[pinto]

roger555, quite a story. I´m sure you couldn´t be happier. Probably everything was as you say, but let me comment nevertheless. Misdiagnosis can happen. Once, a doc told me I likely had serious kidney disease but later had to retract it because the lab tech´s description of my urine sample was misleading. Misdiagnosis happened at other times too. Medical machines also can err but docs take them at face value. Just within this year, I was misinformed about having high cholestoral and high BP when in fact a different lab and different clinic gave me normal readings. The former doc wanted to give me some serious drug to alter my supposed ill health. I couldn´t accept it because I am extremely fit and questioned the doc about the reliability of her tests. As I said another clinic´s tests showed the opposite, and I continue to have normal readings at different locations.

Your case is interesting because it being asymptomatic must mean it is harder to diagnose. If yours was correct, then it technically disproves what many docs say about IHs (and I emphasize I am not talking about any other type of hernia) being immune from any treatment other than surgery. Could it be possible that your IHs had a certain missing attribute that would put them in, say, a “pre-hernia” category?

While sleeping position would be a reasonable factor to consider, at the same time, reclined positions make many herniae practically asymptomatic at least temporarily. Maybe your sleeping position put stress on the groin which countered the positive reclined effect.

Anyway your case is quite interesting and must be considered for obvious reason. Thank you for sharing.

[pinto]

Thank you. I had it backwards: Here´s an interesting quote:
“Despite statements to the contrary in several textbooks, it is not possible to distinguish a direct from an indirect inguinal hernia by clinical examination, unless the hernia extends to the scrotum (when it must be indirect).” Handbook of Clinical Skills.

I assume that an indirect does not automatically mean it reaches the scrotum but when it does, it must complicate surgery.

Another point of my confusion is that I thought two people can have the same kind of hernia but sourced by congenital cause or weakness later developed in life. In other words, one could get an indirect IH apart from congenital reason. But you seem to say indirect is only traceable to congenital cause. Could you confirm what would be most accurate? Many thanks.

[pinto]

You make a lot of sense. The essential point I want to make is that the medical community overwhelming says that IHs cannot be healed other than by surgery. And further some patients pre-surgery who have tried these hernia cure exercises have reported their herniae got worse. So there is big risk in doing physical exercise programs not medically approved (precisely because the reports of exercise failure could be accurate.) If I am mistaken, then I will be happy to learn of the rigorous research data that support these programs or claims. Otherwise, caution should be taken.

The indirect/direct distinction, so far, is most confusing in my study of IH. I might be wrong but my understanding is that apart from the congenital type, the other type can be either indirect or direct, the main difference being that the direct extends down to the scrotum. Any help in puzzling it out will be appreciated.

[pinto]

Jnomesh, sorry to hear about your ordeal. One is enough so I can´t imagine what you must have gone through. I salute you. BTW, didn´t a fine doc in this forum say how direct IHs are more advantageous than indirect ones surgically? If I got that right, then the more complexity might mean you were very lucky about your indirect one not becoming worse. Anyway among the many pronouncements by medical people that IHs cannot be healed naturally, I have never seen any of them limit the restriction to only the direct. Have you?

[pinto]

[USER=”2813″]GeorgeHirst[/USER], please provide us with the scientific evidence (actual empirical studies) not solely anecdotal evidence for the claim physical exercise reduces the physical gap from which IHs emerge. Some pre-surgery patients have reported that their physical exercising resulted in enlargement of their IHs. Now I realize their self-reporting are likely unscientific, but their claims are potentially valid. Also the medical community widely reports that IHs cannot heal naturally, only by surgery. Given the risk of enlargement making the IH worse, it would be foolish to do physical exercise aimed at reducing the IH physical gap–unless of course your claim has wide acceptance medically. Aside from empirical research, at least can you name any licensed medical hospitals that offer physical exercise found to reduce IH gaps?

[pinto]

First, @Jeremy B and other contributing members: Thanks so much for your input and ditto again to Jeremy B., a great contribution you made. My question: What makes you (to all) think that the surgery was “Shouldice”? Merely by the word of the surgeon? What the surgeon or any practitioner thinks and does can be quite disparate. Indeed the surgeon can add a “curve” to it, making it indistinguishable to the originator himself.

I am reminded of recently found website for a surgeon claiming he performs the X-approach. And his apparent support? He has had conversations with the originator. I kid you not.

By implication, he had never received direct training but apparently by his own observations, perhaps by video demonstrations or written explanations. I dare say that the latter is not proof positive the X-approach is reliably followed and performed. Perhaps Jeremy B’s surgeon is the real McCoy but I think it worthwhile to note that when approaches are critiqued, the possibility exists that the actual approach under our scope is not the real thing.

[pinto]

[USER=”2029″]Good intentions[/USER], one need not be a member here long to soon realize your important contributions here. As I read “patient’s” post here, I was glad and relieved I saw your reply right after it.

[pinto]

Thank you GoodIntentions for answering. It’s helpful.

[pinto]

Thank you for this news. Could you tell us what countries were in the forefront of this, ahead of the US? [… slow to act compared to other countries the US seems to finally have taken action.]
Very interesting considering the companies active as suppliers (Johnson & Johnson, etc.).

[pinto]

Thank you, Dr. Brown!

[pinto]

Thank you for the posting. Also, please elaborate on the slowness of the US to deal with the matter. I would like to find out what countries were in the forefront. It is rather ironic that the US is a major producer (e.g. Johnson & Johnson) of the devices.

[pinto]

Well, I defer to Senator Shaheen’s direct response to the 60 minutes program by getting on the FDA to engage in more oversight:

https://www.shaheen.senate.gov/news/press/following-60-minutes-report-shaheen-seeks-answers-from-fda-on-oversight-of-gynecological-mesh-product-

Presumably she has full-time staff working on this issue, and they were convinced enough by 60 Minutes to engage the FDA about it. Far from to me to presume that I might have a better handle on the matter than a whole gaggle of staffers working furiously to weigh the merits of the program. Apparently they and you might differ on this score.

Suffice it for me to say that when surgeons who have repaired the pelvic mesh failures in women report that mesh is problematic, then it seems reasonable to investigate this avenue for possible causation. I am thankful for the help this present thread gave me in sorting out the 60 Minutes program. The finer details that you raise may have merit, but I don’t see them altering the importance of the 60 Minutes expose in informing the public about the potential defects in pelvic mesh.

[pinto]

Whatever, but Priddy is a fellow with the American Chemical Society, which I presume like with most learned societies, was a status elected by his peers for his expertise. You may not agree with his opinion but you cannot toss him out of hand for lack of chemical knowledge. Again, he expressed an opinion, an opinion recognized as an expert in chemistry. I will not piddle as to what ultimate extent his opinion counts. However his point that polypropylene is oxidatively unstable is pertinent. Do you disagree with that point? And are you arguing that all the uses made of polypropylene human implantation are beyond reproach?

[pinto]

The issue of authoritative sources, the crux of the matter, is an important matter. Although media reports deserve our caution, 60 Minutes appears to have chosen that “engineer” wisely and appropriately–he happens to be a fellow with the American Chemical Society and a recognized trial witness for chemical matters. https://www.massdevice.com/60-minutes-report-claims-unapproved-plastic-sources-used-in-boston-scientific-pelvic-meshes/

So he would appear as a reasonable expert to speak about the chemical properties of polypropylene. His central point is that polypropylene is oxidatively unstable, a well-known fact, a point quite confirmable as I found. Chemistry, a basis of medical science, stands behind him. The issue becomes can polypropylene become malleable for implantation. He does not appear to think so. That is his opinion but quite an expert one on the matter.

You can disagree with 60 Minutes of course but I don’t think you have sufficient grounds for suggesting that this particular engineer is unqualified to speak on the matter. As I previously posted, his view about the potential of polypropylene for implantation needs confirmation, but nevertheless his expertise is quite relevant for our discussion.

[pinto]

“Indication for hernia repair is not based on size, but primarily based on symptoms.”
Surely, but only if the surgeon does mesh repair. If suture repair, then wouldn’t the factor of size loom large?

[pinto]

I wish to clarify a possible misunderstanding earlier in this thread.

Surely, Marlex is polypropylene:

https://onlinelibrary.wiley.com/doi/…nau.1930020208

http://europepmc.org/abstract/MED/3589922

So the Boston Scientific case very much involves polypropylene in one way or another.
PlasticsToday tries to make sense of this:

“To make its case against Boston Scientific, 60 Minutes went so far as to make a blanket statement about how polypropylene is inappropriate to use in any type of implantable medical device. Notably, a plastics engineer was quoted to have said, ‘I can’t, in my wildest imagination, imagine anybody that’s knowledgeable in the science of plastics ever deciding that it was appropriate to use polypropylene in the human body.'”

https://www.plasticstoday.com/medica…66860623758811

PlasticsToday clarifies and concludes:

1. Polypropylene is safe to use in certain medical implants. There is evidence suggesting it is suitable in the peritoneum (e.g., hernia repair), but unsuitable in the vagina. …
2. The charge against Boston Scientific is for its disputed sourcing practices ….

PlasticsToday does us service in pointing out that polypropylene, a common material in hernia mesh, has been deemed safe for that use. Vaginal mesh if found defective does not directly implicate hernia mesh, at least as far as we presently know. I am glad to have this clarification because I didn’t want to condemn hernia mesh for that sole reason. Then again, if the above quoted plastics engineer’s statement is valid, hernia mesh will become a bigger mess than it already is.

[pinto]

Wasn’t the main problem BS’s misuse of the mesh material (polypropylen?), ignoring the specific warning by the material producer against such medical use? A chemist noted that polypropylen is well known incapable to withstand the requirements needed for effective medical mesh. Moreover, a larger problem lie in the apparently loose FDA regulations that “rubber stamp” new devices if they are appreciably similar to devices already in the market? And finally, the FDA is probably under pressure to make speedy medical device approvals. In some cases, mesh saves lives. GoodIntentions cited this article
https://www.nytimes.com/2018/05/20/o…-approval.html
in which the doctor/author (Warraich) remarks how the US could learn from how Euro medical practice reformed its oversight system(s). Maybe that’s the way forward.

[pinto]

Thank you, GoodIntentions! I am medically naive not having until recently needing serious medical attention. However, I have been aghast how my friend, a post-polio victim, has had to feel like a ball being tossed between insurers and doctors in an effort literally to survive. The present medical system I am sure will make medical historians of the future shake their heads in disbelief! Your post makes clear why. I hope you well on your road to recovery and thank you again for the various ways that you help all the Membership here by your informative posts.

[pinto]

That explains some of the inconsistency I perceived in the presentation –but doesn’t he state that pain is relatively equivalent or even less than non-mesh repairs? The latter is extraordinary given what you point out about absence of pain reporting in the non-mesh era. How can the claim be made that mesh repair is superior to non-mesh repair? Comparison cannot be made in the absence of hard data.

[pinto]

All of that quite true I am sure but subtle social reinforcers could have been present. The “conference” has been a subject of sociological study and hardly absent social factors or elements. Even within the sparse commentary available by the lap conference attendees, one can readily see their thinking influenced socially by their medical collective or association. That’s natural of course, for as much as a medical society is medical, it is social at the same time!