[Katherine]

Ugh, I used the wrong terminology! I used prone, which is incorrect. I was lying on my back doing dumbbell presses (actually, to be more specific, I was doing incline dumbbell presses) and when I was finished, I had the dumbbells still in my hands as I rose to a more upright position. It was at that time that I felt a tear. The tear was quite painful, but I didn’t hear any cracks (but it was noisy in the gym). It initially felt like I tore my repaired hernia, but that area appears to be fine. It is higher up (even higher than the scar where the hernia repair is located). So, in between the original repair and the beginning of the ASIS. It is a little sore if I press on it. And somewhat round in shape. Still sore after my last post on this forum. It’s been a week since the incident (December 16th). Do you think that noticeable bulge would still be there a week later if it was a torn core muscle? I have not iced it or taken any antiinflammatories.

I hope you are right about a torn core muscle muscle. I know my entire body is not in great shape, plus I have some type of connective tissue disorder. I used to work out a lot (until around 2010) and I’ve missed it so much. I’ve just wanted to attempt to get back into shape and I may be going too aggressive for my body. Although the dumbbells were only 12.5 pounds each.

I know I need to see the doctor, but wanted to get some forum responses since I won’t be seeing anyone until January or later. I really appreciate your response.

[Katherine]

I wonder if during your heavy labor incident, you may have damaged your spine at L1/L2? That is where the genitofemoral nerve is derived from. There is a peripheral nerve surgeon in Baltimore that is supposed to be excellent, Dr. Eric Williams. I wonder if you could consult with his office to see if you may have a peripheral nerve entrapment. Do you ever have any back pain? You could also consult with a neurosurgeon to see if it is from the spine.

[Katherine]

Thanks so much, Good Intentions for your answer. Is there a place I can find the hernia classification by size? I know that over the last several years, mine has gone from “walnut” size to “egg” size. I can still reduce it and it reduces when I lie down. I also noticed that it will move back in completely on it’s own sometimes. It gets sore and the popping in and out bothers me, but I wouldn’t call it really “pain”, more just soreness. It is an inguinal, not femoral according to all the doctors I have seen. (I saw about 6-7 doctors when this thing first worsened. Most of them except Echo did mesh. I’ve had it since 1996, but it wasn’t until 2018 that it worsened). But I don’t know if it’s indirect or direct. Dr. Echo is a “fast” surgeon – he likes to get in and out of the patient’s room. Once you start asking questions, he almost gets into this “passive aggressive” mode – like he doesn’t have time for all the questions. You feel like you are the idiot in the room. I did ask on my first visit if he always cuts the nerve and he said yes as it is the one to most commonly cause pain post surgery (according to him). I have asked his physicians’ assistant about outcomes and she said they don’t measure them – she was rather evasive. I have seen him twice. The first time was back in 2020?, when I met him regarding the hernia. He performed an ultrasound while I was lying down and said it appeared the opening was small. He quickly explained what he did (what I most remember now is the cutting the nerve) and seemed a little more patient at the time. The next time I saw him was 2023? When I made the appointment, they asked if it was for the same reason. This time I was seeing him about my bilateral tarsal tunnel syndrome (he does all types of nerve decompression surgeries). I had to have a phone consult with his PA first before I could schedule. Then when I had the appointment, he came in and was very rushed. I tried to ask him more about my hernia at that visit, as well and at that point, he literally started walking out. I looked at his PA with an expression of WTF??? And she finished up with me. I think it was at that time I asked her about surgery successes and that’s when she said they don’t track them. I went to see him about my foot nerve entrapment because my orthopedic foot doctor (not podiatrist, but surgeon), told me he had worked with “Tony” on decompression of the tarsal tunnel and he thought he was an amazing surgeon and he referred all his cases to him now. I do trust this orthopedic doctor; however, they also could just be buddies. Who knows? Anyway, sorry about the long story, but just wanted to give you an idea of my experience with Dr. Echo. I do know that some surgeons are just that way – that’s why they become surgeons. But it still left me with a bit of a hollow feeling. However, as a last note, I did see a recent review on his website where an athlete (female) had inguinal surgery with him and was bragging about her experience. But I’m an old lady with other pre-existing issues. There is one other surgeon in Houston that may be an option, Dr. Michelle Loor with Baylor, but she’s more into the robotic laproscopic repair with mesh and from what I have read, I don’t think I want that.

[Katherine]

Hi Peter – I sent you a PM. I am in Houston and looking for a hernia surgeon.

[Katherine]

I don’t know if there is a way to avoid them. I think we are born with a genetic predisposition to them. I think my primary reason for saying this is that in my “former healthy life” I knew many bodybuilders that were into lifting very, very heavy weights (like 1-2 rep max stuff). None of them I knew ever got a hernia while doing so. Some of these guys were putting 5 – 45 pound plates on both sides of a 45 pound bar – that’s close to 500 pounds.

[Katherine]

Also – out of state is impossible – out of the country is really impossible. As much as I would like to win the lotto to take care of all my issues with the best surgeons available – if you don’t have the money, you just don’t have the money. It doesn’t grow on trees last I looked – lol.

[Katherine]

Hi Chuck – thanks for your input. I didn’t know that about Yunis. Believe me – I understand a botched surgery. I have a rare spinal nerve condition called Tarlov Cyst Disease. Back in 2012, I elected to have surgery and selected a surgeon that was supposed to be the best in this procedure (it’s very rare and I also had a hard time getting it approved by insurance). He had to do a sacral laminectomy in order to perform the surgery. Unfortunately, he used a “reabsorbable mesh” to close the laminectomy. Me bad – I should have done more research – I even asked him if this ever caused any issues. Of course, he answered it did not. Well – it does. And it’s not even approved for use in the spine! In addition, as it “dissolves” since it creates more scar tissue, it also can entrap nerve roots. You cannot remove it once it has started dissolving. However, the mesh also causes inflammatory and autoimmune responses in certain individuals. So – lucky me – I developed the further complication of adhesive arachnoiditis and several autoimmune conditions. I haven’t even considered suing – as you said – lawyers don’t want to take it on. The waivers you have to sign before surgery are so iron-clad. So, I do not want mesh in me ever again. But… with my connective tissue disease, I don’t know if I will have a choice. And I already have issues with entrapped nerves elsewhere in my body (tarsal tunnel – bilaterally and left peroneal nerve issues near the lateral knee) which I think have resulted from the connective tissue disease. So, I am not at all taking any surgery lightly. But I am also afraid that the larger it gets, the more difficult the repair and the harder it would be for any surgeon to do it without some type of reinforcement.

[Katherine]

Here are two I found in Houston, TX that can do pure tissue, no mesh… but they prefer mesh. One is Dr. Wade Rosenberg. When I saw him he told me he did a modified Bassini. The other one is Dr. Richard Andrassy. He was one of the first ones I saw and I couldn’t really get a good answer on the procedure that he used. But he prefers mesh. Wasn’t real comfortable with either, but just mentioning their names as one can do their own due diligence since pure tissue seems very hard to find. They are both older, so perhaps they were trained in pure tissue repair?

[Katherine]

Hi Chuck, I watched a video on this forum with Dr. Towfigh and Dr. Yunis – it was very informative. I do think he would be an excellent option but… what if I have complications once I return home? I won’t have easy access to help unless I fly back to Florida. That is one thing that really concerns me. I do have some type of connective tissue disorder which complicates matters, as well. I will do more research on Dr. Yunis and see if he takes my insurance. That would be one big hurdle. But I would also want to be able to book a consult and surgery for the same trip and I don’t know if that’s possible. There are just so many things that get so complicated when you consider out of state possibilities. But your concern is most appreciated and I am so happy to have so many knowledgeable people respond to my post even though they are not familiar with Dr. Loor.

[Katherine]

Hi Good Intentions – Thanks so much for sending this video. I’d love to have Dr. Towfigh’s insight on what is said in the video and if she thinks females have more success (at least from what she has seen in her practice) with the MIS approach vs. the open approach.

[Katherine]

Hi Chuck, I totally get it about the travel – but both health issues and money is involved – otherwise I wouldn’t think twice about it. I do agree that this surgery (like so many others) can ruin your life. Trust me – I’ve had one that did. So, I do not take this decision lightly or I would have already had it done locally without a second thought. There are no shortages of general surgeons in Houston, TX! Hernia specialists – haven’t found one I’m comfortable with yet.

[Katherine]

Hi Watchful, yes it is Dr. Echo. I have actually seen him twice and both times he said he would cut the genital nerve branch. So I presume he cuts it in most everyone if you say it is common practice in men and I’m female. I wasn’t really clear which method he would perform – perhaps a combination of the two? He did mention the first time studying under Dr. Muschaweck. I’m sure he is a very good surgeon, but he was also very quick in his delivery. I think had it not been for the fact that he cuts the nerve, I may have gone with him because of his background in plastic surgery. Your last comments are exactly why I have not had it done. However, it does continue to get larger and I fear that I may run into the situation where a pure tissue repair would not be feasible. When I had my first surgery done on my left side back in 1994 (this unrepaired hernia is on my right side), I saw several doctors and many of them were starting to use the mesh at that time. I went to an “old school” doctor that didn’t and am so happy that I did. Unfortunately, he’s long retired or passed on (he was older when he did my surgery). I appreciate this forum so much. It has educated me – but it has also frightened me. It’s not an easy decision and I find it so ironic that it is presented as an “easy” surgery by so many general surgeons. Are you in Houston, by chance or just familiar with Dr. Echo through this forum? You can PM me if you would like.

[Katherine]

Thank you, Dr. Towfigh! It if weren’t for your informative posts and this forum, I would not know the information that I do. Dr. Loor is not the one that cuts the nerve – it is another surgeon that I saw that does this (just for clarification). I just wish someone knew of a great hernia surgeon in Houston, TX. You would think with our established medical center, there would be at least one doctor that was an expert. I guess that is why I posted my question about Dr. Loor – it appears that hernia surgery does seem to be her primary interest, but I don’t know of anyone that has had surgery with her. It is so hard when you have had a failed surgery before (not hernia surgery) – it truly gives you PTSD for any surgery in the future.

[Katherine]

Interesting thread. When I got my first hernia back in 1994, I was very, very healthy. Avid runner and weightlifter and loved doing just about any type of exercise. I had a pure tissue repair – no mesh. It hurt like hell for about a week, then I was back to work. It’s been a long time ago, so I can’t really remember how long it took me to go back to heavy weightlifting, but after a month or two, I don’t remember having any pain at all. The only issue that bothered me after surgery was a foot that tingled on the same side as the surgery (went away after about 6 months – never figured out what it was). I guess I was really, really fortunate after the first surgery. Shortly after that surgery, I developed a second hernia on the opposite side and never had it repaired as it never bothered me until the last few years (just as an example of “watchful waiting” – I had this hernia develop in about 1996 and it never got any bigger or bothered me until 2018). What I’ve often wondered is if those that get hernias actually have some type of genetic connective tissue disease (my dad also had an inguinal hernia). And I wonder if in some cases, this may impact the outcome of the repair.

[Katherine]

Hi Eu, thanks for that link. As I said, I had seen him previously and he said he did the Muschenek method which involved cutting of the genitofemoral nerve – but perhaps he has changed his method since I saw him. Perhaps it’s worth another visit. I can’t really afford to travel to see a surgeon (my only options would be Dr. Brown in California or Dr. Yunis in Florida as they take insurance. I would love to see Dr. Towfigh, but she doesn’t take my insurance. In additional to financial constraints, I have other health and chronic pain issues that make it very difficult to travel.

[Katherine]

Hi Alephy, I don’t know about previous issues with 3D mesh, but am hoping better hernia repairs are in our future. It sounds like doctors like Dr. Towfigh are on the forefront of helping us with things like robotic tissue repair. I still don’t like the idea of any mesh, but understand that for some people, it’s the only option. I remember when I was younger, the talk was about hernia surgery being one of the first (and easiest) surgeries that residents learn. I don’t know how true this is, but it made you believe that it was just an easy surgery. I’m glad I at least had the sense to search around when I had my first hernia repair back in 1994 and found an older surgeon that was competent in tissue repair. His repair has lasted me through a lot of heavy weightlifting in my younger days with no issues whatsoever. As I get older, I don’t know what will happen with it, but he did a really good job. Wish he was still around to do my other one.

[Katherine]

Hi Alephy,

Reabsorbable mesh. I have a nightmare story for you. During my spinal surgery, the surgeon had to do a sacral laminectomy on me. He also drilled holes in my sacrum to access the spinal nerve root cysts. I have very little posterior sacrum left. Instead of using an inert material (like titanium) that would protect what was left, he used a reabsorbable mesh – not to be used in the spine (manufacturer’s instructions). He used it off label, and quite negligently I might add. Before surgery, I had other symptoms due to the cysts, but no back pain. Now I have terrible sacral pain and the development of adhesive arachnoiditis due to the mesh. Although the mesh dissolves, some particles still remain. I am one of the unlucky ones that has had a continual inflammatory reaction to it. And it cannot be removed – just particles are left in dense scar tissue. Several neurosurgeons have warned against this use to the doctor that did my surgery, but he continues to use it. A forum I go to has patient after patient with terrible postoperative results due to this mesh. I will never, ever had this again – in any form of surgery. Because once it does start dissolving, it cannot be removed. So buyer beware. I think some doctors have started using this reabsorbable mesh for hernia repair, but I don’t think there are enough post surgical studies to see what types of complications there are yet.

[Katherine]

Hi Andrew1982 – I am so sorry this happened to you. You and PeterC are good examples of why I haven’t had this done. You may have read my other posts (or not), but I had surgery on a rare spinal nerve condition. The surgery was actually considered “experimental” by insurance and they denied it initially until the surgeon fought back enough they approved it. In the surgery, to access the spinal nerve roots, he did a sacral laminectomy and cut a large portion of my posterior sacrum out. He covered it with a reabsorbable mesh (supposed to dissolve in 2 years). However, there are several issues with this – this mesh turns into a thick scar tissue and binds other tissues and potentially nerves in it and the second issue is the manufacturer of this product never intended it to be used in the spine and it says that on their website. And this reabsorbable mesh is made of some type of “acid” and even after absorbs causes foreign body reactions (after all, it is still there, just in a different form). There have been a number of people who had this same surgery, by this same surgeon and have (like myself) developed adhesive arachnoiditis, autoimmune conditions, etc. We all honestly should do a class action lawsuit against this man. But…. that is why I am scared half to death of hernia surgery and when I read about cases like yours and PeterC’s, I think I should just continue to live with the discomfort that I have. The problem is PT is the best solution for the other multitude of issues I have because due to chronic pain, my body has literally turned into just skin and bone (no muscle) over the years since the surgery. But if I do core work, it really disturbs the hernia. I don’t think the pain in my hernia is nerve related – it pops in and out and just gets a bit sore – so why cut what they don’t need to??? Nerves do regrow and then can cause issues later on. And, even if a nerve is just sensory and not motor (which as you said, they don’t always know for sure), who wants numbness where there was ever numbness before? And then when the nerve regrows with a neuroma, you get pain instead of numbness maybe a year down the road. Some of the symptoms it appears you and PeterC have are because you are male, but the GFN innervates other “private” areas in females even if we don’t have testicles! Have you tried going to a surgeon like Dr. Towfigh or Dr. Yunis or perhaps another one that deals with failed surgeries? I wish that this did not happen to you, but I appreciate you sharing your outcome with others so they will at least be prepared that this is a possibility. Something doctors just don’t seem to share. Doctors like to focus on all the good reasons to have surgery and minimize the side effects. But if just 1 in 1,000 turn out poorly, that 1 in 1,000 has had their life ruined.

[Katherine]

Alephy, do you recall who was the poster with the issues following cutting of the nerve? When I talked to my hip surgeon, he highly recommended Dr. Echo and that’s how he came back into the picture. But I told my hip surgeon I had reservations about the cutting of the nerve and he said that Dr. Echo does everything he does during the surgery to prevent a neuroma from occurring (he mentioned tucking it into a muscle??) . I do recall Dr. Echo saying that he cuts this nerve because it is a nerve that has the potential to cause pain post surgery, so he cuts it to avoid that issue. But I would think that until you are opened up, how do they know if the nerve will cause pain or not? If they have to cut it once they are in, that’s one thing – but presuming ahead of time that it is necessary doesn’t make sense to me.

[Katherine]

Hi Johnso,

Thank you for sending the link. I think I just need to visit Dr. Echo again for clarification. I remember him telling me that he specifically learned the Muschenek method in Germany and that he cuts that one nerve. Maybe he does both methods? He seemed knowledgeable – maybe a bit arrogant. But I find that in a lot of surgeons. I am so sad to hear Dr. Brown has retired. I actually sent him a picture of my hernia when I was considering repair (since he did take Medicare), but just not sure how I could survive the trip – not to mention the cost of travel. I think Dr. Yunis would be a bit closer, as long as he takes my insurance. I had previously looked at the video you sent between Dr. Towfigh and Dr. Yunis and think they are both just amazing doctors and wish I had it in me both financially and physically to travel. Right now I’m dealing with other issues, too – hip labral tears. So, my ortho wants me to do PT – so I guess I need to do that first before the hernia surgery (if I do indeed go through with it). It’s a very hard decision to make – I have serious PTSD from my failed back surgery – it was such a huge mistake and that fear of making another huge mistake stays with you forever.