A Surgery Journey with Inguinal Hernias 11-2015
Thank you to all the mesh-free hernia surgery bloggers such as http://thelibrarian.bravesites.com/entries/general/desarda-hernia-surgery , https://shouldiceherniarepair.wordpress.com/ , and commenters who shared their wisdom and experiences with the surgery journey. And special thanks to Fred Amir for writing about his research and personal experiences in the mini Kindle Book “Mesh Free Hernia Repair.” This book provides an easier way to learn about the options regarding an Inguinal Hernia and helps you make an informed decision that is in your best interest.
I wish to expand on their inputs after getting here myself after about 4 years of wearing trusses. I had a left side Inguinal Hernia that had gradually expanded to the size of 1/2 of a big orange, and then more recently, it appeared that another small hernia may have been developing on the right side.
As I understand it, there is no consensus on what starts a hernia- excessive lifting, weakening of area due to age, coughing, heredity based weakness, etc. I have been pretty regular with abdominal exercises after a cyst was diagnosed in the area and then aspirated (drained of fluid) on two separate occasions over the years. And after the first hernia would not go away, I became stricter about tightening the area with different types of toning exercises, including planks and hanging bar knee-ups. I did not spend a lot of time doing hundreds of reps of these (after 40, your focus of time & energy becomes prioritized and/or just isn’t the same as when you are 25), but was very consistent with them.
After doing some research, it became comfortable to stick with “watchful waiting.” Besides, modern trusses were effective most of the time for allowing me to keep active on my very physical job and during limited exercise. And I was fearful of surgery- as stated above I have a cyst inside the abdominal area, and the second, very different (and questionable) procedure to drain it had extremely painful and dangerous complications.
The short explanation is that during the 2nd aspiration of this cyst, they left a small tube and bag attached to me for draining over a few days, (I did not expect this, it’s not like the cyst had that much fluid.) which led to an infection issue and shock of the digestive system, an ambulance back to the hospital, and a week there getting my stomach and intestines back to working-digesting-excreting order. So this experience left me with a healthy, skeptical, questioning perspective of any surgical issue. Medical professionals are as human as the rest of us, and may have their own motivations or opinions of how to treat us, of which we may find disagreement.
Since my initial Inguinal Hernia appeared to be growing, I was thinking more seriously late this past summer of getting repair surgery. I was interested in the Desarda No-Mesh Repair method and aware of Dr. Robert Tomas of U First Health performing this procedure in Fort Myers, Florida. But was anxious of committing to it, partly based on my prior surgery experience.
And after looking further into the Shouldice Hospital of Ontario, Canada, and their method and reputation, I was attracted to that option. They were “all hernia, all the time”- studies have shown that highly experienced surgeons are critical for insuring the best long term outcome for all methods of hernia repair. I also liked the idea of numerous hernia surgeons working alongside one another- creating an environment that I felt could insure high competency. The Shouldice technique seemed to have an impressive success history, but it was an older, not fully accepted, and apparently complicated repair, with a much higher cost and logistical issues for me.
Anyway, as fate would have it (never got to write that before), I fell trying out a neighborhood guy’s electric skateboard (hoverboard)- they are hazardous! Ended up fracturing my wrist, which put my writing hand in a cast and me out of work for at least 8 weeks! I had time to focus on the hernia issue, consider visiting my sister in Florida and at least take a step forward by seeing Dr. Tomas for a consultation and looking into whether I could recover there at her place if surgery goes forward.
After some time adjusting to daily activities using only one arm, I booked a flight and drove a trial run with my sister from her house to see Dr. Tomas- it’s a long drive. By phone and email, the staff at U First Health were very organized and detailed in preparing me for the logistics of surgery preparation and recovery. But I still wanted the consultation before deciding that Dr. Tomas should perform the repairs.
Dr. Tomas was patient with my questions, and confirmed I had a second hernia on the right side. I felt very confident with him after my examination and speaking about the repair. After taking the steps to get to this point, I could finally commit to him performing the procedure. They would have fit me in for surgery the next day, but I still needed at least a week to stop any blood thinning supplements. And the extra time was useful for planning and preparation for recovery in a new environment- a busy household.
I have other health issues and take some supplements, but as instructed, stopped those that could cause blood thinning issues (Multi with Vitamin E, Fish oil, Niacin, Saw Palmetto) for the week before surgery. When in doubt about what to stop, and you can’t speak to your surgeon quickly, www.nlm.nih.gov/medlineplus/ is a great reference.
Preparation was part of minimizing discomfort- starting an am and pm Stool Softener 2 nights before surgery was helpful, as I had a bowel movement the afternoon of the day after surgery, which is ahead of schedule.
And as for shaving the area before surgery: make sure you have proper instructions, whoever your surgeon is. I was not sure until I verified with the prep team at the Surgery Center, to not shave, as they could cancel surgery if I made a nick/cut that added to infection risks. So if in doubt, better to let them do the shaving during the surgery preparation.
Though skeptical, I purchased a Surgery Relaxation-Healing-Recovery program to listen to before surgery, during, (though they did not allow it due to germ issues, and probably since they would be instructing me to cough a few times during surgery), and after the procedure. I believe it was very helpful for being positive and less anxious during the surgery. And being an optimistic patient helped my interaction with the doctors and medical staff at Lee Island Coast Surgery Center. They were caring and informative, and the experience was as positive as I could have hoped for. Dr.Tomas reported that during surgery, he found and repaired a 3rd, direct hernia on my right side as well (hense the title above)! As I was also told, the tough part is the first 2-3 days after the operation.
The Days Just After Surgery
Getting out of bed that 1st day after was a really tough challenge- I felt dazed, with nausea & pain just trying to get off of the bed, stand and eventually walk, then experienced continuous bloating & burping when taking the meds. Having that kind of morning, I was so frustrated, fatigued and disillusioned, that I just stepped outside to get some sun and stumble along a while, as you must get up often during the day to aid blood circulation. I really believe that getting into the sun got me going again. Since there isn’t always opportunity to get regular sunshine exposure, I also stepped up my Vitamin D3 intake (5000iu a day) before surgery and after. I usually take a dose every other day. And I recommend being persistent- keep stumbling along the 1st morning after; it took me an hour to get up and get moving! Your pain and nausea will likely be less- and it begins to get much better.
I called U First Health and was told to chew ice cubes during nausea, and I learned that the meds they prescribed can be taken with a little food to reduce this and gas issues. Percoset (pain med) can be taken with food, Keflex (antibiotic) and Ibuprofen can be taken with food and milk. If your meds are different, you can look them up on Medline. This worked; the lesson here was having snacks or small meals with meds throughout the day. Also drinking plenty of water is instructed as your digestion starts working in the day after surgery and beyond. If you can have a taste for prune juice, that can also be helpful for your digestion.
As I started regular food, this included Probiotics, since the meds, especially anti-biotics, could mess up the healthy mix of bacteria in the stomach and intestines, or as they say, “gut flora.” So each day I included a probiotic such as Kefir, Naturally Fermented Sauerkraut, a Probiotic capsule, or a “green powder” supplement I borrowed from my sister that included probiotic strains.
U First instructs lots of icing during the first 5 days for swelling-inflammation-pain; getting a medical ice bag is a big help. The tummy area was swollen and my “junk” were very swollen and bruised. I was told this is normal, but again maybe more so for me due to having the 3 repairs made.
2nd day after I walked around a little and carefully showered while adjusting to the aches and soreness, icing and fitting in the meds, 2 different Homeopathic pills- Arnica for pain, inflammation, and healing, Carbo Veg for gas issues, and a Bromelain supplement for pain, bruising, healing (I learned about these from Andrew Weil MD, and acquaintances of my sister). Also started the process of taking all of my supplements again, which included a Multivitamin, high dose Vit-C and Collagen Protein powders, and Fish Oil capsules. As I understand it, these should also be helpful for healing and inflammation from the surgery. This continued into following days as I became confident of the incisions not being inflamed or discharging or easily bleeding – I did not want to make things worse by thinning the blood.
3rd, 4th and 5th Days-
I ventured outside to walk slowly and not push myself. The aching became less pronounced and I gradually increased time/distance, but walked slow and stopped at half-way points to rest. I stopped the Percocet pain med during the 3rd day, after getting advice from the staff at U First. Since I noticed not being as sensitive to pain and the timing of the next dose, it was decided the Ibuprofen could handle the pain issue from here (along with swelling & inflammation). Percocet could cause me to be over-confident and push my body too soon.
I really don’t like prescription anti-biotics, but after intensive surgery, I took the prescribed Keflex and then replaced it later in the 3rd day with the natural alternative of Oil of Oregano, and a little raw garlic here and there. I did ask about this before surgery, and was told “maybe after a few days.” So I’m not being too radical here, and I had already used them in a natural protocol to beat a bronchial infection, when a doctor expected me to use a prescription for a” Z-pack” antibiotic, which has dangerous risks of permanent side effects, including heart damage- look it up!
During the recovery period, I would on occasion, need to take a short nap, listening again to a section of the Surgery Relaxation-Healing-Recovery program as I fell into sleep.
Days 6- 8
Tummy swelling has subsided, aches are less noticeable and I seem to be a little flexible without worrying about pain and pulling something. Engaged in slow walking of around 30 minutes with a break in the middle of 10 minutes. As I have other health issues, you may be able to progress quicker to longer walking or more than one each day. I did have some aching with the walks, sometimes as I tried to stand straight with good upright posture.
On day 7-one week from surgery, I borrowed a car and drove myself the 2 1/4 hr (each way) trip to U First Health for a followup checkup. (They say driving is fine after a week-at that point you should be off the narcotic and recovered enough.) The day before, B.J., the very helpful Patient Laison at U First, suggested I take a test drive to see how it felt (smart thinking). I felt ok during a 15 minute drive, but made sure I knew how to use the cruise control (!) for the trip.
Dr. Tomas said I looked good, and it was ok to stretch out my body posture as is normal. He gave me the cough test, to see that things were ok. I mentioned the medications and he encouraged me to reduce Ibuprofen further and phase out, and that I could stop the Oil of Oregano as well. I also asked for a Return to Work Prescription that my employer would require. Dr. Tomas did not mention anything special to consider; just to give time for healing and stay within their guidelines for lifting and activity before transitioning back to limited work duty (my stocking job is very physical ) just about a month from surgery. No squatting/bending at work or lifting over 10 lbs, for 2 months from the surgery date. These activities can be constant at work, so restrictions must be conservative compared to what you would do at home, at times without realizing it!
I was a bit achy in the lower tummy (the incisions were fine) after my walk that day- maybe because of the stress, activity, & all the driving. You tend to get achier in the evening as the body tires. On Day 8 I was tired more than anything else; I think the stress, driving, walk break during the trip to U First Health, and an evening walk, all on Day 7, wore me down. Not that I laid around all day- just walked about normally and did not take a walk specifically for time/distance.
Days 9-12
I took a longer stroll with my sister’s family at an arboretum on Day 9. I needed to walk slow, and did get achy here and there. Also have been getting small aches the last few days when I started to be active with bending or lifting or pulling things in the 5-10 (maybe 15?) pound range. My body’s just gonna heal at its own pace, I guess.
At Day 10, took my last daily dose of Oil of Oregano, since the Keflex antibiotic prescription bottle would be empty this day if they were taken as directed (and there were no infection type issues). And the reduced dose Ibuprofen (200mg am & pm) was stopped and will be as needed.
I don’t seem to have tummy swelling anymore, but the 2 incision areas, sealed with a purple glue called Dermabond, are raised up a bit, though they are starting to heal and some of the glue has been falling away slowly each day in the shower. I remember reading about patients calling these the “healing ridges,” and that over time they would recede.
I went on a little boat trip with sister and family on Day 11- did not go in water or swim, tried not to lift much stuff (some light fishing). But wondered if I was “pushing it” with leg stances and balancing, and movement and slight twisting in a lightly swaying boat. Had some aches afterward that subsided and later we walked a bit downtown to get a meal. I emailed Fred Amir on Day 12, thanking him for his book and asking about when to start ab exercises or if starting stretching soon would be good. He advised to continue to take it easy and give the body time to heal. I really have to be conscious of not pushing physical activity (other than slow walking) too soon, and standing firm with family members, employer and co-workers. Do I really want to end up needing yet another hernia repair soon?
Days 12-17
Nothing special to note- continued with daily long slow walks, most of the time with a short rest break, and a short nap on some days. At times wonder if I am careful enough when helping out in my sister’s big kitchen, etc. to not overexert or bend/twist too much. I was supposed to have my arm cast removed and wrist fracture x-rayed in NY on the 3rd day after hernia surgery. But since I’m still recuperating in Florida, I’ve been slowly, consciously and unconsciously, using my injured writing hand in limited amounts of movement in cleaning, eating, and attempts at writing. Hoping that works out!
Day 16 left FL for Queens, NY with Wheelchair Assist from the airline. I wanted to be safe and reduce the chance of overexerting myself; reaching too far, or using too much force, when feeling rushed in security or pushing bag into an overhead bin on the plane. It was also a self-reminder that I have injuries that require serious restraint of activities and continued time to heal. The airline and Homeland Security people were very conscientious and helped the trip to be smooth. I called ahead for a ride home and help with the bags in/out of the vehicle.
But later eating pumpkin seeds as a late snack, I got a tickle in the throat and had some deep coughs which did hurt- this was alarming as I was managing to move-bend-reach a little more over the days and not feel that I was “pulling things.” There was some aching that night in bed during sleep. Day 17 was hoping this wasn’t going to be a setback, while getting back to my life at home sharing an apartment. Plenty of light bending involved in unpacking, and lifting in shopping for food- so only did light amounts of each. Took small walks and decided not to push too much as later there was aching in lower groin areas I assume where internal stitches are.
Days 18-21
Just more of same. A little ache here and there, from walking, though I maintain a slow pace. Occasionally, I still try to sleep on my side, but that can start a slight ache as well. They do go away. Still taking doses of Arnica, Carbo Veg, and Bromelain, usually twice a day. Maybe they helped with the various surgery aches subsiding relatively quickly? Obviously I was also being cautious not to strain anything. Also still using a stool softener, to prevent straining, as U First recommends for 6- 8 weeks.
There was some purple patterned bruising remaining on my upper inner left thigh since surgery- that is noticeably much better just the last few days- so it can take some bruising a while to completely disappear. On Day 21- Week 3, I finally was able to see the Orthopedist here in NY and have his permission to take cast off my left wrist and arm- yahoo to that! Will start physical therapy sessions for a few weeks to bring that wrist back to normal. Starting limited work duty in a week and a little nervous that I usually use a step ladder during my shift. Asking U First for their opinion, since I forgot to mention it before.
Days 22-28
Day 27 worked a half shift on 1st day back at job. Not my usual stocking duties- instead was checking and printing new pricing tags on shelves and helping customers. So glad my supervisors were able to accommodate me, and no step ladder needed! To mention again- it is better to be conservative about activity restrictions in a work environment- stairs on a job will likely be a lot more intensive than in home life. Tried to limit bending by staying at certain shelf levels and working across, instead of repetitive up and down movements. And used knee pads instead of squatting when at a low level. Still, I was reaching often, bending a bit and walking- decided not to complete a full shift as that felt like it would be pushing the limits at this point. Started to feel “tight” in the belly and a little achy on right side (2 smaller repairs) as I was walking. I decide it is safer to complete smaller shifts as I begin returning to work.
It was a decent shift considering I had limited sleep due to waking up with my previously fractured hand aching. Uh Vey! I did call U First to clarify their recommended activity restrictions- Patient Care Aide Rahim explained that the restrictions can vary somewhat based on how quickly you are healing and what you can sense about your body. So for example, being young and in excellent physical conditioning should shorten the recovery process.
Rahim instructed no stairs for at least a month, better 6-8 weeks. Biking in moderation can be attempted after 5 weeks, depending on how it goes with aching/pain, both during and after the exercise.
One Month
I have started looking into how to help surgical incisions heal and minimize scars. U First had instructed that the incisions should be left alone for the first 3 weeks to prevent any infection. After that, I wondered whether to use Aloe, Raw Honey, Vit E, or Silicon strips. Looking online, it seems none of them stand out from a doctor’s perspective (one study had shown Vaseline was just as effective), except that using them to keep the scar moist is important. And Silicon may also help smooth out the scar as it heals. So I am applying either Fresh Aloe Leaf Gel or Organic Raw Honey (put surgical tape over honey to prevent a sticky mess) on alternating days, since both have natural medicinal properties. Later may use the Silicon strips after the incisions become fully sealed.
There is still soreness near incision areas at times and during/after walks or light lifting or other exertion (cleaning/bending) as I become more active, but these were short and went away. I did not push my body hard, at work or home, and stayed within the activity restrictions nearly most of the time (may have lifted an occasional grocery bag that was a little heavier than 10 lbs.).
45 Days
Now walking and bending at work in increasing amounts while completing full shifts. Aches became less noticable and the incision areas and internal stitching areas below seemed to be less tender to the touch. On Day 48 I increased my speed further on one of the walking loops in the park and set my lowest time so far. I would expect an ache or soreness of some type, on and off in the hours after, but this did not happen; a very good sign! Still taking Bromelain and Stool Softeners on way to 8 week status since surgery.
Anxious to start my Ab exercises, take stairs in building, start pushups and lifting heavier things, but will wait it out and start slowly in small amounts after 8 weeks. The folks at work have been very patient and it’s best to allow recovery between work days as my activity increases there. Though I will keep walking every day at varying distances and intensities, until eventually starting up some jogging when it’s safe to begin.
60 Days
Started regular duties at work on Day 58- which includes moving and organizing stock on shelves, with reaching, bending, and the use of a step stool, but restricted weight to 15 pounds. Very pleased that I felt no signs of irritation or pulling in the surgery areas. As I would normally after a regular shift, I engaged in leg stretches, being cautious, and limiting some such as one type of hamstring stretch, which involved placing each knee to chest, which did not feel like a good idea. I also did not perform hanging from a bar stretches which are great for the spine, back, and upper body after exertion.
At Day 60, I started limited situps, taking a flight or 2 of stairs in my building, and on my daily walk, jogged very slowly for about a minute- those activities seemed to feel okay. Also began lifting the normally heavier grocery and laundry bags. Afterward some achyness did occur, like a warning sign of pushing my limits. The next day I completed some vacuuming that involved extended reaching above shoulder height, while holding a small plastic “shop-vac” in the other hand. This time an ache/pulling in my lower abdomen was more evident- it seems I was pushing myself too much with the reaching/pushing of long vac hose while lifting the canister. Feeling I may have gone too far, I decided that was enough. I stopped the stairs and such to rest the area a few days, tried to remain cautious in all activities, and hoped the area would heal.
90 Days
On Day 78 started wall pushups, incrementally adding knee pushups, and some barbell curls. Continued to ramp up activities at a slow, steady pace. There were some alarming aches as I slowly increased the length of my ab and plank exercises. Thankfully, they have been minor- maybe it was muscle soreness. Now completing these at close to regular levels, except for “knee-ups” while hanging on a bar (I have not started acclimating to exercises for a pullups/chinups bar yet.). On day 89 I used an exercise bike at the Y for first time since surgery. I had put off biking to avoid the temptation of using the nearby weight machines. And this did happen- I did small sets of leg extensions and leg curls at low weight. But just after felt aching in surgery area on right side- I iced the area and was conservative in activities for a few days. Thank goodness it did go away. I still take Bromelian at low doses often, as people online swear by it for soreness, healing and inflammation (not extensively tested for specific conditions yet ( https://nccih.nih.gov/health/bromelain?lang=es ).
At day 104, I am starting to work in a few regular pushups. Walk/slow jog/walks and weekly exercise bike are becoming routine now. Will get back to low weights (!) on leg machines at the Y soon along with multiple flights of stairs in apartment building. And start biking outside as it get warmer. Still coating incision scars most days, alternating with either organic raw Honey or fresh Aloe leaf gel. In retrospect, I could have used Manuka Honey Grade UMF 10-20 on the incisions within the first few days, but I was too concerned with surgery issues to plan ahead. Since it seems this type of honey is used as a wound dressing, the risk of infection from it should not be an issue (thou I would check with the doctor). It is supposed to speed healing and help minimize scarring. I would have to be shaving area to use silicone strips- they may still be an option later -especially if scars are not healing smoothly, without visible “ridges.”
ihernia 