Good intentions
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Are you “registered” and able to read the full article? I have not tried to register.
This article shows the same problem of grouping all mesh in to one big blob. At least the teaser does. I don’t know why there aren’t surgeons giving detailed reasons about the best mesh material. Do they all see mesh as one entity? Somebody needs to step up and start defining the good mesh from the bad mesh. I also see the inherent bias “for” mesh. Objectively speaking, the sentence should say “for and against” mesh.
There are companies discontinuing mesh products. Why? Let’s talk about that. Are they bad products or do they just have bad marketing groups?
ANUARY 18, 2019 [h=1]Talking to Patients About Mesh[/h] In Age of Social Media and Lawsuits, Surgeons Offer Advice on How to Communicate With Concerned Patients
By Christina Frangou
Boston—With more public attention on the potential complications of mesh, patients are asking more questions of their surgeons: Is mesh safe? Will I have pain? Can I have a repair without mesh?Surgeons need to take time to listen to patient concerns and talk to them about the state of the evidence for hernia mesh, said B. Todd Heniford, MD, the chief of gastrointestinal and minimally invasive surgery at Carolinas Medical Center, in Charlotte, N.C., at the American To read the full story, Register or Login
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quote Chaunce1234:[USER=”2029″]Good intentions[/USER] do you mind sharing if you had any of the brain-related aspects of chronic pain, and how or if they developed or changed before and after your particular surgery?
I mentioned in the first post, quoted below. I do not have any psych problems that I know of. No treatment, or thoughts of seeking help. I’m lucky. I thought that I would get my simple direct hernia problem fixed and be back to living my full and healthy life.
” My neural wiring was well-developed to have a fantastic outcome when I had mesh implantation. I actually had to overcome that neural wiring to realize that I would have to deal with the real physical problems that the mesh caused.”
By that I meant that I believed that I would be okay. I had the bias that many healthy people have toward others with problems, that they must be unhealthy or out-of-shape, or old, or whatever other rationalization that people use to believe that they’ll be better off than the unlucky ones. I had a friend who was a surgeon who had had his own hernia in the past, who recommended the surgeon who did the repair. The surgeon was accomplished, well-respected, chair of surgery, at a big clinic. I had the state-of-the-art TEP repair using light weight Bard Soft Mesh. Everything said that I should be a poster-person for how to make the right decision and get a good result.
My issues, besides the discomfort and pain, were some that I cannot imagine are psychological. Penis issues, not just ED, bowel issues – bowel movements the size of a cats, physical manifestations like a very tight and flat abdomen, almost like a drum head. Feeling the edges of the mesh poking in to my groin, and irritated at the center where they had originally overlapped.
I even tried to work up some sort of routine where I could do healthy things like biking or running, then wait a few days for the problems to disappear. But the overall trajectory was down, getting less and less healthy, unable to focus on things after exercise, realizing that whole weeks were passing by where I hadn’t really accomplished anything. I was taking care of my mesh, like it was a baby, it was my sole focus.
The main reason that I am more active here is because the mesh is gone.
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quote drtowfigh:As you know, many undergo what we believe is the right approach to address their chronic pain but they are not cured of their symptoms. Dr Ramshaw has shown that that negative result may be related to the unaddressed neural wiring side effect of chronic pain that is not addressed by the operation.
Are the symptoms new symptoms, from the surgery and/or the mesh, or are they the old symptoms from the hernia?, would be a clarifying question.
I think that much of this problem gets lost in the description and definition of “pain”, maybe assuming that the pain is from the original problem. A cognitive bias toward believing that the mesh should not cause pain. My problems were definitely tied to the mesh. I was better before the mesh, and am better after its removal. Time with the mesh implant was the worst.
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Here is the TAPP presentation from the “Perfect Repair” series. Shows how it’s done, says it as “just as good” as any other method. At the end he just says “pick what you’re good at”. He did not really address long-term complications at all.
One thing I realized as I watched this one was that none of the presentations addressed pure tissue repairs, except Dr. Ramshaw’s, whose presentation was not actually in the “Perfect Repair” session. They are just comparing the mesh procedures. The title of the session should have been “Perfect Mesh-Based Hernia Repair”. And, as in the others, time and money are major concerns. The economics of health care are driving much of what is happening.
TAPP repair: Who, when, how & why? – YouTube
https://www.youtube.com
This talk was presented at the 2018 SAGES Meeting/16th World Congress of Endoscopic Surgery by Jacob Andrew Greenberg during the The Great Video Debate: Perf… -
quote drtowfigh:Dr Ramshaw’s discussion abaiut neural wiring is based on his research and that of others:
Patients with chronic pain suffer from somatic and neuropathic pain in their body. They also suffer psychologically from the chronic pain. This manifests in depression, PTSD, anxiety, insomnia, etc.
he he has shown that patients who can get attention to the brain-related negative effects of chronic pain will have a better outcome from the surgical approach to treating the chronic pain (eg, by mesh removal). As you know, many undergo what we believe is the right approach to address their chronic pain but they are not cured of their symptoms. Dr Ramshaw has shown that that negative result may be related to the unaddressed neural wiring side effect of chronic pain that is not addressed by the operation.
Actually, the start of his comment was “influence from outside of healthcare, the lawyers” as the source of that “misinformation”. He didn’t explain clearly that he meant that the patient had inherent psychological problems. He almost explicitly blamed other people for putting ideas in to patients’ heads.
Looked at alongside his other comment “Let me be clear: mesh does not cause chronic pain”, he seems like somebody struggling to know what to believe himself. You can find him on both sides of the debate.
He seems like a great guy, and hard-working. But there does seem to be some internal conflict and bias to his comments. I wish him well with whatever his new situation is.
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Here is the TEP video from the “Perfect Repair” series. The presenter shows how she does her TEP repair, but at the end, even though she says it’s not a competition, it’s a debate, she “bashes” the other methods. Maybe trying to be funny, but there was no pros versus cons comparison to the other methods. I assume that it happened in the discussion.
The video also shows the dramatic difference in amount of dissection, between TEP and open mesh implantation. TEP splits open a very large are in the abdomen, side-to-side and top-to-bottom, then places mesh in that space. Very large pieces, she says “at least” 4 x 6″ pieces should be placed You can imagine a voice in the surgeon’s head saying “I really really hope this person does not have a mesh reaction”. Open repair is very focused on only the defect, TEP is a big exploration.
TEP really is a go-for-broke approach, huge dissection, peeling apart tissues in the most sensitive area of the body, and large placement of a potentially dangerous material. It looks so clean and neat but when you really look at what’s happening, it seems like a very drastic approach. I appreciate even more the time that Dr. Billing took to remove all of the two 6×6″ pieces that were placed in me. It takes much more time to undo a TEP placement than the few minutes it takes to put it in there.
TEP repair – YouTube
https://www.youtube.com
This talk was presented at the 2018 SAGES Meeting/16th World Congress of Endoscopic Surgery by Archana Ramaswamy during the The Great Video Debate: Perfect I… -
quote Chaunce1234:It is curious to me that this particular subject seems to defy all laws of supply and demand. You’d think given the large number of consumers (patients) interested in pure tissue repairs, that the market would respond and there would be a significant supply of surgeons growing to meet that demand for non-mesh repairs, but that does not appear to be happening.
Dr. Ramshaw talks often about the business aspects of medicine. Much of what’s happening now is due to pressure to standardize health care. One common solution covering all of the patient variations. It’s not really a free market supply/demand situation. It’s like the old joke about Henry Ford’s first cars, and choice of color – you can have any color you want as long as it’s black.
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Dr. Ponsky presented at the recent SAGES meeting, in the “Perfect Repair” session.
Laparoscopic inguinal hernia repair (Based on Patkowski’s technique – YouTube
https://www.youtube.com
This talk was presented at the 2018 SAGES Meeting/16th World Congress of Endoscopic Surgery by Todd Ponsky during the The Great Video Debate: Perfect Inguina… -
Here is a video titled “Inguinal hernia-Open mesh repair” in the “Perfect Inguinal Hernia Repair” sub-category. It’s really just a collection of “state-of-the-art” techniques, I believe. No actual measurement of “perfection”.
It doesn’t really instill confidence. The presenter makes an off-hand comment that if the patient has a non-painful hernia when they come in that they will certainly not have pain afterward. “They’ll be fine” at 4:00. He cites a one year study. This does not fit with many stories on this forum and around the internet. People who got their hernia repaired to be safe, and ended up with more pain afterward. Anecdotal, of course. The pain discussion starts at 2:50.
Inguinal hernia-Open mesh repair – YouTube
https://www.youtube.com
This talk was presented at the 2018 SAGES Meeting/16th World Congress of Endoscopic Surgery by Matthew I Goldblatt during the The Great Video Debate: Perfect… -
Here is a link to the whole 2018 “playlist”. There are a few more hernia, and mesh, presentations.
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quote Good intentions:Dr. Bruce Ramshaw even can’t resist defending what’s happening and seems in denial. His statement from the article is surprising. I can’t see a reason for making such a blunt statement except to defend the industry.
“The relationship between mesh and chronic pain is poorly understood, Dr. Ramshaw said. “Let me be clear: Mesh doesn’t cause chronic pain but it may be a contributing factor as part of the many factors that can contribute to chronic disabling pain.”
That’s the same logic as “the fall doesn’t kill you, it’s the sudden stop at the end”.
I wrote the comment above then went back over what I knew about Dr. Ramshaw. He seems to undecided about the whole “mesh” situation. He has written quite a bit about post-repair pain, and does remove mesh. But sometimes he seems to imply that the problem is psychological. It’s hard to tell what to think about his comment, it might be one of those Freudian slips, from wishful thinking. I don’t know.
Here is a link to his UT page, and a recent video from the last SAGES meeting. He seems like a guy you would want repairing your hernia.
https://www.youtube.com/watch?v=Pffj-GAEMRs
Bruce Ramshaw, MD, FACS | The Department of Surgery
http://gsm.utmck.edu
The University of Tennessee, Graduate School of Medicine is located in Knoxville at the University of Tennessee Medical Center. The Graduate School of Medicine is part of the University of Tennessee Health Science Center and offers residency programs, fellowships, and opportunities for medical students. -
The American College of Surgeons does pretty well but still implies that chronic pain is a short-term issue, “pain one year after surgery”, not really exploring what happens after that. But they do give a value of 10-12% and address it directly. More promising. They also show that the recurrence rate is higher for laparoscopic than open, which is surprising. Overall, they seem to have compiled current study results and are facing them directly. Just not going far enough with chronic pain. “Pain” is the original reason for going to the doctor. It should be of the highest priority.
https://www.facs.org/~/media/files/education/patient%20ed/groin_hernia.ashx
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The US FDA tries to address the issue but still falls back on the lack of understanding, thereby perpetuating the problem. Blaming chronic pain on previously recalled products. Still making very vague statements, “many complications”, and taking no action. At least they’re getting closer.
“Many complications related to hernia repair with surgical mesh that have been reported to the FDA have been associated with recalled mesh products that are no longer on the market. ”
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These two links illustrate the huge disconnect between some hernia repair surgeons and general surgeons, at least in Great Britain. Even though supposedly they are the same type of surgeon, and hernia repair is a skill within general surgery skills, somehow the hernia specialists in Great Britain are on a completely separate page from the rest of the surgical community. I say apparently, I haven’t read the whole article, it’s a pay-per-view article.
It seems that the hernia mesh repair surgeons in Great Britain, or at least their representative, are using the “no firm relationship” view to keep on doing what they do. It’s shocking to see it in print. The first article is about caring for your patients, the second one is about caring for your business. Some of these surgeons must know each other, it’s hard to see how they can coexist. And this is after many years of published studies showing that there is a correlation between mesh hernia repair and chronic pain, higher than pure tissue repairs, where chronic pain was so low that it was not an issue. The chronic pain issue has developed in step with mesh repair.
Hate to be so negative but these are recent results. Strange how the industry seems to be paralleling American politics.
From the article – “Around 570 0000 hernia mesh operations have taken place in England over the past six years, figures from NHS Digital show. Leading surgeons think that the complication rate is between 12% and 30%, meaning that between 68 000 and 170 000 patients could have been adversely affected in this period.”
Hernia mesh complications may have affected up to 170 000 patients, investigation finds
BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k4104 (Published 27 September 2018)https://www.bmj.com/content/362/bmj.k4104.full
From the British Hernia Society – “Some patients can develop chronic pain after surgery. There is no firm relationship with the use of mesh and chronic pain, and non-mesh repairs can equally result in this problem.”
Mesh and your Hernia Repair “helping you to make an informed choice”
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HIPPA might be a concern but maybe dog gave permission to Dr. Brown to talk about his surgery, or at least he could say that dog was there, or pass along our well-wishes to dog.
dog had a second procedure scheduled in Florida, apparently, that required a lengthy stay. Treatment two times per day, for multiple days. He mentioned it in his “recovery” topic. It might be harder to recover from than the hernia repair. Inner ear problems can cause vertigo also, I think. He might not be up to posting. Good luck to him.
[USER=”2580″]DrBrown[/USER]
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A few thoughts…
You didn’t distinguish between open or lap, I think that the results can be different, so you might want to specify. Another one of those cases where anything mesh gets lumped in to one word, mesh. I think that open mesh surgery might also be following pure tissue repair in to the past, with everyone converting to laparoscopy, so you might have to request open repair if you want it.
Dr. Towfigh typically recommends checking the American Hernia Society page, if I recall right. It might be a good start. https://americanherniasociety.org/find-a-surgeon/
I know of someone who had a mesh hernia repair in the 80’s and had no problems. He had a second mesh repair about 15 years later and had major problems from the beginning, eventually having it removed after living with the torture for many many years. Again, all he knows is that both were “mesh”. He assumed, like you, that because the first worked that the second would too. Not to scare you, just passing on a true story. Apparently, there are different effects from different meshes, or the repair itself can be either good or bad, with the same material. He is one of the living experiments, that a registry might clarify if one existed.
In short, I’m suggesting that you be extra careful. Good luck.
p.s. I don’t know what you meant by “bark” at your physician, but it doesn’t have a good look. I don’t think that doctors like being barked at. Maybe it was humor?
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There is also Dr. Petersen in Las Vegas. He is known more for mesh removal but he also does hernia repair, among other procedures. His group can put together a whole travel and stay package. He does non-mesh repair.
https://www.noinsurancesurgery.com/about-us.htm
I’m not sure but I think that Dr. Brown’s group can also help with travel and boarding. dog just had his hernia repaired by Dr. Brown. Search for dog’s posts and you will find a lot about Dr. Brown.
https://www.sportshernia.com/sports-hernia-specialist/
And, of course, Dr. Towfigh’s practice might also have advice for a short stay. Ironically, because she is the administrator of the site, we don’t talk much about what happens there. [USER=”935″]drtowfigh[/USER]
http://www.beverlyhillsherniacenter.com/#
Good luck. Put the time, effort, and money in to it as if you wanted it to last for 50 years.
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There were some posts recently about a surgeon in Scottsdale. You would probably be better off to choose the best surgeon for your problem, and to stay in a hotel or BnB after traveling for the surgery, even paying to have a friend or relative stay with you. Pick the best surgeon, I would say, and arrange around them. I tried to compromise for convenience and to stay in my insurance plan when I had my hernia repair and it was a big mistake. I should have done what my research told me was the best surgery option for me, not tried to put a whole project together. The surgeon and the surgery is the most important part.
Here are the links about the Scottsdale surgeon, if you just have to go to that region to get it done. Post #5 is a copy from some correspondence that dog had with Dr. Repta.
https://www.herniatalk.com/9614-open-mesh-removal-and-non-mesh-hernia-repair-dr-remus-repta
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The NIH should be one of the organizations involved in solving the hernia repair mesh problem.
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Here’s a story I came across a while ago, similar but a bit different. It’s from last year. Our government really seems prone to corruption. These people don’t seem to understand their purpose.
https://www.nytimes.com/2018/03/17/health/nih-alcohol-study-liquor-industry.html