Good intentions
Forum Replies Created
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Here is Topic with some details about my experience and Dr. Billing’s practice details. “Billing” is his name. There is also a comment from dog about Dr. Brown. Look for dog’s topic on his choice of Dr. Brown. If I find it I will post it, it’s on the forum somewhere.
https://www.herniatalk.com/12176-one-year-seven-months-since-mesh-removal
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The Bay Area is not that big. Are you willing to fly, or are you looking for a taxi or Uber distance? Dr. Brown is in Fremont. Dr. Billing is in Seattle.
I went through a similar thought process when I had my original hernia repair. I should have traveled.
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Here is Dr. Felix’s presentation.
https://www.sages.org/video/lets-be-honest-pain-after-inguinal-hernia-repair/
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Here is a recent and fairly comprehensions article about the situation, first article linked below, and a second one from not that long ago. The article answers one of your other questions also, about approving new products.
You”ll find that instead of stopping the actions that cause pain the new advice is to clearly explain to the patient that they might have pain. Basically shifting the responsibility for decision to the patient. Informed consent. The irony is that “they” can’t understand why people don’t want mesh after explaining that there is a significant chance of pain. They’re in a bind, if they explain about pain people walk away, if they want the business they have to stay quiet. There are even surgeons out there, like Dr. Felix, who suggest that patients just need to get tougher. Stop whining.
These two articles are fascinating also because you can see how at least one surgeon is working on both sides. He suggests creating a registry that identifies bad products, but recently recommends clearly explaining to the patient that they might have pain. His second speech seems much less focused than his first.
In sum, somehow, we are all stuck, for the most part, with mesh as the standard for hernia repair. Now, it’s time to weed out the bad products, that cause pain and complications, like the plugs. That’s what a registry could do. But nobody seems to want to step up and make that happen. They’re just living with the status quo, not offending any of the device makers or fellow surgeons. Lots of talk but no action.
Individual surgeons can survey their patients, and track and report the results from the mesh products that they use. They don’t have to wait for the crowd. But I imagine that anyone who does that will feel very exposed and alone.
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Thank you for that information Dr. Towfigh. It looks like a concession but, since the problem is pain, and animals cannot describe their pain, I don’t see a direct link to making things better. The animal studies will show tissue ingrowth and other things that might or might not be tied to pain and discomfort.
It seems like the giving of something of little value. It’s a start though.
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Here is one more thing from that link. You have to click through the other links on their page to fully understand what they are.
“Since the development of the implantable synthetic mesh for strengthening the abdominal wall, the mesh-free procedures are only used for children and in some special cases.’
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quote Fawaz:by the way I have done with same above operation repair with mesh in right inguinal and it is ok and there is NO burning pain as per the umbilical site
I would find out the type of material used for the first repair to see if there is a difference. Compare the operation that worked with the one that is not.
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It looks like some sort of cooperative. The page has links all the way back to the big “Guidelines” meeting set up by Herniasurge. See the link to the Guidelines at the bottom of the first page in your link. The Herniamed page that they link to is sponsored by the major mesh makers, you can see them all at the bottom of the Herniamed page. The “Herniacenter Switzerland” seems to be a mesh-centered hernia repair house. Everything about them says “mesh”.
It looks like there is also a “registry” and survey effort similar to the AHSQC. See the bottom of the first page of my second link to see the “HQAS” description. “If you are interested in participating in the Herniamed Quality Assurance Study please register here:”
Fascinating how the Herniasurge effort is growing. It seems very powerful. All sponsored by the device makers.
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quote Dee:I’ve had a no mesh repair twice now, the thought of more surgery is alarming, why does this keep happening and how can I avoid it happening again.
Who did the first two repairs?
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Dr. Muschaweck has been repairing professional athletes, many soccer players, for many years. I forget to mention her because she is based in Germany.
Here is a sample of old information and new. Soccer might be one of the most demanding sports as far as core strength is concerned.
https://www.theguardian.com/football/2007/sep/28/newsstory.sport2
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Here is another much more recent article. It might the best I have seen as far as addressing all of the issues commonly discussed on this forum. Dr. Towfigh participates. In the end it still comes down to collecting relevant information. Degraded quality of life is the reason that people see their doctors. We are not machines or livestock.
Sorry if I my other post offended so much that you couldn’t release it. But you can see in this professionally written article, the same things that I wrote about. We need useful data with numbers. Thank you.
https://www.generalsurgerynews.com/I…B8C3C8A9101426
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quote drtowfigh:See pinned post re AHSQC. It’s the only effort in US to get longterm mesh specific and repair specific data. We need more surgeons to participate. Plus we need patients to log in their longterm data.
danish and Swedish and German registries are pretty robust for longterm data and they publish their results.The effort is there, apparently, but where are the results that a layperson can use? There is nothing useful to a patient doing research.
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Click “cancel” and you should be able to read this article, below. It’s fascinating and frightening to see how inconsistent the field is. There is no measurement or tracking of results. Note also the recognition of the failure of the FDA”s oversight/regulatory role. The article is from 2016, but not much has changed. Government oversight has certainly gotten worse, considering the overall state of things.
https://www.generalsurgerynews.com/A…rticleID=34826
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Dr. Brown uses a non-mesh repair method on professional athletes. They seem to keep coming to him, I assume that the results are good. [USER=”2580″]DrBrown[/USER]
One major problem with trying to choose the best method of repair is that there is no reliable long-term data available to the public. No way to know if “majority” means 75% or 99%. Or what the bad results are, life-changing pain or just discomfort.
At least one well-known hernia repair specialist, Dr. Heniford, has recognized this and called for a true registry of products (not a pseudo-registry like Ethicon’s) that would track real-world long-term results of each product type. As far as I can tell the effort got no traction at all. The device makers are not interested in knowing that their products are good, just that they keep selling at a good rate with low lawsuit payments, I assume. It’s just the reality of our market system. “Charge what the market will allow and caveat emptor are the basics of business in America.
I just found a recent article quoting Dr. Heniford. It looks like he has climbed back on to the mesh wagon, with vague terms about long-term outcomes. Disappointing, But he says “our outcomes” not patient outcomes. Fighting the “trend” with words, communication, instead of real data. The pressure to conform must be incredible.
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quote Alephy:Did you have a mesh repair in the end? what went wrong if I may ask?
cshelter has posted quite a bit about his situation. You can click on his name while you’re logged in and see all of his past posts. Good luck. [USER=”3125″]Alephy[/USER]
https://www.herniatalk.com/member/3118-cshelter
By the way, if you’ve researched this far you should keep going, in to more detail about the different types of mesh. “Mesh” is a very vague catch-all term used to cover everything from absorbable materials to permanent synthetic polymers. In the early days the “mesh” was made of metal. It is a lot of work and difficult to understand but even most doctors just use whatever mesh their purchasing agents have made a deal for. “Mesh” is a product, sold just like any other commercially available product, with sales people and marketing professionals behind every one of them.
Here is a list of many examples of “mesh”. https://www.herniatalk.com/13873-types-of-mesh-and-their-manufacturers
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Here is another one. You can see that people are still coming up with new ideas and driving them to market. Imagine the chunk of mesh and body tissue that is formed.
http://www.angiomedical.com/pdf/freedominguinal.pdf
https://forum.bodybuilding.com/showt…353003&page=44
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I am 99% certain that I forced a hernia upon myself by trying to play soccer through back pain. I found that I could avoid the back pain by using the Valsalva maneuver to tighten my core muscles. I’ve seen accounts from other people who reported getting a hernia just by twisting backward in their chair to pick up a dropped pencil. The weak area in the muscle wall is present in everyone, as I understand things, due to the nature of how the muscles come together. So, if things come together “right”, with high internal pressure and force on that weak area, the weal area can give way.
But, in your case, a strained or stretched area could cause pain, but maybe, hopefully, without the intestine contents being pushed through. You really don’t want to test the area by stressing git to see if it’s broken. Let it heal and get stronger if it can. Once the muscle wall is breached it won’t fix itself. Don’t try to push to see if there’s a problem. Do nothing and hope it strengthens and goes away.
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I found that tracking my activities and the physical effects that followed helped me draw a correlation between the two. In other words, keep a log of your activities and how you feel. Then you can see what causes problems and what doesn’t. I found that it typically took two days for effects of physical activity to build in and three to four days for them to go away. Your body is not like it used to be.
I have also found that change is slow, both with the mesh repair and after mesh removal. It has taken me two years to get to where I don’t feel soreness or pain at the previous location of the mesh after vigorous physical activity. The body acts rapidly to stop damage, allowing you to function and survive, but very slowly to remodel the tissues to their original plan. I would assume that this is true for suture-based repairs also. Healing muscle tissue/fascia is slow.
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Hello Dr. Towfigh. Overall, the design of the site seems effective. There is a spot for “stickies” aka pinned topics. The path for starting a new topic, or thread, is clear. The message function and how to use it is clear. When the site was working right, new people were joining and meaningful conversations were occurring.
The major problem with the site has been the arbitrary destruction of people’s posts. I’m not sure that you realize how damaging that was. Some of us put quite a bit of time and effort in to considering a person’s problem and writing it in to a post to give them some useful information, only to have it completely wiped out, gone forever. I suspect that some of the more helpful people, like Chaunce1234, have stopped contributing because of this waste.
In addition to a person’s work being destroyed when they tried to post it, the message function stopped working. I still have empty boxes in my Message center, both from the people who tried to contact me and my reply to let them now that I could not see their message.
So, I think that making the site stable and sensible will be a dramatic improvement. If a post violates a rule, please make it so that the content of the post is saved, and a sensible error message is generated. It’s the destruction of people’s work that has hurt the site the most, I think.
As many have already said this site is a great resource, both for hernia patients seeking help , and patients who are experiencing problems. I think that it could also be a great resource for doctors if they were aware of it and not afraid to read about bad things that are happening in the field. The site should really have many more views than it does.
Clicking “Post Reply” now and hoping. I’ve saved my work, just in case.
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[USER=”2580″]DrBrown[/USER]
[USER=”2019″]drkang[/USER]