Good intentions
Forum Replies Created
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The blocking might be back. I wrote a long post (very long) but it didn’t get through.
Ethicon is a J&J company. Sometimes they use the names interchangeably.
https://www.jnjmedicaldevices.com/en-US/product-family/hernia-mesh-fixation
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Thank you Dr. Towfigh. I was able to find and download the app, on “appgrooves.com”, linked below. If I had used the app before I had my operation I would have been predicted to have a 4% chance of pain after repair. The app does not distinguish at all between the types of repair, or mesh or non-mesh. It lays everything on the skill of the surgeon, and the possibility of individual nerves being irritated. Objectively speaking, it’s even less discriminating than the usual reasons to use mesh.
Considered along with Dr. Heniford’s comments over the years about mesh, it doesn’t even look like he had a part in it. It’s very contradictory to his past and recent comments. I would not recommend it to anyone. It draws the patient in with its professional appearance and the supposed program behind it but, in the end, it’s the same advice – get the hernia repaired because you it will/might get bigger, and you might have a strangulated hernia and require emergency care.
It’s free and quick to download. Others should try it, with the symptoms they had before surgery and see what they get. I put all zeros in because that”s what I had. I only had pain after extreme activities, which is not really addressed in the app. I actually went for a 2 mile run a few days before my mesh implantation and felt fine. I got mine repaired “for the future” and because I wanted to get back to high level sports.
https://appgrooves.com/app/ceqol-inguinal-hernia-by-carolinas-surgical-innovation-group-llc
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Hello @cshelter
I went back and looked at your first Topic and if I read it right it syas that you had a failed Desarda procedure, an incisional hernia, then a mesh repair (Post #21117 in the link below). Is this correct? I don’t think that you ever said what type of mesh repair that you had.
As I dealt with my mesh problems I realized why that area of the body is called the “core”. All movements of any part of the body, excpeting eyelids and other small parts, seem to energize the muscles of the core. If you imagine how a person walks and the muscles that are used, we are basically balancing on a pair of stilts when we walk on level ground. On an incline different muscles are used to maintain our balance. This might be why you are feeling pain on an incline.
Also, related to the mesh (if you do have mesh), many surgeons like to attach the mesh to the pubic bone. I assume that they assume that this will stop it from moving and that they can tack in to the pubic bone because it is not one of the defined areas that should not be touched during hernia repair. AKA the “triangle of doom”.
If you started a new Topic with clear details of your situation you might get some good advice. I still don’t have a full picture of what has happened to you. Any previous messages that we shared are gone now, apparently.
https://herniatalk.com/forums/topic/recurrence-with-incisional-hernia-living-a-nightmare/
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More spam with a link at the bottom. The posts should be removed to stop someone clicking through to a bad site.
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That seems like too much to do for the problem that you’ve described. Of the few surgeons that remove mesh most just remove the mesh, then wait for the body to adjust before attempting to repair any hernias. I think that you are well past worrying about the type of meshless repair. Get the mesh out with minimal damage, that should be your priority.
Dr. Koch seems to be associating your pain with a nerve problem when it might be just the mesh. Read the recent discussion about nerve removal, linked below. It is not recommended except in cases where there is very high confidence that the nerve cannot be saved. Triple neurectomies are the ones that people have reported terrible aftereffects from.
https://herniatalk.com/forums/topic/nerve-removal-how-is-this-an-acceptable-procedure/
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You can also see the flawed logic used in describing the problem. They didn’t find the cause for 13 years, but describe it as a “rare complication”. They should really say “rarely diagnosed complication”. They don’t know the true numbers. Out of sight, out of mind. A true hernia mesh registry might have identified the problem earlier, plus helped identify it for later patients.
Excerpt –
“demonstrates that IBS symptoms can be caused by a rare complication of a common surgery: mesh herniorrhaphy repair. “
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Where can a person get the app? Is it still available?
Any thoughts on why J&J doesn’t make their results available? In this era of informed consent it seems like it would be an easy and logical decision. Get those positive results out there so patients know what they are getting in to. What possible reason would they have for delaying, since the followup period is two years? They use the results in their marketing literature to sell product. It must be ready for disbursement. Of course they did just pay a huge amount for false advertising. Maybe they’ll change their brochures.
My questions are serious, if you have some insight it would be great if you could share it. It would be comforting to know that things really are changing. Thank you.
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Thank you for the reply @drtowfigh
You seem to be implying that the problem might be more one of misguided perception than a real physical problem deriving from the use of mesh. One of my main points in many of my points is that the “standard of care” is flawed and is biased toward an assembly-line like repair system, losing focus on the quality of life of the patients.
Does your manuscript address the reality of the problem or is it just about social media pressure on a real problem? I’m not clear on what you mean. Where will it be published and will we be able to read it without paying a fee?
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Actually, the completion is December 2022 now. I assume that each extensions lets them avoid publishing the results. J&J is not what they seemed to be in the past. Maybe they’ve always been this way.
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Actually, digging farther, I see that it’s connected to the “International” Hernia Mesh Registry, which is actually just a tool that Johnson & Johnson created and is using for their benefit. It appears to be only J&J products and J&J has been cherry-picking the results, reporting vague good results in some of their sales literature. It was supposed to be done in 2019 but now they’ve extended the date out to the end of 2020.
Odd how these things that seem good, making progress, just circle around to the same old suspects when you follow them out.
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I think that a lipoma actually looks more like just a thick spot on the spermatic cord. It is in the proper space as the cord so does not show the physical signs of a hernia. The abdominal wall is intact.
You can read the basic descriptions of hernia procedures and you’ll find that they typically just peel the fat off of the cord, if they find it. If you read the link I provided you’ll see that they can be difficult to identify, even during a laparoscopic examination.
Excerpt from the article –
“Lipomas of the cord and round ligament occur with a significant incidence. They can cause hernia-type symptoms in the absence of a true hernia (associated with a peritoneal defect). They should be considered in the patient with groin pain and normal examination results. They can be easily overlooked at the time of laparoscopic hernia repair, and this can lead to an unsatisfactory result.” -
Is it the same side as the mesh implant? Inducible basically means “able to be moved” or similar. Since you had an active MRI, with the valsalva maneuver I think what it means is the the “fat” did not move when you performed the maneuver. Probably because it is stuck to the spermatic cord, a lipoma.
If it’s on the same side as the mesh it might mean that the surgeon either did not check the spermatic cord and canal for a lipoma (fat suck to the cord) or just missed it in your case. It’s not clear (to me) how the fat gets in to the canal, but, apparently, lipomas and indirect hernias are defined differently. Anyway, they are usually found during the hernia repair, and can cause pain similar to a “true” hernia.
Here is one article that I found. Search “hernia lipoma” and you’ll find a bunch more.
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The ability to Edit has disappeared so I will just create a new post here. Here is an in-depth article about x-rays and polymers. It would be possible to make the mesh visible to x-rays. But that would add cost. And make problems either visible, or show that the mesh is perfectly placed but still causes pain. Both are things that would make a medical device maker nervous, I would guess.
https://www.mddionline.com/radiopaque-polymer-formulations-medical-devices
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That was a very thoughtful and informative post ajm22 @ajm222 I’m glad you wrote it.
I agree that the site needs some tuning to be more useful. The format is definitely odd, and there is a lot of lost communication, that was important to the people involved. I think that dev might have moved on, he is not responding amymore. I have several messages out that have received no acknowledgement. It’s probably difficult to put something together then hear that it is not quite right. Maybe he/she is waiting to make one big reformatting attempt. @dev
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X-rays will not damage polymers. So that would be incorrect.
My surgeon made three tries to get imaging for me when I had my mesh problem. The insurance company had a chart of standard procedures for hernia repair but none for mesh-related pain. So he kept getting rejected because they did not have a charge code for what he wanted. His requests did not fit under “hernia repair”. He had to sit through a panel discussion to figure out what they would allow. The only allowed imaging in the end was MRI with no contrast. It was done and read by the imaging expert and nothing was found.
Dr. Towfigh has posted about the best imaging techniques, but also points out that the typical hospital expert is not trained in recognizing small hernias, or mesh-related problems. You might search for her past posts about imaging. So even with the imaging you’re getting, the expert will probably not see anything noteworthy. There are many people who have had imaging done for pain and nothing was found. One side-defect is that it gives everyone involved more reason to reject treatment. They took an image and nothing was seen.
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I lamost hate to do this but I read further down that page and came to what seem like outright lies. Pasted them below. So I think that he is actually, ironically, increasing his liability by furthering these untruths. It’s a mess out there, in the mesh repair field. The NHS in the U.K. seems to be very firmly behind promoting mesh. It’s very bureaucratic system, from what I’ve read, I assume that the doctors have little freedom to choose what’s best for the patient.
Excerpt (incredible in today’s world, where it’s so easy to check facts, that somebody would say this):
“Are there any alternative treatment options and what are the risks involved?
There are non mesh repair techniques but this involves using large amounts of sutur material and the recurrence rate is higher.Prior to using mesh the majority of hernias were repaired using a darn technique and the incidence of recurrence was more than 30%. The use of mesh in hernia surgery has reduced the recurrence rate to less than 5% and in many cases, including our own cases, to less than 1%.
Although the risk of complications from not having any surgery is low, the NHS sees patients with bowel obstruction following inguinal hernias everyday.”
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He has the sales pitch down to a T. Covering himself by disclosing the potential problems, saying the words, acknowledging the percentages, which look terrible, but seemingly oblivious to what the words actually mean. The best that a person might think is that he is really just ignorant of what “chronic pain” means to the patient. He doesn’t know that living with constant pain is not really “living”. He is a mesh mechanic, trained in how to make a sale. I would not call him a true physician.
Excerpt from the web page:
“What is the most effective treatment option for a hernia?
Patients who have a hernia or who have been diagnosed by a hernia expert, I believe mesh is the most effective way of treating these patients. The use of mesh in hernia surgery has reduced the recurrence rate to less than 5% and in many cases, including our own cases, to less than 1%.The incidence of chronic pain has to be documented and should be part of the consent process, but it is also very important to realise that if hernias are not repaired there is a risk of strangulation, peritonitis, bowel perforation and bowel resection. These complications are extremely serious and if such a complication as peritonitis were to occur, there is a mortality associated with this.
What are the benefits of using mesh in hernia surgery?
The main benefit of using mesh is the recurrence rate. Before mesh was introduced almost a third of all hernias came back. The use of mesh in hernia surgery has reduced the recurrence rate to less than 1%.What percentages of those who undergo surgery likely to develop complications from mesh?
Undoubtedly, 10% of patients who undergo the operation with mesh can experience chronic pain in their groin – which, in the majority of cases can last up to a year. That has to be balanced with the fact that there is a risk of severe complications if you don’t have mesh repair.The incidence of chronic pain after mesh repair has been reported to be between 10 and 15%.”
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I was looking through some older posts and came across some information from Dr. Kang that is relevant to this Topic. I will just post an excerpt and link to the original Topic.
From Reply #19071, in https://herniatalk.com/forums/topic/no-mesh/ Dr. Kang also repairs “sports hernias”::
“You will find that many doctors have their own different definitions of sports hernia. Although the same name of ‘sports hernia’ is used, doctors have different opinions on which area is damaged. So, the area of surgery also differs frequently depending on the doctor. Thus, many of you who searched information of sports hernia might have been confused.
I have so far performed about 500 sports hernia repairs mostly for professional soccer players. From my experience, I believe that the sports hernia is an event where the external oblique aponeurosis of inguinal canal is injured. So, I have administered a simple surgery, which repairs the external oblique aponeurosis only. They successfully recovered and made come-backs to their sports.”
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@cshelter Read Dr. Kang’s posts in the link below and you’ll see the difference between a surgeon who truly specializes in a certain area of surgery, and the one-size-fits-all mesh implantation process that is being taught to today’s new surgeons. It’s sad to see how dumbed-down such an important profession can get. Mesh implantation is simple to teach.
I think that there is still hope for you in the long-term. I am two years plus a couple of months out from mesh removal and I am getting closer and closer to being fully healed. Once the mesh was out the true healing started. It’s taken a long time but the body will just keep trying to get things back to the way they were designed to be. I can’t remember the details of your situation I think that I was confused with your initial posts. If you have mesh it can still be removed. If you don’t have mesh a doctor like Dr. Kang or Dr. Brown can probably get you to a baseline that you can really start healing from. Keep trying, there are true experts out there.
Here is the post where Dr. Kang goes in to great detail about his methods and why they are different.