Repairing an epigastric hernia in the middle of training for a 50k race
In the personal news category I took my first ever trip to the operating room last month. I’ve had plenty of surgeries before to remove skin cancers but those were all done in the doctors office and didn’t require sedation or any major recovery time. Ok, now, fair warning, If you’re squeamish you’ll want skip this blog and head over to this week’s News Roundup. But if you are an athlete or otherwise healthy active person looking into a similar kind of surgery read on because before my surgery I found surprisingly little on the internet about epigastric hernia repair and recovery and I would have appreciated more information going into it. So, I’m putting the details about my surgery here as a public service to any of you fellow yogi/runner types who are looking at a midline hernia repair (I have at least three other friends with similar hernias who are also fit and active, so I know it can’t be that uncommon). In addition to the below information, Katy Bowman said some interesting things on her recent podcast about the related condition of diastasis recti (the separation of abdominal muscles that often happens during pregnancy).
What causes an epigastric hernia?
Epigastric hernias is a loose definition for any holes in the fascia above the navel. I most likely acquired mine during my pregnancies when I spent nine months simultaneously puking, gaining weight and maintaining an aggressive backbend practice as recommended by my former yoga teacher who was in retrospect terribly unqualified to work with pregnant women. Truthfully I was probably predisposed to overloading this particular area of my body as I have always had a strong lordodic lumber curve and only recently learned how to support my abdominal area by engaging some key intrinsic muscle groups. Throw some violent puking and deep back bending on top of that inherent weakness and the resulting forces exceeded the limits of my linea alba. I kind of noticed something funny looking above my belly button after my second daughter was born, but being consumed with the tasks of new parenthood I wasn’t too concerned about my postpartum bikini-figure. A few years later, when I finally had time to look in the mirror I noticed that the a funny lump above my navel was bigger. The hernia wasn’t causing me any pain, but it appeared as though a small bit of fat had squeezed it’s way out from behind it’s protective layer of fascia and was trapped
there under my skin (making the bump). It stayed like that for several more years but seemed to get worse the year I learned to swim – which makes sense because when I was learning to swim I still had a major sway back and my belly popped forward. I remember feeling a lot like a copepod that whole first season. I wonder if copepods get hernias? Then one day this fall I bent over to one side to pick up something heavy and that’s when it started to sort of, just a little bit bother me. I began to wonder, what happens if I’m in the middle of nowhere (as I like to be) or in the middle of a crazy hard training season and all of a sudden my midline just gives way and my insides bust out and there I am on the side of some dusty trail, or worse, the middle of the Gulf of Maine, and my abdominal wall just totally gives way and my liver and pancreas come flying out?
Ok, back to reality.
The trust is, nothing really bad was likely to happen but every doctor I asked about it over the years told me that eventually I’d have to sew it up. No one could explain exactly why, but being surgeons, I think they just feel better when things are sewn up.
I opted to have the surgery the day before Thanksgiving because Jerome had the next five days off and would be available to split and carry fire wood while I recovered on the couch. I was anxious about having general anesthesia because my twin brother has a terrible reaction to it and it can take him a week to recover just from that part of surgery. Plus, I’m scared of intubation, and if you ever had me as your EMT, you are too (sorry about that). Fortunately my surgeon agreed to local anesthesia and sedation. Which turned out to be lovely. So lovely that I don’t remember a thing after getting onto the operating table. For the first time in my life I was happy to be completely unconscious. I woke up soon after they stopped the flow of Propofol (a sedative that also causes temporary amnesia) and I sat in my recovery chair feeling more relaxed and at ease with the world than I have ever felt before in my life. I can see why Michael Jackson overdosed on this stuff, it is lovely. It also left me with the craziest case of cotton mouth and I spent the rest of the day drinking water and trying to choke down little bites of food. My daughter helpfully suggested a green smoothie, but I opted for ice cream. Yup, never going to live that one down.
I didn’t end up taken any painkillers even though they gave me a horses-dose worth of hydrocodone. Yup, they just hand that shit out. There are a million reasons why this is just wrong. Totally wrong. For one, pain, like the kind you have while recovering from a minor surgery, is a good thing – it keeps you from moving too much while you are recovering. For another, if you have so much pain from a minor surgery like this that you need narcotics to manage it, something is wrong. Like maybe they accidentally left a sponge or clamp inside you and they’re hoping that you’ll be too doped up to notice? And finally, supplying Downeast, Maine with a steady stream of narcotics has caused us all kinds of problems – problems that far outweigh the need to help clam diggers, farm workers and injured yoga teachers sleep through the night.
Anyway, it was awkward turning over in bed, and I couldn’t get out of bed or off the couch without assistance. I had to really work to not engage my abdominal muscles, which meant no coughing, sneezing or laughing. Given how hard it is to NOT use abdominal muscles during every day activities, I don’t understand why we don’t all have a 6-pack just from getting in and out of bed, sitting on the toilet and walking to and from our cars.
The third and fourth days post-surgery I started going on longer walks but I had to go slow to keep my gate smooth and keep from jolting my stomach muscles. The fourth day I walked about four miles and was feeling much better. On the sixth day I took a spin class and on the seventh day I went on a 4-mile run and felt no painful sensation at all. Since then I have happily and comfortably returned to my regular 50k training program.
The only noticeable side effect from the surgery that I can still feel is that my diaphragm is “stuck”. I can’t take a deep easy belly breath and as a yogi this is quite maddening. Dr. Sarah helped unstick something last week and I got my breath back for a few days, but now I’m stuck again. The other thing is that I can’t backbend much yet, and I’ve been warned against sit-up-twisty things for at least another 4-weeks. That’s ok, I can live without criss-cross for another month.
Overall it was a much easier and more comfortable surgery than I was expecting. The surgeon said she sewed up three (or four?) holes which she described as a “swiss cheese hernia”. She was a lovely surgeon, but her wording made me think of a study I read about recently that looked at how the doctor’s word choice can affect patient recovery (I’ve lost the link, but if you know the study I’m referring to, please comment below!). Fortunately I believe in the resiliency of the human body and it’s ability to adjust and adapt and I’m not too worried about having cheese fascia. Better than spam fascia right? But just in case, I’m going to give myself a year to rework some old patterns that might have contributed to this mid-line weakness. So, no full-ironwoman, 100km races or crazy acrobatic yoga this year. Though I’d like to work up to a few 50km races and maybe one or two 50milers if all goes well. Oh, and this race. Because you know I can’t resist running up something big at least once a summer.