Episode 1: Let’s Talk About Hernias |Hernia Talk Live Q&A

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Speaker 1 (00:00:10):

All right, everyone, I think we are live. This is Dr. Shirin Towfigh. I am a hernia surgeon, and during this pandemic, we are basically not operating, no elective surgeries. I know many of you also have questions. So I thought I’ll take this time, maybe we’ll do so on a weekly basis. I’ll take this time to bring all my friends from all over the world to ask me questions. So let me just introduce you to me. Just so you guys know this is being live broadcast on Zoom and also on Facebook Live. We’ll have a question answer session, so please put in your questions and answers. We have one hour. During that one hour, I will answer as many questions as I can. At the end, I will save this and post it on my YouTube channel, so you can watch it later. If you’d like to follow me and ask more questions in the future, go to my website at Beverly Hills Hernia Center. I have my Twitter and Instagram accounts, which many of you are from, and also my Facebook account. So let’s move on to the regular session. Let’s see how many of you’re already here.


Looks like you all are coming in, so thank you very much. This is, again, my first Zoom webinar for anyone that’s interested to talk about their hernia and hernia related com hernia related problems. As you know, I’m a general surgeon. I practice a hundred percent of my time for hernias and hernia related complications. And, usually you see me on Facebook and on Twitter and Instagram sharing with you all my information. I also own hernia talk.com, which is where the inspiration for this webinar came from, which is to get people that are already on hernia talk, which is a free discussion form. I highly recommend that you all apply to be members of Hernia Talk, to get those people into a more interactive session. So this webinar allows you to do questions and answers, so as they come in, I will try and answer those for you.


In the meantime, many of you have sent me questions on Instagram and Facebook and hernia talk.com. So I will use the rest of our hour to answer those unless I get more questions from you online. Just as a reminder, anything that you miss here will be posted on my YouTube channel, and if you want to continue with more free advice and talk to other people that have hernia related problems, I highly recommend the free patient discussion forum hernia talk.com. Okay, so I thought it’d be easiest if we go through questions,  by me sharing my screen with you. Let’s go here and, uh, go through the different questions. Uh, here is question number one. Uh, is it better to repair a tiny umbilical hernia before getting pregnant again, or should you wait until after? Highly recommend that you do not repair any umbilical hernia that is either without symptoms or minimally symptomatic until you are done with pregnancy and done with breastfeeding.


So if you have a small hernia, it’s not hurting you. You can live life without it. It’s not getting risk. I highly, highly recommend, um, that you do not get it repaired while you’re still in your fertile stages and or still considering having, uh, a pregnancy. The reason for that is, number one, that area needs to stretch during your pregnancy. And if it stretches and you, and you either don’t have mesh, the sutures may tear. If you do have mesh, you may get chronic paint at the area of your umbilical hernia repair because the mesh will not stretch. And so there have been some issues with chronic pain because the whole body wants to stretch and the area where the meshes will not stretch. So there’s no benefit in getting an umbilical hernia repaired prophylactically before you’re pregnant. Um, the likelihood is almost zero that you’ll have any problems during pregnancy. And so just wait until you’re done with all your pregnancy and breastfeeding until that is all done. And then you can get your belly button hernia repair.


Okay, we had a lot of belly button questions, and hernia questions related to unbillable hernias. Who should repair a recurrent hernia? Well, of course I believe that all hernias should repaired by specialists, or at least someone who’s cares about her and loves hernias. What I would like to say is if you do, if you have a general surgeon available for you that likes to do hernias, that’s fine, but if you have a recurrence, you may, or if you have a complication, chronic pain, me infection, inflammatory reaction recurrence, um, maybe either traveling or finding a hernia specialist to prepare the recurrent hernia, because that starts at kind of a, what do you call it, a crazy cycle where you may be getting not the best, most ideal hernia operation for your recurrent journey, then you’ll recur again, and then each time your hernia gets bigger and more painful and more complicated, and that’s just a bad path to do.


So first, hernia can be repaired by most general surgeons. Uh, second hernia as a recurrence. Highly, highly recommend you get it repaired by someone who actually has a specialty in hernia. And what does that mean? Person who is a hernia specialist really knows what they’re doing. More than 50% of their practice is dedicated to hernias alone, which means they’re reading about it, they’re talking about it, they’re involved in society meetings. They’re up to the most current, um, research as to what’s the best to do for your situation, and so they can tailor, um, your repair to your needs.


On that note, why do hernias recur? So what is the most common reason, or what are the most common reasons for repeat abdominal hernia recurrences for women? Very good question. Women and men are very similar in terms of why abdominal hernia, recurs rec, abdominal, hers recur. Number one reason in the United States, why abdominal hernias recur is you have some risk factor that prevented you from, um, getting the best, uh, outcome. So your chronic cougher is either smoke some type of cigarette or, well, I’m in California with a lot of marijuana smokers. You’re coughing, coughing, coughing, coughing, causes a huge amount of abdominal pressure, and you have fresh sutures, mesh, whatever the situation is, and you’re constantly putting that under stress. So coughing is a big cause and risk factor for hurting recurrences.


Let me just double check to see that everyone is here. Can I just get a raise of hands to make sure that everyone can hear and see me? Let’s just double check that everything is up to date. Okay. Everyone’s okay? Good. Very good. Well, maybe you can tell Sheila how to take care of things. Okay, I’m gonna share my screen again. Uh, let’s see. Question was, I already forgot what the question was. Oh, the most common reason. So number one is coffee. Number two is constipation. So if you’re straining and you’re constipated every time you go to the bathroom once a day, probably you’re straining. Another reason for abdominal pressure, constantly putting that pressure onto the hernia pair and, uh, getting higher recurrence rates. Um, obesity is another one. Anything that prevents you from healing well, nicotine is a very poor one. Nicotine really prevents you from, uh, getting that good scar tissue that you need to prevent a hernia recurrence. I tell my patients there’s up to a seven times higher risk of your hernia coming back if you are actively using nicotine, that’s smoking, chewing patches, whatever the situation is. So, I don’t recommend that you smoke.


And lastly, any kind of healing disorder in women. You may also have pregnancies, which can promote hernia recurrences if it’s in the abdominal wall. And then next is also if you’ve had multiple pregnancies, you may have pelvic floor dysfunction. And because of that pelvic floor dysfunction, you are straining and pushing to urinate because you’re obstructing like a cystic rec. And then once that happens, that’s like constipation or adding straining. Oh, we have a live question. Let’s go to a live question. Can you discuss Shouldice, Bassini and Desarda? Okay. Really, really good question. I hope, uh, I don’t know who I asked that question. That was excellent question. Shouldice, Bassini and Desarda, those are all tissue-based repairs for an inguinal hernia. Inguinal hernias are hernia in the groin. We call it groin hernias. Inguinal hernias, they can be direct or indirect.


Those are repaired by mesh or without mesh. The most common two types of non mesh repairs you’ll see used are sutures. We’re basically sewing the whole clothes in a manner is either the shouldice repair or the bassini repair. There’s about several hundred different known types. They’re all named after a surgeon that came up with it. Um, the more recent one is Dr. Desarda. Dr. Desarda is a surgeon in India, and he came up with a desarda, from what I understand that desarda, it’s really a technique that was used back in the fifties. I know that because I have a mentor who trained back then, and it’s the use of the external oblique fascia instead of your mesh. It’s like a tissue patch. Back then the hernia recurrence were way too high, and so that technique was abandoned. The best top two are the shouldice and the bassini. There’s also the McVay for femoral hernias, but we really, or I really go by evidence-based repairs. I do offer the shouldice and the bassini tissue repairs for anal hernias, and that could be for primary or recurrent angle hernias. Keep bringing the questions.


All right, let’s go back to the next question we have from Instagram. And that is, is it true that a big hernia is less dangerous than a little one? Yes and no. So if you think about it, big hernia implies a big hole. So that means a lot of things can go through it. And it also means the space. There’s a lot of space, which means the hernia looks bigger, but the chance of it narrowing or being tight at the neck of the hernia is lower. So risks such as incarceration and strangulation are lower than if you had a small hole and a little piece of something was stuck in the hole, that would be immediately tight. The way I explain to my patients is, if I pinch you and I pinch just a little bit of your skin, that really hurts. But if I pinch a big piece of your, of your skin, that doesn’t hurt as much.


So same way, a small hernia from an incarceration or strangulation standpoint may be more dangerous than a big hernia. However, a big hernia can get bigger and bigger. You can get a bowel obstruction because a, it’s more likely to have intestines stuck in it. So bowel obstruction implies intestinal obstruction, whereas it’s less common with the smaller ones. And if it’s a big abdominal hernia, as you get bigger, what happens is the skin overlying the hernia will thin out. And if you disregard these huge hernias, what we call giant hernias, and the skin over, it thins out, then that skin may eventually erode away, or you can get stuck some scratching it or something. And what will happen is you will, uh, destroy that skin. And then now you have direct communication with your hernia contents, which is usually intestine, and you can get a fistula. That is a horrible complication. You do not want to get to a point where your hernia is so big and so complicated that it gets a fistula because you just bought yourself at least two other operations, and that’s not good. So basically, long story short, what I recommend is to get hernias repaired if they are symptomatic. So it hurts you, bothers you, prevents you from doing your daily activities, number one. And number two, if it’s growing bigger, faster, most other hernias can be watched until they get to that point.


All right, I hope everyone is logging in and having no problems doing that. I’m gonna move on to the next question. This was also from Instagram. It says, hi, can a hernia that was repaired in 1995 be contributing to a weak pelvic floor? No. No, unless that was a pelvic floor hernia and it fell apart. But if it’s inguinal hernia, abdominal hernia, ventral hernia repairing, that has no effect on any type of pelvic floor dysfunction in a negative way. What it may do in very, very small portions of people, if you have a horribly weak pelvic floor and then you get a hernia pair or a tummy tuck that’s really tight, then it’s possible that when you make that tight, you’re not bulging down the pelvic floor, makes your pelvic floor dysfunction worse. But if you had a repair in 1995, good for you, you’re probably doing fine from it. And the pelvic, the weaker pelvic floor is probably part of your underlying disorder. And maybe you already have some type of collagen disorder where you have a hernia and now a weak pelvic floor or multiple pregnancies if you’re female. The two are not directly related. They may be indirectly related.


All right, I had a lot of questions on umbilical hernias, rash, no mesh, et cetera. This is a question from, I believe this one was also from Instagram, umbilical hernia mesh, and then had a C-section with twin pregnancy. What do I look for? Nothing. If you’re fine, don’t look for anything. If you had an umbilical hernia pair with mesh and you had a wonderful pregnancy, your C-section, which does not involve the hernia repair, so don’t worry about that. Then you had, uh, c-section that was delivered to your twins and they close you back up, everything’s fine. Do not worry about your hernia repair. Do not look for anything. Now, if you have pain or bulging, those are signs that you should respond to, but don’t go looking for problems, you’ll be just, just fine.


Okay? Okay. When do you use mesh in umbilical hernia pair? This is a very good question. Everyone’s a little different as to when and how they use mesh for umbilical hernia pair. Here are the, the data, any hernia of the umbilicus with belly bon hernia over one and a half centimeters. So that’s, there’s two and a half centimeters to an inch, about three four, almost three four of an inch. Any hernia greater than one point centimeters should be repaired with mesh in the average patient. Why is that? Because their recurrence rate is much, much higher if you don’t by a factor of 11 x, so 1% versus 11% risk of recurrence. And when you do recur, what happens? You’re actually just tearing. So you sew it together and then it does this and it tears. And when you tear, now how big is your hernia?


Bigger than the original one. Now you really need a, a bigger mesh and a bigger problem. So I personally, in the average risk patient, so not someone who smokes, not more breath, obese, not someone with, uh, you know, poor healing in the average risk patient. I do not use mesh in hernias of the belly button less than one and a half centimeters. And I do use it for gray than one and a half centimeters. Does some people always use mesh for belly bone hernias? Is the reason for that is every single study shows that if you look at mesh versus non mesh, the non mesh fails and the mesh doesn’t fail as much. So the results are always better from a hernia recurrence standpoint if you use mesh. Now, here’s my take on it and let’s get outta this because I want to, I wanna be able to interact with you guys.


So here’s my take. Every single study will always show that mesh is better than non mesh. It just makes sense. So from a hernia recurrent standpoint, if you put mesh in, you’re gonna have a lower likelihood of a hernia recurring than if you don’t put mesh in. That’s true for a one millimeter hernia. That’s true for a five centimeter hernia, et cetera. But that doesn’t mean my interpretation, doesn’t mean that you should put mesh for every single umbilical hernia. Does that make sense? So let me give you an example. If I tell you that you have two choices, walk or drive, I don’t care where you have to go, it’s always faster to get from point A to B if you drive, than if you walk. That’s just makes sense. So if you have to go one block to your neighbor, pick up some toilet paper during the pandemic. If you walk, it may take you five minutes, seven minutes. If you drive, it’ll take you 30 seconds. Now, what if you need to grow the store that’s four miles away, five miles away, you can walk or you can drive.


Obviously driving is faster than walking. So on average, if you walk, if you wanna go to the grocery store, you should probably drive. But very few people will drive for one block, even though it would be faster. So the same thought process to me goes for umbilical hernias, which is, um, if you have a small umbilical hernia, yeah, you could put me in will be better, but I think there’s a lot of benefits not to do that. And the difference between the two risk benefit ratio is not there for me. So for the really small ones, I don’t put, I think it’s overkill to put mesh in level two millimeter hernia. Okay, so I have a question from Facebook and it says, how can we ask questions live, okay. To ask questions live. Um, you can do two things if you’re on Facebook, this is a Zoom based, we’re simulcasting on Facebook. So if you have a question, you can come to the zoom. Uh, the link is on the, the, the event page on Facebook. You can go to Zoom, ask me live questions. Um, if I’m good, I can also do Facebook live questions at the same time. It’s a little bit tricky, but, um, I’m happy to do that. So let’s see. We have one question from Facebook Live, which is, let’s see if I can get that without causing too much interference.


Boy, we have, let me get rid of that. Okay. Um, I read a lot on how women present differently with hernias and wanted to know if you’ve ever had anyone who presented like they had a hiatal hernia, but never showed up on imaging until you got in there. Okay. Hiatal hernias are a completely different animal. They are not abdominal wall hernias, they’re organ space hernias. It’s your diaphragm on the inside. I don’t repair hiatal hernias. Um, in general, we don’t repair hiatal hernias unless they are asymptomatic. And b, they fail medical management, which now medical management is so good. We almost never need to operate on people with hiatal hernias. So it’s very uncommon to need a hiatal hernia repair. Next question on Facebook Live is, do you ever talk about pelvic sling pain? I do not. Why? Because I don’t do pelvic sling surgery.


That’s done by gynecologists and urologists that are specializing in female urology. Of course there is a wide range of complications with pelvic sling surgery, just like there is with any operation. Uh, for sure. It’s not something that I specialize in, although I have some patients that have had complications with both sets of problems. Um, okay, another question from Facebook Live. Is there a list of items one should ask the surgeon as to what Brandon type of mesh sutures he will use on a hiatal hernia? You should you also speak with anesthesiologist prior surgery date, especially some sleep apnea? Uh, yes, absolutely. So you should know from the surgeon what type of hernia repair, what technique. So open, laparoscopic, robotic, mesh, no mesh. The type of mesh may or may not be something you really should like interfere with the type of mesh and the sutures really mesh or no mesh is what all you really should be concerned about.


You can, if you want to read more about it, of course, go ahead. Um, uh, and then the, um, anesthesiologist, yes, so you, oh, also you should know what type of anesthesia. So are you getting general anesthesia, epidural or sedation or combination? And then if you have sleep apnea, your anesthesiologist will for sure know about it and also, uh, change the way they give you anesthesia based on that. Usually we tend to give, um, endo tracheal anesthesia, for example, so you don’t obstruct during, during surgery. Sedations a bit trickier in patient with sleep apnea. So the, um, policy is different. Some people, some, uh, surgery centers or hospitals call the patient the day before. That tends to be, uh, uh, the standards. Some, however, call, uh, or see the same days. Sometimes the bigger hospitals do that. Okey doke. The zoom does not require a password, requires you to register.


So if you register, you can get automatically hooked up to this, to this link. Okay, thanks everyone for watching. Let’s go on to the next question, uh, which is from Zoom. And that is, how do you diagnose a hidden or a cult hernia and what are the symptoms and how would you repair it in a person who has a tarlov cyst, hiatal hernia and possible collagen defect? Okay, so by definition, if you have a collagen, if you have a hernia, you have a collagen defect, um, it may not be a named collagen defect like Ehlers Danlos syndrome. Um, but just know that people who have primary hernias generally have some type of collagen mismatch. They have too much of the immature less, uh, strong collagen and not enough of the mature stronger collagen. Um, so hidden or called ankle hernias, um, are, are what we refer to as, as hernias that cause symptoms.


So pain, uh, however, the surgeon can’t feel it. And oftentimes a patient doesn’t feel or see a bulge either. So if you go to medical school, they will teach you that a hernia is a bulge through a fascia. Um, it doesn’t always show up as a bulge. So sometimes you have to kind of understand the symptoms of an occult inguinal hernia or a belly on hernia and then do some imaging or like really sensitive, um, examinations to see if the hernia may be the cause of, of pain. And then a look at the imaging to confirm it, uh, and correlate the symptoms with the imaging because by definition of an occult or hidden hernia doesn’t have an obvious bulge that tends to be more in women. Um, it’s not something we see with hiatal hernias that’s not a, uh, an occult hidden hernia problem. Okey doke.


All right. Maybe you can for Josh Mitchell on Facebook, uh, you’re registering and ask, it’s asking for a password. I think it was because, uh, I don’t know why that is, if maybe someone could help ’em out. But you can continue to gimme questions on Facebook Live and I will answer them once I see some friends here. Mac, Annie. Hi, and Klaus, I haven’t heard from you for a while. Nice to hear from, see that you’re watching. My whole team is watching. Okay, let’s see. Another question on Zoom. I’m so excited you guys are all here. Okay. Have you seen a full recovery after 10 months? Any hope of still having soreness after 10 months? Thanks. Ooh, that’s a hard one. In general, you should be healed from your hernia repair within three months. That’s what’s considered standard. Anything over three months is considered chronic pain and need to figure out why.


Now everyone’s a little different. That is the standard. Some, uh, studies have shown that if you went up to 12 months, that by 12 months almost everyone is pain free. So a little bit of soreness may take, uh, a little bit more than 12 months to resolve. It shouldn’t be any chronic debilitating pain. Uh, but yes, there is, there is hope if all you have is soreness, little pulling or twinging, um, that will go over time. Uh, anyone who’s had surgery knows you’re never normal in that area of your surgery. You’ll get a twiner or weird feeling or hypersensitive in, in the area, um, for years. But if it’s severe and debilitating or hasn’t addressed your underlying symptoms, then for sure that’s something you should see your doctor.


Ok, let’s go back to Facebook. Oh, Desi’s helping out. Thanks Desi. All right. Um, let’s see. Another question from our Zoom members. I’ve been dealing with chronic left testicular and left Inguinal area pain for 20 years after left Inguinal hernia repair. The anal nerve was cut during the initial surgery. Okay, so you had your hernia repair 20 years ago in the groin, and you’ve had the nerve cut at the par at the initial surgery. And then, um, hold on. Are you trying to talk here? Let’s see. Raise your hand if this is your question and we’d like to discuss it. Um, live. I’ll unmute you. Okay, so as part of the second surgery neuromas were identified. So, okay, so you had a nerve cut, naive neuroma and removed, and the mesh was put in. Have still been, has still been searching for relief since two years ago.


I had a diagnostics for spermatic cord block to explore a degradation operations. Since the spermatic cord block, my pain systems have symptoms have spread to other areas and worsen. Could the mesh be playing a role in my pain? Whew, that is very complicated. Okay, so mesh related pain, highly complicated. I’m happy to, um, help you with that if you want in start an online consultation through my office. Cause I really need to see what type of repair was the first one. How they, uh, did the, uh, the neurectomy, why they did the neurectomy, and then what the type of repair was. Review all of your imaging because there are a lot of things that could happen in terms of, um, uh, uh, you can have a recurrence, maybe you have a recurrence and that’s the reason why you have symptoms. And then with your second surgery, what kind of mesh, what kind of your, how do they address it and so on.


So your operative reports are very important and your imaging is very important. And if you send those to me through an online consultation, I can review all those and then give you an answer in a very, very detailed, um, way. However, on that note, um, short answer is yes, but if this was, if your second surgery was also 20 years ago, likely your mesh is not the problem. And you have a hernia that’s recurred. Um, and that’s why you’re having the testicular pain. These are all little details that a lot of people don’t appreciate. If you had surgery 20 years ago and you’re having symptoms now, or you’re having lingering pain now you may just have a hernia recurrence and focusing on blocks and spermatic cord denervation and mesh problems may not be a good thing. You may actually be wasting your money, wasting your time and potentially causing more harm with each subsequent operation. So that’s definitely a patient I highly recommend you send me an online consultation request and we can get you a perfect answer because that’s very, very specialized.


Okay, love all these questions. Christos is here. Oh, I hope you’re doing well, Christos and staying safe because, um, it’s crazy out there. Okay, and brandy, Brandy, I hope you’re doing well. I miss you guys. Please say hi to, uh, Bruce for me. Me guys are the best. Okay, next question through Zoom for inguinal hernia. Synthetic mesh can be controversial. Our biological mesh products becoming favorable or would a shouldice or must be best. I’m having pain for years following the synthetic mesh implant, hoping to have it removed and use an alternative repair. Alternative repair. Okay, so synthetic mesh is controversial only because mesh in general has become controversial and the surgical world is not controversial, it’s concerned standard of care. However, we understand that not everyone’s the same. So in a general population, the standard of care in the United States is mesh based hernia repair.


However, there will be people that will be hurt from that or we’ll react to that mesh and we need to be very cognizant of that and treat those patients. Or if we know ahead of time who those people may be, then we can prevent them from having mesh. So the question is, are biological mesh pods becoming favorable? No, pretty much pure biological mesh, which started in the early, I think 2000. So 1998 I think was the first mesh product we started using unusual in 2000. We don’t really use those anymore. Not those are completely absorbable very good products, but not durable. You don’t react to them usually if it’s high quality biologic, but it also doesn’t give you a, a good repair. So we don’t really go to biologics anymore. Um, there are synthetic absorbables that have become in style. I’m not a proponent of those because just like the pure biologics, they’re also absorbable.


What has come about are these hybrid meshes, which I think are, are pretty cool. So hybrid mesh is part biologic, part synthetic. So you’re getting the benefit of the synthetic where, which is now not going to go away and it’ll give you a durable repair. But what what you don’t have is as much synthetic as your traditional standard of care mesh. And so in some patients that’s very helpful. So if you think that you have a reaction to your mesh, which is possible, not common, but very possible. I treat many patients that do that, have that, do you feel you have a mesh implant that’s a problem and you need to get that removed for an inguinal hernia repair. You, you do have a choice of then going mesh removal and then take out and, and then redo the repair with tissue only. So shouldice or bassini, you also have the option of a mesh removal and then using this kind of hybrid mesh, which is, uh, an option.


So you do have options. Tissue repair is one. Um, hybrid mesh is another. I usually, uh, not a, um, if there’s any hint of having a mesh reaction, you should not be putting in synthetic mesh again. And you can get a tissue repair and then get an allergy testing. So we do allergy testing for different mesh products and suture products. And then if that hernia recurs, at least we know what we can and cannot put in you. Again, that’s not something that’s considered standard and in my, um, in my experience, we are seeing a lot of false negatives. So lot to learn in that arena, but happy to help if you would like to learn more. Okay, last zoom question before I go on to the prepared questions. Uh, most discomfort from bilateral and more hernia repair with mesh tap. So tap, T A P P is laparoscopic.


T A P P, transabdominal pre peritoneal. So it’s a laparoscopic repair with mesh. Most discomfort from bilateral al hernia repair with mesh top method is standing after about 20 minutes when doing cardio, et cetera. I don’t have discomfort. Any idea why standing in place causes soreness? Well, I would love to read your op report because that will tell me how big of a mesh, how big of a hernia, how was it put in place? Was it tact, suture, glued or nothing? And what type of specific mesh was used because you can have, will be what I call it unstable repair. So here’s your hole, here’s your mesh, here’s your mesh. So if it’s a hole that big and it mesh this big, you’re probably fine. But if you had to hole this big, let’s say a direct angle hernia and the mesh, I don’t know if you can see this, the mesh kind of falls into the hole.


So when you’re laying flats, fine. When you’re standing, the mesh falls into the hole that gives you discomfort. That’s the most common reason why people don’t have recurrences. But they still have discomfort and symptoms after hernia repair. And that is because you had, you have, let’s call it an unstable repair. So it’s a large defect, like, like a big hernia or direct hernia and a mesh that’s falling into that defect whenever there’s pressure. So I had a grandmother <laugh>, she’s a large lady, a grandmother, and she had her hernia repaired, laparoscopically tapped just like our tap, just like you had. And she said, every time I’m at the soccer games for my grandkids and I’m yelling at them, it hurts me. And the reason was it wasn’t that she was, she was doing anything wrong, it’s that the hole had the mesh, but every time she yells she was causing abdominal pressure and that mesh was getting pushed into that hole and she was getting dis discomfort.


So you just have to tighten it up a little bit more. Um, so that’s my funny story about unstable mesh repairs. If we fixed her, she’s now probably yelling at the grandchildren and, and, um, so on. So, okay, another Facebook. So, okay, so therefore you need surgery. Well, let’s evaluate. But once it gets evaluated that if that’s the reason, then you just need the whole tightened up so that it supports the mesh repair better. Hope that was helpful. Okay, my good. Facebook friends. Um, what are some very bizarre adverse reactions you’ve seen patients have with Anglo hernia mass repairs? Why do many doctors believe this doesn’t happen? And also, what is the most minimally invasive surgery to remove large Anglo hernia and what is best option to repair? Michael Valentino agrees from Chicago. Thanks. Okay, so the question is what are the different weird reactions that I’ve seen?


So I have a very unique practice, as you may know. Those of you that follow me on hernia talk or Twitter or Facebook or Instagram, is that I only treat hernias. And so I only see hernias. And most of the people don’t come to me because it’s their first hernia. It’s because it’s their second, third, fourth hernia. And over 80% of my patients are recurrence or have had a complication. And half more than half my patients are women. Like 53% are women. So because of that, I see a very narrow subset of patients. So if you’re a general surgeon, you do, you do all these hernias and I only see this much of their practice. So I see a lot of a small proportion, which means I keep seeing these rare things over and over and over again because no others aren’t seeing it. And the reason, um, why that’s important is because, uh, these rare things then come to light.


I start seeing trends. And what I’m seeing is these trends of people having mesh reactions, you’ve gotta mesh put in. They get these weird rashes, like not where the hernia was, but elsewhere, it comes and goes. Um, their joints start today, they start having problems sleeping. I’ve had people have ringing in their ear, brain fog, they’re driving. It feels like they’re not there. Um, uh, one person felt like, like worms. One guy had problems with one leg, uh, in terms of just weird things. And you go to your doctor and you say this and they think you’re crazy because nothing makes sense. They don’t teach this stuff to you in medical school. But if you put it together as one syndrome and you try and kind of figure out, oh, and also they have lupus in their family, or, um, this lady, she had breast implants and she rejected those and, and now she’s got mesh and that’s what what’s causing problem.


Bloating, nausea, um, all these symptoms as a syndrome can then, uh, um, be something that’s, that’s, uh, that should be addressed and can be from the mesh. And unfortunately, there’s a lot of surgeons that are very afraid to remove mesh. My threshold for removing, uh, mesh is lower than most, but it’s also because I do it a lot and I feel comfortable with the operation. And so, um, uh, it should be considered. But that said, I work with an allergist, so I don’t take this light. I take work with an allergist. I work with a rheumatologist. We try and figure out all different reasons why you have a dermatologist. I work with all different reasons why you have this mesh reaction. Um, and if it’s not a mesh reaction, we need to treat that. Uh, so, um, thank you about he sent the message from Facebook, uh, about six years ago.


You saved my mom’s life. I love you, doctor. Oh, thank you. I love you back. Okay, another question from Facebook. How can someone with an Anglo hernia keep it from getting worse during this time of covid when elective surgeries are not possible? I’m wearing a truss and I’m hoping for the best. Oh, I’m so sorry. Uh, so many of my patients are in the same boat, and as I explained, I don’t treat regular hernias as much as I treat the complications. So I have patients with, with chronic pain, nerve pain, hernia related pain. And, um, in the city of Beverly Hills, elective surgeries are banned. And <inaudible> Hospital at Cedar Sinai also all elective surgeries are banned. So I’m hoping that by end of May, beginning of June, I can maybe operate on these patients. I’m hoping.


In the meantime, we’re staying at home and doing webinars and wearing our masks when we go outside and socially distancing and, and, uh, hoping that all those efforts together will shorten the duration of this pandemic so we can get along to our more normal life. So on that note, the best thing for hernia pain, if this is just regular hurricanes, ice ice packs. So small ice packs, put it over your groin or your belly button. Why? Because hernia pain is inflammatory and ice is a great anti-inflammatory. So if you’re sitting watching your Netflix watching Tiger King, which I just finished watching, which was the craziest, uh, <laugh> documentary series I’ve ever seen, it’s if anyone’s, if anyone’s not seen Tiger King, please watch it. It’s seven hours of pure hell and lots of entertainment. Um, and it’s crazy. Uh, that said, <laugh>. Um, going back to the, the topic.


So ice packs are great. It reduces the inflammatory pain of your hernia. Uh, hernia trust is good if your up and about and your symptoms are worse when you’re up and about because the Truss will hold the hernia back in and it’s the pressure of it being out that’s causing the symptoms. If you put it back in and you, and you have a Truss holding onto it, then um, that will help. That’s said you have to wear the Truss correctly. And there’s some horrible trusses out there. If any of you’re on Instagram, there’s a cool guy named, um, I think it’s Comfort Trusts. He sells comfort trusts and hi, he’s at Natural Hernia Cure. Um, not affiliated with him, but you know, I follow people that like hernia stuff. So he is a bit more of a comfortable, more athletic type of hernia trust. And then, um, other anti-inflammatories also work, so Naproxen Ibuprofens a or Advil, Motrin.


And um, I am also a big believer in natural ways of giving anti-inflammatories. So, uh, ginger, turmeric, those are great anti-inflammatories, rumbling alpha lipic acid B complex, and um, Anika, they are really great. All right, more friends coming on. Hi Allison, I hope you’re safe. And with the babies, baby babies. Um, okay, next question from Facebook. My biggest anxiety about surgery is the waking following surgery to the point, well, you must wake after surgery, obviously to the point my heart race is just thinking about it. I hate the de the dead fish groggy feeling trying to wake so much. It’s is today’s general anesthesia, medications and procedures better? What combinations best allow me to wait. Okay, the best way to wake up is after IV sedation. So not general anesthesia. The patients will wake up nearly, they’re not nausea, they’re not groggy. So if you have a hernia that can be repaired under local with sedation, so it’s open repair, not laparoscopic, um, if that’s an option for you, then IV sedation only is awesome, awesome, awesome.


I I use it all the time. So you’re basically asleep, you’re breathing on your own, there’s nothing in your mouth to help you breathe, redo the operation of the groin. You wake up shortly afterwards, it’s a great sleep. Not groggy. Not nauseated. That said, if you talk to your anesthesiologist, because you definitely need general anesthesia, there’s a lot better combination of drugs that he can give you that reduces any, um, nausea and then doesn’t make you a sedated. What makes you very sedated is a fentanyl. Don’t let him give you so much fentanyl or ask for a non-narcotic, um, general anesthesia and you will feel as groggy. It’s mostly propofol based. Um, and they give you little to no fentanyl. It’s a fentanyl that really makes you groggy. So that’s what I recommend. Thank you for the live video. Yes, please, um, contact my office if any of you want to continue this to a much more detailed tailored, um, you’d be surprised how much detail I give you in real life.


Sheila is my office manager. You guys will learn to love her if you contact my office and she will walk you through the whole process and she knows, and my nurse Bell knows that, um, when I do these online consults, it’s like page and pages of information to you. So I, I hope you like that. And if you do, call the office and the man picks up the phone. His name is Myron and he is my awesome, awesome, um, scheduler who also helps with the phones. And um, I hope you’re staying safe. I know Matt’s on on here. Okay, can you mention those anti-inflammatories again? Yes. So turmeric, ginger, brom, a lipoic acid Super B complex Antarctica. If you, um, didn’t write that down so quickly, go to my website under homeopathic regimens on the first page, just click on it and I have exactly the regimen that I use.


So we actually, before your operation, we actually give you anti-inflammatories three days before and that lowers your inflammatory statement. Continue that five days afterwards and that, um, makes you have less bruising, less swelling and less pain. And we also have a clinical trial doing the same thing with Chinese herbs that are very good at reducing inflammation and bruising and all that. So, um, big believer in anti-inflammatories. Everyone gets an ice pack in my office because that really helps with your pain before surgery and after surgery. Um, but all that information’s also on my website. Uh, I think I may have posted it on Instagram too, but I definitely have my website under homeopathic regimens play Continental has a pre on exactly what we give all our p all our patients okay to is here. Talk to you tonight. Okay, another Facebook question. Had anal surgery four years ago, still dealing with that, with what feels like nerve pain been to the doctors with no results after four years.


Would you still feel pain if nerves have been damaged during surgery or would it be more likely that it could be related to mesh and nerves? Both, both are possible. So chronic pain is a problem. Um, and mesh related chronic pain is a problem. And that pain can be from nerves, from mesh, from inflammation, from a recurrence, from the actual foreign body reaction or any combination of all of those together. But it’s very important to narrow it down because you don’t want to just have all your nerves and all the mesh and everything redone. Um, if you could just be tailored. So the first thing you do is get, um, a very detailed history because nerve pain feels different than hernia recurrence pain that is different than mesh related pain. Um, so I ask you very detailed questions like do you have pain that radiate to your inner thigh or to your scum around your lower back?


Do you get bloated? Is it worse when you’re standing or sitting or crossing your legs? So these are all, um, parts of the, the detailed, um, history. And then, um, we start with imaging to rule out if it’s mesh ball or hernia recurrence or inflammation. And then we do a nerve block to see if a nerve block reduces any of your pain. And that helps, helps figure out what the problem is. But it can be any combination above. We have less than 10 minutes, guys. Now I promised you I will do this once a week while I am quarantined. Um, Ida brought a whiteboard for you in case you want me to write, but for now, um, I will just ask the questions, which is great. Uh, were you healthy to fit having issues as well? Oh, okay. Dylan’s talking to Josh. Great, you too are talking.


Great. Um, so how you can combine homeopathic remedies with your social activity? Oh, absolutely love it. I think we need to be open to every thing. If it works, uh, you should do it. So western medicine, eastern medicine, um, anything that has actual, uh, evidence behind it, I’m a big, big evidence-based person and I have an open mind. So I know that we don’t know everything and that, um, there’s a lot that we don’t know and we don’t know what we don’t know. So when patients come to us, we should believe the patient and trust your story and help figure out how we can, um, figure out what’s wrong with you based on what you’re telling us. Um, and that’s, I would like to say to all my patients out there, um, prospective patients that one of the things that really I think differentiates our practice from many others or a typical general surgeon is that I do spend a lot of time with you and I believe you and I give hope and we will try, we will figure out if you’re here with any pain, even if it’s not her related pain, I will work my butt off to figure it out for you because I what it’s like to be in chronic pain.


It’s, it destroys your life, it destroys your family, it, it destroys your work. Um, and there’s no reason for someone to just wake up one day and have chronic pain. So there is almost always 99% of the time, um, an actual mechanical functional reason for that pain. And we’ll figure it out and I will help figure that for you. Okay, zoom question. I heard I shouldn’t get open surgery to repair my original laparoscopic angular mesh implant, but open is the option being offered. What is a real consequence? Open repair. Oh, don’t do it. Okay, so basically the situation is you had a laparoscopic repair and with mesh that means the mesh was placed behind the muscle through three little holes. You now have a problem with that laparoscopic mesh. Maybe it’s folded, maybe it needs to be removed, replace whatever the situation is. If that’s what happens, then um, you should attack it again through those three little holes, laparoscopically or robotically. If you do it open, you are cutting through all the muscle that’s currently normal and your skin and the nerves to get to the, to the mesh. Okay? I’ll give you an example.


Let’s say I have, let’s say this is your skin, okay? And on the other side of this wall, so there’s a hole, this was your hernia, right? And on the other side of this wall, and you had your laparoscopic rash place. So, uh, there was a, there’s a hole here and on the other side you had your repair, your mesh repair, right? Would you rather I walk around this, this wall to the back of this wall to fix what’s wrong in the back? Or do you want me to demolish this wall to get to the other side of that wall? Maybe just doesn’t make any sense? So yes, it’s possible for me to demolish this wall to get to the other side of this, of this wall will really make sense. It’s for me to walk around to the back of this wall and deal with whatever’s the back of the wall.


So that’s why laparoscopic should be done laparoscopically. Um, open mesh complications should be done open. That’s my two sons. There are some people who disagree. Every one of us that does this for a living disagrees with that, with those people. If you are being offered an open repair. And the reason is because that surgeon cannot do it laparoscopically, robotically find another surgeon I’m telling you to go. That’s just a disaster to go through it open when you, when you can do it, uh, laparoscopically or robotically, that’s my 2 cents. Find another doctor, travel. Um, do what you need to do. Uh, I have a long list of friends that I know and that I work with. So, um, if I’m too far away from you, uh, I can help refer you to someone or get someone near you who can help you if I feel that’s a good option for you.


Okay, four more minutes. Just so you know guys, I have, where am I, I have all these questions that we’re ready to answer for you from other places, but what I’ll do is these questions will wait until next week. Um, maybe we’ll do two hours next week. One hour kind went pretty fast. And what I’ll do is we’ll do another hour next week. And if I’m really bored, I’ll do one during the middle of the week. I’ll let you guys know. But, um, it’s three minutes left to the hour. Let’s do one quick question. Uh, it’s possible that my groin seems fattier after hernia surgery. Not fattier, but the scar tissue and the way things were sewn and put back together, it’s possible that you may feel may, it may look weird compared to the other side. Um, that’s just the way the tissues were sew together and they healed.


So in our last three minutes, I just wanted to thank everyone for coming on to here. There’s a lot of activity going on here on the, uh, Facebook. Let me just double check what’s going on. Oh, people are making friends. Josh and Dylan or, okay. Do you take insurance for online consults? Online consults? No. That, um, is purely online. A lot of emails going back and forth. I never get to examine you. So insurance doesn’t consider that as telemedicine or telehealth consult that I can bill for. So no, I can’t send that to insurance. However, if you want a telehealth consult that’s a little bit different, that’s live. It has to be done by by law. That’s to be eligible for insurance, it has to be done live like this by video. You can’t ask for one of those.


Uh, the process is very similar. Just call my office and share all your medical records with me so I have all the information, um, that I need before we can initiate the telehealth or online consult. So on that note, oh, I’m very awesome. Thank you so much. I love what I do. Okay, let me just share this last screen. I just want you all to know that, um, how much I love what I do and I’m kind of crazy like that with all the hernias. So I know it’s not a very sexy topic, but I do love it and my whole office loves. So at the end of this, I will save this broadcast and I will post it on YouTube. I’ll share that to all my followers on Facebook, Twitter, and um, Instagram. And also those of you that have signed up on herniatalk.com, you can also link to YouTube if you want to go through this all over again and see, see what it is.


You are your affiliate. Do you have document doc recommendations on the East coast? Absolutely. Dr. Eric Poll and, awesome. PA U L I. I hope you enjoyed it. Hernias aren’t the most like cutest thing to talk about, but, I enjoy. Okay, thanks everyone. I hope you enjoy the rest of your weekend and I’m about to go and hang out with my family. So don’t forget follow me on Twitter, Instagram, Facebook, sign up for herniatalk.com and I will see you next week. If you have any suggestions for another type of time, please let me know and we’re gonna end this right now. Thank you.