pinto
Forum Replies Created
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Chuck, as you well know I am a proponent of Dr. Kang’s. I am also not a surgeon and with little medical knowledge. However, I trust him. When he showed me his data on his computer screen and explained it, I accepted it simply on human trust authentically felt. I have also pointed out at HT that there is almost no independent data anywhere. Ultimately all comes down to the matter of trust. I have that for Kang. Pain–I can say with Kang it is relatively painless, incl. post-op. Also you get the services of Stephen, who becomes your advocate and trusted companion during the stay. The hospital appears world-class and spanking new, specialized for hernia (and good food). You have been through hell and likely gun-shy about decisions. Consult however much you can through Stephen. If their prognosis is likely success, then go for it.
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I believe the collective wisdom here incl. Dr. Towfigh’s is the gold standard is ultrasound with Valsalva (a technique). I had that at Kang’s and before positively made by MRI elsewhere. I had a CT but received contrary interpretations by doctors. Along the way I had some ultrasounds done by others but not properly. The other day I had an ultrasound of my chest (cardiac) and was so surprised 1) that such was done; and 2) the clarity of the pictures was awesome. (Got a green light by the doc for playing basketball.) Everything has to be interpreted, so it’s not just the hi-tech but recent is better. I don’t want to second guess your test result, but in fact they sometimes err.
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btw, tests can be wrong, sometimes thankfully. Once I got a call from a clinic telling me a urine test indicated I had kidney disease. It turned out false due to a reading by an inexperienced lab techie. Alarm turned to glee. You’ve received different readings but the one by technical measurement might not necessarily be correct. One gas station wanted to sell me a new car battery because their test indicated a near-dead condition; whereas I went on the same day to the same company but different location to find their test showed my battery had some life. It had enough juice to get me through a few months. The tech instruments differed, at least one of them faulty.
Now with ultrasound they produce images of internal organs or at least facsimiles. Have you thought of going back to the NHS operator with your contrary findings and ask for confirmation? What in the technical record indicates a direct hernia?
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“If I only knew then what I know now.” The moment I absolutely knew I had an IH (by self-diagnosis) I was in Soul Korea and didn’t know about Kang!! I was on a business trip and really scared. What if the thing erupted while there??? At the end of my work, there was a sightseeing trip planned and all, but I didn’t dare go. I stayed in my hotel bed until I could get on a plane back home. I was freaked out. To think if I had known Kang, wow, I could just take a taxi ride and get it all done. I came full circle back a yr. and half later.
My advice to William is if you don’t mind at all an unknown general surgeon in the case of an emergency surgery, then by all means do watchful waiting. It sounds like your everyday life is not particularly bothered by your IH. If however you do mind in either of those cases, then you ought to get your surgery done as soon as you can. Many members have said health is most important and a very wise investment.
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Gentlemen, Good intentions and Watchful, thank you for your robust replies. If Watchful is correct that there’s “nothing really to debate” because you gentlemen agree that in some cases “mesh is the best option,” then this is a step forward in our understanding of things inguinal hernia. In my opinion, too often this website drones on mesh doctors as a class of villains and that mesh has absolutely no redeeming value. Please don’t take my statement as one in support or against mesh. Unquestionably mesh is intuitively a sound idea; how it is actualized can be a problem.
Again if Watchful’s assessment is correct, then I hope Good intentions remembers that he actually allows for the application of mesh in some cases. Let me point out though that because one has had “experience working for large corporations” does not necessarily “give [one] more insight” into the matter. Belief that it does or “probably” so could unfortunately be self-deceptive by believing major litigation is ipso facto that mesh or its producer is the evil presumed.
Is “hernia repair mesh … part of the club now”? Thus tobacco, like mesh, can be a viable medical remedy? If one allows the use of mesh in some instances, hardly can one claim that mesh is on par with tobacco–that they form a club together. Further to put “guns, tobacco, self-driving cars, opioids, asbestos-containing talc, herbicides (Roundup)” together presumably as a class of evil doers is quite a stretch to say the least. Conspiracy theories are best left in Hollywood yarns than in critiques of medical practices. The more the two separated, the more insightful the critique. Thank you!
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MarkT, thanks, you helped satisfy our curiosity. Let me note a couple of observations: I found inguinodynia defined as that related to mesh surgery. Not a crucial aspect but you do wish for preciseness of terms. The article combines both mesh and tissue repair, which if continued will require a redefining of terms. Not mentioned in the post above is the proportion of cases for each type of repair. Could be important.
Stranger still is nearly 2,000 patients observed but have a very very narrow range of age. Not only that but they are “all older vets, around 60yrs old.” These people have or had a physically vigorous occupation–the military. I believe in the general population a much, much wider range of age of patients would be the case. Or would it?
What might be happening is that many individuals 35-45 are coming with symptoms but he massages them into watchful waiting, at least some. It’s probably good in that he’s not pushing surgery on them. Finally, he might not include these patients in his case load figure until they actually get surgery.
That the article is a letter to the editor explains why data is not included. The doc is probably concurrently preparing a full article for publication somewhere.
Overall I think the biggest factor of his success is that he is likely a highly skilled surgeon based on his emphasis of correctly fitting mesh by size/shape for each patient and his neurectomy. This seems borne out by his using the same mesh since 2005. Was he just lucky in choosing mesh or has surgeon skill been much much more a factor than kind of mesh all along?
If we stick to GI’s original question, “what[‘s] the best prevention for post-hernia-repair pain” rather than treatment, then we must be confined to interventions before and up to completion of surgery. Thus treatment is excluded, which puts more emphasis on surgeon skill and patient physical condition.
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Save your money because I don’t think the article will reveal “the best prevention” of post-op chronic (mesh) pain. Given that the field appears not yet to wholly recognize “inguinodynia,” I suppose that little has developed into effective management of pain. So my guess is the article will promote more effective surgery as a preventive.
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PeterC, I understand you had a crippling experience by an apparently botched surgery by your surgeon. Seems to me that any patient would be engulfed in rage by being tragically transformed in body and spirit as you have numerously described at HT. Such patients would normally seek restitution as the tragedy must be very costly to deal with, so the logical recourse is legal. However you stated publicly you didn’t want to do that. How else have you dealt with the repercussions? Not getting restitution (I presume) must make matters worse physically and mentally. I believe you were encouraged to seek counseling. Have you done that?
Seems to me you’re regressing by this latest thread–using a Hollywood portrayal of medical doctors as a template upon which HT members judge hernia surgeons. Hollywood portrayal. It’s fiction, unreal. Shall doctors affix those fictional faces on themselves? Do those Hollywood actors truly possess compassion for others? Is it possible that your surgeon truly felt compassion but unfortunately messed up (a plausible scenario I presented to you elsewhere)? Either way how do you judge whether a surgeon is truly compassionate?
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Chuck, Wow, “patient still wants to proceed.” Even granting the copy/paste operation noted, it’s bizarre language. The double-faced nature of it made me laugh (excuse me). I can concur with your tenor because I received disbelief expressions from some mesh surgeons (not to pick on mesh) when I raised the matter of risk. With such surgeon attitude, I can well imagine that “patient still wants to proceed” is not copy-paste! (surgeon self-delusion)
@Good intentions, does your account mean your original surgeon got tripped up by his own copy-pasting? Could titanium tacks somehow disappear?? Should he have even considered such tacks? And even the op report appears unclear precisely what implant device was used. This would make assessment of post-op condition incredibly difficult.
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Your first statement evinces the problem I noted: You say, “The authors categorized the results. Hernia surgery would most likely be under general surgery or undifferentiated surgery.”
You say, “most likely,” thus it’s your interpretation not that of the authors. It is just as likely that hernia surgery cases were not included. Without explanation HT readers cannot be assured that the medical report applies here.
HT cases are not just merely “undifferentiated” or “general” surgeries. HT cases are failed surgeries. Again without explanation HT readers cannot be assured that the medical report concerns cases of pain from failed surgeries.
My assumption–and a reasonable one–is that toleration of pain will differ between cases of successful and unsuccessful surgeries. Your information sidesteps this distinction; thus the medical report appears irrelevant to us.
If I am wrong, I will be happy to hear why. In that case you should explain how the report applies to HT cases of failed hernia surgeries (i.e., patients are left with debilitating conditions and at least some of them claim their surgeons have ignored them). Thank you.
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I am disappointed that this study of patient pain has little to do with HT issues. Why? The medical report presented is not directed to hernia patients or hernia surgery. A quite different animal. The patients under-reporting pain likely are not in opposition to their type of surgery nor do they perceive their surgeons as non-cooperative or unfeeling about their pain.
How about reports of pain here at HT? Quite different. My impression is that these HT patients complain that the surgeons involved avoid the patients or downplay their pain. In the hernia literature some surgeons have acknowledged this surgeon avoidance of post-op pain is an issue in the field. Some of these patients experienced failed surgeries, which in turn led to questioning their surgeon’s ability and/or method. Thus these HT patients are in conflict or opposition to their surgeons or hernia surgery. Contrast that with the apparent situation of patients in the pain study presented in this thread: those patients are cooperative as are apparently their surgeons. So we are left with an apples and oranges comparison. Caution should be raised about generalizing non-specific studies of patient pain to the hernia patients we know here at HT. -
NFG12: “… that [doctors] don’t get surgery, …should say in itself!”
Say what? Says nothing because 1) many reasons exist for avoiding surgery; 2) watchful waiting is highly individualized, allowing some to live lifetimes without surgery; 3) some have managed to live comfortably with grapefruit-sized hernias.
Hello? Hernia surgery is not unique by using plastic implanted devices. Plastics are widely used medically for implanting as they have been found superior to metal and other substances. See “Why is the future of implantable devices plastic?”
https://www.solvay.com/en/article/why-future-implantable-devices-plasticMesh has apparently been involved in some medical tragedies. We all have read about them or experienced such first hand. It’s enough to give pause when contemplating surgery. Although much here at HT has talked about these horrors, very little attention is given to the fact that thousands and thousands of individuals have had successful mesh implants. I know some of them happy about it. We will never be able to understand this disconnect without dispassion.
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Chuck, the depths of despair you probably were in would test anyone’s mettle. I don’t think anyone here took it other than expressions of pain normally expected. I know you are still on the road toward recovery but suppose your condition has greatly improved from a year or so ago. As far as our friend, GI, is concerned, I believe he’s on a mission to destroy mesh as a medical intervention. Given the trauma he experienced, it’s understandable but it could make oneself myopic. You probably can understand him more than most. Failed surgery can be crushing. You both make contributions here, which I’m glad continues.
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“Earth to @Good intentions. Earth to @Good intentions. Do you read me?”
A businessperson, an investor, actually considers return of investment more importantly than altruism? Come on say it’s not true. And I guess you’re gonna tell me research and development of medical technologies require no financial investments, that most medical devices are simply made in the innovator’s backyard or basement for just pennies for the scrap material already laying around? So I guess all the players in the “industry” that is mesh should be working for free, including surgeons and other medical professionals, not to mention the technical innovators and administrators that help make it happen? Would this industry then be a conspiracy to do people in? -
@ajm222, excellent, excellent post. Granted as you suggest it is impressionistic but it is all we can do as a patient. You make a well-reasoned proposal for the state of affairs in mesh. Let me add the previous posts I made pointing out some surgeons have publicly acknowledged that some fellow surgeons in the field have been irresponsible about post-op complications. That is an important first step by recognizing a problem. Bravo, your post.
@Good intentions, you are fortunate that Dr. T. is gracious for not putting you in your place. True, the good doctor might be so ensconced in her practice/approach she might miss the full import of competing views. Hmm, are there any dedicated professionals that could elude that characterization? How about you? Are you so balanced that you are able to view the field dispassionately? Not. You sometimes misread medical reports egregiously but refuse to recognize it like the time you reported how a routine hernia operation turned into a loss of a leg. You missed that the guy had ten operations worth of scar tissue making it an extraordinary medical challenge–exactly why the surgeon could make a public “confession” about it as he did!
@Chuck is not far off in voicing similar concern. Both of you have been through hell medically and so share commonality in opposition to mesh. Further don’t butt into people’s personal affairs not your own as when you PMed me. You see, it shows how extreme your personal campaign against mess has taken you. Your criticism of Dr. T mirrors bias you have in the opposite direction!
I was disappointed, GI, that you couldn’t see some way around the security concern when Chuck appealed to you for personal help. He was in dire straights. Apart from a personal phone call wasn’t there some other way to connect outside of HT? Chuck, if you surmise correctly about GI’s medical status, then he, as many might be, reluctant to connect personally. I’m just happy that both of you are on roads to recovery. Ironically mesh injury can strike again in making our human relations difficult. I’m glad that both of you are mending in that way as well.
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Let me disabuse you gentlemen of the idea that a surgeon doing their own imaging must be expert at it. Not in my experience. 😀 A couple of surgeons did an ultrasound on me, both non-standard in some way, and one them actually injured me. Also your note about Dr. Kang might be mistaken according to the separate testings I received. He relies on staff he considers highly higly proficient. He’s there at the side of the patient and discusses the findings with both. Given his many operations preformed, he has had many chances to test their proficiency.
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Thanks for the invite, Chuck, but I’m not a member of FB.
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Thank you for your comments. My purpose is to raise my understanding about these things. We’ve got the latest authoritative scope on hernia, so how does it fit with what we already know. Can we sharpen our focus a bit. A big issue is chronic pain. Probably it’s been around that prior pain raises the chance for post-op complications.
William points out that some findings show it’s less clear: absence of prior pain is no guarantee. I would want to know if prior pain was truly absent before doubting the role of prior pain in surgery outcomes. Would you classify patient condition of “didn’t trouble them much” as an absence of pain? Perhaps it were enough to derail successful outcomes.
Why important? The more relevant prior pain is the more the patient condition factors into assessment of surgery. What’s more relevant, patient condition or surgeon skill? Various patients over the years here at HT describe how they have gotten the run around post-op by their surgeons. Isn’t it a matter of responsibility? How much is failure attributable to the surgeon? Some surgeons seem to avoid the question.
To be reasonable, the subject of pain is ill-understood scientifically/medically and unfortunately some patients with criminal intent will try to milk the system for whatever they can get. It’s fascinating that train wrecks typically invite onlookers who later jump onto the train posing as actual passengers for the victim benefits! I’m not a doctor but I must imagine that they must be on the lookout for scammers. This is maybe why only belatedly has chronic pain arrested the attention of hernia surgeons.
My commentary reminds of discussion at HT of methods, Kang Repair vs. Shouldice. Isn’t it interesting that Dr. Kang treats all comers whereas Shouldice has strict requirements as to who they will treat? Could this difference be ultimately that of responsibility? One is more willing than the other to assume responsibility? Or put another way, one is more fearful of responsibility than the other. How is it that Kang’s incision for IH repair is less than an inch and half but Shouldice’s, two to
three times bigger? Could this difference also be one of responsibility? The bigger the incision, the less responsible the surgeon needs to be? Just some random thoughts for pondering. -
Assuming a state-of-the-art book, it would be worthwhile to evaluate the book’s overall assessment of hernia complications as follows:
“Chronic or severe pain following inguinal herniorrhaphy is reported in 10% to 14% of the
cases. It remains a perplexing and challenging problem. it is associated with preoperative
chronic pain and with recurrent inguinal hernia repair. The identification and protection
of the ilioinguinal, genitofemoral, and iliohypogastric nerves are important in preventing
nerve entrapment injuries. if a nerve is injured, it should be transected and ligated
proximally, allowing it to retract into the muscle or preperitoneal space. Operative
treatment with planned resection of the three nerves can improve or resolve the pain.
However, a multidisciplinary pain team approach is imperative for optimal patient
outcomes.” (Itani & Sbayi, 2023)At least one of the two authors advocates “mesh-free” surgery (though he also does mesh perhaps even more). Both are distinguished professors of surgery. They recognize chronic pain can be a post-op complication and point out an association with preoperative pain. Surgical technique is implied as a factor also. The field has yet apparently been unable to sort this out. If acknowledgement of chronic pain is only recent, then hardly much will be known about causation. Perhaps why this book chapter avoids relative results between mesh and non-mesh methods despite an author of the two being a non-mesh advocate (but not totally).
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Hey @G is your sudden appearance from Providence or what? You must be an MBA by your use of “business models.” I’m in need of some financial advice, so could you give us a tutorial on business models and medical devices? Particularly which device do you think projects as the most profitable and the business model that would most foster its growth? I’ve got a few $Ks yet earmarked, so your appearance is a knick in time. Maybe your tutorial could go on a separate thread. Also any stockbroker recommendations would be welcome.