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Wait or repair lateral cutaneous impingement?

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  • Wait or repair lateral cutaneous impingement?

    I知 8 weeks out from left inguinal hernia repair. Otherwise great health, 61 yrs old. Five days after surgery I started getting intense stabbing pain in lateral thigh, along with numbness and extreme skin sensitivity. Symptoms have eased very slowly but I still can稚 wear fabric on my thigh for long without increasing discomfort. Pain increases through the day as I tire. (Luckily I work at home!) Mobility is fine. I知 an avid exerciser and am returning to my usual activities. Surgeon now wants to get it over with by going in and removing a mesh staple, which he seems certain is the cause. He thinks I値l never fully heal without this course of action. He is a hernia specialist, seems truly puzzled by this complication and won稚 admit ever having had this outcome before. I知 wondering if I should just wait, since I知 seeing slow (but very slow) progress.

    Also, my wife is adamant that I need to get an MRI scan. The doctor says it's pointless, let's just go in and remove the staple.
    Last edited by Dwight; 06-13-2018, 05:16 AM.

  • #2
    Originally posted by Dwight View Post
    Surgeon now wants to get it over with by going in and removing a mesh staple, which he seems certain is the cause. He thinks I値l never fully heal without this course of action. He is a hernia specialist, seems truly puzzled by this complication and won稚 admit ever having had this outcome before. I知 wondering if I should just wait, since I知 seeing slow (but very slow) progress.

    Also, my wife is adamant that I need to get an MRI scan. The doctor says it's pointless, let's just go in and remove the staple.
    If he's never seen it before then he will go to the books to learn. And the books say that staples or tacks in to sensitive areas are the primary cause of pain. So you have a few contradictions and concerns. If he is an expert then he would not have put the staple in a sensitive spot. So, how did it get there? How can he be cert an that it's the staple? The guy that made the mistake is going to be back inside. Is that a good idea? If he is an expert and he did everything right, then the staple won't be the cause.

    And if he's never seen it before then he will be, essentially, experimenting on you. Using you as a learning aid. That's not a good scenario and can lead to a series of potentially harmful procedures as he tries to understand.

    I saw this with the surgeon who implanted my mesh. He was very very reluctant to seek outside help. He tried to make his limited knowledge work, at my expense. I had to implore, via a written letter, that he seek help from someone else and he finally gave in and agreed to do so. But he was still too slow and I found my own solution. I never heard from him again.

    On the other hand though, if you go to another surgeon he or she might just assume that the first surgeon made a mistake and also suggest staple removal. I would try to find a very experienced surgeon who will have seen some problems and know how to deal with them.

    Your wife has good point. If the staple is in an "incorrect" spot it should show up via imaging.

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    • #3
      Originally posted by Dwight View Post
      Surgeon now wants to get it over with by going in and removing a mesh staple, which he seems certain is the cause.

      He is a hernia specialist, seems truly puzzled by this complication and won稚 admit ever having had this outcome before.

      The doctor says it's pointless, let's just go in and remove the staple.
      Just to break the problem in to it's simplest parts. Your surgeon can't be certain and puzzled at the same time. What he's offered would be his best guess.

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      • #4
        I just came across what looks like an excellent publication on pain management after hernia repair. It might help you with your decision-making. Good luck.

        https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896652/

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        • #5
          Wow, thank you, Good Intentions. That article was helpful and reinforced my instinct to wait another month or two before agreeing to anything drastic. Your first two notes pretty much described the doubts I already have about this doctor at this point. Again, much appreciate the responses.

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          • #6
            Removing a tack seems like a reasonable course of action if the staple/tack looks as if it was impinging on a nerve. But yes I would assume that would require diagnostics, whether an MRI or otherwise, depending on what the staple / tack type is to see if it can show up on imaging. Metal tacks and staples should show up on most imaging type I believe, I am not sure about dissolvable tacks. You'd want to confirm that with a doctor of course.

            Have you had any treatment for your discomfort thus far? Any nerve block injections or extended anti-inflammatory courses?

            Where are you located? If you are regionally near a hernia repair expert, it may be helpful to consult with one.

            Good intentions makes a good point about the contrast between certainty and puzzled, it reminds me that medicine is sometimes called an 'art' rather than a science because there is sometimes imprecision, intuition, and guesswork involved.

            Good luck and keep us updated on your case.
            Last edited by Chaunce1234; 06-18-2018, 07:04 PM.

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