RJ

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    • #12271
      RJ
      Member

      future of inguinal repair and PT


      @Groundfaller
      ,

      How are you doing now? Have you continued on a physical therapy regimen? Does stretching help? Have you tried other treatments to address your pain? How have you progressed?

    • #12233
      RJ
      Member

      Transparency in pricing for surgery

      Yes I think it would be helpful to have transparent prices and/or known prices for general services.

      My health insurance is limited to in-state providers, so if I was to travel out of state for any health service I would be paying out of pocket entirely for everything. Nonetheless, this is a scenario I consider as I’m sure many others have too. For something like surgery, performed by an expert, services are expected to be fairly expensive.

      What would be really great would be a variety of package prices to make the entire experience easier for travelers: total fees for consult, fees for surgery (maybe even repair types), pre-arranged hotels that are near the site of services, pickups from airport, etc. almost like a package vacation, except surgery.

      Slightly off topic, the country of Singapore publishes their costs online per hospital and service, for hernia repair that can range from $900 to $22,000 (USD), depending on the choice of hospital, service, complexity of case, etc. Sure that’s a big range, but at least you know what to expect. Here’s the Singapore government website, kind of interesting if you like data:

      https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/HospitalBillSize/hernia_repair.html

      It would be great if the USA had something similar for US providers and hospitals, but we’re obviously a much larger country than Singapore.

      From looking online at actual patient bills, I’ve found laparoscopic hernia repair bills from a general US hospital to range around $10,000 – $35,000, thus after insurance the patient is usually left with a $1000 to $7000 bill depending on their insurance policy and co-insurance. I would imagine open hernia repair with mesh to be a bit cheaper than that but that may be an incorrect assumption.

    • #12257
      RJ
      Member

      Chime in


      @tyrone
      , I can relate, pre-surgery, and nervous. I suspect almost everyone feels similar before making such a decision.

      Out of all places, I’ve found the video blogs and comments on hernia repair videos at YouTube tend to have a lot of success stories or casual reflections (and yes, I know YouTube is kind of a cesspool). Most are just short little blips about an experience with whatever types of hernia surgery from everyday people.

      Below are actual patient post-surgery videos for inguinal hernias, which I’ve found to be quite helpful, and again, the comments have many others who have been through the same thing.

      Also, if you can stomach it, the actual operation videos of surgical procedures can be helpful to understand what’s going on, and again the comments can be sometimes helpful. I won’t link to any of those here because they’re fairly graphic and certainly won’t be viewable for everyone, but if you can stomach actual surgery videos, look for things like “Laparoscopic TEP Inguinal Hernia Repair” or “Open mesh hernia repair” – these are the two most common types of groin hernia repair and there are many, many videos online about them.

      Reading medical studies can reveal an abundance of information which could help to make a data-driven decision. I find the long-term followup studies to be most helpful in this regard, at 1 year minimum and preferably 5 and 10 year followups.

      http://archsurg.jamanetwork.com/article.aspx?articleid=1107390

      Finally, there’s even an app for iPhone and Android that uses Q&A and statistical data to predict outcome of hernia surgery. Could be useful to some.

      http://www.carolinashealthcare.org/ceqol

    • #12837
      RJ
      Member

      Concerns with laparoscopic repair

      These are valid questions as are many others. From what I understand there are three major nerves in the area, genitofemoral, ilioinguinal, iliohypogastric, and who knows how many vessels and other structures that could be damaged.

      I’ve noticed that laparoscopic surgery is the default recommendation of many doctors if you have hernia repair in an elective setting, whatever that suggests. One would hope that if someone is offering the laparoscopic approach, they’d know what they’re doing and how to avoid nerves in the area, and be well aware of techniques to avoid mesh related complications. To the untrained eye (like mine, just a patient) the laparoscopic TEP field of vision looks like… absolutely nothing identifiable at all. If you don’t mind watching surgical videos, watch a TEP repair on YouTube, it certainly gives you an appreciation for good surgeons since it literally looks like nothing at all. This contrasts greatly to the YouTube videos of standard open repair, where anatomy is easily visualized even by a total novice.

    • #12835
      RJ
      Member

      Importance of lipoma of the cord

      quote :

      Ultrasound does not reliably differentiate cord lipoma from fat-containing hernia.

      This may be a silly question then, but if a fat-containing hernia and cord lipoma look the same on ultrasound, can anyone tell them apart before surgery? Do they differentiate clearly in MRI or CT imagery?

      Can a cord lipoma be asymptomatic and a random finding, whereas a hernia is maybe more likely to cause sudden pain onset or general aggravation? Or are they both possible to be causing inguinal symptoms in a patient?

    • #12829
      RJ
      Member

      MRI with valsava for imaging & diagnosing hernia?

      For anyone out there wondering what the actual test process of MRI with valsava is like, it is non-eventful. There is no prep. You lay down very still for about an hour and a half while wearing ear plugs, and the MRI itself sounds like exceptionally bad music. It feels a bit warm, but a fan is blowing on you. Towards the end of the MRI they instruct you when to do valsava, I did three sustained valsava sequences (take big breath, bear down) for about 10-15 seconds each, with a few minutes between them to relax. Doing a valsava while laying down is kind of challenging, but it works.

      The particular imaging center I went to said mine was the first MRI with valsava they had done, but they had experience doing CT with valsava before. It sounds to me like this is a relatively new technique for diagnostics, which I think it is clearly beneficial to patients, and I think for people with pelvic and/or groin pain with no obvious cause it could be quite helpful. I specifically mentioned the Imaging Occult Hernias JAMA study and research by Dr Towfigh to my doctor when discussing the MRI, and he was more than willing to give it a try. Here is the link to that JAMA research for those interested: http://archsurg.jamanetwork.com/article.aspx?articleid=1893806

    • #12828
      RJ
      Member

      MRI with valsava for imaging & diagnosing hernia?

      Hi Dr Towfigh, thank you for the reply and additional information!

      A quick update: I had the MRI with valsava done and just got a call with results, the radiologist interpretation is a “small inguinal hernia that increases in size with valsava”, it is “fat containing” and “tip of bowel may be present during valsava”. There is also a “thickening or edema of the cord structures” – but they aren’t sure if that is related. I find that particularly interesting because the pain and discomfort I have often feels like a pinch in the left spermatic cord, sometimes radiating down and sometimes radiating up. I basically never have pain in the thigh, pain is almost always in the left groin, sometimes left testicle, and along the lower portion of the left inguinal region. Also curious to me is that no femoral hernia was visible on MRI, which was what an ultrasound had reported, I am not sure what to make of that. I do have an appointment with a surgeon in two weeks to hear additional details, and to see what their thoughts are. I don’t know if it matters, but I am thin / athletic with low body fat, and there is no palpable finding and nothing visible to the eye. Nonetheless, I am hoping for a match with the physical location of my pain and the physical location of the defect found on MRI – we’ll see if that is possible.

      Now this is just my personal opinion, but for anyone with pelvic or groin pain that has been an ongoing diagnostic mystery (it sounds like there are a fair amount of us out there!)… I would HIGHLY recommend having the MRI with valsava done, it may show information that has been missed or otherwise not seen, and it may lead to getting some answers.

      Anyway, I’ll continue to post updates as I get more information.

    • #12820
      RJ
      Member

      MRI with valsava for imaging & diagnosing hernia?

      Just an update, I have an MRI pelvis with valsava (without contrast) scheduled.

      I can’t seem to find any reliable information on if contrast matters for imaging pelvic anatomy and pathology, so hopefully this will be an informative imaging modality without it.

      I will update with details when available.

    • #12819
      RJ
      Member

      Desperate

      Hi Kathleen,

      First off, I’m not a doctor nor a medical professional, and I’m also not a female, so none of this may be relevant to you or even helpful. Anyway, from some personal experience and hernia research, I have learned the following:

      * Hernias are commonly missed during a standard physical exam or standard imaging protocol

      * Hernias are often only found with provocation during imaging, like Ultrasound, provocation as in performing a valsava maneuver (taking deep breath and straining down)

      * Apparently an MRI of pelvis with Valsava can sometimes image or discover a pathology that may be otherwise impossible to see – I personally am going to have this test soon and will report back anything notable

      * Even if a hernia is found, it may not explain the experience

      If you have not had a pelvic / abdominal ultrasound with valsava to try and image regional hernias then I would request one from a doctor. The ultrasound test is quite fast and could at least rule something out.

      Also, knowing what triggers and worsens, as well as relieves, your discomfort / pain can be helpful for doctors. For example, if pain resolves with laying down, worsens with picking up heavy stuff, if NSAIDs help, etc

      Best of luck, keep us updated on your pursuit and findings

    • #12818
      RJ
      Member

      future of inguinal repair and PT


      @groundfaller
      , I’ve had no experience with tumeric but I do take fish oil supplements, which have an anti-inflammatory effect and are good for you anyway. It doesn’t have the immediate impact of something like a pharmaceutical NSAID, but it does seem to help over time. It’s another thing to consider, usually well tolerated too. Also, from personal experience, after a particularly annoying pain ‘flare up’ or whatever you’d like to call it, using ice on the location of discomfort can help considerably, as can a hot water bottle on nearby muscles – these may just be distracting with other strong sensations, who knows, but it can offer some relief.

      My personal advice is to find a way to participate in your active pursuits anyway, even if in a new way, at a reduced pace, or a different intensity level. If that’s who you are and what brings you joy, it will help your mental health and self esteem, which is equally as important as physical health. Find the pain threshold or movement triggers and avoid them as best you can. It sounds like you’re working on this with the physical therapist, which I think is an excellent decision.

      It is fairly clear to me that hernias and whatever other related issues pertain to the anatomy are obviously far more complex than people (and perhaps some doctors) may realize.

    • #12812
      RJ
      Member

      future of inguinal repair and PT


      @groundfaller

      For full disclosure I have yet to have hernia surgery so this may differ from your situation – nonetheless, before a hernia diagnosis was made I have had a notable amount of pain reduction success using anti-inflammatory medication. Ibuprofen or aleve are good, but what helped most significantly was a 30-day course of prescription NSAID called Meloxicam which notably reduced regional inflammation and groin pain. That was some months ago but the effects have been long lasting, presumably from the anti-inflammatory effect of a sustained dose of powerful NSAID. Obviously you’d want to consult with a doctor (and you’d need an RX for the latter anyway), but if you tolerate NSAIDs well it’s something to consider while you work through physical therapy.

      Keep it up, and keep us updated on your progress.

    • #12808
      RJ
      Member

      future of inguinal repair and PT

      I think this is a very fair question. Presumably Physical Therapy for hernia repair has some effect on outcome and return to normal activities just like it would with any other surgery, some evidence for which is seen with professional athletes. If you’re a sports fan, you’ll undoubtedly notice that many pro athletes are sidelined during the season for various hernias (usually inguinal and sports hernia it seems, from what I understand the repair is often similar involving a groin mesh overlay despite the two hernia types being very different), yet they’re often back at it in 6-8 weeks. That’s rather amazing, so what’s their routine and how soon does it start?

      Here are three recent examples of pro athletes having hernias repaired, it’s a regular news story in sports:

      http://www.washingtonpost.com/blogs/nationals-journal/wp/2014/12/03/denard-span-has-sports-hernia-surgery-is-expected-to-be-ready-for-spring-training/

      http://hardballtalk.nbcsports.com/2014/09/28/a-j-burnett-will-undergo-hernia-surgery-still-undecided-about-his-future/

      http://espn.go.com/nfl/story/_/id/11996675/andre-ellington-placed-injured-reserve-arizona-cardinals-hernia-surgery

      There certainly must be some protocol that is used in pro sports to quickly rehab groin hernia surgery for a rapid return to the field that could be simplified for the wider public, so what is it? Perhaps surgery type matters as well? It seems most pro athletes have laparoscopic repair.

      Anyway, as an active person myself with a hernia that has yet to be repaired, I’m certainly curious. This is something I’m sure many others would be interested in as well.

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