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Speaker 1 (00:00):
Hey everyone, it’s Dr. Towfigh. Thanks for joining me live on a Hernia Talk, our weekly Q&A session. My name is Dr. Shirin Towfigh. I am your hernia and laparoscopic surgery specialist. Thanks for joining me currently on a Facebook Live at Dr. Towfigh and many of you are here by Zoom. You can also find me on Twitter and Instagram at hernia doc. As always, our YouTube channel will have every single episode including today’s archive for you so you can watch it with your friends and so on. So today’s kind of special, I know it’s just me. I’m going to be talking about all the myth busts. We’re going to talk about what’s myth, what’s misinformation, how can we kind of figure out what’s real out there. But before we do that, let me pretty much kind of, let’s just double check that we are here.
Speaker 1 (01:05):
There we go. Let me just very briefly tell you that it’s kind of an exciting day today. Let me explain to you why I got an email from our president of the hospital yesterday, and as of today, officially my hospital, Cedar Sinai Medical Center in Los Angeles is ranked number two in the nation based on US News and World Reports best hospitals ranking. We’ve been in the top 10 for several years now, and number two is really special because no hospital on the West Coast that I know of has ever been number two up until last year. I think U C L A was number three in addition. So no, so just so you know, this is available online. It’s the annual US News World Report Ranking of hospitals this year. Mayo Clinic is number one in Rochester, Minnesota, Cedar Sinai Medical Center in Los Angeles, number two, that’s my hospital where you all get to care for.
Speaker 1 (02:10):
And then number three is NYU Langone Hospital in New York. The full ranking is on their website. And then I belong to the GI surgery group. We have been number two in the nation for GI surgery for years, several years. I was, I want to say three to five years. And actually if you look at this picture, this is a picture of our hospital, Cedar Sinai. Again, Mayo Clinic is considered number one, Cedar Sinai number two, and UCLA number three. So for those of you who are in Los Angeles, you’re very lucky because you’ve got two excellent hospitals. And I just wanted to also show you this is the ranking of the top 20 hospitals according to US News and World Report. So Mayo, and I want to bring this up to you because if you look at the guests that I’ve had, many of them work at these hospitals.
Speaker 1 (03:05):
So we’re I think on episode 105 of all those guests that I’ve had, whether they’re hernia surgeons, pelvic floor specialists, urologists at plastic surgeons, many of them work at these hospitals. But I do want to say that just because you have a high ranking hospital doesn’t necessarily mean you’re getting the best hernia care. There are some amazing hernia surgeons out there that belong to hospitals that no one’s ever heard of, or they’re really small hospitals like boutique hospitals, and yet they’re really good at what they offer. So don’t think that just because you’re going to an amazing hospital, a highly ranked hospital necessarily, that the hernia repair options would be equally excellent. And I guess in the fact that we’re talking about myth busting, that would be a myth that the top universities necessarily provide the top pur care. That is not necessarily true. However, we have had people from Mayo Clinic, Cedar Sinai, nyu, Cleveland Clinic, Johns Hopkins, ucla, Columbia, mass General, all of these hospitals. We’ve had their specialists on our show, Mount Sinai Hospital, Barnes Jewish Hospital. Let’s see, who else have we had?
Speaker 1 (04:37):
Ringman Women’s, Mayo Clinic, Phasix, Vanderbilt Rush University. So that’s kind of cool that we’ve on here already talk live. We’ve also had a fairly broad series of doctors and surgeons that also work at these amazing hospitals. But I just wanted to share with you how excited I am. I’m technically not employee of Cedar Sinai. I am part of their educational team. I do provide care at the hospital. I do provide care at their surgery center. Their surgery center is actually shared with us in my building. So right here where I am in my office is on the second floor of the most amazing office in Beverly Hills. It’s the number one, what we call a plus rated building. We have two surgery centers that are affiliated with Cedar Sinai in my building on my floor and five floors up, which is great because we get to care for you in the same kind of setting as building as when you come to see me in the office and it’s all Cedar Sinai Medical Center affiliated, and then the hospital is down the street about seven minute drive or so.
Speaker 1 (05:46):
And now we’re number two in the nation. Oh, and I think I told you earlier this year that our surgery center, the 9 0 2 10 surgery center, which is the affiliated surgery center is number two in the nation. And let me tell you, there are many more surgery centers than there are hospitals in the United States, and for us to be number two is really amazing. Really, really, really amazing. So if you’re ever questioning where do you operate or what kind of care do I get, you’ll be cared for at the number two hospital and the number two surgery center in the nation United States based on rigorous scoring by US News and World Report for the hospitals and by Newsweek for the surgery center. So I hope you all kind of enjoy that because I was super excited, to be honest. I thought that was really, really cool.
Speaker 1 (06:47):
We are now considered best in the west number one hospital in the west coast and also number two in the nation. So that’s, that’s never happened before to any hospital. So let’s get back to our show. It’s kind of one of my favorite topics. This is part three. It’s the third time I am doing a myth busting session and I’m doing it because I enjoy it and a lot of what I choose to as topics for myths are there because the patients come in and tell me, oh, I was told this or I believe that and I have to spend a good amount of time kind of reeducating or undoing the education or knowledge that was offered to the patient. So shall we start? Okay, myth number one. Excuse me. Let’s see.
Speaker 1 (07:53):
I’m not blacking this. Give me a second. Let’s just share. So these are questions that were provided by you. It was also questions that were provided by my patients in terms in the terms that basically they told me that these answers, so misinformation number one, Mesh is dangerous. This was a question submitted to me on Instagram. So is Mesh dangerous? Let me just tell you this. The fact that people go around saying Mesh is dangerous is a lot of misinformation. Are there risk with Mesh? Yes. Is there risk with surgery? Yes. Am I going to tell you surgery is dangerous? There’s risk with general anesthesia. Will I tell you anesthesia is dangerous? No, that would be kind of sensationalizing and kind of feeding on your fears. So Mesh has its benefits and has its risks. Driving a car has its benefits and has its risks.
Speaker 1 (09:01):
So in the right situations, the right patients, Mesh is absolutely, absolutely a good thing. It’s necessary. It’s revolutionized the care that we can offer our patients. Are there people that are hurt by meshes? Of course there are the same way people have been hurt by driving a car, walking the streets or having non Mesh repairs. There are plenty of patients that I know of who have had non Mesh tissue based repairs specifically in the belly button. That’s the worst part area where this happens. And they’re, they are in significantly worse situation than in the past. So that’s my answer. I don’t call it a myth because I would call it mostly misinformation. Here is a myth though, which is pedaled by some people that want to take advantage of a patient that have Mesh in them all. Pain is Mesh pain, absolutely incorrect. Absolutely, completely incorrect to say that all pain is Mesh pain.
Speaker 1 (10:06):
And I feel very strongly about this because I have so many patients that I know of that have been maimed because they were told, oh, you have pain. It must be your Mesh. We have to take it out. And they absolutely did not need it taken out. It was because their hip was an issue or they had, let’s say a nerve entrapment had nothing to do with Mesh or they had a hernia recurrence which had nothing to do with the Mesh and they had an operation done. They had complications from the operation, they never needed it because they were led to believe that all me pain is Mesh pain. And I, I’m telling you this because I want those of you who have been told this to contact me. I want to know why You’ve been told that all your pain is Mesh pain. And my concern is that people that are out there that are pedaling, pedaling this are wanting to put you into this whole legal class action lawsuit group to make money off of you and you’re being hurt by it.
Speaker 1 (11:12):
So if anyone is being told that all pain is Mesh pain, which is complete bs, I want to hear from you because my inkling from my experience is those people were being pushed into law firms to claim that they needed surgery to have their Mesh removed for their pain because it was shown that that happened for the pelvic Mesh. And I believe that that’s being happening for the hernia Mesh too. So let me know. Here’s a question. When I lift around 10 kilograms, which is about 23 pounds or so, is it normal for my suture based inguinal hernia repair? So non Mesh inguinal hernia repair to still hurt four months later? Yes, it is normal. It can then take days to settle. I was told there would be no pain after six weeks. So that’s the issue with tissue repair. It is tighter. Tissue repair is tighter than a Mesh repair.
Speaker 1 (12:14):
The whole issue of tension free repair was invented at the same time as the Mesh repair, the Lichtenstein online Mesh repair and it was performed. It was performative because up until then all the tissue repairs were closing a hole and therefore it was closed under tension and therefore because they were under tension, patients had pain and they had chronic pain and they felt pulling and tearing. And that’s because they in fact, were tearing or pulling apart their suture repair. I’ll give you an example. If you have a jacket and the buttons tear off and you have to have or the seams tear off and you have it to be reseed without patching it, it’s going to be a tighter jacket and therefore it’s also more likely to tear again. So no tailor will tighten a outfit in efforts to close a tear and expect you not to tear it again.
Speaker 1 (13:21):
So they never do that. They patch it. Same thing is true for hernias. When you have a tissue-based repair, if that’s what you choose, do understand that the tissue repair is tighter and so anything you do to pull on it may feel you’re going to feel that tightness. And some people have chronic pain because what they’re actually doing is they’re trying to tear the repair. And I see that as one reason why people get chronic pain after a tissue based repair. So there’s no perfect repair. Mesh is not dangerous, and there’s no perfect repair. There’s absolutely risk for chronic pain with a tissue-based repair, especially if one is done too tightly.
Speaker 1 (14:03):
Next question is a spermatic cord lipoma typically present symptoms before surgery? Not typically, but it can. How is it treating surgery? We remove the lipoma. What is the outcome and the risk? Outcome is a better good hernia repair and there’s no risk with doing that. So I hope that’s helpful. Okay, so going back to the tissue repair, if you’re feeling tightness and tearing, that doesn’t mean necessarily you have a recurrence. You can still have a pulling and tearing of the tissue at the microscopic level or very tiny level so that you feel it. However, your tissue hasn’t torn full thickness in order to get a hernia recurrence.
Speaker 1 (14:51):
So that’s kind of where the side kind of delicate part of it come up. Let’s do another myth and then we’ll do more of your questions. So next myth is it’s it’s not safe to fly with a hernia. I just had a patient who had to fly cross country and found a hernia and was concerned, and actually their doctor was concerned too that what happens if you have a hernia and you’re in an airplane flight and there’s maybe pressure changes, is that going to promote a hernia incarceration, the hernia getting stuck, increased pain, whatever it does not. Basically it’s totally safe to fly with a hernia. Now, I don’t recommend you travel to Antarctica or some remote area that has no medical care. If you have a hernia that is symptomatic, that you has pain associated with it because you may need urgent medical care and there won’t be any around.
Speaker 1 (16:00):
However, flying in and of itself in an airplane is perfectly safe if you have any type of hernia. All right, next question. My belly bun has been used multiple times in procedures most recently January 6th for a double hernia pair. So that’s actually very interesting point. The belly bun is a great access point for laparoscopic surgeries in the middle of the belly. It is structured in a way that you can hide an incision in it. So with the of so much laparoscopic surgery in all the different fields, the belly button is often over accessed. Okay? So my belly button has been used multiple times in procedures most recently in January for a double hernia repair. It’s always inflamed. Oh, okay. I can’t sleep on my stomach at all. Any thoughts or questions? Yes, absolutely. Most likely that inflammation feeling or swelling or pain in the fact you can’t sleep on your stomach means you may have a hernia and it’s not unexpected to have that. Even one laparoscopic surgery can promote a hernia in that belly button, and if you’ve had multiple, then it can also increase your risk of having a hernia, most likely going on every so often. Someone has a stitch in there that’s bothering them or small infection, very, very unlikely, but most likely you have a small hernia, very small, and if you go to see a surgeon, they should be able to identify it and if they don’t feel like you have one, you should get a CT scan to identify it.
Speaker 1 (17:49):
Isn’t the umbilical hernia repair done with abdominalplasty also under tension? No, it is not. What is the likelihood of tearing for this? So umbilical hernia repair is actually best done at the time of an abdominalplasty because the abdominalplasty or tummy tuck takes the tissues to the left and right of the belly button and closes it over the belly button. In fact, what it does is it’s a second layer of repair on top of the first layer of the belly button, hernia repair number one, and number two, you’re actually taking tension off the first suture line by adding a set second suture line. So I hope that’s clear. Let’s do another myth and then we’ll come back to your questions. I love it. There’s so many live questions, guys.
Speaker 1 (18:37):
Misinformation. My Mesh cannot be removed. I just got a text, not text, like a direct message from a patient saying, you know, what can I do? I have Mesh, but can I, they can’t be removed, blah, blah, blah, blah, blah. And I’m like, wait a minute, hold on. You’re asking me about blah, blah, blah, blah, but let’s go back. What do you mean your Mesh can’t be removed? Almost all Mesh can be removed. a lot of times patients come to me being told that Mesh cannot be removed is too risky. We can’t do it. You may die, you may lose a testicle, you may get a colostomy. You are going to lose your abdominal muscles. It’s all completely false.
Speaker 1 (19:25):
Almost every Mesh can be removed. It’s a risk benefit ratio. And oftentimes if someone’s telling you something cannot be done, my interpretation is that they cannot do it, but maybe someone else that is more skilled in that can do it. We see that all the time. They’re operations of cancer operations where they go to their local doctor, oh, we can’t operate, and they go to major cancer center and they do this operation all the time. So for them it’s not something as challenging because they have the experience. The same is true of hernias and hernia related complications that need surgery is that those of us that operate every day, oh, I’ll give you another example.
Speaker 1 (20:16):
A lady who had a very complicated kind of toxic type hernia, like perineal hernia, and she was told, yeah, like there’s a hernia there, so there’s nothing else we can do. You can’t get anything done. Or I saw another lady perineal hernia. She had pain. They basically told her, oh, there’s nothing to be done. So if you’re getting negative feedback from your doctor, that doesn’t necessarily mean that there’s no hope for you. That’s something I say all the time on this episode. I is, I hope that I kind of empower you to take advantage of or not take advantage of. I hope to empower you to fight for yourself and be your biggest advocate and interpret what people are saying. Read between the lines. If someone says there’s absolutely no way to operate on you, they may mean there’s absolutely no way I can operate on you, but maybe another surgeon can.
Speaker 1 (21:17):
And they’re just not finishing that sentence and saying, but maybe you should see a Doctor X. So that’s my interpretation of a lot of the patients that I’ve seen who have come to me that have said, I was told, what else can I do? I’m told my hernia Mesh can’t be removed. Like well, hold on. Why not? Why can’t it be removed? Let’s review that. Okay, next question. I have a piece of Mesh in my abdomen that’s 11 and a half by 11 and a half square inches. It was that size in 2012 when it was put in, I had three surgeries after that one to remove Mesh from my small bowel. I’ve seen four surgical specialists since January and none of them will operate on me according to them. I will die during surgery. Oh, this is what we’re talking about.
Speaker 1 (22:06):
I’ve been taken to the ER over 20 times by ambulance due to pain. If you remove my Mesh, how long would recovery be? Okay, so first of all, I’m very happy to help you out. Just call my office and we’ll figure something out. But here’s the thing, I also see people who say, oh, I’ve been to four specialists. I was like, okay, great. Who are they? Dr. Smith? Yeah, I don’t know. Dr. Smith. Dr. Jones. Yep. There’s no Dr. Jones who’s a specialist and whatever, and they say, oh, I was in such and such city. I was in San Lu Obispo and I went to hernia specialist. I’m sorry. There is no hernia specialist in San Luis Obispo. I know all the people that need to be known. If I don’t know them, likelihood is they’re not a specialist. So what people may call themselves may not necessarily be accurate.
Speaker 1 (23:06):
So if you’re a hernia specialist, that means at least half of what you’re doing is hernia based. You deal with hernia surgeries and their complications. You’re able to do open surgery, laparoscopic surgery, robotic surgery, tissue based repairs, measure repairs, whatever you need, you can deal with the complications. You research, you publish, you give talks, you come to the meetings. If you don’t do any of that and you’re in your little little corner, then you can call yourself a hernia specialist, but you’re really not. I’ll give you an example. I opened the Beverly Hills Hernia Center 2013. There was not a single hernia center around me within months. I’m now surrounded by 10 hernia centers. They’re all basically marketing employees for people trying to, they’re also a gallbladder center. They’re also a breath center. They’re also a wound care center. They call themselves all these different things.
Speaker 1 (24:05):
It’s just the same office and yet they don’t really deal with any true specialty stuff and have no special interest in hernias. It’s mostly for marketing and the patients don’t necessarily know that. So I don’t want to sound mean, but I don’t know who these four surgical specialists are that you’ve seen, but it’s possible that they’re just not offering you the care that you need because they feel you’re too high risk or it’s too complicated. But I’m not scared about complicated procedures. So I’m happy to see what’s going on and give you some advice. And if I can help you, then I’m happy to be the one to do that operation.
Speaker 1 (24:50):
Not to too my own horn, but let me tell you this. I’ve had a couple of patients I’ve had this week, this last week alone, a couple patients from major institutions including like Mayo Clinic and New York hospitals and so on that have come to me because they weren’t getting the care and the information they needed. I’ve had people come across country from other countries. One person who I know follows us and watched us from Italy, and he actually saw legit surges in Italy and they all gave him the most negative like, oh, you can’t do this, you’ll die. No, this doesn’t exist, whatever. And I took care of him and knock on what he is doing very well. He was an excellent patient, very followed every instruction, which is great. My point is that even if you’re the chairman or head of this, and that doesn’t necessarily mean you’re the best surgeon and you should advocate for yourself. So if someone’s giving you negative feedback and saying something cannot be done, that means you, they cannot do it and you need to move on to the next surgeon who may be able to do it.
Speaker 1 (26:17):
Okay, here’s a myth. Toxic substances are released into the bloodstream as a result of polypropylene Mesh oxidation. There is zero evidence for that. I know people talk about this on Facebook, it’s been touted on Twitter. Is there a name for these toxic, it’s always, oh, toxic. What are these toxic substances that are released into the bloodstream? Can you measure them? I just feel like so many people are preyed upon their fear to add to their fear. I had a patient today, lovely gentleman, was moving in the right path, and then he decided to go on Google and start searching, and now he’s all anxious about every single little thing that can happen from his anesthesia to his hernia repair, to the Mesh, to everything. And a lot of times people make the wrong decisions because they have fear of the consequences of maybe the right decision.
Speaker 1 (27:19):
And so this whole idea of toxic substances being released into the bloodstream. So polypropylene Mesh does oxidize. What does that mean? It just means that the tissue grows into it and the process of doing that is an oxidated process. It means nothing. All form bodies, even the suture that I put in you, the suture, right suture, not the Mesh, the suture oxidizes. That’s how it works. That’s how the, it’s a chemical process. And yet, I don’t know, I don’t how better to explain this to call it toxic without sharing any data, without claiming any, I don’t even know what, I read so many about these, but what’s toxic? I mean, if it is, I believe you, but tell me what it is. All right, next question. I am in New Zealand recent welcome. I do want to visit New Zealand, by the way. I heard it’s beautiful and I understand there’s an overpopulation of sheep in New Zealand, and so we’re using the sheep stomach for Mesh.
Speaker 1 (28:35):
They come from New Zealand. I’m in New Zealand. I recently learned about a Mesh specialist, Dr. Hazel Estone from the UK close to where I live. I’ve requested a referral from my GP. I live in constant daily pain. Inguinal hernia Mesh was performed in 20 14, 20 15. Okay, so I hope you do get the care that you need. Unfortunately, Australia New Zealand have very few hernia specialists and those that are there don’t really do Mesh removal surgery. From what I understand, I don’t know Dr. Hazel Estone, neither from the UK nor in New Zealand. So I hope that you do get the care. There are several Australian surgeons. We’re planning on getting at least one of them on so that we can kind of get almost every continent covered on Hernia, Talk, Live. But you lemme know how that goes. You lemme know if you like I do have online consultations that you can just email me and maybe I can help guide you a little bit and I can help find you the right specialist in your country.
Speaker 1 (29:43):
I’m happy to do so. Let’s the next question. Oh, thank you. I agree with you about the surgeons. Yeah, unfortunately true. Here’s another one. You’re so right about the doctors who call themselves hernia specialists. There should be some sort of governing bodies that only authentic doctors can say they are. I mean unfortunately that becomes elitist or something like that. So we can’t, but I mean at least be a member of a society or write a paper or give a talk or something. Let’s see. What do you think is the right follow up for a patient that’s had a lap al hernia repair, both for the patient as well as the surgeon so she can know her true results? Very good question. So in general, if you have any hernia surgery, including laparoscopic al hernia repair, your surgeon should see you within the first two weeks or so, two or three weeks, and then it’ll be nice to at least have 30 day follow up.
Speaker 1 (30:49):
So that’s kind of mandatory, not mandatory, but it’s kind of like good practice. All the hospitals, and sorry, all the insurance companies, including Medicare, intend for the surgeon to provide 90 days of care as needed. So if you have any problems in the next 90 days, they should be able to provide it to you. There is no mandate to follow your patients for hernia surgery. There is a national database called the ACHQC, which I belong to that helps us follow our patients for their lifetime. So we usually enroll our patients into the ACHQC database. It’s someone anonymous and then at three months, six months, one year, and then every year after that you get a follow up, Hey, how you doing hernia? Did you have to go to the hospital for any reason and do you still have pain? And unfortunately, most patients don’t respond to those emails.
Speaker 1 (31:55):
I think they hate emails and texts and whatever, but that’s the process that we follow. I also have a research team that’s very interested in following our patients and our quality. So every year or so we do every year or two, we do contact all our patients to make sure they’re doing fine. To be fair, most of my patients have my email or my nurse bell’s phone number and email and they call us during constant contact anyway. Or I’ll tell them, Hey, I really want to know how you do in about a year. Let me know. I want to see what your belly looks like. Let’s say I did some weird cosmetic reconstruction. I really want to see what the long term results are. So the short answer is up to 90 days, up to 30 days, the hospital’s interested up to 90 days. They’re mandated to take care of you if you need, but they don’t have have to follow up with you. Now if you were a cancer patient, if you had cancer, there’s mandated follow through.
Speaker 1 (33:02):
You cannot maintain a cancer center, a designation for example, unless you can show that you’re following your patient outcomes and a certain intervals. So as a cancer surgeon, as a cardiac surgeon, that’s another one cardiac surgeon, you have to follow your outcome that’s mandated. But there isn’t for hernia surgery. And it’s a good point that you brought up in that. Okay, should we do another myth? Okay, let’s do a misinformation. The hernia repair weaken my abdominal wall. Yeah, I have a lot of people that have said this mostly for the abdominal wall, like belly button or ventral hernias and less frequently for the groin. But what they say is, I used to have this great core, I’ve lost my core, my belly’s weak. I can’t engage my belly every ever since. The Mesh repair, that seems to happen more often in patients that have had a patch job and not a reconstruction.
Speaker 1 (34:07):
Let me tell you what I mean about that. So if you have a hernia, it’s a hole. For a long time we were just patching the hole the same way we were patching the hole for the groin. We found out over time that that’s not the best idea because what you’re doing is you’re allowing the hole to be there and therefore the real muscles that help you do a sit up and get out of bed in and out of a car are not in their normal location because they’re spread apart. And then you put Mesh to just seal the hole, prevent more hernia, but you haven’t returned the function of the abdominal wall because your muscles are way out here and what you need is the muscles, muscles to go back in the middle, which is why what we do now is more of a reconstructive surgery where we manipulate the tissues to bring the muscles back to the midline to the middle of the abdomen where they belong, where you can engage them and be able to do your Pilates and your sit ups and pick up your child or your pet and be able to bend down and pick up something from the ground and get out of bed without having to use your arms and legs.
Speaker 1 (35:15):
So that is true that that’s how it used to happen. But there’s also this other factor which is not proven, but I wonder if it’s true, which is that since the Mesh is basically non stretching, it’s possible that some people feel they’re not engaging their abdominal muscles because they’re trying to engage against Mesh. And what you have is your muscle, which is very loose and pliable and moves around and stretches and stretches, engages when it is sewn against Mesh, which is like a sheet that doesn’t stretch and doesn’t shrink shrinks a little bit. It’s possible that that interaction makes it so that your abdominal muscles are kind of lose their function. They don’t actually lose it, they just aren’t able to optimally function because there’s Mesh against it. So there is a little bit of that and people misinterpret it as like, I have a weak abdominal wall.
Speaker 1 (36:21):
It’s not weak, it’s just the interaction potentially of the Mesh with the muscle may make it so the Mesh works more. Sorry, the muscle works more like Mesh because the Mesh cannot take on the properties of the muscle. I don’t know if I said that clearly, but that’s kind of how I feel. How do patients enroll in the ACHQC? Okay, so your surgeon has to be a member. It’s free. If you’re a member of the American Hernia Society, it’s free to be an ACHQC member. Otherwise it’s some cost. I actually don’t know because I’m a, I am a member, so to me it’s free, but your surgeon has to enroll and then when you have surgery, your name is put into the database. If you’ve already had surgery, you’re not eligible to be in the database. It has to start on the day of surgery.
Speaker 1 (37:18):
So can’t, your surgeon can’t go backwards and enter you. Not the best, like the most ideal database, but it’s the only thing we have and therefore any amount information we can glean from it is helpful. Next myth. General anesthesia caused my mother’s dementia 15 years later. So this was something that a patient of mine told me they were really scared of having laparoscopic surgery because what happens is you must have general anesthesia and their experience with general anesthesia was bad because one of their family members had very difficult time waking up from anesthesia and they had to watch that and then 15 years later they actually had dementia. So is it possible that they’re linked? Yes and no. Mostly no. So it’s normal for people to not wake up immediately after general anesthesia. Depends on how fast your body processes the anesthesia. You are given medications so that you don’t remember that you were under anesthesia.
Speaker 1 (38:28):
And so it’s normal to have amnesia during the time around the time of the surgery doesn’t mean that anything wrong with your brain that was chemically induced by your anesthesiologist. Plus it takes some time for the anesthetic to wash out of your system. The more fat you have, the hard it’s to wake up. The older you are, the hard it’s to wake up the longer it takes and it’s kind of normal for someone to be elderly and then 15 years later to have dementia. That’s not uncommon. So it’s the two are not linked necessarily. That said, certain operations like cardiac surgery have been shown to induce some type of embolic events to the brain where you can get what’s called multi-infarct dementia or kind of give you like heart surgery brain or what they call a pump brain. If you’re on a cardiac pump during surgery, it can potentially affect how the blood flow is to your brain. So a lot of surgeries are now done what we call off pump, but not with hernia surgery. So the risk of all these problems with hernia surgery is general anesthesia is basically very, very safe. Doesn’t mean everyone has to have general anesthesia. I actually love operating on patients with IV sedation only. It’s a great way to do nice surgery. The patient wakes up smoothly. They don’t, they’re often not nauseated, so it’s great, but certain things like robotic or laparoscopic surgery pretty much have to be done under general anesthesia.
Speaker 1 (40:13):
Okay. Do you use larygeal airway mask or endotracheal intubation for most of your laparoscopic operations? Have you ever heard of laryngeal airway mask to cause a tendency to aspirate? Okay, good question. So general anesthesia typically is done with what’s called an endotracheal tube or we often call general endotracheal anesthesia. And what implies is you’re completely, you’re given medication to completely knock you out and then they put a tube through your mouth in down your throat towards your lungs and the lung machine anesthesia machine takes over your breathing. That is the most typical way. That’s one extreme. The other extreme is you undergo no, no intubation, you’re breathing on your own. You just get IV sedation and there’s something in between where you can have something down the throat but not down towards your lungs. That kind of allows you to have deeper anesthesia without necessarily having full general anesthesia. So the safest, the safest type of anesthesia for people that have reflux issues is the endotracheal intubation, laryngeal airway mass. There’s different types of it and there are some that include little suctions. And if please correctly, you should not be refluxing into your lungs for it, but I don’t know much more than that. We can ask an anesthesiologist next time.
Speaker 1 (42:00):
Let’s do another myth. Oh, here, I did that one. Wearing a hernia truss will cure my hernia. All right, let’s discuss hernia trusses. I do have a video I believe on Instagram and Facebook where I went over all the different hernia trusses and which ones I like because they’re different models. But a hernia truss is the same thing as a hernia belt. It’s made for the groin and it is intended to hold a bulging hernia in. The only purpose of a hernia trust is to hold the hernia in. It in no way helps the hernia. It doesn’t cure the hernia.
Speaker 1 (42:53):
If you have a hernia that’s large and let’s say security guard, you got to stand for your job all day and this hernia is medium to large size and the longer you stand, the more pain you’re in, the more achiness and you just can’t do your work or you can’t concentrate on what you’re doing or hernia trust will help you. You lay flat, you push your hernia back in, you wear the trust over it, then you get up and about. And the hernia trust prevents your hernia from pooching out and in doing so allows you to do your normal activities without worrying about your hernia. But if you have a small hernia or if you have a hernia with no symptoms, the trust doesn’t help you at all. If you have a hernia that’s small with symptoms, usually a trust also will not help you and don’t believe that the hernia trust will in any way protect you from needing surgery.
Speaker 1 (43:51):
It cannot make it worse. They cannot aggravate a hernia or enlarge it, especially if Warren correctly. I’ve seen people that slap on a trust on top of a bulging hernia. You have to reduce the hernia first and then use the trust to hold it in. The whole purpose is to hold it in. So if used correctly, it doesn’t hurt, but it’s kind of a difficult uncomfortable thing to wear. So if you don’t have to wear it, there’s no reason to wear it. I assume most surgeons do not enroll their patients or not enrolled in ACHQC. That’s true. I think it’s under a thousand. I think several four or 500 surgeons are members of the ACHQC, which is very low compared to the 40,000 surgeons that do hernia repairs. So you are correct. Keeping in touch me is responsibility. That is true. Now let’s go. I had sutures removed seven weeks now the original sutures removed.
Speaker 1 (44:58):
Who takes out sutures anymore? The original horrible pain has been relieved, but I’m still sensitive around the repair area. The normal recovery pain is a normal recovery pain still at this point, I really haven’t done anything to strain things I’m afraid to do. See, so this was the situation of the Inguinal hernia? No, I don’t know what kind of surgery you had, but we often don’t use sutures that need to be removed anymore. But seven weeks after surgery, you still have, if your horrible pain is gone, great. That means the operation was a success from that standpoint. Oh, umbilical hernia. Thank you. So I don’t know why you had sutures put in that that need to be removed. Usually we have absorbable sutures regardless, you’re pretty sensitive rather period. That’s normal. The more swollen you are, the more sensitivity you will have. And normal recovery pain, is it still normal at this point?
Speaker 1 (46:07):
It can be. Everyone’s a little bit different. I really haven’t done anything to strain things I’m afraid to try and pushups and all that should be totally safe to do seven weeks after surgery. Can the truss weaken the surrounding angle floor or other upper neurosis? Not that we know of, no. No, it doesn’t do any of that. It just holds in the bulging. That’s all it does. Here’s some misinformation. I got a hernia because of COVID. I’ve heard that before. Or I was opening up a heavy door and then I got a hernia or someone was falling, I grabbed them and now I have a hernia. So people don’t get hernias from those single activities. You have to most likely have a pre genetic predisposition to the hernia first. And if you have the genetic predisposition to the hernia, then you’re at higher risk of getting the hernia. Not everyone who has genetic preposition gets a hernia. Not everyone who has parents that didn’t have hernias doesn’t get hernias. Does that make sense? That’s double triple negative.
Speaker 1 (47:17):
Yeah. Just because your parents didn’t have hernias doesn’t mean you won’t have a hernia. But if you did an activity like COVID is a big one. We’ve had a spike in hernias that have become symptomatic because of the COVID cough. So they contract COVID and then they cough for three months or the cough doesn’t go away or they’re like incessantly coughing for a full month. That is a lot of abdominal pressure. And in doing so, what’s happening is you are adding strain and risk to an area that’s already at higher than average risk for herniation. And those activities are an extra layer weren’t, it wasn’t because of that, but it was an extra layer. Now, work-related hernias is an interesting issue from an insurance standpoint. If you are, let’s say a construction worker and you get a hernia or you’re in a car accident and you get a hernia, insurances often agree to pay for that hernia repair as a work related accident. The reality is the work increased their risk, but they had to have had some underlying risk to begin with. Does that make sense? I hope that makes sense. All right, more questions.
Speaker 1 (48:42):
Here’s another one. Myth. Oh, okay. I’ve heard this before. Oh, well my surgeon is lying to me because he’s trying to protect the other surgeon, or my surgeon’s lying to me because he’s protecting the Mesh companies. So first of all, surgeons typically don’t lie. Doctors in general, they don’t go around lying. Were not just a uniquely compulsive liars as a specialty. So this whole idea that doctors are evil or all about their money and they’ll lie to do whatever is just not, it’s, it’s really unfair to do that. There’s good and bad in every specialty, whether you are a priest or banker or a surgeon, but in general, doctors just want to help patients and they just want to have a life where they’re helping others and they’re not Compulsive wires are going around trying to protect other surgeries or protect Mesh companies. So I’ve had patients that come in with an agenda like Mesh is dangerous and then they’re morbidly obese.
Speaker 1 (50:01):
They’ve had a hernia recurrence and therefore they basically need a Mesh repair. But they’ll claim that their surgeon is trying to protect the Mesh to protect the idea that Mesh is good. And that’s why he won’t admit that the Mesh she put in him is dangerous. And if I agree with the surgeon, I’m like, no, you’re, you had a hernia that’s recurred. You’re morbid obese, you’re a smoker. What of all these risk factors, what was done was the right thing? Oh, well, you’re just lying to protect that surgeon. And I don’t know how to politely and respectfully respond to that because that patient clearly has some negative feelings, whether it’s because he has a lawyer or he has been reading online or he feels like he’s been lied to or he feels like he’s been taken advantage of. But whatever the underlying thing is to then claim that your surgeon, the surgeon, one patient told me, this is interesting.
Speaker 1 (51:13):
One patient told me that their surgeon put Mesh in him out of spite, out of spite to prove that, to prove him wrong, that Mesh is not dangerous. So out of spite, he never needed a, actually, he never even had a hernia. That’s what he claimed. Which is completely false by the way. And I’m just like, we don’t just do that. That is so conspiratorial and no surgeon goes around putting Mesh in out of spite just, I don’t get it. I hope you guys understand what I’m saying. Do you guys get it? Can you please give me some feedback? Because I didn’t know, am I the weird one? Am I not being caring enough or not understanding the patient enough or am I just don’t know. I wanted to be, I was respectful to the patient, but I tried to explain with facts, here’s your hernia. This is the different repair options. This is the best option. You’ve already had a recurrence, you need Mesh. And because I was claiming the same information as the other surgeon that he didn’t respect, for some reason I was trying to lie to protect that surgeon, that surgeon hit him. And so just put med him out of spite. It just doesn’t make any sense to me.
Speaker 1 (52:44):
Your bedside manner is outstanding. My view. Thank you. Sometimes I feel like my bedside manner is maybe too kind. I don’t know. I really dunno. Here’s another answer. I don’t think any surgeon would do anything that would cause a lawsuit against them in the future. That’s interesting. Interesting response. So if what you mean is that a surgeon won’t do anything egregiously wrong because they know they’ll be sued, that’s probably true. If a surgeon says they would refuse to do an operation, there’s a right operation because they’re afraid that they’ll sued. There may be surgeons actually that do that. That’s very possible that they’ll be like, I won’t touch this patient because I think they’re going to, they’re, they’re going to sue me. That’s possible, but I don’t know what else to say.
Speaker 1 (53:42):
Oh boy. Sharing a lot with you guys today. It’s one of those days. Okay. All right. Here’s some other questions. How much of the original tensile strength do you lose after healing from a surgical incision In this regard? Are transversal incisions better or worse than midline incisions? Okay, good point. So in from a hernia recurrence standpoint, because the pressures, I’m going to show it to you on screen because the abdominal wall pressure is pulling this way towards your left and right then a midline up and down incision has more pull on it than the transverse incision because a transverse incision is closed parallel to the opposing factors pulling on the natural belly, whereas a midline incision is being pulled apart perpendicular with perpendicular forces. So from a hernia standpoint, the transverse incisions have a lower recurrence rate than a midline incision That has nothing to do with tensile strength. It’s just vectors of force.
Speaker 1 (55:00):
In terms of tensile strength though, question is how much of the original tensile strength is lost? And I’m not sure it’s lost. In fact, it may be increased because scar tissue can be much stronger than your normal tissue. And so you may actually have more tensile strength and also, therefore probably a stiffer area than you would without an incision. Here’s an answer. You’re correct from my standpoint, thank you. I needed most validation as possible. Sometimes it’s very stressful to have my job. I just had two incisional hernias repaired by Dr. Mary Han at Stanford. Great. She’s amazing. The surgery was only one and a half hours, and after a month of I was healing. Well, that was my second Mesh. I live in Reno in the doc here said she would have to do open surgery. That’s why I asked for referral Stanford and Dr. Han was very helpful. Yeah, she’s great. Dr. Han is a chair at the department surgery and she does hernia surgeries. Very uncommon to see that combination. And she’s a very fashionable and beautiful lady, so I like that about her too.
Speaker 1 (56:17):
Okay. I, I’m trying to clarify your statement. I don’t think surgeons would just put mesh just to be mean. Yeah, I agree. There’s nothing we surgeons just don’t do that unless you’re a psychopath. You would not just do a procedure just to hurt someone because they’re mean. Doctors don’t do that. Although there are doctors that are a psychopath too. There’s Doctor Deutch, right? He was the neurosurgeon who I think is in jail now. I think he was a psychopath. There’s a whole series of podcasts and TV shows about him. But yeah, there may be one hernia surgeon out there that maybe a psychopath, but in general, we’re not anyone knows who I’m talking about, who I’m talking about. Okay. Are adhesion barriers useless? Is there any difference among the different adhesion barriers? Okay, so what we’re talking about is Mesh that has a layer added to it.
Speaker 1 (57:16):
Usually it’s a clear layer that prevents the Mesh from sticking to, let’s say, bowel bell. Back in the day, we didn’t have that. So then people were getting fistula and that was a horrible complication. So people came up with different types of sugars and oils and fibers that you can add to Mesh. They’re almost always absorbable barriers. And once they’re absorbed, the Mesh acts normally, but during the healing process, it’s a barrier to prevent it from eroding or causing injury mostly to in intestines. So they’re different in that some of them cause inflammation. The omega-3 fatty acid that was used for the C cure Mesh, which I think it’s off the market now, don’t quote me on that, I may be wrong. That has been shown to be highly inflammatory. And so that is something we don’t use anymore. But there’s separate film and other types of tissue barriers that are very good methyl cellulose, and they all vary based on how long it takes for the barrier to stay on. It’s usually somewhere between five days and three weeks. It’s how long those barriers stay if they’re absorbable. That’s the main difference between among different barriers. And let’s see, I think we’re done. That was the full hour with all your questions and everything. It was nice to have you back on Hernia, Talk Live. Thanks everyone for watching and following and listening to my stories. I hope you relate. So thank you everyone. This ends our session of Hernia Talk Live Q and A. My name is Dr. Shirin Towfigh. Please do follow me on
Speaker 2 (59:21):
Facebook at Dr. Towfigh to make sure you’re all, and also Instagram and Twitter at hernia doc. I will make sure you always know when the next Hernia Talk, Live q and a is. And if you’d like to watch even more sessions besides today’s, go to my YouTube channel. All do those links are available online. And my bios, hope to see you next week. I will see you again. Thanks everyone. It was fun. Take care.
