This blog article is a journal of my personal experience recovering from Hernia surgery. I hope you find its contents useful in preparing for similar surgery yourself.
For several years I had noticed the gradual appearance of bulges just above and either side of my penis. I had hernia surgery as a baby on the right side as did my brother. A congenital weakness I conjecture. I noticed some dull pain in the right bulge occasionally, especially if I hiked with a backpack or camera waist-bag. It wasn’t severe enough to warrant a trip to the doctor and did not affect my lifestyle. I hiked, completed 2 half marathons, no big deal.
Just prior to Christmas of 2010 I got a head cold and coughed a great deal. The right hernia was much more painful and if I pressed on it I felt my insides pop back inside my abdomen. The pain disappeared after the cough went away and I didn’t see a doctor as I had intended. A few weeks later I started on a walking program in readiness for the Music City 1/2 marathon in April 2011. If I wore my camera waist-bag, the right hernia was painful, I had to stop using the bag as I did my walks. I now realized that I was making lifestyle choices based upon this hernia, time to go to the quack.
I first went to my family doctor to confirm my self diagnosis. He agreed I had a hernia and sent me to a general surgeon, Dr. Peter K Smith of Hendersonville Hospital, TN. (I had seen Dr Smith 18 months prior to treat a spider bite that would not heal). He immediately diagnosed an inguinal hernia on the right side and noted the left side was herniated also. He advised fixing both sides (bi-lateral) at the same time, fixing the weaker right side only would put more strain on the left weakness and the intestines would probably protrude in short order. I agreed. He said I could wait, it wasn’t a critical situation just yet, but since it was forcing me to make different lifestyle choices I wanted to go ahead.
The doctor advised that I should plan on at least 4 days to recover. Despite the fact the operation is routine, he said that men find this procedure very painful. Surgery was scheduled 10 days later, with a pre-op visit 1 day prior. Dr Smith performs hernia repairs using mesh, which provides for a strong repair with lower recurrence and quicker recovery than sutures.
I researched inguinal hernias on the internet and found a lot of useful information. Use of mesh is relatively recent and well respected by doctors and patients alike. This was reassuring. Less reassuring were the stories of 6 weeks off work for some, although others seemed to take it in their stride like it was nothing. My doc said in his experience the older the patient the less post-operative pain, at 52 I should not suffer for an extended time.
I experienced a few nights where I didn’t sleep well. The anticipation was obviously a stress to me. I was glad I decided to go ahead straight away and not string out the experience.
Hospital & Insurance
About 7 days prior to surgery I received a call from Hendersonville Hospital advising me my out of pocket expenses would be just over $2,000, they were willing to offer me a 20% discount for immediate payment of this amount prior to the date of service. I negotiated to pay this on the date of service. This bought me time to check my companies health insurance policy/deductible amounts were in line with the hospitals claims, which they were. This practice is becoming more common, however actually realizing the discount is not certain. If the anesthetist, doctor, lab etc get their bills submitted first the deductible will be applied to their claims, not the hospital. The hospital will refund any overpayment but benefit from an interest free loan. We’ll see which way the chips fall.
Pre-Op Visit – February 2nd 2011
I went through the admitting registration quickly, many of the routine questions had been asked on the phone one week earlier. I paid $1900 (plus change) to take advantage of the 20% discount (maybe). I was called into the lab by Missy, a pre-op nurse, she made me feel comfortable and made the experience as pleasant as possible. She went over my health history and performed an EKG, which was normal, my pulse was between 65 and 72 during the time I was hooked up. Blood pressure was normal at 120/80, I gave a urine sample and three vials of blood were drawn by another nurse. She had trouble finding a vein and the blood flowed slowly when she did find a good one. I don’t normally have issues with drawing blood, she advised me to drink more water next time. I was sure to drink plenty that evening before going to bed!! I got the expected advice not to drink or eat after midnight. I was given a pouch of anti-bacterial wash soap to use in the shower the following morning on my lower abdomen. I was then taken to the radiology department to get a chest X-ray. They were closed, so I had to wait in admitting for someone to be called. They took 2 xrays of my chest and I went home.
I drank plenty of fluids and took a stool softener before retiring, I have heard from patients that have had this surgery that the first bowel movement can be very ‘special’.
Surgery Day – Thursday February 3rd 2011
I was due at the hospital at 6am, and woke up at 5:10am, later than planned !! I quickly showered, remembered to use the antibacterial soap. After showering I inserted a Preperation H suppository in the hope that this would make my first bowel movement easier to pass. I would have preferred a more waxy suppository but its all I had at the time. I dressed in loose fitting sweat shirt and pants and headed out the door with a light jacket, it was 27 degrees F. My wife drove me to the hospital, we got to the day surgery center right at 6 and were quickly ushered to my room. Room number 3, a lucky number no less!!
I changed into the gown provided, my wife noticed a poster showing a fancy heated gown and how to put it on. Maybe my insurance didn’t cover such luxuries I thought. I do remember being very cold after a prior surgery and felt like I’d been jipped. My nurse was Kerri, she was very pleasant and made me comfortable very quickly. I was hooked up to a monitor and an IV was started, she found my vein very easily and it was not too uncomfortable this time. She asked who had been hacking at my arm, she could see the repeated attempts from the day before. My blood pressure was 135/85, I didn’t feel nervous, but clearly I was! Then she noticed I had a standard issue gown, she got a special plastic gown and hooked it up to a heated blower. I had a remote to control the temperature, it was great!! Kerri, and three anesthetists asked me a similar series of questions over the next 30 minutes or so. Dr. Smith the surgeon came by and asked me if I had any questions, I didn’t and said ‘let’s get this done’. About 7:30 am I was wheeled towards the OR. The anesthetist said he would administer a sedative, the last thing I remember is being wheeled past day surgery reception.
Post Operative Recovery
I woke up shortly after 9am and asked Mellisa the nurse if it was all over. She confirmed it was and monitored my recovery. I was nice and warm, the heated gown really worked well. I commented how comfortable it was. Meilissa said most people like it, except overweight people who tend to sweat due to the plastic material it is made from. After about 10-15 minutes I was wheeled back to room 3 where my wife was waiting on me.
My wife said she had met Dr Smith in the waiting room and he found the hernias to be bigger than he had anticipated. I felt better about not waiting any longer for the surgery. I took a look at the incisions, they were 4 inches each vs the 2 inch incisions I was anticipating! It felt like a donkey had kicked me in the groin. More than once.
Another thing I noticed about the incisions is that there were no stitches or staples. Apparently the incisions were glued together, super glue!! The benefit is that the scar will be less noticeable without the ‘train track’ appearance sutures or staples make. Another feature of this method of closing the wound is that there were no bandages, what you see in the photograph is the way I looked during recovery and discharge from the hospital.
The nurse, whose name escapes me, asked me my pain level on a scale of 1-10. I said 7-8, she gave me a Percocet for the pain. I decided to wait for the meds to kick in before trying to get up and urinate.
My blood pressure was 137/90, the pain was obviously stressing me. After 15 minutes or so I got up. Ouch! Walking was very slow and painful. I had to wait over a minute for urine to flow and had to restart the stream 4-5 times, it was very weak. I began to feel nauseated so headed back to the bed before I threw up. The nurse asked how I felt and I said I was hot and felt queezy. She administered an anti-nausea medication once I was back in bed. While I was in the bathroom the nurse told my wife I was one of the few who can urinate after this surgery, they normally have to catheterize. I’m glad I avoided that outcome.
At about 11:30am the nurse said I looked very healthy and told me I could go home. An orderly wheeled me to the front door. He grabbed a barf bag on the way, he could tell I was getting nauseated. Getting into the car was slow and awkward, but I was glad to recline the seat to get rid of the nausea. I felt even the smallest of bumps, my wife took a different route to avoid the level crossing on the way home.
I have to say that the level of care and attention at Hendersonville Hospital was second to none. I can’t imagine anything else they could have done for me to make me more comfortable or at ease.
Recovering at Home – Day 1
Dr Smith had advised me to move around the house and not just lay up all the time, he said it would make my recovery on following days easier. I got up out of the recliner on the hour, every hour from 12pm until I went to bed at 9:30.
Changing from a sitting position to standing or vice versa is where I experienced the most pain. My wife left for the pharmacy to get Oxycodone (generic Percocet). Dr Smith prescribed 18 total tablets to be taken every 4-6 hours. I took 3 the first day. Walking got a little easier each time I tried it, but standing straight was too painful, I hobbled around like an old geezer. Urination was still a trial in patience. this is where I am glad guys can go standing up!! I tried using ice packs, but found myself getting nauseous due to the weight on my abdomen.
Sitting on the couch aggravated my back, I have suffered lower back pain for years. I found that a full sized pillow behind the small of my back gave the best support and relief along with frequent changes to the level of reclining in the couch.
At 2pm my wife and I were kissing when I noticed a movement ‘downstairs’. Hey my junk still works!! I can get a woody!! My mood improved 100%
I had chicken noodle soup and a ham sandwich followed by a yogurt. Yummy. By the end of the evening I was feeling somewhat better, and managed to get up the stairs ever so slowly under my own steam.
I slept flat on my back, turning over was not a possibility.
Friday February 4th 2011 – Day 2
I slept to 1 am when I got up to urinate. That went quite well and I felt that I might be able to get off the oxycodone and use Ibuprofen only. At 4am I got up again, and was now in excruciating pain, my wife got the oxycodone from downstairs and I went back to bed.
I got up at 7am and the oxycodone had alleviated much of the pain allowing me to catch up on some sleep between 6 and 7. I made my way downstairs.
Dr Smith told my wife I could shower the next day, the discharging nurse said to wait two days. I didn’t feel like a shower at 7am so waited until later in the day when I was doing better. I could climb the stairs without leaning on the banister, things were getting much easier.
I continued to get up every hour and started to feel almost normal with minimal pain. At 12pm I was able to pass gas without pain, and how that was a relief. Urinating was normal again. I ate normally all day and had a normal appetite. Each hour I’d get better. I took 800mg of Ibuprofen at 1pm, I didn’t need the oxycodone anymore, it makes you constipated anyways, the last thing I want.
I think I would have gone quietly insane reclined in the couch if it wasn’t for Netflix streaming shows and movies and Pandora. The Roku box I got for Christmas made the experience less boring.
I started this journal and didn’t get up for a few hours. Ouch! That was a mistake, need to keep moving every hour, and I resumed the ice packs.
By 5pm I was mostly pain free, took 400mg of Ibuprofren at 6pm to relieve mild pain.
Went to bed at 9pm, just a little pain getting into bed, I didn’t need anymore pain killers.
Saturday 5th February 2011 – Day 3
Got up at 5am to urinate, not much pain today!! Went back to bed until 7:30. My wife said I slept on my side for some of the evening. I’m obviously more mobile in bed. Took more stool softeners, I’m getting a little concerned that the first bowl movement will be very painful. I ate 3 apples during the morning, apples are natures gentle laxative. I also drank plenty of decaf coffee and water.
My back is quite painful, being immobile hurts my back at the best of times. Took 800mg of Ibuprofen at 8am for the back pain.
9:30am saw the re-consummation of our marriage, glad to see my equipment is still in working order.
At 1pm I finally had the bowel movement I’d been waiting for. All the stool softeners and suppositories did the trick, no straining was necessary. I also believe moving around gently but frequently was also important to waking up my bowels.
The trick now I am out of pain will be to not to do too much too soon.
I noticed a niggling pain in my groin when repositioning myself in the recliner, it felt like a tendon or a muscle had been pulled.Changing position while fully reclined is a tough thing to do when you can’t use your stomach muscles.
Back pain which radiated into my right hip began to be a problem after about 6pm, I took some Ibuprofren and went to bed at 7pm.
Sunday 6th February 2011 – Day 4
I had congestion during the evening, looks like a head cold is starting. I started a nose bleed early Sunday morning. This is a sign to me that a head cold is just 1-2 days away.
Changing position in bed I noticed that pain in my right groin getting worse, like someone sticking a knife in, quite sharp and hot feeling.
Sitting up from a lying position in bed was painless for the first time. Standing from sitting was only mildly painful.
Sitting technique – Let me explain my technique for sitting up in bed without straining my stomach or back muscles as shown to me by a chiroprator many years ago. Roll onto your side on the edge of the bed, then place the elbow of the lower arm on the edge of the mattress and hold your forearm vertically and make a fist. Push down with your free arm on the erect arm using your upper body muscles to raise your torso, at the same time, keeping your ankles together, let your legs drop off the edge of the bed. You use the force of your upper body and gravity from the weight of your legs to rotate into a sitting position without using your lower body to sit up. Practice this maneuver before your surgery!!
Took Vitamin C and Echinacea when I got up to try and stave off the cold.
Back to Netflix for entertainment. I plan to go to Church for an hour this morning to see my Christian brothers and sisters.
In the location where the bulges existed due to the hernias, I now have an area which numb. According to medical websites this is very common and a small area of numbness may persist permanently. The numbness feels like it is just on the skin surface. There is feeling below the skin. Clearly I’ll ask the doctor when I return for follow-up in another weeks time.
Church visit was kept to 1 1/2 hours, other than back pain while sitting I did great.
While watching the super bowl changing position the recliner got quite painful due to that new pain in my groin, still getting worse. At least the Steelers lost the super bowl.
Went to bed about 10pm. I didn’t use any pain killers all day.
Monday 7th February 2011 – Day 5
Turning over or changing position in bed is sometimes very painful due to that groin strain or whatever it is. It has got worse again. Made a mental note to see the doctor later today rather than wait until follow-up next week. Somethings not right.
Got up at 4:30am today so I could avoid changing position in bed. Sat fairly upright while watching TV, I’m going to avoid reclining too far anymore which avoids using my legs to change position. Did some research on the ‘net to see what could be hurting so much in my groin. There’s a ton of stuff down there, tendons, muscles, blood vessels, spermatic cord, anyone of which could be giving trouble due to my exertion or surgery complications. Made an appointment to see the doc at 1:30.pm. Another day off work :-)
The good news is that I am able to move around the house freely without pain. Blowing my nose or coughing is still a little sore but not nearly as painful as before.
Doc said I had a burst blood vessel in my scrotum and it was no big deal. I’m to apply heat to the area 3 times daily and take 800mg Ibuprofen 3 times daily until the pain and swelling is gone, then taper off the ibuprofen over 3-4 days. I asked if any long term damage came from this and he said no, I got a little unlucky. It should clear up in 5-10 days. The hernia repair is in good order with no-recurrence. No strenuous activity for a week to ten days and no sex while it clears up.
Tuesday 8th February 2011 – Day 6
Got up at 4am to let the dog outside. She had an upset stomach. As I descended the stairwell I felt the groin pain as I lead with my right foot. It hadn’t hurt in this way before. As I coughed the groin pain was present also. This had not occurred before either. My concerns are renewed. Made a mental note to contact Dr Smith again.
Other than the groin pain I am getting around easier now.
After showering I notice that the skin of my scrotum close to the groin injury is scaly like a snake and sheds some flakes of skin. I made a call to Dr Smith’s office. He’s in surgery all day, they’ll contact me when they hear from me. I got a return call to see the doc on Wednesday at 8:30.
I called a local Urologist to make an appointment. I gave them my reason for calling (burst blood vessel after Hernia surgery). It will be 3 weeks before I can get an appointment. I made the appointment anyway, who knows I made need it.
Stayed on the couch most of the day watching Dr Who and applying heat from a heat pad to my groin on and off during the day. The heat does appear to be theraputic.
Started to take pseudoephedrine for congestion, that head cold is starting to make me cough.
Wednesday 9th February 2011 – Day 7
I can get out of bed using my stomach muscles now. No need to ‘roll out’ of bed anymore. Evidence that further healing has occurred!!
Saw Dr Smith at 8:30. I explained the new symptoms and change in appearance. He made an examination and asked me if it was painful to touch my genitals. Not really I said, it hurts (burning sensation) when I cough or climb stairs. He is satisfied that I do not have either of the two rare complications that can occur after this type of surgery and that things should clear up within a week. He is pleased with the progress in just the two days since I saw him last. He was very reassuring.
I went to work for 4 hours today. After the 4 hours I am ready for the trip home, it was uncomfortable sitting in an office chair. I tried several chairs. Sitting in a car seat is thankfully more comfortable.
I took it easy the rest of the afternoon while another snow storm rolls through Tennessee. When will it ever stop being winter?
Reflecting on the past week I do some further research on surgical complications from hernia surgery. The treatment I am prescribed (Ibuprofen) is the same as is used for Ischemic Orchitis, though the symptoms of that condition sound more severe than I am experiencing. I begin to wonder if I have an early or mild case of it. I decide I need to go back to my family doctor and get a second opinion given the urologist appointment is so far out. The websites I found very informative are
Thursday 10th February 2011 – Day 8
Last night’s snow storm leaves me at home today. Normally I would shovel the driveway and salt it in order to get out. Not an option so close to my recent surgery. 34% of Nashville workers worked from home today, me included.
I call my family doctor, the office is closed due to the weather. I’ll have to call again tomorrow.
By the end of the day I find myself pain free and the groin pain has receded and the inflammation has diminished. Things are looking up.
Friday 11th February 2011 – Day 9
I work half a day today and do very well at it.
The earliest appointment I could get at my family doctor is 9am Monday. Since I’m doing better it can wait. I can start tapering off the Ibuprofen tomorrow.
I worked from home in the afternoon, everything seems to be going well. I have a coughing fit around 6pm due to this head cold and the groin pain returns. Looks like the mending that occurred yesterday has been reversed.
Saturday 12th February 2011 – Day 10
My sleep was fractured during the evening, my right testicle ached all evening no matter what position I got into. Other than the groin pain I am doing very well, probably 90% recovered.
I will try and use my visit to the family doctor to try and get the Urologist appointment accelerated. This problem isn’t mending on its own.
I helped some folks with computer problems today at their home. 2 Hours was just about the right amount of time to be away from home.
Later in the day my grin pain went away and things started looking much better.
Sunday 13th February 2011 – Day 11
Feeling much better today, weather is great outside, but I don’t get tempted to do too much. I spend most of the day relaxing and just taking it easy. I caught myself taking the stairs two at a time today, probably a little to ambitious right now, but an indication that I continue to improve.
Monday 14th February 2011 – Day 12
Went to the family doctor and got meds for my cough. He also sent me for an ultrasound to see what was going on with the groin pain. The ultrasound was normal, blood flow is normal in the testicles and round about. Looks like the problem maybe receding for good.
I worked for half a day today at work. Wearing business clothes was quite uncomfortable compared the the sweats I’ve been wearing for the last few weeks. My right testicle got really uncomfortable in the tighter fitting clothes. One doesn’t realize how much walking one does each day at work, I was quite tired of walking by the end of the work day and glad to get home and relax.
Tuesday 15th February 2011 – Day 13
Did 3/4 of a day of work today. I chose my underwear carefully this morning so as not to be too restrictive and was considerably more comfortable. About 3pm I got really tired and had trouble keeping my eyes open. I suppose I have got used to napping in the afternoon on the couch. I am able to walk at normal pace now without pain. I expect that I should be able to work the full week next week. I plan on another 3/4 days work tomorrow and 1/2 day Friday.
I don’t think I will make daily entries in this journal from this point forward, maybe 2-3 per week until I am totally recovered.
Wednesday 16th February 2011 – Day 14
Did another 3/4 day of work today. I noticed my walking speed decreased in the early afternoon. I experienced quite a bit of pain in my right upper inside thigh, it was even painful to touch. After sitting for a while the thigh stopped giving me trouble. Another indication that I have to restrict the amount of walking I do each day. I’m simply not up to it, even though in the morning I am able to get around normally and feel like I could go for hours, I can’t.
I’ve noticed that the scab on the incisions is now falling away to reveal a thin scar line below. The incision lines are beginning to itch as the scab loosens.
Friday 18th February 2011 – Day 16
Another 3/4 day at work today. Walking around the office I got the sharp pain on my inner right thigh again, it certainly is debilitating until it wears off after a few minutes. Very sensitive to the touch. Since this is twice this has happened it’s worth mentioning to the doc next week. I was very glad to see home time come round today and another weekend.
Monday 21st February 2011 – Day 19
The weekend rest has re-energized me and I plan to work each day this week, mostly full days except the odd Dr Visit. This week is the last week I am authorized by my employer to park in the disabled parking areas in their parking lot. They prefer I park there rather than in visitors spots. It’s their parking lot so I’m good with it. The day went well. I got sleepy mid afternoon, missing those afternoon naps I was used to at home :-)
Tuesday 22nd February 2011 – Day 20
Today was a long day, did a full day at work and then went to the Chiropractor early evening. I get adjustments for my lower back pain every 5-6 weeks. The Chiropractor had gone through similar surgery himself and was surprised to see me standing straight and relaxed so soon after the procedure. He modified his adjustments so as not to cause me any discomfort or problems. I was certainly glad to get home and crash.
Wednesday 23rd February 2011 – Day 21
I visited Dr Smith the Surgeon this morning. He felt that my progress was very good, all problems seem to be a thing of the past, the wounds are healing well. He gave me the green light to return to a full schedule of activities. I aksed him about the sharp pians I had experienced on my inner thigh the previous week. He asked if it was like an electric shock going up my leg, I said it was very much like that. He was confident that it was nerves settling down and that it would subside on its own. If not to give him a call.
I went walking at lunch time at work, it was a nice day. I did two laps of the building, my initial idea was to go around just once, but felt strong and made two laps without problems. General discomfort was reduced as a result of the walk. I’m pleased with the outcome.
Saturday 26th February 2011 – Day 24
I went for a two hour walk today. I am contemplating training for the music city half marathon at the end of April this year. This is a test run to see if I have any stamina. Things went very well for the first 1 1/2, then I started to feel dizzy like I would pass out. I headed for a bench in the park and laid down on it for 5 minutes or so to gather my thoughts. I made the last 30 minutes back to the car OK. Clearly I’m not strong as I think I am.
Sunday 27th February 2011 – Day 25
Today promises to be even warmer and more agreeable than yesterday. I went to church all morning. When I returned home I was quite tired and uncomfortable. I just wanted to lay up in the recliner. Yesterday took more out of me than I realized. No walking today, bedtime can’t come soon enough. My back decided to act up during the day, so a few beers took care of that. I find two beers gets rid of lower back pain better than maximum strength Ibuprofen. I had just weaned myself off Ibuprofen earlier in the week, so had no intentions of going back on it.
Monday 28th February 2011 – Day 26
I feel much better in the morning, the nights rest had gone well. Just prior to leaving home for work a lightening strike occurred in our back yard. The AC unit was taken out of commission as well as anything connected to the telephone line or the antenna cable. It was a busy day rush too and fro from work and home trying to get things done and also get the house back in order. I did a lot of standing with contractors and many trips up and down stairs. as well as start a claim against my homeowners insurance. It was an exhausting day, more stair work than I am used to. Two more beers were the order of the day at dinner time.
Tuesday 1st March 2011 – Day 27
Slept well. I can stretch fully in the morning or sleep in any position. I don’t have any residual discomfort apart from an occasional pains at the site of the old hernia bulges where most of the skin on the surface is still numb. Went for a 40 minute walk at lunchtime today. Felt good as I went round. If I felt a pain start in my groin, I simply eased the pace and picked up again once the pain was gone. I have given up the idea of participating in this years half marathon, it will be a while before I can walk at full pace up and down hills without symptoms. No point in setting myself up for a failure or over do it and cause any set back. The sharp pains in my inner thing have not returned. Hopefully its just a question of gradually building up my stamina and strength from here on in.
Monday 7th March 2011 – Day 33
I went to Cornerstone Healthcare today, they accept walk-in patients. I have a bad cough, and am concerned it will cause problems if not treated aggressively. The hernia repair on the right hand side gets sore after a bout of coughing. I’m advised to continue taking Mucinex-D and am prescribed anti-biotics in the form of a Z-Pack.
Wednesday 16th March 2011 – Day 43
6 weeks in now. I can walk easily now with no aches or pains. Sleeping is easy in any position. I only get occasional twinges. I haven’t done much lifting even though its probably OK. The cough is much better but still present, so I will ask at Cornerstone about it again tomorrow when I go in for a full physical. Now that I have paid my deductible in full I may as well get caught up on appropriate screening as it will cost little to nothing.
8 Months later – What’s happened since?
Several folks have asked me how I am doing further down the road of recovery. I am glad to report that life is now as normal as I’d like it to be. Even 9 months later I still get periods of dull aching or an occasional sharp pain, but these are more and more infrequent. At about 7 months after surgery I experienced a dull ache almost every day towards the end of the day for about a month long period. I began to worry the muscles were weakening and giving way under the strain. This too has passed.I can’t think of anything that could have triggered this, I believe its just part of the healing process.
Several of my friends at church have had similar surgery and report occasional pain more than a year later, but it is transitional and not too significant. Lifting is one thing that will cause symptoms.
I hope to train for the 2012 Music City Marathon soon. I’ll report back if that was symptom free or not.