Good intentions
Forum Replies Created
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Has anything been determined about Dr. Sea’s Topic, and his disappearance from the forum membership? Did he ask to be removed? Did Dr. Sbayi ask to have the Topic removed? You said that you would follow-up. Without a follow-up the void can be filled with conspiracy theories, to mirror the news of the day.
As you can imagine, it’s disturbing to see a person’s efforts destroyed so thoroughly. Many, most, of the posts were very thoughtful and took some work to produce.
Thank you.
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It is interesting how the surgeons seem to view their bodies differently than their patients’ bodies.
Here is an old tweet on the watchful waiting topic. Even though they could die or end up in the emergency room from an incarcerated hernia they choose to wait. Very strange.
The choice of surgery method is not the same as what you saw though.
https://twitter.com/Herniadoc/status/1114246402950012930
Fascinating audience polling by @DrMicki of laparoscopic general / hernia surgeons. Here are 3 questions:
Q1: how many of you would have your minimally symptomatic inguinal hernia repaired?
A: 56% choose watchful waiting. pic.twitter.com/oZ0RCpcknH— Dr. Shirin Towfigh (@Herniadoc) April 5, 2019
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Dr. Krpata might be worth consulting with. I’ll post some links.
https://my.clevelandclinic.org/podcasts/butts-and-guts/chronic-groin-pain-clinic
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In the Shouldice repair the cremasteric muscle is completely removed from the spermatic cord. Any surgeon who does a Shouldice repair should be able to examine the cord and muscle and remove any staples if appropriate, without major concern, I would think. Maybe that’s why you came to a hernia repair site.
I would find a good hernia repair expert who understands the Shouldice repair. If you browse through the forum posts you’ll find several comments about surgeons who do not have a good understanding of the anatomy of the inguinal region.
There are thousands of surgeons out there who will try to help you, many just for the challenge of something new, but many who will not actually have the expertise to do so. Be careful.
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I don’t have any suggestions Daniel. Just wonder if staple/clip removal is possible or has been suggested. Since the cremaster muscle is actually a muscle that moves and slides against surrounding tissue in the inguinal canal it seems to make sense that a metal clip would cause problems after activity.
And, if you’ve seen Watchful’s Shouldice thread you’ve seen that cremaster function after Shouldice is a big topic. Have you noticed if the scrotum is able or unable to lift the testicles? Maybe you could comment in his Topic. Good luck.
Here is is:
https://herniatalk.com/forums/topic/where-would-you-go-for-shouldice-surgery/
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That is a good suggestion David. I had the same problem then realized that I could put the page number in the web address box at the top of the page. Might be hard to do on a phone but pretty easy on a computer.
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Sounds like the nerve that controls the cremasteric reflex is being impinged. I actually just posted an article about it in Watchful’s Shouldice discussion. I will link it below. It’s old but it describes several case studies, similar to your problem.
You didn’t say what type of mesh implantation you had 20 years ago, open or laparoscopic. Also not clear if any mesh was removed when the recurrence was repaired. Dr. Towfigh says that new mesh is never laid over old mesh but you can find several reports of this being done around the various internet sources. It sounds like you had another piece of mesh placed to fix the recurrence but the old mesh was left in place. I would guess that you’ll need more work done to fix the testicle retraction problem.
This paper will be informative, I think. Good luck.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1979762/pdf/brmedj03205-0028.pdf
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Also just saw this on the Shouldice site. Visiting Vancouver n late September.
https://www.shouldice.com/remote-clinic
Shouldice Hospital is returning to Vancouver!
Hernia Examination Clinic September 26, 27, 28 & 29
For further information call 1-844-712-1362 -
If I had an indirect hernia I’d talk to Dr. Ponsky. He seems very rational and very well-informed. Even though he is primarily a pediatrics surgeon, he also works on older adults. He might be open to repairing an adult hernia via his laparoscopic procedure.
You might be find that his method makes the most sense and you can move on from considering the Shouldice repair.
https://herniatalk.com/forums/topic/laparoscopic-non-mesh-hernia-repair-todd-ponsky/
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I would study more about the actual function of the cremaster muscle. My shallow reading is that it serves a dual function. One is the rapid protective retraction of the testicle in cases of danger. The other is the temperature regulation function. Which is also a function of the scrotum. The scrotum might also pull the testicles up, rather than just going along for the ride. Somebody has probably studied this.
So it might be that all that is lost is the speed at which the testicle moves. Not the actual range of movement up and down.
Sometimes when I see these concerns I also wonder about boxers versus briefs. Brief wearers spend most of their day with the testicles high. Boxer wearers not so much.
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Don’t overlook the scrotum. The body often has redundancy (e.g two testicles). Here’s a couple of references and one that I pulled from the Wikipedia entry about the cremaster muscle.
https://www.verywellhealth.com/scrotum-anatomy-4782407
https://en.wikipedia.org/wiki/Cremaster_muscle
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1979762/pdf/brmedj03205-0028.pdf
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When talking about mesh you have to include the solution to the chronic pain problem if it happens. With mesh it’s mesh explantation. I have not seen anything that suggests, realistically, that the pain clinic remedies actually “cure” the problem. They cover it up and create new pharmaceutical based problems. A person could be on pain meds for life. The same with neurectomy. A new risk of new problems.
I like your summary but the discussions of risk almost always end short, in my opinion. You have to consider the long-term.
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That is an excellent find, thank you for that. Everybody should read it, whether they are looking at a Shouldice repair or not. Dr. Netto covers the inguinal hernia repair in whole in his remarks. With some very interesting comments about why mesh is so popular today. Save the link immediately. The battle continues. It’s like a civil war.
I would be very interested to know how, exactly, the Shouldice Hospital uses mesh. Dr. Netto seems to have fallen in to the trap of referring to all types of mesh and ways to use it as “using mesh”. It’s the great confuser of the hernia repair field.
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Thank you for that link to the Comment. It’s funny how you can find more if you look, I didn’t look hard enough.
But, the one reference that we would all like to see, #5, about chronic pain rates, is still behind a “sign up for free trial” wall, just a few lines down from the preview. Oh well. This internet world is a strange place. It might be worth a sign-up for Watchful or others.
“lower post-operative complications (including chronic pain) [5]”
In addition though, another useful item in the Comment article is the email addresses of both Dr. Netto and Dr. Szasz. Maybe somebody could invite them on to the forum, for their views. Or they might respond to a well-written query about chronic pain or other details of the Shouldice procedure.
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Dr. Netto and Dr. Szasz also had some comments about the Lorenz et al paper that was referenced in the missing Dr. Sea thread. It doesn’t look he has published anything since his Towfigh interview.
It is pay-per-view and a comment so there is no abstract.
https://link.springer.com/article/10.1007/s10029-021-02455-z
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I found the video with Dr. Netto discussing chronic pain. I think that you have to listen to everything he says about it to understand what he means. He said that they did not know and guesses at “maybe 5″%”. He also talks about the type of pain, describing it as pain that does not require pain meds. Overall, he seems to be just saying that chronic pain from the Shouldice procedure deserves more study. He has an accent so you have to listen carefully, plus his microphone was cutting out.
It’s at about 19:00. I timestamped the Share so it should start there.
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Here are links to the sites you mentioned above.
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Thank you WB. I also appreciate Dr. Towfigh’s efforts in keeping the forum going. I’ve enjoyed the discussions and have learned a lot. But I think that the reality might be that this forum is not really high on Dr. Towfigh’s list of things that she enjoys. Her youtube channel seems to be much more fun, where she participates directly with a fellow surgeon.
If Mr. Sea’s post cannot be recovered then how can a person be confident that the whole site won’t be inaccessible someday? It’s just the reality of today’s internet that things never really disappear. We should be ready for that possibility.
One thing that might happen is that in order to resurrect Dr. Sea’s Topic, everything that has been written since then will have to be disappeared. So, more discussions lost. It’s a vicious cycle.
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It really is a shame that Dr. Sea’s Topic is gone. All of these details were discussed in that Topic. It makes you wonder what causes things to get lost and how much effort a person should put in to participating here. How can a whole multipage thread just disappear, without a trace? It’s like the Secret Service text messages. Very strange.
Anyway, didn’t you say that you had an indirect hernia? The Shouldice repair seems kind of invasive for a small indirect hernia. The point that Dr. Kang made in the missing thread.
Also a shame that a professional’s efforts would be disappeared. Most of us on the forum are just internet “experts”, surfing around the web, reading, trying to understand. Dr. Kang contributed his thoughts to Mr. Sea’s thread as a bona fide experienced professional. And they just disappeared. How can that happen?