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I met with Dr. Muschaweck Today (4/16) in New Jersey
For anyone who is interested, here is how my appointment with Dr. Muschaweck went. Everyone's Groin Pain is different, this is my case so process this accordingly.
Back from Jersey.
Dr. Muschaweck was extremely thorough and I learned more today in 35 minutes than i have from everything I have read on the Internet. Here is what I found out.
1. Unless you have a digital Ultrasound done to determine how big the weakness or bulge is on the posterior Inguinal wall, then you are really shooting darts with rehab or any type of surgery. My bulge was 1.5 cm and was directly on top of the nerve, thus my pain. She was hesitant to push surgery on me at this point. She considers bulges that are over 2.3cm, more critical for surgery. Not once during this entire exam did she push any kind of surgery on me.
2. The ultrasound was very clear and I could easily see the bulge. She also checked my right side and the lining of the inguinal wall was completely intact with no damage or bulges. The bulge was visible on the left side when i pushed down with my muscles then relaxed. She recorded the pictures of the ultrasound for her records and took thorough notes during the meeting. She also did the standard physical exam to check for a true inguinal hernia. Ouch.
3. The bulge is not going to heal itself over time. It is there to stay, what may change is how much pain I feel from it. I can try to rehab the muscles around the bulge and she recommended that I do that since my bulge was not over the 2.3cm limit she goes by for recommending repair.
4. Our plan of action is that she will be back in Charlottesville, Va in early July to speak at UVA. I am going to see her again. She will do the ultrasound and we will measure the bulge again and discuss my pain. She wants me to try and get back to full activity before the meeting to see how I feel. If I do rehab and it works for me, then we will continue to monitor and check my "sportsman's groin".
5. Her biggest concern is that over time, if the bulge is growing and continues to press on the nerve, then the nerve will be damaged and becomes un-repairable as far as the pain. The nerve pain will then become chronic and is something the patient is going to have to face with some harsh reality. Early detection is key to a successful repair of the Sportsman's Groin. There is no doubt about this IMO.
6. There was 1 NHL and 2 MLS players in the waiting room. All of them have had the Sportsman's Groin problem for close to two years. She was very surprised I diagnosed this on my own and saw her in less than 4 months since this problem started. This is another reason why she is recommending to take some time and see how this plays out. We have time to fix it if that becomes necessary. I was by far the oldest person there.
7. Dr. Muschaweck is extremely thorough and punctual. Not one person went into the exam room with her after their appointment time. US Doctors should learn from her on this. She took copious notes.
8. The Digital Ultrasound was run off her laptop. I watched the whole thing and she explained all of it to me. I'm a techie at heart. Amazing that no Doctor in the US could do this for me, pretty sad if you ask me. The weakness in the posterior wall of my inguinal canal was clear on my left side ( a little round bubble right along the canal) and the inguinal wall was solid (no bubble) on my right side.
9. For people who have extreme pain with their Sportsman's Groin, she will see them in less than 8 weeks for repair. For people like me, who are not debilitated by the pain...then she takes 2 months to see them for the fix. She keeps her queue open, so that the patients who need the fix the fastest get it. She wouldn't do the fix on me in less than 8 weeks, even if I wanted it is my take.
In conclusion (and this only applies to my case). Sportsman Groin (hernia) is definitely a nerve related issue. The size of the bulge on the posterior wall of the inguinal canal matters. If you have this, you should have it checked. If you don't, then you are rehab'ing in the dark. I feel lucky that my bulge isn't any bigger and that I may have a chance to rehab this injury. It is never going to go away. The bulge is here to stay with me forever unless I get it fixed, but the pain could stay or go. Only time will tell. I'm going to execute on my core rehab program and start to walk a little harder until I get to the point of a slow jog. By my visit in July I want to be back to running my normal 3-6 miles with minimal or no pain. If this is not happening, then a Minimal Repair by Dr. Muschaweck may be necessary. Ask me any questions. I took a ton of notes.
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