Episode 106: Medical Gaslighting | Hernia Talk Live Q&A

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Speaker 1 (00:00:00):

Hello everyone, it’s Dr. Towfigh. Welcome to Hernia Talk Tuesdays. I am your host, Dr. Shirin Towfigh, your hernia and laparoscopic surgery specialist. And we’re here again on Tuesday evening on our Hernia Talk Live Q&A session today. Many of you’re joining me by Facebook at Dr. Towfigh as a Facebook Live. And thanks to everyone who’s here on Zoom, remember you can always follow me on my Twitter and Instagram page at hernia doc and at the end of this episode, I’ll make sure as with every week that you can access this session and all prior sessions completely on YouTube. So for those of you that have been following me that today’s session is on medical gaslighting and the reason why I chose that topic was, so I read the New York Times is kind of a thing that I do on a regular basis. I also like the medical part of it, many of me or were introduced to me based on my article, my own article in the New York Times back in I think 2009, maybe no 2012 maybe I think 2012, where basically they did an expose on how most women who present with groin pain are dismissed and they actually have inguinal hernias as the cause of their pelvic pain.

Speaker 1 (00:01:33):

So that was my kind of entree into the New York Times and I, I’m a big fan of theirs because their writers are really, really fantastic. Jane is like an amazing writer and I also had a Washington Post article, but the goal of all of the these runnings is to add to the knowledge base out there that hernias can cause pain and women can get hernias. And that’s been pretty much my practice is treating patients with hernias and hernia related complications. And it’s, my practices have kind of evolved into seeing patients that are maybe told there’s nothing wrong with ’em, you don’t have a hernia, there’s no surgical options, go home, it’s all in your head, et cetera. So then I saw the article in the Washington Post and I was like, okay, this is definitely something that I need to address because they actually published two articles within the past month and a half both talking about what’s called medical gaslighting.

Speaker 1 (00:02:45):

And if you follow me carefully on Hernia Talk Live that I’ve had one prior episode dedicated to gaslighting and we’ve on and off talked about the topic, but now that the New York Times has kind of brought it out as a public discussion, I thought I’d bring it up too. And let me tell you, you guys have been amazing. The amount of interest in this has been intense, I think because many of you felt like you were gaslit based on your symptoms, whether it was before surgery where you basically were told you don’t have a hernia or you’ve had a hernia surgery and that you were told that there’s no reason for you to have pain. And so I’m going to share all your stories today and many of you shared your stories online with me. I’m going to help bring that up to the rest of the public audience.

Speaker 1 (00:03:38):

And you sent me great, great questions and I expect to get some live questions from you today as well. So let’s get started. Before I start with those questions, do you see this beautiful flower bouquet bouquet behind me? I actually got these today. For those of you that can see those of you that are online that cannot see it is a gorgeous, gorgeous bouquet of orchids and tulips and just fancy flowers. Beautifully done with a thank you note. And a thank you note was from a patient of mine, not from California who actually had pain for a long time, had to go to multiple specialists, multiple hospitals, and eventually got surgery for the pain. Unfortunately, the surgery that she got was not perfect, so it addressed her pain initially, but then she had new pain that showed up and she went back to that surgeon again out of state and that surgeon didn’t really know what to do and basically told her the imaging looks fine, you don’t have a hernia recurrence, the Mesh looks fine and here’s some pain medication.

Speaker 1 (00:04:48):

I don’t really know that they were off of her any treatment besides pain. Maybe she gets some injections, maybe it’s another problem, maybe it’s her colon. So she eventually reached out to me and I figured out what her problem was. The repair was too tight. So when they did it initially, the Mesh was placed perfectly. But a perfect Mesh repair is almost always done with a little bit of laxity in it because Mesh shrinks, those of you who follow me know Mesh shrinks and Mesh can shrink between 10 and 25% depending on the type of Mesh that are that’s put in. And her Mesh was, I think hers was the heavy weight. So it would have shrunk 12-25%. So if you put Mesh in that’s already too tight and then it shrinks, it’s going to be even tighter and cos pain. So for her it was fine for the first two to three months, but right around six to eight weeks, which is when the Mesh shrinks, she started having her pain.

Speaker 1 (00:05:54):

So what I did was I undid the repair and redid it in a more lax manner and she’s doing great. And so I got these beautiful flowers as a thank you. But I must say she had to travel across the United States, across the United States to see me for this problem. She shouldn’t have to, but she did. She should have had surgeons and doctors that would listen to her and not just look at an inmate and say, there’s nothing wrong with you because there was something wrong with her. She couldn’t sit. I mean a normal daily activity should be the ability to stand and the ability to sit. And she was not able to sit as a young woman. And if you see a patient like that, it’s very hard for me to dismiss that as it’s all in your head or maybe you have pain issues, especially since, well, I don’t know, she’s, she’s just an amazing woman. So my point is these flowers are from a patient that was medically gas lit and I really appreciate that it arrived today the day of our medical gas lighting for the episode. So thank you all for and following me. And I just want to spend a little bit of time reading all these great posts that you sent because I mean the number of comments just on my announcement for this episode was amazing. I’m going to read some to you.

Speaker 1 (00:07:32):

Okay. One said I was a personal contributor to a actual article in the New York Times, so I appreciate you sharing it. That’s great. The other one is a former patient of mine that says, I never felt that way with you, but since losing my private insurance and having to go on state insurance, I’ve had so many doctors do this to me, terrible. I have a foot appointment tomorrow and I’m going to have to fight for an x-ray. Let’s see, another comment. Yep. It’s a thing I advocate hard for myself and if a doctor acts annoyed or dismissive by my questions, I have no problem getting up and walking out and finding someone who will hear me. Lemme tell you, I had a doctor, I follow a lot of people that follow me. One’s a resident, I think not even a doctor in train. He’s a doctor in train, he’s a doctor, he’s in training and I was very disappointed because he actually posted this article and in the article it has four or five bullet points describing different ways in which people can be gaslit.

Speaker 1 (00:08:42):

And let me read this to you. It says, what are the signs of medical gas lighting? Number one, your provider continually interrupts you, won’t let you elaborate and doesn’t seem to be an engaged listener. Oftentimes I go to the doctor’s appointments for my mom or family member and they always say, when you are in the room, the doctor spent so much time with me and they answered so many of our questions, usually it’s in and out. So I do understand that that happens a lot and unfortunately it’s not just a medical doctor issue, it’s a medical system issue in that the doctors are paid and promoted based on their productivity. So same way as a factory worker is paid, promoted, given bonus, expected to do a certain volume of work. The same is true of many, many doctors that are employed physicians and as an employee they have minimum number of patients or billing or whatever that they have to do.

Speaker 1 (00:09:51):

And if they don’t, they can potentially not bring in the amount of money that they are supposed to get paid. So because of that, and since insurance doesn’t pay that much because of that, the doctors are always in a hurry to do the next and the next. And because it’s become a volume game, that is not my practice. It’s why I got out of the system. I do not like that practice at all. And unfortunately that’s the way most people’s practices are. Next on the list of what are the signs of medical gaslighting is the provider minimizes or downplays symptoms like questioning whether you really do have pain or refuses to discuss your symptoms. That’s a major one that I see among my patients is that they’re told, yeah, but how much does it really hurt? It’s that joke, it only hurts when it hurt.

Speaker 1 (00:10:53):

Touch when I touch it, well then don’t touch it type of thing. But it’s kind of not a joke for these patients that his lives are destroyed by pain. And I see that in women it’s even more common for them to like, oh yeah, doesn’t really hurt. Are they just being whiny? And the reality is women aren’t as whiny as men. In fact, my male patients are often, my female patients are often more stoic and my male patients, the smallest little thing, they’re going to have to come in and show me. So I’ve had patients that have been told, it’s on your head, go. He’s a psychiatrist.

Speaker 1 (00:11:41):

If they’re married, they’ll say, how’s your relationship with your husband? Is it really that that’s giving your pelvic pain? Maybe you should go see a psychiatrist or marriage counselor. Meanwhile, they have a hernia, they just need their hernia repaired and it’s really sad when I hear their stories. Okay, third, it says number three in what are the signs of medical gaslight? The provider will not order imaging or lab or rule out or confirm your diagnosis. In Canada, I see this a lot. My Canadian patients, I feel like the socialized medicine, and I see it in the UK as well, the socialized medicine, disincentivizes, the physician from using technology. In the US we don’t really have that, so we’re much more likely to order some form of technology, whether it’s labs or imaging. But in the socialized medicine world, which is usually the Canada and the UK, in my experience, it’s really hard for them to even get imaging ordered.

Speaker 1 (00:12:43):

So sometimes my patients just go to a private area and pay for it themselves, and then of course the diagnosis is there. Number four, you feel the provider is rude, condescending, or belittling. That’s really, I’m not sure that’s so much gaslighting as it is just a inappropriate doctor. And number five, your symptoms are blamed on mental illness. Yes, we’ve been saying this, but you are neither given a mental health referral nor screen for such illness. Very, very good point because they say it’s all in your head, just don’t think about it or focus on something else. I’ve had patients that said, I went and saw a psychiatrist just to prove that there’s nothing psychiatrically wrong with me. So I can check that box off, go back to my doctor and say, okay, you think it’s all in my head or I’m depressed or whatever, I’m not.

Speaker 1 (00:13:37):

Here’s my evaluation by the psychiatrist. Now I’m back to you. I still have this growing pain or abdominal pulling or whatever and so on. So I say this because I saw a post on Instagram by a trainee, I believe he’s still in residency, I believe that wrote stupid article, four years of undergrad plus one year grad school plus four years of med school plus five years residency. So my patient can tell me what tests and imaging to order, plus all the stupid hospital bureaucracy physicians have to deal with. So obviously this physician is frustrated, but the frustration is misplaced. There been many times when my patients, do you think maybe we should get an MRI or ultrasound? I’m like, that’s actually a great idea. We should do that. I don’t take offense to that. Now, infrequently patients will tell me what to do and I have to explain to them the logic behind why I’m not following that algorithm that they want.

Speaker 1 (00:14:50):

I had a patient who claimed he didn’t have a hernia but had a hernia repaired anyway because the doctor had some personal agenda against the patient, which makes no sense. And then he basically wanted me to admit to that and then do some weird take out the Mesh and he never had a hernia, just the whole where things weren’t going, were going through it. I’m like, well, that’s a hernia. It was a very odd, odd situation. Anyway, my point is that it’s unfair for doctors to take it out on patients and say like, don’t tell me what to do when at the same time they may not be helping patients or listening to patients. So, okay, let’s do another one. Here’s another comment. Fortunately, I’ve never felt dismissed or ignored, but I remember when I had severe chest pain, excessive sweating, memory problems, panic and anxiety attacks, and the subsequent medical tests of heart ultrasound, blood pressure, et cetera.

Speaker 1 (00:15:57):

I was told I didn’t have a heart attack or heart problems and was sent on my merry weight. Later I figured out I had some depression going on. Years later I found out about acid reflux and heartburn and non resolution of my chief complaints. So everyone’s been through this. Here’s another comment. I was told by my good friend that I have good patient syndrome. What an interesting statement. I go and talk about the positives and I don’t share how badly the pain et cetera has affected my life. I have two appointments this week with my general practitioner and my surgeon to tell them how my life really is as a woman, even though I consider myself outspoken, competent, I find that I’m still a bit intimidated by any older male doctor and I downplay everything. Thank you for tackling this. So true. I even go, I may have all these I don’t know issues and I see my own doctor, I’m like, I’m okay. Everything’s fine. I just don’t want to make a big deal about it. And all of a sudden I find myself downplaying everything.

Speaker 1 (00:17:05):

Here’s another comment. Other doctors ignored me. He fixed three hernias, removed a big piece of Mesh and anchors, ended abdominal wall reconstruction. Let’s see, that was one set of comments and here’s, oh yeah, this was another one. Wow, so many comments. So I’ll read some of them for you. Thanks for taking my symptoms seriously and never questioning my experience. You’re one of the good ones, Dr. Towfigh. Thank you. Lyme patients have experienced this for decades. That’s true. So Lyme is an interesting diagnosis because in California people don’t usually get Lyme disease, but that diagnosis is thrown around, but it is an actual disease, so unfortunately it’s treated as being fake sometimes because it may be misdiagnosed to many people and yet people that actually have it are not diagnosed.

Speaker 1 (00:18:00):

Here’s another one. My four-year-old just had umbilical hernia surgery and her pediatric surgeon said, hernias don’t cause pain. Well, or nausea. Whoa. Or vomiting. What? Okay, they follow up writing. I myself, as an adult have had three umbilical hernias with repairs and mine hurt like hell and I had nausea and puked because it hurt so bad. Of course, I still have pain even though I had a surgery to remove the permanent stitches from my last hernia repair, they can’t figure it out, but the pain is there every day. But I have flareups where the pain is so bad, I’m in tears and nausea and puke, but CAT scan is fine. Also, FYI

, all three hernias were small and never seen on CAT scan. They were there and repaired. I’m sure they were there on the CAT scan. It was just misre Talking about pediatric hernias, I’ve had a fair number of children that have reached out to me via their parents and they chose the online consultation because they were out of state and I’m not really a pediatrician, but I helped them figure it out and I pushed them to see the right specialist.

Speaker 1 (00:19:08):

I reached out to their specialist and they had their children are like 9, 10, 11, 12. And it’s hard for them to say, mom, I have a hernia. What they’ll say Is, my belly aches or I don’t want to eat or I don’t want to play or I don’t want to go to school. And that’s how they express themselves. And the kids are then treated as maybe there’s something wrong with ’em or they’re anorexic or something like that. And all the time, all this time they have a hernia and they tend not to image kids. At the most do an ultrasound and ultrasound on the belly button’s never, never easy. And I was like, no, there’s this really small hernia, you got to fix it. Anyway, long story short, they went to their pediatric surgeon that was convinced eventually to go in there and take a look because they weren’t convinced fully there was a hernia and Indy, they found a hernia, fix it and the kid is like gained back his weight back in school, active, et cetera.

Speaker 1 (00:20:07):

But man, it’s just sometimes it’s like pulling teeth trying to get doctors to think outside the box. And it’s true of everyone. I think in all specialties, whether it’s medical or non-medical, there are people that think outside the box and are willing to listen and others are like, Nope, this is the way it is and there’s no other option. And I’m more of a out-of-box thinker. I’ve told you before, I always liked solving puzzles even as a child. So the same is true for solving puzzles medically usually. Here’s another one. You were the only one who took my suspicions of a hernia. Seriously. I had one surgeon tell me my stomach looked that way because I was fat and I wasn’t eating the right things. When I was in total alignment with my B M I, he didn’t even look at my file. I walked out, demanded my money back and then came to your office where you diagnosed me with an umbilical hernia based off scans done at OSU. That’s Ohio State University. Best surgeon ever. Thank you.

Speaker 1 (00:21:13):

Wow. There’s the whole Transvaal Mesh. So I’m one of the many thousands of patients who were implanted with transvaginal Mesh. We have suffered years of pain and not been believed. I was virtually told that I had mental problems for the women pelvic accept. It’s a lot of questions about mental problems. Thankfully most of it has now been removed. Doctors have pass us from pillar to post because the Mesh was because quote, the Mesh was well placed and you are not suffering pain. That is gaslighting of the worst kind. True, sadly, although I’ve hadn’t removed, I’m suffering from other problems brought on by having had the Mesh. Now I suspect that I have anal hernia. The doctor says she cannot find anything. I’m now awaiting a scan to find the truth. Nobody’s going to repair this with Mesh. Yeah, no, you don’t need to. Tissue repair is fine. Mesh is the nastiest torture device anyone has ever invented. Well, some people need it.

Speaker 1 (00:22:10):

Let’s see what else? Here’s another one. Want to guess how many times I heard occult hernias don’t cause pain? Ugh, I published so many times on it, written articles given talks. It’s so ridiculous. This weekend actually on Sunday, I’m going to give a talk to a group of a medical all different specialties that what you should say and my Tela-talk is why it’s not just a hernia. And I’m hoping that each specialty understands that even within their specialty, they may see a patient that has a hernia and that the hernia is a cause of their pain. I’ll give you an example. Today I saw a patient, she was seen, she’s actually not from this state. She was seen from multiple, she’s actually on vacation here and she came to see me on her vacation. Can’t believe that. Now that’s dedication. I felt kind of bad, but she’s from a different state, chronic pain and everyone was focused on blood clots and her blood disorder and vein issues. So she’s seen like three vascular surgeons and in doing so, none of them thought her groin pain was from a hernia. They came up with all these other diagnoses, May-Thurner syndrome and all these different potential causes. It’s your fibroids and other things that don’t actually exist as diagnoses. And then hernia, which is so common, never cross their mind. So even a vascular surgeon needs to that the groin pain or leg pain that they’re seeing, inner thigh pain is related to a hernia.

Speaker 1 (00:23:53):

I’m going to finish up on some more comments and then we’ll go to your questions. Thank you that you never made me feel this way. Thank you for being this to light. Thank you for being you. I love you. Thank you. That’s because they don’t acknowledge internal hernias here. I have had five surgery where five surgeries where I’ve had a rectal hernia and they ignored it every time. As a result, I’m not repaired still. You can clearly see it on the CT scan, European Hernia Society and American Hernia. Hernia Society mandates are a problem with Canada. How they check for bowel prolapse. Okay, and here’s a male saying, dammit, aren’t all people being gaslighted, not just females? Yes. Is this true?

Speaker 1 (00:24:37):

Yes. Men suffer differently along with the era of males are toxic, et cetera. Males commit suicide four times higher than females, which is also true. I have patients that I’ve known about that have committed suicide because usually it’s because of a complication from surgery, not before surgery, but these things happen. Here’s a response. I think women’s symptoms in particular are more likely to be labeled psychosomatic, anxiety induced or hormonal. So true. So true. Many assume women have low pain tolerance as well, which is actually not true. At least that’s what I’ve been a witness to. But no doubt there’s a problem for everyone. So these are all you guys can go on my Facebook. These were all, I’m not going to go through all of ’em because it’s a lot, a lot of comments, a lot of, a lot of comments about all this in terms of gaslighting not being heard, delay in care. We actually published a paper that showed the women are delayed by more than a year for the same exact symptoms, the same exact problems. Let’s see. Lots of questions guys. Thank you so much. I have an epigastric hernia that needs surgery. I’m so scared to do it. Epigastric hernias actually do really well. Of all the ones that we repair, it’s more of the better tolerated operations. So don’t be scared.

Speaker 1 (00:26:11):

Here’s some other comments, quote, you shouldn’t be having pain from that. I am having a follow up with my surgeon on Thursday for this. My pain is real true. Another comment I got told yesterday that the pain causes trauma and the brain never forgets that pain. So when you get anxious, it creates the pain. So why does mind hurt daily enough to make repute? Okay, let me address this. There definitely is a case for mind over body. In other words, can two people can perceive different pain for the same pain? Does that make sense? Their perception can be different. I could have pain right now and not even know I have pain and someone else may feel a one out of 10 pain is like ruining their life.

Speaker 1 (00:27:03):

I told you they had a patient that came and saw me for one out of 10 pain and he was like, my life has ruined. And I’m like, did you really mean one out of 10? Maybe you mean 10 out 10 because one’s the lowest number. He’s like, yeah, it’s one out of 10. I’m like, well, how does that ruined your life? And I didn’t mean to gaslight him, but my point is the same, same pain can be perceived differently by different people. And that the reason for that is they’re the way that they process pain may be different. Some people are medically anxious and do perceive pain more, but that shouldn’t be discounted is the issue. And bottom line is they have the pain so people don’t make up pain. 99.9% of patients don’t make up pain. There are patients that do it, but it’s not common.

Speaker 1 (00:27:55):

And so you have to believe them. And if they’re telling you the pain is like with certain activities or better when they do put ice on it or whatever the situation is, then that’s anatomically and medically correct. And so you have to act on it and try and figure out what’s wrong with them. We need more doctors. We need more like you. Okay, not just more doctors. What kind of training do med students get on empathy and patient communication? Actually much more than I did. I would say I actually went to uc, San Diego. It was a great medical school. It’s very progressive. And starting with year one on Saturday as we would go talk with patients and we were taught patient communication, empathy, we were graded on, graded on it. Nowadays it’s even more about that. They use a lot of real patients, fake patients, actors, which we didn’t have before and they’re graded on it. You’re actually graded on your empathy and ability to communicate with a fake actor patient as part of your exam to pass as you move on. So actually in medical school they teach you much more than they did in my generation.

Speaker 1 (00:29:16):

Lyme disease, you get in Scotland from bite. Okay, good to know. My four-year-old has had an umbilical hernia and she got it fixed after four years of them blaming constipation. Yeah, that’s just drives me nuts. Let’s see. I was actually often told that only men get hernias. I get used to give talks to the gynecologists and they would come up to me and be like, I didn’t know women hernias, but you’re hernia, you’re a gynecologist. That’s not really taught, I guess. And many of them would come to me after my talk lecture to them and they would say, man, I think there’s about three people last week alone that I saw that maybe they have hernias. I kind of dismissed their pelvic pain or thought it was endometriosis or ovarian cyst or something. So we’re coming out with a scoring system like a barely hills hernia score and based or a calculator.

Speaker 1 (00:30:20):

And based on that, it’ll help predict how much of your symptoms that you are having are due to hernia. Therefore hernia repair would fix it. So I’m hopeful that that’s going to help promote more diagnosis, earlier diagnosis because not only can your doctor stick all your symptoms in there and figure it out the probability that you have a hernia, but you can do it. Just go online and do it. So we’re working on the scoring system. Let’s see. This has happened numerous times in my journey to Pudendal Neuralgia diagnosis and I still bowel with the leftover trauma that this kind of dismissive nasty treatment created for me who was an agony and looking for answers, but for more but more so help. It’s so damaging and we’re still sorting out this terrible pain Mesh in my life. It ripped in two pieces, removed in suture, and I’m now numb in pain and bruised.

Speaker 1 (00:31:19):

No synthetic material should ever be put in human being. Well, the reality is we are putting synthetic material in people, everything from joint implants and cardiac pacemakers, which is part of saving lives. So I don’t agree with the comment about the implants. Here’s a question M C A S patients, that’s mass cell activation syndrome. Patients also deal with this. Very true. My new allergist stated, my previous doctor who diagnosed the condition was incorrect because I’ve never needed to use an EpiPen and tryptase had shown in normal range. Yeah, see, here’s the thing. I didn’t even know about mast cell activation syndrome as a diagnosis until I started doing removing meshes for Mesh implant illness issues. And then I started learning about it and I hooked up with a great allergist. So if any of you need any Mesh allergy testing, contact my office and we can help link you with the allergists that I use because she’s got sutures and meshes that she can use to do your allergy testing.

Speaker 1 (00:32:33):

Of course you had to physically fly into Los Angeles for it, but no one else really offers it the way that does because of her collaboration with me. So on that note, yeah, the problem is a lot of these diagnoses were it’s so rare and as a physician, let’s say orthopedics surgeon, he’s never going to know about mast cell activation syndrome. It’s just not. I mean maybe a rheumatologist or allergist will, but not necessarily a surgeon. So then you get a patient with that diagnosis that is now worse after Mesh was put in them or some other implant and they can’t figure it out, but it’s because they have mast cell activation syndrome, which makes your Mesh implant illness worse. It just goes on and on. So my point is part of the problem with GA medical gaslighting is that the doctors just don’t know. I try to learn, I bring specialists in and to introduce them to you, but also I learn from them. And the more I learn the better doctor I am, other surgeons may not be as inquisitive. Why do I know about allergies? Allergies, I’m a neurosurgeon, let’s say, but then you’re going to have patients with this problem and you may shouldn’t do a certain procedure because of this other medical problem they have.

Speaker 1 (00:33:58):

I kind of digress a little bit, but my point is it’s be kind to your doctors because oftentimes the medical gaslighting is because they don’t know enough and they’re uncomfortable with not knowing because they feel like they should always know. I always say, just be honest with your patient and instead of saying, there’s nothing wrong with you, say that I can’t figure it out. And instead encourage them to see other doctors, other surgeons, other specialists as opposed to knocking the them down saying, there’s nothing wrong. Nothing can be done. Here’s a prescription. Or go see a pain doctor and completely making them lose hope because so many of my patients came to me after having gone through that cycle of being dismissed and I just say, don’t dismiss them, just be honest. And instead of saying, there’s nothing wrong with you, really what you’re saying is there’s nothing that I can figure out that’s wrong with you. Does that make sense? I hope that makes sense.

Speaker 1 (00:35:02):

Here’s an answer. Kaiser Permanente has entire departments for group therapy for pain in different areas. The GI doc sent me to therapy, then found out I have E P i. I don’t know what E P I is. Then I found I had two hernias corrected last month by Dr. Mary Hahn. Yes, she’s great. Such a great doctor and fast with surgery. Yeah, she’s super talented. That’s pretty cool that they have all that group therapy. I think Kaiser does well in many, many aspects. Why do so many doctors blame everything including hernias on i B s Irritable bowel syndrome? Yeah, because bowel syndrome, chronic fatigue syndrome, chronic pain syndrome, these are all like undefined, poorly defined things and it’s easier. Doctors don’t like not to have a diagnosis. So IBS is like, oh, it’s IBS, it’s I B S. No, it’s a hernia that’s causing your bloating and your nausea and your intermittent diarrhea and constipation. It’s your hernia, fixed a hernia and not everyone in the world should have I B S.

Speaker 1 (00:36:08):

Let’s see. Oh A P I stands for extra pancreatic insufficiency. Thank you. Learn something new today. What does a person do when doctors keep saying there’s no reason for the pain that the patients claim to have? The patient has had two abdominal surgeries, vertical and horizontal incisions for open surgeries. Surgeon tells you that she shouldn’t have pain related to cohesion or nerve damage caused by the surgeries. Nerve damage does not impact organs. That’s true. The nerve damage does not cause impact. Organs, he said she should consult with a psychiatrist. Does surgery and muscle layers and tissue not cause adhesion issues? Yes and no. So surgery in the muscle layers does not cause adhesion issues. And if your surgery was extra peritoneal, so outside the peritoneum, you should not have intestinal adhesion issues. Also, the reverse is true. a lot of people blame everything on your adhesions and it’s not.

Speaker 1 (00:37:03):

It’s another problem. So the point of this is at the end of the day, you as a patient are and should be your biggest advocate. And if you feel that what they’re telling you doesn’t make sense or it’s not providing you with the care that you need, you are empowered to see another doctor. This lady that I saw, she already seen so many doctors and she didn’t give up. She’s still seeing more because she’s waiting to find someone who will address her pain. And I think I figured it out for her. But we’ll see after in about two days. But my point is this, you are the only person that will care as much about yourself. No one else will care as much about you as you will. So if you feel you’re not getting the right care or the right answers, see another doctor. If that means leaving your town or your network or your paying out of pocket, whatever it is, your health is very important is up to you. So some people I feel mop about it, but then they don’t do anything about it. So you must be a person of action.

Speaker 1 (00:38:22):

Let’s see. What can mimic an umbilical hernia? I mean, you can have a lot of gastric problems or intestinal problems that can mimic milk, hernia pain, but an actual milk hernia itself is hard to be mimicked on the epigastric hernia. Can you repeat your answer? Yeah. Patients with epigastric hernias degrade with their repairs, very low risk for problems. They don’t know what they don’t know. I love that. I say that all the time. They don’t know what they don’t know. That is a perfect statement. It’s one of my favorite statements of all time. I always say it. They don’t know what they don’t know.

Speaker 1 (00:39:08):

Mesh costs a dollar which costs $70 to remove in and out and to remove into out, and it’s all about the money. Mechanical synthetic items are different that promotes life than a plastic used as a bandaid. I don’t know what that means, but I think yes, medical industry that makes implants, whether it’s a heart valve or a Mesh, is in it for the profit. So don’t expect them to try and give anything for free or at a low cost. That’s just not going to happen in the US medical system, number one. Number two, Mesh can save lives. So I understand that there’s a lot of Mesh sentiment, especially by people who’ve been hurt by it. I’m not discounting that, but there’s a lot of reasons to use Mesh as well. And so the same way lifesaving things such as heart valves are important, Mesh can also be important.

Speaker 1 (00:40:14):

Can we have better Mesh? Yes, but that’s this topic for a different day. In fact, we have discussed that in my experience, gaslighting also happens by medical staff. It often is reversed when face-to-face or call with a doctor. So true. Not with my, I would say not with my people. Mine are great. They’re basically an extension of myself and in some ways even more caring, even more caring than I am. But I must say I don’t like dealing with staff. Have some doctors. I go straight to them because I’m a doctor and I, I’ll just call the doctor myself personally and bypass. And often, you’re right, the doctor doesn’t even know that their staff is just giving some bullshit to the patients.

Speaker 1 (00:41:06):

Using synthetic material to save a life is different than a dollar material used to wrap yourself like a bandaid. Too easy to use than fixing it the old-fashioned way. Unfortunately, there are a lot of people that cannot get the old-fashioned repair. So that’s the issue. I have to advocate for myself and sign myself to the operating room table to the doctor who will believe me that I was ripped inside eight doctors didn’t believe me. Yeah, that’s a problem. I’m about to lose my job because no one can figure it out. Nausea, vomiting, pain and all. I wish so badly I could afford to come see you because I’m just done. Well, I’m happy to see you whenever you’re ready. And I do offer online consultations.

Speaker 1 (00:41:51):

So many questions. I had like about 12 questions pre-prepared for you guys and we’re not even going to get to them because you guys are busy. You’re giving me all these live questions. I love it. If the pain you experienced after growing surgery is similar to the pain you had before surgery, although, oh, okay. This one. I see where you’re going with this one. This was, let’s let me share screen so I can read it off for you. Okay. This is a long question, but it’s very meaningful if the pain you experienced after groin surgery is similar to the pain you had before the groin surgery, although more severe and slightly different location, which means by the way that it’s not the same pain. So if you had surgery and you before, if you had surgery and you had pain before surgery and pain after surgery, but there are different locations or different severity, then it’s not the same pain.

Speaker 1 (00:42:46):

And that’s very, very important to identify because that helps me as your surgeon figure out what this new pain is. Okay. Does that always mean that the surgery did not address a true source, true source of the pain? No. And therefore the pain is not from the surgery? No. Or is it possibly related to the surgery? Yes. For example, the pain is from sutures used for the repair place into tissues near where your original pain came from and replaces the original pain. Yes. Or because the failure or pulling of the sutures or hernia or the repair was fine, but now it’s recurred or something in that experience. So that’s kind of why it’s so important to be able to differentiate pain before surgery from pain after surgery. And the little minutiae is very important. It’s not just pain. It’s like is it different quality, different severity, different location is implicating upregulation of nerves such as peripheral and central, central sensitization as a cause of postoperative pain rather than surgery itself a form of gaslighting.

Speaker 1 (00:43:57):

I do feel that we bullshit a lot, not a lot sometimes with our patients where we can’t figure out why you have pain and we’re like, oh, it’s because you’re having upregulation of your nerves or you’re having central sensitization of your pain. That may be part of it, but especially if the pain is different, then the original pain is hard to judge that. And as a surgeon, I always think if you have new pain after surgery, then we need to identify that pain. I cannot say it’s not from my surgery and I need to be able to rule that out before I blame it on something else. Otherwise it’s a form of gaslighting. Is implicating the P dental nerves as a cause of postoperative pain rather than the surgery itself a form of gaslighting? No, I think that’s more like just being uneducated about what pudendal neuralgia is.

Speaker 1 (00:44:54):

So that term is so overused and people, I see people all the time with pudendal neuralgia, it’s just a very uncommon problem. And for that to be like, oh, maybe now all of a sudden you have pudendal neuralgia just means that they don’t know why and you got to move on to another person. Regarding hernia related misdiagnosis, have you seen that women, people of color, geriatric patients, and L G B T Q people are disproportionately affected? Yes. So women, we’ve already discussed one of the two New York Times articles specifically focused on women as a higher likelihood of getting gas lit for their pain to the point where women are dying of heart attacks because they were told that their chest pain was because of an anxiety attack and they’re just being too much and they’re freaking out too much and then they go home and they die of their heart attacks.

Speaker 1 (00:45:58):

So whereas men get a little bit of chest pain and they get full cardiac angiogram, true story. And so yes, women definitely. And then I would say people of color as well and people of lower socioeconomic status. I worked for six years at the LA County Hospital in a large proportion of our patients had no insurance and some were even homeless. Many were immigrants that did not have a stable and or did not have a stable housing situation or work situation or family situation. And I really felt for all of these patients and I treated all of them with respect, but it’s so easy to just dismiss them because they often don’t have a voice. So when you’re in Beverly Hills and your movie producer patient comes, they will hold you accountable for every little move that you make until you have a perfect outcome. When you are treating patients that are much more kind of on the outskirts of city living and they’re not empowered, they don’t have the ability to advocate for themselves as much, they’re not empowered, they don’t have a voice and I feel it’s much more easier to take advantage of them and potentially have them be in harm and gaslight them like, oh yeah, pain’s not that bad, just come back when it’s worse.

Speaker 1 (00:47:44):

I’ll give you an example. In private practice, patients often come to me and they say as of 48 hours ago, I’ve had this growing pain, or it’s the county that’ll be like, yeah, for the past 15 years I’ve had this growing pain just a totally different population and the expectations about their care is also different. And so I feel that that’s kind of an issue, issue that I hope as a society we try and prevent, but it’s prevalent everywhere. Do you believe any of your guests you had on hernia attack are capable of gas line? Yes, absolutely. And I must say, although I respect and would like to promote as much of them as possible because I feel that everyone I’ve I bring on as a guest reflects somewhat on me and I only invite people that I feel are good representatives of their field. I do feel that sometimes their answers don’t really jive with what I would say. And if some of you notice, sometimes I disagree with them or I hold them accountable for what they’re saying or correct them or challenge them in their comments. And so it does. I get a little put off a little bit sometimes by it the same way I got put off by that post, by this doctor that I know who called it a stupid article because how dare you question my medical knowledge base and call it gaslighting. That’s just horrible.

Speaker 1 (00:49:31):

I think that’s a stupid way to live your life. Here’s another question. I had to cancel Monday’s surgery due to COVID and a nurse’s comment was we can’t reschedule again. I almost cried. I didn’t want COVID and I planned to travel to Florida with family for the surgery and paying out of pocket a simple statement by support staff has me in a tailspin and panic, I’ll work hard to get back in the right headspace for August 29th. Side commons by support staff is important to an excellent practice. Yeah, I totally agree. What the nurse probably meant was we can’t reschedule you yet or we will get back to you to reschedule, but unfortunately the way they mention it to you implies that they’re done with you and that’s obviously not correct. I would like to say that geriatric patients are another huge group of patients that can be mismanaged.

Speaker 1 (00:50:33):

Again, they are not as good as being their own advocate as the average, let’s say male executive. And so sometimes I see the kids bring their elderly parents and the kids are even rude to the elderly parent and kind have lost, how should I say that? They kind of lost their patience with their elderly parent. And I feel so, so bad because I love old patients. I think they’re so amazing and so cute and I want to know all their stories and I have a great respect for the geriatric population and I really don’t like it when they’re disrespected by their own family, mostly because they’re just tired of them, I guess. I don’t know. And so their problems tend to get dismissed by their own family sometimes and then also therefore by the doctors potentially. And of course LGBTQ people. I think for them we’re really lucky in California that we have a very strong base and those patients still also probably get either misdiagnosed or underdiagnosed, but I have a feeling we may do a better job in some of the other states.

Speaker 1 (00:51:59):

Have you seen complications requiring mass removal concealed or misdiagnosed by surgeons who are not able to safely perform this surgery? I won’t say concealed. I would say that you have to understand that every doctor has their limitations. I have my limitations as well, but my limitations may be different than another surgeon’s is or another surgeon’s. And therefore, if you have a complication required Mesh removal, the surgeon who had that Mesh placed sometimes is not physically capable of doing that operation. They’ve never done it before, let’s say, or they’re not mentally capable of even recommending that because it’s like a mental block. Of course, it’s not a complication that I caused. It must be something else and I’d rather blame the patient because they shouldn’t have gone surfing six months after surgery. Of course they’re going to get Mesh complication or some story like that.

Speaker 1 (00:53:12):

So anyway, let’s see. Can autoimmune disorders be so poorly understood as to affect health Often they’re underdiagnosed? Yes. So I’ll just as I explained with M C s, the mass cell activation syndrome, a lot of disorders, including the autoimmune, et cetera, are very complicated, poorly understood diseases that are best treated by a rheumatologist or allergist or basically a specialist. And those of us that don’t really dabble in those specialties like surgeons are, we poorly understand that. I mean, over time I have learned all these things, but I am much more knowledgeable about autoimmune disorders today than I was 10 years ago or more 20 years ago. So that’s all based on my experience with my patients. It has nothing to do with the fact that I’m like, I used to gaslight people for patients diagnosed with Mesh and plant illnesses. Do you think there’s a correlation between Mesh and exacerbation of their preexisting autoimmune disorders or appearance of Yes, absolutely.

Speaker 1 (00:54:20):

That’s the whole point of Mesh implant illness is it is an autoimmune or inflammatory syndrome induced by adjuvants, that’s Asia syndrome, and those that already have a pension towards an autoimmune or inflammatory disease like mast cell activation syndrome like lupus or rheumatoid arthritis or some autoimmune vasculitis, those patients with the introduction of Mesh into their system may have an even higher inflammatory or autoimmune activity, which means their underlying disorder of, let’s say rheumatoid arthritis will be much worse once the Mesh is implanted. And that’s part of the Mesh implant illness. Asia syndrome is a rarity of Mesh implant illness, the cause of frequent misdiagnosis, yes, anything that is rare is at risk of being underdiagnosed or misdiagnosed. Unfortunately, hernias are not rare. But the reason why a lot of hernias are misdiagnosed is because the symptoms associated with hernias may be atypical or uncommon. So if you have a big bulging hernia, most doctors will all diagnose that. But if you don’t have a bulging hernia that is not common and therefore it’s not noted to be a hernia. Or if you have pain that’s let’s say into your testicle or vagina or down your inner thigh, that’s usually not typical symptoms that are taught as causes of caused by a hernia and therefore it’s misdiagnosed. So whatever is rarest is most likely to be misdiagnosed. Absolutely.

Speaker 1 (00:56:10):

Yeah. These are all facts. Thank you, thank you, thank you. Oh, I see the nurse said if you have to cancel again that they cannot reschedule you. Well that’s bullshit. Why would they do that? I guess some people take rescheduling seriously, but whatever it all has to do with the factory that I was telling you about. How can you advocate for yourself when the surgeon acknowledges your symptoms but is not able to find their causes as all the exams turn out normal? Because another surgeon may acknowledge your symptoms and may find that those exams are not in fact normal. What can you do when you have seen multiple surgeons, but no one is able to find the causes of a variety of seemingly unrelated neurologic symptoms such as fatigue or sleepiness that appears shortly after hernia repair with Mesh? Okay, well, obviously if you have fatigue or sleepiness, it can be caused by a variety of things.

Speaker 1 (00:57:21):

And the first thing to think of is not your Mesh, but if you’re a totally normal healthy patient and then you had Mesh implanted and now two months, three months, six months later you’re a completely different person because you have chronic fatigue and sleepiness and maybe other symptoms, then it’s very logical and open-minded to want to correlate what happened to you, which is the surgery with your new symptoms. And it’s incumbent on your different doctors to want to make that correlation or rule it out or something. I mean, there are patients that will be hypothyroid after surgery and that’s the reason for it. And they just have to get their thyroid tested and have a doctor with an open mind that will consider hypothyroidism, let’s say, as a reason for their chronic fatigue and sleepiness after surgery. And the surgery was kind of a red herring.

Speaker 1 (00:58:17):

But that said, everything we learned today, which is new, we didn’t know 10 years ago. And so the same patient who comes to me with Mesh implant illness today may have come with me to meet to see me or any other doctor 10 years ago. And we would’ve said, oh, we don’t really know. So do understand. We don’t know everything in medicine. a lot of doctors are uncomfortable with the fact that they don’t know. I’m very comfortable with it because I feel like part of what I do is I try to learn more. And part of my role in hernia surgery is to increase the wealth of knowledge out there by sharing my knowledge base with others, not just to you the patients, but also by giving talks and being active in societies and publishing and writing papers and giving lectures and making it so that doctors are better doctors because they’re learning from specialists the same way I learned from them.

Speaker 1 (00:59:26):

And so for example, I learned a lot from the allergists that I work with Dr. Kathy Green. She’s amazing. Super smart lady, loves what she does, fascinated by the fact that there’s this whole Mesh implant illness that she can now be involved with and we’re writing a paper together on allergy testing. So my point is this medical gaslighting is real. It’s often a symptom of two things. One is medical system you’re in, whether it’s socialized medicine or the economically driven US medical system does not promote true doctoring, which is sit down with the patient, figure out their story, try and gather as much information as possible and be their advocate to really figure things out and be like a complete doctor. Number two, we just do, we doctors just don’t know enough. I don’t know every single thing in medicine and I know a lot I could calls every day from my own colleagues asking me stuff. It’s not even related to hernias and I somehow know the facts or whatever, or at least I Google it and try and learn it from it. So do understand that surgeons and doctors are human beings. We are not perfect. We should not be gaslighting. I totally agree with that. It’s based on our own weaknesses and deficiencies.

Speaker 1 (01:00:57):

I hope that with time we learn to be more caring and better at what we do because we will be patient too. And we want our own doctors to be caring and not just dismiss what’s wrong with us. And so on that note, I really do want to thank you all for being with me and being so active on this one topic. It’s dear to my heart, it’s a term that I not used when I first started hernia talk. And as I started talking to you guys more, this word gaslighting has become even more necessary to address. And so on that note, thanks everyone. I will see you again next week on another Hernia Talk Live. We will be having some special guests coming too, so I hope you’re ready for them both from the US and international. So I’m super excited about that. And don’t forget to subscribe on YouTube so that you can watch this and all other Hernia Talk Live sessions as they occur. Take care. Bye-bye.