Good intentions
Forum Replies Created
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Good luck dand. 14 years is a long time to live with a hernia.
Posting your surgeon’s name again to add to the list of experienced hernia repair surgeons who use robotic methods. Also, another Progrip story. I hope you’ll post again as time goes on.
Stephen Pereira MD at Hackensack NJ
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I don’t really know where Wikipedia information comes from. But the Inguinal Hernia Surgery page is very well referenced. And seems to fit my own general impression, from the numerous articles I’ve read.
But, even so, there is little distinction between the brands and types of synthetic mesh, except for lightweight versus normal weight. Still, it’s very well written, and was updated on May 18, 2018. Much more useful than the SAGES page.
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I assume that you meant Brian Jacob, not J Brian? They have the experience. I’m surprised though that they would make a blanket statement like that. Maybe they don’t know of or don’t believe the stories.
Still not clear what you me by “lifting”. Are you talking about gym lifting? Weight work? This is not a body building or weight lifting site where “lifting” would mean squats or dead lifts or similar. No offense. I’m guessing that that is what you mean, but you might mean something totally different. The type of lift, even if it is in the gym, might be a clue.
Also, the “area” where the mesh is is pretty large for laparoscopic surgery . Typically about 4×5″ at least after they trim 6×6″ pieces to fit the space. That’s just one side. If you had bilateral repair then you have twice that. So pain “where the mesh is” covers a lot of area. That would mean that all of your lower abdomen is in intense pain.
Sorry to keep picking on your posts. There’s just not much there to think about.
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It sounds like the expected “foreign body reaction”. You’ve had the peritoneum peeled off of the abdominal wall and pieces of mesh inserted in between. It takes time for your body to cope with the foreign material and cover all of the mesh fibers.
Do you know what brand of mesh was used?
Since you are only 4 weeks after surgery you’ll just have to wait and hope. It’s still very early. Good luck.
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quote routern7:I saw many doctors and they say no way it is the mesh. They said mesh complications should start directly after surgery and that heavy lifting will never cause mesh to fold or move or cause this kind of pain especially after 1.5 years from surgery.
I did have tenderness after surgery but it was not blocking my life.
Mesh problems are like a nightmare to surgeons that implant mesh and they seem to have a psychological block to dealing with them. The responses that you got are what they are typically taught in medical school or residency. The fact that you had tenderness and discomfort right after surgery, is, by definition, a complication. They are ignoring that fact. If you are just seeing general practice physicians they will go to the current references to learn about mesh problems and that is what they will read.
Can you describe what you mean by “heavy lifting”? It’s very vague.
Also, post a general location. State, city, metro area.
Good luck.
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Hello msp. Just wanted to let you know that I did actually post a long reply to you but it got flagged as spam. It’s out there somewhere, I hope that Dr. Towfigh will release it.
The gist of the post was about keeping a log of what works and what doesn’t. And possibly ramping up activities to see how much is too much. Since you’ve been dealing with it for three years you might feel like you are familiar with it, but I’ve found that some actions can cause a delayed response. The correlation shows up as you look back on what you’ve been doing.
Good luck.
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quote emckenna:I am an endurance triathlete who recently underwent two hip labrum repairs and FAI (left hip in Sept 2017 and right hip in Nov 2017). I had great recovery for both until February 2018 when I began experiencing left pubic bone pain and lateral/outer hip pain. Shorty thereafter, the pain turned from muscular/skeletal pain (which was painful yet tolerable) to include nerve pain. At this point, everything seemed to spiral.
Since February, I have been unable to partake in all physical activities and require assistance for routine activities such as lift pots and pans too cook, carrying a light suitcase, etc. After months of trying to understand it, I think it is nerve pain.
In terms of test and diagnosis – I have seen several orthopedic hip specialists and surgeons as well as general surgeons, a rheumatoid specialist (who confirmed no rheumatoid issues), and pain management specialists. I have had two pelvic MRIs (one that included a few images of my upper abdomen), a left hip MRI, a lower lumbar MRI, and a CT scan (with my left and right hips read). I have also had multiple nerve blocks into my hip joint, psoas, genitofemoral nerve and ilioinguinal nerve. All have provided some relief but not full.
My MRIs show possibility of a very small re-tear of my left labrum or perhaps just abnormalities from the original surgery –
I have been diagnosed by a general surgeon with a likely hidden inguinal hernia. I have received mixed diagnosis on athletic pubalgia/sports hernia and/or perhaps mild chronic detachment of the rectus abdominus-adductor plate at the lateral edges.
I lived and was very active with labrum tears for years and so I am relatively confident my pain is not coming from a possible small retear. I do however have some swelling, numbness, and burning/tingling feeling (with certain movements) in my lateral/front hip and upper/outer thigh though which is perplexing
Hello emckenna. I don’t have any direct advice but I did have some questions while reading your post, that others might have also. I broke your post in to pieces to try to make it more clear.
Your last surgery was about 6 months ago? You “recovered” then were okay for about 2 – 3 months. Then started having pain which has lasted about 2 – 3 months. So, it’s been a relatively short time since surgery.
How long did you wait before going back to full effort activities? Your “recovery” time. Did you feel like you were completely healed up or were you training around the healing process?
Did the pain in February come on “overnight” or did it slowly build as you ramped up activity level? Are you taking full rest and recovery breaks or are you testing things as soon as you can? Maybe you need to take more rest and start from a lower base. I know that athletes hate to lose their fitness and will often try to shorten recovery times.
Did you talk to the surgeon who did the original surgeries?
I’m not a doctor but I think that swelling is caused by some sort of physical damage. I’m not sure that nerve irritation alone will cause swelling. So, the swelling seems to show that some sort of physical damage is occurring. Even if nerve irritation alone will cause swelling, it seems like the physical manifestation of the pain is a good area to focus on.
Good luck. I’m trying to work back to higher fitness myself, and figuring out what is happening in the surgery area is very difficult.
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I have read good things about Dr. Ramshaw. There are some posts that mention him on this site. He is certainly worth contacting, I think.
I just got my medical records today, from my mesh removal procedures at the end of 2017. I asked for them just to be sure I understood what had been done. There are some comments in the post-operative reports that might be of interest to you, but probably won’t make things more clear. Dr. Billing reported that both sides of my abdominal wall, where the mesh was, looked “normal” after inserting the tools and taking a look. In other words, there was no obvious sign of a problem. But we already knew that it needed to come out, based on my description of my symptoms, so he removed one side, the worst side, as planned. So, I think that’s why it’s best to find someone who has experience removing mesh or knows of cases where mesh has been removed. They know the symptoms, and, as in my case, sometimes the symptoms are all there is to work with. If just an exploratory look had been planned, nothing significant would have been seen. I don’t have any regrets about having the mesh removed, but my symptoms were obviously tied to the mesh.
Also, one thing that struck me about reading my own correspondence with Dr. Billing, which is included in my records, is that I really did put a lot in to describing my symptoms and the activities that preceded them. I think that that helps everybody involved in making the right decision. The words on the page are all that most of the people involved will have to examine, from the insurance company people who have to approve payment, to the surgeons themselves when studying the case later. Things will also become more clear to you as you try to describe them.
Good luck.
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Have you read the Sports Hernia thread? There might be some clues there.
Hernia pain is, in essence, nerve pain, as nerves get stretched and damaged in the area of the tissue damage. Since you’ve had all of that surgery in the area and probably have lots of scar tissue pulling in unusual ways, even if you had a hernia, and had it repaired, it might not solve your pain problem directly. Just a perspective.
Have you tried varying or expanding your activities to see if anything helps? I have had short times, days long, of persistent pain after mesh removal that would not diminish with rest. I decided, based on the research like that of Dr. Bendavid, that the scar tissue might just need to be moved around to get fluids flowing and help with moving irritants out. Nerves are growing in to areas of low blood flow, the scar tissue. So I went for a solid 2 mile run. And it worked, the pain went away and I got back on the path of recovery. It’s counterintuitive but it’s part of my routine now. Certain types of pain are a sign that I need to do more.
I also found, back when I was trying to make the mesh work, that lifting weights had a similar effect. The increased abdominal pressure, and straining to lift, seemed to stretch and move things to where they felt better. It wasn’t the range of motion it was the activation of the muscles, I think.
In short, I’m suggesting that maybe you try to stress the problem areas, in a controlled fashion. Go beyond walking or stretching, maybe do something more extreme. Ideally, you’d have a professional physical therapist help you, but I don’t think that the problem is amenable to the common therapies. It’s a risk of more pain, but if you don’t overdo it you should at least be able to get back to where you are now.
I also just suggested this in somebody else’s thread – keep a log of your activities and how you feel. It looks like you already do, but make sure that you track the time between also. I’ve found that some actions have a delayed effect, and you can miss the correlation if you don’t keep track.
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In broad terms, the statement is saying that all mesh products are the same. There are many many alternative designs, but somehow the “expert” witnesses were not able to make that clear.
The irony is that Bard markets its “alternative” design, the 3D shape, explicitly. 3D Max is the alternative, feasible design for flat mesh.
It’s one of the barriers to understanding why one out of six people will probably have chronic pain from mesh repair. Bard put a lot of time, money, and effort in to developing 3D Max as a “better”, different, product. Without understanding why these failures occur they just allow them to continue happening. Letting the courts classify all mesh products in to one broad category is not helping anyone, except Bard.
p.s. I don’t mean to seem argumentative. I’m just stating what I see. It’s a missed opportunity. Bard has a financial obligation to their shareholders to win these cases. But if they lose, the obligation turns to making a making a better product to avoid similar losses, which requires understanding the failures. It’s the great strength and weakness of our free market economy. Money drives progress.
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There are many things that you can strain down there that will cause pain. Have you read the “Sports Hernia” thread on the front page? They usually show pain during activity, not so much at rest.
Good luck. You’ll probably need to monitor it over time. I’ve found that keeping a simple log or diary of activities can help show what causes pain and how long it persists. It forces you to review what you’ve done during the day, and makes things more clear.
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My situation was very different from yours. It was very clear that the mesh was the problem since the pain, soreness, discomfort and side effects covered everywhere the mesh was in contact, and surrounding areas, from the first few weeks after implantation, never ending.
As far as exploratory, the first surgery was for removal of one side’s mesh, it was that bad and we knew it was going to come out, and the look at the other side was just to plan the second surgery. It was one month to the second surgery, but normally they would wait six weeks. I asked to have it moved up to four weeks.
When I was initially planning to have my hernia repaired I searched for surgeons that had experience working with athletic people. It was surprisingly difficult to find any that were close to my location, and known for that type of work. But you might have better luck. With the large number of people that have hernia repair you would think that there must be a surgeon who has seen your type of problem. One who repairs construction workers, for example, maybe.
I found that my whole lower abdomen would swell and be painful like you’re describing, when I had the mesh. I often left my pants unbuttoned and used a belt. Does the pain subside at all over time, if you stop all activities? I could go through a cycle of feeling “okay” by not doing anything but could not go back to being active without starting the whole process of pain and soreness over again.
This thread, linked after, might help you. Dr. William Brown, in CA, has lots of experience. It might be a good starting point for recovery even if it ends in mesh removal. Since you caused some new damage, it might be that you just need help in getting it healed. https://www.herniatalk.com/7643-hern…oid-injections
Dr. Billing in Shoreline, WA is also very good at assessing these types of problems for what they are, he has been removing mesh for over eight years. I mentioned telling people your general location earlier, if you want specific recommendations.
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Your problem seems difficult to tie directly to the mesh, since it happened during a specific action. Mesh problems generally seem to build up over time, from what I’ve read, or show up immediately after implantation. You’re saying that you weren’t disabled for about 1 1/2 years, then suddenly, in one action, injured yourself.
Was it one lift of a heavy weight or a period of heavy lifting, like a training session? If it was one lift you might have damaged something else. Of course, since you know what the discomfort felt like originally, you would know if it is more like an amplification of the mesh-based discomfort.
A good surgeon will just do what is appropriate, even if it means closing you back up with no action taken. I think that TAPP is the method that would be recommended. My surgeon looked at the left side while he was removing the right, then used the same entry point to remove the left in a second surgery, so it can be done. I had TEP originally for bilateral implantation. Some surgeons will just go ahead and remove the mesh though, as I understand things. Recovering from mesh removal is a whole new experience, it takes time.
I would make sure that your description of what happened is very accurate and let your surgeon help decide if it might be the mesh. Unless you’re positive. Find a surgeon who knows about the other types of injuries that might have happened.
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This is a very interesting topic. Neurectomy is almost a standard procedure for mesh removal,with from one to three possible, as I understand it.
It’s easy to understand what it is, but not so easy to get details on what happens afterward.
The topic has come up in many past threads. Use “site:herniatalk.com neurectomy” in Google to get a list. Good luck.
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Hello Greg. I don’t have actual experience with the steroid treatment for pain relief but I have read about it. It seems to be one of the older “standard” options for treating mesh related pain, and many other types of chronic pain, or injuries that need to heal quickly. I think that the actual steroid is cortisone based, and lidocaine is a pain reliever that is injected along with it. Cortisone injections are often used in professional sports to get athletes back on the field quickly. They promote healing. In your case, it seems like there would need to be some sort of physical therapy involved to get the hard body, the mesh, away from whatever it is irritating. Otherwise, why would it be a long term solution?
Can I ask the details of your original repair? I’m guessing that it was an open surgery? 16 years is a pretty good run for a repair. Has it been a good 16 years? I’ve been collecting stories to try to find these types of experience, in a thread called “Successful, good “mesh” stories”.
Dr. Brown seems to be very knowledgeable and experienced. Worst case, you would probably suffer some immediate pain and discomfort from the procedure itself but it wouldn’t work in the long-term. I think that the risk of creating more damage is slim. I believe that, big-picture wise, it’s one of the treatments attempted before taking more drastic measures.
Good luck.
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quote Chris k:Sorry.. Had a bialateral hernia operation nearly 5 weeks ago. I get stomach aches that come and go and my Doctor said that is refered pain.
.You need to add even more detail. “Bilateral” just means both sides. Laparsocopic, open, type of hernias, type of mesh, etc. The more detail the better.
Good luck.
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I can’t really speak to “normal” since mine never worked the way it was supposed to. I had bilateral Bard Soft Mesh via TEP. Wish I could help.
Good luck. Your surgeon should know best from his own history of patients.
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The area that the mesh covers is much larger than the entry points for the implantation. Typically a 6×6″ piece of mesh is cut, per side, to fit the space they create. You can measure across your abdomen and see that they cover all the way across your abdomen and down to the pubic bone. Bard 3D Max is different in that it is preshaped, but it is still covers a large area. So you will feel discomfort in areas you would not expect. I provided a link below showing the sizes. They range from 3.1 x 5.3″ to 4.8 x 6.7″.
What are you doing for recovery? Walking, stretching, light workouts? Your symptoms are not unusual at all, they’re actually somewhat mild, compared to what others have experienced.
Most surgeons will say that the mesh is pretty well locked in place at 2-3 weeks. Although it’s not clear that that is always the case. So, more “healing” is kind of vague. Not clear what you would be looking forward to.
Good luck. Provide more details and you’ll get some answers.
https://www.crbard.com/davol/en-US/products/3DMax-Light-Mesh#SpecificationTable
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There are quite a few comments on the site about how the images need to be read by somebody with specific expertise in hernia repair. If you can get the images and your medical records it will be be very useful for you. Contact the facilities where you had the work done and they will send them to you, probably on a CD.
And your story could use much more detail. Tell the whole story. How long ago? Type of hernia – direct, indirect, inguinal, ???. Type of surgery – TAPP or TEP. Bilateral or one side. Brand of mesh. What was the initial reason that you thought you had a hernia? How was it diagnosed.
Also, more detail about what you mean by pressure and inflammation. I know it’s probably difficult to sit at a computer or your phone to type out the information but it would be helpful. I felt like I had a sponge inside me in the early months after my mesh implantation, which made it difficult to sit in one spot for very long.
If you tell your general location people might have advice on who to see. I know that TAPP can give a good internal view of potential problems but I think that the surgeon would need a good reason to try it. Good luck.
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Some of us have already commented about how the risk of chronic pain is higher for active people, or thin low body-fat people. Even the surgeons agree about problems with low body-fat people. Professional athletes avoid mesh, and even though they are more skilled than the average person, they are not that much more active than many of us. One of your doctors thinks that you might also have athletic pubalgia, which comes from too much physical activity, generally. In sum, even just using the generally accepted risk multipliers accepted by the professional surgeons you seem like a patient that would be most likely to suffer from mesh after the repair. Low body-fat, very active person with athletic pubalgia and an inguinal hernia. You seem ripe for mesh problems.
That’s what I see for you , based on my own experience and what I’ve learned over the years.
This is the one area where it seems like the surgeons just don’t pass on their knowledge. I think that you should see a surgeon that repairs hernias in professional athletes, without ruining their careers. One who understands both true hernias and athletic pubalgia. If you want to be physically active again.
It’s been very surprising how nobody can show the evidence that justifies using large pieces of mesh in an athletic person. I think that for some surgeons the win-some-lose-some principle is in play, because they see a cross-section of society. If you lose, he or she still has a bunch of wins out there. But you’ll lose a lot.
Good luck. If they can’t show evidence that their repair method will get you back to where you want to be, keep looking. Don’t become just a statistic.
Dr. William Brown is known for repairs on professional athletes. He has some thoughts.
https://www.sportshernia.com/no-mesh-hernia-repair/mesh-mesh/
p.s. it would be fantastic if a surgeon could reply with their own data about successful repairs using mesh, and not just the SAGES guidelines, which are very general and seem to accept chronic pain as normal. The data is out there. Dr. Kang is an excellent example.