Good intentions
Forum Replies Created
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I would go see Dr. William Meyers at the Vincera Institute. He works on athletes.
It sounds like you got on to the “one size fits all hernia repair for the masses” conveyor belt. Within the last few years there is even a tendency for prophylactic mesh implantation, “while they’re in there”, although they can always find a reason. I don’t know if they can actually tell that the wall of the inguinal canal is weak if they don’t see a defect. They’d have to poke at it and do it by feel. Very suspicious, it looks like they got in there, found nothing, and thought you would want some value for your time. Good intentions at work. Or just didn’t want to close you back up and tell you that they did nothing. Many hernia mesh implantation surgeons don’t really seem to know how an athlete’s body works, so they probably didn’t even consider that aspect.
Dr. Meyers can probably tell you what was or is really wrong. Whether or not he’ll remove mesh is unknown. He might, I think, if he thinks it will help and if he can get it out before it gets covered with scar tissue. “Incorporated” in to the body is the popular term. Once it gets incorporated, with tissue ingrowth, things get more difficult.
Send your medical records (get a copy soon) to the Vincera Institute, with a letter, and they will at least get back to you with an opinion, I’m sure. They did for me. I would do it very soon.
Sorry if it seems that I’m confirming worst fears. That’s just what it looks like based on what you wrote. No hernias found but they implanted mesh anyway. And athletes are known to have problems with mesh. Those are the basic facts. Good luck.
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Thanks for adding. Do you have any details on your dad’s surgery? Type of mesh, type of hernia, how long it took him to recover? And any details on your own, the same questions.
One of the major difficulties in learning anything at all about what the cause of the problem might be for those of us that had problems, is that ALL mesh gets grouped together. Even though there are many many different types of mesh, currently and over the years since it was introduced.
Did you have the same surgeon perform your surgery? Did he use the same material and method? Somebody recently had a hernia repair at a VA hospital and, apparently, they are doing the same thing that they’ve been doing for many years. So, it might be that we just need to unwind some of this “progress” and go back to what was working.
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My direct hernia progressed sideways, toward the center, after it broke through. It was a bit higher than the pubic bone though. I have not seen much written about where the material that pushes through the abdominal wall actually goes, with a direct hernia. With an indirect hernia, it ends up in the scrotum. But the direct hernia material goes wherever the weakest point lets it go, I believe, once it pushes through the fascia. There is a defect, material gets pushed through, and the sac continues to grow as pressure “bluntly” dissects a bigger cavity. My surgeon described pulling a large amount of material back through the defect, and I had what looked like a deflated balloon shape under my skin after hernia repair.
So, in my uneducated view about how hernias work, it seems like you could have hernia sac material in that area.
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Sharon Bachman looks like an interesting surgeon also. “Hernia geek”. Not clear where she’s based. MO or VA, or both.
https://www.google.com/search?client=opera&hs=K7n&ei=npHqWpHlIeSU0gLt-7_oAg&q=Sharon+L.+Bachman&oq=Sharon+L.+Bachman&gs_l=psy-ab.3..0i30k1l2.57905.59272.0.60544.3.3.0.0.0.0.67.171.3.3.0….0…1.1.64.psy-ab..0.3.171…0i7i30k1.0.ejKjQ0KTtXE
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Thank you for that link Chaunce1234. Andrew Wright looks like an interesting person. I can’t tell if he’s chosen a side. Of course, it’s best to be open-minded. Some interesting comments on the Twitter feed though.
Here is Andrew Wright’s bio from the University of Washington. Also a link to another Twitter feed that says Andrew Wright is “tackling the tough topic of Conflict of Interest and surgical research. “We all have implicit bias.”” I think that the thought can be applied to just general practice. Who is “running the show” and what are their motives?
https://www.uwmedicine.org/bios/andrew-wright
https://twitter.com/JohnRomanelli2/status/985213199476637696
@andrewswright tackling the tough topic of Conflict of Interest and surgical research. "We all have implicit bias." #SAGES2018 #WCES pic.twitter.com/1w1c4cjP81
— John Romanelli (@JohnRomanelli2) April 14, 2018
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Dr. William Meyers of the Vincera Institute uses MRI. They like to look at the hip joints also, a common cause of pain. Athletic pubalgia (the more proper term) is more of a muscle, tendon, bone attachment problem, as I understand it, that also effects the abdominal wall. The sticky at the top of the Forum’s first page is informative. I’m surprised though, that they still call it a “sports hernia” in the thread title. Kind of perpetuates the misnomer.
https://www.herniatalk.com/6882-in-depth-sports-hernia-guide-infographic
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I commented in your other thread. Don’t know if you saw it.
There is quite a bit of discussion all over the internet about the two types of hernia repair. Focusing on the short term could be a huge mistake. If it was war-time and you needed to get back to the battlefield, then paying a long-term price for a rapid return to action might make sense. Otherwise, you’re trading days for years. It makes no sense at all to even talk about it. The fact that a faster recovery is used as a selling point, while long-term issues are ignored, is disingenuous and could be considered unethical.
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Still looking for any success stories. Some positive stores that might give some guidance.
I just got back to someone I know who said that they had almost forgotten that they even had surgery, after less than a year. Hopefully he’ll have good news after several years.
Any stories will work. The time frame alone might be telling, 20 years ago, versus 10, for example.
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You’re following the same thought path that I did. I’m not so sure that people get on-line to give bad reviews of their surgeons, after many months or years. I haven’t because I don’t think that the individual surgeons have the means to know better. I’m also not so sure that it’s the surgeon’s skills that matter so much either. Many of the accounts on this forum are more about general problems with the mesh that they had implanted, not so much who implanted it or how they did it. It can go in exactly as the device makers say it should, but people still have problems. It’s either a problem with certain types of mesh, either the polymer itself or the way the fabric is put together, or individual people respond differently to the material. Or maybe they’re just putting in too much fabric, creating a much too large foreign body response. Like getting stung by 100 bees compared to just 1.
The problem for everyone right now is that the device makers and the medical institutions have all hunkered down to see how things play out. I have heard from people that develop new products and this is their impression, at least for the device makers. That’s why you can’t trust a brand or a clinic or a hospital as an entity. You have to find a person who you trust for their sincerity and, just as importantly, their knowledge. I think that there are many sincere, caring, professionals that do hernia repair but don’t have any way to find out what really works and what does not. They just don’t know and can only do what the device makers tell them to do. Follow the instructions and hope.
As far as protection from the Food and Drug Administration, the FDA, all you have to do is look at how these new materials have been approved for use, the “substantially equivalent” rubber stamp, and some of the weird ideas out there like coating polypropylene mesh with fish oil (it’s been approved and is in use now – Atrium C-QUR), to understand that they have little influence over the device makers. As long as nobody dies from mesh they won’t be involved. Consider how long it’s taken to do anything about transvaginal mesh problems. The same people are behind the development of hernia repair mesh, and the FDA oversight was of little use in stopping the thousands of women from being harmed.
Good luck. Sorry to be so negative. It’s a mine field though. Be careful.
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quote clive63:Thanks, GoodIntentions. Are you suggesting there are some advantages to open surgery over keyhole/mesh? I think mine is what you call direct: i.e. it shows as a visible bulge in the groin area. I do need a rapid convalescence,
Hi clive63, sorry I missed this. For whatever reason there is a very big push to laparoscopic implantation of large pieces of mesh, somewhat recently, like over the last 5-10 years, for hernia repair. I think that it might be partially or predominantly due to fewer immediate complications, and the rapid return to functionality. Cheaper for the clinics and hospitals. But the long term issues with laparoscopic implantation of large pieces of mesh seem to be of higher frequency, according to many research papers. It’s not even clear that recurrence rates are actually lower than open with mesh.
You’re trying to compare a few days or weeks of recovery time to the rest of your life. Choose the method that is best for you and what you want out of the rest of your life. Take the time off to recover if you have to. Find somebody who has had a hernia repair and is happy with it then find a surgeon who will do that same repair on you. Not all meshes are the same and as I said above the trend today is to cover as much abdominal wall area as possible. The whole lower abdomen if they can. The device makers even recommend it, indirectly, in their marketing videos. You’ll miss many many more driving days if you get a bad mesh repair, and nobody can predict who will get a bad one. It’s big gamble.
I still have vivid memories of discussions with surgeons before my initial repair surgery, and how I saw the warning signs, that they didn’t really believe enough in what they were doing to be enthusiastic about it. I even got a second opinion after talking to one who seemed more enthused about the operating center he was using than the method of repair. But I convinced myself that no doctor would knowingly do something that they thought might harm me in the long run. “Do know harm” and the Hippocratic oath, and all of the things you associate with physicians. It’s a disturbing situation for everyone involved. I think that the medical device makers and the insurance companies know, they have the most access to long-term results, but they aren’t talking, even though they could easily show what’s true.
Good luck.
p.s. when I said above that “Males in their later years are about perfect mesh implantation patients” I meant that any problems could just be blamed on normal aging, instead of the actual cause. Perfect for avoiding the issue. Hope I didn’t give the impression that we’re actually great candidates for repair.
[USER=”2470″]clive63[/USER]
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quote SomeGreyBIoke:Hi Good intentions,
Thank you so much for your message. I’m in a bad place as my pains started after another operation back in January, part of me thinks that pain is still to do with that op and not hernia, and probably hang on and don’t do anything drastic at this stage.
Did they do any exploratory surgery at the time? Was the right side examined?
Maybe the scarring on the left side is pulling on the right, causing pain. January is not that long ago. Have you tried any methods of reducing the material in the canal? I don’t know if it was a real physical effect, but I seemed to get some relief from my direct hernia by elevating my pelvis above the upper half of my body. It takes the pressure off of the area. It’s actually what they do during laparoscopy to create a space in the abdomen, tilting the body, letting the intestines slide downward. Of course, there’s no CO2 to help but it might offer temporary respite.
Good luck.
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jnomesh had his mesh removed by Dr. Belyansky. Here is one thread in which he talks about it.
https://www.herniatalk.com/5829-simu…-hernia-repair
And the search function on this site works well. I searched “Belyansky” and a few stories came up. Since he also will remove mesh he should have some idea of what to avoid when repairing a hernia. The surgeon who originally repaired my hernia using Bard Soft Mesh wanted nothing at all to do with removing it. If I was starting over I’d find a surgeon who has seen, or at least is aware of, and accepted the problems with all of the hernia repair methods.
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I’m not sure that size of the hernia is the issue for pain, it would be what tissues are being strained. Location, more than size. It sounds like you’re describing an indirect hernia, which would be an expansion of the inner ring of the inguinal canal. It’s not supposed to expand at all, it’s supposed to be just big enough for the spermatic cord.
If you read more threads you’ll find several on “hidden” or “occult” hernias. I think that these are areas that are starting to stretch and grow in to visible hernias, but haven’t created enough deformation yet to be visible. The tissue is being strained and creating pain, but there’s nothing to see. Read some of those and it might give you another point of reference.
On the other hand, some people have very large hernias, that are not very painful at all. My hernia was a direct hernia and the pain would go away after a week or two of no activity. I only had surgery to try to get my potential for activity back.
I’ve wondered sometimes if the words used to describe size of a hernia are describing the amount of material pushed through the defect, or the size of the defect itself. Even the size of the defect can be vague, since there are three dimensions to consider, along with shape. Round versus long and narrow, for example.
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inguinalpete just posted something similar and I replied with my own similar symptoms. I wonder if something like tendinosis could happen, as the mesh rubs on the tendon. Does your problem reduce with rest, then come back with activity?
https://www.herniatalk.com/7084-2-hernia-surgeries-and-now-chronic-problems
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Hi Katie. I saw your other post with the @ symbol used. I don’t think that all forum software use the @ notification system. It might not even be activated on this forum. I’m pretty sure that Dr. Towfigh will see a message though, if you use the messaging system. If you click her name on one of her posts there will be a link to messaging. You could refer her to your thread.
You injured yourself deadlifting, or something like it? Bouncing the bar off of your pelvis, if I recall correctly.
I experienced pulls and soreness periodically over the three years that I had mesh implanted. One thing that often caused soreness was any strenuous actions with my arms raised, that stretched abdominal muscles longitudinally, like putting a heavy object on a shelf or doing pullups. Felt like it was pulling something free from my pubic bone, or just overstressing that area. They like to get the mesh all way down to the pubic bone so it will form a good attachment and not move. Unfortunately it also reduces the flexibility of the lower abdomen as a whole, turning it into a leathery plate attached to the pubic bone, after tissue ingrowth in to the mesh fiber knots. Not the way the body was designed to work.
Good luck.
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I also have a similar “ridge” that seems to follow a muscle feature. I don’t know my anatomy well enough to know exactly what it is. It’s in the same area as the original direct hernia lump. I had TEP placement of Bard Soft Mesh, both sides, but the side with the hernia is the only side that got the ridge. Initially, it only appeared after exercise, then reduced with rest, like a void that was filling then deflating. But eventually, over months and years, it became permanent. It was not a recurrent hernia, just a spot that swelled.
With TEP they often like to place as big of a piece of mesh as they can fit in there. To allow for shrinkage and movement. Do you know how big yours was? Do you have your medical records?
Your story seems to imply that the “sports hernia” repair caused your inguinal hernia. Since you’re out of the ordinary now you should probably find a surgeon who is an expert in both of your problems. Many surgeons are very well-trained in specific procedures and will try them on you but may not get he fine details right to achieve the best outcome for you. You don’t want to get in to the “more mesh will fix it” cycle.
Dr. William Meyers of the Vincera Institute is an expert on athletic pubalgia, aka “sports hernias”, and would be a good place to start if you can get there. He’s in Philadelphia.
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Chaunce, do you have a link to the internet forum thread with the surgeon’s discussion?
Many of the SAGES presentations end up on youtube. I don’t know who decides what gets released but I hope that the mesh discussions are.
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quote W.Parker:I’m not sure of the material used to make the mesh. I was told it’s comparable or looks like fishing line tightly woven and they’ve(the VA) used the same mesh for 50 years. Really odd feeling the body trying to adhere to the mesh. It was a itching scratching feeling. I had a open RT inguinal hernia surgery where they layed and stitched the mesh together on the outside of the inguinal canal. The Doctor did confirm extra work was done repositioning the spermatic cord and extensive scared tissue which seemed really weird- extensive scared tissue?
It sounds like your surgeons are using something close to the original mesh repair methods, which generally worked well, but cause more short-term healing pain, requiring more time, and also left more external scarring.
One reason that laparoscopy is gaining popularity is because people get back on their feet sooner, and the signs of surgery are reduced. Tiny scars. Which, somewhat ironically, probably makes it easier, subconsciously, to think that there can’t be any problems inside, because there are no scars outside. Surgeons are people too. The people with problems from laparoscopic mesh implantation look fine from the outside. Especially the TEP procedure, which leaves almost no sign of surgery, but does the most internal dissection.
A good medical student could probably put a survey together that would show the difference in chronic pain between old methods and new. I’ve seen a few attempts, in research papers available n the internet, but they generally downplay the type of pain, ignoring the persistent low-level pain, focusing on more extreme pain, and they usually have some bias apparent in the discussion. Research to prove a point instead of research to solve a problem.
Your previous scar tissue might have been from the areas that were dissected so that the surgeons could get in to fix the hydrocele. I’ve wondered if the dissection process alone isn’t part of the mesh implantation problems. Peeling apart tissues that were perfectly fine just to “take a look” or make room for the mesh.
Good luck.
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You should describe the major abdominal surgery. There might be clues there. You could also get checked for a hernia.
Good luck.
p.s. choosing a serious user name would make your problem seem more serious.
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It’s been 3 1/2 (Edited – was 4 1/2) years since I got my right side direct hernia. Since then I’ve had Bard Soft Mesh implanted, then removed, and am now recovering, trying to get back what I can. I often wish that I had just lived with the hernia. I thought that I was choosing between staying at 85% of my former capabilities or paying the time, surgery pain and risk, and money, to get back to 95%. Nobody described the potential complications, or the probability of having them. It all seems hidden, and purposely ignored. The surgeons I talked to before-hand implied that it was an easy, outpatient procedure. All I needed was a ride home afterward.
It’s very surprising how many surgeons, and doctor’s just don’t acknowledge the problems with the current methods of mesh implantation, despite all of the lawsuits, and new forums like this one cropping up, and their own patients coming back with problems. I think that they might just realize that people won’t have the surgery if they tell the truth about what they know. It creates a whole undesirable atmosphere of distrust; of the medical profession, the insurance companies, and the various clinics and hospitals. It’s more than just a few patients that have their lives screwed up.
But there are honest, open, forthright individuals out there. I recommend staying away from the large clinics, because they have incentive to stay with the mainstream methods, right or wrong. They are large for the purpose of negotiating contracts, and subsequently have large outside influences pushing them to avoid acknowledging problems. Many surgeons in the big clinics don’t really have a choice of materials, their purchasing departments choose for them based on cost, assuming that the meshes are all the same, and they are probably also limited in methods of repair.
If your surgeon can’t describe a few stories like you’ve read on this forum, and discuss why they might be happening, then they’re either in denial or dissembling, avoiding the issue. Choose a surgeon who will acknowledge and confront the issue directly. One who keeps track of their patients progress and doesn’t assume that “no news means success”. Then you’ll have a better chance of a successful repair. The individual surgeons shouldn’t be avoiding responsibility for the work that they do. If yours denies there’s a problem, I would move on to another.