Good intentions
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I wrote a long post but got blocked by the green screen. I should have copied and saved it first. Can you help with that [USER=”935″]drtowfigh[/USER]
Find a surgeon who removes mesh but does not do so as their primary business. One who might be familiar with the Prolene System. Your mesh is polypropylene. Keep a log of your activities and compare them to what you used to do, to see the rate that your life is changing. My personal opinion as a mesh “survivor” is that if the body does not accept or incorporate the mesh that the damage will accumulate over time. Constant inflammation is generally not healthy, I think. Healing and recovery after removal will be more difficult the longer that it is in place, and beside that, the time with the mesh in place is like a sort of limbo, once you know that it’s not getting better. It can’t be enjoyed. In many ways, it is wasted life.
Post your general location and people might know of surgeons to to talk to.
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The Prolene Hernia System is a trademarked Ethicon product which uses polypropylene mesh. It is two layers of mesh connected by what is, in essence, a “plug”.
I personally, as a person who had Bard Soft Mesh (also polypropylene) implanted then removed three years later, think that the constant inflammation and damage that the mesh causes, if it doesn’t work for you, builds up the longer that the mesh is in place. The damage seemed to be cumulative in my case, getting worse as time passed. All of the tissues in the vicinity of the mesh are affected by it, and the loads and stresses on those local tissues are also changed. Some areas will stiffen and toughen up while others will get weaker. After the mesh is removed those areas have to readjust, and it takes a long time.
If you’re not doing so already, keep a log of the things that you do and the after-effects. Your life can be diminished very slowly as time goes by, as you avoid doing the things that are uncomfortable, and with a record of your activities it will be easier to recognize. Compare what you do now to what you used to do. It will help you organize your thoughts also for communicating with surgeons, wherever you find them.
Your best option is to find a surgeon who removes mesh but is also very objective about their profession, as a surgeon and doctor. Surgeons are normal people, and you’ll find good and bad as you search. Talk to as many as you can, via written letter, internet, or phone, to find one who is familiar with the Prolene System and may recognize your symptoms.
Post your general location and people might have suggestions for surgeons to talk to.
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On the other hand, Dr. Bendavid seems to be thorough in his research but also seems very biased. He could probably persuade more people to examine their methods and materials if he was not so critical of the surgeons who use mesh. I suspect that he offends many surgeons that use mesh, which makes them more defensive, resistant to exploring the possibility that some or all mesh devices might be bad. Closing ranks, as they say. Dr. Bendavid might actually be contributing to the continued use of mesh by polarizing the subject, instead of fostering an objective analysis.
Although his comments about conflicts of interest are probably very relevant. Many surgeons who support the use of mesh are getting paid by the device makers that provide it, apparently. Consciously or subconsciously, they have a financial interest in promoting its use.
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The comments at the bottom of the article are worth reading too. One is a student of Dr. Voeller, who “attests” to his method and says that he has a low chronic pain results. But he offers nothing to support the statement. He does seem to be aware that there is little followup, for recurrence, but seems to overlook that the same lack of awareness applies to chronic pain. Almost like he doesn’t really know what it is, or that it can manifest years later. He might be using the two week followup as evidence of no chronic pain, or “nobody has mentioned it” as evidence.
“I’ve copied Dr Voeller’s approach in over five hundred TEP repairs with two recurrences (that I’m aware of) to date over eight years and can attest to the lack of chronic pain with this repair with mesh and glue alone.”
Another surgeon comments about removing mesh, and avoiding plugs. But he still seems to assume that his method works well, not discussing his method’s chronic pain level. John Morrison might be a good surgeon to contact for mesh removal, since he seems to have experience.
” I do not advocate using mesh plugs in any patient.”
“My referral practice is almost entirely devoted to the care and treatment of hernias and their complications. Make no mistake, chronic pain is a major problem with devastating results. I spend a lot of time in the OR removing these patients meshes, with the majority having their VAS score reduced from 6-8, to 1-2”
It’s good to see individual surgeons thinking about these things but the lack of organized research is incredible. So many individuals making their own guesses, experimenting, but no quantifiable evidence of effectiveness.
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quote iceflow:I have a bulge of varying size right in the same spot as before. It varies from nothing when standing up from seating or getting out of bed to ‘just proud’ of the original scar tissue once I start moving around to let’s say if you cut an egg lengthwise and stuck the half into your abdomen. The latter is after activity. There is no pain to speak of, perhaps a burning sensation on the very odd occasion but mostly nothing painful.
It might be just tissue damage and swelling. You really need to get a good diagnosis. Don’t assume too much, this early. If there’s no pain and no recurrence your best option might be to accept the unsightly lump and live with it. Don’t get surgery for cosmetic reasons. The risks are too high.
If you can find the details of your surgery there might be something there. Of the many many varieties of mesh and implantation techniques, each has its own unique faults along with the common inflammation problem.
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[USER=”2769″]HerniaQuestions1[/USER]
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I’ve read and heard comments about “angry” or irritated spermatic cords after surgery. I had a small lump like yours after my first repair which eventually disappeared. When the hernia sac is pulled out of the canal I think that it leaves irritated tissue behind.
The plug and patch method blocks the hole with a substantial piece of folded up mesh, backed up by a flat piece of mesh. I think that a recurrence is unlikely. One reason it’s a popular repair method. The plug does sit next to the spermatic cord though so the cord has to adjust to its presence. The 14th is ten days ago. You’re still in the healing response time frame.
Why didn’t you talk to the surgeon who did the repair? You saw an ER doctor and a “second” surgeon. Curious.
Good luck. Enjoy the holidays, if you can.
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I found a page on Dr. Grishkan’s site describing the trend of what’s happening in the insurance industry.
http://www.herniasurgeries.com/cleveland-ohio-hernia-insurance.htm
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I don’ t know if this will make you feel better or worse, but my surgery site from mesh removal is still changing, a full year later. There have been long periods of time where it seemed like improvement had stopped, but then more change and improvement happened. The body just keeps adapting, trying to get back to the original design. Sometimes it seems like it’s on its own schedule, independent of activity. I’m finally to the point where I live a normal life, and don’t hold back to save the site of the former mesh from pain.
Here is the link to Dr. Grishkan’s practice. He says that he does use a “special” mesh for certain cases. Have you seen your surgery notes? I’m not trying to add something scary, just curious about the details. Looks like he’s popular with the body building crowd so you’d imagine that the lump will reduce, but they do seem to recover faster, by the stories.
Good luck.
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I can’t speak to the details of your problems but two things do come to mind.
One is that if you are unemployed you’re probably paying for your own insurance. If so, you might find that your insurance provider will only reimburse for work done by “in-network” care providers. This is a very recent development, for 2019, that seems to be almost industry-wide for individuals paying for their own insurance. This might narrow your choices if you want insurance to pay for any procedures, since 2019 is just days away. Check your coverage. One the other hand, you might find that paying full price outside of your insurance network is actually less expensive, after calculating for deductibles and the percentage that you’ll pay.
The second is on finding somebody who will do a non-mesh repair, let alone consider doing one. Mesh repairs are rapidly becoming the “standard of care”, I believe because it simplifies the whole healthcare process. Healthcare is trending towards more of a triage type system, designed to get large volumes of people in and out and as quickly as possible, and to use the cheapest methods, because controlling costs is so important. Healthcare is not really for the patient anymore, so much as it is a business for taxpayers and shareholders. It is highly likely that you will find many surgeons willing to “try” a mesh repair on you, even though the result of a mesh reaction for you would probably be a disaster.
This might sound discouraging but I think that it is true. Don’t be persuaded to do what you know won’t be right for you.
On your bulge, I think that hernias get larger because more material is pressing through the defect, and also because the defect gets larger. You will want to avoid letting the defect get too large because that is one of the original reasons to use mesh. It can cover a large area, making a difficult job easy.
Since you were and might still be very athletic, consider consulting with physicians who treat professional athletes. They will be the ones most likely to know who does non-mesh repairs, since most athletes avoid mesh. Contact the trainers at teams like the Dynamo, Astros, Texans, or Rockets. You never know, somebody might have advice.
Good luck.
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[USER=”2766″]Katherine[/USER] You can notify people also using the @ symbol followed by their screen name.
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There seem to be certain words or phrases that trigger a spam filter. Dr. Towfigh can release them if she sees them, but your best bet might be to just try again with fewer or different words. Good luck. Welcome.
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Here is the full text from that tapatalk forum. Many insurance companies will no longer be reimbursing for out-of-network work after 1/1/2019. Claims can not even be filed, it’s just a flat “in network or nothing”. So the reins are being tightened even further, with the insurance companies controlling the care choices.
From the tapatalk herniadiscussion page. The North Penn web site is expired also. http://www.nphernia.com/
“Dear Friends and Patients
Founder, Hernia Specialist and Principle Surgeon, James A Goodyear, MD, FACS,
of the NORTH PENN HERNIA INSTITUTE has, as a result of a recent decision by the parent health system, been obligared to close his Specialty Practice of Hernia Surgery in Lansdale, PA as of Dec. 1, 2018.Dr. Goodyear can still be contacted directly at:
GoodyearHerniaInstitute@gmail.com –
“
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quote VegasHernia:About 12 years ago, I had an inguinal hernia repaired laparoscopically with mesh (original hernia was on left, right side repaired “proactively”). Recovery was quick and any residual pain was gone after 6 weeks or so.
Can you find any information on the materials and method for the bilateral repair from your original surgery? 12 years ago it was probably TAPP with a “heavier” mesh.
I know of someone else who had a laparoscopic repair many years ago, over 15 I think, and had no problems. Then they had a second laparoscopic mesh repair on the other side about six years ago and had problems from the moment they woke up. Eventually having the newer mesh removed. A person would assume that something is different between the long-term success, for 15 years, and the immediate mesh reaction from the second surgery. This is on the same person, so the “individual patient differences” theory doesn’t work well.
It could be materials, or method, or maybe quantity/coverage area. A good medical student could probably figure something out, with a good sponsor behind them. If people want to know.
[USER=”2725″]VegasHernia[/USER]
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I was just offering a counterpoint. I think that many surgeons and medical institutions have been captured by the powerful marketing programs of the medical device makers. So you can’t just trust the surgeon who seems to know what they’re doing. That’s why I offered my own real world example.
And, specific to your post, I think that harm can be done by reassuring people about something that is actually very risky, with a very high personal cost if they get bad results. People should be very fearful about this supposedly simple operation.
I would say that I am playing “devil’s advocate” but I think that the devil already controls the situation. I’m on the other side.
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Thanks for posting this Chaunce1234. It’s a shame that Dr. Meyers isn’t more active professionally. His quiet nature and skill only helps a relatively small number of people. Maybe as he gets close to retirement he’ll share his knowledge. Otherwise everything he knows will be wasted. He must have something to say about repair of direct and indirect hernias.
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WasinTN, you are repeating much of the marketing words of the mesh industry. Skill of the surgeon is most important, etc. Surgeons are trained in how to speak to their patients to get them to accept the operation. So demeanor in the exam room doesn’t tell anything about odds of success either. Your comments about doing your own research are valid, but without long-term, verifiable results, the research has little value.
If I recall, you had your procedure recently. You can find views like yours all over the internet, people hoping that they made the right decision, and assuming success after just a few months, then offering their advice. I did the same thing, telling people to talk to their surgeon if they had issues after mesh implantation, and to expect a long slow recovery. But, my long-term result did not support the decision I made, even though my surgeon met all of the best available criteria, used state-of-the-art materials, and state-of-the-art methods.
Really, the best that you can do to help people out here is to describe what exactly that you had done and when, with details, and how, exactly, you are doing today. Compare who you are now, emotionally, mentally, and physically, with who you were before the hernia. Not before the surgery, but before you had the hernia, when you were healthy. Are you doing the same things as when you were healthy, or are you still taking care of your malady? I knew that I had made a mistake when I realized that my whole life revolved around taking care of my mesh/abdomen. It was all I thought about from the moment I woke up in the morning. I was half the man I had been before and felt like I was just waiting to die.
I’m not trying to start an argument. But I read and re-read what you wrote and couldn’t find much hard substance to use in a decision. No numbers. And really, should this problem be as big as it is? If it was a “skill” issue you would expect specific surgeons to be getting sued out of the field for malpractice. But the reality is that chronic pain with mesh implantation is “normal”. It is state-of-the-art. The actual odds of having it though are concealed or unknown, and efforts to define it are avoided. That’s what patients doing research need to know. If they knew the odds many would make a different decision.
Good luck. Post up a description of how you’re doing today and how long it’s been. Who the surgeon was. At least people can use those specific details to possibly have the same exact procedure done, if the long-term results are what they are hoping for.
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Here is another paper that cited the one you linked. It looks promising.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321139/
One major problem in the hernia repair field is the huge investment that has been made in the mesh-based methods. Large corporations with large revenue streams based on selling mesh devices, and the fact that most educational institutions are supported by these medical device makers, training their new students in mesh implantation techniques, means that the incentive to learn non-mesh techniques like this have to come from the individual student. It is hard to imagine a young new doctor joining a practice and refusing to use the “state of the art” method. You’re new, you’re there to learn how things are done, you do what your mentor tells you to do. On top of that, the insurance companies decide what procedures are acceptable, for reimbursement.
Here’s an interesting article about the early years of a surgeon’s career. One sentence seems especially relevant. The “standard of care” is the phrase that you’ll see often when looking at why mesh is used. The device makers have managed to make mesh implantation the standard. Which just means that everybody is doing it, whether it’s the best or not. You can’t get in trouble if you’re doing what everyone else is doing.
“Case Selection. Young surgeons need to be constantly reminded to do what is safe, proven, simple, and accepted as the community standard of care. Those heroic procedures done as a resident will get you in trouble more often than not outside a tertiary care center.”
https://jamanetwork.com/journals/jamasurgery/fullarticle/508661
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The mesh forms a stiffer material after your body’s tissue grows in to it. Stiffer and less elastic than body tissue, and stiffer than the original mesh. It won’t flex or stretch like original body tissue, or like the mesh before it was implanted. It forms what would be called a fiber reinforced composite in the materials science world, of stiff polymer fiber in a collagen matrix. Composites tend to take on the elastic properties of the fiber material. Something to think about that might explain what you’re feeling. It will never remodel itself back to normal mechanical properties of unreinforced body tissue. The loops and knots of the mesh are no longer free to move like they were outside the body, they’re full of collagen.
I’ve mentioned this in other posts but the body will continue to try to get back to what’s “right”, for years, probably until death actually. I’ve experienced this with a broken collarbone, and injured leg, and a finger tip that was cut off and reattached. The initial healing is quick but the process continues for much longer. It’s pretty amazing to think about. Good luck.