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Speaker 1 (00:10):
Hi everyone. It’s Dr. Towfigh. I’m so happy to be back. Thank you everyone for joining me. I am your hernia and laparoscopic surgery specialist and we are here live once again on Hernia Talk Live every Tuesday night. Thanks to everyone who’s logged in on Facebook as a Facebook Live and following me at Dr. Towfigh. And also thanks to people who regularly talk to me and DM me and message me on Instagram and formerly Twitter at Hernia Doc. As always, this episode and all prior episodes will be posted on my YouTube channel, which is at Hernia Doc. And as you all know, we also have a podcast. So the podcast is called Hernia Talk Live. So do follow me, subscribe to the podcast. You can listen to it when you’re driving or working or whatever it is that you like to do without having to really pay attention to YouTube channels.
Speaker 1 (01:21):
You don’t really need internet access with a podcast once it’s downloaded. So I am a big fan of podcasts, and so I’m really excited that Hernia Talk Live is now a podcast and it’s actually been a pretty successful podcast. We have almost a thousand downloads already, which I think is nuts, but it is what it is. I’m super excited that people want to be on a podcast about hernias. Anyway, so we’ve been a little bit offline lately because I lost my voice right after literally hours after the Hernia Talk Live episode right before Thanksgiving on being thankful. I woke up the next morning and had no voice to lead, to not feel that sick. I just had no voice. It was like a laryngitis. It was some bacterial thing, I think because it got better with antibiotics. So then I just had to deal with my voice, which I’m a surgeon and I teach, and everything else I do on social media involves voice.
Speaker 1 (02:32):
But really I teach and I operate. So I need to talk to people during my teaching episodes and in the operating room because you give orders all the time asking for instruments and so on. I had no voice, but I was feeling okay. So once I got over that, I was so excited, okay, the voice I can deal with, but at least I’m not dealing with the other repercussions of an upper respiratory infection. And then boom, I got another disease. I think RSV, I don’t know if you guys care, but I’m just sharing with you my story. So that is like, I don’t know if anyone’s had respiratory syncytial virus. It was going around a lot around here and just lots of drainage and that made my voice worse. So as you can hear, there’s a little crackling in my voice still. It’s not perfect, it’s not clear, but it’s so much better than it was. I sounded like those patients that smoke and drink a lot. I don’t know if it was a horrible sounding voice. It wasn’t sexy at all, but long story short, I’m better and I’m back, and I thank you all for following me and asking me what happened, heart attack. I’m like, we’ll get there. Just let me feel better.
Speaker 1 (04:09):
So that was the story. That is what happened. Some of you got to at least interact with me online on hernia talk.com. So there is that. I’m very happy that we have a revised website for that. So thank you for that. Alright, so on that note, let’s start our episode. So today is just me, no guests. We’re going to give them it’s kind of Christmas time. We’re going to give a break a holiday to my guests and not put them to work. They’re always volunteering their time and I’m very grateful to the doctors and specialists and some of the patient advocates who do volunteer their time to come on this episode every week to help answer your questions. So it’s just me, and we’re going to answer your questions. And I came up with today’s topic because I was talking to a friend of mine who works a lot with injured patients.
Speaker 1 (05:17):
So he’s a very well-respected surgeon, and people get in car accidents and fall, slip and fall, and they injure themselves and he helps them get the care they need usually as a work-related injury. So you’ve heard of workers’ compensation or things like that. Your employer typically has some type of insurance to help their employees with their healthcare costs if they have an injury that was due to their work. So let’s say you’re working at and there’s a spill on the floor and you accidentally slip and land on your hip and now you need a hip surgery or you’re, let’s say you’re at the supermarket and you get carpal tunnel syndrome from the work you do. Often those are work-related injuries. You would not have incurred that injury if you were not working at that specific place doing the specific demands of the job. And so workers’ compensation helps with that.
Speaker 1 (06:30):
So the question is, what about hernias? So a lot of patients have hernias as work-related injuries, and I’m sent them sometimes, not a lot. I don’t really specialize in workers’ compensation. I usually get sent the workers’ compensation botched hernias. So they had a hernia determined to be related to their work, and then after that surgery gets botched, then they send it to me. But let’s say that’s not the situation. Let’s say the situation is your working. Let’s say you work for FedEx or UPS and you have this repetitive lifting, dropping off things, taking boxes no matter how heavy from your truck to the door and back or picking up stuff and putting in the truck, and it’s a repetitive action. So there’s no good science behind anything I’m telling you because no one that I know of has really studied it. But the thought is that repetitive motions that involve lifting can induce hernias in some patients. So the same way that not everyone gets hernias, for example, athletes tend not to get hernias. Bodybuilders tend not to get hernias because they have very strong core, but those that do get hernias, usually there’s a genetic predisposition or some underlying collagen disorder that is making them more likely to get a hernia. So that’s kind of the underlying problem.
Speaker 1 (08:23):
But then add on top of that risk factors. So usually on Hernia talk, we’ve talked about risk factors. What are the risk factors? If you’re following me on this, you already know the answers. Coughing, chronic cough, which is what I’ll be doing throughout this podcast. Constipation, straining such as for an enlarged prostate to urinate and so on. So why do people cough? They have asthma, they smoke, they use marijuana, they get an upper respiratory infection. They have postnasal, drip or acid reflux. Those are the commonest reasons for a chronic cough. Well, I tell you, go treat it. Constipation. Another major risk factor for hernias.
Speaker 1 (09:09):
And how do you treat constipation? Take some type of magnesium based supplement, either magnesium, milk, magnesia, MiraLax, anything of that nature. You can take mineral oil, you can have prunes and dried fruits and some people coffee helps them. There are certain teas for constipation. It’s mostly natural things, high fruit and vegetables, fiber content, fiber supplements, lots of variety of ways that you can treat and or prevent constipation. So you should not be constipated. That will promote hernias. Work is another one. So there are people that lift for a living. Let’s say you’re at the airport and you are the person that is constantly moving luggage back and forth throughout the airport process loading and unloading and so on. Currently, almost all that is done by a human. And so that’s a lot of lifting. So the same thing that’s bad for your back, it’s probably bad for your front or your core, and it can promote hernias.
Speaker 1 (10:26):
So if you have a job and you believe that something acutely happening because of the job gave you this hernia, then that’s considered a work-related injury. Usually it’s in truck drivers, delivery people, or I’ve also seen it in people who’ve had some type of car accident or trucking accident. So they were in normal health, they got a bad car accident and then boom, they looked down and Oh, I didn’t notice they had this groin bulge or this belly button bulge. And the timing of it is correlated to that specific accident. So let’s say your Uber driver, you got in a car accident, well, it’s possible that that car accident, let’s say it was not your fault that the car accident was therefore the instigator of the hernia you got immediately after the accident.
Speaker 1 (11:28):
In other words, that is a work-related injury. Your driver, you got in a car accident that was not your fault and so on. So there’s some debate among surgeons, how much of someone’s hernia is related to their work because, and there’s a question that was presented to me earlier. I’ll answer it now. The question is, I always say exercise, right? Go exercise. Heavy lifting is safe. We’ve measured abdominal pressures with planks and sit-ups and dead lifts and overhead lifts and pull-ups and push-ups and so on. And we have not shown that there’s an increase in abdominal pressure from lifting weights at the gym for exercise. And so when people say, how could I prevent a hernia? We say exercise, don’t gain weight, do core based exercises, and that includes lifting weights. So why is it that lifting weights for exercise is considered protective of hernias? But now I’m telling you, lifting heavy objects during work can be a work-related hernia injury. Number one, we don’t know the answer to that question.
Speaker 1 (12:52):
Number two, the thought is the repetitive two things. One is the repetitive motion over and over and over again, twisting and pulling and lifting heavy objects is injurious and can cause hernias. But number two, the thought is that when people are lifting things, I mean I often get the story of I was totally healthy. I didn’t know I had a hernia. I came to help my neighbor move and I was moving their tv, which was very heavy, or lifting their sofa, moving the sofa, which was heavy, and then I felt a pop. That’s a very typical scenario that we’ve heard I hear a lot. And because I lifted the sofa, I caused the hernia and therefore because I am working at delivery service and I’m lifting and then now I have a hernia, then it’s because of the work-related injury. So we don’t have good evidence to prove that if you weren’t lifting, you wouldn’t get a hernia.
Speaker 1 (14:07):
But the way I think of it is, yes, it is true that, and studies have shown that exercise does reduce your risk of hernias or delay your risk of hernias because everyone who gets a hernia, typically it’s not a trauma. It’s usually because of a genetic predisposition. However, why is it that exercising is protective, but lifting weights for your job is not protective? And the answer that I give and I have yet to hear an actually evidence-based answer is when people are working or they’re lifting I for work or to help someone move or groceries or whatever, they’re usually not thinking, okay, I’m going to tuck in my pelvis, I’m going to engage my core, I’m going to straighten out my back. They often do it without any support of their core without thinking. Whereas when they’re at the gym, they’re making sure they’re protecting the core when they’re doing heavy lifting because if you’re not, you’re going to injure yourself. They often don’t do it at work. And you see people that have back injuries, the same people who get back injuries from work-related activities are also at risk of getting hernias from their work-related activity.
Speaker 1 (15:39):
So that’s my answer, which is that you’re just not doing it correctly. And of course I’m going to sneeze right in the middle of my time, but that’s the whole thing is that if you very conscientiously wore some type of brace and talked in your core and used your core safely during your job, the chances are that you’re not going to get a hernia. So yes, I do believe that car accidents heavy lifting and things like that that are work-related can cause hernias. Often those people already have some type of genetic predisposition to get a Hernia, but in some people it’s traumatic. There’s something called a traumatic Hernia. We’ve discussed this before. You get a car accident and just rip the abdominal muscle off of the bone. The same thing can happen as a traumatic hernia during a car accident, let’s say, or airbag deployment where your belly is basically torn at the area of an actual angle hernia. So what do you do about that? Well, one is prevention, right? Because there’s already enough hernias out there in the world for sure. An employer does not want their employee to get a hernia. It’ll cost them money, both physically cost them money, but also indirectly by not having a person in the employee working while they’re in recovery from surgery, let’s say.
Speaker 1 (17:30):
So most employers want to prevent work-related injuries, and so they should be providing you with a back brace if you’re regularly lifting. And I think some employers actually provide ergonomic education. So sit this way, lift this way, stretched out before you work type of things. And then also some of ’em, a lot of employers nowadays also offer gym memberships as part of their benefits because they understand that a healthy fit employee is going to be safer and less likely to injure their back because they’re going to have a strong core. So it’s worth it to pay $20 a month for each employer employee to go to the gym and maintain their weight and not be overweight and have a safe core to therefore come to work that way. Then for the average patient who may be not in good shape or obese, and then they get a Hernia, because obesity is a known risk factor for hernias as well.
Speaker 1 (18:46):
So based on that, I personally do believe that there are certain aspects of people’s jobs that can promote hernias. Most of them are not traumatic like a car accident. Most of them are. Over time you keep stressing your core and increasing your abdominal pressure, lifting weights, lifting weights, lifting weights. In the same way that you’re at risk of hurting your back, which is part of your core by the way, then you’re also at risk of hurting your groin. So I’m going to stop for a second, review some of your comments. Here’s one. Thanks you guys. This is nice. Merry Christmas from Perth. Perth. Is that Australia? I think that’s Australia. And a huge thank you for your informative videos and responses to my questions of course. And another one, local from a great patient. We love you, doc. You’re a blessing. Merry Christmas. Merry Christmas to you.
Speaker 1 (19:49):
I didn’t wear my scarf this time, but I should have. Yes, Australia. So I need to come visit Australia. I know I have a couple of friends there that I’ve never personally met, but we know each other through our Facebook groups that are Australian surgeons. Actually, I do know one of them. I met one of ’em several times because he does come to a lot of these meetings, but most of the people that are surgeons in Australia don’t leave or I haven’t seen them leave Australia, but I would love to go to Australia. That would be a great trip. I heard New Zealand’s also really cool, so I’d have to visit both. So thank you very much for that. And maybe if I ever do visit, I’ll let you guys know. Maybe I can meet some of my followers that are Australian. How cool would that be?
Speaker 1 (20:37):
Because last year when I was in London, I did exactly that. I got to meet many of my followers that are in London, or actually some of them were not in London, they were in the UK somewhere and took a train ride or even a flight down to London or technically Manchester to meet. So that was really cool. I hope to be back in London next year and maybe we can do another session. I don’t know. That was really cool. All right. Some questions are coming up by lifting something too heavy at work with pore form, which is what I was talking about. That’s the right way to describe it. Pore form. In addition to injuring the inguinal canal and causing a hernia, can other muscles, ligaments, pubic plate attachments in the neighboring groin or core area be injured at the same time? And will they also need to be addressed at the time of surgery?
Speaker 1 (21:35):
So that’s a really good question. So yes, the same way you can pull a groin from certain sports, usually not so much exercise, but certain sports like hockey, soccer, sometimes basketball, you can also pull a muscle or have some type of muscle injury, muscle or fascial injury during work, not as common because you need to exert a lot of stress to actually tear your muscle. Whereas the inguinal canal, if it’s already open, and if you also have a propensity to get a hernia anyway, then that area is more prone to tearing and becoming a hernia where you’ll seal a bulge as opposed to tearing the muscle. So muscle tearing is very traumatic. It can happen during a car accident, perhaps during work, or it can happen during a sports injury. Very uncommon to have a muscle tear from work-related injury. The hernia would be much more common, but you can strain and pull strain but not tear.
Speaker 1 (22:51):
So strain is like micro tears, and that can happen from work as well. Usually these all happen with rapid traumatic movements, and of course there’s no real surgery for most strains. They tend to heal and scar on their own for groin strains also. Usually it’s not surgical and you purely need to wait it out, rest it out and maybe do some injections. Now the other question had to do with basically the pubic plate. Some of that, some of what people refer to as sports injuries or pubic plate disruptions are actually just direct anal hernias. And if you’re, let’s say, and you’re not really working much, that’s just a direct hernia, that’s not a pubic plate disruption. You need to actually have a lot of force to have a true sports hernia of sports injury, and it’s usually not from work. Follow up question. If you’re doing strength training without a trainer, should you exhale or inhale during a lifting phase or straining phase of exercise? Oh, you’re asking me questions. I may not be correct. So I have a trainer and he tells me I don’t do a good job of breathing.
Speaker 1 (24:22):
You’re supposed to inhale and exhale during certain points of your exercise, and it depends on the exercise you’re doing. So whether it’s core related or not core related, if it’s lifting or not lifting, the point is to have very controlled breathing because your diaphragm is also part of your core and you want to make sure that all of that core is in sync. So I don’t have the perfect answer for that. I would love it if you could hold on to that answer, and then maybe I’ll bring a trainer, I’ll bring a trainer that knows these answers that can and do a good job of answering them because it’s really important. There is actually next year, I haven’t confirmed the date with them yet, but I have this great group of trainers that have some really good information online on hernias that I’m going to invite and let’s put a pin in it and come back and ask them specifically how appropriate it is to breathe inhale versus exhale at what specific point in time during exercises and how that would be protected. But that’s great. Great question. I do appreciate that. So what happens if you do have a work-related injury? Unfortunately? Well, here, let me answer that. Oh, sorry. As a follow-up question with respect to the earlier question, if you had an earlier good hernia repair, if lifting with poor form in work and that, are you more prone to injure other core muscles rather than angle floor? No, not necessarily. Not necessarily.
Speaker 1 (26:21):
Oh, so what do you do once you do have a work-related injury? Well, hopefully if you do have workers’ compensation insurance through your employer, you can go through that. So your employer pays a sum of money to secure workers’ compensation insurance. That is separate from healthcare that you normally have that’s either private or corporate through your workplace. And the reason why it’s separate is it doesn’t necessarily require surgery, let’s say, but it’s intended to be an extra, like a safeguard for your employer, and you should not be paying out of pocket. If your injury is work-related, your employer should be paying for that. Whereas for your health insurance, oftentimes that is paid out of pocket or it comes out of your check or something like that. And if any of you’re online right now that are outside the United States, I would love to hear from you.
Speaker 1 (27:33):
If you have a concept of workers’ compensation insurance, please make a note in your comments because I really want to know what happens outside the United States. Now, there’s a lot of countries that have socialized medicine and the country pays for your health insurance to begin with. So it’s not like you have to have private insurance and then separately, your employers need to have workers’ compensation charges because it’s free either way. But what happens is there used to be a lot of fraud through workers’ compensation. The lawyers and the doctors, they all kind of got together, this is a while ago, and they saw workers’ compensation insurance as a way to make extra money. So they would take patients that claim, let’s say they had a hernia as a result of, or back pain, let’s say easier one back pain as a result of their work, they would get imaging and MRI and all these images at an imaging center that would get a kickback, and then they would send ’em to chiropractics that would get a kickback and say, oh yeah, horrible pain.
Speaker 1 (28:49):
Of course it’s from work. And then they would send them to, let’s say a spine surgeon who would recommend injections or surgery or whatever, and then there’d be a lawyer or a patient representative that represents the patient, that also gets paid. So that was a while ago, decades ago where there were just this rampant fraud going on in the system. From what I understand, again, I’m not really in the workers’ compensation world. I have treated a handful of patients that had botched hernia surgeries that was part of their workers’ compensation, and so I kind of had to get involved that way. But nowadays, it’s a bit more regulated and the workers’ compensation insurance process is a bit more onerous, which means that patients are not as easily able to get care as they used to. So you have to go through a lot of hoops and a lot of bureaucracy and paperwork to then get the treatment that you need. So I’ll give you an example. If a patient has a hernia first, they have to go through some type of legal process, including a lot of paperwork to substantiate that al hernia was not there before and was directly a cause of something work-related. Often a lawyer is involved or a patient advocate is involved, then you’re sent to a surgeon, let’s say me, who says, yeah, you definitely have a Hernia and you have symptoms from it, so I would recommend surgery, or you don’t have symptoms from it. You can just do watchful waiting.
Speaker 1 (30:41):
And then they say, okay, you may need imaging. Let’s do physical therapy. Let’s not jump into surgery, let’s do injections. Let’s not jump into surgery. They’ll do all these other things, and then one or two years may go by while you’re fighting the system. And finally they say, you know what? That’s fine. Go ahead, do your surgery, send us the bill, and then there’s a fight over the bill that’s too much. We’re not going to pay that much, or we’re not going to approve this doctor. Go to another doctor. That’s part of the system that does a lot of these things and time just keeps passing by. There’s a lot of paperwork each time, which is why many people with workers’ comp insurance that use that are assigned like a patient advocate that will make sure that when the doctor says you need an MRI, that MRI gets done and doesn’t fall into paperwork and bureaucracy for another six months.
Speaker 1 (31:41):
Or if the doctor says you need to go see physical therapy, that gets approved immediately so the patient can go start their physical therapy. So there’s not a delay. And often that patient advocate is paid for by the employer because they just want their employee back at work and healthy. So that’s usually the system with workers’ compensation, a lot of paperwork, a lot of back and forth. A million people need to approve every single step, however, oh, sorry. And therefore many people are like, listen, I just want to get better to go back to work. I have health insurance. I’m just going to go use my personal health insurance. I don’t need workers’ compensation insurance, and I’m just going to go ahead and just do my hernia surgery with my private health insurance, which may or may not be paid for already by your employer. And so that’s kind of the situation.
Speaker 1 (32:41):
If any of you have been through the workers’ compensation process, I would love to hear from you. If you could just make some comments in here so I can hear back from you. Because every company is different, and every workers’ compensation company is different. And I’ve had good experiences with some where they’re like, yeah, the patient’s got a hernia. Thank you for repairing them. We appreciate it. Let us know as soon as you think the patient can go back to work. And there are others that are like, we don’t want to pay this much and we’re going to send ’em to another opinion, and then they have a botch surgery, then they have to come back to me and we had to fill out a bunch of forms and they have to see other doctors to fill out those forms and they won’t let you.
Speaker 1 (33:25):
Let’s say the patient comes to my office and I say, they don’t need surgery, they need an injection, let’s say. Well, in the typical scenario, if I see a patient in my office and I feel they need an injection, assuming the patient agrees to the injection, then I’ll inject them right there with workers’ compensation, they will not allow that to happen, and by allow that to happen means they will not reimburse or approve the charge for that procedure unless it goes through an approval process. The patient has to leave my office, go through all this bureaucracy and paperwork to get, let’s say injection approved, then come back to me to get that injection if we want to do it the correct way. Sometimes I’m like, you know what? That’s just a waste of time and I’ll just do the injection, but it’s not the right thing to do if you want to do it the right way, you’re supposed to go through all the hoops. Anyway, my point is this, workers’ compensation definitely is something that is used in the United States. Hernias are among the top work-related injuries, probably after some type of back injury for which people seek care. And I usually don’t get involved in that stuff unless it’s complicated and no one else really is there to help. But there are plenty of people that need hernias that are induced as a result of their job. Let’s go through, let’s see. Let’s go through the next set of questions and maybe we will.
Speaker 1 (35:14):
Here’s another question. You previously said that the physical exercise of any kind does not increase substantially the risk of developing a hernia that is true to the contrary. It can have a protective effect. That’s what the studies show. Yes. Why should it be different for a job than evolves such exercise? Yeah, we kind of discussed that already, which is the short answer is we don’t know. It sounds contradictory, I understand. But at the same time, what we do believe is that it’s a part of the repetitive action. It’s done in a job, and B, people often don’t perform their job duties with the same diligence of core protection as they would in the gym, and that’s why you have more injuries. What are, according to your experience, the jobs that are most likely to increase your risk of developing a hernia? That’s a good question.
Speaker 1 (36:09):
Usually things that involve lifting on a repetitive basis. So the luggage transportation person at the airport, the delivery of packages person for the postal service, construction workers, that’s a big one. Construction workers, the amount of their body abuse that they get as part of their job is crazy. And there’s a lot of workers’ compensation going on related to construction workers. They lift, they throw, they’re distorted in weird ways. I once had a plumber that got work-related hernia, and the way it was is he’s like, I have to contort my body to go into these weird holes that sinks underneath homes. And it was that contorting twisting weird way that he would have to work that increases his abdominal pressure and then cause the Hernia. So that could be a potential cause. Let’s see. Here’s the next question. You mentioned injections, but I’m not sure what you meant.
Speaker 1 (37:39):
Where do you inject and with what medications? If you have a strain or a nerve entrapment or other reason for pain that is not hernia related, sometimes you need injection. So that could be injection of local anesthetic. It could be injection of a steroid. It could be injection of a neurotoxin like Botox. It could be injection related to PRP to help with muscle strains, for example. Expedite the healing of that. It could be an injection of hyaluronidase to help hydrocele to hydrocele dissect nerve entrapment from scarring. So there’s quite a bit of different things. Let’s go back to the questions. Let’s see. Can work-related activities be the only cause of developing a hernia? So no. And that’s where the problem arises, which is we don’t really have strong evidence to support why hernias occur. Most hernias occur in people with some type of collagen disorder where there’s a weakness in the area of a natural orifice or a natural hole like the inguinal canal or the belly button. And in those patients there tends to be more of the weaker collagen and less of the stronger collagen, so more of the immature collagen, less of the mature collagen, and that disparity makes it more prone to developing a hernia.
Speaker 1 (39:30):
So the question is like chicken versus egg. So did the patient already have a predisposition to get a Hernia? And you add on top of that that they’re now a construction worker. So let’s say everyone in their family has had a hernia, then they’re a construction worker, and as part of their job, they’re lifting bricks, let’s say, and then he was about to slip, and during the slip he kind of controlled his step and then he felt a pop in the groin. Can that be it? Here’s a common here. Pregnancy caused my hernia. Absolutely. So pregnancy, especially larger bellies or can cause increasing abdominal pressure. The active labor can cause increase in abdominal pressure and all that is a pregnancy is a risk factor for hernias, both umbilical in the belly button and in the groin or inguinal. And sounds like, here’s a comment. I tried the numbing injections guided by ultrasound didn’t work. Yeah, if it didn’t work, then it’s not a strain or nerve issue. So nerve issues or best treated with at least initially with injections, whereas hernia, hernia is not treated by an injection. It doesn’t work.
Speaker 1 (41:01):
Okay. Let’s see. What can you do to reduce your risk of developing a Hernia if you have a job that is likely to cause it? So first of all, you have to reduce your own personal risk of getting a hernia. In other words, don’t be overweight. Control any coughing, don’t use nicotine and control any constipation or straining. So that would initially reduce your baseline risk of hernias. You can’t change your genetics. So the next step would be to reduce your risk of core injury, and that’s back injury as well as hernias. So how do you do that? If your job involves lifting, make sure you are healthy and strong exercise. Strengthen your core, do your own weightlifting, strengthen your belly, do your own Pilates or yoga or other core based exercises, cycling, swimming, all of those are activities that can now strengthen your core. So then when you go and do activities such as lifting for your job, that you’ll do it without straining or tearing, injuring your back or injuring your groin or abdominal wall.
Speaker 1 (42:19):
And then every time you do an activity, do it correctly. The same way when you’re at the gym that your trainer or spotter or whoever tells you to tuck in your pelvis and engage your core and keep your shoulders down and your scapular retracted, do the same thing when you are lifting. Now that’s hard to do if you’re doing it for eight hours and it’s the same thing over and over again. But the more conscientious you are, the more you’re aware of the fact that you’re lifting and don’t want to injure yourself, the less likely you are to injure. And part of that would be, for example, some people wear where belts or binders. You’ve seen people that are working at Home Depot and construction workers wear binders, and your local UPS driver may wear a back brace. It’s partially to provide external support as part of their work.
Speaker 1 (43:27):
Next question. After having a work-related hernia injury repaired is changing your job, the only option to prevent a recurrence? So that’s a good question. I had for example, a carpenter, I don’t know if they still do that anymore, but when they were, back in the day when carpets were being installed, there’s this machine that tucks in the carpet ends underneath the walls at the corners. And the way they would do it is they would use their knee, so they’d be on all fours and they’d jam their knee. I don’t know if it’s still done. It just seemed like a horrible thing to do multiple times a day. But you’d be on all fours on the floor, you’d stick this thing on the carpeting to push the carpeting underneath the wall edge like that rim in the wall, and then you just take knee and jam it, jam it, jam it. That takes a lot of core, a lot of groin increases. Abdominal pressure a lot.
Speaker 1 (44:39):
Yeah. So if it’s a simple hernia and you’re a low risk patient, I would say you don’t have a change of job. But if it’s a complex Hernia or it’s multiply recurrent, and the reason why it’s recurrent is because of your own risk factors and also the type of work you do, then you may want to consider not doing that anymore. So I have construction workers, let’s say, that have hernias that see me because that hernia was botched. So then I had to redo the Hernia sometimes with mesh, sometimes with more than one Mesh, sometimes reconstructing the tissues. And I was like, is there any way you could just not do this construction job? It’s very, it’s a lot of additional pressure and every time you tear, that makes it even more difficult the next time. And you can have loss of domain and really bad nerve injuries and scar tissue and entrapment. So they moved him to a more of a desk job, but in the same construction company. So yes, there are situations where you would benefit from changing your job to one that’s not so physically taxing. Here’s another question on another note. If you had no pain after a laparoscopic mesh repair, but develop pain several months after and no recurrence is detected, what other mechanisms can cause late phase pain?
Speaker 1 (46:12):
I had fibrosis with nerve entrapment, IE fibrosis with nerve entrapment, shrinkage, et cetera. Are you personally always able to predict the right size of mesh? So there’s a standard size of mesh, and to go under stat, standard size puts you at higher risk for a chronic pain and b, recurrence. And then in terms of pain, so if you had a laparoscopic Hernia repair and you have no pain for let’s say a year, and then you start developing pain, then usually that’s a hernia recurrence. If you had a hernia repair and you did have much pain until around weeks three to six, then that’s usually too tight of a repair and the mesh has shrunk and it’s the shrinking of an already tight repair that’s pulling on sutures and pulling on tissues and causing tightness in the area that can cause chronic pain. That’s usually the reason. And then if the mesh was put in, okay, but then it starts folding, usually symptoms start also around week three, or it can occur earlier or later as well. And then you’ll feel the effects of let’s say Mesh and trapping a nerve or just bawling up and causing pain or exposing the Hernia and causing a hernia recurrence.
Speaker 1 (47:50):
So those are what happens where there’s a lot of reasons why people get pain after a Hernia repair. It’s not always nerve problem, it’s not always a recurrence. It can be the mesh itself. It could be inflammation, it could be a seroma hematoma, nerve entrapment, scarring, shrinkage, inflammatory reaction, balling up with the mesh and so on. So there’s a lot of questions and queries and imaging and physical exam and so on. That’ll help with that. Here’s a comment. I had tight stitches. They removed them. They were not dissolvable, they were surgically removed. I’m still having pain. So if you had tight stitches that were removed, did you have mesh and were they tight that they were causing therefore tearing? And now you’re still dealing with the tear, the instigator of the tear is gone, but you may still have those tears. So if it’s just a tear and you don’t have any other reason for pain, sometimes PRP or other types of injections can help you naturally heal those tears.
Speaker 1 (49:07):
And sometimes you just need to have surgery to address those tears. No mesh. Yeah, so when you have tight stitches, if you have tight stitches that tore through and that’s what was causing you to have pain, once you remove the stitches, then you either have now a hernia or you have tears that need to be addressed. Scanning will not necessarily see tears. It will see a Hernia, but you may have tears without a frank hernia and what you’re feeling are the side effects of the tear. Here’s another question. Can a Mesh ball up or fold with a laparoscopic inguinal Hernia repair, or does the pre peritoneal retroactive space secure the Mesh to prevent folding, bawling and migration? So you can get a meshoma with a tap or tap repair depends on the space that is made to accommodate the mesh and how flat the Mesh was placed before finishing.
Speaker 1 (50:21):
Those are usually the top two reasons why mesh can fold. It’s the wrong size Mesh and the wrong placement of the Mesh and the wrong size positioning of that mesh. How do you find tears? So usually it’s indirectly, it’s not found unless you physically operate. So you indirectly presume there’s a tear. You treat it as if there’s a tear because often tears are not treated surgically. They just need injections. Often with PRP, sometimes with local anesthetic and steroids. If that doesn’t work, then sometimes you need the area explored to actually physically find a tear. But we prefer not to operate on tears and just allow a combination of physical therapy and injections to heal those tears.
Speaker 1 (51:18):
Let’s see. All right, well, that’s it with all the questions that were submitted. I’m happy to answer any more questions for you all. This was kind of fun. My voice lasted the full hour. You can hear I don’t have a normal voice. It’s a little nasally and it’s a little like crackly. I’m not crackly, it’s just not clear. I’m trying to drink some hot tea. Honestly, I’m tired of cough drops and teas. It’s been, I feel like I’ve overdosed on it. Some experts claim PRP can cause calcifications. I don’t know that they do. Trauma can cause calcifications. I don’t know that PRP can cause calcifications. I’ve never seen that. That’s like your own, it’s your own tissue. Why would it cause calcifications that I don’t understand. So let’s see, next Thursday, sorry, next Tuesday, I believe the day after Christmas day. So I’ll see, I may just be in the giving mood and we’ll do another heart attack Tuesday, the day after Christmas day because it’s been a while and I feel like because of my voice, I haven’t been here for you guys.
Speaker 1 (52:46):
So I kind of feel guilty. I feel like I owe it to you to come back. There are all these great questions. Here’s another question. Does milk make hernia, parasites inflame causing pain? So I assume you mean drinking milk, not putting milk on your wound. So there are people that get inflammatory reaction to milk or other animal products, and those patients tend to have autoimmune disorders or an inflammatory disorder to begin with. So if you drink milk and you start getting joint pain or let’s say pain, wherever your wound is, then that’s really kind of like an Asia type problem where you are reacting to an inflammatory influence on your body, and that’s the animal-based product. So you may want to try non-animal based milks like oat milk and see if you get a similar reaction, you should not because they tend to be low inflammatory. So that’s what I can tell you very much So that’s it for us. It was fun. I enjoyed it. Thank you very much. I would like to thank you for asking me the questions, and I hope this was helpful to all of you. Every so often I get inspired.
Speaker 1 (54:24):
When I get inspired, I feel like I have a discussion with someone or there’s specific patient in the office and it kind of sparks a topic of discussion. We don’t really ever talk about work related heart injuries, and it’s so common. So I hope that was helpful. So yes, he had an umbilical hernia repair. When he drinks milk, he gets pain at the repair site. I mean, if the milk is giving him bloating and he gets pain or food gives him bloating, gives him pain, then that’s more likely a little tear and or a small Hernia that’s not seen on imaging. So on that note, please do subscribe to my YouTube channel at Hernia Doc. Go to hernia talk.com if you want more questions answered. Got to sign up for that. It’s free. Become a subscriber to my YouTube channel, but also to my podcast when you talk live. It’s actually pretty good. We have, I think, close to 90 episodes uploaded already of the 150 plus that are from YouTube. So that’s exciting. And follow me on Instagram and x, formerly Twitter at Hernia Doc. And wishing you all a merry Christmas. Everyone who celebrate Hanukkah, I hope it was happy for you. I wish everyone a great new year. I will see you hopefully Tuesday after Christmas, and that will be it for us. Thanks everyone.
