204. Hernias & Social Media

This week, the topic of discussion was: 

• Social Media
• Misinformation 
• Disinformation
• Trolling
• Instagram
• Twitter
• Facebook
• TikTok
• Watchful Waiting
• Scrotal Injury
• Negative Posts
• Respectfulness

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 (00:11):
Hello everyone, it's Dr. Towfigh. Welcome. Today is Tuesday, first Tuesday after Labor Day Weekend first. I guess that means summer's pretty much over. I don't know if it's officially over, but welcome to Hernia Talk Live. We, after many, many, many years, decided to take a summer break off in August and it was very, very helpful. I'm so glad to have you all back. As many of you know, I am your host, Dr. Shirin Towfigh. I'm a hernia surgery specialist. For those of you that want to see everything that goes on in my life from an academic and a research standpoint where I talk mostly to surgeons, do follow me on X at Hernia doc on Instagram, I mostly try and be entertaining and sometimes funny, but I also share a lot of my knowledge base to my patients on Instagram. Also at Hernia Doc. Similarly here on Facebook, many of you're joining me as a Facebook Live.

(01:21):
And then lastly, if you enjoy Hernia Talk Live and like to watch prior shows, go either as a podcast or on my YouTube channel at Hernia Doc, and you'll be able to experience the 200 plus episodes that we have talking with you all and also with many, many hernia specialists or hernia adjacent specialists. So I hope you enjoy today's show because it's going to be a special one. I have multiple announcements to make. The reason why we took a good month off was to be able to expand our offerings at the Beverly Hills her center. So I'm very excited to announce that as of this month, we will be expanding to a separate office in Northern California. As you know, I'm in Beverly Hills, which is southern California, but a very large proportion of you who seek my care are in Northern California. It's a big state.

(02:33):
It's not that difficult to travel back and forth, but for medical care, sometimes it's easier to have people closer to you. So we will be seeing patients starting the end of this month in September, and if you're from Northern California or maybe Oregon adjacent and it's easier for you to fly in or see me in Northern California, we will have office space in Mountain View to see our patients in Northern California. And I kind of like Northern California. It's very different than Southern California. It's literally like two different states, but we love our very beautiful state of California and it's my privilege to be able to have the opportunity to come up north to you all. So one day a month for now, I'm going to entertain seeing consultations in Northern California. Of course, if you are not in Southern California, you can always fly in to see me.

(03:39):
A lot of my patients do. Let's see, today alone, I had three patients that flew in and were not local, so it's doable. But we thought because we have such a high proportion of our patients flying in from Northern California that it may be beneficial to have a little presence there. So we'll be in Mountain View. Mountain View is a beautiful city in northern California in the Silicon Valley area. People in San Francisco, Sacramento, east Bay as they call it, our nearby can come down very easily to Mountain View and of course anyone in Fresno in those areas. So that's the current plan and I'm really very much looking forward to being able to provide that service to those of you that would like to take advantage of it. So let's see. What other announcements do I have? I have multiple announcements. We'll soon be going live with our Beverly Hills Hernia Foundation.

(04:47):
The foundation is our opportunity to have many of you who've been asking how they can help promote knowledge to patients and to surgeons. So it's really a charitable organization. Up until now, for the past how many years, I'm going to say 15, 20 years, I have been self-funding all of the research efforts and education that happens that gets presented and published, et cetera. But we are now officially a charitable organization that you can donate to and I'll reach out to you all to give you more information about that in the weeks to come. Tomorrow I am flying out to Nashville. That's my next announcement. I've never been to Nashville. Last time the American Hernia Society meeting was in Nashville. I couldn't make it. I forget why it was, I think I had some issue anyway, and I had to send my team to go to it.

(05:53):
So the American Hernia Society meeting this year is in Nashville, and I'm super excited because my research student, his research with us got accepted. So he'll be presenting his research on Friday. I'll be helping teaching live cadaver dissections for hernia surgery on Thursday, and then also giving a talk on private pitfalls and pearls and pitfalls on how to run a hernia practice, which is what I do. So that's going to be very fun and hopefully I'll be able to provide a little bit of insight because there's a lot of interest in hernia surgery a lot, a lot, which is why I decided to talk about hernias on social media.

(06:50):
I'm on social media and I tend to use it as a way to help educate all you all. And in addition, I use it to have fun because I think hernias are funny. So I do that. And then lastly, I do share ideas and so on with my colleagues that are surgeons from all over the world. So when I do that, it's done with as much evidence-based information as possible, and I kind of peruse the internet so people send me articles or posts and so on and what I cannot tolerate. That's what today's episode will be about. What I cannot tolerate is misinformation on social media. Go figure. It's literally everywhere. So what I will say is just turn in your questions if you want. I'm happy to answer any questions you have while I'm talking, but I've spent a month away from you all trying to expand our practice and improve our offerings to you all.

(08:15):
And as I was on social media, it really pissed me off to see so much misinformation. Now, one of the most egregious and misinformations is trying to scare patients about their hernia. I hate that we have so much data to support watchful waiting for minimally symptomatic or asymptomatic umbilical or ventral hernias, minimally symptomatic or asymptomatic inguinal or groin hernias, that there is absolutely no room for any doctor to go online or health practitioner to go online and make comments such as if you have a hernia, you have to get it fixed. That's not true. Not all hernias need to get fixed. And then to follow up that you quote, you have to get it fixed and with a statement like it can get stuck, it can cause an emergency, it can cause incarceration. Be honest about the data. What is the risk of a completely asymptomatic or minimally symptomatic single hernia umbilical hernia, epigastric hernia, ventral hernia?

(09:33):
What's the risk? We know that risk, it's 0.2% per year risk that you'll end up in the hospital needing surgery because the hernia got stuck. It's the symptomatic hernias where we do recommend repair, and it doesn't have to be under emergency situation, but we do recommend you don't ignore a hernia that bothers you, but a hernia that doesn't bother you, especially groin hernias in men and umbilical hernias in men and women that is out there, 0.2%. So one fifth of 1% risk per year that something will occur and you'll need to go to the emergency room because it's stuck or it hurts or whatever. No one dies from watchful waiting. It's the symptomatic hernias. The ones where it bothers you, it hurts, you notice them, it's those that should be addressed. But if you're going online, whether it's Twitter or Instagram, and you see a doctor talking about hernias, and I recommend you Google this because I've been doing this and it's egregious, and they say you have to get your hernia repaired, otherwise it gets stuck, otherwise complete misinformation or as they call it, disinformation. So it's just the wrong information and it really, really bothers me because it puts us doctors in a bad light when you're like a salesman and the information you're providing as an advocate for the patient is not true, and in fact is scaring people into getting operations that they shouldn't have gotten. As many of my practice, about 80% is focused on undoing what was done. So recurrences, complications, chronic pain, mesh removal, nerve injuries, whatever the situation is, and I really enjoy that.

(11:48):
A lot of those patients say, I even have pain. They told me I had to have my hernia repaired. And so there's a lot of what we call regret. In fact, research in the hernia world is also now focusing on surgical decision making regret by the patient. So they wish they hadn't had this hernia repair for it. It's not like they knew they needed the surgery and it's a bad complication. They start thinking about their hernia and they're like, I was actually fine before surgery and now I'm so much worse after surgery. And so there's a sense of regret, and now they're working on scoring the regret and coming up with a bit more objective ways of managing the regret. But inguinal hernias actually have more regret than ventral hernias, and it's because of this. It's such a common disease. So many people have hernias that if you talk with your family members, I'm sure most of them either know what it is or know someone who's had it done. So it's a common disease. And then if you just offer hernia repairs to everyone without picking and choosing the ones that would benefit the most, you're going to have people that will be regretting their hernia repair.

(13:15):
So that's part of the social media that I hate and I don't know how to fix that. If any of you have any ideas, I mean, you could argue it's not my problem to fix whatever, but if I can have a role in improving that, I really would like to play a role. So for those of you watching, if you can maybe reach out to me and give me some guidance. So sometimes if I really don't know the surgeon and they're just being really horrible, and there's usually the ones on TikTok, I do slip into their comment section and I try and reeducate their audience. So they'll say things like, this is bad or this shouldn't be done, or this must be repaired, your hernia must be repaired, or there's no risks with placing mesh or I've never had a complication, something like that. These are all false statements. By the way. There's no surgeon that's never had a complication.

(14:29):
In fact, one of my patients actually walked away from a surgeon because that surgeon told him he had a 0% complication rate. He's like, wow, if you're so blind that you're not aware of any of your own complications, that's a bad sign. As surgeons, we're very humbled because we operate on patients and sometimes that means operations have complications. So if you ever go to a doctor and they deny ever having any recurrence or any complication, just walk away, not either not being truthful or it's just being you. It's like the ostrich head stuck in the sand situation. So that's where I was going. So the other, usually TikTok, but sometimes there's some doctors that I know or there are clinics that are very famous for the type of surgery they repair and they hire like a social media or PR group. And then that PR team writes these elaborate things for the doctor to say, I assume, and they just read off a script or they say, tell 'em this or that, and it comes off as being very salesmany.

(16:00):
And so they'll say things like, if you have a hernia, you have to get it repaired, and this is what we offer, blah, blah, blah. Not understanding that that's actually not a valid statement, and yet your audience is so vast. How would the average person know that what you're saying as a doctor or professional in a clinic that only does hernias, why would they not believe what you're saying? So I don't know. Is it appropriate for me to out these doctors by name or go on their comment section and say, that's not true or somehow, or do I just do what I do and let it be? Most people would tell me, just let it be. I don't know.

(16:54):
Oh, this is a good one. So this is a very good comment. It says, I would love to see more clips from hernia talk live on places like TikTok. There's just not enough of you going around to counter all the bad ones. That actually makes me feel very good because you're right, I do have a TikTok account. I should maybe upload more videos on that account to help counteract all the other people because it's literally ridiculous. It really bothers me that so many people go on that and say wrong things. Half of the people that go on it are not even surgeons. I've perused TikTok and others and their chiropractic ER doctors, family medicine, I'm okay with because, but not if they're talking about surgery and so on. And then they have a, what do you call it, like an account. So they feel like they should say, talk about things on their account, but they don't stay in their lanes. Then they make these egregious comments about, oh, you must have your hernia repaired. And don't really preface that by if it's symptomatic, because most hernias are not symptomatic. They also don't understand the nuances between male versus female. So we don't really know if it's safe to do watchful waiting for women.

(18:30):
The team out of University of Michigan who I interviewed in past Herney Talk Q and As are actually finally trying to get an NIH grant just to answer this question. But now with all the NIH being kind of dismembered, it's unclear if they'll be able to do that research. But there's been zero research done about women, whether it's safe to do watchful waiting for women. So what does that mean are too many women undergoing hurting repairs and therefore the percentage of women that are maimed or have complications for hernias relatively larger than among males because males are at least a portion of them are not getting their hernias repaired because it doesn't bother them, and therefore they're not putting themselves at risk for a hernia repair complication. We don't know that. These are all research questions that would be great to know and to expose.

(19:30):
Unfortunately, sometimes the way these kind of things get exposed is the New York Times gets on board or LA Times gets on board or Washington Post Wall Street Journal, all of them have had articles that shed a very bad light on hernias because you do have this group of doctors that feel they can sell hernia repairs on social media without being honest about the data that's out there. So that's why I bring in specialists. I bring in my colleagues, some of them, most of the people that I bring in, I agree with, I respect their opinions. I feel like they're good doctors, and so they kind of have my stamp of approval for coming onto the show. And any of you who write me either emails or DM me on Instagram, et cetera, except for the recent one who talked about his clog fetish, but those of you that legit DM me about I am in such and such city or state, I'm in Colorado.

(20:45):
Can you help me find a hernia specialist? Who do you recommend in Virginia? I highly encourage you to go to either my YouTube channel or as a podcast or it's even on my website and look through and search. There's a search option. Search your state, let's say, or go to hernia talk.com, search your state and see if I've made any comments or interviewed on hernia talk live, any surgeon in your town. If I have, that's kind of my stamp of approval. These are friends and colleagues of mine who I love and we'll soon be hanging out in Nashville at the American Hernia Society meeting. And these are all people that share their interest in hernia just like me and therefore are not going to be going out there saying stupid things like all hernias need get repaired and it is got to be repaired by me. I have zero complications that really pisses me off. So that's my take on hernias on social media.

(21:54):
Some of the social media videos on hernias are just, they're meant for what they call it clickbait. So thin gal with his hernia popping out. I mean, do you see patients like that? Maybe one. It's usually not that bad. Those are usually patients not in the United States. They're often in less developed countries where they've had some type of trauma and life-threatening needed lifesaving surgery and then they got a hernia from it and then they just could not afford to get the hernia repaired in the United States is less common to let your hernia go to the point where it's completely deforming. Whereas if you go to other countries, and we do missions and charitable events in Central America, south America, Africa, some parts of Asia, and when you go there, the hernias are much bigger. They've had it for much, much longer. The skin over it gets really thinned out and the operation becomes a bit more complicated, but they also complain less. It's so interesting, but I think it's a cultural thing.

(23:25):
So those are the clickbait ones where it's egregious. And then there are patients that post. So on the patient side, so we already talked about the physician side. What irks me is when they misinformed patients and scare them into needing hernia surgery immediately and by 'em. But the other situation is the patient side. So there aren't that many individual patients actually talking about their hernia, but there are a handful. And the ones in my experience, the ones that have the most, the saddest stories are often the ones in the UK for some reason where if they were in the United States, I would've repaired them like yesterday. It's totally doable hernia repair, but there just aren't that many specialists in the uk and the NHS system is hard to navigate for specialists. And so they have these huge hernias that should have been repaired five years ago and now it's even bigger, so it's even more complicated.

(24:46):
And now paradoxically, they're even less likely to get the repair they need because again, there's a wait list and then so on. So there's one lady that shared her story and these were I think, is it TikTok or Instagram sharing her story? I think Instagram and her whole IG is focused on her lifestyle slash hernia. And so it is a huge baby coming out of her belly and is always like, I can't get surgery, I can't get surgery, I can't get surgery. And my comment is, if you had cancer, let's say you would've had your cancer surgery, so why are we not operating on patients that need their hernia surgery? So in her situation, I think she was on the wait list and then she had some surgery, got botched, and then she was put on another wait list. And then when it was time for her to have surgery, she got sick, I dunno, like COVID or a cold or something.

(25:54):
So that had to have to be canceled. So she kind of fell back again on the wait list and now everyone's telling her, you'll die if you have surgery. There's no surgery to offer you, et cetera. Meanwhile, in the United States, those kind of hernia repairs are performed on a regular basis in many, many centers in the United States. So sometimes all you have to do is just get it done in the United States because we have a appetite to fix these complicate hernias, whereas a socialist medicine system does not have the appetite to do that. It's just not resourceful to do it in those systems. And so you kind of have to work your way outside the system unless you can find some advocacy to get it done.

(26:49):
You may recall I was in London a couple months ago and I met some patients while I was there and one of the patients who came to see me, I've known her for a while actually. So every time I go to London, I do try and catch up with her and she updates me and I am trying to get her care in the UK and she's being very good about it, but I've known her for years and she still hasn't had her surgery yet and I just don't understand why. There are a handful of surgeons that you can go to. But she went to this other surgeon and I told her, listen, this is the surgery you need. This is the surgery you don't need. If anyone tells you this second option, run away. That is not the right operation for you. And of course she went to the surgeon and they offered her plan B, which I told her is completely wrong, not appropriate, you need plan A.

(27:46):
And so she's kind of in limbo. But some part of me, I wish I could just fix everyone. It would be awesome to be a traveling hernia surgeon that you just kind go from place to place and credentials weren't an issue and malpractice insurance wasn't an issue and getting privileges at hospitals wasn't an issue or getting licensed in countries wasn't an issue and you could just go wherever you want to go and start fixing people, that would be so cool. But of course there are rules and regulations and laws and I can only dream about it. I still have this dream of building the world's number one hernia center outside of my Beverly Hills one. So that's more of a global center, but I'm too busy building my own practice to do that, but that would be so cool if I did that.

(28:52):
Anyway, so going back to the social media thing, the last comment I'd like to make is I love the Facebook groups. So most of the Facebook groups are a great place for patients to get help, talk to people in similar situations, share information. A handful of the Facebook groups are well curated, and so the people that moderate it assure that it doesn't run amuck. But there are some other Facebook groups that are a little bit more liberal in their attitude and anyone can say whatever they want. And then you have some people that are either very negative or very pessimistic in their discussions and some are just outright misinforming and it's very stressful. What I hear a lot from my patients is that they went on the Facebook group and then they left because these Facebook groups are very negative, very my way or the highway never used mesh.

(30:13):
Mesh is evil. Anyone who uses mesh should be banned or their arms cut off or something like that, and then they kind of shame you if you had to get mesh even though your outcomes were perfectly good. So it's this kind of very unitary way of thinking I think is not healthy. And then it makes people think that there's only one good decision and there isn't every patient's different. Everyone has a different lifestyle, different priorities, different health factors, and the surgeons they go to are different. They could be a skilled surgeon or not skilled surgeon, surgeon with an open mind or one with a closed mind that does everything the same way for every patient. So many of them leave because it's just not tolerable because environment's a bit too harsh. And then lastly, there's this final group, which is really mean. People, I have a feeling they've toned it down a little bit since maybe 10 years ago, but it was like I was getting hate mail and hate DMs from these people and I'm thinking like, are you kidding me?

(31:40):
The way you're acting is so disrespectful and aggressive that no doctor will want to associate themselves with you. And because what you're saying and doing is so aggressive and negative and misinformed often and mostly to fearmongering, and then you've got a doctor me who is trying to be your advocate and tease out the negative emotions and the misinformation and promote the evidence-based data and advocate for patients and of all the people you want to piss on, it's me. You're not going to get anywhere in making change if you disown the people that can help you make the change. So in the past, I've had some who've come back and actually I'll tell you this interesting little tidbit. I have literally had patients that either belong to these groups and are very vocal on these groups or they have gone on other social media platforms and just shit on me. I've had those patients come in to see me in consultation like, okay, I'm happy to see you, I'm happy to help you, but isn't that weird? You literally just call me all these names on social media and then now you want my advice.

(33:47):
Now I am good enough to give you advice. And then some of them would apologize and say, oh, I was in a bad mental state. I understand that part. I mean I thank you for the apology, but social media as many of can really mess with your head. So if you are purposely trying to say bad things or be mean or try and promote your agenda in a very disrespectful and mean way and to hurt that person or hurt their reputation, that's not excusable because oh, you were having a rough day or having a bad time, or you're just, I've been dealing with a lot. I don't know how you guys think about this or you think it's appropriate. I don't know.

(34:44):
I mean I'm adult enough to be able to survive these things, but there were a couple out there that were so horrible to me. Again, this is before nowadays I feel like everyone's mellowed up or they just stopped trying to fight me. I don't know. And then you have the balls to come and seek my consultation. I just don't get it. I don't get it. I mean I treated all of 'em. I was happy to do so, but just the hypocrisy was hilarious. Yeah, so I don't condone disrespectful and whatever you say on social media, which is why, going back to my original statement is even the people I don't agree with that go on the surgeons that I don't agree with that go on social media or the doctors that say things that I feel are completely incorrect, I feel like I should not be disrespectful, but at the same time I feel bad not trying to give a second opinion, I guess. I don't know.

(36:15):
So I dunno. Here's a question. Have you ever been to Canada for one of these hernia meetings? So Canada doesn't really have hernia meetings. We have had sages, the Society of American Gastrointestinal and Endoscopic Surgeons meeting in Montreal a couple of years ago, and that has a big hernia component. The American Hernia Society has not had any meetings in Canada yet. They may they have not yet. There is a Canadian Hernia Society. I've never been invited to them. I have been invited to the Mexican Hernia Society, the Brazilian Hernia Society, the Peruvian Hernia Society, a bunch of the British Hernia Society I've been invited to. All of those are meaning hernia, Iranian Hernia Society, Indian Hernia Society. I've done all those.

(37:17):
I've never been invited to the Canadian Hernia Society meeting and I don't know how active they are to be honest, but I do know they exist. So they may not just be as active. So they may exist, but they're no meaning. I don't know. But I love Canada. Montreal's cool. Toronto's great. I think I could live in Vancouver if I had to. So yeah, Canada's great. It's looking even better as years go by from, if you know what I mean. Okay, so let me know what you guys think. It's a touchy situation. I feel that in general there's not that much about hernias on social media. It's not really what it's like talking about hemorrhoids, who talks about hemorrhoids on social media. Very few people, but I feel the majority of the information out there is not correct and I don't know how my role should be.

(38:25):
Okay, another question. I had hernia surgery using Shouldice technique, which is potentially from the clinic, but many surgeons, including myself, offer the shouldice technique on the left side. I was gradually recovering after surgery. I could sit about six weeks later. My scrotum was injured, my scrotum got hit, then I have pain when sitting. I could not even sit for one minute. About one year later, the pain has improved. I can sit for 10 to 20 minutes but can never fully recover. I applied voltarin diclofenac cream to the pain spot between the scrotum and the leg. It did not help. I applied lidocaine cream on the pain spot between the scrotum and the leg. It worked and my pain was reduced for a few days the first time. However, when I applied lidocaine cream a few days later, it was not less effective. Why is that?

(39:23):
So what you may have done was injured your spermatic cord and it's possible that your scrotum and or testicle hurts. That's the question. Is it your scrotum that hurts or your testicle That hurts because you can have bleeding and then scarring from the bleeding, which can cause pain either from the genital nerve or from the vasal nerve, the nerve by the va. And the best diagnostic treatment is to get what's called a formatic cord block. Go to a urologist. I do it as well. It's in the office. They numb up directly with the needle, not with cream, the nerves along the vast deference. And so in the office you'll know within five minutes if your pain goes away or not, and if you add a little steroids to that local anesthetic, then potentially you can just get that injected every so often until whatever scarring or kinking or injury there was isn't proof, whatever it is.

(40:44):
It's not a major injury because it's hard to injure nerves without directly cutting 'em. So they're either involved in scar tissue, there was some bleeding, but then made the area kink for something of that nature and therefore some local anesthetic and some steroids to kind of massage the area out will help. Also, massaging is good. So if you massage the whole scar from your Shouldice repair and all the way down to above your testicle, that whole area, if you massage it, you may physically loosen up scar tissue and any kind of area there and help with the pain as well. So that's another option is to do it is to massage. It doesn't involve a needle. One last thing is I'm a big fan of what's called red light therapy. So red light therapy is like LED lights of a certain wavelength that you can buy the belt.

(41:56):
They're cheap ones and there's expensive ones. They come in handheld scanners or I think the belt is the easiest. You just wrap it and you put it on for 10 minutes a day for a week and then 20 minutes a day. And the red light helps not only warm up the area and increase blood flow, but specifically it is supposed to penetrate the tissues and help regenerate so your scar tissue will become less and the collagen and other kind of good parts of your muscle and all that will start to heal. So if you have a strain, a muscle strain or something, it should heal better with the red light therapy. So a lot of patients notice an improvement when using red light therapy. It doesn't hurt, it just costs the money to buy the belt. You can go to a physical therapist and they'll do it for you. Of course that'll be much more expensive, but there's no, it's not rocket science. You just need to apply it so your skin sees the red light and it works really well. People do it for their face. You've probably seen those funky looking red light face masks that's supposed to regenerate collagen and decrease scarring and make you look more youthful.

(43:27):
People who have physical injuries like muscle strains, groin strains, groin poles, any type of athletic injury, they definitely get red light that really helps and ultrasonic therapies and all that. So why not for your groin in the area where you had surgery? It works really, really well and it's little known problem, little known solution and I think a really, really good one. Okay, I really do want to hear you guys give you some feedback as to what else I should do. I really like the recommendation to do more TikTok. You have to promise to follow me, but yeah, I'll do my TikTok on that. Sometimes I have some funny stuff. I should just do it on TikTok. It seems more appropriate for TikTok. Okay, going back to the question, is it possible that the posterior scrotal nerve and perineal nerve got injured too unlikely. What treatments are available for these nerve issues?

(44:40):
Shall I do a predental nerve block for these two? No, this does not sound pudendal at all. It's very unlikely that you have a pudendal nerve injury. This sounds like a local situation and probably a minor situation, so don't get it too complicated. Start with a very simple low risk procedure, which is a spermatic cord block that will focus on the spermatic board and also massage the area and see if it'll help break up scar tissue, et cetera. You don't want to bring in new diagnoses like you had their surgery and so on. So let me look at your original answer or question. Six weeks later, the scrotum was injured, it got hit. Yeah, you can't injure the penal nerve by getting your scrotum hit, but you can bleed into the scrotum and you can get scarring from the bleeding. And if your scrotum or testicle hurt, if your testicle hurts, a spermatic cord block will help.

(45:44):
If your scrotal hurts, you may want to do what's called a genital nerve block. Now at the s shouldice clinic, they do cut the genital nerve if you didn't have it done at the s shouldice clinic, or you should ask your surgeon if they cut the genital nerve, in which case it would change how your doctor does a genital nerve block because if it's been cut, then you can't block it where it's been cut, you have to go where it hasn't been cut. Red light therapy, I bought one myself from Amazon, but there are also fancier ones you can buy online. But basically online you can buy it. If you have a physical therapist, ask if they have a favorite one, you can probably ask chat GBT, what's the best one to buy? They're all pretty good. There are some theories that one's better than the other.

(46:45):
So if your testicle hurts and the peroneal area hurts when sitting again, I can't imagine how you would be able to injure the pudendal nerve. So if your testicle hurts, just focus on these spermatic cord block and see how that works. And scar tissue can tear, that can hurt and then it'll recar again. So that's something that you should look into. So if it's scar tissue massage and red light therapy will help. If you bled from your scrum getting hurt and then you scarred from the bleeding massage can help that. And then I would do a diagnostic spermatic cord block if that helps you then continue with doing some steroid injections into the spermatic cord to help you with that.

(47:46):
All right, so I feel like I'm getting some good feedback from you all about how I should handle social media. I'm not an aggressive social media person. I try and keep it as respectful and non, what's the right term? I'll give you the example. So I do follow many doctors on social media. The famous ones, the ones that do skits or they following hundreds of thousands of followers. And I feel like some of 'em, they make these comments that I'm like, I'm not sure I want to go to a doctor that is talking like this about patients. I love my patients and I respect them very much, and I would never post something that's derogatory to a patient or makes fun of a patient. I'll make fun of myself. I'll even make fun of surgeons. But I feel like patients should be respected and they're already usually very vulnerable before they go see a doctor. So I would not want to be that doctor who's like, ha, you have so many complaints, you're taking up so much of my time. I would never do that. So I don't understand doctors that make posts like that and I shy away from that, but I do like to make fun. So I come from a family of satire, so that's kind of in my blood and I don't think I've really crossed the line much. I may have come close to the line, but I don't think I've been bad. I'm hoping I've only been funny.

(49:42):
And then talking about social media, if any of you guys follow me on Instagram, I just recently posted a story, so if you haven't seen it in the past day, you've missed it. But I get dms, okay, so if you're sending me a dm, you may get a response about contact my office directly. We'll be happy to help you because it's usually a medical question or how can I get an online consultation question or something like that. But every so often, and by every so often I meet at least once a month. I get these people, the one I posted about what he had a fetish on clogs and he thought my clogs, he liked the post where I had my clogs on because they were so sexy and he has a clog fetish, like the type of shoes.

(50:39):
I've had people with umbilical fetishes where they really want an Audi or they want pictures of people playing with their belly button that turns them on. I've had patients request to get hernias, can you make me a hernia? I want an Audi belly button or I want to get a hernia. I'm like, well, I can't give you hernia. I'm a hernia repair surgeon. I'm not a hernia maker surgeon. There are patients from other countries. I'm Middle Eastern, so there are patients usually from the Middle East and maybe because of my name, I'm not sure who think it's appropriate to want to start a romantic relationship through my doctor's page. I don't understand that. But I just ignore those mostly. But now I'm thinking anonymously. Of course I should just repost them because a lot of you like the clog fetish post that I recently made. If you missed it, you can go on my Twitter page. I did post on that. So that's going to be permanent about the clog fetish. Yeah, that was a unique one. Very unique one. Another question here. People said ketamine will cause major bladder issues, will applying lidocaine, ketamine, gabapentin, compounded cream on my scrum and testicle and the area between my legs and scrum. Cause bladder issues. No, this is all local. I've never heard of ketamine causing bladder issues. We give ketamine for anesthesia all the time. It doesn't cause bladder issues.

(52:35):
See, this is misinformation. I don't understand why people will tell you this. It's literally like topical. So it doesn't give you a systemic effect. It just provides with local anesthesia. So gabapentin maybe can cause a little bladder issues, but not topical. Not the topical one. Yeah, these things, it just drives me nuts how people come to my office sometimes and they say, well, I read this and I read that. I read that, oh, this is a good one. I read that mesh cause cancer. I'm like, literally, we put in maybe 10 million meshes a year worldwide. You'd think since 1980 we would figure out that there's a correlation between mesh placement and cancer. Why would you believe these statistics? When people make comments and then they don't back it up with any data. It's just so, so weird to me. Okay, going back to that conversation.

(53:38):
Well, taking ketamine as a recreational drug caused major bladder issues. Not that I know of. Not that I know of. Yeah, ketamine's supposed to give you an aura or a high almost. So it's why it is a known drug of abuse. You may have heard the actor from friends, he died from a ketamine overdose. The kids like it. Sometimes they, because it gives them an aura, but it's used pretty commonly for anesthesia. It's also used very well for patients that require some type of nervous system, reprogramming and remapping because of chronic pain. PTSD, other type of mental health issues. Ketamine has been used for that, but it's a risky drug in that it can be abused.

(54:40):
I guess there was some lady called the ketamine queen or something in Los Angeles that was giving out ketamine like candy. I don't know. So if anyone has any more questions, please let me know. Do follow me on social media and I hope those of you that are in Northern California will be able to come and visit us in our Northern California office. So now we'll have one office down south, one office up north where I can see you and hopefully soon operate up there as well. And then I'll see you all in Nashville. By the way, if any of you are from Nashville, I'm happy to see you just to say hi. But more interestingly, send me some recommendations of where to eat and where to drink. I don't drink alcohol, so good coffee places and good lunch and dinner places. I heard that Nashville is good for southern food, not necessarily western food. So I'm open to all of that and I'll be at the, we have a honky tonk event, so if you really want to know how funny I can be, follow me on social media on Instagram and you'll see my honky tonk outfit. I may actually post it. It's too funny. Remember, I'm from Beverly Hills. You're telling someone from Beverly Hills raised in her entire life in southern California to attend a honky tonk event. So the glam may have to come out cowboy style.

(56:28):
All right, well, I had lots of fun with you guys. Thank you for tolerating me. I don't know how informative it was for today's I her attack live, but I had so much to get off my chest after a month of not talking to you guys that it all kind of had to be blurred out today. So enjoy your evening. I am going to start getting go to get packing. I'm going to go pack. I can't talk anymore for my Nashville event. I need boots, I need jeans, I need cowboy hat. What else do I need? I lots of turquoise jewelry and I'll be live tweeting for the meeting, by the way, on my Twitter account. So if you are interested to see what I'm learning and what we're talking about and what's new and hernia research, follow me on Twitter at hernia doc and I will be posting about the meeting. I'll be live tweeting the meeting. See you all next week. Bye.