Good intentions
Forum Replies Created
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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.
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Here is an interesting but frustrating article about athletes and inguinal hernias. It goes in to depth about using unltrasound and Valsava to diagnose hernias. The frustrating part is that they do not describe at all the hernia repair method, but do report that the repairs seemed to alleviate pain and allow the athlete to continue in their sport.
But they do use the word “herniorrhaphy” which, by definition means no mesh is used. So, even without the details, here is a small positive study showing that non-mesh repairs can be successful for the athlete. Off the topic of the thread title but it follows from the discussion. The authors would be worth seeking out if you’re in the upper midwest area of the US.
Excerpt –
“Clinical Relevance:
Persistent groin pain in the athlete may relate to inguinal hernia, which can be diagnosed with dynamic ultrasound imaging. Herniorrhaphy is successful at returning athletes to sports activity.” -
There have been comments about how surgeons use mesh in athletes but, so far, no specific success stories. Not even anonymous stories. If you follow sports you’ll often see stories about athletes who go to specific clinics to have their knee, ankle or shoulder repaired. Or stories about sports hernias. But no stories about inguinal hernia repair. The one common thing you’ll see about the clinics that operate on athletes is that they avoid mesh.
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I think that I would focus less on the fact they specialize in athletic pubalgia and more on the fact that professional athletes seek them out for their core injuries. To them a common inguinal hernia is probably simpler to repair than a “sports hernia”. They all avoid mesh for any purpose in repairing an injury. I think that that is telling. The common man/woman gets mesh, the elite athlete avoids it. Search “dai greene mesh” to see what happens when an elite athlete gets the run-of-the-mill repair.
Dr. Brown also has athletes that seek him out and, as you probably know, avoids mesh, even though he was in the original group of surgeons who used the Kugel plug repair method. He saw firsthand the damage that mesh causes and stopped using it. Dr. Kang also used mesh and stopped using it because he had too many patients returning with pain.
Those are basically the two types of surgeon that are out there. Those who know mesh causes more damage than a pure tissue repair but say “oh well, that’s just how things are done today”, and those who see the damage and refuse to participate. People who just do what they’re told and collect the paycheck and those who control their own lives and destiny, doing the things that made them want to become surgeons. So that they can help people.
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Dr. Muschaweck is known for repairing hernias, groin strains, athletic pubalgia (sports hernia), and other ills of the professional athlete.
My reference to the porcine material was because the article mentioned specific people with “hernias”, then started talking about porcine mesh. A typical lazy journalist method of trying to add interest to to an article. But the lazy comment led me to the Biohernia site when I started researching Lampard’s injury.
It looks like Lampard’s injury, and Glenn Murray’s, were both of the “sports hernia” type, maybe leading to full tears in the groin area.
Dr. William Meyer of the Vincera Institute is also known for working on professional athletes, with an emphasis on “sports hernias”. I think that he also avoids the use of mesh, but it looks like they have hired others that do use mesh. I’m not sure how they use it though. I’ve had correspondence with the Institute and asked if they could share their knowledge but, unfortunately, in today’s world, knowledge is money. If they show everybody how to do a better repair they’ll probably lose business. Capitalism.
https://vincerainstitute.com/core-muscle-injury-treatment/mesh
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The critical error message is new, I just got the same thing. You clicked in the right place, but there is a problem with the site software.
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Do you know the details of the repair? The type of mesh, and the surgery notes? There are many different types of mesh implanted via open surgery. And many surgeons do more than just implant mess, like performing neurectomy (cutting nerves to avoid future pain). The details might offer some clues about your best path forward.
Also, the imt elapsed before pain started would help. 12/16 to 1/17 is different than 1/16 to 12/17.
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Here is the ACHQC youtube channel video page and a video showing how the PRO form is used.
https://www.youtube.com/channel/UCtsURlxpeI3s6zIzOmLYxKA/videos
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Here is a link to the AHCQC web site and a link to the inguinal hernia Patient Reported Outcome survey form.
The results do not appear to be freely available, it has to be requested. If the news is good, why not broadcast it to the world?
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I saw your post about porcine mesh material and read the attached article. It led me to look for more about Frank Lampard’s hernia (Lampard is a famous soccer player). The article seems to imply that maybe Lampard had porcine mesh used to repair a hernia. But it turns out that he had Dr. Muschaweck (I think) repair his hernia.
The Biohernia project is getting very sophisticated. Here is the latest from their web page.
https://biohernia.com/en-ie/inguinal-hernia-elite-athletes/
https://biohernia.com/en-ie/inguinal-hernia/non-mesh-hernia-operation-methods/
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Tela-Bio’s Ovitex is the latest biologic to hit the market. It is made from sheep intestine, but the premise is the same – strip the tissue down to its basic collagen and assume that the human body will remodel it into human tissue.
Dr. Towfigh and Dr. Szotek are both proponents of Ovitex for inguinal hernia repair. Dr. Szotek presents at the big meetings nad has made youtube videos.
https://finance.yahoo.com/news/tela-bios-ovitex-reinforced-tissue-110000926.html
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The lack of regulation in the field for new products means that many new products get introduced and sold with claims that turn out to be untrue. This is from 2014.
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You can look back over the years and see that blaming technique is the tool that the mesh-makers and users have used to deflect attention from the mesh. Blame the technique, but don’t name a specific technique. Claim that there is no evidence of problems inherent to mesh alone but provide no evidence, and ignore the fact that there is no evidence that mesh is not the problem either. It’s just a coincidence that mesh is there, and that the pain disappears when the mesh is removed..
Simple logic can be used to draw a solid correlation between mesh implantation and chronic pain, if enough data is collected. Laparoscopic procedures that involve peeling the peritoneum from the abdominal wall but with no mesh implantation, for example. Explaining why removing mesh removes the pain. That one seems very clear. I had mesh with pain, the mesh was removed and the pain was removed. How can the cause of the pain not be considered an intrinsic property of the mesh? There was no neurectomy done during the mesh removal.
I think that the word game here is the same word game used to make jokes, or to retain something that makes money, or continues something that a person has invested time and money in to. It’s not the fall, it’s the sudden stop at the end that injures people. Guns don’t kill people, people do. It’s not the mesh causing the pain, it’s the shrinking and buildup of tissue around the mesh that causes the pain.
In the big picture, the mesh-makers plan has worked. They have delayed and deflected and convinced for many many years and today’s surgeons have their whole careers invested in supporting mesh-based hernia repair, and, therefore, they have to support mesh. They have investments and bills and don’t know any other way. Pure tissue repair is not taught in the major medical schools. Everywhere you look, behind the scenes, you will find mesh-maker support, for the conferences, paying the huge exhibitor fees to the various surgery or hernia societies (75,000 – 100,000 for a booth in an exhibit hall), at the universities with their on-campus robotic surgery training centers, consultancies, and complimenting the surgeons who say good things about mesh.
Dr. Towfigh, can you give a few examples of the “problem in surgical technique” that you have seen? And explain how it was the cause of the pain, and not the mesh? It shouldn’t take long. A presentation on the topic at one of the big meetings would surely be well-received, even applauded, if you could show your colleagues what mistakes to avoid. Much more impactful to patients and colleagues than busting myths. Busting myths helps the mesh-makers but does not help your colleagues and their patients. Think of all of the patients you could help by speaking up. I think that it would be much more personally satisfying and fulfilling also, than just defending the use of “mesh” in all of its forms.
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Hello @drtowfigh . Could you provide some follow-up on your meeting with the FDA. I know that the times have been tough, and all government agencies were seriously handicapped by the last administration (no offense to anyone’s political views, it’s just a reality), and the ongoing COVID pandmeic, but, maybe, efforts can be re-initiated? The FDA is the supposed regulatory body that would be monitoring product problems. There is little sign of their efforts in the past.
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I just checked, and Ethicon’s “Two Year Study”, started in 2007, is still pending. It’s a good example of an industry-managed registry.