Interesting situation, to say the least. Did they mesh the repair? If not, why not?
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Introduction and Burning Question
First post. My name is Brent Smith. Not really a big social network/forum guy, but when I do lurk, this has been one of my favorite places. A little background, I'm 34 years old, I've been training for about 5 years. My best lifts are a 525lb deadlift, 445 squat, and 340 bench, as well as a 220 press, which at the time was w/in 5lbs of my bodyweight (close , but not close enough).Most of my twenties were wasted 'working out'. I've enjoyed reading all of your books. Have hard copies of 'Starting Strength' and 'Practical Programming', and bought the Kindle versions of 'Mean Ol' Mr. Gravity' and 'Strong Enough?'. I'm a Steamfitter by trade, and training has made even the most difficult physical parts of my job a walk in the park.
At the risk of boring you, on to my question. I was diagnosed with testicular cancer last Monday, and had a radical inguinal orchiectomy Friday. Naturally since the disease and its spread is currently out of my control, I started thinking about barbell training which will be back in my control w a little time on the couch. The surgeon said I'd be at higher risk of inguinal hernia because of where the incision is. Through my own research, it looks like they cut through the oblique fascia(?) I'm not asking for medical advice, and realize the implied risk in giving it, so just your experience in coming across people with damage to these kinds of structures, specifically damage by scalpel. Will this increased risk be permanent, or just until I'm healed? Is there a way and time frame to come back to training, other than the standard linear progression that would take place after a long layoff? They're telling me 2-3 weeks before 'heavy lifting' which for the general population probably means anything more than a remote. (He recommended not returning to work during this time because of the nature of my job). I was considering walking about two miles a day while slowly adding weight into a weight vest over the next 2-3 weeks(my weight vest maxes out at 90 lbs). Seems like this would get the area re-conditioned to the bearing down, valsalva maneuver-type stress while still waiting the appropriate time for 'heavy lifting'.
I respect and appreciate your input, and apologize for the long winded post. If it's any consolation, I'm usually a man of few words and won't be cluttering up your forum much. I have a lot of spare time right now and keeping my mind busy seems to be helping to keep things positive while waiting for the unknown. Hopefully I'll bounce back quick and meet you at one of your seminars in the future. By my approximation, you seem a very intelligent and simple man, two refreshing qualities you share with my late grandfather, and that I try to emulate in my own life in this world full of fluff.
TMPHBITEU
Interesting situation, to say the least. Did they mesh the repair? If not, why not?
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I will leave specific training prescriptions to the professionals, but I can speak a bit to some of the OP's other questions. I am not a surgical oncologist or urologist, and radical inguinal orchiectomy is outside my scope of practice, but I've done a fair number of inguinal hernia repairs. The approach to a radical inguinal orchiectomy is essentially identical to the early phases of an inguinal hernia repair. You are correct- in order to expose the spermatic cord (which carries the vas deferens and blood vessels that supply the testicle) the external oblique fascia needs to be divided, thus "unroofing" the inguinal canal. The vessels and vas are ligated, and the testicle is removed. The external oblique is then sutured closed. Mesh would not routinely be used for closure, and to understand why a little anatomy is in order. The spermatic cord exits the abdomen via a defect in the abdominal wall called the deep inguinal ring. It then traverses the inguinal canal, a natural weak spot in the abdominal wall (essentially where the internal oblique is absent; the "floor" of the canal is only formed by a single layer of fascia), and exits the canal at the external ring, a hole in the external oblique fascia. The cord then drops over the pubic tubercle of the pelvis to enter the scrotum.
Inguinal hernias come in two types (simplifying a bit), indirect and direct. Indirect hernias protrude via the deep inguinal ring, and as such the hernia "sac" runs within the spermatic cord. Direct hernias protrude right through the floor of the inguinal canal, due to weakness of the fascia making up the floor. The external oblique is a bystander in all of this. Weakness of the external oblique does not typically predispose to inguinal hernias. When an inguinal hernia is repaired, either with mesh or without, the external oblique closure does not significantly contribute to the strength of the repair. I would have to imagine a similar consideration is at play during orchiectomy. Unless there was some specific subtlety of your case that would predispose to hernia (e.g., if the deep ring had to be opened to facilitate ligation of the cord, or if the dissection of the cord off the floor of the canal was difficult and led to weakening of the floor), or unless you had a hernia discovered at time of surgery, I don't see that mesh placement would have been indicated. I also am a little unclear why your surgeon would feel that your risk of inguinal hernia would be higher. That said, standard surgical dogma, based on fairly old research, is that fascia that is cut and then sutured never regains its full strength, but only about 80% when it's fully healed. Half of that healing occurs around 6 weeks, barring issues such as infection, malnutrition, or immunosuppression. I have no data regarding the effect of weight training on wound healing or scar maturation. So, I guess it's theoretically possible that you are at higher risk of hernia, but I really don't know for sure.
Insert standard medical disclaimer here (I'm not your doctor, this is for general information only, no medical relationship, etc), but my usual post-hernia advice to my healthy, more active patients (sadly, a minority in my patient population) is to gradually resume normal activity at about the same point as your surgeon said (2-3 weeks), take it slow, and if it hurts, back off a bit. The way I see it, the goal of surgery, whether for hernia or for cancer, is to allow a return to as normal a life as possible, not to make an invalid out of a previously healthy person. Only you can decide how to balance the risk of hernia (largely speculative) vs the risk of not training (which has been amply documented on this site). Best of luck to you, I hope your recovery is uneventful and complete.
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I was diagnosed with Testicular Cancer about 4.5 years ago (I'm 42 now). Welcome to the club! I have been told, if you're going to get Cancer, this is the one to get...Originally Posted by B. Smith
I can talk from personal experience and the feedback from my urologist and oncologist. After surgery, I was lifting after 2 weeks with the encouragement of my urologist. He was confident that I was not going to do any damage as long as I "started light" and didn't "over do it." Light for me was a 225 pull for a set of 5. My advice. Give it time to heal. Give yourself a big deload and run an LP.
In regards to treatment, I was lucky. I caught it early. It was the seminoma type (slow growing) and, as far as they could tell, had not spread further. 3 months after surgery I did 5 weeks of radiation. I trained through radiation. In the last 4.5 years, I have gained 65 pounds (I was fat, then got too skinny, now I am about 15 pounds too heavy). My oncologist and urologist have encouraged me to continue strength training throughout my treatment. My oncologist calls me his star patient and has said repeatedly he wishes all of his patients would do what I have done, train and get stronger while gaining weight. My last visit in November, he actually paraded me into the waiting room and began bragging out loud to the nurses up front about my progress and increases in strength and bodyweight. He has told me BMI doesn't apply because of my muscle mass and has made numerous comments about the thickness of my abs when reviewing CT Scans.
My advice: Train. Train for as long as you can throughout the process. Both my doctors encouraged it. I believe both for physical and psychological benefits. Good luck!
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Thank you all for your replies. A little late getting back, sorry. Recovery seems to be doing well, just got back from a two mile walk with the dog. No mesh was used during the surgery, and thanks, PKShah, for shining more light on the situation. Biopsy results show stage 1, mixed seminoma, and embryonal carcinoma. CT scan tmrw and follow-up next Tuesday to discuss what further treatment will be necessary. My reading of cancer related cachexia, and strength training's positive influence on it actually brought me to another thread on this forum first, and reaffirmed by decision to train through every phase of this however little or long the treatment(s) might be. Crookedfinger, it's encouraging to hear from someone who has gone through this successfully, and I echo your sentiments regarding training. I don't expect to hit any pr's in the near future, but training will certainly keep my head on straight. It's good to focus on the things you can control when there are other elements at work in your life that you can't. I will start light here in another week or so and proceed with caution.
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You'll come back man. You'll come back stronger. I pulled 615 last night and will be squatting 500 Saturday. Life throws us shit. Training helps us get through it.
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