Good intentions
Forum Replies Created
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quote SighFigh:I’ve seen some doctors on this forum say that mesh can be a superior repair when applied correctly when compared to tissue repairs. Does this observation also apply to thin people? I’ve seen it mentioned
that thinner people can be more sensitive to mesh implants.Would it be better in some instances for a thin person to pursue a tissue repair for an indirect hernia?
My own experience and conclusions are that when you see a description of “thin people” or “low body fat” you should mentally replace it with “active people”. Active people tend to be thin, and the surgeons and doctors reporting that “thin people” have problems are only seeing a static body, not considering activity level.
My problems with Bard Soft Mesh all came from trying to be active. Running, hiking, biking, playing sports – all caused irritation, swelling, and other problems, which lasted days and weeks after the activity. It was impossible to get close to my previous activity level, without having constant soreness and pain.
So if you are thin because you’re active, then consider it that way. If you do some research on what the surgeons known for working on professional athletes do, you’ll find that most, maybe all, of them avoid mesh, and most have negative comments about its use. See work by Dr. William Meyers, Dr. Ulrike Muschawek, and Dr. William Brown. When I was looking for someone to repair my direct hernia I came very close to traveling to Canada for the Shouldice procedure but I allowed myself to be convinced that laparoscopic mesh implantation would work. It was the worst decision of my life.
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I think that effectiveness depends on the type of hernia and the magnitude. They probably help with reducible hernias by stopping the material pushing out in the first place. But indirect hernias, where the material is pushed down in to the canal from inside probably are not be affected as much by a truss or belt. I did not try a truss or belt with my direct hernia although I did do some research on them.
Good luck with your consultation. Make sure to browse the threads on this site and read the stories. There is a “mainstream” procedure that will probably be offered to you, laparoscopy with mesh implantation, with rapid return to work or active life as a benefit. Little will be disclosed about long-term effects though. They’ll talk about “exploring” the other side, because they can and why not, and “fixing” any hernias that they find. But there is almost always some sort of potential hernia sign, so you’ll wake up with mesh on both sides.
It’s a big decision, don’t let the comforting voice of the surgeon convince you that what they offer is guaranteed to produce good results. The benefits described will probably be about reducing the risk of strangulation, a rapid return to work, and an outpatient procedure requiring no hospital stay. But if you ask about 5 years out, they will probably not have much to say. No news must be good news.
And, unfortunately, because you’re older, any new problems from mesh implantation that you experience will probably be attributed to your age. Males in their later years are about perfect mesh implantation patients.
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Working from the principle of why people take addictive drugs it’s reasonable to assume, I think, that people will generally vape or smoke until the nicotine level in their blood reaches the desired amount. So dosage level would be self-determined, regardless of mode. Nicotine level might even be higher with vaping because the ill effects of the other smoke toxins are not there. I don’t think that you can rationalize that vaping is better for healing than smoking, based on nicotine dosage. You could argue that vaping is more healthy than smoking. But, regarding healing, the vein constriction aspect of nicotine will still be there.
I’ve always thought that vaping is one of the oddest developments of modern technology that I’ve ever seen. Building an electrical device to vaporize potentially toxic oils so that a person can suck them deeper in to their lungs. It’s bizarre. No offense. Although, rolling a shrub in to a paper tube so that you can do the same with smoke is also bizarre. I grew up around that though so it seems normal.
Good luck with your decision. Seems like you’re deciding how much risk your smoking habit is worth though. Taking a chance on a hernia recurrence so that you can keep taking nicotine. Not as bad as smoking with an oxygen tank, but still…
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quote Spoonman:Does Desarda carry any long term risks other than recurrence?
McVay and Bassini I have not really researched, I only know them by name. So I would like any feedback on their benefits relative to Desarda if anyone is familiar with them.
You might try contacting surgeons directly that use one of those techniques, and ask them why they chose it. If I recall correctly, for example, Dr. Petersen in Las Vegas, uses a “modified” McVay method after he removes hernia mesh. Desarda’s technique is relatively new, I believe. I would guess that the only person who could compare it to the others is someone who uses it. Dr. Robert Tomas in Florida, does, I think. Not many others. I’m not sure that many surgeons visit this site, and the activity from them seems to be dropping. Maybe too much negativity about mesh, and too many problems reported.
Good luck. You never said what type of hernia you’re concerned with. Direct and indirect are both inguinal but they are not the same.
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quote nesd:I did have two of the doctors I’ve seen question me why I went in for surgery. It made me wonder if it was even a hernia. The Sioux Falls Dr. Peery said it could of been pulmonary, what ever that meant.
I would spend extensive time on really understanding what is going on with you. It doesn’t sound like your situation is clear, even to the experts.
In my experience, most of today’s surgeons specialize in doing certain specific things. They have trouble working outside their specialty, either because they’ve never had the training or they’ve just gotten rusty, or they are not allowed to by the organizations they work for. They’re not really “general” surgeons. Most of their professional interactions with patients are boiled down to 15 minute consultations and snap decisions about if they should do what they specialize in doing, not so much about if they really understand what’s happening. It’s a byproduct of automating the health care system.
You’ve seen four surgeons and had four different suggestions about what to do, but nothing concrete about what went wrong the first time. I would go back to the beginning and try to understand if a mistake was made in the original diagnosis and/or if the first procedure failed because of the material or the procedure, or because the wrong problem was treated. So far, it sounds like you’ve just had four people tell you that they’ll take another try.
Unfortunately, you kind of have to go from gut feel about the doctor that you are talking to. And learn more about what they are telling you. “Pulmonary” has to do with the lungs, so, dealing with air, in principle. If one doctor said you could have a “pulmonary” issue, how does that translate to inguinal hernia? Was he suggesting that you had an air bubble in your abdomen? Could it actually be a seroma?
One big positive for you is that you seem to be in a stable condition and able to think clearly and function well. So you have some time to put a good plan together. Good luck.
p.s. these are actually, in general, my thoughts for anyone who sees a surgeon. You have to help them help you.
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The second http://file dot scirp.org/pdf/IJCM_2014072117033945.pdf
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It didn’t work. try this -www dot goremedical.com/sites/g/files/ypyipe626/files/resources/assets/2017-10/AD0205-EN5.DLM_FINAL.pdf
Paste this in to a browser and replace the first “dot” with a period.
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Here is the second.
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Here are the links to one the two sources I used.
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It has tiny pores, of less than three microns, apparently. A typical polypropylene mesh will have pores of about 0.55 to 1.5 mm. Huge compared to the Gore pores. Microns to millimeters.
I will post the links in a second post. The site often locks up my post when I try to add a web link.
Gore has web pages that describe their products, and Dr. Robert Bendavid has summarized the state of polypropylene mesh with pore sizes in some of his publications. Those are my two sources.
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nesd, your case is unusual because you have reported a failure of the mesh repair, a recurrence of the hernias. That’s not supposed to happen. But it’s unclear from your first post that any of the three surgeons you saw afterward actually confirmed a failure. You said that they told you what they would do to fix what you told them had happened, but you didn’t say that they confirmed that the prior repair failed. Your description of a “bounce” during the examination is odd also. And the fact that your surgeon said that he would like to get his associate involved makes one wonder if he is unsure about what’s actually happening. It’s also unclear what type your initial hernias were, direct or indirect.
I’m not sure anyone can give good advice beyond “find a surgeon who is known to be knowledgeable in hernia repair”. I reread your first post and there is really not much information about what your actual condition was before the mesh implantation, or what it is now. It doesn’t sound like you are in pain or discomfort so taking the time to understand your true condition would be worthwhile. Unfortunately, apparently, there are doctors ready to accept you as a patient and do what they do, but it’s not clear what you need to have done, to be well again. I would try to learn more about your condition, and get your medical records together so that you can accurately describe what your problem is.
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Hello. I notice that you left out the Shouldice repair method. Also, Dr. Kang and his method, in South Korea.
What type of inguinal hernia do you have? And what type of activities are you hoping to do afterward? Those might be considerations. Good luck.
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Hello Amanda. I would contact Dr. Towfigh directly by sending her a message. She has experience in working with infected mesh, and has published in the past.
Click her name in the sticky at the top of the main page.
Can you give more detail about the operation. Type/brand or mesh, type of hernia, etc?
Also, the Carolina group works on infected mesh problems.
https://www.carolinashealthcare.org/for-providers/todd-heniford
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Hello Amanda. Good idea to start a new thread. I have seen past work by Dr. Towfigh dealing with “infected fields” and another type of mesh, biologic mesh. She might have a more direct interest in your husband’s problem, since she has experience with it. You could send her a message using the forum’s messaging function.
Click her name on the sticky at the top of the main page of the forum. You can also contact her work place, there’s a link on the Surgeons page. Or use the links I copied below.
Can you give more details about the operation and the types of mesh? It’s unclear if all meshes cause problems or if specific weave patterns and materials cause problems. There might be a clue in the details. It’s possible that the place that did the original repair in 2008 still has his records, although many institutions purge their files after a relatively short time. It would be worthwhile to contact them and see.
Here are links to the ways to contact Dr Towfigh –
https://www.herniatalk.com/member/935-drtowfigh
https://www.herniatalk.com/surgeons
The Carolinas group also seems to do a lot of work with infected mesh problems.
https://www.youtube.com/watch?v=ri4_afSvGms
https://www.carolinashealthcare.org/for-providers/todd-heniford
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I suggest seeing a surgeon who has experience in mesh removal. Because they might have seen the symptoms that you’re describing and will know the signs of mesh rejection. There are hundreds or thousands of surgeon who know how to implant mesh but few that know what to do when it doesn’t work. Dr. Towfigh, Dr. Billing, Dr. Belyansky, and others will remove mesh if it is the cause of your problems.
You also mentioned that the mesh that was implanted is the “self-sticking” type. There are at least two type of “self-sticking” or tackless mesh. You really need to get your medical records so that future doctors know what they are dealing with. That should be your #1 focus – get those medical records. It might be that one or more the new mesh designs isn’t working well.
Many surgeons will work with you via email or phone as an initial consultation. Get your medical records then email, or paper-mail, a descriptive letter and your records out to them. Paper mail if you’re worried about confidentiality. When I had my problems I didn’t care who knew about them but it is something to consider.
Also, don’t assume that any “good” surgeon should be able to help you. It’s the individual surgeons that put the extra time beyond their general medical education that will have the answers. You’re not part of the general population any more. Mesh is supposed to work, always.
Good luck. Don’t despair. There are doctors out there who are willing and able to deal with these problems.
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Since you already have mesh implanted you should make careful note of how your body is responding to the mesh itself. If you feel like the area is more inflamed than when you had the hernias then more mesh might be a bad idea. It might solve the hernias but leave you with new problems. Excessive inflammation from mesh is a real problem, but not one that the repair industry wants to deal with.
Take a little more time and get a copy of your medical records from the surgery. There might be some information there that will help a good knowledgeable surgeon, who stays current with what’s happening in the hernia repair field, to figure out why your first surgery failed. It might be that your body is just rejecting the mesh and that it never did “bond” to the muscle wall like it was supposed to do. Just floating in a sea of inflamed tissue, moving in to the original hernia sites. If that’s the case then more mesh would not seem like the solution to your problem.
Try to get more detail about the material and the methods the surgeons that you see propose. There is much more detail available than just “open” or “mesh”. The details are what matter. There many different types of mesh, and device designs, some of them pretty bizarre. And some of them have a history of problems, so you can avoid those if you know they are part of the plan.
Good luck. Most of the doctors that you see will only have experience in implanting their type of mesh, their way. You need to find one with a broad base of experience since you’re outside the norm.
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Four years is not that long. Nerve regeneration and growth will continue, probably forever. Even proponents of mesh will acknowledge that the body will be “working” on the mesh as long as it is there, as a foreign body. Whether for good, tissue ingrowth to hold it in place, or bad, constant inflammation. I am aware of at least one person who had some form of mesh implanted many years before a second repair on the other side, and the more recent repair caused problems, while the old repair was fine. The materials and techniques are constantly changing, often for unclear reasons, so what you had done in 2003 might not really be “identical” to what you had in 2014. You haven’t supplied any details beyond “mesh” either. That doesn’t tell much.
Look for Dr. Kang’s posts on this site. He seems to understand the field. He might know somebody that can help. He is based in South Korea.
Here are search results. He hasn’t been active lately but he was very helpful for a short while.
https://www.herniatalk.com/search?q=dr.+kang&searchJSON=%7B“keywords”%3A”dr.+ kang”%7D
Here’s a link about nerve growth – http://file.scirp.org/pdf/IJCM_2014072117033945.pdf
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I just posted in your other topic.
When choosing a surgeon, and even more importantly, what type of surgery to have to repair your hernia, extend your results time-frame way out to when you are old and feeble. Because that is how long you will be living with the results of your choice. The two weeks or months or even years that of time that you save by making a quick decision will seem like nothing if the results are poor. I know of people who have dealt with poor repair (mesh) problems, for many years. I spent the three immediate years after my surgery dealing with the issue.
See Dr. Towfigh’s recent topic about a Patient Advocacy Forum. https://www.herniatalk.com/6583-dear-patient-advocates-seeking-feedback
Good luck. Don’t assume that the people you see complaining are just outliers, or people who had surgery before the methods and materials were developed. I was strong and healthy and had those thoughts until I became one of them. The same materials and methods have been used for at least the last 12 years and people keep getting screwed up. And the people you see on the internet are just the tip of the iceberg.
Be careful.
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I recall that post from Dr. Towfigh and as I recall it was referring to studies that others have done. More specifically, I think that she referred to “barbell lifting”, which, of course, is an odd way to refer to weight lifting. I think that it was recent and you could probably find it by browsing topic titles. It was similar to yours, I think.
My understanding of hernias is that once the “hole” is created, it’s abdominal pressure that will push material through it. So you want to avoid things similar to the valsava maneuver, a common weight-lifting technique to stabilize the pelvis, that pressurizes the abdomen. Personally, from my own experience, I would also avoid activities that might result in rapid reactions that create abdominal pressure. I played soccer after my hernia and think that reacting to the situation around me caused the hernia to increase in size. But, just before my repair surgery, I was able to run a couple of easy miles and do easy workouts at the gym. I had the surgery in an attempt to get back to my higher level of activity. It didn’t work.
I saw your other post. There is a lot of good information on this forum. Read carefully and consider well.