DEAR DR. GOTT: My husband had laparoscopic surgery in August 2008 to have one kidney removed because it had a large cancerous tumor on it.
In October 2008, a blood clot was found between his knee and ankle on the back of one of his legs. He is currently taking Coumadin to keep the blood flowing and reduce the possibility of further clotting.
In November 2008, he was found to have an incisional hernia in his abdominal area, which was the result of the August surgery. No one would operate on it until six months had passed from the discovery of the blood clot because of the risk. Every physician we spoke to said something about this being “generally accepted medical theory” regarding blood clots and surgery, etc.
In April 2009, the surgery for the hernia occurred. During the time that elapsed, it had become huge. It made his abdomen look as if he were nine-months pregnant, and he had significant discomfort.
As part of the hernia surgery, they made a big incision to try to reposition everything as it should be and added the mesh. After the surgery, the hernia was contained and everything looked terrific, but within a day or two, it was obvious that it had failed. The surgeon finally admitted this in June 2009.
At that point, the surgeon told my husband that he needed to lose weight before surgical repair could be considered again. We were told that this is necessary because his first hernia repair had failed because his stomach muscles were too weak to hold due to the fat in his abdominal area. I told the doctor that the reason my husband’s stomach muscles had become weakened was caused by the six-month delay in doing the surgery in the first place. If it had been done sooner, the muscles would not have become weakened to this degree. The surgeon then told me that he had no input into that decision or in advising us in that regard.
My husband is now trying to lose weight, but he can only walk because other exercises put too much strain on the hernia. He currently weighs 300 pounds. If he is to lose a significant amount of weight, it will take a huge amount of time, and the hernia will continue to go unresolved.
Is there anything that can be done in the interim to try to contain the hernia?
DEAR READER: Blood clots can develop for a number of reasons, including clotting disorders, being over 60 years of age, obesity, pregnancy, prior surgery, cancer and more. Because your husband had major surgery to remove a cancerous tumor, he was at an even greater risk of developing a blood clot.
Incisional hernias are also a possibility following surgery. They are typically associated with traditional surgeries that involve larger incisions.
Because I am not a surgeon, I do not know what standard guidelines are followed in treating a patient with a blood clot for an unrelated condition. Those with blood clots or other clotting disorders that require the use of anticoagulant therapy, such as the Coumadin your husband is taking, who require any type of surgery, are usually told to discontinue the medication a week or two prior to prevent hemorrhage or excessive blood loss. However, this recommendation is likely for those who are well established on the anticoagulant and have been stable for an extended period.
As to your husband’s worsening hernia and why his surgeon waited for the six-month mark, I am not only surprised but disappointed. He should have been informed of other options in the interim. Even though it’s not a cure, your husband probably would have benefited from the use of a girdle or elastic support garment that would have put pressure on the area of the hernia, helping it to stay in place. It is also important to avoid activities such as bending or heavy lifting that place excessive strain on the abdomen. Obesity can worsen hernias.
I am shocked that your husband’s current surgeon blamed his hernia on abdominal fat and weakened muscles. Clearly, he had just undergone major surgery to remove a diseased organ and was probably still recovering from that when the blood clot and hernia developed. After such an ordeal, one can hardly be blamed for not being as active and fit as before, especially immediately following the situation.
While I believe your husband would be better off losing some of his excess weight, I do not think that postponing the hernia repair is in his best interests. I suggest he begin his weight loss by following a simple diet plan, such as my no-flour, no-sugar diet, exercising as much as possible without overdoing it, and seeking a second opinion.
About Dr. Gott