Good intentions
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quote katiebarns:[USER=”935″]drtowfigh[/USER] My symptoms are achy and drawing pain in the same area as my inguinal hernia repair (pubic and pubic bone and rectus abdominis area kinda).Hi Katie. I know that you’re looking for Dr. Towfigh’s advice but a couple of things that might be considered are that the mesh is often attached to the pubic bone, and the rectus abdominis. That’s what my surgeon reported and he used the main stream method. And as it shrinks it will pull on those areas. You mentioned a “drawing” pain. I don’t know/remember the details of your procedure.
Also, while much focus is placed the main branches of the nerves, I think because they are visible and can be manipulated, or cut, those branches extend out to smaller and smaller nerves. So it’s possible that localized pain can be due to local nerves. Focusing on the main branch is a way to suggest that the patient is having some sort of referred pain, not correlated to local damage. Pain and the “quality” of the mesh repair are often not connected. The mesh can look fine, placed where it’s instructed to be placed, and still cause pain. It’s not the technique, it’s the material and its interaction with the body tissues.
Sorry, I know it doesn’t help you find a solution but just knowing the cause can sometimes reduce some of the mental stress. Good luck.
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And another. I got green-screened,it might be a double.
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I had that problem. It has gone away since having the mesh removed, everything is back close to normal. I think that the inflammatory response affects surrounding tissues, including nerves involved in other bodily functions. In my case, the affected blood flow was not a general problem, fixable with a pill, it only affected the corpus cavernosum. In other words, it wasn’t an excitation problem, it was a physical, call it mechanical, problem.
The doctors I talked to did not comprehend what I was describing or how it could be, even two urologists. But the evidence before and after, before mesh and after mesh, is very clear to me. We’re all part of a big uncontrolled and unmonitored experiment.
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My view, emphasized by my experience after mesh removal, is that chronic pain is signaling chronic damage. I was and still am physically damaged from having the mesh inside me. Many surgeons, apparently, know and accept this damage and have mentally justified it as normal and “how mesh works”. The foreign body inflammation is what causes the tissue “ingrowth” and “incorporation”. I put these terms in quotes because I think that ingrowth is actually individual fiber encapsulation and incorporation means, essentially, becoming one with the body. There is no ingrowth and there is no incorporation. But the terms sound comforting and healthy. Much of what is happening today is because there is too much hope and not enough objective analysis.
I think that the reality of the situation is that the body is constantly trying to encapsulate and isolate the individual polymer fibers, causing an inflammatory response wherever there is mesh. Since many surgeons are on the bandwagon of the more mesh the better, the inflammation problems are increasing in kind, and that’s where much of today’s problem comes from.
In short, we need parallel efforts on understanding and controlling the damage. Pain management’s purpose is to fix the mistake, the inherent flaws of a bad product. It should not really be considered as part of the repair. There is not supposed to be pain.
Sorry, I know that’s not why you posted. I use the forum to collect and amplify my thoughts, and your post coalesced a few. I have not been able to rationally justify what is happening in the hernia repair field. It has all of the hallmarks of a project that started out with promise for true health care but grew uncontrollably because the financial aspects overshadowed the reality of what was happening.
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Hello Vegas. One week is not really enough time for the entry incisions to even heal fully, I think. Open surgery is generally known to be more painful in the early days than laparoscopic. More invasive, bigger entry incisions, work done right inside the inguinal canal. I can’t speak specifically about the feelings of open surgery, since both of mine were laparoscopic.
Can you give some details on what was done, just to round out your story? It’s an interesting one. What did they find, what did they do, was any of the original mesh removed or moved? Thanks. Here is a link to your original topic.
https://www.herniatalk.com/8826-recurrent-hernia-12-years-later
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There are quite a few references to Dr. Brown on this forum. Use Google to search the site if the search function doesn’t find them. Good luck.
https://www.google.com/search?source=hp&ei=cXfsW8eHDMLB0PEP8a63sA0&q=site%3Aherniatalk.com+dr.+Brown&btnK=Google+Search&oq=site%3Aherniatalk.com+dr.+Brown&gs_l=psy-ab.3…1129.8207..9438…0.0..0.49.1112.29……0….1..gws-wiz…..0..0j0i131j0i10.n1AfEIXY61w
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Was your injury sports-related? Are you athletic? Consider seeing Dr. Meyers at the Vincera Institute. He does labrum repairs and hernia repair. He specializes in sports medicine. My one big mistake in life, so far, was having my hernia repaired by the main-stream methods. I was very athletic and should have put extra effort in to finding a doctor who knows athletes.
I’m not sure that a layperson can really make a good choice based on method-name alone. I would focus on finding a proven surgeon.
Good luck.
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There isn’t really any “normal” for hernia repair results. Especially considering the huge range of materials and methods used.
If you could describe the material used, for example; 3D Max, flat mesh, light weight mesh, self-adhering mesh, two component mesh like Phasix, etc., and the type of hernia, direct or indirect, people who’ve had a similar procedure can give their opinions. But you can’t really lump all of the methods and materials in to one basket of “lap with mesh”.
Also, what have you been doing since the surgery?
Good luck. Provide more details if you can.
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I found this Twitter link that offers a way to get to one of them.
https://twitter.com/HerniaToo/status/1056153655081082881
Also found a fairly recent article, one year ago, about the topic, but in Ireland. Hopefully one of these government organizations will get some traction and make something happen. Notice the vagueness about “most effective”. Effective for who? Medicine as business.
“The Royal College of Surgeons said while “any poor outcomes are regrettable”, mesh implants were the “most effective” way to deal with a hernia.”
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I forgot to say that I had Bard’s lightweight mesh implanted, Bard Soft Mesh, and after just a few months it had stiffened. It felt like a plastic picnic plate in my abdomen. The mesh is only soft when it’s outside the body, and for a short while after implantation. Once it gets “incorporated”, filled with collagen, it shrinks and stiffens. I’m sure it looks like a good idea when the surgeon is holding it in their hands.
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And here are the two studies I mentioned.
http://file.scirp.org/pdf/IJCM_2014072117033945.pdf
Watch Brent Matthews in this video and read the questions on the screen. It’s from 2018.
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Here are the Parietex products. Many different ways to knit a polyester fiber.
https://www.medtronic.com/covidien/en-us/products/hernia-repair/mesh-products.html
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There are studies that indicate that the “light weight” concept doesn’t actually work and may actually cause more chronic pain. See Dr. Bendavid’s work about nerve damage in small pores. Also Dr. Brent Matthews of the Carolina Group recently presented work that showed that “light weight” mesh seemed to have no benefit over “regular” mesh. He also showed that mosquito netting used in more primitive areas of the world worked as well as the medical device makers’ expensive products. Light weight mesh is an idea that has not really been proven for long-term results. But it sounds promising as a solution for chronic pain so it made it to market.
Parietex is a brand name that covers many different forms of device. I’ll try to post a link to the numerous products that use the name “Parietex”. Search it on the web if I get blocked. Get more details about their plans and how they will make decisions. Don’t be afraid to say no if they can’t give you proof that their patients have actually done well with their method and materials. Don’t let the device makers’ own internal studies be used as proof. Your doctor should know through correspondence with his/her own patients.
As far as being thin, it might be that thin people are generally active people. I am thin and active and it was the activity that caused the pain. Not being thin. From an anatomical perspective I think that the “thin” thing is just a simplistic way to place blame for a failed repair method.
Many many surgeons are on the laparoscopic large mesh implantation train. There is security in numbers, for them, but not us. Get details. It’s the rest of your life. Good luck.
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I might qualify as a fellow runner, but my repair method was different. My impression, overall, about having mesh in the abdomen was that it was the cyclic damage that causes problems. Just the expanding and contracting of the abdomen from breathing, and the flexing and bending of the mesh from running. Quantity more than quality. Each cycle, or step, causes a tiny amount of damage.
But I think that if the mesh is localized to a small area it might not be stressed like it is if it covers all of the lower abdomen, like it did in my case. In my case, if the lower abdomen got stressed the mesh got stressed. If it just covered a small area it might be that the unmolested tissue around it could have taken up the load.
In short though, I think that you just have to go out and try things and see what works. Personally, I don’t think that running itself would cause an immediate recurrence. It would take extreme abdominal pressure to force a failure, which would be unlikely from normal running.
I was mechanically very strong after my mesh implantation. I could lift weight and do repetitive physical work with no recurrence of a hernia. But it felt terrible, a constantly shrinking, constricting feeling, with side effects, and the feeling occupied all of my thoughts. Okay for a farm animal, maybe, but not a human. I was healthy but didn’t feel healthy. I spent all of my free time trying to figure out how to feel good again.
Good luck. Keep a log of your activities and you might find a trend of cause/effect that can guide you.
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Hello Milo. It looks like you had your surgery done back in April by Dr. Martin? Can you give some details on the method and materials used? You should still be well within the time frame for the surgeon who did the repair to respond to you with no charge. Have you tried contacting him?
With the details of your repair people who have had a like repair can respond with their experiences.
Here is a link to your first topic –
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It might come down to the surgeon and how hard they want to fight for you. They are the ones that submit the bills and sit on the panels and justify what they did. Ask your surgeon if what you heard is correct, to be sure. The people that man the phones at the insurance companies are often not really experts, and are just reading from a script.
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I had general persistent soreness and a swollen stiff feeling across all of my lower abdomen, sometimes specific sharp pains in the corners or at the original hernia site. The more exercise I did to try to loosen it up the tighter and stiffer it got. I didn’t have any referred or shooting pains, to other areas. So, apparently, no nerves were being damaged, mine was a generalized damage, everywhere the mesh was in contact.
I had two 6×6″ pieces of Bard Soft Mesh implanted via TEP, bilateral, for a single direct hernia on the right side. Removed three years later, although I knew at two years it would have to come out.
What type of repair did you have the first time, and how did the surgeon go “back in” the second time? And what did he find, or do? You can get your post-operative notes from your surgeon’s office or the facility where the work was done.
Good luck.
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Hello paco. I had mesh removed from both sides, via TAP laparoscopy, and everything functions as it is supposed to afterward. I have full functionality and can run and work, although to a lower level than before my hernia. Full healing is taking some time.
I think that Dr. Billing left as much of the nerves, veins, arteries, etc., intact as he could. He did have to remove part of the epigastric artery because it was entangled and couldn’t be saved. He made a note of that in his post-operative report so I assume that he would have made note of any other important structure that had to be removed or was damaged. That was the only note he made about cutting something that would best be left alone.
So, in short, I don’t think that neurectomies are necessary for successful mesh removal. It probably depends on how entangled they are with the mesh that needs removing. I was probably lucky. It’s the judgment of the surgeon at the time of the surgery, I believe. One reason that robotic surgery seems to be gaining popularity for mesh removal, apparently, because the fine work necessary to save those structures can be accomplished with better success.
Good luck.