Good intentions
Forum Replies Created
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You can call her office directly. @drtowfigh
https://twitter.com/Herniadoc/status/1010040439401877504
Dr. Shirin Towfigh
@HerniadocNot near? No problem.
I offer “Online Consultation” to those who cannot physically see me for surgical consultation. I’ll review your history, images, & help w/ a diagnosis & plan.
Contact my office (310-358-5020) or email (info@beverlyhillsherniacenter.com)
Not near? No problem.
I offer “Online Consultation” to those who cannot physically see me for surgical consultation. I’ll review your history, images, & help w/ a diagnosis & plan.
Contact my office (310-358-5020) or email (info@beverlyhillsherniacenter.com)#ItsNotJustAHernia pic.twitter.com/SVTkEFRAUh
— Dr. Shirin Towfigh (@Herniadoc) June 22, 2018
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Here is a good place to get a fourth opinion. Their focus is on athletes and core injuries, the professionals go here. Free consultations.
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The gastro surgeon makes the most sense. One thing that you should consider is what, exactly, any surgery would be. What would the surgeon do to fix your problem, and what unintended consequences might you suffer? Surgery is very specific to the problem being addressed, and, ironically, incisional hernias are a very significant problem, after surgery. In other words, your small hernia repair could lead to a big hernia later, just through the act of surgery. Even laparoscopic surgery has the risk of adhesions and/or unintentional nerve damage.
The pain specialist story is a good example of what’s happening in medicine today. Specialists that can only see the world through the lens of their specialty.
@drbrown might have some thoughts. He has probably seen similar over the course of his career working on athletes and “sports hernias”.
It looks like you have been very healthy for most of your life and maybe have not had any significant medical problems. So, as a “first-timer” you might be expecting too much from the medical field. They are excellent at getting people back close to normal after disasters and major events, but recreating perfection from small amounts of damage doesn’t really happen. All of our bodies take some damage over time. Be careful trying to fix what looks like a minor issue. You might end up in a loop of fixing new problems created from the prior fixes. No offense intended, but if you look back through the posts in the forum you’ll find several stories from people who thought they were going to be fine after a “simple” procedure but ended up in terrible shape afterward.
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Dr. Todd Heniford is in North Carolina if you can go there, link below. He seems very conscientious and aware of the problems with mesh. You’re probably going to get mesh unless you travel so make sure you choose a surgeon who is aware of the issues and working to deal with them. Dr. Heniford might even do non-mesh procedures, I would be surprised if he didn’t, considering his involvement in the various hernia repair focused groups.
Dr. Voeller is also at the UT Medical Center but he is 100% a mesh surgeon, and considers the problems with mesh unsolvable. Be careful if he comes up as a possibility. Good luck.
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There are insidious side effects to the mesh pain. You might eventually realize that you’ve been getting weaker and less healthy because you’ve been less active, to avoid the pain. If you try to become more active to get your overall fitness back you might find that the pain grows with the activity level. That is the bind that causes people to have mesh removed, I think. Either accept a weakened, less healthy life, or get the mesh out and hope that your body recovers.
The recovery from mesh removal does take a long time. The patient’s body has adjusted to the mesh for as long as it’s been there and now must readjust to having it gone. Mine has been out for just over three years and I still feel twinges and swollen feelings sometimes, but overall my activity potential is back to normal. Even the small mesh fragment that was left seems to have settled in, it doesn’t get sore as much as it used to. And, no new or recurring hernias.
I think that longer it is in there the longer it will take to normalize after it’s removed. It makes sense. But only the person with the mesh can tell which way things are going. It’s a difficult decision. Take an assessment or where you are physically and where you want to be and evaluate whether things are stable or getting worse.
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The surgeons at OHSU are known for their expertise in hernia repair also. In Portland. They have a very long waiting list though.
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Dr. Towfigh does remote consultations and might know someone in your area.
https://twitter.com/herniadoc?lang=en
Dr. Shirin Towfigh
@Herniadoc
Not near? No problem.I offer “Online Consultation” to those who cannot physically see me for surgical consultation. I’ll review your history, images, & help w/ a diagnosis & plan.
Contact my office (310-358-5020) or email (info@beverlyhillsherniacenter.com)
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Your surgeon was right about the timing, in the early days you just can’t tell what the final result will be. Make sure that you stay active, walking and moving, but nothing extreme, so that things can settle in to the places that they’ll be in for your normal life.
I had odd sensations that only resolved after about a month, when I was stretching in bed after waking. But, in the end, I did not have a good long-term result. You probably will do better, it can’t be determined ahead of time.
In the early weeks, there is not much that anyone can or will do unless you have obvious physical problems.
As far as right versus left, direct versus indirect, with mesh they just do the same on both sides. Lay the mesh over all of the areas that might herniate in the future, after they pull the material back from the wrong side of the abdominal wall. Your surgeon probably had to dissect the “fat” from your spermatic cord and the trauma is where your pain is originating. The cutting/peeling of the material from the cord, leaving a raw surface behind.
Don’t do anything crazy. Wait, stay active, hope. Odds are you’ll be okay.
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Hello Star. Dr. Towfigh is well-known for her methods of diagnosing hernias using imaging. If you read through the many posts on the forum you’ll probably find a wide variety of symptoms from hernias. It seems like you’ve followed the normal path of feeling pain, seeking help, and getting a proper diagnosis. Are you wondering if you can avoid surgery? Or are you second-guessing whether or not you really have hernias?
Good luck. Despite the prevalence of the condition in society the number of possible “solutions” is huge. It’s a difficult place to be.
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Peter C makes a good point about Dr. Muschaweck’s thought’s on neurectomy. He jogged my memory about her reply to my query about mesh removal. Actually, her reply is why I decided she would not be a good option for my problem, I pasted it below. I could tell just by the way the mesh felt inside me that my problem was not due to a specific neve or set of nerves. And that is what Dr. Billing found when he removed the mesh. All of the mesh was surrounded by edematous tissue. In other words everything it contacted was irritated, not just a nerve.
But, she still seems to know how to repair hernias. That is another thing I’ve learned. Doctors can have great expertise in one specific area but just be average in others, thinking along with the crowd. With the mesh companies controlling the discussions, the meetings and topics presented, they control the overall situation, hindering open sharing of information so that people can learn. So, a person has to be very focused on what, exactly, their problem is and choose an expert in that specific area. Your problem still seems a bit undefined. So, a consultation, for information, with her might still be useful.
Here is what she said in response to my question about mesh removal.
“Unfortunately, these mesh complications are very common and sometimes really difficult to treat. We see a lot of patients with these problems, you are describing.
The pain cause always is a nerve irritation because of the mesh, which can be dislocated and can cause a stretching of the nerve. This can be solved with open surgery and neurolysis and possible neurectomy.”
Before surgery, a dynamic ultrasound should be done to see the mesh and a possible dislocation, which we perform by ourselves.
Would it be possible for you to come to Munich?”
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I would start with a consultation with Dr. Muschaweck if you can arrange it. Even if you choose a different option for surgery, the knowledge that you’ll gain about your condition will probably be very helpful. I went through a similar thought process as you, collecting information and considering options around the world. I had considered Dr. Muschaweck for both my original hernia repair and for mesh removal.
One realization I came to and still believe is that most of the surgeons and doctors involved in hernia repair are thinking in terms of the “average” person. A person who just needs to drive to work, do, at most, some light labor, some light gym work maybe, a jog or two during the week. They don’t comprehend that an average person can put as much strain on the repair area as a professional athlete, if they are physically active. You can tell them that you are an athlete but all they will know is the “standard of care” for the average person.
So, if you are planning rigorous physical activity go to a surgeon who repairs athletes. If you want to continue with light jogs and desk work, go to one of the big hernia repair centers that serves the average person.
Do you know what was done for the “sports hernia” work in 2007? There was a time not long ago when surgeons thought that mesh was a good repair tool for that condition also. And, the thinking on athletic pubalgia has changed quite a bit over the years. They might have tied some things together that are now causing tension.
You should consider also, Dr. Meyers at the Vincera Institute. He is known for fixing athletes and is aware of mesh problems and athletic pubalgia. He is kind of like the Muschaweck of the United States. I pasted the link below.
Good luck. 41 is young, take your time to make the right decision.
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The hernia sac can travel quite a distance. It almost like a liquid that just follows the path of least resistance. Imagine the path it follows to get in to the scrotum, and the amount of material that can end up in the scrotum. Softball size is not uncommon. I think that hernia sacs getting underneath a mesh implant is a common cause of recurrence.
You said 4×6 inch piece of mesh, which is large for an open repair. But there are many many different types of open repair. And it is not uncommon for mesh to move, and shrink, that’s why they use such big pieces. Sometimes it just keeps moving until it balls up.
Do lots of research before you see any surgeon. The “standard” for mesh pain is neurectomy, often as a preventive measure. It’s not supposed to be but there is incredible leeway in what a surgeon can do in hernia repair.
Since you’ve had fairly good results so far it would be a great shame to slip down the slope to chronic problems. But you are right on the edge, I think. Make sure that you understand what your surgeon plans to do and that you trust their track record.
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I think that the only thing that is almost certain is that the original mesh will be left in. But there are many ways that the recurrence could be repaired. There are stories on this forum about placing new mesh over the old mesh, or placing new mesh next to the old mesh and tacking them together. Or attempting a tissue repair and attaching to the mesh. Dr. Towfigh has commented on the “proper” way to fix a recurrence but, nonetheless, people have reported that their surgeons did not do things that way.
I don’t think that there is a “standard” for recurrence repairs with mesh. The surgeon’s creativity is the source of what you’ll get. So make sure that you choose a good surgeon. I would not go through the “system”‘s referral process. If you’re seeing the same surgeon that did the first repair, maybe get a second opinion before committing to surgery. Good luck.
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Your earlier post sounded like you don’t trust the surgeon who did the work to tell you the truth about what is happening. You might be best off to find a new surgeon who does hernia repair.
Pain management specialists will not know how to remove the source of the pain, only how to live with it. Be careful that you don’t get on the carousel of specialists. If you mention your genitals they’ll send you to a urologist. Pain gets you to a pain specialist. You might end up with several pill prescriptions and no solution. I would find a hernia repair specialist who also understands mesh removal. Just to be sure that all possible solutions are considered.
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That is a good story meshagony, thanks for sharing. I have been tempted to respond to this Topic with advice about moving and exercising when things get painful. I had found that with both the mesh and after mesh removal that sometimes I would have localized pain that felt like it needed rest but only got better with movement. Walking or running or biking. I could wait days for the pain to subside and it would not, but a long hike, or a run or bike ride did help. It’s a little bit counterintuitive and you don’t know if it works until you try it.
Three months is still very early for Eva’s husband’s problem, considering all of the work described. It should be noted that the “biologics”, as they seem to be called, are not all the same, and they do not have a long verifiable history. In essence, they are just another prosthetic material, similar to the synthetics, with a similar history of problems, successes, and no collection of results to study. Another hit or miss hernia repair method.
Do you know what type of “biologic” was used for your repair? Eva says that the porcine material was used on her husband. The new one is the sheep rumen derived material from Tela Bio. It is very new and also has little verifiable history in inguinal hernia repair but it is being pushed pretty hard, and the company just went public. Time might tell something, but odds are it will just join the crowded field of choices.
Wikipedia’s entry gives a pretty good overview of the state of the “biomesh” materials.
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Pain from fixation methods is almost an outdated concept. Be careful that your surgeon is not on an old outdated “mesh pain solution” path.
Dr. Towfigh mentioned the specific method for determining tack pain. Dr. Brown has also. If it’s not the tacks, but you have another operation, there will be more scarring and foreign body response. There is probably a significant downside to tack removal, if it’s not the true cause.
Sorry, just offering a counterpoint. My surgeon went through the routine of ordering an MRI, sending me to a urologist, offering pills, then giving up.
Here’s your other post, for reference. Good luck.
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Here are Dr. Ramshaw’s thoughts from just about a year and a half ago. Still weighted heavily toward monetary issues for the industry. I hope his new definition of “value” is much more skewed toward the patient.
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“The relationship between mesh and chronic pain is poorly understood, Dr. Ramshaw said. “Let me be clear: Mesh doesn’t cause chronic pain but it may be a contributing factor as part of the many factors that can contribute to chronic disabling pain.”
For many years, the main outcome measure in hernia patients was recurrence, Dr. Ramshaw said. But surgeons need to consider more than just recurrence when weighing mesh choice. “We can’t just look at one specific outcome measure. The outcome measure, I think we’re learning, that’s most important to measure is value—financial measurements combined with outcome measurements.”
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Tissue remodeling after the initial surgery and implantation can go on for years. On top of that is the persistent foreign body reaction that the mesh causes. Ideally some sort of comfortable middle ground is found between the two, with the individual mesh fibers being encapsulated in a way that allows your body to function properly
Your first thought seems most likely. You stretched the tissue in and/or around the mesh. The mesh and the tissue that has filled in its pores is not as flexible or elastic as the tissue around it.
Search “wound healing”, “tissue healing” and/or “tissue remodeling” on the internet and you’ll find a bunch about what’s happening in there. Probably best to let the tissues heal and/or rebond to the mesh if some has been pulled free. Since the mesh is placed on the muscles of your core, “core muscle injury” would be technically correct.
Good luck.
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I posted this once already but it has disappeared. I hope it’s not a spam filter. The site is doing some weird things. Maybe I just didn’t click the right buttons.
The Vincera Institute mentions a snapping hip joint as a potential source of the pain or discomofort. Maybe you picked up an injury unrelated to your hernia repair. Worth considering. They do free consultations.