What Every Musician Needs To Know About
Hernias
Symon Sez: Pay Attention!
What is a hernia, anyway?
Special information for horn players
How can I prevent this from happening in the first
place?
Inguinal hernias must be repaired surgically.
Good news!
Follow your doctor's instructions
Playing the Workman's Comp Game
After recovery - some things to watch out for
What about horn playing and other types of surgery?
Summary and List Of Resources
You've Got Mail! LAST UPDATED
3/15/06
Symon Sez: Pay Attention!
I'm not a medical expert,
but over the last twenty years I've suffered through four inguinal hernias.
Trust me when I say that I really do know what I'm talking about.
The complications of my condition severely affected my life, and I've had to
stop performing for various periods of time throughout my career. At one point
I was afraid that I might have to stop playing my horn altogether. But being a
stubborn bastard who loves the tenor sax, I did my homework, applied what I
learned, and to this day I'm still playing saxophone!
Even with the dawn of the Internet, I haven't seen a lot of good online
resources for musicians regarding hernias and hernia surgery, so I put this
page of resources together to help every musician understand what hernias are
and what to do about them. Hopefully this information will help musicians and
non-musicians alike make good, informed choices about this issue.
TOP
What is a hernia, anyway?
A hernia is a mechanical
failure within the body of a muscle wall - that means, tissue actually rips
internally under stress and some organ, tubing or fat will poke into some place
that it's not supposed to. There are several different types of hernias, and
the name usually refers to the area of the body that is affected. The two most
common types that you should know about are hiatal hernias (usually
occurring in the chest or upper back) and inguinal hernias (occurring in
the crotch). All of my hernias have been inguinal, which is very typical for
healthy men who are physically active. There are some special circumstances for
horn players, so please read on.
Anyone can end up with a hernia, although inguinal hernias (like mine) are much
more common in men. Usually you'll notice a sudden pain or pulling in the left
or right side of your groin, and a visible bulge under the skin may (or may
not) be present. This might occur within a few hours of lifting something
heavy, or you might notice some pain while showering the morning after a
strenuous hike (or after a long night of sax playing). Usually, you don't feel
it right when it happens, it takes some time for the swelling and binding to
start to become obvious. My simple advice is: DON'T FUCK AROUND - GET IT
CHECKED OUT BY A DOCTOR AS SOON AS POSSIBLE! I cannot stress this enough. If
you have a hernia, it's not going to get better by itself. You require prompt
medical attention.
TOP
Special
information for horn players
Inguinal and
hiatal hernias will make it painful for you to play your instrument, and may
actually make the situation dangerously worse, so my best advice is to STOP
PLAYING until you see a physician and get a diagnosis. Doctors understand that
this is an urgent matter and you are usually seen fairly quickly. Also, lifting
anything heavier than about 8 lbs. can also cause the rupture to widen, so
helping your best friend roadie a bass cabinet or humping a Hammond B3 organ up
a flight of stairs is a really bad idea. (yeah, I made this mistake
myself, but only once!)
TOP
How
can I prevent this from happening in the first place?
The truth is, you
really can't. Although heavy lifting is often a factor, experts now
think that heredity may have something to do with it. The fact is that anyone
can end up with a hernia, heavy lifting or not.
MY STORY: In my case, I was probably just asking for trouble - I am
6'1" tall, slender build, and became obsessed with gaining weight and
"beefing up" to be strong when my parents refused to let me join the
Boy scouts as a child. I suffered my first inguinal hernia during a high school
weightlifting class. This was surgically fixed over Christmas break, but I was
not given any warnings or information (remember this was 1980, before everyone
became obsessed with information) so I went right back to lifting weights and
didn't allow enough time for proper healing. Two years out of high school, I
suffered another hernia, also repaired. Then I was employed for 13 years as an
exercise equipment repairman. I also worked in a warehouse and helped deliver
and install multistation weight systems, treadmills and Stairmasters (etc.) in
gymnasiums and health clubs. During this time I was playing sax in a bunch of
very loud rock bands, blowing my brains out every week. Even though I was
skinny, I was physically very strong and lean, and thought I was invincible! I
had a my third hernia at some point in my mid 20's, and was forced to sue my
employer to get the surgery paid for (see Playing the Workman's Comp Game below).
I won the lawsuit and took about two months off work to let myself heal, but
then I went right back to the gym and rehearsal studio.
Eventually I quit the exercise business and went into technology, and now I
work a desk job during the day. I quit lifting weights and switched to bike
riding and running, and I rarely lift anything heavier than my horn case. A few
years ago I suffered my fourth inguinal hernia, and this time there was not
enough natural tissue left to effect repairs, so the surgeon installed a piece
of mesh. By this time, I knew what the score was - I am personally susceptible
to this kind of injury and will have to deal with this fact for the rest of my
life. I will most likely incur additional hernias as I get older. I have to
choose how I will "spend" my body because my abdominal wall is
permanently compromised.
TODAY: Specifically, I couldn't bear to part with my signature Bobby
Dukoff 8 Star metal mouthpiece, so I switched to a softer reed (I
use La
Voz Medium Soft for tenor), and now I don't need to blow nearly as
hard as I used to. I spent about a month playing around with clipping and
sanding the reeds to get a slightly softer sound I was happy with. I also made
my practice room acoustically brighter by hanging pieces of thin plywood on the
walls - more reflection, easier to hear, less heavy blowing. I take Ibuprofen
before, during and after practice and shows in order to control any swelling in
my groin (not to mask pain, although it helps with that also). I wear an
athletic supporter when I play, and anytime I feel pain. I also started doing
some basic yoga exercises to help strengthen my abs. And I limit my practice
time to 1 hour a day, and plan my weekly practice and rehearsal schedules so I
have days to rest and not overdo it. I also traded in my original Selmer tenor
case (24 lbs empty) for a very slim hard shell gig bag, which is much lighter
and more compact than the old case (looks really cool too!) There are several
manufacturers but I personally recommend Walt Johnson Cases, a little more expensive
but worth every penny. When slung over your back, the strap is positioned so
the case hangs in the center of your back, along the support line of your legs
and trunk.
In the spring of 2005 I began experiencing swelling and pain again, even though
it has been more than ten years since my last hernia surgery. As an experiment, I tried putting the Selmer
away and concentrated on only playing my Martin
baritone sax for awhile, and I discovered that I could effectively
play the baritone without the pain that the tenor seemed to cause. The only explanation I have is that since
the baritone requires more air, so there may be less back pressure and strain
on my diaphram while I am blowing. For
artistic reasons, I just went ahead and put the tenor away for awhile and now
only concentrate on the bari, which has had other benefits as well – I am
finally being forced to learn how to transpose for an Eb instrument.
TOP
Inguinal hernias must be repaired
surgically.
No offense to
anyone in the alternate healing arts, but this is a fact - if you have an
inguinal hernia, it's a mechanical failure and must be repaired by surgical
procedure. "Psychic surgery", herbs, vitamins, acupuncture,
chiropractic adjustments or special exercises might make you feel better, but
you're still going to need surgery. Sometimes well-meaning friends will tell
you things like, "Oh, you can push it back in. As long as you can push it
back in, don't worry about it!" That's kind of like saying, "Yeah,
the tires on your car are starting to go bald, but hey - as long as there's
still enough tread to keep the car on the road, you'll be fine! The truth is,
it's a mechanical rip in a muscle wall that is not going to fix itself, and
it's only going to get worse over time. If a piece of intestine or fat slips
through the tear and gets caught in the wrong position, an inguinal hernia can strangulate
(yes, that's a real medical term), leading to peritonitis and even
DEATH. I'm not kidding. It's similar to what happens when someone's appendix
suddenly bursts - they haul your ass into the emergency room and get it out as
quick as possible to prevent a major infection.
TOP
Good
news!
Now that I've got
your attention, here's some good news - inguinal hernia repair surgery is
typically a minor outpatient procedure and may not even require any drugs other
than local anesthesia and pain killers. If you've been diagnosed, ask your
doctor about what options are available - surgeons do so many of these that
they keep finding better and faster ways of doing it. Also, general anesthesia
is much better today than it was 20 years ago when I had my first surgery, and
most patients wake up without the nausea and disorientation that used to occur.
Recovery is now days (or even hours) instead of the two weeks that they used to
tell you. Wow!
The important thing to remember is that everyone is different, and you DO
have options.
TOP
Follow you doctor's instructions
Many patients
ignore the recommendations of their health care providers. I don't recommend
this, but - if you absolutely must continue playing during your recovery,
pay attention to pain and irritation signals from your body. Usually your
doctor will prescribe some really hip pain killers like Vicodin, Percoset, etc.
but remember that these drugs mask pain, which is the first indication that you
are overdoing it and need to slow down. Allowing a surgical procedure to heal
appropriately gives you the BEST CHANCE of a full recovery without any chronic
problems, pain among others.
TOP
Playing
The Workman's Comp Game
Although modern
hernia surgery is usually straightforward and simple, it usually ain't cheap.
If you have a day job and your employer provides your health insurance, be
prepared for a visit from the folks at the State Workman's Compensation Board,
your employer's insurance adjuster, or both. Because the U.S. does not have
socialized medicine, these folks are in business for themselves, not you! As a
result, they are specially trained and highly motivated to deny benefits and
save money for their employers whenever possible. Even though my job
required me to lift very heavy things 40 hours a week, week after week, my boss
didn't want to pay my hospital costs because the insurance adjuster claimed I
had injured myself playing saxophone on the weekends!
I am not advising anyone to commit fraud, so just as a point of history,
here's how I ended up handling this ridiculous bullshit: I got
one story and I stuck with it - Since I was unable to pinpoint exactly when I
became injured, I picked a likely date and time when I knew I was at work, and
then chose some typical work-related task that involved lifting and stretching.
I memorized the details and told the same exact story over and over each time
they asked me what had happened.
Insurance adjusters will also usually do a "lifestyle
assessment", which is another way of trying to collect and assemble
information in an effort to disqualify your claim, so UNDER NO CIRCUMSTANCES
did I ever let them know that I was a musician. (If it had been more obvious, I
probably would have told them that I actually quit playing several years ago
and that I still dressed the part in order to get dates, etc.) They also tried
to trick me by asking what my hobbies were, so I used my head - "Hey, I
watch TV every night. I just sit on the couch all night long, actually. I'm
scared to death of motorcycles, I've never been to a gym, I always have my
groceries delivered by Safeway, I never do yard work, if my car breaks down I
call a tow truck, blah-blah, etc."
Again, I probably sound neurotic but I had to fight this out in court the
first time because I didn't understand how the system works. Years later, I had
to fight an insurance company over an examination for carpal tunnel syndrome
because I made the mistake of telling the nice lady on the phone that I played
acoustic guitar sometimes. Never mind that I sat on a cheap, old second-hand
office chair that couldn't be adjusted and that I typed at a computer all day,
almost 160 hours a month - the sons-of-bitches at the insurance company
maintained that the pinched nerve in my wrist was caused by the less than 3
total hours I spent each month playing guitar!
TOP
During
recovery - some things to watch out for
After inguinal
hernia surgery, there will be some scar tissue. For men, this can lead to
problems, the most common being epididymitis. This still comes back to
haunt me. Talk to your doctor and give yourself time to heal properly before
heading back to the studio or stage. Finally, ask the surgeon who is doing the
procedure what he or she thinks - how long should you wait before you practice
stuff that requires significant abdominal support (therefore creating increased
abdominal pressures)?
TOP
What
about horn playing and other types of surgery?
I've been told
that vasectomy surgery can leave some men unable to play a horn for a week or
two, but I don't have any first-hand experience with this one. Check with your
urologist if you need specifics.
TOP
Summary and list of resources
I cannot give
you medical advice, so this is not medical advice.
Talking with your doctor is usually the best way to answer your questions.
A hernia is an urgent medical matter.
Also, they do not fix themselves - they have to be surgically repaired.
You have options.
Even if you are unemployed or don't have health insurance, you are entitled
to quality medical care. YOU will need to investigate and discover what's
available and right for you.
Your career is worth more than any one gig or tour.
If your doctor advises you to take it easy after surgery, remember that
your future career is at stake. Resuming playing or strenuous activity too soon
could cost you a lot more than you bargained for.
Consider playing other horns as a long-term option.
If you have recovered from hernia surgery and you find that blowing your
primary horn causes you pain, consider borrowing or renting a different type or
size of horn and see if it makes a difference.
This worked for me, and I found that I actually became a more versatile
player as a result. (and it was a lot
of fun, too!)
Feel
free to write to me
directly if you have any question or suggestions about this page, especially if
you are a horn player suffering from a hernia. I'll continue to update and add
to this page as new information becomes available.
"You've Got Mail!"
Click here to read email I've received regarding this
web page.
