Good intentions
Forum Replies Created
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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.
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Many people have problems with mesh. It’s unclear why. There are many different types of mesh and many different techniques for placing it. Generally, anecdotally, athletic people with low body fat have more problems with mesh. More chronic pain. You can find a many success stories and many horror stories. So many stories that there will be no clear “winners”, or losers. Recurrence is only one aspect of a successful hernia repair. The other big one is chronic pain.
So, your surgeon might have done you a favor, in the long run. If he is trained in the various mesh placement techniques and uses mesh, but he chose the modified Bassini repair he must have thought you were a good candidate for it. Mesh is generally considered to have a lower recurrence rate, and seems to be the “safe” route to take, based only on recurrence rates.
You should really be focused on the long term, not the next two weeks, or two months, or the fact that you’re losing your conditioning. If you go too fast and create problems you could have serious regrets, and be out of running for much longer. Maybe forever if things go really bad. Hernia repair is simple in principle and description but complex in practice. I was a very active runner and soccer player until I had laparoscopic mesh implantation with Bard Soft Mesh. It ruined me for athletics and running and hiking. It’s hard to say that you’d be better off with mesh implantation.
Good luck.
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Here’s another reason to maybe wait a while. These things have to come to a head eventually. Wait, let the bad ones get rooted out, there will be a period where things are better, and safer. Then the whole cycle will probably start over again.
Notice how the physicians are at the mercy of the device makers. They can’t even save themselves.
https://www.nytimes.com/2018/01/13/opinion/sunday/can-your-hip-replacement-kill-you.html
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Here is a good overview, from somebody who’s apparently been around long enough to see the whole field develop (edit – no offense to those who are fairly new to the field). Published less than 2 years ago, ~July, 2016. After I had my surgery, in late 2014.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/
Here’s an excerpt –
“If the incidence of chronic pain after mesh repair approximates 16.5%, then a very significant number of patients will have debilitating pain resulting from the procedure when most patients likely had little or no preopertive [sic] pain.
This possibility presents a potential time bomb for the surgical community and medical device suppliers. Hernia recurrence has been largely reduced by the use of synthetic mesh for repair, but a new problem, chronic postoperative pain, has arisen to rival recurrence as a serious consequence of surgical intervention. ”
From Chronic Pain Following Inguinal Hernioplasty by Michael S. Kavic, MD.
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quote ajm222:i’ll say that i know several people personally who had mesh repair and haven’t had any further issues. some of these had the surgery done 5 or ten years ago, and some almost 20. so i guess it depends. the bigger question is: is non-mesh repair any better.
Seems like you, and many of us, might be getting overwhelmed by all of the information out there, and are trying to generalize it down to something useful. You’ve distilled everything down to “mesh repair” and there might be much more to it than just mesh.
Saying that “all mesh is bad” is not good enough to make progress in getting rid of the bad materials and methods. Many people are happy with their mesh implantations. But many are not. We need to find the correlation between the unhappy people and the materials/methods used.
If you read through all of the mesh removal and mesh problems threads on the site you’ll find that many, 4 of 9 for removal, are for Bard 3D Max. I had problems with Bard Soft Mesh. Bard has a very large presence in the mesh market place. Many surgeons are stuck using the material of the device maker with which their organization has a contract, and contracts are awarded based on cost. So you could find that experienced expert surgeon but he/she will be inclined to use what their organization has contracted to use. One more way the big device makers can control the situation. Read the article in this link, from just two years ago, and you might rethink who you choose. There’s a definite view of “any and all mesh is good”, and “all that matters is surgeon’s skill”. It’s actually scary to read, considering all. http://www.generalsurgerynews.com/Ar…rticleID=34826
Alternatively, if all mesh really is the same, then the 15-20% chronic pain number is your chance of getting it. If you thought you had a 1 in 6 chance of chronic pain would that sway your decision? Because without a correlation to specific brands of material, that’s where we’re at. Take a single die and roll it one time.
So, besides the general advice to find a happy person and use their surgeon, it would be reasonable to avoid Bard 3D Max. It seems to be one that often causes problems.
Good luck. Whatever you do, don’t just decide to roll the dice and see what happens. There are no do-overs.
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Prof. Aali Sheen (aka Herniator) is from the U.K. so might know of somebody. But, he is a believer in the use of mesh so there might be some reticence to advising you. Worth a try though, and he is on your side of the Atlantic. You can click the box by his name ands send a message to him. He posted in the “mesh removal” thread I attached below.
People have waited much longer than 5 years to have their mesh removed. Good luck.
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quote WorriedWife1:I’m concerned that he is moving forward with the hernia diagnosis
If he got the vasectomy so that you two could have a better sex life, then you should be very concerned about today’s hernia repair method of choice. Laparoscopic implantation of large pieces of mesh can impact the penis and surrounding body parts. It did mine. The more active I was the worse it got. And it wasn’t the type that a pill can fix. So, your husband’s physical type of work is going to make these problems worse if he has them. He won’t be able to stop sports or working out and just spend more time at a desk so that he can have his penis back. The inflammation affects all surrounding tissues, and gets worse with movement. It’s not a problem that most men will talk about, but if it doesn’t work there’s no point in not talking about it.
The big risk for both of you right now is that the majority of surgeons out there who do laparoscopic mesh implantation will seem very confident in the materials and method. You will feel very comfortable that he or she is going to fix him. You’ll feel relieved once you choose a doctor to do the work.
If you go for a consultation the surgeon will probably discount stories of dysfunction or chronic pain as internet rumors, or from the past. They might cite research work that supports what they plan to do, but not the research that describes up to 20% chronic pain. They might have hundreds of surgeries under their belt. Mine had over 400, I believe, so the advice to look for an experienced surgeon does not guarantee success if you find one. I had my surgery in 2014, and they still do things the same way.
Watch this video and you’ll see the guidance to place large pieces of mesh, even on the side that is asymptomatic. Sponsored by a medical device maker. Click anyway, even though it’s intended for the professionals.
http://www.ethiconinstitute.com/node/885/asset
If he does decide to have surgery, find a surgeon who can say that they know their past patients are doing well, years later. “I don’t know, I haven’t heard anything bad” is reason to keep searching. Find a friend or colleague who has had successful surgery, and does what your husband plans to do, and get the exact same surgery. Make sure that your surgeon knows that their method and material choice work in the long-term, and that recurrence alone is not their criterion for success.
Good luck. Be careful. The news these days is full of stories about the big corporations of the medical industry pushing sales over patient welfare. Opioids, birth control, trans-vaginal mesh, and hernia mesh among them. Even the physicians are trapped in the mess. It’s up to the patient to find somebody that they can really trust.
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quote Ddot14:I’m located in Minnesota and would obviously love to find a surgeon in-state, but am willing to travel if necessary to see an experienced, talented, and supportive surgeon. I would like to find someone in the Midwest someplace (Minnesota, Wisconsin, North or South Dakota, Iowa, Illinois, Indiana, etc) if possible, but will consider traveling farther if I need to. I’m aware of Dr. Kevin Petersen in Las Vegas and Dr Robert Tomas in Florida, but I’m unable to fly and the long drive with a hernia isn’t very appealing if I can find closer options. But I’ll do it if I need to!
Just had another thought also. Don’t be too economical or “practical” when making your decision. The effects of a poor decision will last for the rest of your life.
I think that one of the problems with today’s hernia repair with mesh method is that it is so easy to do the repair quickly, with no short-term complications. It’s a battle of short-term results versus long term results. We all tend to think in the short-term, and even long-term to most of us is months or a year or two. Both patients and doctors tend to lean toward the mesh repair, I think, because it gives immediate relief and seems so simple. Just get that mesh to cover the defect with a lot of extra just-in-case material, then get out. The patient only has to plan for a few hours away from home. It all seems so simple. The protruding abdominal contents are placed back where they should be, the mesh covers the hole, and the access holes are sewn up. One to two weeks later the patient is functional. But the relief is not full or complete. The patient ends up at some lower level of the person they expected to be, with no apparent solutions.
So, even though you’re avoiding mesh, to avoid long-term problems, you’re still planning in a short-term, convenient, way. I did the same thing when I had mesh implantation. I was close to traveling to the Shouldice Hospital but then a different easier path appeared, with confident people telling me it was safe and effective.
Just an observation and maybe a push for you to go a little farther to get what you want.
Don’t overlook also though, that there are many stories of successful open repairs with mesh. But open repair has more short-term risks, like bleeding and infection. It leaves a bigger scar and there might be a bump. Healing is slower. But the long-term results might be better.
If somebody on the inside collected information they might find that there are specific bad materials and/or bad methods. Everybody would benefit if the bad actors could be rooted out. It might be though that the biggest device makers are the bad ones, and they control the field. Until somebody identifies who the bad ones are though many people will assume that all mesh is very risky and avoid it like you are.
Good luck.