[pinto]

@Goodintentions, must one go to such extremes to get tested? Now, I for one found out that testing can be hit or miss, especially if the ultrasound radiologist is unfamiliar with the Valsalva maneuver! Even getting the Valsalva test can be unreliable?

[pinto]

@drtowfigh, that’s awesome to hear. Because American society is an open society, its “dirty laundry” is easily criticized; yet it often leads toward advancement of civilization, a word I use sparingly. It’s great what you said. I never heard of such a formalized policy. I’m sure its helpful for both doctor and patient and overall advances medical practice. @jack2021, thank you for that. I appreciate it because my experience has been very trying, very trying. Not mentioning any names will help, I think, in highlighting the remarkable. As I look back despite all my “researching” of hernia, I was naive for not locking down the post-surgery experience. Will the warm smiles “pre” still be there at “post”? Important to consider.

[pinto]

Physicians can wear different hats. Sometimes it is necessary to use Dr./MD. so as to indicate the person has the license, qualification as doctor for example in the case of a medical emergency. Contrast that with a doctor being a Little League baseball coach. It would be unlikely he/she would use or be addressed as “doctor.” Within a small community, more likely is addressed as “doc.” Outside of it, his/her hospital, medical society, and so on, but as an author/researcher, he/she would likely be referred to solely by their last name, so as to dispense with social niceties for the sake of intellectual exchange and free thought.

Here in HT, many of us are patients and so we wish to both acknowledge the physician’s qualified status but also social respect for their very kind participation here. For physician non-participants however who are authors being discussed, I don’t think it necessary to use honorific address terms. Doing so could conflict with the examination of ideas. When Dr. Ramshaw dispenses with self-reference of MD it does not necessarily mean he has withdrawn from being a physician. I think he does so to emphasize his wish for the free exchange of ideas in keeping with his philosophy of data science. Even if he has made a career change, I don’t think that would completely stop all uses of his MD self-reference. Sometimes surely it becomes necessary for him.

[pinto]

@mitchtom6, thank you. You make a good point about the tacit admission matter. In fact my first statement but later deleted (by me) was my applauding the apparent acknowledgment about polypropylene. Haven’t we seen caution/alarm written about this across the ‘net, but not by docs? That’s my impression but could be wrong. I wanted to ask if other docs put the spotlight on polypropylene for its potential danger. However as I went through Ramshaw’s article more, I saw some red flags. Overall it seemed to me that while on the surface there’s an admission about trouble with polypropylene, I think his main purpose is to counter the bad press about polypropylene.

He mentions (I believe if I remember correctly) that some cases of mesh were in pristine condition. They didn’t have the deterioration expected. I presume that Ramshaw is well aware of what chemists and others say about polypropylene not being fit for implanting. So isn’t he countering that by pointing out the pristine cases? So the title suggests that those chemists are wrong.(You see that, right? “both sides are wrong”) And why do you think he tells us–and he does–that he keeps a friendship to this day with Shiela, his guest materials engineer who expressed alarm about using polypropylene for implanting? It is almost like the politician caught in sex scandal who gives a mea culpa at a podium before the public with his wife standing next to him. That is a hint for the public to forgive him because of all people his wife does.

This is just a taste of what I could say. Please however take my rant provisionally because the space, time does not permit it otherwise. I am confident though the author made strategic, stylistic choices along the lines that I am claiming; some of it might only be unconsciously made. How correct the claims remain to be seen. But that is what forums and discussions are all about. 🙂

[pinto]

Ramshaw might actually still consider polypropylene as being inert. His words betray him by revealing a lack of responsibility. Essentially Shiela asks him, “What material do you use for implanting?” Rather than active case grammar by which the actor/agent is highlighted, his grammar switches to the passive: “the most common polymer used … was polypropylene,” by which he removes himself from the equation.

It is not necessarily the case that surgeons must use the material however widely it is used elsewhere. He had invited her to work with his team (“our team”), so how he describes it, it is likely Shiela was asking about his or his team’s use, which normally would evoke a “we” response (“We use …”). Indeed he used “we” for the reference in her question.

Further in the metaphors he uses about science and medical decision making, it appears to me as if he as a surgeon has his decisions made not by himself but by other entities, such as the human brain. He is not unique for skirting responsibility–it’s a human trait–but it is ironic in contradicting the tenor of his article of being straightforward, etc. The thrust of the article is to say that polypropylene is not necessarily harmful, a claim he weakly substantiates. Here again, we can see a retreat from responsibility by his saying that in patients harmed, polypropylene is not THE factor but a contributing factor, shifting responsibility at least partially onto the patient. As long as responsibility is not grasped by surgeons themselves, hardly will they be expected to push for reform.

[pinto]

@Herniahelper,
>Sometimes if you have a weak spot it will scar down.<
You speak specifically in the case of mesh? Such a “weak spot” is a precursor to hernia or is already formed one?

[pinto]

Further @Antony, I just remembered that I came across the injunction against weight belts for people with hernia. I don’t think it was here HT but somewhere on the ‘net. Your weight belt could possibly be the root of the problem.

[pinto]

I’m sorry to hear about your setback. There’s a glimmer of hope though from this in Wikipedia concerning EU citizenship if accurate: “a provisional agreement [between the UK and EU] outlines the right of British citizens to remain in the EU (and vice versa) where they are resident in the Union on the day of the UK’s withdrawal.” You possibly might be able to retain EU citizenship.

[pinto]

Sounds like you’re well on your way. The Pinch. I’ve tried a variant: intake air counter to expelling it. Kinda like a jet landing. Either way we wont be joining the sneeze clubs I’ve come across.

[pinto]

Colin, did Shouldice use steel suturing? If so were you made aware of it at the time? And if so again, do you ever feel a tinge or something?

[pinto]

Almost every post is from personal experience. Personal experience is vital.
Colin, you wrote, >I just thought after experiencing two leading hernia surgeries, I could compare the two.<
Of course you can, Colin. But you also were making a claim that X is better than Y, which surely invites discussion. Please recognize that. As I said, your experience can fit in immediately (and variously).

[pinto]

Colin, everything flows from purpose. I’m unsure what you want to do. This thread was couched kind of like a strawman debate, which I think you realize that now. What is it that you want to say? When you’ve got that run with it. There are already existing threads that talk about these individual IH methods. Maybe that’s the way: Fit your experience with what was being discussed. I think you would fit right away. 🙂

[pinto]

Hi Colin,

Your points are well taken. Let me clarify my post by noting your original post began by saying “people who visit here to figure out which is the best surgery for an inguinal hernia.” If we’re trying to do that then wouldn’t we want to be systematic doing it?

Because modern medicine is so technological, taking two cases separated by twenty years surely is lopsided. The earlier one is disadvantaged by its older tech or possibly less developed technique. That has to be an unfair comparison.

If I am not mistaken your purpose was to compare the two IH methods you experienced and concluded by saying that one was better. Perhaps that’s true but technically it’s a weak comparison to say the least. I don’t think you would personally decide on a surgery for tomorrow based on that kind of comparison, right? Your post based its conclusion on a Shouldice incision measurement more than 20 yrs. ago or more. The length of incision possibly has shortened over time. Moreover decision of surgery surely wouldn’t be based solely on incision, right?

I appreciate the uniqueness of your experience and welcome your sharing. It would be more appreciative, I believe, if it were less evaluative because of the reasons stated. Friendly chat is appreciated but technical talk prized. Some people will make possibly life-altering decisions based on the information at HT. It’s in our collective interest to together develop information most helpful in that regard. Thank you for your kind attention.

[pinto]

At the outset let me state clearly that I long have been a fan of the Kang method but actually of both methods. However for the sake of discussion I must point out, Colin, your comparison being made is applies and oranges. First “A” was done 20 years before “B.” Second, they very likely were very different surgical situations. It’s unfair to both methods. As great as the Kang method may be, it is not proper to put such a supremely classical method as Shouldice in a compromised position as you did. It suggests bias. We can say, however, that from what is presently known about the most recent iterations of both methods, the Kang method appears to have two advantages, incision size and suturing (though some will debate the latter). Another point is how the cremaster muscle is dealt with, seemingly a Kang advantage. As far as your recovery time, etc., here again, is a situational matter. Anyway the three points I mentioned are likely important Kang advantages, but nothing is perfect. Any such comparisons need to be done fairly.

[pinto]

Brilliant example. It’s like the fox speaking for the hens. 😀 😀 From the start he clearly puts himself in the ring of mesh proponents, which makes me wonder why in the world does this conference choose a mesh provider to give us the state of the art for tissue repair??? (He stated he was invited to speak on the topic.) Oh but he states he does tissue repair. But that’s an afterthought. For unwittingly later he shows the truth: “When a patient comes to me, I tell them, y’know, we do use mesh to repair.” (So if you don’t like it, there’s the door. 😀 )

The y’know signals a collective unity with his audience, which is likely mesh providers and a sentiment he signals prior to talking about the apparent rampant litigation against mesh providers and then he says, “What do we do?” 😀 :D. So rather than a pres on the state of the art of tissue repair, he already has set the pres up as one highly favoring mesh. Or could mesh providers be thinking of switching ships to tissue repair and need affirmation? 😀 Seems funny but actually the litigation he shows is likely to scare mesh people. So more and more the fox sheds his chicken appearance!

Amazing to me is that the conference organizers would invite this fox to present if they really wanted an authoritative pres on tissue repair. I think it is likely that they felt compelled to keep it “in house,” for various reasons make it difficult for them to “cross the aisle” to invite a true authority on tissue repair. So we see how everyday actions maintain a rigid division between mesh surgeons and tissue repair surgeons. Complete separation likely exists, preventing advancement of surgery that would likely occur if there were more cross-fertilization!

Amazing as well, for I didn’t know: tissue repair, as he says, is “really cheap” compared to going mesh. There you have it folks: the cash cow is threatened, so taking stock is necessary, if not to switch ships then it’s to strengthen their rear guard. “Man your battle stations, we’re heading into rough waters of the backlash to mesh. We had better fully know about the alternative tissue repair if we’re going get out of this unscathed!” At the very least we see that the mesh community has been affected by the growing concern about mesh. Bravo, @good-intentions for his intel.

[pinto]

That’s a good question, @alephy. To which I would add “crunch” exercises, which I suspect may have caused my first hernia. I have not done any since reading about a hernia surgeon who leaves his card at every crunch machine.:D I used to use something similar seen on this page: https://www.oko-7.xyz/products.aspx?cname=ab+crunch+machine+gym&cid=40

[pinto]

@Goodintentions always brings a keen eye to things here at HT. By my own medical experience I have come to appreciate him and others here more and more. It cannot be denied that “something out there” in mesh practice worldwide has brought harm to certain patients. Multiple accounts show relief has been in short supply aggrevated by some unhearing medical doctors. Such will invariably be invited by hernia topics so we need patience at such time. To @Dr. Jacob, I want to thank him for his candidness but also greatly thank him for doing mesh removal. Good Intentions recently pointed out how the field is being thinned out of removal specialists. He seems a patient person in Dr. T’s video, which must greatly account for his choice of field.:) We need more hearing and patient docs like him. We thank him much for sharing here at HT!

@Good Intentions is incisive in his comment, one that would be vitally revealing in any field: how close is theory and practice? As indelicate as it may appear, the question is pertinent but will likely remain unanswered for some time to come, I suppose. It’s the kind of question that would be foremost in the guide I proposed be made collectively here at HT but I guess went unnoticed.:D I’m unsure though that the last video clip reveals a WW connection as the patient said his pain was present before his hernia surgery. It would take some doing to unravel pre and post pain.

Congrats to @scarletville for his find. Good luck to you and thanks for the great intel you provided. Remember to report how things work out, wonderfully we hope. Before then, it would help to hear your experience with a truss. You said it was helpful. Give us more about that. @Alephy, the coffee connections seems a real one. You had some cramps likely brought on by the strong brew. You though seem to be doing well with WW. I’d be interested in hearing more.

[pinto]

@alephy, interesting! Do you happen to know if you’re doomed if a recurrence? I thought I did all the things right but still failed.

>>>as (they claimed) watchful waiting is not recommended anymore.

By that you probably know that the UK health system is built on WW. What they said doesn’t make sense anymore. 😀 The first time, an internist told me not to wait. Interestinqly, he is quite old; maybe younger doctors have a WW mindset.

>>They also mentioned that with time the (inguinal) hernia becomes bigger.

The fly in the ointment, huh. It seems likely, maybe more than likely, but I haven’t seen any info that delves much into it. Have you?

>>…my hernia already too big, and another one (a specialist, and a good one
>>>actually) found it quite small (he still suggested surgery in few weeks
>>though, and with mesh).

Hmm, fishy. The first time, a doc looked at my MRI and calculated the size of my hernia. His matched what another had said. And these matched what sizes I have seen used in research studies using size a variable. So from that it seems there’s a standard scale for size.

>>>during the COVID pandemic hospitals saw fewer hernia emergency surgeries,
>>>to the point that the article asked what happened to the “missing”
>>>patients

Maybe because there was no hospital space for them? Unless a person gets a serious illness they will never know what really happens inside medical care.:D

>>>ps3: I wouldn’t be surprised if some patients got an hernia but managed
>>> to cope well, with the hernia even shrinking thanks to lifestyle
>>>changes

There is something to that. I’m unsure about shrinkage but I suppose if a person brought their physical activity to a minimum, the hernia would likely become less problematic maybe even submerge if a reducible one. Would like to hear more about it.

[pinto]

@Scarletville thank you for the post. Did you notice that I, pinto, contributed to that discussion? 🙂 Let me point out also that the link actually relates little because the time frame differs so much. His reporting was immediately after surgery going on to about two months. But my case is approaching two years. Quite a difference. Swelling immediately after surgery is to be expected. But not a protrusion (I suppose). Mine did not immediately happen after. The whole area was numb for about six months.
Anyway, if able, could you explain why that link relates? It escapes me why for example sutures would play a role almost two years out.

[pinto]

@Antony, has this pain come only recently or has it been pretty much present the past six years? Free weights? Say, from a dead lift position or whatever? No bulge ever? Quite interesting though I’m sorry to hear you’re in this fix.