I found a hernia surgeon who says he is 100% convinced that I have an inguinal hernia, and he is ready to do surgery -- as soon as I lose enough weight for him to operate laparoscopically. I'm getting there, but slowly. His diagnosis was purely on symptoms: pain that's mostly absent in the morning, worse upon sitting. I mentioned that when I have an erection my left testicle (on the same side where I feel pain) retracts entirely, and my theory that this is an additional sign of hernia because:

an inguinal hernia can -->
irritate the genito-femoral nerve -->
which innervates the cremaster muscle -->
which controls testicular contraction.

Makes sense, don't you think? Put more simply, asymmetrical testicular contraction can be a sign of hernia. I think. Anyway, if the surgeon was impressed with that line of amateur medical thinking he didn't say so. He also didn't recommend ultrasound or herniography.

-- Have you had a herniography

No. I'm not even sure where to get one.

I have seen studies that say "we find herniography a safe method for imaging occult hernias..." and maybe the hospitals that hosted the studies still do 'em. The problem, apparently, is herniographies are not 100% safe, and hospitals seem reluctant to take the risk with a purely diagnostic procedure. Too bad, IMO, when you consider the price we pay for living with this stuff. Apparently the procedure is common in Sweden, and perhaps other nordic countries.

-- or dynamic ultrasound performed?

I feel kinda dumb about this, but I only recently learned that (1) there is such a thing as "dynamic ultrasound" (compared with lie down and don't move sonogram); and (2) that its chances of detecting an otherwise "occult" hernia are pretty good. So now I want one.

But the question is where to go. I'm in New York. Easy right? Ha!

Columbia amazingly enough (based on the 2 surgeons I contacted there), if it does any imaging procedure beyond palpation, does a CT scan. Institutionalized incompetence!

I could always go to Denver, and it's tempting. Their procedure is CHEAP (less than $300) and at least as described on their website it's unbelievable -- dynamic ultrasound by people who seem really to understand hernias.
http://www.riainvision.com/invision/patientinfo/conditions/patinfo_cond_hernia_sub.asp

My latest lead is the Hospital for Special Surgery in NY. I hope to give 'em a spin next week.

Even if a dynamic ultrasound turns out negative, I will almost certainly still go to the surgeon willing to do the laparoscopic procedure. I know that it's not risk-free, but there are a bunch of studies where such investigations were done with less evidence than I have of a hernia, and they found problems in a significant percentage of patients, fixed them, and relieved all pain.

Thanks for your interest, and suggestions always welcme.

Spy