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Speaker 1 (00:00):
Good evening everyone. It’s Dr. Towfigh. Welcome to Hernia Talk Live. Our weekly question, answer session on all things hernia. My name is Dr. Shirin Towfigh. I am your hernia and laparoscopic surgery specialist. You can follow me on Twitter at hernia doc and on Instagram at hernia Doc. Many of you are joining me on Facebook live at Dr. Towfigh. The rest are here, zoom based and I hope that you share in today’s session because it’s going to be really fun. I’m hoping, cause I have some stories to share for you as always. And let’s see, once we’re done, I’ll make sure this is on YouTube for you so that you can go on my channel and catch up on it. But the plan today is to talk about Dr. Google. I would suspect the majority of patients that have hernias that come to me for sure, but also probably the majority of patients that have any disease.
Speaker 1 (00:59):
Honestly, it’s they go on Google and they search. I do the same if I have any illness or if I have friends that have illnesses, they want to ask me about things. I do use Google and I do search information on it. So the internet in general has become a huge depot for medical information. Now, when I go on Google, I kind of know which websites to look through, which ones not to go through, what to read, what not to read. I have a sense of what is just hearsay and what is true medical knowledge. I go through publications and even the publications that are peer reviewed in surgical or medical journals, I read those very critically. I submit my own publications and the peer review system is very critical. So I feel like the problem with today’s internet is not so much that we have bad information on it, we actually have quite a lot of good information.
Speaker 1 (02:04):
It’s just so hard to be able to parse out the good with the bad. And I feel that information on it, quite a lot of good information and I feel that the problem that we have is that it’s hard to know what is good and what’s wrong. And so as a result, I get a lot of patients that are well-informed but misinformed. And lately in the past couple weeks I’ve had a string of them, a string of patients that have come in with very strong feelings about what’s going on with them. And when they come to see an expert myself or they’ve seen colleagues of mine, if we say anything that disagrees with what they’ve read and the research they’ve done, we come out as the bad person. And it’s really hard to navigate that relationship where you want to have trust with the patient and the patient legitimately has done their research and is coming to you as the expert, but whatever you’re saying is not being taken as the expert advice. And so I thought maybe I could help discuss this and also get some of your feedback because it’s been challenging with a couple of patients lately to try and maintain their trust but still try and debunk a lot of their, what they strongly believe is a problem and therefore what they think should be done.
Speaker 1 (03:41):
I have family members myself that are into TikTok and they’re arguing with me that what I’m saying is wrong because on TikTok, someone said something. Now I’m also on TikTok, so it’s not like I don’t want to sound elitist in any way. I’m also on all of these medias. But my goal in being on these different social media aspects and venues is to help balance out some of the information that’s out there in hopefully entertaining ways so that other people will listen and learn. Otherwise, it’s so easy to get trapped in these misinformation cycles. So I hope you guys can join me and help me with this process. I need some advice from you all to see what it’s like to let me know what you think should happen. I already have some comments. It says I read your post that lifting cannot cause a hernia, which surprised me.
Speaker 1 (04:47):
Someone as mine was considered almost certainly a cause of lifting. If you Google it, virtually every source of information states heavy lifting can cause a hernia. If lifting doesn’t cause a double inguinal hernia, then what does? Excellent question. That’s exactly where the nuance of what’s on the internet and what we can help share with you is people who lift cannot get hernias if they are not prone to getting hernias. That’s what we know. So people who get hernias tend to have a genetic disposition towards hernias, that means their collagen and some other tissue based components are immature and weaker than the average patient. And so the groin, the belly button areas where they have had surgery are naturally weaker than the average patient. And because it’s weaker, what we see is that if they add X, so it doesn’t mean they’re going to get a hernia necessarily, but they may get a hernia more.
Speaker 2 (05:57):
They’re more prone to getting a hernia. So the question is this, if you didn’t have that weakness already, could you get a hernia by lifting? The likely answer is no. So most people who get hernias already have a genetic predisposition. Once that predisposition is there, then they’re likely to get a hernia if they do something to make it worse. So if you have a genetic pre genetic predisposition and you exercise, you don’t gain weight, you don’t smoke nicotine, you’re not diabetic, you don’t have a chronic cough, you’re not constipated. Low likelihood you’ll have a hernia, but you may still get a hernia despite doing everything correctly. If you have a predisposition, genetic pre predisposition to get a hernia and you’re constipated, you’re your lifting incorrectly, lifting in and of itself is not considered the cause. Those activities may exacerbate or hasten your ability to get a hernia.
Speaker 2 (07:09):
Let me give you an example. Oh, and just to finish that thought, exercise has been evaluated back I think 2006 with a couple interesting studies on medical students. So normal healthy patients and they looked at also presumably normal healthy patients. So they looked at abdominal pressure and they had people lift dead lifts, weightlifting, overhead lifts, bench press, whatever. And they found actually no increase in abdominal pressure and therefore lower risk of having a hernia. Because we feel that increases in abdominal pressure are one of the factors that promote hernias. It doesn’t cause the hernia. Hernia risk is already there and then you add a risk to it that promotes it. So let me give you an example. If you eat sugar every single day doesn’t mean you’re going to be diabetic. You need to have a genetic predisposition to be diabetic. And then when you eat lots of sugar, your blood sugars are going to be high. But in a normal patient, the amount of insulin that your body responds to flute foods will automatically make up for the fact that you had donuts yesterday and a cake today. But if you’re diabetic, that predisposition makes you closer to becoming diabetic or more likely to have a high sugar when you eat that. So yes, if you look at Google, lifting will cause a hernia that is not correct if you look at it scientifically in and
Speaker 1 (08:54):
Of itself, lifting does not promote hernias. You have to have a predisposition, number one. And number two, weightlifters. We don’t see weightlifters running around with hernias. So weightlifting or lifting in general is not considered a main risk factor. Now it used to be a myth that you shouldn’t lift. That’s old news. That’s like when I was a resident, no lifting for six weeks after surgery. That’s been completely debunked. The current international consensus and what I follow with my patients is no restrictions at all after hernia surgery or even during hernia with a hernia for lifting. So what you’re reading is old information that’s been kind of spewed out by non-experts. And so that’s hopefully a long answer to a short question.
Speaker 1 (09:43):
Next question, what’s your advice about polyester Mesh? Polyester Mesh is one type of Mesh. It’s perfectly good type, it’s very soft. a lot of us like using it because it’s softened tends to be well tolerated. I tend not to remove a lot of polyester meshes. It is concerned to be slightly higher risk of infection and less likely to be salvaged if it is infected. By the time a Mesh patient gets to a doctor who specializes in Mesh issues, they have been left to languish as a medical mystery. They then are blamed. See, that’s a very interesting comment. So first of all, I’m hoping that the message that I bring out to you is you should educate yourself either on Google or by the surgeon, hopefully by your surgeon on what surgery is best for you if you have, it’s true that most patients will not be able to be treated by a surgical hernia specialist. We’re just not that many of us out there in the US or throughout the world and people, they’re just, not only are we not out there enough, but although we are training more and there’s more interest in hernia surgery, so I have residents that are really interested to go into hernia surgery, which is great. That does not occur when I was a resident.
Speaker 1 (11:14):
But at the same time we tend to be a bit more expensive because we are specialists or more like we’re busier. So we may not be able to see people immediately and you may need help. So my point is I don’t, you’re right. I don’t want you to be blamed for it, but what I don’t understand is when people have a complication, which from the surgery which they paid for, then they go to the same surgeon, they get a second complication, which is fine, but once you get second complication, you may want to start looking for a specialist. Instead of coming to me and saying, you’ve had seven operations and now you want to invest in your health, you should at some point decide the risk benefit ratio and the cost differential is to your advantage if you get treated earlier better than in the long term.
Speaker 1 (12:14):
So that’s kind of my take on it. Next question saying most Mesh Mesh patients have large mental injuries from being labeled, et cetera. The tests are horrible, horribly inaccurate, saying most have some form of P T S D being second in place. You can’t escape and trusting the medical community. Yeah, I understand the P T S D portion of it. I personally understand PTSD and we talked about medical P T S D or surgical P T S D a couple of sessions ago. I totally get it. And at the end of the day, the patient themselves has to be the one that makes a final decision about what they want to do. Some people like me, I would want to be find the best doctor, figure out what they’re telling me, maybe get a second opinion and see if they confirm and then just go with it and get things fixed.
Speaker 1 (13:14):
Others want to see 10 million doctors and never agree to get repair. They just want more information. That’s not my style. Some people do have complete faith, don’t do any research on their doctor or their disease and go see a surgeon and are very trusting and fall into a cycle where they’re constantly trusting. So after a couple of complications, you should start moving on to maybe a second or third opinion. And the mental injury of dealing with the complication is for real, it happens with plastic surgery, hernia surgery, it can happen. There’s actually a show on it. Plastic surgery, I think it’s called killing, killing for beauty or something like that, I forget. But it’s about plastic surgery gone wrong where you actually almost die. And then there’s like breast surgery. There’s a lot of things that can mentally affect you as you move forward in your goal to be healthy. You may recall several couple months ago I had one of my own patients that went through this process. No one would believe her. She’s took I think 15 years, 16 years to get the care that she needed. But she was her own best advocate. She did have depression over this. She did feel like there was gaslighting and P T S D, but at the end of the day she was her own best advocate.
Speaker 1 (14:54):
Let’s see, next question. I had a hernia in the triangle on my back where it was weakened by the latissimus dorsi breast reconstruction. So not so not S L L hernia, a stroke predisposed. Why wasn’t I warned this could occur. They use polyester Mesh and they have lots of pain, digestive issues and have developed two AI issues. Can my polyester Mesh 15 by 27 years with over 40 ProTacks be removed? This is a complex question. The question is number one, why’d you have the hernia? Sounds like you had a hernia from a donor site for breast reconstruction. That’s not typical for latissimus dorsi flaps. So you’d have to see what it looked like and then what the technique was to repair it. 40 tacks may or may not be too much for operation. That sounds like it was done laparoscopically.
Speaker 1 (16:04):
And if you have pain actually from the Mesh that can be addressed. I’d like to address this though. I had a recent patient who was convinced he has Mesh pain, absolutely convinced he had Mesh pain, came in very loud, very aggressive, angry, very, very angry, and had surgery by another surgeon for hernia repair with Mesh. And actually that Mesh lasted 15 years or 20 years, something like that. And he had no pain for 20 years. First what he actually had was probably a tear because he’d gained a lot of weight, gained like 50 or 60 pounds. So now you have a repair where it’s tearing. So if I give you an outfit that you wore 20 years ago and I’m forcing to still wear that outfit 40 to 60 pounds later, you’re going to tear that outfit. The same has happened with his Mesh most likely.
Speaker 1 (17:08):
So he had pain and he went online and did his own research, which is what he write. He was telling me I did my own research, the Mesh should never have been there. Well the Mesh lasted you for 20 years and you gained 60 pounds. So your Mesh tore. Actually it’s not that the Mesh, there’s nothing wrong with the Mesh. It lasted 20 years. If you had a tissue repair, you would’ve torn it earlier, most likely. So my point is he’s blaming the Mesh. He now has a lawyer that’s telling him stuff that they really shouldn’t be telling him that his surgeon lied to him and we can’t trust the operative report unless it’s done under oath under deposition. And he’s like completely into this whole Mesh thing. Now there are plenty of people that have Mesh complications. He is not one of them. So long story short, he chose to have the Mesh removed and didn’t want Mesh put in him again.
Speaker 1 (18:18):
Now again, he’s like hundreds of pounds overweight and for some reason he had a tissue repair, which was a wrong choice for his body happiness, but he refused. So now he’s tearing through the tissue repair and he is still blaming the Mesh. And it was so difficult for me. I spent three hours maybe more overall with this patient and I was exhausted. I mean I was like, you’re exhausted, you’re exhausted. And I’m trying to not lose his trust, but at the same time I’m trying to reverse all this anger against the Mesh so that he could agree to get an actual operation that he needs. And he’s read about all these different muscles and so on and it’s just he’s read the Shouldice is a very invasive operation and a bunch of other things. So my point is for this lady about the polyester Mesh polyester may not be your problem.
Speaker 1 (19:22):
The Mesh itself may not be your problem. Maybe the tacks are your problem, maybe the repairer needs to be supported better there? No. Oh, obviously it’s a Mesh we, that’s what I do. I spend time reviewing your chart, seeing what it was you had before, what was done afterwards, evaluate the technique and come up with a plan. So if you want to reach out to me, I’m happy to review your chart to see how I can do my detective work and figure out what’s wrong and why you have pain. But in the meantime, and there are nerves actually on the flank, there’s the ilio inguinal, ilio hypogastric and the 12th thoracic nerves that can be injured as part of the repair. So it may not be a Mesh issue at all. It could be a nerve problem.
Speaker 1 (20:13):
Following up with that becomes impossible. Why wouldn’t it? Just my opinion. Hope it helps you understand why and what you’re up against. Yeah, I’m up against a lot to be honest. I had a patient recently say, yeah, you know what, I listened to your hernia talk a couple weeks ago, this is a couple weeks ago. And you were sharing how exhausted you can be and getting burnt out because you’re dealing with patient with chronic pain, hernia, Mesh lawsuits, what they’ve learned on Google and trying to balance all that to provide the best care with patients. And it can be exhausting. Of course being a patient with a complication obviously is a big deal and can be very medically and psychologically exhausting. But they’re like, I hope I’m not one of those patients you were referring to. Which of course that patient is not. But it’s stressful and as a result a lot of us hernia specialists are a little bit burnt out and some of us actually have left the practice or have changed the practice so that we don’t see as many chronic pain pages. I have not done that. I’m actually am somewhat of a masochist. I’m like plotting forward and hope to do more and more patients with chronic pain. So that’s kind of where I’m at with that. Let’s see. I was told that my Mesh cannot be removed. Does the lady actually answer Our questions are refer to me because I believe I’ve been talking about your question this whole time.
Speaker 1 (21:54):
So all Mesh can be removed, almost all Mesh can be removed. So I don’t agree with the statement that Mesh can’t be removed. The question is shouldn’t be removed. How is pro or anti Mesh bias formed? Do you believe there’s a fracture between the standpoint of patients and that of the medical community? Oh, very good question. Very, very good question. Yeah, so I’ll tell you there’s definitely a fracture. There’s definitely a fracture between what the patients see and believe and what the medical community sees and believes. First of all, there’s little to no literature that addresses some of the complications we see with hernia repairs. Little to no. And I would say that for example, allergy Mesh allergies, we just turned in two papers this week and I’ll post about it later on. Mesh allergies and how to diagnose it and also Mesh allergy testing.
Speaker 1 (22:59):
I’m the only one that ever publishes or talks about this, which to the medical community means either I’m crazy or I’m seeing a population that doesn’t exist or okay, maybe there is something there, but we’re not seeing that. And so that’s what I’m dealing with is I’m trying to publish as much as I can to help with the experience of other surgeons who may be at a loss seeing patients like that pages are experiencing it, but I, not to discount the experience of patients, but they are experiencing things that they think there is a problem, which is may not necessarily be the problem. I’ll give you an example. There’s a Facebook group that I was told by a patient on this kind of rare disease that I treat, it’s a nerve problem. There’s actually a Facebook group on it. I’m like, she said, you know what, you should go on this Facebook group and maybe you can help these people. So I went on the Facebook group and I’m willing to bet 90% of the people on the Facebook group do not have this nerve problem. Now if they’re on the Facebook group thinking they have a nerve nerve problem and they’re going to their doctors trying to convince them they have this nerve problem, that’s a problem because they’re going to get either inappropriate care or they are going to get very disappointed and then lose trust in their doctors because they so strongly believe that what their problem is this specific problem.
Speaker 1 (24:38):
But if they’re just lurking and trying to learn a little bit and have convinced themselves, and maybe I don’t have this nerve problem as kind of a cool Facebook group, that’s fine, but I feel that a lot of people go on Google and they’re like, yeah, that’s me. That’s exactly me. And so me as a surgeon, I hope to see patients medical problems without a hammer. Everything’s in, everything’s a nail. So kind of a 30,000 foot view. So when they come to me, I’m like, no, you don’t have a hernia. It’s not your Mesh, it’s actually your hip or you have sacroiliitis or you have some other disorder that endometriosis something else that is causing your pain. It’s not the Mesh, it’s not the hernia. You don’t have a hernia for example. Something like that. So I try and be as wide as possible, but if you go online, you’re convinced that you have a Mesh problem and I have a couple of patients, one is convinced that they have a hernia and no, and they just want me to operate.
Speaker 1 (25:47):
I’m like, I can’t operate on something you don’t have. And yet I become this kind of in their mind, a surgeon that’s not trying to help this patient even though this patient doesn’t have a hernia. I don’t know what else to say. And I try and prove to her, prove to this patient about the reasons why to try and prove to the patient why I believe there’s no hernia as objectively as possible. So I don’t sound subjective, but if you’re doing a lot of research or reading a lot of papers and I get papers sent to me on a regular basis and the papers are, some of them are completely like it’s talking about a completely different situation, different patient, different pro problem, and they’ll be like, well look here, look at this example. I’m like, but that’s not you. Anyway, there is a disconnect in summary to your question.
Speaker 1 (26:47):
There is a disconnect between doctors and patients. We see the world differently because we talk differently. Our vocabulary is different and we have a broader knowledge base about our narrow topic and patients can get very put off when you have a doctor that is not able to spend too much time with you and explain to these situations or because they’re just, there are bad doctors out there and now you’ve already have no trust in the system. Next question. What is the incidence of chronic postoperative anal hernia? Orph pain following repairs of bilateral recurrences? So okay, this is about recurrent hernias. So the question is how much is the chronic postoperative pain after recurrent hernias? So if this is a recurrent hernia and it’s performed as a separate operation, the original hernia, the chronic pain rate should be similar to a regular anal hernia.
Speaker 1 (27:53):
Now the rates are different for laparoscopic or open. We don’t have a grasp of exactly the data. 12% seems to be the consensus right now of chronic pain. Chronic pain meaning any pain at three months, that number should go down to less than 6% at one year and then continue to decrease is a nerve problem. You’re referring to PD neuropathy? No, but that’s another Facebook group where they talk about PD Neuralgia and most of the people don’t have PD Neuralgia on that form as well. But that’s another form I mentioned that one too. So I have a lot of patients that have been even diagnosed with predental. Neuralgia like out of the blue. You don’t just wake up one day with predental Neuralgia, but some people they have al hernia for example, they or another disease that gives them pelvic floor spasm. The pelvic four spasm causes whatever going through the pelvic floor muscle to also get pinched.
Speaker 1 (28:55):
That happens to be the pudendal nerve and you get pedent nerve pain or ental Neuralgia, but your nerve is normal in people with true ental neuropathy or Neuralgia. They have an injury to the nerve and therefore you get surgery on the nerve or injections to the nerve. But if you have pelvic floor spasm and the spasm is what causes the secondary pain, you do not be getting any treatment for your nerve. You should be getting treatment for the pelvic floor spasm. Oftentimes that’s a hernia repair or other problems and then once you get that fixed, the nerve pain should go away.
Speaker 1 (29:36):
Okay, next question. Why do surgeons seem so hesitant to say anything as far as possible Mesh side effects or pain caused by hernia Mesh repairs, my original surgeon said she has no clue what could be causing referred pain above my repair. Even though it only only hurts when my Mesh is aggravated. I feel it lends to not accepting doctor’s explanations. You answer questions here without hesitation. Others seem ignorant of the complications of Mesh failure are coming unattached. Yet they are repair surgeons. Well first of all, general surgeons are repair surgeons. Hernia repair is considered bread and butter for most general surgeons and they should be able to perform that. It does not mean that they’re comfortable dealing with complications, contributed by the repair. There used to be this talk about, well you should not be able to put Mesh in if you don’t know how to take it out.
Speaker 1 (30:31):
That’s not true. There are plenty of people that fix roofs but when there’s a leak they don’t do the leak repair. That’s like another kind of specialty or kind of talent. So the same with hernia repairs, same with actually any operation. If you do an operation where you are, let’s say you need breast reconstruct like breast surgery, you can do breast surgery but if it looks to form you need a breast reconstructive surgeon to deal with that and that’s different talent than the breast surgery itself. So based on that is a problem, which is if you’re not getting the right answer from your surgeon, you should move on to another surgeon.
Speaker 1 (31:22):
It’s possible that in your situation it actually isn’t referred pain from your hernia. There’s something else going on and your original surgeon was correct. But that’s kind of what I’m trying to hint at, which is if you want to get the answer you’re looking for, you can find it on Dr. Google. The goal is to get the right answer and you can often get sidetracked on Google if you are trying to just get an answer to your question, an answer to your liking and I hope that you find some type of balance that, okay, so I’ve been answering questions and I don’t understand why this one person thinks I’m not answering any questions and then here’s her answer to the question. So the polyester Mesh might not be my problem, it might be the ProTacks. How can you tell which it is? Do titanium ProTacks cause AI issues autoimmune.
Speaker 1 (32:32):
So auto, a lot of these can cause autoimmune issues. Usually the titanium tacks do not. Usually the polyester Mesh does not. I just haven’t seen as many as I have the polypropylene. But it can be. I have had patients that have had reactions to their polyester Mesh, but you need a very complete rheumatology and immunology workup allergy workup before committing to actually removing the Mesh. Just removing it because you want it removed is not usually the best option. Here we are. We’re talking about medical P T S D After being a patient for 15 years trying to solve my medical mystery, Dr. Towfigh was the first doctor to break that traumatic mental state. This is what we’re discussing several weeks ago.
Speaker 1 (33:19):
I had been facing for so long where doctors telling me my issues were quote in my head end quote, she is a best patient advocate and would go to the end of the world if it meant her patients could be treated. She provides the best care. Thank you. I did not pay for that little advertisement, but thank you very much. I do have fans out there at their appreciate my time. Thank you. I highly recommend this for unanswered questions. An hour with Dr. Towfigh on Telecare call was enlightening. It gave me direction and hope. Thank you Dr. Towfigh. Okay, that’s a good point. So there’s a lot of patients that just need direction. I can’t operate on every single patient or see every single patient, but many of us, including myself, we do offer what’s called online consults. Just send me all your information and book an online consult.
Speaker 1 (34:09):
So by email you send everything. I review everything and I give you my feedback. It’s very detailed, it helps provide you with some direction and then I’ll say, oh, you live in Georgia? Okay, go see my buddy over there. Oh you live in Florida? Okay, go see my buddy over there. They could help you so at least you’re not wasting your time without any direction, not knowing who to go to and getting frustrated. So what I recommend, if you wish you’ll save you time, it’s actually quite affordable. Just call my office, ask for an online consult, they’ll work with you. They’ll get CDs, past opera reports, et cetera. I’ll sit down usually on like a weekend evening or something because I have no life and go through all of your chart and forensically evaluated and give you my 2 cents. It’s not really a doctor patient relationship cause I’m not examining you or touching you or seeing you, but it does give you some guidance as to you know what, this isn’t even your hernia. This is your hip or your shoulder or your acid reflux or your endometriosis and that will hopefully give you some, I’ve helped a lot of patients that way, a lot of patients and they’ve written back to me saying Because of you I then saw Dr. So-and-so and they got the right treatment.
Speaker 1 (35:32):
One of the last patients I diagnosed them with ulcerative colitis and that’s what was the cause a lot of their problems are Google Scholar or PubMed better options than Google or social media to learn objective career related information. Yes, I think Google Scholar is the best option. PubMed’s also very good. Unfortunately there’s it’s very medical and dense often there’s also MedScape and up-to-date those also kind of give you up-to-date information. They tend not to be very narrow in scope. They tend to be wider in scope. Let’s see, Mesh allergy have other allergies prior to being I have other allergies prior to being meshed. Can you check to see if my, I’m allergic to my Mesh. So we’ve discussed this before. In fact you may want to go to the session I have with Dr. Tervaert where we talked about Mesh allergies and allergy testing. I’ve also sprinkled that discussion throughout.
Speaker 1 (36:40):
I may bring my allergist one day to discuss the process because yes, we are publishing our own data because no one else is doing this in our data. Just like a little sneak peek. We found that I think 80% of the people that have shown Mesh allergies also either had an autoimmune disorder or a Mesh allergy, sorry, or an allergy like laundry list of things they were allergic to. So that does likely make you more prone to having an allergic or autoimmune reaction to your Mesh. Also what we found in the other paperwork where we touch talk specifically about allergy testing, we go through the protocol that we use. There’s no standardization. We’re hoping to standardize that protocol and we found that if you find an allergy, sorry, if you demonstrate a skin type four hypersensitivity to a compound like polyester, polypropylene sutures, et cetera, it’s very possible that that’s a true truly positive test and you should believe that test.
Speaker 1 (37:50):
However, a negative test unfortunately is not very persuasive as about, I think just under 40% of patients do not have like a false negative. So yes, we can check to see if you’re allergic to your Mesh, but there’s no definitive standardized test for that. When I had my Mesh installed in 1999, I was told it would never tear, et cetera. Four surgeries later. Patients are laymen who become advocates for themselves. Is this true Because they’re left of suffer. That is also unfortunately true. The only way anyone can understand the mental aspect is to have a complex P T S D is a club you have to join to understand, I don’t hate doctors et cetera, but make a Mesh Mesh a injury that make Mesh a injury that the powers to be would recognize be a big help. Law firms pushing removal is gross. I agree, I’m shot but can’t get any sort of disability, et cetera. Agree with you Dr. Google. Where’d he get his degree? Well first of all we don’t know that Dr. Google’s male or female, but yeah, where’d they get their degree?
Speaker 1 (39:08):
Hey, love questions. So I seen the surgeon again and a pain clinic doctor. He says I have unhealthy muscle and a lot of scar tissue called abdominal adhesions had not been for you. I wouldn’t have pushed for more answers. Thank you. Great, thank you. That’s kind of why I do this as well. It’s not just the online consultations but the hernia talk because there’s really no other. There’s also hernia talk.com, which is my patient discussion form. All of this is free, but it’s just trying to get more information out there because there’s a lot of misinformation. You mentioned the incidence of chronic postoperative pain de decreases from 12% of three months to less at one year. Can you elaborate on what is happening in the body that leads to that decrease in which of course is a great thing? Yes. So some of the pain is purely from inflammation and over time inflammation will reduce the other cause for pain may be scar tissue and over a year scar tissue starts to remodel. And then thirdly, some of the pain may be just your body feels tight in the area and it can loosen up over time. So there’s the top three reasons why pain early after surgery is often gone at about one year.
Speaker 1 (40:25):
Okay, answer that question. It’s no wonder we lose faith in our surgeons. Mine has made me for sure I start injections to numb my pain. They say it will break down the scar tissue and it’ll repair itself or heal itself over time. This is true, you can get either steroid injections or what’s called hydrocele dissection of scar tissue, especially around nerves. That’s usually done by a pain medicine specialist to help with certain pains. Mine feels like a hernia come to find out because the adhesions are getting trapped around nerves and organs and my bowels squeezing them like a hernia. What I guess you could say. So that’s what I’m talking about. If you have a nerve and trapped in scar tissue, there are doctors that can buy ultrasound guidance, evaluate that nerve and then put local, an aesthetic and maybe some other chemicals into the area. To quote hydrocele dissect, they dissect with fluid, the scar tissue around the nerve and release attention on the nerve. It’s kind of cool thing to do. You need a very skilled surgeon pain doctor to do it. I have a couple here who do that and it definitely helps if the nerve itself is not injured but just trapped in scar.
Speaker 1 (41:53):
I have a partially torn labrum. I assume you mean hip labral tear and I’ve had this for many years prior. However, now that I’m having major pain, immediately after Mesh surgeries, doctors are saying the pain could be labrum. The area of pain is in front of the muscle area and a stabbing pain in the obliques. I thoughts on this assumption since the pain was not present prior to Mesh surgery. So you’re right, if you were fine, you had surgery and now you’re not fine, most likely it’s a surgery that’s causing the pain. I agree with that. The way to figure out if your labral tear is any in any way contributing now even though before it wasn’t. It’s possible maybe now it does, is to get an injection into your hip and see if the pain goes away. If the injection does nothing to your pain, then it’s not your hip.
Speaker 1 (42:37):
If you’re having pain, stabbing pain in the obliques, you may have a nerve problem because then the nerve may be affected by the repair, specifically the ilio inguinal or ilio hypogastric nerve and then radiate around towards your spine, around the flag, towards your spine. And that is what can cause that rating pain around your obliques. That’s only with open surgery, open angle hernia surgery. If you had laparoscopic surgery, then maybe you had some tacks that are placed kind of around towards your obliques and now the tacks are causing your pain. So these are all kind of things to look at.
Speaker 1 (43:22):
Why are the complicated of hernia surgery not told to us before surgery? It’s too late afterwards for those like me left with chronic pain for life. So first of all, chronic pain is should not be life time. Almost all hernia related or meth related pain is cured. Curable. So you should not think that there’s no hope for you, number one. Number two, yeah, the surgeons should tell you about the complications, but we don’t tell you about complications that occur less than 1%. That’s just not considered standard. So I’m not going to tell you that you may die from your hernia surgery. You may get a heart attack. I don’t tell my patients that because I frankly have had no hernia related deaths and most people have not either. Can’t happen, sure. But it kind of depends on each surgeon and what they think are the risks for you for them to tell you. If they told you that you have no risks, then obviously that’s not adequate. They say that I may have endometrial tissue getting stuck up in my belly button or whatever during periods because it hurts a lot more during my period, but also hurts all the time. So they’re talking about endometriosis or endometriosis in belly button, that’s a surgical problem.
Speaker 1 (44:35):
So it’s likely then that polyester Mesh is a cause of autoimmune issues for me and not the ProTacks causing my autoimmune issues. Thanks for that advice. You’re welcome. Even though you thought I was ignoring you, I am hearing your answers ages after I type them. Could be because I’m in UK. Oh well yes, that could be it. Are you in the UK? It’s like what time is it right now? Because I did prepare for my UK friend here. There’s somebody here, I’ll show this, I’ll show this with you. There’s somebody who reached out to me who basically said that I’m in the UK and I can’t watch this live. So can you please answer this question for me? And of course I said yes. And on that note, thanks for reminding me. So here’s the question. I’m going to share it with you in a second.
Speaker 1 (45:31):
I don’t know if it’s the same person. I understand you shouldn’t read stuff online and you could go see a doctor for medical advice. My experience has been that I saw a GP, he believes I have a small hernia. There’s not a lump or bulge to feel, but I can, when I am sitting upright such as driving my car or sitting at my desk, I can feel a discomfort and pressure or what feels like a bulge inside me. I’ve had an ultrasound and a CT scan with IV contrast, but I’ve been told nothing showed on either. The surgeon I saw said if nothing showed on the scans, they would not see me again. I mean every surgeon’s different. Some surgeons are like, if there’s nothing for me to operate on, I won’t see you. I’m like a detective. So I’m like, if I can help you figure out what’s wrong with you, I’m happy to see you.
Speaker 1 (46:13):
The pain is not far below my ribcage and to the left. Okay, well that would not be a hernia. Usually there’s no hernias that occur below the ribcage. I think it might be a Spigelian hernia, likely not because Spigelian hernias usually occur in the lower abdomen. I know I shouldn’t go online for a diagnosis, but when you are in pain and discomfort, you haven’t got many other places to go. I agree. I have asked for a second opinion have been referred, but it will take months for an appointment to come through and going privately is not an option for me. So this is a perfect situation to initiate an online consult. Send me all your stuff, give me your imaging, your story, any operations you may have had. Give me everything, mail it to me by initiating an online consult. I will go through it carefully and email you back my impression of what’s going on.
Speaker 1 (47:06):
Certainly you will not have seen your second opinion by then, number one and number two, maybe I’ll give you some direction and I have buddies in United Kingdom that can help you. So maybe I can help you that way to help get your referrals to someone who can help you in that region. So don’t waste your time. You see that you cannot go privately. It’s not an option, but at some point you need to kind of take a handle on your care. So if that means skimping on certain things to save money to do it, I highly recommend it. I feel that a lot of people don’t take the time to very objectively assess what’s going on with them. And in doing so they’re kind of not living their life as well as they would they should. So let’s see, where are we going with, let’s see. All right, so no more questions. In your recent article on outcomes of neurectomy, you mentioned, hold on.
Speaker 1 (48:18):
You mentioned several patients receiving neurectomy developed complex regional pain syndrome. Yes, this is true. Is your opinion that the neurectomy contribute to or cause of CRPS or C R P S, which we call Crips? Yes, it is my opinion, but I do feel that the more you manipulate nerves in some patients, the more you push them towards CRPS or complex regional pain syndrome and it’s a horrible complication. And so I’m, because of my experience and my results of my own study, I am very, very judicious about what nerves I cut and what options I provide. Patients that have nerve pain, Dr. Google pronouns are, good question. You should probably ask Siri or ask Google, what are your pronouns? Good evening. I’ve had a large Mesh removed was a large full abdominal Mesh, which was attached to my hips, the pelvis, the bone, and the Rives.
Speaker 1 (49:16):
My surgeon was amazing, but now I have a large bulge on one side, weak abdominal wall, not a hernia. Keeps getting bigger. What do you recommend? It’s been two years. So weaken abdominal wall is usually because of denervation. So you’ve had nerve injury. So I would make sure that your spine is intact and you haven’t had nerve injury because if you do, there are treatments for that. But it does involve Mesh and especially if your muscles are already too thinned out, you kind of do what’s called a tummy tuck of that area. But often it doesn’t work without having Mesh because the muscle’s not technically healthy enough to hold the sutures.
Speaker 1 (50:03):
Here’s a patient I was talking about who was on hernia talk. She writes, I appeared as a guest on Hernia Talk Live in December as a patient, I understand deeply the medical P T S D club many of you speak of. I’ve spent my life learning how to become my best advocate as a patient. She really has. She why I brought her on because she was such a great example of how to navigate the system and get the best care from your doctors. If any of you have any questions on navigating the healthcare system from a patient perspective, I’m very open to answering questions. Dr. Towfigh was an advocate for me and I feel like I want to pay it forward for others. I highly recommend you guys on contact her. She shared her story. She goes see her hernia attack episode in December. She’s a nurse, which is kind of interesting because it gives her a little bit of insight on both sides, the patient’s side and the physician side.
Speaker 1 (50:55):
And she’s just a great, great, I mean she had over a decade of problems and she reached out to me. Not that I could personally help her in any way. I didn’t need to operate on her, but I helped her kind of get the care she needed. But that’s kind of my shtick. I enjoy solving mysteries and puzzles and I’m on wordle and cordial and obturator and cord, all these other things. I just like solving problems. So that’s my thing. But I understand. I had a patient, I had a patient tell me a couple days ago and she said, I want to give you some feedback but I don’t want you to take it the wrong way. Okay. She’s very happy with the discussion we had. So she said, you’re very old school. I feel like doctors have forgotten how to take care of patients.
Speaker 1 (51:57):
They don’t listen, they don’t sit down, they’re not patient, they don’t talk to us. They talk at us and which is very nice. I love the fact that she called me old school because I do feel like we need to be more old school nowadays. Everyone’s on their computer. The doctors, I went to a doctor once the nurse came in to do the intake and her back was to me the entire time because she was on the computer now she could have switched the computer around. So she’s facing me as she’s putting in the, but she chose not to and she was totally clueless to the fact that I’m sitting there and she’s talking to me with her back to me. I mean even something like that, I was like, that’s all cool. But the goal was to finish her charting and put everything in the chart before the doctor comes in. So I like being old school. I don’t have a computer. I do have a mini iPad that I text on. Let me show you what I have here.
Speaker 1 (53:01):
It’s like a mini iPad. So when you see me, it’s small, it’s not obtrusive. I’m able to take notes while you’re talking but still be able to see you and look at you. Some people have scribes so that someone’s in the room like writing up stuff. Some kind of weird a little bit. But it does help because we’re so mandated to do so much documentation. I’ve unfortunately experienced the same issues in the medical world. Thanks. Keep up the good work. Goodnight. Thank you very much you guys. Wow, that’s almost our full hour. I have. Here’s another one. Diane would love your contact info on Facebook. How can we be done while keeping your privacy? Next information? I wish I could take credit for writing that book, but the author is Martine Ehrenclou. Yes. It really is an amazing research. I’m so glad you got the book.
Speaker 1 (53:59):
She’s not even promoting the book anymore. I feel like I’m promoting it more than Martine Ehrenclou is. But she was a patient that wrote and she’s a award-winning author that then wrote a book about navigating the medical system. I buy it as gifts for the holidays to certain people. It’s actually really, really good book and all the secrets of how to get the doctor’s appointment and your doctor’s to call you and prescriptions adequate done in the hospital visit and questions answered. It’s all in there. And I do that when I take care of my own family. But I feel that if you don’t know the system, it’s hard to know. But she gives you all the secrets. It’s Martine Ehrenclou, it’s called The Take Charge Patient. You buy it on Amazon, The Take Charge Patient by Martine Ehrenclou. It’s very important for patients to read. A hundred percent agree with that. And I’m so glad you got the book. I love it.
Speaker 1 (54:55):
Basically my patient, one of my patients sent me a couple books. He actually sent me two copies of each so that I can share it with my surgeon colleagues, which I thought was really great because I love reading books. I read books all the time. And any book you guys send me, I will. I would love to read. And it was really nice that I’ve had a lot of books sent to me. My patients are given to me by my patients. We also accept chocolates and granola cookies, homemade bake baked foods. But books are really, really great. So appreciate that. Well my friends, that was very fun. I always get bombarded with questions when you guys come on and I love it and I feel that I get dehydrated. That’s why I keep drinking tea because I don’t want to have a sore throat. Yes, orchids. I do love my orchids, although these are my, I don’t have orchids on my desk right now. I have these succulents because they’re actually growing really nicely. I don’t know if you can see, but they’re got new fresh buds of succulents. And also I love it when patients give me orchids. That’s really nice. And recently a patient gave us these venous effleur, they’re called forever roses.
Speaker 3 (56:22):
It’s supposed to last a year. It’s beautiful. If you come to my office, I haven got this big arrangement of red roses that hopefully will last a whole year. It’s so interesting. They’re like freeze-dried or something. Anyway, thanks very much for you guys. Thanks for having fun with me. I’m always pressed that you all have so many questions and are so engaging and respectful and appreciative of each other and of what I do. And next week I’ll be traveling. If I am able to get reception in my hotel room, I will do a Hernia Talk Live with you all. But it’s really hard when I’m at conferences and so on. But I will share with you what I learned at the different conferences. So if you follow me on Twitter, Twitter is like my academic arm of social media. So if you follow me on Twitter, cause I have a lot of doctors following me on that. So if you follow me on Twitter at Hernia doc, you’ll, you’ll see that I will start live tweeting at the meetings that I go to. So thank you very much. Hope to see you guys. Probably not next week, probably in a couple weeks when we have some guests already lined up for you. And that’s it for me. Thanks everyone. Go on my YouTube channel and watch and share this episode in all previous episodes. And on that note, goodbye and goodnight.
