Note: Please keep in mind, as you read this story, that I am not a medical professional and I am not giving anyone any advice about how to treat a hernia. I'm just reporting my experience.
One day in 2022, I made the mistake of sneezing. I felt a sudden pain in my groin. I didn't think much of it until I sneezed again and felt the same pain. I looked in the mirror and discovered my hernia.
The whole foods, low-fat vegan diet will protect you from obesity, heart disease, Type 2 diabetes, and a world of health problems, but it will not stop you from sneezing your way into a hernia.
I didn't know much about hernias, but I knew that they could be corrected only by surgery, and that the surgery was considered minor and exceedingly common. While that was true, I wasn't prepared for the level of complexity I faced.
A neighbor recommended a young surgeon in my town. I set up an appointment and went to see him. I had diagnosed myself correctly with a right inguinal reducible hernia ("reducible" meaning that when I lay flat, it disappeared). This phenomenon briefly led me to believe, on the first night that my hernia and spent together, that I had been miraculously cured! The surgeon proposed that I submit myself to a laparoscopic hernia repair with mesh. The "mesh" is a prosthetic material, usually plastic, that resembles a window screen. The justification for using it is that it is designed to hold the repair in place, ostensibly reducing the rate of hernia recurrence. Think of a patch used to repair a tear at the knee of your jeans.
Now I have not researched the use of mesh in hernia repair thoroughly enough that I am prepared to attack the procedure. There are about 800,000 groin hernia repairs performed annually in the United States, and more than 90% are accomplished using mesh. So if you are reading this and you have had mesh hernia repair, I am not saying that you have made a mistake. I'm sure that mesh repair works out just fine for most patients. But it is central to my view of health, and to the ideas I expressed in my book Own Your Health, that we should make our own choices regarding treatment. Of course, we have to do our best to make sure those choices are informed, but we should not disregard our gut instincts. If we always take the attitude that we should simply "listen to the experts" well, it's the doctors who are by definition the experts, and we will find ourselves without agency, doing whatever they say.
My gut told me that I didn't want a piece of plastic in my groin, and that I didn't like the idea of incisions made higher in my abdomen than the location of my hernia, and my belly inflated with carbon dioxide to facilitate a surgery during which other organs, like my bladder, could be put at risk. I asked the surgeon how many hernias he operated on annually. He said "about one hundred." I asked how many were laparoscopic repairs using mesh. He said, "about ninety-nine."
Clearly this surgeon (by all accounts a fine surgeon, by the way) had something close to a one-size-fits-all approach to hernia repair, as did (I learned) the other surgeons in my town. I asked him why he almost always used mesh. He said to lower the risk of recurrence. I asked him how much lower the risk would be if I received the mesh repair, versus no mesh. He said 50% lower. Now that sounds pretty significant, doesn't it? But I was aware of the math trick involved. I said, "A 50% reduction: is that in absolute or relative terms?" He said, "I guess that would be relative." I said, "Give it to me in absolute terms." He said, "In absolute terms, about a 1% risk of recurrence using mesh, and about a 1.5% risk without mesh."
See how that comes to 50%? 1.5% is 50% more than 1%, relatively speaking. It's a neat math trick, but even if the stats are accurate, it means that the extra risk in recurrence would be felt by only one person in two hundred getting a non-mesh repair. I'll gladly take those odds to live without the plastic inside me. And then let's think a little more deeply about it. In the unlikely event that your hernia repair does fail—as could happen either way, after all--would you rather have a repair that involves removal and replacement of a piece of mesh, with tissue growing around it, or a repair that didn't have to deal with that problem? So all repairs are not equally easy.
And is recurrence of the hernia more likely in an American with an ever-expanding gut who eats cheeseburgers, or a slender guy who eats a low-fat vegan diet? They don’t factor diet into their numbers, but I felt pretty confident that, as long as I had a good surgeon, my chances for recurrence were remote.
I consulted "Dr. Google" and did a search for non-mesh hernia repairs, looking for a surgeon who did them all day long and knew all the latest techniques. I found a surgeon in Florida who repaired over 500 hernias per year, using both mesh and no-mesh techniques, and was trained in techniques that I read about: the Dasarda technique, named after a Dr. Dasarda, and the Shouldice technique, named after, you guessed it, Dr. Shouldice. I scheduled the surgery after the surgeon committed to me that he would not use mesh. He would perform "open" surgery, making the incision in the groin, rather than laparoscopically. It never made sense to me to do the operation laparoscopically, if it wasn't necessary--and it wasn't. A study I looked up on "Complications of laparoscopic surgery" contains this sentence: "Excluding laparoscopic access associated injuries, intraoperative complications include bladder injury, injury to the epigastric vessels and to the spermatic cord." For what advantage? Less pain, and easier recovery, I was told.
Anyway, since the surgery involves general anesthesia, first I needed to get cardiac clearance with an EKG. I never had a bad reading of an EKG before, but the one I got pre-surgery showed a mild bradycardia (my heart was beating 58 times a minute instead of 60, sue me) and other minor electrical abnormalities; I therefore needed to get an echocardiogram. (Btw, world-class athletes have hearts that beat about 40 times a minute. So I view my mild bradycardia as proof that I'm a pretty good athlete, in spite of any evidence to the contrary.)
I knew this much: never panic because of an abnormal EKG! I think something like one out of three are "abnormal." Few things are more normal than an abnormal EKG. I was worried, though, about the echocardiogram. That's a perfectively non-invasive test but it can sometimes pick up information that you might, in my opinion, be better off not knowing, like a faulty heart valve that you're told doesn't require intervention now but instead you're told to just follow a plan of "watchful waiting." The trouble is, "watchful waiting" becomes "watchful worrying." It's very hard to watch your heart valves on a daily basis. Personally, I'd rather not know. But there was no way to get the hernia surgery without doing the echocardiogram, so I reluctantly went ahead with it and was told that my heart looked "fantastic." I was never so glad to ace a test.
By the way, "watchful waiting" is also one legitimate approach to an inguinal hernia, and one that I strongly considered. The problem is, you can find yourself watching your hernia grow larger (as mine seemed to be doing) and watching yourself grow older, complicating the surgery that may become inevitable. So I wanted to get it over with.
My wife and I drove 1,000 miles to Florida for the surgery. I met the surgeon about an hour before the operation, and asked him if he would be using the Dasarda technique or the Shouldice technique. He said he wouldn't know what was best for me until he opened me up. So not only was the man trained in these techniques that (as far as I could tell) nobody back home knew, he was going to call an audible and select the one that would be right for me
His staff had discussed with me a regimen for painkillers. I have the problem of not being able to swallow a pill, but there were liquid versions of painkillers to be found. They suggested 400-600 mg of ibuprofen every 6 hours, plus 650 mg of Tylenol every 4-6 hours.
After the surgery, I awoke in the Recovery Room and in wonder told the nurse that I felt no pain. She said, "Of course not, you're still under the effect of the anesthesia. Wait till tomorrow!" But there was no pain the next day, or the day after, or ever. The surgeon had cut me open, repaired my hernia, and sewed me shut, and had somehow managed to do it without causing me any pain. Yet "open surgery" was allegedly more painful than laparoscopic. I never took any painkiller at all, not even an aspirin.
Now the surgeon of course deserves most—okay, maybe all—of the credit for my lack of pain, but my low-fat, whole foods vegan diet has left me with a low level of inflammation in my body (as evidenced by a CRP test), and surely that helped me recover so well.
And so my surgery (it was a Shouldice) was successful, and it was accomplished without compromising my abdomen (not above my groin, anyway) with incisions, without blowing up my belly with carbon dioxide, and without any pieces of plastic inserted in my body. A peer-reviewed study of the Shouldice technique says "The Shouldice repair has been refined over several decades and is the gold standard for the prosthesis-free treatment of inguinal hernias. A recurrence rate around 1% has been consistently demonstrated over the years." Only 1%? I don't even have the 1.5% to worry about! The supposed advantages of laparoscopy--less pain and quicker recovery--would have meant nothing to me, since I had no pain and a speedy recovery.
The best technique for hernia repair may be somewhat controversial, but here's something everyone agrees upon: sleep is healthy. I sleep better knowing that I don't have the mesh inside me. If you google "hernia mesh lawsuits," you will find a lot of activity on that front.
Anyway, a hernia operation, with or without mesh, open or laparoscopic, is surely a minor, safe operation. But I can't say it was easy. So think twice before sneezing.