Significant pain 4 weeks post-surgery, looking for advice

[Tj37067]

GoodIntentions/Jnomesh — the information you have both provided is extremely helpful! I am so thankful! Jnomesh — yes, I am very skinny and I will monitor the situation closely. I am actually going to get a second opinion from a mesh removal surgeon recommended on this forum just to monitor my progress over time so I would have some answers sooner than later, and in the interim will definitely focus on rest!

[Jnomesh]

Tj37067
i was hesitant to reply but would feel remissed if I didn’t as I would of greatly appreciated if someone had done the same for me.
First of all you are still early on in your recovery and I hope you will continue to heal and the symptoms you are feeling will reside.
i like you had my hernia repaired from a hernia surgeon (private) on the upper east side and he used the Bard 3D maxx back in 2011
i didn’t feel right throughout my recovery and had to see him 3 or 4 times in the first year-he said there was no recurrence and a follow up MRI confirmed that-he said give it time.. I accepted that. The pain and discomfort I was going through for the most part did not stop me from living my life-but about two or thre times a year tje area would flare up and knock me out for 2 or 3 days-bed rest and Tylenol. My lower abdomen would feel heavy like I was 4 months pregnant and there was a lot of burning in the groin. It would for the most part resolve with rest but I always had a feeling like something was kind of stuck in there.
long story short 5 years later (2 years ago) severe pain was brought on and it turned out that my mesh had folded over and balled up after a lengthy and painful search to what was causing me these symptoms
There seems to be a “non admitted “ design flaw in the 3D maxx that since it is concave it in certain cases can fold over on itself. On my mesh removal journey I have spoken with about 6 or seven other man who ended up having mesh removal and it was discovered that their bard 3D maxx mesh has also folded over or clam shelled on itself causing pain.
if you google this type of mesh you can learn more about it.
My original Sutrgeon was only concerned with hernia recurrence when I went back to him over the first year. Subsequent surgeons and imaging tests also did not show anything- no help.
Finally after a exhausting journey I found a mesh specialist who saw on the same cat scan that other surgeons said was normal that my mesh has bent and shifted. Only after removal was it found to be even worse-balled up.
My removal surgeons said the 3D maxx isn’t a good mesh for thin people-I don’t know if this is true or not but I am thin.
like you I was active-sports and weight lifting etc .
My advice would be to take it easy while you heal and avoid weight lifting and other sports while you heal-maybe for at least 3-6 months. Avoid lifting anything to heavy without support. Walking and stretching and other movement shookd be ok.
If however, your symptoms do not resolve in time or shookd get worse you may want to look into the mesh itself.

[Good intentions]

Here is the Bard 3D Max literature.

https://www.crbard.com/davol/en-US/products/3DMax-Mesh

https://www.crbard.com/CRBard/media/ProductAssets/DavolInc/PF10162/en-US/wazfaqlf5g21e0b9ps1vtsmfe8916fan.pdf

[Good intentions]

It looks like you got the one size fits all full mesh treatment. Does it say totally extra peritoneal (TEP). or does it say transabdominal preperitoneal (TAPP)? It reads like TEP, I think, with dissection all the way to the pubic symphysis. If you had one substantial hole in the navel and one or two very small holes (needel size) to the sides it was probably TEP. If you have two substantial holes (small incisions) to either side of the navel and one in the navel it was probably TAPP.

You probably actually got two 3D Max pieces, maybe overlapping in the middle. The size of the mesh pieces should be in the notes also. You will probably be surprised at the size of the pieces. Maybe even an other piece for the umbilical hernia.

Aside from the details though, you have had a very large space dissected in your abdomen, the tissue peeled apart to create a cavity,and mesh placed in between those tissue layers in that cavity. As your body tissue grows in to the mesh and causes it to shrink there will be inflammation, edema, and shrinkage as “healing” occurs. The shrinkage will pull on surrounding tissue and structures. If you are lucky the important structures will handle the new environment and things will feel more normal overtime.

It’s good to know what’s in there and what it’s doing so that you can understand what you’re feeling. There’s not much you can do about in the early stages though. Rest when things get painful but keep moving so that things can work in to normal life.

[Tj37067]

I was able to get a copy of my post-operative report. My postoperative diagnosis was: Bilateral indirect inguinal hernia and umbilical hernia. A 3DMax mesh was placed bilaterally. Some notes, right side: “I was able to visualize the patient had a large lipoma of the cord which was reduced and the peritoneum was tracking to the cord. I took that back and was able to free it and pushed it all the way back and dissect. There was no direct defect and no femoral defect. I turned my attention to the left side, and in a similar way, mobilized all the way out to the anterior superior iliac spine, and again there was a smaller lipoma on the left and the peritoneum was tracking toward the cord. This was pulled back from the cord structures and teased back so that a mesh could lay there, and then dissection was carried out medially to the level of the pubic symphysis again. No direct defect as seen only indirect.” I am still having a decent amount of nerve pain into my groin, buttocks, and hamstrings (37 days post-surgery now), I get the feeling of something pushing down into my pubic area when I walk for a long time or run. I also have pain when I am sleeping on my side. The best position for me is standing up. Also, I have a small dent above my penis that looks like another belly button hole, which wasn’t there prior to my surgery. I can post a picture if needed. I have a follow-up with my surgeon on Wednesday to discuss if my recovery timeline is normal. I am planning on getting a second opinion as well. Any suggestions from the forum?

[pinto]

Thank you, GoodIntentions! I am medically naive not having until recently needing serious medical attention. However, I have been aghast how my friend, a post-polio victim, has had to feel like a ball being tossed between insurers and doctors in an effort literally to survive. The present medical system I am sure will make medical historians of the future shake their heads in disbelief! Your post makes clear why. I hope you well on your road to recovery and thank you again for the various ways that you help all the Membership here by your informative posts.

[Good intentions]

I can.

If your surgeon “codes” your visit as “hernia repair” and you describe a problem that the surgeon decides a urologist should look at, for example, the insurance system might not recognize the urologist visit as reimbursable, even if it’s determined that the problem was caused by the hernia repair. My surgeon did not know this and, really, did not want to deal with it. So he sent me off on a wasted visit, the urologist was clueless, that I ended up paying full cost for. And I knew it was a waste of time from the beginning I only went to help my surgeon make progress on my problem. I think that the surgeon knew it was a waste of time also, he was just checking the boxes, to be thorough. I even talked to a rep at my insurance company and she agreed completely that it was a mistake and said she would fix it. It was still refused as “not a recognized condition of hernia repair” or something like that.

You can probably get sent down other paths easily, for example, leg pain is not going to be a result of “hernia repair”. That’s how things work these days, there’s somebody at a computer making sure that the codes are allowable for reimbursement based on whatever the main, first, code is.

It probably works in reverse also, if you go to a neurologist first and they determine that pain is a result of the hernia repair, they might have to fight to get it recognized as such. They might have to have a panel discussion where they are second-guessed and they might or might not be allowed to continue on the path that they feel is correct. And the patient could end up on the hook for a big non-reimbursable bill. Or, maybe, starting with a neurologist is actually the best way to start. It depends on how the databases are constructed, I would guess.

Mesh-induced pain or problems are not recognized as “real” by the healthcare systems, in general, despite the high rate of occurrence. “It must be something else” is the starting point for evaluating mesh-induced problems.

The International Guidelines discuss pain treatment paths but I don’t think that the Guidelines are followed by the “payers”, the insurance companies. It is very very bureaucratic. So be careful. Mesh problems are outside the system.

.

[pinto]

[USER=”2029″]Good intentions[/USER], could you elaborate about this: “Be careful what you describe to your doctors, certain words will not be accepted as standard for “hernia repair”. You can get deflected down wasteful paths, both time and money.”

[Good intentions]

By type of hernia, I meant direct or indirect.

[USER=”2835″]Tj37067[/USER]

[Good intentions]

quote Tj37067:

I got surgery at a Hospital in the Upper East Side (Manhattan) for a bilateral inguinal hernia repair (with mesh) as well as an umbilical hernia (stitches only). I am a 30-year-old, 6ft 2 inches slim male with a history of a chronic daily headache but otherwise very active prior to my surgery (tennis, basketball, and rock climbing) usually two to three times a week. I had surgery on March 7, 2019, and about three weeks after surgery I started having a lot of tingling and paresthesia down my glutes and hamstrings.

The details of your surgery, materials (there are many types of mesh) and method, and type of hernia repaired, would be useful. But, you’ll probably just have to wait and see. There are no formal physical therapy recommendations for recovery from laparoscopically implanted mesh. If that’s what you had, that’s my assumption since most people start with just one hernia, but lap tends to end up bilateral once they inspect the other side.

Wait, take pain medication, and try to get back to normal is the usual advice. I got that advice for months, then was told to just accept my new fate. Be careful what you describe to your doctors, certain words will not be accepted as standard for “hernia repair”. You can get deflected down wasteful paths, both time and money.

One thing that might help is to keep a daily log of your activities and how you feel. I found that the effects of activity could take a day or two to manifest. Certain things, like lifting weight above my head, caused more issues than expected. It was easy to see the correlation via a written log.

Good luck.