Sucks..... I think I have a hernia

[MattTuck]

So, I think I have an inguinal hernia. Happened I think last Monday on a ride when I was sprinting to make it through a set of two intersections with cascading red lights.

Didn't bother me at that point. When I woke up the next morning, it was VERY tender and hurt to move in certain ways. It got progressively less tender/painful through the week and now doesn't seem to be causing any pain. I had been hoping it might just be a muscle strain or something, but there is a definite pea size lump.

No real question, since I read previous posts on hernias and most people seem to make it through OK. Just kind of bummed. haven't ridden since last Monday, and the earliest appointment I could get to even diagnose it is September 3! So I have to wait until then to even ask if I can still ride with it, or if I am at risk with getting back on the bike.

I'm contemplating going to Shouldice Hospital for the surgery, if they recommend surgical repair (which I guess they don't for small hernias due to risk of post-op pain).


Anyway, like I said... no real question. Just a little depressed about it, and felt that sharing my feelings might help.

[false_Aest]

SUCKS!


Next time use Duck Tape.

T

[pjmsj21]

I went through my third hernia surgery in June and while not all hernias are the same, I was back on the bike in 7-10 days after my surgery, with my doctor's ok. And this was not the arthroscopic surgery.

I noticed my hernia in the spring and wanted to get it fixed and out of the way for Ramrod and Cycle Oregon in July and September, but my doctor said that I could have easily waited till after September, not that it would have been particularly comforatble. You might just want to wait until the off season, so you dont loose any of the wonderful fall cycling days ahead.

Pat Mc

[BumbleBeeDave]

. . . these days. I had one in '97 and the paperwork and prep took far longer than the actual surgery. They implant a piece of nylon mesh and I was told at that time the rate of recurrence with the mesh was only about 1%.

I was out for a slow walk the next day and back on the bike in 7-10 days. The post-op pain was negligible as long as I laid down for a few days. Just don't let them give you Darvoset for pain. I took one, got up to go to the bathroom an hour later--and woke up on the bathroom floor. I had blacked out while standing there to do my business. I was very lucky not to have hit my head on the tub or sink as I went down. No more Darvoset for me!

The worst part of the whole thing was the twinges that went on for 6-9 months. Scar tissue grows into the mesh, so it would keep growing in, then getting little tears in it and re-healing over the next months until it had grown in just the right way to accommodate whichever way I would move.

BBD

[erikbrooks]

I asked if I could wait, because I was actively training for the masters national champs in XC skiing. Doc said that in my case, if pain was managable, then go ahead and put it off, so I did. IIRC, I put it off for 6 months - til the end of ski season/start of bike season. After the op, I stayed home 2 days, and then walked the 3 miles to work for a week, and then was back on the bike.

One other comment. Five years after, mine still pokes out a bit. The surgeon thought that it would smooth over, but during the 6 month followup checkup he decided that for low fat people, it may not happen. For 'normal' folks, the fat layer sort of adjusts around it.

The only remaining negative for me is that mine is at exactly the same height as countertops - and when I'm prepping food, I often lean against the counter and it causes some mild pain. C'est la vie.

[MattTuck]

The Shouldice Hospital method (which I'm considering) does not use a mesh. It is a connection of tissue to tissue. and supposedly is better. I think the recovery may take longer than the mesh.

[gasman]

You can keep riding and just use pain as your limiting factor.
Don't push if it hurts. Find an experienced surgeon and your long term results will be better. I had a hernia that I waited almost a year to have fixed.
Laproscpic repair on Friday and back to work and on the bike easy on Monday.
If you have a marked increase in pain or inthe size of the hernia go to the ER.
Good luck.

[Bud_E]

I had open mesh-implant surgery on both sides at the same time. My recovery took several weeks until I was 100% but I haven't had any issues since then. The thing that helped me get through the first few days ( besides the happy pills ) was using ice bags - I had a rotation of 4 or 5 of 'em going the first 3 or 4 days.

[Louis]

I'm contemplating going to Shouldice Hospital for the surgery

Because of the B-school case study?

[MattTuck]

Because of the B-school case study?

Actually learned about it before b-school. Featured in a book called "complications" by Atul Gawande and elsewhere.

[Kurt]

and although its common if its not done right like many things it can ruin your life. just had a friend come out of a 5 hr surgery last week to repair a botched lap. he has been in constant pain for almost 2 years, many surgeries to snip nerves, etc. the best of the best are below. towfigh did my inguinal last oct and I drove a stick the next day and was on a bike in a week - never took a single pain pill, she is over the top amazing. if you research Shouldice a bit more you can see that unless you live around the block there are much better options. they cut muscle and also snip a few nerves and the recovery is long. nothing beats a lap done by an expert, one day it will be the only way its done but you have a lot of guys trained in only open that are fighting it. good luck

Bruce Ramshaw -- Columbia, Missouri
Kevin Peterson -- Las Vegas
Shirin Towfigh -- LA
Peter Billing -- Seattle area
Miami (FL) Hernia Center
Jonathan Yunis -- Sarasota, FL
Todd Heniford -- Charlotte, NC
Dr. Grischkan -- Cleveland
Dr. Ferzil -- NYC

[bob the nailer]

I agree with kurt about the shouldice but it is certainly FAR from unanimous that the lap is the best way to go. First to do a lap repair you have to transgress the abdominal cavity, which risks damage to intestine and blood vessels, and particularly if you are only doing one side there may not be an advantage. Now back to the OP, you don't say where the "pea sized" lump is but a hernia is usually larger than a pea, it would be more on the size of a grape or even a plum to stay with the food motif. Does it go away if you lie down? Is it in your groin or by your testicle?

[gasman]

If the surgeon is worth his/her salt the whole repair is done laproscopically but with a pre-peritoneal approach. There should be no violation of the peritoneum. Mine was even fixed under spinal anesthesia with minimal sedation.

[bob the nailer]

That may be how yours was done Gas but I would wager that most of the surgeons doing laparoscopic hernias are doing transperitoneal. Preperitoneal is much more challenging than transperitoneal for the surgeon, requiring a greater expertise. Urologists like me at one time tried to adapt extraperitoneal approach for laparoscopic radical prostatectomy but that has been largely if not completely abandoned with the advent of the robotic prostatectomy( a whole nother can of worms to be opened regarding whether it is science or just hype in relation to an open procedure. )

[MattTuck]

I agree with kurt about the shouldice but it is certainly FAR from unanimous that the lap is the best way to go. First to do a lap repair you have to transgress the abdominal cavity, which risks damage to intestine and blood vessels, and particularly if you are only doing one side there may not be an advantage. Now back to the OP, you don't say where the "pea sized" lump is but a hernia is usually larger than a pea, it would be more on the size of a grape or even a plum to stay with the food motif. Does it go away if you lie down? Is it in your groin or by your testicle?

I usually don't see the wisdom in trying to diagnose this type of stuff over the 'net, but since you are a Doctor... I'll try to describe it.

I haven't spent a lot of time feeling it, I figured I'd let a doctor do that. But I think I have been able to feel it while lying down.

As far as location..... this picture describes it as best as I can. Sort of on the front/middle of my right leg but just above where my leg connects to my torso. I still stick by the "pea" size. MAYBE the size of a marble. But certainly not as big as a grape. It is also fairly "firm", it doesn't give much if I push on it gently.

[gasman]

Matt-
It is in the location for a hernia but you really need to be examined. In the meantime if it isn't painful don't worry about riding.

Gas

[gasman]

That may be how yours was done Gas but I would wager that most of the surgeons doing laparoscopic hernias are doing transperitoneal. Preperitoneal is much more challenging than transperitoneal for the surgeon, requiring a greater expertise. Urologists like me at one time tried to adapt extraperitoneal approach for laparoscopic radical prostatectomy but that has been largely if not completely abandoned with the advent of the robotic prostatectomy( a whole nother can of worms to be opened regarding whether it is science or just hype in relation to an open procedure. )

Bob-
We still have some good surgeons doing an open approach for hernia repair. I get to see all of them operate (400 bed hospital) and the couple of really good ones still do a preperitoneal approach but you're right most have gone to an intraperitoneal approach.
I agree that robotic almost any procedure (prostate, gyn, cardiac) seems to mostly hype in my eyes as the outcomes seem to have little difference. i think the surgeon makes the biggest difference in outcome.

[davidlee]

Could that be a swollen lymph node he's feeling?

[Kurt]

That may be how yours was done Gas but I would wager that most of the surgeons doing laparoscopic hernias are doing transperitoneal. Preperitoneal is much more challenging than transperitoneal for the surgeon, requiring a greater expertise. Urologists like me at one time tried to adapt extraperitoneal approach for laparoscopic radical prostatectomy but that has been largely if not completely abandoned with the advent of the robotic prostatectomy( a whole nother can of worms to be opened regarding whether it is science or just hype in relation to an open procedure. )

all of the folks on the list I provided do it tepp, extraperitoneal preperitoneal. because I have now had 4 people I know use towfigh after me I can say she has an amazing outcome with what she does, 3 weeks out I could not tell me good side from the one that was done - what more could a person ask for.

[BumbleBeeDave]

Now I'm really getting queazy looking at this! :eek: :rolleyes:

BBD

[OtayBW]

I usually don't see the wisdom in trying to diagnose this type of stuff over the 'net,....

As far as location..... this picture describes it as best as I can. Sort of on the front/middle of my right leg but just above where my leg connects to my torso.
I had an inguinal hernia years ago in apparently the exact same place, and oddly enough, I sort of figured it out on a bike ride when it began to feel....uh...sort of...well, like I blew a gasket. Fixed it via outpatient surgery and went home that afternoon. This was in ~1993, so I don't know how things have changed since then.

The worst part of it for me was NOT the surgery, but the diagnosis. Forget this 'turn your head and cough BS' - the surgeon had me lie on my back on the table while he did the equivalent kind of probing, and man, I gotta tell you: I was flopping around on that table like a fresh caught fish! And then he had to do it again later to check the recovery. Wowie!! Wow! Wow! Didn't hurt, per se, but sure was creepy.

(Good news was that I was able to crack the GF that night after surgery, so no worries....but I digress...). ;)

You'll be fine. Good luck.

[bob the nailer]

Lymph node sounds like a good possibility, but in any case get it checked out, you know the history is only part of the equation, a good examination which can't be conducted over the net is also essential. Best of luck.

[cw05]

all of the folks on the list I provided do it tepp, extraperitoneal preperitoneal. because I have now had 4 people I know use towfigh after me I can say she has an amazing outcome with what she does, 3 weeks out I could not tell me good side from the one that was done - what more could a person ask for.
That is untrue, all Heniford does is TAPP. It is surgeon choice as the hernia repair with TEPP and TAPP are equivalent. Most surgeons are not married to a single laparoscopic technique as each has its place in the right patient. The advantage of TAPP is that is easily allows visualization of the contralateral side so if you have another inguinal hernia, you can have it fixed at the initial operation...not later when it becomes symptomatic/clinically evident.

[Endless Goods]

Focus on getting a thorough inspection with a surgeon you are comfortable with. I also had a painless bump that turned out to be an inguinal hernia.

First doc wanted to do lap, second doc did not due to its large size. It was open procedure.

We eat so many cheeseteaks in Philly we're blowing gaskets left and right, so I was pretty comfortable with the second doc who headed up a hernia dept and taught.

I wouldn't over research on the internet- you'll only go in circles. Not to scare you, but my recovery period was longer in terms of pain than most. I think it was due to the large size of the repair. I think I was 26 at the time.

It's taken a few years to get my flexibility and power back, although I was sprinting at full force on the track about 9 months after the procedure. Felt some pain afterward of the muscle still stitching together as Dave mentioned.

The doc said I could ride after the two-week post op, but it took a good while longer before I was comfortable doing so. Don't worry about re-injuring the repair. Your more likely to injure the other side. As males, our testicles passed through this muscle wall and the opening was sealed up. It is always a weak spot that women do not have.

Best of luck.

[MassBiker]

I'd focus more on getting it done right........once. I'd worry less about a speedy recovery. My .02 cents - open repair, no mesh.

[cw05]

I'd focus more on getting it done right........once. I'd worry less about a speedy recovery. My .02 cents - open repair, no mesh.
Good luck finding a surgeon (besides Shouldice which really is an anomaly) in the modern era who will fix an adult inguinal hernia without mesh. More important than the presence of mesh, is the weight of the mesh. I would lean more towards surgeons using lighter weight mesh (whether open or laparoscopic) such as Ethicon's Ultrapro. One's post-operative quality of life (ie, whether the presence of the mesh causes post-op pain or activity limitations) is almost as important as whether or not the hernia recurs.

[MattTuck]

Went to the doctor today. What a load of crap. After feeling me up down and all around town, she couldn't give me a definite answer. She thought that the "bump" I felt was probably a lymph-node. But wasn't sure, then she felt something that MIGHT be a hernia.

Going to see a hernia specialist in early September. Hopefully I can get some resolution then.

Good news is that she said I could ride.


Thanks to those who passed on the tips, info and advice.