hidden hernia, mostly seen among women. For the first time in its history, with my prodding, the American Hernia Society began a panel discussion on hernias among women last year.
I really do appreciate your posts on this forum, too, as many patients and doctors will also be able to read and learn from it.
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Trying to Get A Hernia Diagnosis
Fantastic. Best of luck. And thanks for sharing your story. I hope it can help others
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Trying to Get A Hernia Diagnosis
Sounds like a “hidden hernia.” I just presented my results on re value of Ultrasound vs CT vs MRI for hidden hernias and hopefully the journal will accept my manuscript. CTs are typically falsely negative. Ultrasound and MRI are much better options. Also, many films can be incorrectly interpreted anyway.
I would find a surgeon that would provide laparoscopic exploration and hernia repair.
If the ultrasound proves hernias, not sure why a CT scan is necessary. -
Chronic Pain after Hernia Surgery in April 2011
Sounds like it could be a hernia. A surgeon skilled in laparoscopy can do an extra peritoneal exploration and repair any hernias. Sounds like hernias can be the cause of pain. Not sure why you’re not being offered a repair. Cystitis is a different problem.