Herniated
Forum Replies Created
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Chuck, make sure that you investigate the availability and cost of appropriate overseas (Korea) health insurance coverage. If anything goes wrong and you don’t have appropriate coverage then you could face financial pain as well!
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Purdue Pharma (Oxycontin, etc.) provides a useful case study for the ethical quagmire that arises when the medical profession interfaces with marketing (Wikipedia has an overview). There are indeed many parallels with the big tobacco story.
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Peter, you wrote
“Now everything is just jello. The separation between my rectus muscles, my groin, my obliques, etc. All jello.”
You ascribe that to surgical slicing and dicing of the your external oblique, etc. However your description also seems consistent with muscle paralysis (e.g. from motor nerve damage). Can you voluntarily contract your abdominal muscles, or are they “jello” and you have no control over them?
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https://doi.org/10.1007/s10029-020-02365-6 may be helpful regarding the issues you raised.
Also, some may not be aware that “absorbable sutures” come in many flavors with widely varying dissolution rates (from days-weeks to months-years). There are also hybrid sutures made with a permanent core coated with an absorbable outer layer.
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Peter, you previously indicated that you are in Canada. Have you approached the surgeons at the Shouldice Hospital, just north of Toronto? Their chief surgeon (Dr. Fernando Spencer Netto) was interviewed here by Dr. Towfigh. In that interview Dr. Spencer Netto mentioned that in addition to his hernia practice, he also has practiced trauma surgery. If he can’t help directly, he may be able to point you towards other specialists. Similarly, Dr. Frederick Brenneman at Sunnybrook Hospital in Toronto is a trauma surgeon who expresses an interest in complicated abdominal hernias.
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@drtowfigh wrote:
“For myself, I’ve always wondered who I would choose if I had a hernia. There are a lot of great surgeons out there by reputation. I’ve seen some of them operate and for some of them I was unhappy with their technique. I feel I do a much better repair and a more dainty one.”At first glance Dr. Towfigh’s implied preference for a Beverly Hills hernia surgery experience seems self-serving. However, given her expertise with robotic surgery, self-servicing hernia surgery seems plausible, although anesthesia could be tricky 🙂
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Also, $600- for an MRI AND surgeon consult seems reasonable. Have you looked at what just an MRI costs?
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“cause other problems like chronic pain or discomfort”
But this misses the point that hernias also can cause chronic pain or discomfort. For example, it can hurt when an indirect hernia forces its way along the inguinal canal tearing tissues and irritating the nerve. The impact of the hernia on quality of life and health can be significant. Repairing the hernia removes/reduces those issues. Taking that improvement as the reference point, we can now perhaps better assess the relative negatives of the sequela that you point to.
For example, if a hernia is painful and fear of further damage constrains activities then some postoperative discomfort or pain may be a net improvement. In contrast, the report from someone else living with the consequences of a medical fiasco may well be a net loss relative to the impact of the hernia itself.
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I suspect that happy/unhappy with the repair is too unstable a reference. Perhaps a better perspective from which to compare values and outcomes could be obtained by asking whether the hernia repair improved the hernia and consequently your quality of life and health.
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Drs. Towfigh and Spencer Netto (tissue repair expert) conclude that mesh is needed for a reliable repair.
LD50 fears developing an ASIA response to the mesh.
Have any immunologists or allergists developed tests that would address her fear that she might have a negative immune response the implanted polypropylene mesh?
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Pinto, you have presented a straw man argument. Nowhere did I imply that Dr. Kang “is involved in
- racially motivated
experimentation without patient consent”. Rather I observed that Dr. Kang appears to be failing to provide full and transparent disclosure of the ‘Kang Repair’ to his patients (and the field). Telling patients that they will receive a modified Marcy without detailing the modifications is not full and transparent disclosure. This is especially troublesome because he appears to be conducting what is essentially a clinical trial as he accumulates completed surgeries and tinkers with perfecting the Kang Repair. If so, then informed consent should be an important part of that, as stressed in the Nuremberg Code. Race has nothing to do with the issue.
Perhaps you have conflated the Nuremberg Code with the Nuremberg Trials. The Nuremberg Code is a document that was the foundation of modern medical ethics. Its importance is outlined in the following text from the Wikipedia entry on the Code:
“However, the Code is considered by some to be the most important document in the history of clinical research ethics, because of its massive influence on global human rights. In the United States, the Code and the related Declaration of Helsinki influenced the drafting of regulations promulgated by the United States Department of Health and Human Services to ensure ethical treatment of human research subjects, known as the Common Rule, which is now codified in Part 46 of Title 45 of the Code of Federal Regulations.[16][17] These regulations are enforced by Institutional Review Boards (IRBs). In 1966, the International Covenant on Civil and Political Rights was adopted by the United Nations, and after enough nations had ratified the Covenant, it came into force on 23 March 1976. Article Seven prohibits experiments conducted without the “free consent to medical or scientific experimentation” of the subject.[14] As of September 2019, the Covenant has 173 states parties.
In his 2014 review, Gaw observes that the Code “not only entered the legal landscape, but also became the prototype for all future codes of ethical practice across the globe.”[11] The idea of free or informed consent also served as the basis for International Ethical Guidelines for Biomedical Research Involving Human Subjects proposed by the World Health Organization.[11][failed verification] Another notable symposium review was published by the Medical University of Vienna in 2017: “Medical Ethics in the 70 Years after the Nuremberg Code, 1947 to the Present”. President and Rector Markus Muller writes in his introduction that the Code “constitutes one of the most important milestones in the history of medicine, providing for the first time a proper framework for research on human subjects. This milestone was not a voluntary, precautionary measure, but only came into existence in the aftermath of Nazi atrocities. The Nuremberg Code became a cornerstone of clinical research and bioethics.”[18]
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In honor of the fact that the indirect inguinal is the most frequent hernia type, I’ll address your request indirectly by quoting the Gibbium Hospital’s explanation of the Kang Repair.
“Kang repair for indirect hernia is similar to the one described by Dr. Marcy in the past, but modified to avoid the high recurrences. In fact, most of the internal inguinal ring is occupied by the spermatic cord which contains the testicular vessels, lymphatics and sensitive nerves. So it is very difficult to close the internal inguinal ring securely without damaging the aforementioned sensitive structures. That is why this new sort of procedure has not been developed until now. Kang repair for direct hernia also modified the older posterior wall repair methods to minimize damage to surrounding structures and to make the repair stronger. In Kang repair for direct hernia, the scope of surgery has been much smaller than in the older posterior wall repairs including Shouldice or Desarda. In conclusion, another characteristic of Kang repair is that it minimizes the scope of surgery and closes the hernia hole directly.”
We are told that the Kang Repair for indirect hernias is “similar to the one described by Dr. Marcy, but modified to avoid the high recurrences”. Thus we have a reference to a standard well-defined procedure, the Marcy procedure, but the modifications of the procedure are not specified. How is the patient/subject supposed to assess what will be done to them? Is it rational? What is the evidence that the modifications have the intended benefits? What are the potential complications? Why are they kept secret? Is that ethical to keep the patient/subject in the dark? I don’t think so!
To be more direct regarding the relevant standard indirect procedure, a useful resource is the textbook “Hernia” edited by Lloyd M. Nyhus and Robert E. Condon (see the contribution discussing the Marcy Repair).
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Shouldice Hospital, provided
1. you are essentially healthy and not obese (or are willing to drop weight and keep it off).
2. you have strong tissues (no genetic or other issues resulting in weak tissues that won’t hold sutures).
3. you put in the effort to figure out exactly what you want done, how, and by whom. Then pursue your thoughts with the Shouldice staff to ensure that you and they can agree on a sensible plan.
4. you have or can obtain medical insurance that will cover you for any unforeseen medical events while being treated in Canada.I am not familiar with the implications of “mesh removal skin”, but preexisting conditions would be an important part of developing your plan with the Shouldice team. If their experience informs them that your case would likely be problematic they will be reluctant to take you on and will tell you so.
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And questions regarding the proposed treatment of potential patients should be forthrightly and transparently answered. The lack of such openness is cause for caution.
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“Not in every minute detail”. The person presenting as Dr. Kang on this web site has for years been promising to publish the details of the Kang Repair. Deflecting or ignoring multiple independent requests for explanations of how the Kang Repair differs. The patients summarizing their experience here seem to be in the dark regarding how their surgery differed from standard, well defined procedures.
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Straw man argument. I drew no comparisons to Nazis or their experiments. Rather I quoted one of the pillars of contemporary medical ethics, the Nuremberg Code, regarding the ethical necessity to transparently explain what will be done to the patient/subject.
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Sorry, I assumed you were dealing with the aftermath of hernia surgery. Given that you are in the dance world, perhaps try using your connections to get a consult with a large company doc (e.g. the National Ballet). The goal being a referral to appropriate expertise given your condition. See the MD list here: https://national.ballet.ca/Meet/Staff