160. Hernia Health Resolutions 2024

This week, the topic of discussion was:
- New Year’s Resolutions
- Hernia Health
- Risk Factors
- Constipation
- Chronic Cough
- Nicotine
- Collagen
- Obesity
- Exercise
- Core Health
- HerniaScore
- Chronic Pelvic Pain
- Mesh Removal
- Triple Neurectomy
- Second Opinion
- Expert Opinion

Welcome to HerniaTalk LIVE, a Q&A hosted by Dr. Shirin Towfigh, hernia and laparoscopic surgery specialist who practices at the Beverly Hills Hernia Center. This is the only Q&A of its kind, aimed at educating and empowering patients about all things related to hernias and hernia-related complications. For a personal consultation with Dr. Towfigh, call +1-310-358-5020 or email info@beverlyhillsherniacenter.com.

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Transcript

Speaker 1 (00:10):

Thank you for all for joining me. Today is Tuesday, the first Tuesday of 2024. We are on Hernia Talk Live. Many of you are joining me via Facebook as a Facebook Live and also on Zoom, which I appreciate very much. So thank you for giving me the feedback In terms of Follow-up, my name is Dr. Truman Towfigh. I’m your Hernia and laparoscopic surgery specialist. As you may know, this episode and all prior episodes are recorded on my YouTube channel. You can find me there at Hernia Doc. We’ve got thousands of you already subscribed. Please do subscribe. The more I subscribe, the better. I can help you navigate the system, basically trying to figure out how best to get your hernia treated or prevented or whatever you would like. And for that, do subscribe to my YouTube channel. And if you’re not like a YouTube person, you prefer to listen while you’re working, driving at set, washing the car, whatever you like to do, then I recommend that you go to my podcast.

Speaker 1 (01:20):

So we are now available on podcast form as Hernia, Talk Live, and we have most of the prior episodes that are currently on YouTube uploaded to the podcast. We’ll soon catch up. And I’m super excited about that because I personally like podcasts. I don’t necessarily have to see the person who’s talking to me, but I like to listen and learn. And so I hope that you all do the same. So being that it is the first Tuesday of the year, the first Hernia Talk Live of the year, I thought we would kind of follow the whole New Year’s resolutions theme and therefore talk about hernia health resolutions. And that could mean multiple things. It could be what are my resolutions for hernia health out there? And I’ll share with you my plans for 2024. It’s going to be a couple of bombshells. And then secondly is what are your hernia health resolutions?

Speaker 1 (02:27):

Please feel free to post ’em and I’ll read them out for you all. But for those of you that want some guidance, I can kind share with you what I think your resolution should be based on my experience as a Hernia surgeon, like how should you lead your life to either prevent a Hernia, reduce complications from a Hernia repair, and so on. So based on that, let’s start first to talk about what is the resolution. Resolutions basically means setting goals. Usually you want your resolutions to be something that you can achieve and not something maybe a little bit aspirational but not completely unattainable. And then what you’d like, what I would recommend is that I take this time to first start with your hernia resolution. So for those of you that would like to share your Hernia Health resolutions, post them here or message us.

Speaker 1 (03:33):

However, I think based on my experience, these are what should be your hernia health resolution. First of all, Hernia health and regular health are very intertwined. In other words, if you tend to be a healthy person, you don’t smoke, you eat right, you eat the right foods, fruits and vegetables, you exercise, you don’t eat too many greasy foods and so on, then you’re less likely to get a hernia because we know that major risk factors for getting hernias or include constipation, chronic cough, use of nicotine and being overweight. So if you’re not overweight and you’re fit, the stronger your core, the less likely you are to have a Hernia or a Hernia related complication. If you’re not constipated because you have adequate water intake and a balance of food that includes high fibers, which includes mostly fruits and vegetables, then you’re less likely to get a Hernia or Hernia exacerbation because constipation causes a lot of straining and that is a huge amount of abdominal pressure that can make any hernia worse.

Speaker 1 (04:46):

If you have a chronic cough because you have acid reflux or you smoke a marijuana or you smoke a cigarette, those are all risk factors For hernias of chronic cough is not good. Acid reflux causes chronic cough. So if you maintain a healthy diet which reduces acid reflux, you don’t use nicotine, which has been shown to reduce collagen deposits and you don’t smoke marijuana because that can cause a lot of coughing, then you can reduce even more risk for your hernias. And then we were talking about obesity, constipation, chronic cough, nicotine. Yeah, so I pretty much covered it, so that is my recommendation for you. However, you can’t do much if you are genetically prone to get a hernia. It’s like spine disease. Some people will get back problems, others don’t get back problems. Look at LeBron James. He just turned 39 a couple days ago. He turned 39 years old, oldest ever, NBA professional player in basketball. We’re big Lakers fans and we love having LeBron James in Los Angeles. He’s just a good guy and a great athlete. Greatest of all time. Think about this, Michael Jordan, Kobe Bryant, none of ’em were able to play basketball as long as LeBron has wanted to. Kobe had a major injury with his Achilles, he had to leave. Michael Jordan just got too old. It was too tiring for him to do that.

Speaker 1 (06:32):

But LeBron James, physically at age 39 is able to do the same exact running and jumping and so on that all these other kids are doing much younger than his age, and he’s able to at age 39. Now, do you think he hasn’t had injury? I’m sure he has. We definitely know about his groin injury and his groin poles. He’s got ankle problems, a little bit of knee issues, but genetically LeBron is stronger than many of the other NBA players, which has allowed him to play at such a high level and at age 39, now 39, whereas they were talking to James worthy, was it James worthy? I think so. And he was saying after so many years, decades of playing, because they’re playing as they’re teenagers, your body, it just gets run down. So every day is painful, walking is painful, sitting is painful, and so on.

Speaker 1 (07:34):

I’m sure LeBron has pain too. However, the fact that he’s able to play at such a high level at age 39 implies that genetically he is stronger. And the same activity that causes a bone spur or a micro tear or a strain in one athlete in LeBron does not. Or if it does, he heals it quickly. So that is what I’m saying about genetics. So we know that hernias are genetically dominant. In other words, you can pass on your genetic genes about hernias with regard to hernias. And we know from my research and others that these genes are passed on both on the male and female side. So both parents can pass it on. However, a female is more likely and more strongly to pass it on. There was a pediatric study that showed that patients, kids who had hernias were much more likely to have it if their mom had a hernia than if their dad had a hernia, for example. And we found the same in adults that if you have a female patient, sorry, if you have a female family member who had a hernia, that’s a much stronger link to you having a Hernia than a male.

Speaker 1 (08:55):

So what do you do if you’re genetically prone? And what does it mean if you’re genetically prone? Currently in today’s state, 2024 January, we have no ability to alter your genetics and make you less prone to getting hernias. And why is it genetically linked? It’s mostly related to collagen. So the same way some people have more wrinkles and droopier face with age and others don’t. Or some people heal scars nicer and others don’t. Hernias are also related to your collagen. So there’s multiple different types of collagens. Let’s call them good and bad, let’s call them young and weak and mature and strong. So you want to have more of the mature, strong collagen relative to the amount of younger, weaker collagen with nicotine. For example, when people get more wrinkles, it’s not because they’re just smoking and they get wrinkles around their mouth. Actually their whole body wrinkles more.

Speaker 1 (09:59):

Why? Because they lack collagen deposits. The collagen that is laid down is not beautifully laid down when you add nicotine. So with hernias, the collagen that you have is relatively weaker in certain areas of your body than others, and specifically in the herniated parts, and therefore you’re more prone to get a hernia in that area than the average patient because of what we call a collagen mismatch, where instead of having more mature, stronger collagen, less of the weak, younger collagen, it’s reverse. You tend to have the, there are other things too. There are these MMPs, other proteins that have been looked at. No one really understands the genetics of hernias like we do, let’s say genetics or breast cancer or genetics or heart disease. But what we do know is that it definitely is genetically linked. So for now that you can’t do anything about it.

Speaker 1 (10:57):

However, we know that athletes tend not to get hernias. People that have core strength and are good body weight tend to have less hernias. People that have core strength look at bodybuilders. I do hernias for a living. How many bodybuilders do you think I see in a year? Zero. Maybe one. Relatively rare for me to see a bodybuilder or heavy weightlifter because they have slowly grown to be that strong, didn’t happen overnight, and they have very strong muscles that support any potential collagen defect that they may have. Now, are there weightlifters with hernias? Yes. In fact, I’m going to post one pretty soon. I was on Instagram or TikTok, I forget what it was. And my weakness is when I’m on these social media posts and I see pictures, I don’t focus on the content. I focus on the belly button to see if there’s a hernia. So I’m going to give it away. But there’s a really amazing bodybuilder with this huge umbilical Hernia like, you have an umbilical hernia, shouldn’t you get it fixed? But then I’m like, okay, if he comes to my office, how am I going to fix this umbilical hernia? Because you don’t want to mess with nature, you know what I mean? If he tears through it, then that’s going to be kind of sucky.

Speaker 1 (12:24):

So that’s kind of where I’m at with that. So healthy diet, healthy lifestyle will help you a lot of things, including hernias specifically to reduce obesity, don’t use nicotine, don’t have constipation and chronic cough. And if you look at our prior episodes, we actually have had several episodes where we talk about risk factors for hernias and genetics for hernias. And I went through each one of them specifically. We had a GI doctor who was great, Dr. Leo Treyzon, that we talked about constipation. How do you treat it and how do you prevent it? And what if you have it, what are the risks of just having constipation? So you strain a little bit, who cares? I’m not going to get a Hernia. What other problems can you have such as diverticulitis and anal fissures and hemorrhoids and acid reflux and so on. So there’s a lot of things that can go wrong if you don’t maintain a healthy lifestyle and hernia is just one of ’em.

Speaker 1 (13:28):

So the hernia health kind of resolution I would like you to take is to include hernia health in everything you do, and it’s basically your own health, which is to maintain a low risk lifestyle for hernias. Now the other thing I’d like to talk about is, okay, let’s say now you do have a hernia. What does it mean? And before I go on, lemme answer some of your questions. One is, has there ever been any studies done that relate being a premature birth to being prone to hernias? Yes, actually, yes. So there’s two things. One is the pediatric hernias are developmental hernias, whereas adult hernias are acquired hernias in the western world. In the western world, and I say western world because most people in the western world, if they are born with a hernia, it either resolves or they get it surgically repaired. And therefore if they present to you as an adult with a Hernia, it doesn’t mean they’ve had it as a child.

Speaker 1 (14:37):

It means that they have a new Hernia. Whereas if you go to some of the poorer countries with poor access to healthcare, and these are some of the missions that we like to do, a lot of these people have humongous hernias and it’s not because they developed enormous hernia, it’s because they had the Hernia as a child and never got fixed, and now they’re 25, 35, 45 and they have a humongous Hernia, and now they’re finally getting care because it’s getting in the way of their lifestyle and they can’t chop down trees or work in the factory. So the question was, is there a relationship between premature birth and hernias? For pediatrics, yes. For adults, no. So if you’re a pediatric patient and you’re premature, the chances of you having a hernia and there’s multiple types of hernias, but any hernia is higher risk in a premature child because their college is not developed yet and so on.

Speaker 1 (15:36):

However, in adults we have not shown, there’s no study that I know of where adults have been looked at to see if they were born premature or not, and to see if there’s a higher relationship between prematurity and that and hernia as an adult. So we don’t know that. Okay, here’s a question. So since having my second child, my daughter, she is two, okay, so she’s two births and the youngest is two years old. My stomach sticks out like I’m six months pregnant because you have a diastasis. I had a CT scan and it shows a small fat umbilical and small fat inguinal hernia. How should I go about handling my diastasis?

Speaker 1 (16:28):

Oh, how should I go about handling my doctor? Doesn’t seem to think anyone would do anything about it. I’m unable to engage my center core area. I’ve been doing Pilates to help strengthen. Is there something else you should be doing or should I definitely push to get a referral? Okay, so it sounds to me, just based on what you told me, not based on any pictures you sent or anything that you have a rectus diastasis. Rectus diastasis is a separation of the muscles. You lose your core strength and get a rounded abdominal wall. I’m sure when you had the CAT scan done, it showed it as well. They just didn’t mention it. So if anyone including me reads it, we may see that there’s a rectus diastasis or separating of muscles. There’s some exercises that you can do. I do have a pamphlet on it.

Speaker 1 (17:12):

You can call my office or go to my website, https://beverlyhillsherniacenter.com and look for the hexacore on my website. Hexacore exercises for diastasis. So those can help. But your child is now two years old. That means you’ve had a diastasis for at least two years since the last delivery. And by the way, diastasis occurs more commonly with the second child and even more with a third child. So the process starts with a second child usually, unless you have triplets as your first child or something really huge. So the fact that you have a small belly bone hernia, a small inguinal hernia, it’s irrelevant to your core strength and rounded abdomen, they’re missing the diagnosis. You have erectus diastasis. Now, we’ve had multiple episodes in the past talking about rectus diastasis. You can search on it on my YouTube channel. I would like you to go to those and watch ’em and read them because what you’ll learn is there’s no good exercise regimen that’s going to cure you. If you did it early and you bind yourself early after pregnancy, that’s one thing, but not if two years later you’re saying I’m doing Pilates. And there are certain exercises you should not do, which many people do in Pilates. So if you have a good pilates instructor and that instructor is aware that you have rectus diastasis, then they should change their regimen so you don’t do certain things. Planks will be one of them.

Speaker 1 (18:50):

Go to my website, https://www.beverlyhillsherniacenter.com. Look for the Hexacore pamphlet. It’s in the section of the rectus diastasis portion of my website and you can download, it’s free. These are basically exercises that you can use early postpartum and exercises that you shouldn’t do to make your erectus diastasis worse. Okay, another question. What do you mean strong muscles can support a collagen defect in the fascia? Please explain in more detail. I have seen bodybuilders with apparent diastasis, yes. So do not mix diastasis with hernias. So diastasis is not a weakness in the fascia or the collagen. It is a separation of the muscles, the fascia still there is a separation of the muscles. Just because you have a diastasis doesn’t mean you’re going to have a hernia and vice versa. There’s not been a correlation specifically of people with diastasis more likely to have hernias and vice versa. They do work hand in hand. So if there’s a thinning around the belly bend because the muscles have spread apart, you’re more likely to get a hernia if you have an incision through erectus diastasis, yes, but a Hernia is a different situation. So a hernia is actual collagen defect. There are no studies that shown that a diastasis has collagen defect.

Speaker 1 (20:24):

That’s so yes, bodybuilders can have what seems to be a diastasis. It’s not clear, which would call it diastasis because it’s actually indentation than a bulging out because of their core is so fricking strong. But that’s it. Okay. Are we allowed to post photos or scars of scans? If you would like a consultation, I’m happy to have you call my office or go to my website and send us a request for consultation, but I will not be interpreting CAT scans on social media. Okay, next question. Let’s see, what do you, oh, please explain more. I just explained it.

Speaker 1 (21:24):

Strong muscles can support the collagen defect and the fascia. Oh, okay. So the fact that you have a hernia means one of two things that the hernia will get bigger and it’ll become more symptomatic or that you can maintain a strong core and reduce the rapidity or the intensity or how fast your hernia will become bigger and more symptomatic and or more symptomatic. So most hernias with the exception of let’s say femoral hernia, sciatic notch hernia, et cetera, most hernias are surrounded by muscle. And if you can strengthen the muscles around the Hernia, then it will hold that hernia in place. It won’t cure the hernia in any way. That’s a surgical process. But whereas if you gain weight or lose muscle, then those muscles are flabby and stretch out and you allow for the hernia to get bigger without any, what’s the right term?

Speaker 1 (22:28):

Any kind of force against it opening up. So for example, I have patients that come in, they’re like, oh, I have a hernia. I went to stop my family doctor. They said, you have a Hernia. They told me, don’t lift anything and stop exercise, don’t go to the gym. So they stopped exercise, stopped going to the gym and they gain weight and now they have more pain and the hernia is bigger. So I said, listen, exercise is good. It protects your core, it controls the hernia and so on. Go back to the gym, lose the weight, work on your core. If you still have problems, come back to me. But if your pain is less, your hernia is smaller, then maintain the core muscles and we can delay surgery until you become symptomatic. So that’s what I mean by maintaining your weight and also your core strength as a means of non-surgically preventing hernia exacerbation.

Speaker 1 (23:27):

You can’t change your genetics, but you can make it less likely or less symptomatic. Do some people like me, I’m sorry I don’t know who you are, get worse when they’re advised to do specific exercise targeting course such as gluteal lift. I’m not a fan of the gluteal lift. Go to my Hexacore website, sorry, my website and look for the Hexacore pamphlet. It’ll tell you activities that aren’t good for diastasis, and I’ve had multiple patients that have felt tears with specifically the gluteal lift and I don’t know why that is. I need to bring on a physiologist of some sort who can help explain all the different exercises and why some are better than others. The squats, for example, also not a good idea. That increases your abdominal pressure a lot. So yeah, good point about the gluteal lift. Here’s a question I’m seeing Dr.

Speaker 1 (24:32):

Yunis and Sarasota tomorrow at noon for possible program mesh removal. Wow, sounds great. Sounds like it’s a consultation because usually surgery is not possible. That’s definite. We’ve had Dr. Yunis on as a guest, he’s a great surgeon. Is it possible to remove a fatty lipoma in the inguinal canal at the same time as the inguinal mesh is being removed? Well, the answer is yes. So regardless of whether your lipoma is, sorry, regardless of whether your mesh is anterior as open or posterior as in laparoscopic or robotic, if the mesh is being removed, you’re also in a position to have the fatty lipoma removed. In fact, this is an interesting situation. So the question is why are you having the Mesh removed? If it’s for groin pain, you may want to see if the pain is from the Mesh or it’s from the spermatic cord lipoma, it’s much easier to remove a lipoma, which is a fatty tissue that maybe was missed from the original surgery. It’s much easier to remove that and leave the Mesh alone than to go through the process of mesh removal. So if the mesh removal process is not going to treat your pain because it’s really the lipoma, then there’s no reason to remove the mesh. Anyway, that’s kind of my 2 cents. I don’t know your story, but that’s kind of where I’m going with that. So these are all great questions you guys.

Speaker 1 (26:14):

Let’s talk about your own hernia health during or after surgery. So we’ve had a couple of prior episodes where we talked about how to get ready for surgery and how to optimize best outcomes for your surgery. I would like you all to come up with the following resolutions. Number one, if you’re seeing a surgeon, I do recommend you see for a primary hernia and if they recommend surgery or they don’t recommend surgery, I recommend you see a second surgeon. It’s good to at least get some questions out there answered. Maybe second surgeon will come up with ideas that the first surgeon maybe can help answer because you really like the first surgeon. Anyway, that’s kind of my shtick. I think surgery is a big deal. If anyone is offering you surgery or if you think you need surgery, you should always see more than one surgeon.

Speaker 1 (27:05):

Even if you’re a small town and you have one surgeon in your town, you can do telehealth within the same state or you can travel to another town to see a surgeon because you always want to have different options. I mean, when you go buy a car, you don’t usually go to one dealer and buy a car and leave. That’s not typical. You do your research online, then you go to multiple dealers to see what options they have for cars and what car you want and then the different options and then get a good deal.

Speaker 1 (27:44):

You should treat it the same for surgery. Get multiple questions answered and multiple consultations. Secondly, do take your surgery seriously. I have people like, oh, well it’s just a small hernia, right? Oh, it’s just a small surgery, right? I mean maybe it is a small surgery in my view, but let me tell you, having had family members hernia, sorry, who’ve had surgeries, every patient reacts differently to surgery, whether it’s pain control or lifestyle changes, et cetera, or it’s still anesthesia, it’s still an incision. Everything is at risk for going wrong and you need to be prepared and do that by reducing your inflammatory statement before surgery, preventing constipation before surgery, treating any cough before surgery. If you use nicotine, stop it for at least six weeks and be serious about it. And then if you’re overweight, lose your weight, you really want to go into surgery feeling your best.

Speaker 1 (28:58):

And then next, you want to continue that during surgery so that you maintain a good healthy recovery. If the surgeon says walk, walk, don’t sit around. Push yourself. If the surgeon said wants you to take certain medications, I’m a big fan of anti-inflammatories. I think the whole inflammatory state of the body should be reduced before surgery because surgery is trauma to the tissues regardless of how wonderful your surgeon is. And that trauma causes inflammation and pain and so on. So take it seriously. Don’t say, oh yeah, then I’ll just go to work the next day or it should be fine. Take it seriously. Take your time off, make sure there’s someone there to take you home. Go buy your groceries for the week. Make sure you have a comfortable bed or pillow or clean clothing. Take it seriously, tell your job you need time off and do all that.

Speaker 1 (30:04):

And if you’re not ready for to do all that, don’t have your surgery yet, it’s really not worth it to wing it. Some people don’t take it serious. Oh, it’s just a hernia surgery. And then they come to me because they went, they had constipation or chronic cough or they had a wound infection or they didn’t have access to their surgeon or whatever the situation was. You just want to take it seriously. And then after surgery, know that the same risk factors that make you higher risk for getting a hernia, especially you’re genetically prone to it will be there after surgery as a risk of hernia recurrence. So if you’re constipated after surgery or you start smoking again after surgery using nicotine or if you gain weight after surgery, those are all risk factors for a bad outcome because you’re going to add tension to your hernia repair.

Speaker 1 (30:57):

You’re going to have it pull away and be on stress because you’re increasing your abdominal pressure and straining and that’s all going to give you a worse outcome. And the worst thing about hernia surgery is another hernia surgery. Let me tell you, if you think it’s a struggle to find a hernia surgeon near you that you can also afford who can do an excellent job with hernia surgery, it is even more difficult to find a highly talented surgeon that can see you in a timely fashion that you can afford that’s near you. It’s very difficult. There are very few of us out there. So you don’t want to end up with a second surgery. You want the first surgery to be perfect and you move on with your life. And that’s my recommendation. Your resolution should be to take hernias seriously and prepare for your surgery, make sure that you have all the amenities that you need to have a really good repair and then for the rest of your life, know that you don’t want to mess up this hernia repair.

Speaker 1 (32:10):

You don’t want to be in the middle of a beautiful vacation and then have a pain or a tear or something. So you want to take care of this wonderful investment that you made into your health to fix your hernia. Here’s a question. It’s going back to the patient that asked about the spermatic cord lipoma and the mesh removal. Unfortunately, the groin pain is bilateral and occurred the moment I woke from hernia surgery and has gone on since 2019, had recent triple, and the surgeon said the right side cremasteric muscle was angry, bright red, huge, and had tons of scar tissue on it. Possible mesh rejection. So that sounds like you had an open repair, but open repair with pro grip Mesh, that’s not common to have had an open. It can happen that there just aren’t that many people that use the program grip mesh for open repairs, but it’s not technically a mesh reaction.

Speaker 1 (33:15):

Well, there’s no such thing as mesh rejection, but as a reaction, like a mesh implant illness, that’s usually it’s total body issue and not a local problem, but laparoscopic, this is laparoscopic surgery. Why did you have a triple neurectomy? There’s no indication for triple neurectomy for a patient who’s undergone laparoscopic surgery. Number one, because the nerves aren’t involved usually, and then there is no cremasteric muscle involved laparoscopically. So I don’t know what was done for you. Triple neurectomy and cremasteric muscle means an open surgery. So I don’t understand any of this. Now, if you had some type of surgery that involves obstruction of your spermatic cord because of the way the mesh was placed, especially if it was placed as a what we call keyhole technique as opposed to an only technique or a subway technique, then that could cause an obstruction of your spermatic cord especially.

Speaker 1 (34:28):

And if you have it done on both sides, then it would be done on both sides. That is a mechanical problem and you need your Mesh removed. But if you want a consultation and you want to initiate consultation and you don’t live in California, I do offer online consultations to figure this out. But sounds like you had a couple of operations or a couple of things that don’t really make sense. But no, it is not a Mesh rejection. That is not what a mesh rejection looks like. Let’s see, I had robotic surgery for the belly, the mesh cause obstruction. The surgeon thought theories will help with pain. Yeah, that’s like saying my arm is obstructed so I’m going to get a haircut. It’s completely hoping that it’ll make you feel better. So neurectomies do not address obstructions. Obstruction is a mechanical problem. You have bowel obstructions, you got to release the bowel, you have kidney obstructions, you got to take the stones up, you have an obstruction of your spermatic cord by the mesh, you got to remove the mesh.

Speaker 1 (35:40):

So I don’t understand the logic of what’s been done to you, but hopefully Dr. Unis can help you do some surgeons bleed. Triple neurectomy is necessary for chronic postoperative pain because of crosstalk or intercommunicating branches between the three major groin nurse. Yes, that is a theory has not been proven to be valid. That is a theory and the reason why this theory came about is the original surgeon who came up with the triple neurectomy noticed that when he was doing single or double neurectomies, he still had patients with pain, whereas going to triple neurectomy, much less patients have pain after surgery. And so the idea that there’s, and then if you probably talk to other neurosurgeons or nerve doctors and they said, oh yeah, there’s crosstalk among nerves. In my opinion, the reason why triple neurectomy works better, one or two nerves being cut is because it’s just a statistical thing. It has nothing to do with being the right thing. In other words, if you didn’t really talk to the patient much or really spend enough time with the patient, just go in there to cut all three nerves. Whereas if you talk with the patient and examine the patient, you’re like, oh, this is your ill nerve, or this is your general nerve branch and the other nerves are completely untouched and not involved, there’s absolutely no reason to do a triple.

Speaker 1 (37:07):

You only should do a single neurectomy and focus, focus, focus. If you want the whole world to do triple neurectomies, then you’re overtreating many patients. And of course there’s consequence with directiveness, which includes chronic pain and neuroma. But my point is, if you sit down, spend enough time with the patient, help figure out what is the actual nerve that’s the problem and focus on that nerve, then you don’t need a triple. But yes, there are, to answer your question, there are some surgeons who believe the triple neurectomy is necessary because selective neurectomy doesn’t work because the nerves talk to each other, not been proven. And secondly, they believe a triple neurectomy is a cure all for all growing pain after hernia repair. That really bugs me because the majority of patients that have chronic pain after hernia repair is not a nerve issue and never need any nerves cut.

Speaker 1 (38:11):

It’s a Hernia recurrence, not a nerve issue. It’s a Mesh ball up, not a nerve issue. Usually it’s a Mesh impingement or Mesh obstruction, not a nerve issue. So triple neurectomy is unfortunately somewhat of a waste basket of like oh, triple neurectomy triple. I had a patient, I’ll give you a good example. I had a patient that had, what’s his story? He went to a surgeon, they said they’re going to do a triple and all this stuff. And I said, that’s not your problem. Your problem is yeah, he had a Mesh obstruction. Your problem is the obstruction of the spermatic cord with your mesh, but your problem is your spermatic cord. It has nothing to do with all the other nerves. And we focus on that and he got cured. So that’s kind of where I’m at with all of that. I hate the term triple neurectomy. Now some people may need it and that’s fine.

Speaker 1 (39:17):

Maybe they do have neuromas and so on, but most people do not need a triple. So some of the questions that were submitted to me ahead of time relate to my own resolutions for the year. I have a lot of resolutions for Beverly Hills Hernia Center. We have some really, really great things that we’re going to drop soon. Our hernia score is going to be live soon. It’s free to all of you. You can go on the website as soon as it’s up and I’ll let you know when that is. And it’s an amazing, amazing machine learning AI algorithm that we develop based on our own patient experience where you can plug in all of your symptoms and the algorithm, the hernia score will shoot out a score to kind of help estimate the chances that your chronic pelvic pain or your groin pain or your testicular pain, whatever it is, is related to a Hernia.

Speaker 1 (40:24):

Now if you have a big bulging hernia, that’s really easy to diagnose. But what if you don’t have a big bulging Hernia or you also have a hip disorder or you also have endometriosis or ovarian cyst or you have diverticulitis. This algorithm will give you a hernia score and based on your hernia score, you can help figure out if the pain you’re having is related to your hip surgery or your lower back spine or is it related to a hernia. And if it is a Hernia, then great, you can figure that out earlier. Go to your doctor, tell ’em, my hernia score is 92% chance that this groin pain I’m having or this pelvic pain I’m having or et cetera is due to a Hernia. Can you please evaluate me for a Hernia? Or you can go to your doctor, the doctor will fill it out for you on hernia score.com and they’ll say, huh, I dunno, maybe I do have a Hernia.

Speaker 1 (41:24):

Let’s see. I can’t really feel a hernia but wonder, maybe I do feel a Hernia. I wonder if your pain is due to your hernia because you also have a bad hip arthritis, let’s say, and they plug it in and you get a score of 20%. Well, okay, let’s not focus on your hernia. Maybe you do have a hernia, but that’s also what’s causing your problem. Let’s go to the hip doctor, for example. So, hernia score is going to be amazing. It’s going to revolutionize how we approach hernias because up until now, hernias have been treated by doctors looking for a bulge. If there’s no bulge, there’s no hernia, which is completely false. By the way. Hernias can cause pain and will need to be repaired even if they don’t present with a bulge. But many doctors don’t know that. They weren’t taught that in medical school. They’re not up to par with really advanced Hernia research that I published. And they don’t understand that you can have a painful occult or hidden Hernia in the groin causing a lot of symptoms, pelvic floor pain, urinary symptoms, bladder symptoms, pain with intercourse. All of these could be from your hernia.

Speaker 1 (42:39):

And as many of you know, I’m very interested in women’s hernias because they do tend to present with smaller hernias and hidden hernias. And therefore they go to their doctor and their doctor tells ’em it’s all in their mind. They have no problem, go home. Here’s some hormones. And what they’ve always had is a hernia. So they have years of delay in treatment and suffering of chronic pelvic pain before they find a doctor such as myself that will diagnose with them with a hernia, fix their hernia and get their pain, how their pain go away. And therefore, I’m hopeful that the hernia score will not only tell you if you have a hernia, but get you treatment earlier than you would if you just went from doctor to doctor to doctor, especially if you don’t have a specialist near you. What if you don’t live in Beverly Hills, which I understand most of the world does not.

Speaker 1 (43:31):

So that’s kind of where we’re at in terms of hernia score that’s going to be launched pretty soon. There’s some other really great, and these are all free by the way. I don’t believe in charging the general public for education. So if you want a personal consultation and you want me to review all your images and give you my expert opinion directly, specifically at you, that’s going to involve an actual consultation, which will is not free. However, for educational purposes, I travel all around the world and I give talks. I don’t get paid to give those talks. In fact, I pay to give those talks because I have to pay for the hotel and the airline or whatever. And online things like Hernia, Talk, Live hernia talk.com, hernia score, those are all free. I don’t believe in charging patients to get educated. So I believe you get educated, you can educate your neighbor, your spouse, your friend, your own doctor, spread the word. My hernia health resolution is to get as much crowdsourcing and information out there on hernias as possible so that there’s less and less misinformation, disinformation information, malformation, all these different types of poor information out there that are wives tale, this and so on, that result in people getting the wrong care, poor care, or delaying care. It just really, really bothers me when that happens because it’s preventable.

Speaker 1 (45:12):

What were the major accomplishments, including patients’ cases of significant complexity that you treated successfully that you were able to achieve in the last year? Lemme tell you. So today was a perfect example. We had a patient from Canada that saw me. She unfortunately went to the Shouldice clinic and got an operation that had a complication. And unfortunately the Shouldice clinic does not typically treat their own complications. And she was basically given the good luck out there. And as you know, Canada doesn’t really have that much access to hernia specialist. So she had to self-fund her whole trip to come here. But I figured out what was wrong with her. BI operate on her C. I saw her today less than one week postoperatively, and she looks amazing. A hundred percent of her pain before surgery is gone. She’s barely taking Tylenol for her pain control. She’s going to be on a flight back to Canada in a day. Like those kind of stories I love because how many years has she been dealing with this? Years Actually no, for her, it was not years. She had her surgery within the year. No, no, no, no. She had the pain six months after her Shouldice repair at the clinic. So I’d have a look at her records to see how much time she was dealing with this. I think maybe two years, but don’t quote me on that.

Speaker 1 (46:50):

Another patient, this was another good one also out of state. I think this one was Oklahoma. So she had, check this out, so many different operations. She had really complex high risk operations and basically no one listened to her. They totally miss the fact that the fact that she had a tummy tuck and required unrelated emergency surgery after that meant, and then her pain started ever since that surgery means that it was that surgery that caused it. And guess what? If you’ve had a tummy tuck and now you have surgery that’s going to mess up your tummy tuck. Why? People don’t understand that. I don’t know. But I see it too often, maybe because I work with plastic surgeons that I understand and have a special kind of appreciation for operations that are done by plastic surgeons. You don’t want to mess it up. The patient paid thousands of dollars to have a tummy tuck, don’t mess it up.

Speaker 1 (47:53):

So anyway, they mess it up and after that she’s had chronic abdominal pain, no one could figure it out. So that she had multiple other operations over a span of many years, many years. And I figured it out. I’m like, they just disrupted your abdominal plasty. I’ll redo it for you. I redid her tummy tuck pain gone, I think over a decade of pain, I think 11 or 12 years if I’m not mistaken. That was amazing. She had some really high risk operations that totally didn’t make sense. The symptoms she had and the operations she had did not match, right? It’s like saying, my toe hurts, so let me do brain surgery on you. Makes no sense at all. So the resolution I hope other surgeons have is not only to be inquisitive and to believe their patient, but it’s to listen. So if you have a patient that has a hernia and they come to see you for groin pain, it doesn’t necessarily mean the hernia is causing the groin pain.

Speaker 1 (49:09):

You can have groin pain from other things. So for example, the patient who had a hip disorder and then had a Hernia repair, but they presented with groin pain due to their hip disorder and how you know it’s a hip, not the Hernia, they were limping, they couldn’t walk. Hernias do not affect your gait, wasn’t thinking. So the surgeon wasn’t thinking they fixed the hernia, wasn’t the problem. Now they have hernia repair pain and their original groin pain is still there. Now everyone’s like, oh, now you have chronic groin pain after Hernia repair. So then they start doing the triple neurectomies and the mesh removals and all this and he loses his testicle, right? And all during this time, he just needed a hip to hip surgeon, an orthopedic surgeon. So listen, listen, listen to patients. I don’t know how I can stress this more according to the current hernia treatment landscape.

Speaker 1 (50:06):

What do you think are the areas that mostly need to be improved and how do you plan to contribute this year? Okay, listening and a good history, everything I do is based on history. The hernia score is based on history. You’re not going on the hernia score.com to share your examination or give a picture of yourself or show your imaging. It’s purely history. So the history is very strong if you listen to your patient, it’s all about the history. You can do imaging and so on to help support your theories after you get the history. Physical exam of course, is important, but nothing is more important than history. I’ll give you an example.

Speaker 1 (50:48):

I hate to keep picking on them, but I was on Instagram and I follow the Shouldice clinic on their Instagram posts and they’ve had a change in some of their surgeons. There’s new surgeon who I’ve not met yet, who was at the same time saying, it’s all about your history, which is true. And the other time saying, if you don’t have a bulge, we’re not going to operate on your hernia because the Shouldice thing, they don’t believe in occult hernias, the which is unfortunate. And then he was saying how he has patients come in with an ultrasound that shows there’s a Hernia and their story is good for hernia, but he has a fetal a hernia and therefore there’s no hernia. That makes no sense. It’s about the history, number one. Number two, our study has actually shown that ultrasound is very specific, which means that if you see a Hernia, it’s there.

Speaker 1 (51:55):

What else are they seeing? Now if you get an ultrasound and they don’t see a Hernia on ultrasound, then maybe you could follow up with an MRI or something. If the story and the exam are suggestive, have a Hernia, but specifically don’t discount the story because your exam does not support it as a big hernia. It really bothered me, and I’ll probably do a social media post on it because it’s a little bit of disinformation, but I just don’t want to be mean about it. I’ve had severe pain post an open hernia repair for recurrent bilateral hernias and after workup do not have what the original surgeons considered a surgical target that is specific enough to warrant a third surgery with increased risk for pain if pain comes under control with complete cessation of healthy exercise, given the risk of inactivity. Is inactivity the best strategy for managing pain as opposed to third surgery in an lb retired male teacher myself?

Speaker 1 (52:58):

Well, depends. If you’re older and retired, doesn’t mean you’re not active. Surgeries are meant to improve your quality of life. If there’s an actual finding that can be surgically addressed and you’re safe to have the surgery, then you should consider it. But if someone’s just going in there willy-nilly not with no pain, no plan, then run away. You don’t want to go in there with anyone’s like, oh, we’ll just go in there and take a look. We’ll just explore wrong. Hello, doctor, I need a Mesh removal due to a bowel adhesion, hernia recurrence and systemic reaction. That’s three problems in one patient, bowel adhesion, Hernia recurrence and systemic reaction. Hard to believe based on outcomes razor that three things are going wrong. I have a feeling someone is not giving you the right answer. I was proposed here in Paris.

Speaker 1 (53:58):

I was proposed here in Paris. An open removal was shouldice repair. My implant was laparoscopic. Oh, runaway. Do not do that. Do not do that. Is this a good idea? No. I called your office. I’m willing to travel for Mesh removal but cannot connect on your website. The firewall is blocked here in France for some reason. Thank you for letting me know. I’ll double check that. Do you do long distance calls? Absolutely. Yeah. I have a lot of online consultations that I do from patients from Asia, Australia, Europe, middle East. I already said Asia, so I just haven’t had anyone from Antarctica, although I did have a patient go to Antarctica post-op. Cool story. I’ll tell it to you later. I’m happy to help you. You should not have your laparoscopic surgery Mesh removed open that is completely unnecessary and can only cause more problems.

Speaker 1 (54:50):

But we had to figure out, do you even need your mesh removed? And what are your symptoms? You should not have bowel adhesions from a laparoscopically replaced mesh, for example. In theory, how long can you wear a hernia truss for inguinal hernia if there aren’t any symptoms? If you have no symptoms, there’s no reason to wear Anglo hernia. Truss number one. I have a whole episode on trusses, but if you would like to wear the Hernia trus because it helps reduce your symptoms, you can wear it until you die lifelong, not an issue. I did start a little bit later, so I’m going to give you my full hour. Has your research on mesh implant illness had any impact on the adoption of permanent synthetic mesh as one size fits all solution to the medical? Yes, it has. So first of all, my original paper on using MRI for inguinal hernias and evaluation of chronic groin pain, it’s now considered standard by most Hernia specialists to use. MRI. Wasn’t like that before. My paper, number one. Number two, my paper on Mesh implant illness. Finally, it’s getting some a buzz. First of all, I’m being asked to give a talk on mesh and plant illness to a lot of the societies, which means there’s an interest and people believe it’s now valid. Whereas before it was like fufu.

Speaker 1 (56:10):

And now that it’s published, it gives a little bit more legitimacy and people can read it outside of the more exclusive societies meetings that we go to. And finally, in the forums that I belong to that are surgical forums where surgeons talk and also at meetings and even emails and social media. I have surgeons that are specifically saying, huh, maybe this is mesh plant illness from various countries. So I’m very excited that people are open to the idea now they’re talking about it. And now patients are more likely to get at least a thought out there, at least a thought that their pain or there’s weird symptoms, rashes, headaches, hair loss can be related to that. So on that note, I just want to thank you all. You’ve been very loyal to me. We’re on, I think episode 1 59 today, or maybe even one 60.

Speaker 1 (57:20):

Have we hit one 60 yet? Multiple years of doing this, we’re starting a brand new year. This is going to be a very special year for me, 2024. I will share all of my new tools for you as I have them done. And thank you for joining me. Do go to my YouTube channel at Hernia Doc, subscribe, watch, and or go to my wherever you listen to podcasts and find the Hernia Talk Live episodes and listen to them. Some of the older ones are actually really, really good. They’ve kind of become classics because some of the surgeons that I interviewed actually don’t even practice anymore. So it’s very, very cool. So that’s it. I will see you all next week. Thanks everyone. Happy New Year.