Good intentions
Forum Replies Created
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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.
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Dr. Peter Billing is in Shoreline WA. He removes mesh. He’s been doing it for eight years. No offense, but I’m not sure that he will be open to spending time on the thoughts about the mesh implantation field, and the doctors involved. I understand the frustration but he won’t be able to help with that. But he will know how to remove the mesh, with a good outcome likely. You’ll need to carefully explain to the front office people that you’re not a referral (most practices deal mainly with referrals from primary care physicians so will get perplexed when somebody calls out of the blue) and that you’re calling about groin or abdominal pain. Get an examination then let the doctor make the decision on the appropriate course of action.
https://www.evivamd.com/about-eviva/meet-our-physicians-providers/peter-s-billing
Full disclosure – I am not Dr. Billing
One problem with making progress on the chronic pain issue is that mesh works very well for many people. And not all mesh is the same. So, blanket statements about its suitability or non-suitability just don’t work. Real progress probably won’t be made until there is a suitable replacement for woven mesh, that gives better results. The investments in woven mesh have been made by the medical device makers, and they won’t give up the return on those investments until they have another revenue stream. The device makers are not composed of physicians, they are manufacturing companies, composed of engineers, and executives, and factory workers. They see numbers, not people.
Good luck. Call Dr. Billing’s office. Start a new thread if you want to get more looks. You’ve tagged on to someone else’s story and it might not be fresh enough.
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Is it this one? Seems to fit the criteria.
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Thank you, Dr. Earle, for reading and commenting, and the article.
My impression is that the “industry” is aware. The’re getting sued on a regular basis so it’s hard to believe that they’re not. Cost seems to be playing a much greater role in their decisions than you would hope or expect.
Coincidentally, somebody sent me a link to a very recent NPR podcast, an interview with Jeanne Lenzer, a former “physician’s associate” (I don’t really know what that means), who has written a book about the medical profession and how they seem to be captured or controlled (my words) by the medical device suppliers.
I also added a link to an article transcribing a panel discussion of some well-known surgeons, describing among other things, how their choices are controlled by their organizations, often based primarily on cost.
Here are links to the audio and the transcriptions.
https://itunes.apple.com/us/podcast/fresh-air/id214089682?mt=2&i=1000400086850
https://www.npr.org/2018/01/17/578562873/are-implanted-medical-devices-creating-a-danger-within-us
“On the Spot With Colleen Hutchinson: The Art of Herniology 2016”
Just click “Cancel” and the article will appear, or go ahead and print it. Or just read it in the preview window.
https://www.generalsurgerynews.com/Article/PrintArticle?articleID=34826
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Probably depends on the time-frame of “recovery”. Open can be done using local anesthesia, so you’re wide awake through the whole procedure. Laparoscopic is always general anesthesia so you have to wait to get your senses back. So on the day of surgery, recovery is probably faster for open.
I think that open tends to use less material also. You can only reach so far in to the hole from the outside. So the short-term recovery might also be faster. Laparoscopic uses a lot of material, covering a lot of internal area.
On the other hand, I think that you can get back to increased exertion faster with laparoscopic because the entry holes are smaller and because there is so much mesh coverage. So if recovery means back to work, laparoscopic might be better.
I had bilateral laparoscopic TEP surgery and was released for full activity at 22 days. I didn’t have any trapped gas that I could feel. I did have lots of fluid buildup though. The dissection peels open a large area in the abdomen which all leaks a little bit of fluid, I believe. Felt like I had a giant water balloon in my gut. Of course, you’ve probably read my other posts so you know that there’s more to it in the long-term. If you’re focused on recovery time I think that you’re making a big mistake. Those couple of weeks or months of extra time will be long-forgotten if you have a mesh reaction.
My understanding of robotic surgery is that it basically gives the surgeon a steadier, more controlled instrument. So they can focus on fine details that they otherwise would not chance. I think that’s why it’s good for mesh removal, because they can get close to arteries and nerves and other parts that they would otherwise avoid.
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Another interesting paper, with some good references. It’s a shame though that Dr. Bendavid’s ego and offputting bravado in his writing style overwhelms the material that he’s reporting, and probably fortifies the people advocating mesh usage to resist what he’s saying, based on that alone. It’s human nature. He seems to have lost his objectivity. I got irritated reading it and I’m kind of on his side.
Still worth a look.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734928/
in PDF form – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734928/pdf/05900e3.pdf
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The hospital should have your surgery details, or the surgical center if they sent you to one. Many places do everything on line now, you just fill out a form. The surgeon would not likely be involved in that, the front office people would. You can probably find something on the hospital web site or find out with a phone call to the hospital. It’s usually free and should be simple to get done.
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A call to the Vincera Institute might be worthwhile. Dr. Meyers will take a look at your MRI’s if you send them but likes to have his own people do them. They do them a certain way to focus on specific areas. He is an athletic pubalgia (sports hernia) specialist. I put a link to their site below. They’ll want you to travel to Philadelphia but if he sees something obvious maybe he’ll offer a suggestion.
Also, from my own experience, ibuprofen causes constipation. It is a documented side effect also. So, maybe the constipation isn’t from the condition itself but the pain medication. It’s a dilemma, pain or constipation.
Dr. Levi Procter, one of the surgeons who contributes to the site, has offered to read other people’s MRI’s, I believe, if I remember his posts correctly. Might be worthwhile to send him a message.
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quote Mbs:One year after mesh repair I’m experiencing pain on my right side lower abdomen and into the scrotum.
Can you provide more details on the procedure, and what you’ve been doing since then? More clues will help. Open or laparosocpic, TEP or TAPP? Type of mesh. Both sides or one. Location of hernia – inguinal, etc. Direct or indirect. Does the pain go away? What initiates it?
“Mesh repair” doesn’t tell enough. Good luck.
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Thank you Dr. Towfigh. It seems to be back to normal.
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I had written a much longer response this morning but it was “Unapproved” and not allowed, apparently.
Anecdotally, athletic people with low body fat have more mesh problems than the average person. Might be why he used the modified Bassini approach. You might actually be better off.
Think long-term. Let it heal properly before trying to get back to your old self, I’d say.
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Maybe certain words are getting flagged? Computer censoring? That would be a shame.
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Another test
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There are several posts on this forum about how mesh sometimes does not work well for athletic people with low body fat. Could be that your surgeon did consider your activity level and gave you the most appropriate solution.