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Saw three doctors - more confused than ever...


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  • Saw three doctors - more confused than ever...

    I had posted previously looking for a doctor in the Houston area. Briefly a history - I am already a chronic pain patient with chronic neuropathic pain in the spine due to two rare nerve conditions. I had a reaction to a mesh plate put in during back surgery, so will not do mesh. I developed a left inguinal hernia in 1994 which I had repaired successfully without mesh. I developed another hernia on the right side in 1996 that stayed the same size for years and never bothered me. But then, I stupidly did some core exercises with a PT that made the right hernia bulge a lot more, and the left side start hurting.

    Doctor 1 - agreed that he would not do mesh on me, but does mostly mesh surgeries. Said he did non-mesh in med school. Wasn't real concerned about the left sided hernia. Asked him about the nerves during surgery - said he normally cuts them - says they are not really visible because they are the same color as the tissues?
    Doctor 2 - older physician (not real old, but maybe in his 60's?) has had a lot of experience with hernias. Has worked on some of the professional sports people in the area. Said he wouldn't know if he had to use mesh or not until he got in to see how large the hole is. Said he could inject something (not sure what) to the previously repaired left side hernia that is hurting during the surgery if I decided to get the right one repaired. Said he uses the Prolene mesh system (I believe this is one of the meshes that has caused significant issues?) Seemed over confident a bit. Actually knew my surgeon that did my first surgery. Asked him about the nerves - honestly, I don't really recall his answer because it seemed like he was "skating" it a bit.
    Doctor 3 - spent the most time with me with the actual physical examination. Seemed very caring. Told me that she suspected that the left side that was previously repaired could either be damaged from muscle tears or torn scar tissue, but could also have re-occurred. Wanted to do a C-Scan to determine. Based on my previous experience with mesh, would do an open non-mesh repair on both sides if necessary. But said the surgery on a re-occurrence is much more difficult because of the previous scar tissue. She does almost all mesh repairs, but said she knew the anatomy enough to do a non-mesh repair. (this comment scared me a bit!) I asked her about the nerves - she said there were two major nerves that run in this area, in 50% of patients, she has to sever one of the nerves. She also thought the hernia was large for my size - the other doctors didn't seem to think it was that large (definitely visible, but they said they have seen much larger).

    So, I'm not really comfortable with any of the doctors. I don't agree with the cutting of the nerves with the first doctor and don't feel that he has done many open non-mesh repairs. Doctor 2 is the most experienced by far - but uses the mesh that has caused many issues - I worry about the ethics on that. Although my friend who works with the professional ball teams in Houston spoke to the orthopedic doctors she works with and said he is one of the doctors that they use (they use several - some out of state). Doctor 3 didn't seem to do many open non-mesh repairs, but did seem to be more thorough and thoughtful about my co-existing conditions. She also was the one most concerned about my left side potential re-occurrence. However, she said two nerves are in the area (aren't there 3?) and uses C-Scan to detect a re-occurrence (I thought MRI was the standard).

    I can't afford to go out of state and couldn't do it physically anyway. I just had a few questions, red flags.

    1. Isn't MRI the right way to DX a re-occurrence?
    2. Can you have a re-occurrence if it's just painful but you can't feel a lump? The area of my previous scar is really tender and if I bend down and try to pick heavier up, it hurts even more. I think both the first and second doctor weren't worried since they couldn't feel a lump.
    3. I was told that if they cut the nerve, it would just cause some numbness in that area. But I have read conflicting things on this - such as development of a seroma, etc.

    I'm in some discomfort now, but I wonder if I would be better off doing nothing? I've read so many bad stories about hernia repair (and especially repairs of failed hernias), that I'm scared to death. I truly can't afford another chronic pain condition - I think it would literally push me over the edge.

    Any advice? Thanks in advance.

  • #2
    - prefer to not cut any nerves, especially given your current chronic pain situation and nerve disorder.
    - sounds like tissue repair is feasible
    - I don’t believe the PHS hernia mesh is a good one for women and for small hernia
    - delay your repair unless the discomfort is preventing you from performing your daily activities
    - consider traveling.


    • #3
      Thank you so much, Dr. Towfigh for your very helpful suggestions. I didn't like the idea of cutting of the nerves if they could be preserved. I had a few follow up questions if you can assist:

      1. Is it possible to have a re-occurrence without a lump? I have heard both standing ultrasound with valsalva or pelvic MRI is the right way to diagnosis this. Which do you utilize in your practice?
      2. The physician that suggested the PHS mesh uses the ultrathin mesh in his repairs - although he said he would do a tissue repair if at all possible (he was referring only to the right side that has not been repaired) He said the ultrathin PHS works best on very small individuals (I'm 5 feet tall, around 93 pounds)
      3. What is the best way to repair a tear in a previously repaired hernia? Laproscopically or open? If open used, is mesh necessary?

      Given my health issues, travel would be difficult; however, not impossible. The main reason I cannot travel is my insurance plan is a regional PPO. I'm trying to research further if it is possible out of medical necessity to see a physician out of state. Of course, that would only be an option if the physician would work with the insurance company.

      Thank you again so much for your expertise. I'm so glad I found this site and am not hurrying into this like I did my failed spinal nerve surgery.


      • #4
        Dear Katherine.
        I agree with Dr Towfigh that in a small woman that a non mesh repair would be an excellent choice.
        To evaluate the left side, consider a standing ultrasound with a Valsalva Maneuver.
        If you wanted a non mesh repair on the left, then you would have to have an open repair. Your previous repair was a long time ago and
        you are skinny, a repeat open repair should be possible.
        Bill Brown MD


        • #5
          Thank you so very much for your response, Dr. Brown! I am so pleased you have joined the forum!!!


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