Good intentions
Forum Replies Created
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Here is a link to Dr. Priddy’s Curriculum Vitae. It’s impressive, but the 60 Minutes topic is not in his wheelhouse. Smart people tend to think that they’re smart about anything and everything.
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Dr. Priddy has no apparent experience with degradation of polymers in the human body. You can look through his Vitae and see that despite his huge number of publications, none of them are about this topic.
Expert witnesses are chosen for their ability to sway a jury, and the impressiveness of their credentials, relevant or not.. Not for their expertise. There are polymer scientists who work in the biomedical field, on these types of subjects, that could probably have offered a more trustworthy opinion. Dr. Priddy was a poor choice, except that he created a quote-worthy definitive statement, true or not. He doesn’t even realize (or maybe he does) that oxidative degradation is not the suggested cause of the mesh problem. Big picture wise, his statement is essentially irrelevant. It might be true that polypropylene is a poor choice of material but not for the reason that he stated.
Rejecting the material for the wrong reasons just allows more wrong material to be chosen, just to fail again. It’s best, in my opinion, to reject all unproven or verifiable statements, even if they support your overall position.
The counterfeit material proposal is one of those things that also distracts from determining the truth. If there’s no evidence that the original polypropylene was better then there’s no way to show that the counterfeit material was the cause.
What the program did show though, which I believe is the most important thing, is that there are dishonest morally corrupt people in high positions at these types of companies. Boston Scientific is probably no different than any of the other companies, except that they got caught.
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Extrapolating from a small set of data, or a very narrowly defined “fact”, to all of what’s happening today is actually a huge part of the problem, I believe. The FDA’s 510(k) process is essentially a continuous “safety” extrapolation, assuming that because something is safe in small does that it must be safe in large does. I’ve tried to think of an analogy and one that keeps coming to mind is bee stings. If you get stung by one bee, it’s usually not a big deal. 3 or 4, you’ll probably be in pain for a while but will recover. Hundreds or thousands of bee stings though and you could die, or suffer organ damage and be debilitated for life.
Polypropylene is a very inert polymer, chemically. One thing that I think often gets blended together in thinking about or discussing mesh reactions is the biochemical reaction and the physical damage reaction. Two different things. The body would normally just encapsulate a small piece of polypropylene and would be done with it. But the mesh devices are placed in physically active regions, with lots of surface area. Maybe it’s like 100 bee stings, 100 times per day. The body never “heals” in the area of the mesh and just continues to try to remove the damage, physical, biochemical, or both.
As far as the 60 minutes program, it was interesting that they chose it as a topic but they also chose interview subjects that would say the right things, for a dramatic TV show. A plastics engineer is generally not trained in polymer science or in medicine. I think that 60 minutes went for a dramatic sound bite in that interview. That type of journalism actually hurts the efforts of people trying to really understand the problem.
Even the engineer’s dramatic statement was poorly formed. Why would a plastics, or polymer, scientist even being determining what’s appropriate to place in the human body? That’s not what polymer scientists do. That should be a collaborative effort between medical doctors and materials scientists, with real data, generated from well-designed experiments, being used to make decisions.
Nothing like the current 510(k) process though, which is being used to shortcut real science for the sake of, apparently, selling new unproven medical devices.
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It looks like you got the one size fits all full mesh treatment. Does it say totally extra peritoneal (TEP). or does it say transabdominal preperitoneal (TAPP)? It reads like TEP, I think, with dissection all the way to the pubic symphysis. If you had one substantial hole in the navel and one or two very small holes (needel size) to the sides it was probably TEP. If you have two substantial holes (small incisions) to either side of the navel and one in the navel it was probably TAPP.
You probably actually got two 3D Max pieces, maybe overlapping in the middle. The size of the mesh pieces should be in the notes also. You will probably be surprised at the size of the pieces. Maybe even an other piece for the umbilical hernia.
Aside from the details though, you have had a very large space dissected in your abdomen, the tissue peeled apart to create a cavity,and mesh placed in between those tissue layers in that cavity. As your body tissue grows in to the mesh and causes it to shrink there will be inflammation, edema, and shrinkage as “healing” occurs. The shrinkage will pull on surrounding tissue and structures. If you are lucky the important structures will handle the new environment and things will feel more normal overtime.
It’s good to know what’s in there and what it’s doing so that you can understand what you’re feeling. There’s not much you can do about in the early stages though. Rest when things get painful but keep moving so that things can work in to normal life.
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I am not an expert but recall a couple of people who are dealing with problems similar to yours. It might help, or might not, to know the type of mesh that was used in your previous surgeries. It is unclear if mesh material and/or knit pattern and other details matter or not. Many surgeons think that all meshes are essentially the same, while others choose based on device properties. Many surgeons have no choice of the device they use, their purchasing department chooses for them, based on contractual negotiations. Anyway, the small details might offer a clue for you.
This forum uses the @ function to notify people if you want them to know you’ve posted. Type the @ symbol then the first few letters of their screen name and a small menu should pop up to choose from.
Here is a thread with comments from both of the people I mentioned above. Good luck. [USER=”1593″]mamadunlop[/USER] [USER=”1176″]Momof4[/USER] [USER=”935″]drtowfigh[/USER]
https://www.herniatalk.com/5297-what-is-the-long-term-outcome-will-it-ever-stop
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quote drtowfigh:My personal feeling is that today’s mesh is not the same as the original mesh in their manufacturing. I believe that companies have changed the contents of mesh and no longer buy from the same manufacturer. As a result, we are seeing way more mesh-related complications that are not explained by surgical technique alone. I think the inflection point occurred somewhere in the late 90s/early 2000 when mesh companies surged in their products to market.
The 60 minutes exposé on Boston Scientific’s transvaginal mesh basically proves my point. I believe the same actions are being taken by the hernia mesh companies. I wish someone (60 minutes?) would try to prove (or disprove) my theory.
Thank you Dr. Towfigh for acknowledging that there are possibly problems with the material itself. From out here though, the broad view, looking at the forest itself, the picture seems more complex than just a batch of bad or counterfeit materials.
The transvaginal mesh situation seems to actually confirm that the device makers are responsible, in large part, for the pushing of new untested materials out to the market, for the sake of making money. The investigative work done is pretty damning, especially for Johnson & Johnson (Ethicon). I’ve included three links below.
I wish it was so easy as just a one time mistake. When I started looking in to why I had my problems I was ready to find and accept that I was one of the very few, and just move on with my life. But instead the more I look the deeper it gets.
The executives that decided what to do with TVM are the same ones that decided what to do with hernia repair mesh. And it is true that the lawyers are like scavengers, looking wherever they can for a case. But without proper regulation, that is their purpose. They are actually dong the public a service. Instead of complaining about them and fighting them the community of surgeons should be helping them, for everybody’s benefit. Except the executives who caused the problems, they should go to jail.
https://www.thedailybeast.com/the-million-dollar-deal-behind-the-vaginal-mesh-implant-mess
https://www.nytimes.com/2019/02/01/business/pelvic-mesh-settlements-lawyers.html
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Here is another of Dr. Felix’s presentations. You can see how people are pushing for laparoscopic mesh placement to be the state-of-the-art, or “gold standard” as they like to say. Apparently Dr. Felix considers himself to be a spokesperson for lap and mesh. He seems to be on a mission to make it the “gold standard”.
MIS is short for Minimally Invasive Surgery, even though much more space is invaded than for an open procedure. It’s a misnomer carried over from procedures where it actually is minimally invasive. But it’s not for hernia repair.
The presentation gives a nice short history of mesh development. 5:20 is telling, in that he describes the placement of large pieces of mesh as the goal of laparoscopic methods training today. Lap placement of large pieces of mesh is the future, and the people promoting it still focus on the level of pain, compared to other methods, but don’t talk about the difficulty of removing the pain if it occurs.
What is fascinating, from a psych perspective, is how he can be so pro-mesh and pro-lap, then a year later give a presentation describing how there is no useful data about chronic pain. He is enthusiastic about forging ahead with new unknown techniques, at the expense of the patient. He doesn’t see the correlation with the lawyers that he keeps talking about.
These two presentations are both within the last two years. You can really see the army forming. He makes a call-to-action at 11:30. Pretty amazing. He is a “believer”, he’s really selling it.
He does mention his own repair though, at the end. Apparently it was a lap repair with mesh. If you watch his first presentation you’ll see that he said that he had “almost no pain”, and that old people don’t complain (he mentions it above as a reason that younger people seem to have more pain). Who knows. One of thousands.
Anyway, this is the future. Good luck to all.
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quote HoleintheWall:Here is another talk that followed. Apparently there is not only nothing wrong with mesh, there is nothing wrong with anything.
Thanks for posting that. I watched it and, frankly, was embarrassed for him. What he said at 7:00, basically explained what he was doing with his presentation. He said that the data in the meta-analyses can be used to show whatever that surgeon doing the analysis wants. He cherry-picked data from the papers, sometimes showing better or worse comparisons with no number and sometimes showing pain numbers. Whatever was needed to make the point.
His overall message was that there’s nothing to worry about with “mesh”, just work on your skills. I think that any surgeon who was there probably felt like they wasted their time. It was another “mesh” defense. He even mentioned that what he was presenting could be used as “defense against those lawyers”. At about 3:10 he talks about “the lawyers”. At least he was honest about that part.
And, somehow, he didn’t even describe his own hernia repair. It was probably Shouldice. Who knows. Seriously, does anyone know how his hernia was repaired? That might be the most honest answer to his presentation.
If you search his name on the internet you’ll see that he is one of the vocal defenders of mesh, he’s a popular speaker. He really should tell people what repair method he chose.
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If you’ve had it for 4 years and it hasn’t changed and it doesn’t bother you much, the “watchful waiting” is recommended. Even surgeons with hernias would wait and watch.
Is your surgeon recommending surgery?
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I can.
If your surgeon “codes” your visit as “hernia repair” and you describe a problem that the surgeon decides a urologist should look at, for example, the insurance system might not recognize the urologist visit as reimbursable, even if it’s determined that the problem was caused by the hernia repair. My surgeon did not know this and, really, did not want to deal with it. So he sent me off on a wasted visit, the urologist was clueless, that I ended up paying full cost for. And I knew it was a waste of time from the beginning I only went to help my surgeon make progress on my problem. I think that the surgeon knew it was a waste of time also, he was just checking the boxes, to be thorough. I even talked to a rep at my insurance company and she agreed completely that it was a mistake and said she would fix it. It was still refused as “not a recognized condition of hernia repair” or something like that.
You can probably get sent down other paths easily, for example, leg pain is not going to be a result of “hernia repair”. That’s how things work these days, there’s somebody at a computer making sure that the codes are allowable for reimbursement based on whatever the main, first, code is.
It probably works in reverse also, if you go to a neurologist first and they determine that pain is a result of the hernia repair, they might have to fight to get it recognized as such. They might have to have a panel discussion where they are second-guessed and they might or might not be allowed to continue on the path that they feel is correct. And the patient could end up on the hook for a big non-reimbursable bill. Or, maybe, starting with a neurologist is actually the best way to start. It depends on how the databases are constructed, I would guess.
Mesh-induced pain or problems are not recognized as “real” by the healthcare systems, in general, despite the high rate of occurrence. “It must be something else” is the starting point for evaluating mesh-induced problems.
The International Guidelines discuss pain treatment paths but I don’t think that the Guidelines are followed by the “payers”, the insurance companies. It is very very bureaucratic. So be careful. Mesh problems are outside the system.
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quote ajm222:Most surprising to me was the waiting part. It was my understanding that if you’re going to bother getting a repair at all, the sooner the better.
Yes, it doesn’t seem to fit what most surgeons tell their patients. Very few seem to recommend waiting. The message the patients receive is that bad things can happen, emergency rooms and death, so you should get it fixed soon.
Also, I didn’t mean to give the impression that I agree with what the surgeons would do. I posted to show the mismatch with what is recommended to the public, but also how their other thoughts follow the Guidelines. The typical surgeon today will recommend lap with “mesh”. But, in the end, the surgeons know as much as us, which is not much, about what really works well to avoid chronic pain, which appears to be at about a 10 – 30% level, today.
A follow-up survey that might be very informative would be one asking surgeons who had had their own hernias repaired to report on the results. How do they feel about it? Would they recommend what they got to friends and family? Not talking from the Guidelines but from something that they’ve actually experienced.
The pool of respondents would be small but the answers should be of very high quality, a surgeon’s perspective, from inside. With anonymity the answers could be very honest. With presentation at the bigger meetings like this one, their thoughts could spread much farther. Everybody wins.
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Type of material used might be a clue also. And 5 weeks is still early. Getting back to work, and full recovery, are two different things.
Good luck. [USER=”2840″]ctguy[/USER]
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I believe that “check” means poke, prod, and stretch the potential problem areas to try to find weakness. Also, from my limited understanding, the surgeon will firmly pull the testicles downward after surgery to ensure full range of motion for the spermatic cord. And the penis is generally tied up, with surgical sponge, or some other method.
So, there’s a lot more that goes on for the full procedure than just laying down a piece of mesh. Maybe something got overstretched. Plus, for TAPP, I think that adhesions are possible.
Do the notes say how big the piece of mesh was that was implanted? It’s possible that mesh was placed well beyond the site of the hernia.
Anyway, good luck. If you can share the details of your procedure, please do. Robotic surgery for inguinal hernia repair is still new. You’re at the leading edge.
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By type of hernia, I meant direct or indirect.
[USER=”2835″]Tj37067[/USER]
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quote Tj37067:I got surgery at a Hospital in the Upper East Side (Manhattan) for a bilateral inguinal hernia repair (with mesh) as well as an umbilical hernia (stitches only). I am a 30-year-old, 6ft 2 inches slim male with a history of a chronic daily headache but otherwise very active prior to my surgery (tennis, basketball, and rock climbing) usually two to three times a week. I had surgery on March 7, 2019, and about three weeks after surgery I started having a lot of tingling and paresthesia down my glutes and hamstrings.
The details of your surgery, materials (there are many types of mesh) and method, and type of hernia repaired, would be useful. But, you’ll probably just have to wait and see. There are no formal physical therapy recommendations for recovery from laparoscopically implanted mesh. If that’s what you had, that’s my assumption since most people start with just one hernia, but lap tends to end up bilateral once they inspect the other side.
Wait, take pain medication, and try to get back to normal is the usual advice. I got that advice for months, then was told to just accept my new fate. Be careful what you describe to your doctors, certain words will not be accepted as standard for “hernia repair”. You can get deflected down wasteful paths, both time and money.
One thing that might help is to keep a daily log of your activities and how you feel. I found that the effects of activity could take a day or two to manifest. Certain things, like lifting weight above my head, caused more issues than expected. It was easy to see the correlation via a written log.
Good luck.
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If you get a suture repair and it fails they can always go in and put “mesh” behind the failed repair. Just like starting over. “Mesh” was developed for that type of problem, mainly for inguinal hernias.
But, if you get a mesh repair and have chronic discomfort and pain issues, a “mesh” reaction, you might have to have the mesh removed. You might have more extensive reactions than just discomfort and/or pain. So, logically, from the standpoint of your personal welfare and future, it seems to make sense to try a suture repair first, since it has the least risk as far as chronic pain is concerned, both in probability and it having it fixed. If you believe the recent reviews about the growth of chronic pain with the growth of the use of mesh, as described by both Kavic, and Bendavid, both former presidents of the Americas Hernia Society.
I’ve realized fairly recently, it’s kind of crystallized for me over the last few weeks, that many of the surgeons that recommend the mesh repairs, in all of their variations of methods and materials, don’t really understand pain, they conflate mesh-induced pain with the pain of a recurrence or other suture-repair types of pain. They consider them all as one “pain” just like they consider all types of mesh and methods as “mesh”. I don’t think that they really understand the difference between the two problems. They don’t distinguish between the hopelessness of trying to find a solution to mesh-induced pain, as opposed to the ease of finding help for a recurrence. The two efforts are not even comparable, one is almost impossible as mesh-induced pain is mostly denied, even today, while the other, recurrence, is coded in to the “system”. So you’ll see many comments comparing suture-based pain with mesh-induced pain, essentially describing them as comparable, but without considering the vastly different solution paths to the problems.
If you have a recurrence you’ll find thousands of surgeons ready to fix it. If you have mesh-induced pain you’ll be in a whole different world, alone.
Good luck. That’s my view, as of today.
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A controlled Valsava maneuver might make the bump show again. If you are subconsciously holding your abs tight, you might be closing the defect. A direct hernia bulge will disappear when you lay down and reappear when you stand up and your intestines press against it.
But, overall, it seems like you should go see a hernia repair expert, instead of a GP.
If it doesn’t bother you could just join up and let the military take care of it.
Good luck.
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It is much much easier to repair a suture-repair recurrence than to fix the damage from mesh-induced chronic pain. I doubt that the recurrence repair takes 4-6 hours under general anesthesia, with all of its associated risks, plus the extended years-long healing time from mesh removal.
Oversimplifying the damage that mesh can cause is one reason that progress is not being made. It’s not just “pain”. I’m not surprised that people don’t understand that damage, if they haven’t had it. It’s hard to comprehend, by itself, let alone understanding the difficulty in finding a solution if you have it, including the resistance to dealing with it from most surgeons who encounter it in their patients. It’s a nightmare.
Rand Paul’s decision to have a Shouldice repair makes sense. If his Shouldice repair fails, he can have a mesh repair, as you are doing for your two patients. But if he had chronic pain from a mesh repair it would probably be permanent in some ways, even after mesh removal. Neurectomies and mesh removal are both drastic attempts to fix the problem that “mesh” caused, and they often aren’t enough. Why start with the riskiest procedure, the one that causes the most damage if it fails? “Mesh” should be the last resort.
The results of “failure”, recurrence or chronic pain, from “mesh”, versus sutures is vastly different and not really comparable.
I’m sorry Dr. Towfigh, but I’m still in the middle of recovering from a top-notch state-of-the-art best-methods mesh failure – mesh-induced chronic pain. My diagnosis and surgeon’s choice of repair method is perfectly described in the Guidelines. Checked all of the boxes. Perfect candidate, very healthy, non-smoker, no history of health problems. The procedure went perfectly and I had chronic and increasing problems as soon as I became active again. I know how bad mesh can be . I should have had a suture repair.
I don’t like to argue, I just would like to see my comments stand for what they are. The rebuttals just aren’t very substantial and seem to downplay the damage that mesh causes.
I posted the link to Doctor’s Suicides to express some empathy, as a patient who thought a lot more about suicide while dealing with the mesh-caused chronic pain. Lucky 46 was not being overly dramatic in his past posts. I hope that he is still alive. If you can’t work and you can’t think and you’re in constant pain, there’s little point in being. Those three things are probably the most common topics you’ll find in a suicide note, and those three things are what you’ll have if you have a mesh reaction. Please don’t try to compare a suture-based recurrence to mesh-induced chronic pain.
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Sorry Dr. Towfigh. What I’m suggesting is that because the specific cause of the 10 – 30% chronic pain rate is unknown, apparently, that it is “baked in” to the International Guidelines. Only the plug is called out as one “mesh” method to avoid, and even that reasoning is based on gut feel by some committee members. So if a person’s surgeon says that they use the Guidelines, or “mesh” because it is the state-of-the-art, they are saying that you have a 10 – 30% chance of chronic pain if you get a repair from them. It’s just how the numbers and logic work out. If they say that you’ll “be fine”, you can’t trust their words, because they can’t know that, they don’t have a basis to say those words, unless they know more than the Guidelines suggest. So don’t trust blindly, ask specifically. It’s more skepticism than cynicism.
My comment about the doctors being “against” the patients was extreme, but that’s what it looks like from out here, for certain doctors. Dr. Voeller’s comments about 4 – 6% debilitating chronic pain not being an epidemic, so it’s no big deal, and Dr. Ramshaw’s comment about “mesh clearly not being the cause of pain”, are examples of “protecting mesh”. Accepting the high pain levels as part of a mesh-based hernia repair. The “state” of the art. My statement is too broad, it should have been specific to the apparent leadership, the vocal representatives, of the community of surgeons. Maybe it’s time for new leadership, more vocal representatives?
I’m just trying to make it clear to any future patients that come to the forum that they have to do their own research, because there is no clear way to avoid chronic pain if they have mesh implanted. It’s a gamble. You can’t trust what the common surgeon tells you unless they have their own numbers to back up what they do. I have not seen any surgeons clearly state that they know that what they do causes less chronic pain than anyone else’s method/materials. 10 – 30% chronic pain is normal. The surgeons are accepting the Guidelines and the Guidelines have 10 – 30% chronic pain as normal.
Trust but verify, in simple terms. Everyone, including the surgeons,will be better off.
I wish it was easier. It should be.