Good intentions
Forum Replies Created
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quote Beenthere:About 5 years ago to this date, went to have the mesh removed and a small inguinal hernia on the other side fixed and the Dr. found a femoral hernia on the original hernia side. Pain gone and movement restored.Have you contacted the surgeon who fixed the poor first surgery, 5 years ago? One of the problems with our big bureaucratic medical system is that doctors lose touch with their patients. They don’t know if what they did worked, or how well it worked if it did. He/she might have some thoughts on what happened. You might have something in common with their former patients. They might have a solution already in place. Worth contacting them anyway, just to let them know.
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quote NFG12:Also I was wondering if my mesh was put in with the TEP method that when I got it removed robotically does that mean it is more invasive because the mesh is placed outside the peritoneum? Would that mean you have to go through more tissue to get to it rather than if it was done with the TAPP method when the mesh was put in?
I think that both TAPP and TEP place the mesh in the same are, between the peritoneum and the fascia. TEP apparently avoids the possibility of injuring the abdominal contents, I believe, by leaving the peritoneum completely intact. But, if healing goes well, the end result is about the same, with a sandwich of peritoneum, mesh, and fascia, all bound together. Mesh removal is the same for both, either TAPP or open, because the TEP approach is not possible anymore as everything is too tightly bonded. The T in TEP stands for “Totally” and it’s only possible because the peritoneum easily peels off of the fascia on the first surgery. After that first surgery the tissues get all tied together. That is my understanding. With TAPP the surgeon still creates a space between peritoneum and fascia but starts from the inside, instead of the outside.
A good surgeon can tell you what to do about the spermatic cord pressure. It sounds like the MRI doctor is describing the scar tissue pulling the deep ring open, the dilation, and applying some sort or pressure as well. More surgery might just be used to relieve that pulling. I recall reading about injections to break up scar tissue also. Seems like the surgeon who removed the mesh would have some advice and also find the followup information useful for future patients. Have you contacted him/her?
Good luck. The annual SAGES conference is coming up in April so maybe the forum surgeons are too busy to visit the site. Hopefully, these mesh problems will be a very active topic this year.
http://www.nmcsurgery.ae/laparoscopi…tepp-and-tapp/
Edit – here’s a more descriptive explanation of TAPP. The one above is not clear about mesh placement.
https://www.laparoscopyhospital.com/transabdominal_pre-peritoneal_(tapp)_vs_totally_extraperitoneal_(tep).html
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Recurrences are usually from around the edges of the mesh. Material gets under the edge and works its way under and back out. The mesh can fold over also, creating a shorter path for a recurrence.
A trained doctor could tell you if you’ve had a recurrence. Your post is not very detailed, besides some new pain and a bulge when you cough. Nobody can really give you more advice than “see a doctor”.
I would be interested in the details of the operation if you can supply them. Open or laparoscopic, direct or indirect hernia, type of mesh, brand of mesh, etc. Good luck.
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quote Jhf1210:I am now 16 months past my open ilingual surgery with as
much if not more residual pain post surgery. I’ve been able to participate in some strenuous activities without being incapacitated by the pain but wake up every day with some level of discomfort and outright pain. I’ve been through acupuncture, massage and rest with varying degrees of relief. I’ve even been to another University of Washington surgeon for a second opinion and been told that the history shows that the surgeon did what he would have done and that neither of them have had this experienced before. He indicated that mesh removal is painful 2 plus month recovery and likelihood of recurrence, pushing me toward not pursuing removal.It’s very difficult for healthy people with no pain to understand what it’s like to live with constant pain. The typical surgeon is healthy with no chronic pain. The word “pain” implies something sharp and intense but it’s really the knowledge and feeling that the pain, even if it’s at a very low level, never goes away, that you’ll never be healthy again that drives the patient to having mesh removed. The doctors tend to think mechanically, about where the parts are and if they are functioning correctly. So, really, the typical doctor’s opinion about what you should do about your pain is almost meaningless. He or she can only really offer good advice if they have a history of patients who they have “fixed”. Then they’ll have a base of opinions from their patients that they can pass on to you, and they’ll have a better idea of who they can help. In short, find a doctor who has “fixed” people with mesh problems. The ones who haven’t can only do what yours did and say that they don’t know. They don’t have anything to refer to.
I know that’s what you’re asking for but I just wanted to reiterate the fact that talking to someone with experience in mesh removal is the key. Chaunce1234 supplied a list in Post #4 in this thread – https://www.herniatalk.com/6259-seek…emoval-surgeon
Do you have any more details about your procedure that you can supply? Type of hernia, type of mesh, brand of mesh…etc. Direct or indirect hernia, plug and patch, Bard/Ethicon/Covidien… Those are factors to consider. Your records should still be available from the facility where you had the surgery. Where the operating room is, not your surgeon’s office. They will have the records of materials used, plus your doctor’s notes.
One thing that might drive you to having it removed is when you realize that nothing has changed for many months. You’re not improving and you might even be getting worse.
Good luck.
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It’s barely been four days. You’ve had your peritoneum peeled off of the abdominal fascia and an irritant, the mesh, placed in between. Your body is working to cover that irritant with protective tissue. The mesh is placed directly on top of the various arteries and nerves at the area where the spermatic cord enters the inguinal canal. Those parts are now rubbing on the mesh until it gets dealt with by your body. It will take a little while and the type of pain will probably change as things progress.
Walking seems to help move the fluids around so that they can be removed, and reduce pain. It did for me, and I’ve seen others report the same. Ability to work without causing damage, and pain, are two different things. Didn’t your surgeon give you a pain medicine prescription and advice? The internet is nice but there should be direction from either the facility or the doctor. Sometimes it’s buried in the paperwork, you should go through your documents closely. Mine was “do not lift more than 10 lbs”, a prescription for hydrocodone, and advice to use ibuprofen or acetaminophen, singly or together.
The real risk would seem to be doing something that increases abdominal pressure to a level high enough to push the mesh through the hole, or to tear a stitch or tack free. But I don’t think that the actions to avoid, to avoid that, can be specifically given. One pound lifted with your arm at full extension might be worse than ten close to your body. I don’t think that anyone really believes the lifting instructions are worth anything, but they give a clue. Good luck.
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“Can fatigue be caused by a hernia” might be a better form for your question.
I would add more details. Like what kind of exercise you’re doing (“light” means different things to different people), what caused the hernia, and how long you’ve had it. And how long it’s been since the initial surgery that created the incision. If you took a lot of rest after getting the hernia and are just starting exercise again, maybe you’re out of shape and it’s taking a while to get back. Not so sure also that exercise is good for a hernia. I’ve not heard that.
Good luck. The body likes its rest after injury, so if you’ve had the initial surgery to create the incision, then a hernia afterward, you might just need more rest than normal.
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quote Chaunce1234:I’m a fellow patient, not a doctor. But…
Somehow I had got the impression that Chaunce1234 was Dr. David Earle. Maybe somebody else got that impression because some of your previous posts were signed off as “DE”. I haven’t found any posts where you describe your problem or procedure. Could you clarify? Thanks. I’ve only seen three surgeons post on this forum, and only two, Dr.Towfigh and Dr. Procter, post often, even though seven are listed. I wish that more of them would post more often.
To SpringsMan – I’ve found that many surgeons don’t read images themselves. They are interpreted at the facility where the images were taken, by a specialist in imaging, and a report is written. Typically, the specialist will look for signs of whatever the cause given is for the purpose of the image. And mesh does not show clearly on most imaging methods, so imaging is often not very useful. “No recurrence” is a common conclusion from imaging, which is meaningful but often already known. In short, you might want to pick a doctor first, and see what they recommend.
Can you give more detail on your procedure? Open, lap, mesh brand, direct or indirect, etc? A general location might get some recommendations also, for a good doctor.
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Sorry about that. I see bad mesh everywhere now. Most of what I said still applies though, I think. Here’s an edited version. I removed two “mesh”es. Interesting that he had a non-mesh repair six years ago, when even open with mesh was about equal with laparoscopic with mesh. Now it’s mostly laparoscopic with mesh.
“Pain after hernia surgery is not uncommon. Six years is a long time to deal with it though. Post your general location and somebody here can guide you to a doctor who understands and accepts that some hernia repairs have problems. You’ll need to see a doctor with experience in dealing with the problems, not the common surgeon who will only deal with implanting the mesh. You’ll waste a lot of time and money unless you just get lucky and find the right doctor.
And don’t assume that you need a neurectomy. Cutting functional nerves is a specific procedure for specific types of pain. It’s not a general pain reduction technique.
Actually, at this point you probably shouldn’t try to diagnose your own problem. Your assumptions might be wrong and lead you down the wrong path. Best to find a doctor that will deal with hernia repair problems, and will choose the best procedure for you.”
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Pain after hernia surgery with mesh is not uncommon. Six years is a long time to deal with it though. Post your general location and somebody here can guide you to a doctor who understands and accepts that some hernia repairs have problems. You’ll need to see a doctor with experience in dealing with the problems, not the common surgeon who will only deal with implanting the mesh. You’ll waste a lot of time and money unless you just get lucky and find the right doctor.
And don’t assume that you need a neurectomy. Cutting functional nerves is a specific procedure for specific types of pain. It’s not a general pain reduction technique.
Actually, at this point you probably shouldn’t try to diagnose your own problem. Your assumptions might be wrong and lead you down the wrong path. Best to find a doctor that will deal with mesh problems, and will choose the best procedure for you.
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No direct thoughts on your symptoms but I do have a suggestion for when you next see a doctor. Don’t focus on the past hernia repair as the primary reason for your visit. Try to give a broad view of the actions that preceded the current problem, and give a good description of the symptoms. It might be that you’ve actually caused a new problem, not related to the hernia repairs or mesh. Let the doctor decide how to handle it.
Unfortunately, in today’s database category based health care system, the words that you use to set up your appointment will be used to put a label on you. If you say that you have a hernia repair mesh problem, your symptoms will all be referenced against pre-defined hernia issues. Often it won’t be the doctor who does the defining it will be somebody at your insurance company trying to figure out if your visit and tests are “covered”. Any tests the doctor would like to have done will be referenced against a list of “hernia” procedures. And “hernia repair mesh problems” is not a category yet, although it seems like it might be soon.
I had major problems and as soon as I mentioned ED as a sporadic problem after physical activity I got shuttled off to see a urologist. And ED is not covered under my plan. So, even though the real problem was inflamed mesh and my point in talking about ED was that it was just a symptom of a bigger problem with the mesh, once my visit got the ED label it couldn’t be changed. I even talked to somebody at the clinic who agreed with me and said that she would get it corrected but it just went back through the system and I ended up paying a lot of extra money just to see a guy who said “wow, I’ve never heard of that before”.
My surgeon also had to sit through a panel discussion just to get approval for an MRI, later on. Because MRI’s were not covered for hernias. He would make a request and get rejected, then write another and get rejected again. “This procedure is not approved for ‘hernia'”. That simple.
Overall, it was a sad example of the bureaucratic nature of our healthcare system.
Good luck.
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The MRI itself doesn’t cause any pain. It’s just radio waves passing through the body. Laying in the machine without moving is kind of tedious. I’ve had a typical lay down in the tube MRI. It takes some time to get a complete set of images, so patience and being prepared to do nothing for a while are what she should be prepared for. There are different types of MRI machines, of course, so it might be worthwhile to look in to that. Most hospitals or facilities have a guide that will explain what to be prepared for. You might check their web site.
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Incisions usually come from previous surgery, don’t they? The details of where the incisions came from might help.
Chaunce1234 (Dr. Earle) made a comment recently about knowing of surgeons who do non-mesh repairs on professional athletes. When I was looking for surgeon I tried to find that type of doctor but couldn’t find any. That was three years ago. The laparoscopic mesh repair movement is even stronger now, but you might have better luck. Look at Dr. Earle’s recent posts.
If you’re okay with traveling and maybe spending more money that if you stay in your insurance plan you might contact the Vincera Institute. Dr. Meyers is known for working on athletes.
Good luck.
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Hello Frogdog. I don’t know anything about mid-line hernias or thinning or component separation but I do know a little about how people use the internet. Most people just browse the titles and only click on the interesting things.
If you want urgent information you need to put that in the title. Even better, pack as much detail as you can in to the title. Something like “Need surgeon recommendation by XX time today for component separation, within XX miles of KC, MO”. Maybe details about which state also, since KC is on the border. You might actually have insurance in Kansas.
Good luck. I can almost guarantee that the doctors or other forum members who might see your current title will think that they have a few days to think about it.
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Was your appendix removal done laparoscopically? I assume that it would be but you never know.
You mentioned sports hernia (athletic pubalgia), but apparently haven’t seen a specialist in that malady. As I understand athletic pubalgia, it generally hurts when you’re active but not so much when you’re not. At rest the symptoms will diminish but they come back when you become active again.
Here are a couple of links to look over. Good luck.
https://orthoinfo.aaos.org/en/diseases–conditions/sports-hernia-athletic-pubalgia/
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I sent Dr. Towfigh a message. Neither one of your new topics are showing up.
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Maybe he used absorbable tacks and they show up on the X-rays. Your surgeon’s denials are probably just from a lack of a path forward. He put the mesh in as Bard directed and doesn’t know what to do now that you have problems. A common situation for those who have post-procedure pain, as you can see from other posts on the site.
As for uploading pictures, some image handling programs, like Google’s Picasa program, have an “export” function that allows you to shrink the image size down to a useful level, with no significant loss in quality. I can shrink 1 Mb down to 800 kb. You might check your iphone settings or see if there’s an app. I don’t know iphones.
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Re the paper I linked above, the excerpt below might the most concerning part. The authors did a very extensive review but in the conclusion did not acknowledge or even mention chronic pain and discomfort reduction as a goal. Hard to believe that they are unaware. Incredible really.
Review Past, Present and Future of Surgical Meshes: A Review Karen Baylón 1 , Perla Rodríguez-Camarillo 1 , Alex Elías-Zúñiga 1 , Jose Antonio Díaz-Elizondo, Robert Gilkerson and Karen Lozano
“5. Conclusions Surgical meshes have become the system of choice for hernia repair. Even though it is not the optimum method, so far it is the one that has shown a lower rate of recurrence. Currently, there are more than 70 types of meshes commercially available. These are constructed from synthetic materials (absorbable, non-absorbable, or a combination of both) and animal tissue. Despite reducing rates of recurrence, hernia repair with surgical meshes still faces adverse effects such as infection, adhesion, and bowel obstruction. Most of these drawbacks are related to the chemical and structural nature of the mesh itself.”
They only mention chronic pain in the discussion as a result of adhesions. Makes a person question their expertise in the field, as a whole. At least they collected many references.
“Furthermore, adhesions between the visceral side of the mesh and adjacent organs still occur. These complications may have serious consequences, such as chronic pain, intestinal obstruction, bowel erosion, or hernia recurrence.”
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I found a good review of mesh materials used in hernia repair, pdf link below. I noticed some flaws in thinking, for instance, associating fiber fragmentation during usage with flexibility instead of fatigue resistance, but I think that the authors are not experts in materials. It’s a very broad-based review and seems well-done.
It’s from 2017, so it’s good to see that there is still development work ongoing. Unfortunately, in the meantime, there are still surgeons working from what they learned in 2005, with the same materials. That should be a takeaway for anyone considering hernia repair today. Make sure that your surgeon is up to speed on advancements, and can address the very well-known problems with hernia mesh. Chronic pain and discomfort being the issue most overlooked or discounted.
The section on knitting, on page 12, is very interesting in that it relates back to Bendavid’s paper about SIN (post #1 above), perhaps caused by small “pores” created by the knots and loops of the knitting process. The knit fabrics are designed for flexibility and feel by hand, outside of the abdomen, and one time placement during surgery. The issues with shrinkage and SIN don’t seem to be addressed. This seems to be a big oversight, probably due to “out of sight, out of mind” once the material is implanted, so “easily adapts to the movement of the human body” (from the review) is nonsense, in the long-term. Once the material binds up and shrinks, in the abdomen, it feels like a playing card has been placed inside. It’s no longer soft.
There is hope for better materials, I think, if the right people are working on new materials and design. As better mesh is introduced to the market, maybe the old bad ones can be whittled away, and replaced.
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Dr. Sean Orenstein is one of the site’s surgeons, although I’ve never seen a post from him (I don’t know his screen name though), and is at OHSU. I assume that you’re in the Portland/Vancouver area. The wait time for an appointment with him can be very long. Dr. Martindale is at OHSU also. OHSU is a teaching hospital so a visit might also involve a group of students. Dr. Peter Billing is in Shoreline, just north of Seattle. Dr. Earle just posted a list of surgeons in a recent post, one was at the University of Washington.
https://www.herniatalk.com/6259-seek…emoval-surgeon
I’m not an expert but your level of activity before the “hernia” seems extreme. Seems like a “sports hernia”, athletic pubalgia, or something similar, due to overuse would be more likely. Maybe that was the true cause of your pain and it never got addressed.
I mentioned in a different thread the value of writing a letter. With a letter, the doctor can decide whether or not they have the knowledge and skill to help you, unofficially. “Off the books”, so it won’t count as a switch until you, and they, know they can help. I’ve had two positive responses using that method without scheduling a visit and a copay an all of the other insurance system requirements. You can send copies of your medical records also to get them there quickly. Put your phone number and/or email in the letter so that somebody can contact you quickly.
Good luck. I don’t think that there’s anything wrong with posting the name of the doctor your friend suggested, since he had good results. Might get you more feedback on suitability for your problem.
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quote jerseattlewa:SEEKING AN EXPERIENCED HERNIA MESH REMOVAL SURGEON.
I had mesh implanted 16 years ago for a hernia.
Was the procedure open or laparoscopic? Probably open? It might be a factor in choosing a surgeon.
Ironically, I think, when choosing a mesh removal surgeon you’re in about the same boat as when you were choosing a hernia repair surgeon.
I think that there are doctors at the University of Washington who remove mesh also.
Good luck.
p.s. your posts are very long and unformatted and difficult to read. Even though you’re frustrated and have been dealing with the problem for 16 years, you still have to make it as easy as possible for other people to help you. Especially the physicians since they live with the modern bureaucracy on a daily basis. Their professional lives are complicated. Get your medical records compiled and in order. Write a short concise direct summary of your problem, and make it available. I’ve found that sending letters helps because they can read them (or a medical assistant can read them and summarize) at a convenient time, and because your thoughts will be clearer. The letter needs to be short, direct, and to the point though. If your graduate work wasn’t in medicine, your thoughts on the field will be discounted. Stick with history and symptoms, I’d say.