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Think you have a hernia? Maybe not...

There's about a 40% chance that even if you have been diagnosed with a hernia that you don't have one.

Let me explain...

I was moving pickup truckloads of sand with a pickup truck and a shovel.

Sitting at supper with friends that night I felt a pain like something ripping in my gut. Being a guy, I ignored it, even though it scared me a bit, and I tried to continue moving sand the next day.

That wasn't going to work, too much pain, so it was off to see the doc and get a diagnosis on what I suspected was a hernia.

The doc says no doubt about it, it's an Inguinal Hernia and you'll need surgery. We scheduled me for a consultation with a surgeon at one of the local hospitals.

An Inguinal Hernia is what 85% of hernias in men are. There's a small "tube" called the Inguinal Canal that passes through the abdominal wall where the testicles descended before birth. This is also where the spermatic cord passes through the abdominal wall to get from the prostate to the testicles.

If the abdominal wall tears at this point it lets the intestines squeeze through the tear, down the Inguinal Canal and bulge out next to the penis. There are some videos of this HERE.
There are some good animations of hernias on that video page but you may have to use the search box to find them.
The next move was internet research, with some mighty interesting discoveries:

Hernia Repair Problems

  • Most hernia repair surgery in tha US is done by sewing plastic mesh over the damage and/or putting a mesh plug in the Inguinal Canal. The mesh is installed from inside the abdominal wall with a lapiriscope or from outside via traditional surgery.

  • There is a huge failure rate with the mesh, leaving people in horrible pain. From what I could find, it looks like about a 20-30% failure rate.

  • If the mesh type repair failed, you have a big mess of scar tissue and a hole in your abdominal wall. This is often not repairable and you end up disabled and in pain for the rest of your life.

  • The repair was done in the past by stitching up the torn abdominal wall including the inguinal canal and had a very high success rate with no ongoing pain if done correctly.

  • There are a few places left in the US that would still do the stitch type repair. One in Las Vegas looked pretty good and the doc there checked out as OK on evaluation sites online.

  • Shouldice Hospital in Toronto Canada was looking like the best place to have a stitched type repair done. They have been doing these since 1947 and hernia repair is all they do. they have something like a 0.5% failure rate.

There's no doubt in my mind that I'm going to get this thing stitched up.  No way I would have a mesh type repair.

So now it's time to go talk to the local surgeon...

Checking it Out with a Surgeon and "Watch and Wait"

The surgeon checks me out. Yes, he says, you have an inguinal hernia and surgery will be necessary eventually.

We discussed "watch and wait"...

A lot of people do this with their hernias. It means to keep an eye on it and postpone surgery unless absolutely necessary, or, until you can raise enough money to do the surgery. The surgeon agreed this worked. More on watch and wait in a minute.

When I told the surgeon there was no way I would have a mesh repair, and why, he said that he understood. The problem was that there is no one left in this area that still knew how to do a stitch type repair.

This surgeon was a good guy and very honest.

So the next question was....

What Will it Cost?

I thought I would check and see how much it would cost if I did have it done at that local hospital.

They wanted $25,000 to do the operation. About $1300 for the surgeon and about the same amount for the anesthesioligist. The rest would be for using the hospital surgery for 45 minutes and a few hours of recovery time. They would not do it without full anesthesia either.

$22,400 just for the "privilege" of being in their hospital? Yeah, right.

To top that off I tried to get the paperwork documenting my visit and got jerked around, abused and sent from office to office with no one really knowing what to do or how to get me the paperwork. I guess they thought if they were nasty enough I would go away.

That was correct, I went away, hopefully to never return.

 Unfortunately, if you end up unconscious from an accident, that hospital is the default setting for where the ambulance will take you.

Getting back to the cost, I already knew that either the guy in Las Vegas or Shouldice Hospital would do the stitch type repair surgery for $5000. In Las Vegas they even had an arrangement to put the surgery on credit so it was affordable.

Time for the next decision...

Pros and Cons - Shouldice vs. Las Vegas

These are the pros and cons that eventually led me to decide in favor of Shouldice:

  • The Las Vegas outfit would do the surgery, look at you the next day and send you home. Shouldice keeps you for 2-3 days, watches your progress, and teaches you how to recover more quickly.

  • Shouldice is like an upscale resort. Might as well enjoy yourself as much as you can while having a traumatic experience.

  • Experience, experience, experience - I worked as a mechanic for years. The more you do one type of repair the better you get at it. Shouldice is coming up on a quarter million successful hernia surgeries.

  • Shouldice does the operation with partial anesthesia. You are awake but in the "twilight zone". I don't know how Las Vegas does it.

  • Shouldice invented the first successful stitch type hernia repair.

  • My health insurance would not pay for surgery outside of the US, even if it would save $20,000. The Doc in Las Vegas does not take health insurance because his practice is based on affordable surgery for folks without health insurance. Sounds like a good guy with a good idea.

  • I had watched the movie "Sicko" which will give you an interesting take on US health insurance companies and US medical care. A US hospital recently killed my sister by infecting her with MRSA.
    Hint: The US medical system is ranked 37th in the world, right after Slovenia. The health insurance companies are the problem.

  • Either solution involved paying for airfare and hotels. About equal either way.

  • Whoever I talked to on the phone for Las Vegas was a bit high pressure sales oriented. My warning alarms go off when someone is in a hurry to get you to commit $$$$ to them. I think they're probably OK out there in Vegas but this worried me.

My Big Mistake

When I decided on Shouldice, they began sending the paperwork. I was extremely impressed with how thorough and competent they were. Before they even consider working on you, you'll have have to:

  • Provide a detailed hernia diagnosis from your doc that they will accept.

  • Have blood work, an EKG, and tests for MRSA if you've been in the hospital or on antibiotics recently. The MRSA cautions meant a lot to me after my sister's death.

  • Not have too much extra weight. When I was there I watched them send a guy from Germany home without surgery because he lied about his weight. They don't play around, they're not in it for "maximum profit" and they're highly focused on getting it right.

  • Have good enough overall health.

Now, about that big mistake. They say right on their website that they suggest you come to Shouldice and be sure you have been diagnosed correctly. I figured, hey, no need for that, I've got intestines bulging out my groin, I hurt, no doubt I've got a hernia.

I was wrong. It wasn't a hernia. If I ever have to do it again I will fly up there and get diagnosed by them before I do anything else.

So what did I have?

Groin Sprain and Fatty Lipoma

The groin sprain probably came from all the heavy lifting while I was shoveling all that sand. The doctors at Shouldice told me that it often happens when you slip and try to check your fall. The tendons joining to your pubic triangle tear some. They said you heal it with time, ice, good nutrition and vitamin C.

The fatty lipoma is the fat layers on the outside of your intestinal muscle wall peeling off the wall and going down the inguinal canal. Looks like a hernia, feels like a hernia....NOT a hernia. The Shouldice doctors told me it's nothing to worry about unless it gets really large. Further research online seems to indicate that it might heal up, might get bigger, might stay the same. I may be lucky enough to have it healing up because the incidents of it slipping out are less and less. If it does get too big you can have it fixed surgically, possibly as simple a procedure as liposuction.

I'm working on losing weight too so that should provide less fat in the area.

I think part of my improvement is due to some maintenance things that I did, assuming that I did have a hernia. We'll get into that next with...

Watching and Waiting, Easing the Pain - Hernia Belts and Trusses, Reducing the Hernia/How to Push It Back In.

When this happened my first thought was that there was no way I was just going to sit around for months waiting to get worked on.

I mentioned Watching and waiting above, and there's more about it if you look around online. The basic idea is to keep an eye on the hernia and keep it supported so it doesn't bulge out or hurt.

I went looking for a solution that would let me do my work until I could get it fixed.

The most likely looking thing was a hernia support from England that cost about $100. They had a lot of testimonials as to being able to work and do sports with this support. It looked like a girdle.

I ordered it but when it got here it wouldn't keep the bulge in or ease the pain, so back it went. It may have worked if I tried different sizes but the turnaround time from England was too long.

I did pick up one idea from them. They said that hernia support was much more effective if whatever pushes on the bulge area is flat instead of rounded.

While I was waiting for the English support I ordered a more typical hernia belt...one of the ones with an elastic waistband and two stiff foam rubber pads hanging off the waistband in fabric pockets.

The pads push on the bulge/pain area. There are also straps that start on the bottom of the support pad pockets and then go between your legs and fasten to the back to pull the support pads into your groin, holding the bulging in.

I changed the foam rubber pad in the support pad around. That way the flat side was facing my groin, instead of the way it came, with the flat surface facing out. This was the idea I got from the English support.

The greater adjustability of this type support and the flat instead of rounded surface let me get the pressure where it needed to be. It stopped the pain completely and held the bulge in.

That solved the problem and let me continue to do what I need to do work-wise. I guess we can say it will work for both a hernia or the fatty lipoma/groin sprain combo.

I read about others having success in supporting a hernia with jock straps, jock strap type brief underwear and the like. They fastened some kind of pad, folded towel or foam rubber to these to support the bulge/pain where needed and had good results. I tried this so I could go swimming without wetting down the good support. It worked,and I had pretty good success with it, but lots of trial and error to get it done that way. The hernia support belt was a whole lot easier to get set up and working.

Before using any kind of support you have to "reduce" the hernia or lipoma, which means push it back in where it came from.

This is most easily done by lying down, taking the pressure of gravity off your guts and the torn area. Then you can push it back in with your fingers.

If you ever need to sneeze or blow your nose you'll want to put some pressure on that spot to keep it from bulging out.

That cover the basics, so I'll finish up with...

A Big Thank You!
to The Doctors and Everyone else at Shouldice Hospital. 

Some other interesting facts I picked up talking to the doctors at Shouldice and others there.

  • The failure rate on mesh type hernia repairs is really more like 40% if you look over a ten year period after the surgery.

  • Doctors in Canada can get in trouble for "advertising" if they're mentioned in a website, so I'll just say special thanks to the doc who first looked at me and the head doc who graciously took his time explaining all this to me.

  • When the original Dr. Shouldice first opened the hospital in 1947 they immediately noticed that a high percentage of the patients sent to them for surgery did not have hernias.

    This was a tough situation. A doctor had sent them there for hernia surgery and that doctor was going to be very upset if they disagreed with his diagnosis, even if he was wrong. That's when the original Dr. Shouldice decided that no one goes into surgery until Shouldice was 100% sure there was a hernia.

  • If the first Shouldice doctor that looks at you isn't 100% sure that you do or don't have a hernia, you go to the head doctor for his evaluation. If the head doctor has any doubt, then a third Shouldice doctor will evaluate you.

    Unless all three doctors involved agree that you DO have a hernia, you will NOT be having surgery. They've had some ugly situations with famous celebrities and their handlers demanding surgery but it doesn't matter. No hernia, no surgery.
    Ethics! I love it!

  • There's a funny old video (funny because it's so old and dated in many ways) about how things work at Shouldice HERE. It's still very much the same level of care and expertise you'll see in the video.

  • Why aren't the US doctors mentioning that a lot of what gets sent to them for surgery is not a hernia?

  • The food at Shouldice is awesome!

  • And last but not least, thanks to the people of Toronto...lots of good conversation and great company.

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