MY HERNIA: A record of one man's symptoms, his operation, and experiences during healing.
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Disclaimer: I am not a doctor and have had no medical training. Nothing I state should be taken as a recommendation. My experiences may have no relevance to anyone else's. I am posting this page only as an isolated example of one case so that others might get an idea of what was involved in this particular case of having an operation to correct a hernia.
This is a very difficult page for me to post. Raised as an old fashioned gentlemen, I have an aversion to mentioning certain body parts and functions in a public forum. On the other hand I strongly believe that every human being has a duty to our species to collect knowledge and make it available to everyone. Only in this way can we progress. Intellectually I believe the second issue is more important than the first so I am putting this page together. I trust that anyone logging onto it will approach the subject with maturity and not be offended by anything I say.
My General Health:
I am 53 years old, 6'-1" tall and weigh 175 pounds. I run and lift mild weights almost every day and am not prone to aches and pains.
The first warning that anything was wrong was that I suddenly noticed a bulging sensation on the lower right side of my abdomen half of the time when I coughed, sneezed, or cleared my throat. It felt like a small balloon being gently inflated under the skin. Thinking it might be a hernia I immediately saw a doctor. Close examination disclosed no indications of a hernia: the doctor could detect no bulging when I coughed and there was no visual bulge. I was directed to continue exercising as normal and to watch out for any changes.
Three days later, after two weight lifting sessions and one jog, I noticed a sharp increase in the bulging sensations as well as general, slight abdominal discomfort similar to intestinal gas pains. I could also feel the bulge moving outward if I placed my hand over the location and coughed. Finally, there was a slight bulge visible in the area. I returned to the doctor and this time was diagnosed with a mild hernia. The recommendation was immediate surgery to correct it and I was given a referral to a surgeon.
The surgeon confirmed that I had a hernia on the right side and a weak spot on the left which would eventually develop into a hernia. He prescribed an operation to correct both sides. I concurred and the surgery was scheduled for the earliest possible date, which turned out to be four days later.
While I waited for the surgery, I noticed that the symptoms already described were tending to become more pronounced. I have no way of knowing if they really were or I was was simple paying them more attention. The overall sensation was very mild, occasional discomfort, mostly from the bulging sensation and an intestinal gas-like pain.
What is a Hernia?
Starting from the inside and moving outward, the human lower abdomen consists of internal organs, a membrane, a wall of muscle, a layer of fat, and skin. In a hernia, one spot in the muscle wall weakens to the point where internal pressure causes the membrane between the organs and muscles to bulge outward through the muscle wall. This condition does not get better on its own and has to be corrected with surgery. If not, eventually some of the internal organs can also get pushed through the muscle wall. If that happens, side pressure from the muscles may strangulate the organ and cause it to die from lack of blood. Gangrene can then develop and kill the person. There are different type of hernias depending on where they are located.
While a hernia can be the result of staining, the most common type of hernia is genetic, a naturally occurring weak spot that may develop in youth or later in life. Exercising the abdominal wall may or may not prevent a hernia from forming. Men are six times more likely to get hernias than women.
How is a Hernia Fixed?
Hernias are corrected by a surgeon pushing the bulging membrane and any protruding organs back into place and then strengthening the area so that another hernia doesn't develop. My surgeon explained that as of 2004, this strengthening step usually involves placing a plastic mesh over or under the wall of muscle to hold everything in place.
There are two different ways to accomplish the surgery: traditionally and laproscopically. Using traditional surgery, the doctor makes a three-inch long cut near the bulge and repairs the damage from the outside. In this case the reinforcing mesh is stapled to the outside of the muscle wall. Recovery from this operation is typically six weeks during which time a patient may not be able to walk. In the laproscopic procedure, the surgeon operates through three thin tubes inserted down into the abdomen through very small holes: one in the navel and one on either side. One tube holds a light and television camera, one cutting and grasping instruments, and the third is used to remove material or insert the reinforcing mesh into place. In the laproscopic procedure the reinforcing mesh is placed under the muscle wall. Healing in much quicker and there is less pain.
My surgeon recommended the laproscopic technique and I agreed.
What did I have to do to Prepare for the surgery?
I was told to not eat anything after 18 hours before the surgery and to wear loose fitting cloths on the day of the surgery.
While talking to two other people who had had similar operations, I discovered that prior to the operation I would have to be shaved from my knees to my chest. They stated that this was an uncomfortable procedure both for reasons of modesty and because it is difficult for anyone to shave such a large area of someone else without nicking them. I decided to shave myself. In so doing I discovered that a dry razor worked the best. Shaving wet caused the long hair to clump up in the blade. Shaving dry avoided this, though it was necessary to wipe the blade free of hair after every five to ten strokes. I tried an electric razor and found it worked okay if the sideburn trimmer was used first to cut off the hair short before the screen blades were used for a close shave. However, in areas with loose skin, such as in the groin area, there was an increased tendency to abrade the skin than with a blade razor. It took me 45 minutes to shave.
The nurse assigned to shave me prior to the operation appreciated my having done so myself ahead of time and commented that people who do so end up doing a better job that a second person can.
What was PreOp Like?
PreOp was taken care of in two steps. Two days before the operation I went in and filled out the necessary forms and had blood work done, chest x-rays taken, and had my urine tested. This procedure took two hours. On the day of the operation I walked directly to the preop room two hours before the scheduled surgery. There I donned a surgical gown and had an IV started. I would have been shaved, if needed, and the rest of the time was spent waiting. During this time I was asked by everyone who talked to me to state my name, the date of my birth, and what I was going to have done and this information was carefully compared to the arm band attached to my wrist. I assume this was to ensure that they were doing the correct procedure on the correct patient.
Fifteen minutes before the surgery the nurse pushed me into a waiting area just outside the surgical suite. As I waited the surgeon came over and introduced the attending nurse and anesthesiologist. They all answered any questions I had.
I was then wheeled into the surgery room, which was 30 by 30 feet and crowded with a jumble of electronic and mechanical equipment. Both of my arms were strapped out wide and and EKG leads attached to monitor my heart. Something was injected into my IV which caused an uncomfortable burning sensation in that hand. I asked the anesthesiologist to tell me when he was going to administer the anesthesia. When he did I began counting to see how far I could get. As I did so I focused my attention on the room to see if I could detect how I lost consciousness. I recall counting to 3 before everything faded and have no recollection of how the room faded. (My wife had surgery and stated that as she went under it appeared as if the room darken from the outside to the center of her field of vision.) The anesthesiologist told me later that I had actually counted to 13 before passing out. My son, a psychologist, explained that the difference in what I remembered to what happened was the result of the difference between the time it takes for short term and long term memoeries to form.
What was PostOp Like?
The surgery took one and a half hours and I woke up an hour after that. Consciousness seemed to come quickly and I don't recall any grogginess as if I were drunk. I felt sleepy and believe I drifted off to sleep once or twice. An hour later I was awake and feeling quite good. My abdomen was sore but I wouldn't call it painful. Sitting up put strain on the incisions which hurt, but it was minor. I was able to stand within two hours of waking up, though the soreness caused me to hunch over.
A six-inch wide elastic band had been placed around my lower abdomen with thick pads under it covering the areas of hernias. It was explained that these pads are necessary for one to two weeks to keep everything flat. Without them fluid could fill any open areas and cause problems.
I could have been released at that time but they held me until I urinated. They needed to do this to make sure that there was no blood in my urine, an indication that either the bladder or urethra may have been damaged. Unfortunately, the trauma of having a catheter in my urethra during the operation and the discomfort I was feeling made it impossible for me to urinate. After four hours of drinking so many cups of water I felt like I was downing, the doctor directed that a second catheter by inserted up my urethra to empty my bladder. This procedure was one of the most painful things I have ever experienced. Fortunately, the urine was clear and I was discharged.
I was able to climb into my car and have my wife drive me home without significant discomfort. Once there, I discovered that the most comfortable location was in a reclining rocking chair. It offered many different positions including laying out almost flat for sleeping at night.
The biggest surprise was that after such major surgery I was able to walk around almost immediately with little discomfort.
The First Week of Healing:
My sensations during the first few days were a feeling of having been kicked in the lower abdomen. I felt slightly nauseated, swollen, tender, with an occasional sharp pain if I twisted or stretched. After sitting for a few minutes I noticed that when I stood up there would be a momentary stretching pain similar to a stiff muscle. I had been given several dozen vicodin tablets to ease the pain and they did this well. They also made me sleepy and very slightly mentally foggy: I found it hard to accomplish creative tasks when using it. I attempted going without it after two days and after 18 hours the pain was bad enough to make my teeth chatter.
The most painful sensation started the second day after the operation. When I cleared my throat, coughed, or (God forbid) sneezed, there was a sharp tearing sensation three inches below my navel as if a stitch or staple were ripping loose. I asked the doctor about this and he said it was a normal sensation and would fade as the abdominal muscles grew into the reinforcing mesh.
During surgery there is always some bleeding and fluid loss. These tend to settle to the lowest part of the area around the surgery, which, for a man, is the genitals. This results in minor swelling and a black and blue discoloration similar to bruising. However, because the area was not traumatized, as it it with bruising, the discomfort level is much less. It took two weeks for swelling and discolorization to go away.
By far the most uncomfortable part of the convalescence was constipation. In spite of eating the recommended high fiber diet and availing myself of several different types of laxatives, this problem would not go away. Doctor's orders to avoid straining made the problem worse. It resolved itself after a week but it took several days for my system to get back to normal. If I had to do this again I would discuss this problem and ways to circumvent it with my doctor before the operation. I have heard that some pain medication can cause constipation but I do not know if the vicodin I was prescribed does this.
Urination caused similar, though more temporary problems. The trauma of the catheter and resulting dryness and natural muscle tenseness made the first half dozen urinations difficult and painful because of a burning sensation. Again, my doctor assured me that these were normal. The burning sensation lasted a day and a half and it took a full week for this function to become normal.
I found it most comfortable to sleep in a reclining chair because it prevented me from rolling over on my stomach. Also, sleeping on a flat surface caused uncomfortable stretching of the abdomen. The curved shape of a recliner eliminated the stretching.
By the end of the first week, the tearing-stitches pain when I coughed was noticeably milder. The doctor stated I needed to continue wearing the pads and elastic band for another week but that I could take it off at night to sleep. This was good because it was beginning the chaff and cause sores. The first couple of times I did this I woke up slightly nauseated. I believe this might have been a reaction from having the pressure released after having gotten used to it.
At the end of the first week the elastic support band started to stretch out with the result that it got narrower. Because it was held in place with a Velcro strip, the plastic hooks on the strip began to extend over the edge of the elastic band and cut into my skin. I found it necessary to trim the Velcro several times over the two weeks I wore the band to prevent the plastic hooks from painfully abrading my skin.
After the first week the hair I'd shaved off had grown to such a length that the whiskers were uncomfortable. I found that a liberal application of talc eased this discomfort... a little.
At this time I was able to walk comfortably, though slowly, up to one mile and mow the lawn. Twisting, pulling and stretching motions were uncomfortable and could be painful. Pushing actions, like mowing the lawn, did not cause any discomfort. Bending at the waist was uncomfortable, but doing a deep knee bend to get low to pick up something wasn't. Easing down into a chair by supporting my weight with my arms caused tightening of the abdomen and discomfort. Lowering myself using my legs and keeping pressure off my arms was less painful. If I had to open a sliding door, doing so with one hand was uncomfortable. Doing the same thing by pushing one hand against the door and one against the frame kept the stress concentrated in my upper body and didn't cause any pain.
After one week I quit taking the vicodin. I experienced one day of minor headaches, which I assume was the result of coming off the medication. Other than that I experienced no problems.
At about this time most of the genital swelling had gone away. I noticed that I began waking up at night with a nauseous sensation and discomfort in the genital area.
After eight days I was able to bend all the way over at the waist to pick up something off the floor with little or no discomfort.
My Big Blunder:
Ten days after the operation I was feeling pretty good so I took a three mile walk to start getting back in shape. It felt good so I repeated it the following day. The day after that I began experiencing testicular pain. It wasn't too bad if I was sitting down but walking and any jostling motions were extremely uncomfortable. I called the doctor to ask if this were normal. He stated that some minor pain of this type is common after hernia operations because the testicles have been irritated, The jostling from the walks had exacerbated the problem. He prescribed some anti-inflamatory medication and directed that I remain still as much as possible until the discomfort went away, which should take four to eight days. I was to contact him after that if the pain persisted or immediately if it got any worse. He emphasized that patients should always report any pain to their doctors.
Sitting quietly seemed to help this condition go away the fastest.
Two Weeks after the Operation:
The hair that had been shaved has grown back long enough so that I'm no longer itching from being stabbed by whiskers. The tearing-stitch sensation is also gone. I experience a slight stretching sensation if I stretch backwards and still get an occasional stitch at random places in the abdominal area when twisting. Bending over at the waste to pick something up off the floor causes no discomfort. My groin area is still tender from my walking blunder but that's getting better every day. The most uncomfortable sensation is that the skin in the abdominal area seems to be over sensitive to touch, especially cloth rubbing across it. The sensation is similar to the sensitivity caused by a rash. I find that wearing soft, snug, but not tight, clothing that doesn't slide over the skin to be the most comfortable. Folds created by stiff, loose clothing scratch the area and is annoying.
Six Weeks After the Operation:
I had my final exam by the surgeon and he pronounced me 90-percent healed. In two more weeks he okayed me for jogging and in one month I can start weight lifting again.
The only sensation I have is a pulling feeling when I lean backward and do a hard stretch. Other than that everything's fine.
Eight Weeks After the Operation:
I began jogging and had no sensations from the area of the operation. Shortly after this I began light weight lifting. I could complete all the usual moves without discomfort. The only time I experienced pain was in trying to do leg lifts to work the lower abdominal area. Crunches and sit ups, to work the upper abdominal zone, caused no pain.
Three months after the operation I was 100 percent healed. I could do any type of abdominal exercise without any noticeable discomfort... other then being out of shape. It seems a little harder to contract the muscles of the lower abdomen to hold my stomach flat, as if the mesh were stiff enough to inhibit complete contraction of the muscles.
The total bill for this surgery was $27,000, of which the therapist from my rotator cuff experience said the insurance company would convince the doctor to settle for something around $15,000. It would seem that one of the benefits of using medical insurance is that in addition to paying the costs, they are also good at getting doctors to accept considerably less payment than they charge. If I had to pay the bill out of pocket, I doubt I would have the knowledge and clout to be able to get the doctor and hospital to reduce their charges.
UPDATE!!! Cough hazard!
One year after the surgery, I caught a cold whose main symptom was a severe cough. This cough was so violent that many times I felt a sharp tearing sensation in my lower abdomen, which I assume was caused by a distention of the abdomen straining one of the sutures that hold the mesh in place. Two weeks after the cough had subsided I still experienced minor stabbing pains in that area. If my assumption about the pain being caused by tissue being torn. It took a full month for this problem to go away completely.
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