Good intentions
Forum Replies Created
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Dang. Unapproved. Anyway, here is an interesting response to Dr. Kavics presentation on the same topic.
Look up the definition of debilitate.
https://www.generalsurgerynews.com/Article/PrintArticle?articleID=38543
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Here is an article about the response to Dr. Kavic’s presentation. Dr. Voeller defends the use of mesh and chooses the low chronic pain numbers of 4-6%, plus adds “debilitating” to the description. Implying that the bar for defining success is debilitation. If the patient who came in to fix a small problem with their hernia, get it “taken care of”, ends up non-“debilitated” that is a success, apparently. Somehow, surviving surgery and being still able to function, with or without enjoyment of life, is the criteria for success. This is why the patient has to be very careful.
https://www.generalsurgerynews.com/Article/PrintArticle?articleID=38543
““The number of people with chronic debilitating pain is around [4%] to 6% so I don’t think this qualifies as an epidemic,” said Guy Voeller, MD, a professor of surgery at the University of Tennessee Health Science Center, in Memphis. ”
https://dictionary.cambridge.org/us/dictionary/english/debilitate [h=2]debilitate[/h] verb [ T ]
UK /dɪˈbɪl.ɪ.teɪt/ US /dɪˈbɪl.ə.teɪt/ formal
to make someone or something physically weak:Chemotherapy exhausted and debilitated him.
Synonyms
drain
enfeebleformal -
Chaunce1234, your list is very similar to one that Dr. Kavic, Professor Emeritus at Northeast Ohio Medical University and editor of the Journal of the Society of Laparoendscopic Surgeons, produced back in 2016, in his review paper.
Of course, he said “mesh”, but a more proper word might be device or prosthetic. The word “mesh” brings up an image of a net-like material, but that might not be necessary.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/
“Most would agree that the ideal mesh characteristics for repair of inguinal hernia include the following and not include symptoms resulting from use of mesh itself:
- Not be modified by tissue fluids,
- Be chemically inert,
- Not excite an inflammatory or foreign body reaction,
- Be noncarcinogenic,
- Not produce an allergic or hypersensitivity reaction,
- Resist mechanical strain,
- Be capable of being fabricated in the form required,
- Be capable of being sterilized,
- Resist infection,
- Provide a barrier to adhesions,
- Respond in vivo like autologous tissue.17
A 12th characteristic might be that the mesh be easily removed whenever a problem such as pain or infection develops.”
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And, a review by an impartial professional is typically a great starting point for any research.
Professor Emeritus at a top medical school and editor of Journal of the Society of Laparoendscopic Surgeons seems good.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000866/
Sorry jnomesh I might be overdoing my response. That video is frustrating to watch. So recent.
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Here is an example of what a person might find on the internet if they search “chronic groin pain mesh”. Dr. Bachman may have overlooked also that a person who works for NIH might have direct access to these papers through an internal database search. No need for Google. Most professionals would use Google Scholar anyway. Still surprised that she discounted the opinions of the very educated people she mentioned at the beginning of her presentation.
https://www.google.com/search?hl=en&authuser=0&ei=jyeZXMrVH4mLr7wPjeuziA0&q=chronic+groin+pain+mesh&oq=chronic+groin+pain+mesh&gs_l=psy-ab.3..33i22i29i30.16781.17798..18192…0.0..0.67.289.5……0….1..gws-wiz…….0i71j0j0i22i30.y-40gGBN-q0
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Here’s the site for the PHS. It’s a lot of mesh.
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quote kevin b:Hey everyone.
I’m 40 years old — 5’8″, 185 lbs. Decent/average shape (at least I was a month ago).
5 weeks ago (2/19/19) I had open hernia surgery on the right side. Surgeon found the following:
- Torn oblique and torn transversalis.
- Entrapped Iliohypogastric Nerve.
- Small direct inguinal hernia
He then repaired it by:
- Removal of section of iliohypogastric. Cauterized ends.
- Repaired the hernia (small bulge of spermatic cord) with medium prolene mesh
- Sutured up the muscles.
I had a lot of post-surgical complications:
Dr. Brown responded to your other post and might have more comments since you’ve added more detail. Are you reciting from memory or notes, or from copies of the surgery notes? I’m not sure that what you described is self-consistent. A direct hernia is a projection of material in to the inguinal canal from the side, not through the spermatic cord. But you mentioned a swelling of the spermatic cord, which implies a lipoma or an indirect hernia. If my understanding is correct. You could have both, of course.
Also, Prolene mesh is used in many different forms, from small patches, to complex two patch systems, connected together. The Prolene Hernia System. It would help to know what was used.
And, Dr. Brown probably has more experience in fixing ruptured muscles since he works on many professional athletes. Suturing them back together and getting them to work correctly are not the same thing, I expect.
As far as “stuff” in the scrotum by the testicles, I also had that experience. It resolved over time. I assume that it was some sort of tissue damage, possibly from the tying back of the penis during surgery.
Good luck. If you don’t have copies of your surgical notes you should get them.
[USER=”2580″]DrBrown[/USER]
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That is a great presentation to watch for someone who wants to see how to convince yourself that what you’re doing is right. She seems very conscientious and gives a nice presentation but she never even got close to answering her primary question. “Why are more patients asking their surgeons for non-mesh repairs?”.
She, instead, suggested that some of the most intelligent people in the world, scientists working at some of the best research organizations in the world, were being swayed by law firm web sites on Google searches. Overall, actually, a poor presentation, whose actual result was to personalize the use of mesh, with the story of the young woman, but avoid answering the real question of why we ask for non-mesh repairs. She asked the right question then diverted to supporting the use of mesh as the core of the presentation. It might even be subconscious, she might think that she actually addressed the question.
It is actually a fairly standard boiler-plate mesh-use support presentation. Not patient-centered, but surgical practice centered. Justifying past and present behavior.
And, as everyone seems to do, she balled all of the different types of mesh and different repair methods in to “mesh”. She was aware of the differences but still referred to everything as “mesh” versus non-mesh.
Very discouraging that this is a “Masters Hernia” presentation in July of 2018. Not even a year ago. Thanks for posting that link.
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[USER=”2814″]Bswilson[/USER] forgot to add a notification.
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Different surgeons use different methods for removal. It is not something that they like to talk about and share, it’s not a popular topic, even though it is more impactful, in a positive way, than a hernia repair, to the patient. I suggested recently that mesh removal should be a major topic at the big surgeons’ meetings but it seems unlikely to happen. And the huge range of materials and methods possible, and combinations, mean that the potential problems cover a wide range.
In principle, the body is “rejecting” the mesh forever. It never gets “incorporated” in to the body although that phraseology is used all the time to support its use. It gets encapsulated at a fiber level with low inflammation if a patient is lucky. Maybe your surgeon(s) mean that they need to give the body tissues time to restrengthen before continuing? So that the strong tissue can be distinguished from the damaged tissue. The tissue around mesh can be full of fluids from the damage of the mesh.
Can you give more details about your situation? The type of defect repaired, type of mesh, method used? And the method being used to remove it? Some surgeons that use an open method to remove mesh can get more done in a shorter time than a surgeon using laparoscopy. Either way, I think that it is a very tedious time-consuming process, and the internal parts of the abdomen can only be exposed for so long before damage occurs. Tissues dry out and the possibility of adhesions increases. If you have mesh entangled with important structures they might be taking their time to save those structures.
Good luck.
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This seems like something that it would be very reasonable for the community of surgeons to get behind. A lever to use for reform or rehabilitation of the FDA. Smoking is one of the worst things for healing, but the FDA’s efforts to minimize the number of smokers produced by big tobacco marketing efforts is at risk.
More smokers means more weak tissue, more disease, poorer healing, more need for mesh implantation and more mesh failures, both recurrence and chronic pain. Staying focused on only the few hours of surgery isn’t enough, if the goal is to produce a healthy patient. “I did my job” isn’t enough.
https://www.nytimes.com/2019/03/15/health/tobacco-e-cigarettes-lobbying-fda.html
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quote kls007:I was wondering everyone, can a hernia or nerve entrapment cause the cremaster muscle to not work properly or over work? It feels that that my scrotum and penis pull into my body even when I’m not cold or its not cold outside?
I still get that response occasionally after mesh removal, after more rigorous activities. I think it’s just the bodies response to damage. Is yours always that way or is it better after rest, like in the morning?
I don’t know that trying to figure out the exact mechanism of the response is going to get you to a solution. Probably any damage in that region could cause the response. Athletic pubalgia, hernia, muscle strains.
If you’ve been seeing mostly general practitioners maybe try to find a doctor with expertise in abdominal injuries, like a “sports hernia” doctor. Athletes tend to have a wide variety of “core” injuries.
[USER=”2580″]DrBrown[/USER]
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If you use these words to search the internet you’ll find another very good article by the Guardian. I’d post the link but I get constant “Unapproved” rejections.
[h=1]Don’t pin the opioid crisis just on Purdue. The guilt runs wide[/h] -
Another article from the Guardian. Considering the recent tragedies with the Boeing 737, you can see that the big institutions are like giant machines, focused on keeping the business alive.
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I know somebody that works in venture capital and they said that all of the device makers are waiting to see where the litigation ends up. Their research budgets are small, they’ll just make the money that they can while they can.
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I’ve been blocked.
[USER=”935″]drtowfigh[/USER]
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Hello Casey. Dr. Towfigh would probably know the answer to that.
I’m posting here to notify her, but also to see if I can post anything on the site. Good luck.
[USER=”935″]drtowfigh[/USER]
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He does not like plugs, as in the plug and patch method of hernia repair. He commented on Dr. Towfigh’s tweet.
https://twitter.com/Herniadoc/status/1021561699290116097
What do you see?
This is a medium size Perfix #plug #mesh that has balled up, aka #meshoma . It was causing chronic groin & nerve #pain due to erosion into the spermatic cord, so I excised it. He is now #pain free!🙏🏻#meshcomplication #hernia #chronicpain #itsnotjustahernia pic.twitter.com/EgnLh0ULXR
— Dr. Shirin Towfigh (@Herniadoc) July 24, 2018
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Another fairly recent article about changing the 510(k) process. It’s not really clear who will benefit though. Seems to be more short-term based.
https://www.cnbc.com/2018/11/26/fda-to-overhaul-510k-medical-device-approval-process.html
And it looks like the head of the FDA has been pushed out. Wants more family time after just two years.
https://spinalnewsinternational.com/scott-gottlieb-resigns-fda/
This is why we can’t depend on the FDA to save us. If they can help, that’s great. But nobody should expect the help.
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About one year ago there was an effort to increase the dialogue between the FDA and the affected parties. Not clear what ever came of it.
https://www.herniatalk.com/6583-dear-patient-advocates-seeking-feedback