pinto
Forum Replies Created
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Spinotza, I’m happy for you you’re in a good place. You did your best under the circumstances and really took control of it all. I’m sure yours will be successful. If you don’t mind, I’m wondering if you really were able to choose your own surgeon or trusted the Center to make the choice for you. It sounds like the latter but just wanna be sure.
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First, thank you to the doctors who kindly responded here and also to Dr T for her patience. The post by Jnomesh should be framed on display in every dr.’s office as a reminder of the importance of listening and as well alternative explanations.
Stories by Jnomesh and Good intentions (here and elsewhere) of mesh mishaps appear authentic and well deserving our attention. The biggest element that strikes me—but seems overlooked—is the powerlessness of patients. The loneliness of a harmed and ignored patient is a feeling like almost no other!
I challenge all medical practitioners to put themselves in like situation so as to really, really know what it feels like. Sadly though I doubt if many would think it important or necessary. A common thread I see among the many stories of medical mishaps at this website is getting or feeling ignored by their doctor. No wonder litigation has become a huge industry. Doctors have only themselves to blame for it.
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@amelia4, ameliakhan is not a an HT participant but rather a carpetbagger. Avoid her.
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Dr. Towfigh, thank you for your gracious reply, being so timely. Generally using google I have not had satisfying searches of HT. For example, my thread on 09/19/2019 titled “My IH Repair by Dr. Kang” could not be found. (I did accidentally locate it and am glad it still is in HT.)
A few moments ago I searched using ‘?’ but google yielded just one of my threads so starred. By HT search, three came but not all of them.
Could it be that there is a technical mismatch between google and this website? Perhaps the revamping of HT did not erase all our posts but searching has been frustrating for me. I am sorry if my thread title is inaccurate, which I hope is the case. Again, thank you for your kind assistance.
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BTW, William, a great find—thank you— but how on earth can this FDA “info-mercial/factoid” be helpful for patients? First I was pleased that this FDA document primarily addressed patients but it seems more directed toward the basic info about terminology rather than the results of surgery, particularly post-op complications. Yeah such is listed but everything but the kitchen sink. How can the long list of complications be weighed realistically and comparatively to other kinds of medical surgeries?
It seems to me it’s like they announce these complications and then patients are on their own. The FDA has done their duty? But have they just by listing complications? No real guidance is given how this information can be weighed. And actually what patient who has already googled the topic of hernia surgery has not already seen mentions of such complications?
Seems the FDA serve their own purpose rather than patients by seemingly being able to say, “we told you so,” in so many words? Maybe I’m being overly critical of the FDA, so I’d be happy to hear otherwise. Thank you.
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William, scary, scary story that one. You often come up with these scoops from the other side. 🙂 At first I thought of the possibility of an agreed experiment with the patient but she made clear that wasn’t the case. Understandably there are times “experiments” happen when patients agree to an unorthodox, last ditch medical effort. But without patient consent it is surely unethical. This is a reason we hear of the advice to steer clear of teaching hospitals. You are likely going to either help break in a new technique or a new surgeon or both.
GI’s call received was likely a tip-off. The surgeon’s reaction suggests the call wasn’t routine, so we must think the caller was motivated by a slip up or failure of some kind. A weird question, how’s the mesh?
Could it be the nurse was in disagreement with surgeon in some way? Once I had gastroenteritis but a doc misdiagnosed it and gave me worthless meds. Luckily a nurse on the side tipped us off that the doc was clueless. If GI reported a problem to the nurse, she might have spilt her beans if in a rift with the doc. Or some words of advice.
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Quote: “The work itself in this paper is obviously of little value….”
Not so. It reinforces in me that my hernia was a godsend! Living a perfect life in perfect health and so with little medical experience, I never would have imagined the realities of medicine today. That is what this article A New Nonmesh… reinforces in my mind. Our @Chuck can be so funny as in a recent thread:
“lap surgeons [might do] unnecessary surgery under the guise of saving you in the future then they get a double payment—-daughters wedding coming up -—better double mesh a few suckers.” Over the entire stretch of the medical world, there must be some unethical acts as those. There must be.Perhaps poor writing of A New Nonmesh… accounts for the suspicions raised but I don’t think so. “Publish or Perish” pressures may have been involved that led these medical professors to do what appears as an experiment possibly unknown to the patients. The paper can be useful in an unintended way.
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If I read correctly, bladder patients were not “selected.” The issue is what happens when mesh cannot be used—either by wish of the patient or mesh is “contradicted,” a patient condition that rules out mesh. But here is where the article gets messy. It is unclear how many if at all were contracted cases prior to surgery. The article states that there were four cases that developed complications—presumably after surgery—two of which had chronic bladder “dysfunction” known before surgery. So we can surmise that at least two of the cases were ruled out for mesh.
The authors are also unclear about what tissue repairs were offered these patients. The authors merely say that “Patients were offered tissue repair.” That seems to skirt ethics because there is tissue repair and then there is tissue repair. The modified-Andrews hardly can be claimed a proven method; thus it becomes experimental. Were the patients offered a standard tissue repair as well or was modified-Andrews only offered as well in the guise of standard repair? Scary!
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INVESTIGATION REQUIRED! Did these patients know surgery was likely experimental and principally done by an intern?
This is a very weak paper considering the authors are unclear why they chose Andrews’ method, apparently unvalidated modifications or explanation missing, follow-up mean is only 13 mos., and possibly authors’ unacknowledged real motivation was to find an easy but yet debunked hernia method.
I would like to know the social status of the patients, for I fear they may have had uneducated, indigent backgrounds without the wherewithal for optimal decision-making.
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T. Hirano, my guess is the surgeon is likely a general surgeon and so his surgery record, frequency of Shouldice repairs, I suppose would be important to consider. @Herniated makes a great point there’s training and then there is training. If it’s just observation, then a patient might end up paying for his actual training.
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I regret I can’t answer your questions but here is an informative website: https://www.drugwatch.com/hernia-mesh/polypropylene/
BTW, would you happen to know if hernia mesh problems are generally known in Japan or China? They seem well publicized in English-speaking countries but I couldn’t find much about in Japanese or Chinese media. I suppose especially in Japan, mesh is the main method so am surprised little is found about it.
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Given Dr. Towfigh’s point above and elsewhere that Marcy is a surgical method for children and small-framed women, I must think that is a generally held view (for doubtlessly Dr. T is quite abreast of the field). So I am surprised that the article addressed here (“Novel modification of Marcy operation…”) shows no awareness of its potentially great contribution to the field—namely Marcy’s applicability for male adult patients!
@KC, the journal editor let you down; he/she overlooked that 90% of the cases were male with mean age of 64! Both age and gender should have rung bells for them. In their defense, the section of the actual version, “Study Population,” no mention of sex/gender or age is made about the patients. Yet Table 1 does have “baseline characteristics” of such included but unfortunately appears several pages away—-likely an editorial mishap. Reading on though in the Results and Discussion we find no mention of the specialness of male elderly adult patients studied. Instead the authors’ thrust is that their modified-Marcy compares favorably with the alternative mesh approaches. Even still the editor did not play their best game for not foregrounding the article in that way—a potential alternative to the use of mesh. Thus in several ways the journal editor did not do their job for the article.
A bigger question: Is Marcy having wider use in Korea than elsewhere? It may be that Marcy has not been confined to solely children and small-framed women as in North America and so on. But in Korea Marcy is used also for male adults.
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@KC thank you for kindly answering and correcting my misunderstanding. If I was more of a camera buff, I would have likely got it right the first time. 🙂 I suppose the metaphor is camera lens shutter.
You are doing quite well, KC, and we appreciate even more how you kindly are working to help us understand in English. Korean and English are so widely divergent languages that mastery for either of us is way beyond that required between West European languages. Thank you for the accommodation.
Interestingly your research paper linked above–actually the condensed version—and likely for that reason—omits the sex and ages of the patients. So your statement above is quite exciting: “I have operated my modification technique not to children but to adult male indirect inguinal hernia.”
Because your condensed version of your paper does not include that, we might not hear the expected shock from the hernia field. It will take more time for that to happen. Maybe like a delayed action shutter. 🙂 I commend you for all what you are doing and am much appreciative.
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Just when discussion about Marcy became a little gloomy, we have this bolt of sunshine of possibly not one but two modified Marcys (made applicable for adult male patients also). William, it seems Kang Repair, if classifiable as a Marcy, was developed earlier. If my understanding of @KC‘s method correct as I posted above, then it is not surprising that we have these two possibly similar approaches. Marcy was ripe for modification. Given Dr. Lorenz’s related commentary, then @KC‘s method gives added credence to Kang Repair (and vice-versa). As far as their coincidentally coming from Korea, great, but not surprising given the country is a hotbed of medical services, as the “medical tourism” corner for visitors at the Seoul international airport typifies.
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@KC, excuse me, I must correct myself for my lapse not realizing you besides being a practicing surgeon, might also be a professor if one of the senior co-authors. Nevertheless your paper contributes importantly to the field particularly tissue repair.
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Thank you @KC for being for so forthright. I’m happy for you that you likely are part of a medical department that is supportive of innovation. Congratulations on your recent publication something particularly impressive by a practitioner (non-academic, I take it) and should be noted by Members here as well, being a major scientific journal, presumably it was peer-reviewed. So it adds credence to the notion that Marcy, albeit modified, could be effective for adult male patients.
Let me ask some clarification about the shutter window metaphor you used, contrasting two vertical columns to close them by classic Marcy (I recommend you use “classic” rather than “old”) versus the modified one using one horizontal column to close the “window.” (1) Is the great merit of modification that the horizontal removes the potentially weak central area between the vertical columns? (2) How many rows of vertical stitching is made?
(3) Is the hernia “shutters” only gapped centrally or like real shutters there are gaps/crevices around them not only centrally?Given the most ideal situation for horizontal stitching/Modified Marcy, did you ever wonder why the originator Marcy chose to do it vertically? Your shutter metaphor is so compelling that is seems commonsensical. Indeed I cannot think of any shutter windows or double doors not closed horizontally. Thus classic Marcy begs to be modified.
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@KC, thank you for so kindly writing in a considered way. It gives us a deeper appreciation and understanding of your method and that of Marcy. Among your IH surgeries, what proportion do you do tissue repair and what proportion, mesh?
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Dear @KC,
Previously you mentioned that your method is quite different from Marcy [ “actually it’s detail is much different from old Marcy operation.] Is it your stitching that does that or are there other ways your method differs?
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Watchful, you ask excellent questions. Thanks to both you and KC.
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A fascinating find. Thanks.