Mesh-Free Hernia Repair 

By Fred Amir

Page 5

 

The Surgery

We arrived in Fresno the night before the surgery and checked into a hotel. On Thursday, October 7, 2010, at 7:30 am, I was operated on by Dr. Parvez under local anesthesia with sedation.

 

After the surgery, we returned to the hotel. I had some pain and discomfort but nothing requiring medication even after the anesthetic wore off. I was fine when lying down, and even sitting for a few minutes was tolerable. The only really painful part was getting in and out of bed. I needed my wife’s help, especially to get out of bed. This was where an adjustable hospital bed would have been very helpful. I managed to walk around the room a few times just a few hours after surgery. Dr. Parvez had used glue to seal the incision. This was really great, as I did not have to worry about changing the dressing or getting it wet when taking a shower. Later on, when it was completely healed, there was practically no scar.

 

 

Recovery, Day 1

I had a lot of pain when I woke up, but as I walked around the pain became less and less. This was the pattern for the first few days—very common with most surgeries. I managed to go outside the room and walk in the hallway a few times. Dr. Parvez came for a visit. I went out and greeted him in the hallway. He was happy to see me walking upright. He said that, with the traditional open repair without mesh, patients walk with a slight bend due to tension in the repair site for a few days after surgery.

 

We sat down and talked for more than an hour. I was amazed how I could sit on a chair and socialize the day after surgery without much difficulty. I continued to make improvements the rest of the day. Later that day I even walked outside with shoes on.

 

Recovery, Day 2

I slept really well, and it was much easier getting out of bed. I went out with my wife and bought chocolate and flowers to take to Dr. Parvez’s office. Just 48 hours after surgery, I was out shopping! It felt great.

I noticed swelling in the scrotum area, which can happen with laparoscopic as well as open repair surgery. I wrote to Prof. Dr. Desarda about it later, and he replied that, in cases of large hernias where repair is more extensive, this can happen and can be easily remedied by wearing a scrotal support for a few days. So I brought one and managed to walk a lot more that day. We went to a beautiful park for a walk, shopped at a supermarket, and ate out. We even went out to do some shoe shopping for my wife. I was still amazed at how much I was able to do just two days after surgery!

 

Recovery, Days 3–6

On the third day, I took a shower, went out to eat breakfast with my wife, and walked afterward. I managed the three-hour ride back home well. It was good to be home.

 

By the end of the sixth day of recovery, the scrotal swelling was 90% better. At that time, it made sense to speed up my recovery. Based on my conversation with Dr. Parvez and an email from Prof. Dr. Desarda encouraging me not to be afraid of performing daily activities, such as climbing stairs and driving, with great excitement I began my rapid recovery. I managed to walk 20 minutes, drive to a nearby supermarket, and help with chores at home.

 

 

Recovery, Day 7

I started the day with a bowl of oatmeal and a 20-minute walk. I was walking at a faster pace and in a much more relaxed and fluid fashion. I managed to get into our van that morning. It was little challenging since it required stepping up to get into it. It caused a bit of irritation and pain. I drove to the post office, ran some errands, and went to the mosque to pray. I thanked God for bringing Prof. Dr. Desarda and Dr. Parvez into my life and for making it possible to have my repair done without a mesh.

 

I was climbing stairs much more easily and even bent down and touched my toes. I went for another 20-minute walk. However, this second walk, which was faster and more rigorous, caused some discomfort.

 

Recovery, Day 8

I slept very well. As I got out of bed, I felt a lot of pain around the entire incision area—the kind of pain you feel if you work out really hard. It was all external muscle pain. I was not worried since there was no discoloration or swelling of the incision area. I wondered if the pain was due to stretched muscles when I was getting in and out of the van or if I had walked too much and overworked the muscles. I did not know.

 

I lay down and cooled the area with an ice pack. It improved quickly, and the pain completely disappeared by afternoon. It was quite unexpected, though, and it made me reevaluate my recovery plan.

 

I was very grateful that I had gotten what I wanted: a mesh-free, tension-free, recurrence-free repair with minimal post-operative pain that required no medication, and a smooth recovery. As far as I was concerned, God willing, this was going to be my first and last hernia repair. Since I was not preparing for the Olympics, at least not yet, whether I recovered in 7 days or 17 days did not matter. The last thing I wanted to do was to hurt myself and delay my recovery.

I was already driving, walking, shopping, eating out, and carrying light items easily. Now whether I ran up the stairs or carried heavier items a few days later, it was not that important to me. So I decided it was best to take my time and let my body heal properly and just continue my recovery at a more relaxed pace.

 

Recovery, Days 9–30

During this period I continued to improve. I drove on the freeway and around town, shopped, ate out, and attended several meetings. I felt pain or irritation at the site of the incision after sitting for more than half an hour or so, but this was relieved by standing or walking. By the 15th day, I literally ran up and down the stairs and felt I was at a point where my recovery was really taking off. I felt much better and stronger, even lifting gallon-size containers from the grocery shelf and horizontally transferring them into the cart. I could sleep on my side again instead on my back all night. That felt really good.

By the third week, I felt very little pain when coughing and sneezing, and by the 23rd day, I felt no pain at all. After one month, I was 99% pain-free and began working out with light weights.

 

Recovery, Days 31–120

We traveled to Southern California for Thanksgiving, just seven weeks after my surgery. I drove 2-3 hours at a time without any pain or discomfort, which was far better than the 20-30 minutes I could drive before the surgery. I climbed many stairs with complete ease, walked a lot, and enjoyed many hours of socializing with relatives and friends.

I truly relished walking in the streets of Los Angeles not feeling any pain. I thanked God with every step and prayed for Dr. Parvez and Dr. Desarda. Two weeks later my family and I flew to Mecca, which required a total of sixteen hours sitting in an airplane, lots of walking, and carrying suitcases. I was careful not to lift any heavy suitcases but did roll them around. It was a wonderful trip and I came back feeling better and stronger. 

 

“Healing ridge” describes the area of swelling and hardness beneath the incision after open repair. The ridge is caused by local tissue swelling and inflammation as it 'heals' into the surrounding muscle. It may harden somewhat, feeling like a roll of quarters or even a small 'cucumber' beneath the skin. It remains virtually unchanged for 3 weeks or more after which it gradually softens and flattens. The size and duration of the 'ridge' are related to the size and complexity of the hernia itself. 

I noticed a definite flattening of my healing ridge after I returned from Mecca. Perhaps all the praying and walking sped up the healing of my healing ridge! It also became much less sensitive to pressure. For the first three months, it was sensitive to direct pressure, whether from a seat belt pressing on it or lying down on it directly. Dr. Parvez told me it may take 3-6 months for it to completely heal. 

 

Also, in open repair, the incision cuts through nerves on the skin so the area will be numb for a while. As these nerves re-grew after about a week or so I began to feel mild and sometimes not so mild electrical shocks. These are very short in duration and have become much less now. Eventually, after many months the full sensation shall return to the area. Frankly, the numbness does not bother me since some numbness in the lower part of my abdomen does not interfere with any of my daily activities.

 

When it comes to exercise, whether walking or weightlifting, I have learned to take it easy and go for small and steady increases. When I did increase the weight or my walking too much, too fast, I experienced pain at night or the next day. When I backed off the pain subsided. 

 

My first dental checkup was after Thanksgiving and reclining on the chair was quite uncomfortable. However, a few days later I noticed that the same position did not bother it. Certain activities and positions may not be comfortable at first. However, as your body heals, these will become much easier.

 

As my “healing ridge” continues to heal I am grateful every day for living an active life again. It feels wonderful to just pick up and carry everyday things without having to first assess if they are too heavy and may cause pain. Now I can focus on more productive and enjoyable aspects of life. For these improvements in my health, I thank God every day and enjoy every moment of my waking hours, as well as my sleeping hours. After so many months of having to sleep on my back practically every night, I truly relish the simple pleasure of lying down on my right or left and sleeping comfortably.

 

Recovery, Days 91–180

Shortly after I wrote the above update I helped my wife prune a tree in our front yard. NOT GOOD!

As I reached up high with both arms to clip and pull the tree branches, I overstretched and overexerted my healing ridge. I started having pain that night and had a lot of pain the next day, especially while sitting and lying down on my sides, but no pain walking and standing. Since it was tolerable I went ahead with my trip to Oregon. When I returned I called Dr. Parvez. He told me that it would take six weeks to recover.

 

He was right. It took about four weeks for me to able to sleep on my sides comfortably and six weeks before I could get back on the treadmill and workout with weights. The good news was that I was able to carry on my daily activities despite this setback. Live and learn!

 

So even if you are absolutely pain-free, be very careful for the first six months or so not to prune trees or any similar activity.

 

Since I began to exercise regularly in mid-March, 2011, I have made a lot of progress. I am walking two miles a day and using heavier weights than I did prior to pruning the tree. I have to admit that I still have some pain from time to time compared to being almost completely pain-free prior to pruning the tree. Also, there is no more numbness around the healing ridge and I no longer get those “electric shocks.”

 

I have received emails from many readers of my hernia story sharing their experiences and asking questions. Among the emails I have received I found the following most interesting:

 

“In January of this year, just a few weeks ago, I was told I had either an inguinal or a direct hernia. I was supposed to have mesh surgery to repair it last week, but it was canceled because I had some infected hair follicles in the area where they planned to make their cut.  I am supposed to meet with the surgeon in two weeks to see if the infection has cleared up.  But since the surgery has been postponed, I have learned about the problems with mesh.

 

Today, a friend of mine told me he had mesh hernia surgery two years ago, and he is still having some problems. He says the edges of the mesh are extremely sensitive, almost as if they are cutting into his flesh. If the area where the mesh is embedded is tapped or brushed, the area where the mesh is swelled and turns red. He says if anyone should ever hit that area hard, he says he will wind up at the emergency.

 

This evening, I got on the internet, and  I read with interest your article on hernia surgery experience, and I am thinking that a few infected hair follicles about your might have saved me from making a huge mistake.”

 

Saved by infected hair follicles!

 

Recovery, Days 181–270

There is not much to report for this period. About two weeks after I wrote the above update I recovered fully from the tree pruning incident and continue to do well. Six months appears to be the magic number as indicated by accounts of others who have had an open repair done, with or without mesh.

 

October 07, 2011

Well, it has been a year since my Desarda repair and I feel fantastic. I am running (actually mostly sprinting) two miles three times a week, and doing push-ups, crunches, pull-ups, leg raises, and more, living a very active pain-free life, by the grace of God, and loving every minute of it.

 

I do feel a bit of tightness around my healing ridge sometimes. I spoke with Dr. Parvez about it. He said that is the external oblique muscle, which is the first layer of muscle surgeons cut through to go deeper and do the repair. The repair itself is deep inside and nothing to worry about. In time the tightness will subside. A friend of mine, who had an inguinal repair done with mesh about a year before my repair, was experiencing similar tightness even one year after surgery. His muscle tightness subsided by working out with a kettle ball. I have noticed that the more rigorous my activities the less tightness I feel. It is a minor issue and is not hampering my activities in any way.

 

Thus far Dr. Parvez has performed more than 83 Desarda repairs, including a patient from Tennessee who wrote me the following email:

 

"Hello Mr. Amir, 

I have been intending to contact you since my inguinal hernia surgery nine weeks ago by Dr. Parvez.  

I want you to know how much I appreciate your encouraging Dr. Parvez to attempt this new (at least to American doctors) technique, as well as the detailed journal you shared with everyone on your Rapid Recovery website. After much research on the internet, including your documentation and references, I made the trip from my home in Tennessee to Fresno and had the surgery. I couldn't be happier with the results so far.  

Like yourself, I attempted to persuade a local general surgeon to study Dr. Desarda's procedure and allow me to be the first patient. He declined, saying that he didn't feel comfortable learning a new technique "over the internet". My hope is that the insurance companies will pressure the medical establishment to learn and perform this simpler, less costly and more reliable procedure."

 

This is certainly my hope too.

 

April 07, 2012

It has been eighteen months since my surgery, and I am doing fantastic. In the past six months, in addition to running, I have done high-intensity workout on a recumbent bicycle, swam, and rebounded on a trampoline.

 

I read about the benefits of rebounding and tried it. It did stretch the right external oblique in a new way and caused some discomfort at first. In fact, I emailed Dr. Desarda and Dr. Parvez and both assured me it was safe to do so. I continued with rebounding and experienced no discomfort. In all respects, I am doing well, with the exception of the occasional tightness of the right external oblique when I sleep on my left side.

 

Now please let me share with you the following interesting post:

 

“Hello Rapid Recovery group,

 

Thank you for letting me join. Sorry for the lengthy post but rather than just staying silent and reading your posts I felt I should introduce myself.

 

I am a 68 y/o retired California physician now living in South India where I have only one, albeit very important patient. She has had a three-year odyssey with back pain just like Fred's and I suspect many others of you. I have learned acupuncture and osteopathy to try to help and have accompanied her to all the allopathic treatments and specialists with the usual results.

I learned about Fred through providence. I had an inguinal hernia and was scheduling surgery when I thought to look on Google images for a picture of my condition to refresh my memory. I found a nice one and clicked on the website for more... it was Fred Amir's site and I started reading his story which caught my interest. I followed his logic and could relate to his misadventures with the medical community. I tried to find a doctor to do Dr. Desarda's repair in the big cities nearby and just like Fred was told mesh was the "gold standard" and the only thing anyone would do. I then called Dr. Desarda and flew to Pune where he operated under local anesthesia and the day after I travelled 8 hours by plane and Indian roads back to where I live. Now 16 days later it almost seems like I haven't even had an operation. A big smile and thanks to Fred.

 

I then noticed Fred also had written a book on recovering from back pain. When I read it for the first time last week I was awestruck by the contents and am reading now for the second time. I know it is correct and have ordered Dr. Sarno's books and other resources suggested in Fred’s book.

 

Thanks to all and especially to Fred for looking for himself for solutions and then for sharing them when finally found.”

 

-Arun Seeley M.D.

 

Here is the video of Dr. Sealy the day after his hernia repair.