Bowman graduated from the During the recovery, patients receive a holistic program of patient care that encourages a safe, healthy and rapid return to normal activities. California Hernia Specialists routinely sees unique and complex cases. Overweight poses a potential risk for recurrence, bleeding, infection, and chronic pain. Another important advantage is significantly lower out of pocket cost since a mesh is the most expensive component of an hernia repair. Your surgeon should discuss this possibility as part of the consent process. Shouldice Repair. His method improved surgical results and reduced recovery time, quickly restoring the recruits to physical fitness for military training. How long is the hospital stay following a Shouldice repair? This site needs JavaScript to work properly. In addition, look for the Patient's Perspective boxes and callouts that tell you what other patients liked about the doctor. Come to the hospital at your appointed time and register at the front desk. To increase the text size, press and hold down the command key on a Mac or the windows key on PC, then press the plus (+) key. Increase text sizeDecrease text sizeReset. For those patients on weight reduction programs please ensure you have attained your weight loss targets as your surgery may be postponed as a result. The UC Davis bariatric surgeryprogram offers acomprehensive surgical weight loss solutionfocused on long-term success. With larger more complex hernias, or risk factors and complications such as infection are a concern, larger incisions may be necessary. 3- Permanent suture is used to join four separate anatomical layers. Shouldice hernia repair is the repair of inguinal hernias without the use of mesh. This technique has improved outcomes from older non-mesh repairs. What is a Hernia? A hernia is a hole in the muscular abdominal wall. It can be located in many locations. When everything is complete, you will be escorted to your room to settle in. In fact, at Shouldice Hospital where I was trained in the procedure, the recurrence rate is only about 1% and the chronic pain rate is 3 in 1,000 patients at 3 years and 6 per 1,000 patients at 10 years follow-up. After surgery, these individuals typically have no need for prescription pain medication. You can also keep an eye out for the awards icon on search pages or the Awards card on physician profiles that indicate Preferred Provider award winners and physicians on staff at WebMD Patient Choice award-winning hospitals. We encourage you to take part in the many activitiesoffered at Shouldice. A systematic review and network metanalysis of randomized controlled trials comparing Shouldice and Desarda 2015 Dec;77(Suppl 3):1023-6. doi: 10.1007/s12262-014-1115-5. Stay connected with whats happening at the Department of Surgery at UC Davis Health. 2510 Airpark Dr Ste 301, Redding, CA 96001, 1335 Buenaventura Blvd Ste 204, Redding, CA 96001. Dr. Bandala works in Roseville, CA and 1 other Bookshelf The limited walk-in spaces are available on a first-come, first-served basis. As part of the Shouldice procedure, we do a thorough search for other hernias, or weaknesses, in the area and repair them as well. Because of this, a formal Shouldice repair of an inguinal hernia requires years of training and experience. 7750 Bayview Avenue,Thornhill, Ontario,Canada L3T 4A3View Map, Tel: 905-889-1125 Fax: 905-889-4216 Canada: 1-800-291-7750 U.S./International: 1-855-328-3423 postoffice@shouldice.com, Shouldice Hospital is committed to excellence in serving all patients including people with disabilities.Learn More. Because of my experience, I serve as a trainer for surgeons across the country who are interested in furthering their education in hernia repairs and I speak about hernias at national medical conferences. Dr.Harris. A: The Shouldice repair is named after Dr. Edward Earle Shouldice (18901965), the Canadian surgeon who invented the technique in the 1940s. Accessibility As soon as you are able, we advise getting back to normal activity levels again. 2335 Stockton Blvd. Patients, ambulant immediately, stay in hospital 2-3 days postoperatively. 2000 Nov;82(6):396-400. On the day of your operation, you will be escorted to the Operating Room (OR) lounge approximately 30 minutes prior to your scheduled surgery. The complete dissection lends itself to the discovery of secondary hernias. Finding good answers to questions about hernias and the different methods of repairing them can be a challenge. All rights reserved. Unable to load your collection due to an error, Unable to load your delegates due to an error. Shouldice Hospital is returning to Vancouver to conduct examinations in March 2023. 510% of patients will experience severe pain that needs to be treated with pain medications. Limited walk-in spaces are also available The location you tried did not return a result. Additional medication may be used when necessary or, in some rare cases, a general anaesthetic may be required. Family Medicine, Surgery, Neurological Surgery, General Dentistry, Oral & Maxillofacial Surgery, Surgery, Other Specialty, Surgery, Other Specialty, Vascular Surgery, Emergency Medicine, Family Medicine, Surgery, Surgery, Internal Medicine, Thoracic Surgery, Cardiovascular Disease, Surgery, Thoracic Surgery. Redding, CA has 57 Hernia Repair doctors results with an average of 27 years of experience and 1 review. It is really challenging to undo the repair, so that is why the restrictions are less with this type of procedure than with others. Hernia 7(1):1720 (Epub 2003 Jan 15) CAS PubMed Google Scholar Bendavid R (1986) The, Fletching: a new implant for the treatment of inguino-femoral hernias. Unable to load your collection due to an error, Unable to load your delegates due to an error. In fact non mesh repair was the norm prior to the introduction and popularization of mesh in the 1960s. Certain medications can affect the bodys ability to clot blood, which can lead to complications during and/or after surgery. 34 Years Experience. WebFor over 75 years the Surgeons and staff of Shouldice Hospital have dedicated themselves to repairing abdominal wall hernias; its all we do, having performed over 400,000 successful But it has relatively low reported recurrence rates in the hands of surgeons experienced with this particular method. Smoking restricts oxygen flow in the body and impairs the bodys ability to heal itself. Fax: 916-734-3951 Our clinic offers hernia examinations by appointment or on a limited walk-in basis. For example, a non mesh repair of an inguinal hernia can be done under local anesthetic and can take as little as 30 minutes with recovery of 5-10 days. As soon as youre able, you can start playing sports and exercising again. Epub 2021 Nov 22. At Stony Brook, we also have a multidisciplinary team that includes weight loss specialists who provide a range of proven treatments, both non-surgical and surgical. A: The pain after surgery is managed with over-the-counter Tylenol and ibuprofen. WebDr. Dr. Iskandar, a renowned expert in complex hernia repair, has extraordinary experience in performing Shouldice repair. Before repairing any weakness, we gently place fatty tissue, and any part of the intestine (bowel) that may have bulged through the abdominal wall, back inside the abdomen. If you are an international or distant patient, you can have your repair checked by a doctor in your hometown. Please see Will I need to lose weight?". Laparoscopic Sleeve Gastrectomy (LSG or VSG), Laparoscopic Adjustable Gastric Band (LAGB), single anastomosis sleeve ileal bypass (SASI), Single Anastomosis Duodenal Ileal Bypass (SADI), Weight regain & Care after Weight Loss Surgery (Post-Bariatric Care), Gastric Bypass Revision and Gastric Sleeve Revision, Laparoscopic Inguinal (Groin) Hernia Repair, Sinus Laser Ablation of Pilonidal Cyst SiLaC, Non-surgical options & diet for acid reflux, Nissen Fundoplication & Hiatal Hernia Repair, Sinus Laser Ablation of Pilonidal Cyst SiLaC. Shouldice repairs provide better results than earlier non-mesh repairs and decreased hernia recurrences. WebShouldice hernia repair is the repair of inguinal hernias without the use of mesh. Accessibility Please call 905-695-4911 to book an appointment, Monday to Friday between 9:30AM and 3:30PM. 2020 Mar 18;18(1):51. doi: 10.1186/s12951-020-00602-9. This rating is based on actual ratings from real patients like you. "I don't have multiple offices with a variety of staff and services. Dr. Iskandar is one of the leading complex hernia experts in the United States, and his training has allowed him to develop his skills and focus on his passion for bariatric surgery, complex abdominal wall reconstruction, and hernia surgery. Bethesda, MD 20894, Web Policies Your symptoms may not be caused by a hernia or you may have a health condition that should be managed before surgery. Your family and friends are welcome to visit you during our normal visiting hours. The use of Mersilene mesh in adult inguinal and femoral hernia repairs: a comparison with classic techniques. Before Within 5 days of surgery, 99% of patients can handle their symptoms with just ibuprofen and/or acetaminophen. If you're looking to schedule a video appointment instead of seeing a doctor in person, doctors who meet with patients online will have a "Virtual Visit" button at the top of their WebMD Care profile page. Currently, 31 providers have noted they are accepting new patients. Few people know that Shouldice Hospital was a pioneer in the early development of mesh in the 1980s. Most inguinal hernias can be treated using the Shouldice repair. Every persons body is unique, so Dr. Iskandar will discuss with you what would be the best plan for your particular situation. If think you have a hernia and you are not an Ontario resident, please complete our Medical Questionnaire. You may actually be put on leave till this is addressed to their satisfaction. The Shouldice repair is intended to restore your muscle function so that you can perform your duties. The inguinal ligament is a pair of bands that runs deep within the groin and joins the pelvis to the external oblique muscles of the abdomen. Bethesda, MD 20894, Web Policies No mesh technique has surpassed the results achieved by the experienced surgeons of Shouldice Hospital when natural tissue repairs are used to repair the hernia defect. What is a Hernia? The Shouldice repair is a comparatively challenging technique. Q: Is it possible to live with a hernia and avoid repair? Ontario patients have two options to have this assessment. After you've searched for doctors by procedure, click the "Insurance" option in the search filter and then select your specific insurance provider. Our body is protected by complex layers of tissues consisting of muscles and tough layers called fascias and tendons. Clipboard, Search History, and several other advanced features are temporarily unavailable. Laparoscopic and robotic inguinal hernia repair procedures performed by qualified surgeons carry complication rates of 1% and the same for recurrence. WebMD does not provide medical advice, diagnosis or treatment. All patients are required to have a personalized assessment by one of our experienced Shouldice surgeons prior to booking surgery. We are high-volume referral center. Your health is your most precious resource and every year over 6,500 patients trust Shouldice Hospital to repair their abdominal wall hernia. Currently 7,500 patients are treated every year. Junge K, Peiper C, Schachtrupp A, Schumpelick V (2003) Breaking strength and tissue elasticity after Shouldice repair. In the first 8 to 12 hours following surgery, mild to severe discomfort will be experienced by 9095% of patients having a Shouldice inguinal hernia repair. In the case of a minimally invasive laparoscopic procedure, patients can even go home the same day. Medical literature has shown that experience matters greatly when it comes to treating hernias. 2005 - 2023 WebMD LLC. Chirurg. Next steps: After reviewing your Medical Information, the surgeon will make a diagnosis and decide if a hernia repair is necessary or if further information is required. The repair is a modified Bassini. Unauthorized use of these marks is strictly prohibited. Mesh is employed infrequently, only in those cases where there is a lack of tissue or scarring has minimized flexibility. Ryan James Bowman, MD. Finding top-rated doctors who perform Hernia Repair near you is simple on WebMD Care. The repair is a modified Bassini. Shouldice hernia repair is a method that Dr. Shouldice created as an evolution from earlier procedures known as Bassini Repairs. Essentially the repair is an overlap of the divided transversalis plane utilising 4 lines of continuous monofilament stainless steel wire 34 gauge. Those able to travel to our Thornhill clinic are by appointment only by calling 905-695-4911, Monday to Friday between 9:30 a.m and 3:30 p.m, and are strongly encouraged to do so for their in-person examination. Q: What types of hernias can be treated with the Shouldice repair? WebMD Care makes it easy to find doctors who take your insurance plan. Doing so will reduce the risk of complications and help patients recover more quickly. The hernia can be painful or even life-threatening if the intestine becomes trapped in the opening and is compressed. 35. Ideally, you should try to achieve your optimal body weight prior to surgery. Federal government websites often end in .gov or .mil. The opening of the hernia can be reinforced using mesh or the bodys own tissues. If you live outside of the Toronto area, we have traveling clinics in Ontario for your convenience. Hernia. Our repair techniques have been widely acclaimed, but it is the total Shouldice experience that underlies our success and attracts patients from around the world to our hospital. The site is secure. 1989 Mar-Apr;107(2):97-104. 2022 Aug;26(4):1189-1190. doi: 10.1007/s10029-021-02541-2. Schedule a consultation today. Although you may resume activities during this time, your body still continues to recover. The complete dissection lends itself to the discovery of secondary hernias. 2023 The Iskandar Complex Hernia Center. Mesh is rarely required in any primary direct inguinal hernia, and virtually never needed for primary indirect inguinal hernia repair. Hernia types are categorized based on where they are located. Q: Why do patients seek out the Shouldice repair? In severe cases where the opening of the hernia is quite large, a skin graft, taken from another location in the body, may be necessary in order to properly close the wound. Disclaimer. and transmitted securely. The goal of hernia repair surgery is to close and support the weakened area in the abdominal wall. | Jobs We offer comprehensive, patient centered care. Why do we avoid the use of mesh whenever possible? Would you like email updates of new search results? Website design by Moon & Owl Marketing. [The Shouldice repair for inguinal hernia--technique and results]. When we compare this with the growing evidence of mesh related complications ranging between 10 and 20% it is hard to justify the use of mesh when there are safer, and more reliable, natural tissue alternatives. Hernias occurs when an organ or tissue squeezes through a weak spot in muscle or connective tissue. I highly recommend Dr. Harris as a surgeon to anyone who has a hernia! -Dr. John P., Orange County Doctor. Your employer will likely be very concerned in your ability to do your job successfully in your current condition, and will encourage you to have this taken care of or at least examined by a surgeon. Even though these complications are rare they are worth mentioning and there is a genuine concern about long term impact of foreign materials left in our bodies. Our surgeons perform open, and minimally invasive robotic assistive laparoscopic procedures for hernia repair. Therefore, Shouldice techniques (non-mesh inguinal hernia surgeries) might be the most minimally invasive alternative for these patients. Q: How long is the hospital stay following a Shouldice repair? WebDr. Complex Hernia Surgery, Repair, and Treatment. Very few cases would require mesh. Mainprize M, Spencer Netto FAC, Degani C, Szasz P. Hernia. Our clinic offers hernia examinations by appointment or on a limited walk-in basis. Limited walk-in spaces are also available on a first-come, first-served basis. All Rights Reserved. 17 Years Experience. Q: Does body weight affect a hernia repair? Dr. Iskandar is a highly trained physician with vast experience and knowledge in complex hernia repair. How its performed. An experienced Shouldice-trained surgeon, Dr. Sbayi has performed the Shouldice procedure for over 700 patients (as of 2018; see patient testimonials). However, the fine art of non mesh repair has been lost to newer generations of surgeons. Recovery back to what normal used to be for each individual patient can vary from four to eight weeks, but you are certainly active in the interim until you feel you are where you need to be. What are the restrictions after a Shouldice repair? The following table used at Shouldice Hospital (founded by Dr. Shouldice) shows ideal weights for height and body frame size: Q: What is the advantage of having a Shouldice repair done at Stony Brook Medicine? It is a surgical procedure that involves utilizing a permanent surgical suture to stitch four separate anatomical layers together. The .gov means its official. Please enter a valid 5-digit Zip Code. Please discuss all current prescription medications with their doctor. Recently, I have noticed almost all of my patients are asking about non mesh repair of hernias and Do I need a Mesh or not. This rating is based on actual ratings from real patients like you. Our recurrence rate for primary inguinal hernias of around 1% is more than comparable to the best results of any mesh surgeon in the world, yet we do so with a complication rate of <0.005 (less than one half of one percent). Yes, this is ideal for athletes and very labor-driven jobs. MeSH A: There are no weight or lifting limitations after surgery. The .gov means its official. The answer to that question is, Yes, almost ALL hernias can be repaired WITHOUT mesh. In a no mesh repair, regardless of the technique, the hernia is closed and secured by carefully stitching the tissues of the abdominal wall closed. Mesh, at times, may be required when repairing recurrent hernias, incisional hernias, most femoral hernias and large umbilical hernias. Speranzini MB, Mittelstaedt WE, Fujimura I, Pires PW, Rebelato FJ, Rodrigues Jnior AJ, Deutsch CR, Souza JF. Blood work and an ECG may also be done to confirm that you are in good health for your surgery. WebOur surgeons perform open, and minimally invasive robotic assistive laparoscopic procedures for hernia repair. Once youve decided to seek treatment, review our patient outcomes data to help you choose the best surgeon for your care and then schedule your appointment with us online. Some patients may experience a low level of pain after an open repair procedure, while others may experience a high level of pain and discomfort after a laparoscopic procedure. Surgeons in other countries now employing this technique achieve comparable results, often using other non-absorbable suture material. With little risk of harm to the Shouldice patient, the technique has a long history of curing hernias. Despite our remarkable success rates with laparoscopy and robotic inguinal hernia repair, it is nevertheless evident that in some patients, avoiding mesh reduces the likelihood of chronic pain or discomfort at the relatively minor cost of a slightly increased risk of recurrence. Did you know you can have a hernia repaired by a procedure with a low complication rate, with slim to no chance of the hernia ever coming back, very low chronic pain rate, and no need for mesh? The Shouldice repair has provento be exceptionally safe, secure, and reliable. At IBI Healthcare Institute Advanced Hernia Center, we offer non-mesh repair in a Hernia Repair Center of Excellence environment. The procedure is designed so that these secondary defects are easily incorporated into the repair. 2014 Nov;38(11):2784-90. doi: 10.1007/s00268-014-2710-0. Shouldice Repair. WebMD does not provide medical advice, diagnosis or treatment. Finding top-rated doctors who perform Hernia Repair near you is simple on WebMD Care. Inguinal hernia repair: are the results from a general hospital comparable to those from dedicated hernia centres? This surgical pain improves each day and significantly lessens the further out you are from surgery. When surgery is completed, most patients can walk out of the OR with the assistance of the surgical team and return to their room, however, for patients requiring a general anesthetic, a short stay in the OR lounge is required first. WebIn time, new tissue attaches to the mesh to reinforce the abdominal wall, relieving tension and reducing the risk of a recurrent hernia. Essential preliminaries are accurate dissection at the internal ring with adequate treatment of any indirect hernia. Singapore Med J. Our team includes surgeons, specialized nurse practitioners, clinical specialists and registered dietitians all working together to provide a comprehensive approach to providing patient treatment and care. On the day of your admission to Shouldice, there is no need to fast, please continue with your normal dietary habits. symptoms occur to determine the best course of action. WebBest alternatives sites to Californiaherniaspecialists.com - Check our similar list based on world rank and monthly visits only on Xranks. Hernia forms when there is a defect in this protective wall, which allows internal organs to protrude out of the body cavity. Pre-procedure instructions typically include refraining from eating or drinking at least eight hours before the operation. We don't know the reasons for the weakness in the muscle that generates this condition, but we are very good at diagnosing it. There is no use of synthetic surgical mesh material. The recurrence rate is less than 1%, according to the Shouldice Hernia Centre in Ontario, Canada. 2012 Apr 18;2012(4):CD001543. How long does it take to complete the Shouldice repair? Q: What are the restrictions after surgery? Would you like email updates of new search results? After you've searched for doctors by procedure, click the "Insurance" option in the search filter and then select your specific insurance provider. A Shouldice repair is perfect for labor-intensive jobs and athletes. Non mesh repair of hernia has several advantages, the most important of which is the absence of foreign material in the body and zero risk of short- and long-term mesh complications. 2005 - 2023 WebMD LLC. 8600 Rockville Pike Patient recovery begins the moment the operation is over. International and long distance travellers are also able to return home the day of discharge. The published results revealed that the recurrence rate of all general hospitals in the Province of Ontario ranged from 5.21% among lowest volume hospitals to 4.79% for patients at the highest volume hospitals. sharing sensitive information, make sure youre on a federal What kinds of hernias can the Shouldice repair treat? The technique was designed by Dr.Edward Earle Shouldice and became popular when he opened his hernia hospital in 1945 and his technique has attracted patients from all over the world. To this day - the surgeons at the Shouldice Hernia Clinic - provide extraordinary care for their patients and continue to have excellent results. It is a surgical procedure that involves utilizing a permanent surgical 19. WebIn time, new tissue attaches to the mesh to reinforce the abdominal wall, relieving tension and reducing the risk of a recurrent hernia. CALL NOW 678-466-6760 How are Hernias Repaired When a hernia causes discomfort and causes detrimental health complications for an individual, surgical intervention is necessary in order to repair it. A: It is performed with no mesh. 2020 California Hernia Specialists PRIVACY POLICY MEDICAL DISCLAIMER TERMS OF USE. Unauthorized use of these marks is strictly prohibited. I am dedicated to the diagnosis of, treatment for, and recovery from, all hernia types. 57 Years Experience. We specialize in innovative surgical techniques. A: We plan to discharge patients the same day of their surgery, avoiding a hospital stay. Extremely low chance of serious complications or infection. [Recurrence after hernia surgery: complication or natural course?]. Mesh repair versus non-mesh repair for strangulated inguinal hernia: systematic review with meta-analysis. At UC Davis our hernia specialists are experienced in repairing simple and complex hernias with a goal of helping patients to return to pain- free health as quickly as possible. Hernia. No referral is required. 43. Waxahachie, TX 75165. The Global Leader in Non-Mesh Hernia Repair. For over 75 years, we have been the only licensed hospital in the world dedicated to repairing hernias. More than 98% of our cases are performed with our natural tissue techniquewithout the use of mesh. Our Patients at Shouldice Hospital Say it Best. Why Shouldice? Nylon-6/chitosan core/shell antimicrobial nanofibers for the prevention of mesh-associated surgical site infection. WebSurgery, Oncology, Surgical Oncology. Epub 2014 Jun 7. Your symptoms may not be caused by a hernia, or you may have a health condition that should be managed before surgery. Dont let a hernia affect your quality of life any longer. WebHernia Surgery At UC Davis our hernia specialists are experienced in repairing simple and complex hernias with a goal of helping patients to return to pain- free health as quickly as possible. Dr. Iskandar, MD, FACS is a board-certified general surgeon with fellowship training in minimally invasive and bariatric surgery. Your questionnaire will be reviewed by our medical team. Dr. Shouldice developed his repair during World As a Shouldice patient, you can be confident that you will get the best of care in a progressive, patient-centred facility renowned around the world for excellence in hernia repair. Am Surg. 1555 East St Ste 200, Redding, CA 96001 1.46 miles. It is also done with local anesthetic injected into the skin to numb up the surgical site during and for a few hours after the surgery. Surg Clin North Am. The Shouldice repair is used for all types of inguinal hernia whether indirect, direct, sliding, multiple, recurrent, male or female. WebThe Shouldice pure tissue repair for groin hernias, a tested and proven procedure, continues to provide great patient satisfaction. As a leader in pioneering approaches like minimally invasive surgical DaVinci robotic surgery system, our surgeons are on the forefront of reducing sources of bleeding, improving recovery time and reducing time under anesthesia. Your body is still recovering during this time, even though you have resumed your normal activities. Careers. Oct 13, 2007 #12. Recovery will vary for each patient, depending on the type of surgery performed and the overall health of the patient. Accurate recognition and definition of the transversalis plane is routine and fundamental. These are treated in other ways. Try not to overdo it on the first few days home. Joshua Faluwke San Diego, California Joshua Faluwke San Diego, There are other types of hernia for which the Shouldice repair is not used, such as hiatal hernias and parastomal hernias. Choosing the right treatment for your condition increases the likelihood you will have a positive outcome and decreases the risk of complications and hernia recurrence. If you're looking to schedule a video appointment instead of seeing a doctor in person, doctors who meet with patients online will have a "Virtual Visit" button at the top of their WebMD Care profile page. California Mesh-Free Hernia Surgeon in the Bay Area; Compromised Collagen Formation & Hernia Development; BREATHWORK for Holistic Hernia Healing (Video) What to do with an inguinal hernia? You may return to work in less than a week if it isn't a very laborious job, or be set up for light duty for a short period of time. Careers. Despite the Shouldice repairs75 plusyears of success, there is compelling evidence that mesh-based surgical techniques have a lower risk of hernia recurrence than natural tissue repairs. Shouldice repair is an innovative method for treating inguinal hernias without the use of mesh. Your surgeons knowledge about what causes hernias, and new and When a hernia causes discomfort and causes detrimental health complications for an individual, surgical intervention is necessary in order to repair it. If you have concerns about your health as your admission date approaches please contact the hospital prior to travelling. An accurate in-person diagnosis by an experienced hernia surgeon is the best way to find out if you need a hernia operation. That means that as you are returning to work, exercise, muscular conditioning for competitive sports, and moving toward your previous job responsibilities, you should keep in mind that you had surgery and your body still may need time to heal. Early results of inguinal hernia repair by the 'mesh plug' technique--first 200 cases. 2002 Jul;127(7):565-9. doi: 10.1055/s-2002-32844. All rights reserved. Did a relative or friend tell you it might be a hernia? HHS Vulnerability Disclosure, Help Those unable to travel to Thornhill are instructed to fill our Medical Questionnaire. Longterm results of a prospective study of 225 femoral hernia repairs: indications for tissue and mesh repair. More important, it will likely compromise your daily activity, prevent you from keeping your job because of your inability to complete your tasks, and prevent you from playing with your children or grandchildren, or participating in extracurricular activities, competitive and non-competitive.