Good intentions
Forum Replies Created
-
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 –
“
-
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]
-
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.
-
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.
-
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.
-
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
-
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.
-
I don’t want to dissuade you from talking to your surgeon. They would know best. If the history with their method says 3 days is normal then you’re abnormal, by that standard. Worth a phone call for sure. [USER=”2329″]Jeremy B[/USER]
-
My theory on why thin people might have problems with chronic pain from mesh is that thin people are generally active people. In other words it’s not the thinness, it’s the activity level. It’s why professional athletes avoid all forms of mesh. There might be forms of mesh that work for active people. But they are undefined.
-
Here’s another on surgical wounds. https://advancedtissue.com/2013/12/3-ways-know-difference-healing-infected-surgical-wounds/
I still have red spots over the entry points from my laparoscopic mesh removal.
-
BMI is known to be a very poor indicator of body fat, although many assume that’s what it shows. It’s just the ratio of weight to height. More muscle also increases BMI. The industry likes to use it because it captures most obesity, but it’s a sloppy measure, of anything. It’s an example of the over-simplification of complex situations. Like labeling all of the numerous forms of mesh together as “mesh”. Both are classic signs of bureaucracy, dumbing things down to fit the forms.
https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm
-
quote Dave Graham:Is anybody aware of detailed publications on LONG-TERM recovery after an ‘Open’ I. H. procedure?
You’ve probably described in this one of your other posts but are you talking about open mesh implantation or open suture repair?
I posted a link to another forum in my “Good Stories” topic. There might be more information over there. It’s post #30. Good luck.
https://www.herniatalk.com/6883-successful-good-mesh-stories/page2
-
No offense intended, but one week is not really very much time. Even a cut finger takes longer to heal. I found a pretty good summary of the healing process out on the internet. https://advancedtissue.com/2014/09/signs-wound-healing-stages/
I kept a log of my recovery from laparoscopic surgery and at one week I still had some general swelling, and at 12 days I still had a localized lump over the spot of the direct hernia. It was 16 days before I could button up my pants to the top button. Your absorbable sutures should be the type that take quite a while to degrade. Probably months. Even the fast absorbing types take a couple of weeks, I think. I had a piece of one poking out of my navel for a while.
Just a few things that might lessen your stress. I’ve broken bones, and fingers, and they generally take four weeks to “heal”, at least to the point where they are functional again. You’re still in the early stages. You might take more rest between your walks to see if swelling diminishes. Good luck, and stay in touch. You have one of the newer repair methods.
-
Shouldice seems to avoid these horror stories. Another good reason for a registry of hernia repairs. Not just mesh. Without the numbers there’s no way to tell what is best for the patient. It’s all anecdotes and marketing.
-
It is the official guidance of the British Hernia Society as of November 14, 2018. The momentum behind the use of “mesh” is huge. People are putting on blinders and hiding from the truth, I think.
https://twitter.com/BritishHernia/status/1062723661801705473
We have produced a Mesh safety leaflet for patients - https://t.co/a70Q7Go29i
— British Hernia Society (@BritishHernia) November 14, 2018
-
Thanks for posting this paco. It was probably a good idea to get it out early. As NFG12 said, it can take a long time to recover after mesh removal. The surrounding tissue has spent all of that time accommodating the mesh. Don’t expect rapid results but do have hope for constant improvement. Good luck.
It’s good to see that the professional associations are finally taking some responsibility and performing the functions that they were originally formed to do. To monitor and advise. Finally realizing that the medical device makers are not working for the patients’ welfare, and cannot be trusted to advise about their own products.
Here is a fairly recent tweet from Dr. Towfigh about the plug and patch.
-
Here are a couple more informative links. We should spread this recent focus around as far as we can, and keep it alive as long as we can.
https://twitter.com/guardian_sport/status/1066739706312962048
Hernia mesh implants cost Dai Greene five years of his career https://t.co/hKxatVL2BL
— Guardian sport (@guardian_sport) November 25, 2018
-
Not a problem at all. Yours is from a different source and has more information. It’s heartening to see some high-powered light focused on the problem. I just hope that influential people will see the opportunity to get some change started. Otherwise, like many disturbing issues, it will fade in to the background again.
I just realized that I could watch the video on your link. Many BBC.com links are not viewable if you’re not in their region.
I encourage everybody to watch it. It’s only one minute long. I just wish that he would have told us where British Athletics is sending people now. Let the market forces kill the bad mesh.
-
Deleted. Maybe too sensitive. It’s a tough subject.
-
Okay, sorry I took the negative approach. I know that the tissue around the mesh thickens and becomes stiffer, in all cases. So the normal swelling and healing response from your injury might be complicated by the inflexibility of the mesh area, pulling on areas it normally wouldn’t. Hopefully it will relax back to the state in which it was working for you. Good luck.