Good intentions
Forum Replies Created
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Actually, one more last comment. I Googled “medical-industrial complex” and find that others have been using the term, for many years. It’s been a real concern. I can’t even pick out just one article.
https://www.google.com/search?q=Beware+the+medical-industrial+complex&rlz=1C1SQJL_enUS862US862&oq=Beware+the+medical-industrial+complex&aqs=chrome..69i57&sourceid=chrome&ie=UTF-8
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One last comment. Dr. Heniford is a big advocate of the Carolinas Comfort Scale, and developer, I believe. Ethicon uses the CCS in their marketing literature, along with the IMHR data. Read through the Ethicon pdf brochure and you’ll see its usage.
So, in sum, Dr. Heniford is essentially a partner, or subcontractor, for Ethicon, a J&J company. There is no way to explain this away. It’s just the way things are. Atrium Health is essentially partnered up with J&J. To paraphrase Eisenhower – “Beware the medical-industrial complex”.
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And here’s the brochure – https://atriumhealth.org/documents/cmc/clasp/ceqol-physician-brochure.pdf
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I have found a recent update to Ethicon’s marketing literature. They have put the “Registry” at the forefront, highlighting it at the start of their brochure. Even though, the report is not out yet, and the study is, supposedly, not complete. The finish date has been pushed out, it might never be published and available. but the “results”, whatever they might be, are still being used by Ethicon, A Johnson & Johnson company.
Click on Clinical Support in this link and a pdf file will open.
https://www.jnjmedicaldevices.com/en-US/product/ultrapro-plug
Excerpt –
“Ethicon Hernia
Dedicated to evidence and long-term patient outcomesFor more than 80 years, Ethicon has been a trusted partner, leading the industry in providing outcomes-based solutions for our customers. An example of this commitment is our sponsorship of the largest hernia registry in the world, the International Hernia Mesh Registry (IHMR).
Ethicon began sponsoring the IHMR in 2007 through a grant program
so we could play a significant role in providing large-scale evidence of the safety and Quality-of-Life outcomes for hernia-related products and procedures. This repository includes postoperative hernia data on all synthetic meshes and techniques – both Ethicon’s and our competitors’.
Many Ethicon products—including ETHICON SECURESTRAP®
Absorbable Strap Fixation Device, ULTRAPRO® Partially Absorbable
Lightweight Mesh, and PROCEED® Surgical Mesh—are tracked and
measured in IHMR for continuous assessment of outcomes data. This
illustrates our dedication to advancing hernia repair and commitment to evidence generation.” -
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/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075841/
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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.