Good intentions
Forum Replies Created
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Two weeks is still early. Are you active or working, or just waiting to feel better before doing things?
Do you know what type of mesh and procedure was used? There is a large variety out there. Lichtenstein, two-layer “systems”, Onflex, plug and patch, and variations of these.
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The first comment to the GSN article is interesting. The doctor missed the opportunity to describe the method and materials that have worked over the years for him though. But his point is valid.
“Rafaellugomd wrote on: 1/11/2022 3:21:02 PM (EST) 2 days ago.
I looked at the numbers and what stands out to me is that in 23 years doing inguinal hernias in the same city and practice, I have never removed a single mesh and this group has all these patients to remove meshes. The question I have is why? Why so many? Is there a problem with the technique when these are placed? “ -
Here is a publication by the authors on the subject. More good places to consider for mesh removal. Dr. Towfigh is a co-author.
Unfortunately, despite the efforts to make patients responsible for being “informed” so that they can take responsibility for their decisions, the main article is a pay-per-view article. Everything comes back to money.
https://link.springer.com/article/10.1007/s00464-021-08963-4
Three of the authors are from Cedars-Sinai Medical Center, and two are from the Beverly Hills Hernia Center.
Here is the head author’s address:
Desmond Huynh, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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I found an old video of a scene I remembered from a TV show. It seems scary but it’s an example of how the intestines will just keep working no matter where they are. You can find pictures around the internet of much worse cases. I think that if something extra ends up in your scrotum you will know it.
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Dr. Ponsky would be worth a call or message. There might be a hidden network of non-mesh hernia repair surgeons if Ohio is too far. Who knows.
https://herniatalk.com/forums/topic/laparoscopic-non-mesh-hernia-repair-todd-ponsky/
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I have had talks with surgeons who describe that the hernia defect is actually intact tissue that has stretched beyond its elastic limit. Sometimes it stretches so far that is almost disappears, it’s so thin. In other words, it’s not an actual hole but just a very over-stretched area that will try to regain its original shape. But, it will still be weak and easily over-stretched again.
That fits with what I remember about the early stages of my hernia. I would get the odd effects but they would resolve with rest. Then come back again at the next exertion, typically a soccer game. Maybe if I had just stopped playing soccer the problem would never have come back and I would say that I had healed. I did have some longer periods of time off between games where I did not feel the effects and felt “healed”, but the effects kept coming back when I played soccer, until I realized it was a hernia. I wanted to maintain my active life so chose a mesh repair, which produced a worse effect than living with the hernia.
In short, I think that many of the hernia healing stories are actually activity reduction stories. Accepting a diminished lifestyle in order to avoid the aggravation of the hernia. Which makes sense. But the typical surgeon tends to promise that the former life will be restored with a mesh repair. I think that many people with “successful” mesh hernia repairs have actually just accepted their new diminished life. There’s nothing wrong with that, but promising a restored life when it’s known that it isn’t likely is wrong.
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The Search function on the site works now, it has not for a couple of weeks. It is in the upper left corner of the home page. Put Desarda in the search box and many results will come up. This forum does not have many members that participate on a regular basis but there are years worth of past posts that are still relevant. Don’t mingle short-term pain with long-term pain in your thought process. Better to suffer short-term pain and very little long-term pain than vice-versa. Good luck.
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Here’s another example, on a much larger scale, of how the medical industry is focused on market share and revenue, at the expense of the broader good of humanity.
For those who wonder why mesh is so popular, when cheaper, equally or more effective, procedures are available. The same types of executives are making the decisions. Everyone below, with a few exceptions, just does what they are told to do.
We should all hope that more people like this step up and persist in their efforts.
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Here is a link with a good illustration. Medially means toward the middle. In my case a very distinct bump appeared when I was standing. I am low body fat, but high BMI. In other words, there’s not much between my skin surface and the abdominal wall. I can still feel the spot now, it is more sensitive than surrounding tissue.
The labels of direct and indirect seem backward to me. In an indirect hernia the material actually enters the canal directly, through the same opening that the spermatic cord does. In a direct hernia it enters the canal from the side, which seems indirect to me. But, somewhere in the past, those labels were determined. Part of the mystery of medicine and what all of the words mean.
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It’s not clear if you are a skinny low body fat person with defined musculature of the abdomen or if you have some coverage by fat. On a skinny person the signs of a direct hernia are very clear, a pyramid shaped bump appears in a certain area of the abdomen, medially to the crease of the groin. You can find illustrations around the internet showing the location. It’s what I had. As material pushed in to the canal, my right testicle would twist and behave abnormally. This would be after rigorous activity. A physical exam at that point might look like an indirect hernia because there is material pressing on the spermatic cord.
I would think the imaging would be more likely to be correct. It’s not clear what criteria the doctor who did the physical exam was using to make his/her determination.
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That’s expensive. Too bad.
When you are doing the calculations, don’t overlook that your insurance will probably not cover all of the costs that you assumed it would. You might pay a percentage of some procedures, there’s probably a deductible, some things just don’t get billed to insurance, they’ll bill you directly first, some things just won’t be covered at all, like maybe they had to use an outside the system anesthesiologist. All of my surgeries were more expensive than I expected/calculated, and I had good insurance plans and tried to figure out the cost beforehand. There will be many uncovered small charges that add up to a large number.
It’s very difficult to know how much a procedure will cost before it’s done. In short, don’t assume that going with your insurance coverage will be substantially cheaper than paying directly. Especially if you have the procedure done at a large clinic or hospital. The health care “system” is made up of inflated costs and negotiations/agreements between large corporations. Even just a small percentage of those inflated negotiating costs applied directly to the patient can add up to a large number.
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Here’s the page about repair methods.
https://vincerainstitute.com/core-muscle-injury-treatment/mesh
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The Vincera Institute would be worth a look. I think that they avoid working directly with insurance companies but will provide the information needed to make a claim. They do their own imaging, and avoid mesh if possible.
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A failed Shouldice repair would result in a recurrence of the hernia. I don’t see that described. I only mention that for clarity. The description sounds like a guess that a suture pulled free, or impinged on a nerve, or something. They don’t know.
Do you know what type of mesh will be used? I know of somebody that had a synthetic mesh removed and a biologic mesh implanted to replace it, on the assumption that biologic was better. The biologic mesh caused pain and had to be removed also. Beware of surgeons wanting to try the latest thing on you.
Also, laparoscopy surgeons are experts in laparoscopy and tend to believe that it is the “best” way always. There would be no “ripping open” of the Shouldice repair if an open operation was done. It sounds like you will be having a TAPP procedure, with some dissection and a mesh implantation. If they have to remove the sutures from the Shouldice procedure it will probably have the same basic effect as if they were removed from the front. Removing scar tissue is a different issue though. She will be able to access all of the areas that the second mesh implant was contacting and all of the areas that were previously dissected. So that looks promising, if her premise is correct.
I would offer words of hope but they won’t really help anything. It sounds like you have done the work and are already scheduled. Stay in touch.
Good luck.
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I will just follow those posts with a reinforcement of the warning to beware the 3rd surgeon who is discounting everything that happened to you and wants to start over again with another mesh implantation. One of my comments in a previous post to your early problems was about a surgeon I saw for mesh pain who did not read any of my history before my visit, but had already assumed that I had had a recurrence, and was ready to get right back in there and fix it. I spent 15 minutes explaining to a confused mesh-implantation surgeon that I did not have a recurrence, I just had pain and specific physical symptoms that something was wrong, caused by the mesh. All he saw was another mesh procedure sitting in front of him.
I’m sorry that your problems are persisting SFIrish, it seemed like you were on a path to success. I think that they might be beyond the abilities of the common surgeon, especially the odd popping and clicking that continues. I would really consider finding a true expert in abdominal/core problems.
Dr. Meyers would be my first choice. The people at the Vincera Institute are very considerate. Marcia Horner was the one I corresponded with when I was having problems. I sent them a letter, and my images, and received a reply soon after.
Good luck.
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Here is another. I hope that I am not being too involved. Feel free to let me know in the public forum, if I am. I won’t be offended. The message function is broken. It might be that Dr. Towfigh is losing interest in the web site. I hope that she will keep it alive, at least for the wealth of past information.
https://herniatalk.com/forums/topic/doctors-in-bay-area-who-specializes-in-hernia-repair/
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Here is the thread about the results of the removal and Shouldice procedure. It’s not clear who did the procedure, just that it was done at Kaiser Permanente.
https://herniatalk.com/forums/topic/shouldice-post-op-questions/
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I found the thread where you were looking for removal surgeons.
https://herniatalk.com/forums/topic/need-help-advice-on-drs/
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I found your first thread. The search function on the site is broken. You can use Google and put “site:hernaitalk.com” in the search box followed by search words to find things on the site.
So it looks like Progrip was the original mesh, a large piece, ~4×6 inches. A typical mesh implantation.
https://herniatalk.com/forums/topic/stinging-pain-with-popping-and-clicking/
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There are well-respected and well-known surgeons out there who refuse to accept that mesh can cause pain. Dr. Bruce Ramshaw, for example. Many of them will look for other reasons for the pain, like fixation, or contacting a nerve, or various other possible causes.
The damage that mesh and mesh removal causes might have made the remaining tissue unsuitable for a suture-based repair at the time. The inflammation makes all of the surrounding tissue weaker. It’s unfortunate that you ended up with a surgeon who, apparently, is going to try to prove that mesh works. This 3rd surgeon is discounting the work of every doctor that has worked on you, proposing that he can do mesh implantation the “right way”. That is the basis of rejecting all mesh complications. Blame it on the former surgeons.
I think that you are in a very dangerous situation. If mesh caused inflammation the first time, there is no reason to expect it to not cause inflammation the second time. There are theories out there about becoming sensitized to mesh or synthetic materials after mesh implantation. Even autoimmune diseases have ben proposed as resulting from mesh inflammation, or vice-versa.
If you can collect all of your medical records it would be worthwhile to reach out to some of the well-known “non-mesh” repair experts, like Dr. Muschaweck, or Dr. Meyers of the Vincera Institute. If you send them an organized package of your records and a descriptive letter, they will probably respond.
At the least, find out what mesh was used the first time and what mesh will be used this second time. You could end up with the same inflammatory response, but surrounded by tissue that has been abused for several years. I would guess that neurectomies are also planned, since you have specific pain.
I am going to search your old posts, but when you are seeking help it really helps your cause to pull together a very organized and specific story. There is much chaos out there when it comes to mesh complications and it is too easy for doctors to avoid the problem if they can’t understand it.