Good intentions
Forum Replies Created
-
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.
-
“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.
-
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.
-
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.”
-
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.
-
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.
-
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.
-
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.
-
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.
-
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/
-
I sent Dr. Towfigh a message. Neither one of your new topics are showing up.
-
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.
-
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.”
-
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.
-
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.
-
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.
-
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.
-
Is it this one? Seems to fit the criteria.
-
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
-
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.