PART II: GREEK MYTHOLOGY and A MODERN DAY RENAISSANCE MAN – Dr. Dionysios Veronikis
An open-source article bylined by The Mesh Warrior
and contributed to by his patients
November 26, 2014
We begin Part II of the II-Part Interview with Dr. Veronikis where we left off, with this quote by Dr. V:
“Dr. Nichols taught me how to do slings.”
TO MESH OR NOT TO MESH,
THAT IS ALWAYS THE QUESTION
After he runs through his list of mentors and/or collegues, Dr. Veronikis rapidly lists his use of differing protocols for repair of POP and/or SUI, some using organic material or the body’s own material, some using polymers, INCLUDING SYNTHETIC POLYPROPYLENE MESH.
YES, DR. V STILL USES MESH.
Specifically, he lists these procedures and products by name:
- Fascia Lata Sling
(Source added by author: http://emedicine.medscape.com/article/447951-overview)
- Abdominal Fascia Lata Sling
- Mersilene Mesh
(Source added by author: http://www.ecatalog.ethicon.com/hernia-repair/view/mersilene-mesh)
- Polyetheline Synthetic Sling
(Source added by author, Google Scholar: http://scholar.google.com/scholar?q=polyethylene+synthetic+polymer&hl=en&as_sdt=0&as_vis=1&oi=scholart&sa=X&ei=MERpVOvqIZPksASOhoKACg&ved=0CB0QgQMwAA)
- Polyethylene Terephthalate
(Source added by author: http://www.britannica.com/EBchecked/topic/468536/polyethylene-terephthalate-PET-or-PETE)
Dr. V. makes reference to studies done by others, some I recognize, as they are often cited in the courtroom by both plaintiff’s and defense attorneys (specifically the now-infamous Ulumsten study). He’s still doling out the information as if throwing tennis balls for me to catch in rapid succession, and I am grabbing them all out of the sky somehow in a juggling act of words and phrases. His speech is an impassioned rant of sorts, and finally, this statement:
“If they aren’t slings, they’re swings.”
Dr. Veronikis punctuates his list with a sentence.
FROM SLINGS TO SWINGS
Dr. V. continues:
“A Mersilene Sling could give us enough material to suture the sling to the abdominal fascia, so these things fail the least. When we are doing abdominal slings, that’s not enough material so you have to attach a suture onto it. “
He stops to ask me a question, as if teacher to student,
“Aaron, think of a swing, where the rubber seat attaches to two chains and attaches to the bar at the top. When the swing breaks, where do you think that happens?”
I answer, “I would think where the rubber seat connects to the metal chain.”
“Yes,” he says, “You are a very smart woman.” I actually said, “Thank you. I know that.” Not sure where that came from, but Audrey Hepburn once said, “You know you have become a lady when you’re able to graciously accept a compliment.” Not sure I was so gracious, but I guess I felt the question to be condescending. It seems obvious to me, like common sense, basic physics. I’m sure he was trying to teach me with good intentions, because he’s a teaching physician, so I think that was a bit snappish on my part.
Anyway, I am trying to keep up with him, because the question I asked originally was:
“When and how did you first learn about mesh?” And what was your initial reaction? How did you think through the new procedure and device?”
. . . and I’m still waiting for the answer. We are now well into an hour of our conversation, and still I’ve not found a succinct answer to my first question amidst this list of connections and colleagues; credentials; products; procedures and polymers; or even buried somewhere in his hasty pace – quite rapid indeed.
Nonetheless, I appreciate his thorough education. It is a very good base education for all of us. I am appreciative of his time in this regard and I gave my full attention to every word he said, though, at this point, I’m wondering if he’s trying to front-run me so I don’t capture all the info, or if he’s just pressed for time. I would think if it were the latter, he would just answer the question, but still he continues at this rapid pace, talking about history. No matter; I like history, so I’m still intently listening and typing away.
He continues, “In 1994 we were already redoing and undoing procedures. They’d [the patient] then either get a Fascia Lata Sling or a Mersilene Sling. The ideal approach then was Rectus Fascia Retropublic, to the abdominal ‘swing,’ where the “chain” goes to the pole all the way around,” (this a reference to his earlier analogy of a rubber swing hanging from two chains, where the rubber seat connects to the metal chains, as in a swing set). . . . “From the poll, to underneath the swing to where the swing connects to the rubber. Suture attached to the sling, and it will almost always fail.”
Veronikis cites a “98-99% cure rate for SUI, with the synthetic Mersilene Sling,” (petro-based polymer sling, produced by Johnson & Johnson). This fact pulled from the mid 1990s he says.
“[As doctors] We’re trained to care about people. We view medicine as a calling, not a business.” This sentence seems to conclude the answer to the question, which I feel clearly seemed to “set him off” somehow.
ETHICON COMES TO VERONIKIS FOR AN EDUCATION ABOUT SLINGS
. . . and, finally, the answer to my first question!
The first approach by Ethicon came while Veronikis was still a fellow in 1997 and again in late 1998 and 1999 in St. Louis at his practice, he says. The salesman’s name was Will Irby. When Mr. Irby came to visit, Dr. V. listened to him:
“I base my decision on common sense and the philosophy of ‘should I consider this?’ I told him [Mr. Irby] that his procedure is flawed. There is no way they [J&J] put something together that has common sense.”
Dr. Veronikis makes an interesting point, and he makes the point as if it’s common knowledge. “They are engineers and scientists, not doctors,” when he refers to the developers of the device Mr. Irby is pitching to him. This writer would have thought a team of doctors would be working together with engineers and scientists in the development process. Now, that IS new information to me. It seems like that collaboration amongst these disciplines would be as obvious as the collaboration between an architect with a builder to supply a client with a custom-built-to-spec home.
Anyhow, the visit(s) from Ethicon also include a man named Brad Patel at some point. Dr. Veronikis tells them, “You didn’t go to the experts to ask these questions…. Why? You put this in the hands of untrained surgeons.” And then Dr. V asks the Ethicon team to leave his office. At hearing Dr. V say this, I feel a sense of hope: He asked them “Why?” At least now I know that someone in a position of authority asked someone else in a position of authority the simple question, “Why?” and asked that person a long, long time ago. In my opinion, so many more doctors should have acted as Dr. V did. When I was watching the the Linda Batiste vs. Ethicon trial, I watched Dr. Tom Margolis testify. His response to these sales reps was the same. In my own words, on the stand during Linda’s trial, Dr. Margolis testified that he basically said, “What are you people nuts?! I’m not putting this horrible stuff in women!”
And Dr. Margolis made the decision from the beginning, to never put ANY polypropylene mesh in women, not even once, as he testified.
Dr. Veronikis tells me he himself went to Ethicon’s training courses in Cincinnati. He was trained by AMS in Chicago for the Apogee & Perigee systems. He was trained by Avalta in the Twin Cities (Minneapolis/St. Paul) and attended training seminars in 2005 for Bard and was sought out by the VP of C.R. Bard.
He tells me he once confronted the president of J&J saying, “You all are engineers, not doctors,” regarding the Prolift product which he said has “way too much mesh.”
Dr. V continued, “Vaginas are supposed to be soft and pliable – ‘Yiasoo!’” he says. I giggle and ask if that’s a Greek colloquialism. He chuckles briefly and keeps talking.
“TVT (referring to Ethicon’s TVT Team) came and talked to us in Boston.” He says he stopped getting invited to trainings. The reps would come by and give him the DVDs. “Prolift was the most radical,” according to Dr. V.
DOES DR. V STILL USE MESH?
In a word, “Yes.”
In a whole lot more words, Dr. V. told me he’s performed more than 10,000 procedures using polypropylene slings. The Suburethraeal Retropubic Sling is a procedure that uses mesh, and it’s my experience that most established, well-experienced OB/GYNS or Urogynecologists use the mesh for this specific procedure and maintain that the procedure and products they use are safe and effective in the hands of a skilled surgeon (themselves). When Dr. V. told me he’d performed approximately 10,000 polypropylene slings, he stressed that he used Uritex® (made by C.R. Bard) but that the company “got rid of that.”
He switched to a product called Align® (Link to PDF Brochure), also made by C.R. Bard. When Bard came out with that product, he began putting in about 550 slings per year, but he says he never liked it. He tried it for a month or so and saw that too many patients were having problems, so he stopped using it.
Dr. Veronikis now performs approximately 700 slings/year using Caldera Desara® (Link to PDF Brochure) for SUI and C.R. Bard’s Alyte® for Sacral Copoplexy, a procedure for Pelvic Organ Prolapse or POP, as it’s most often called (Source added by author: http://www.atlasofpelvicsurgery.com/2VaginalandUrethra/9SacralColpoplexy/chap2sec9.html).
Again, this practice to correct vaginal prolapse using mesh is NOT UNCOMMON among OB/GYNs and other female pelvic health specialists and surgeons. As one who believes there HAS NEVER BEEN ADEQUATE SCIENTIFIC STUDY DONE ON THE PERMANENT PLACEMENT OF PETRO-BASED SYNTHETIC, POLYPROPYLENE IN HUMANS, I respectfully disagree with Dr. V’s continued use of mesh. My role in this MESH MESS is to educate patients so they can make their own decisions, with Dr. V. or whichever doctor any patient might choose to treat SUI or POP. One’s own health and other factors like co-morbidities make a one-size-fits-all recommendation impossible and irresponsible. I would not choose for myself to ever have synthetic, petro-based polypropylene implanted in me anywhere, ever. In my experience, the mesh “cure” has proven to be worse than the original problems of SUI and/or POP. That’s my decision for myself.
In fact, my own OB/GYN’s practice in Dallas, Women’s Health Central, uses mesh for the Suburethraeal Retropubic Sling procedure. I called my doctor, Dr. Francesca Perugini, whom I have adored for many years. I asked her to call me personally by leaving a message with her nurse. She returned my call within the same week, and I told her my family’s problems (and that of many other women and men) with the mesh and spoke about the scientific papers and FDA warnings I could share with her. She became a bit exasperated and hurried the conversation. I told her, regretfully, that I would not be able to come back as her patient, after many years of loyalty, because she was choosing not to take my comments and the research I offered seriously enough to read or even entertain the notion of a “conversation” about it, like one where we might sit in her office. Is that kind of appointment even billable? I don’t know. So, that is how I held my doctor accountable. I do the same with the mesh manufacturers like Johnson & Johnson. I hold them accountable where I can and where it matters to them most – with the use of my dollars. I do not buy their products, not their Q-tips, not their air fresheners, not their cleaning products, not their hair or skin care products- none of it. I believe when it comes to companies and service providers, the only way we can hold them accountable is to take our hard-earned dollars away from them, use them with companies who do actually honor customers and families. If we do not like the way they behave in the marketplace, which is RUN BY THE CUSTOMER, and if we can gain access to being informed consumers, then we can choose to invoke our own punitive damages, not awarding them our dollars. I know this is difficult to do with many of the manufacturers since they are mainly Business-to-Business service providers, not Business-to-Consumer service providers, but you can experiment with informing yourself about everything J&J makes. It’s a good place to start to take back some of your own power in this equation.
VERONIKIS’ PATIENTS WEIGH IN
A Patient Treated by Dr. Veronikis:
“He was my surgeon and used mesh. It eroded into my bladder but he was doing what he could to repair something no other surgeon would touch. I now have a permanent urinary diversion. I hold noting against him.”
When I tell the doctor about the patient above (who approached me without using her name). He said, “She is the only one.” He asked if I would relay a message to her, asking that I invite her to email him.
MY conversation with Dr. V has been well over an hour, close to two now. I haven’t even asked the second question on my list!
“How has your opinion about polypropylene mesh changed after the last many years and after removing it?”
“Hasn’t changed much from my initial perception. The least amount possible [of mesh] if you have to use it, placed precisely by high-volume surgeons who are trained. Not all polypropylene is created the same.”
Dr. V. concedes he has become aware of some immune issues and says he is still learning about that. He says he’s always believed the least amount of material in the right spot is the best option.
“Do you have the additional three years of urogynecological surgical education that, for example, Dr. Michael Hibner has? Do you think it’s necessary?”
“He [Dr. Hibner] went away for six months, to think about things. “Dr. Hibner wants them [patients] to know how much mesh is left in them.”
Dr. Hibner has gone to his hospital administrator and lobbied, pleading “Please do not allow mesh kits in this hospital.” The same is true for Dr. Veronikis. In the case of Dr. V’s lobby, his actions created a credentialing process. Dr. Veronikis sits on the credentialing board for Mercy Hospital in St. Louis and considers POP repair using POP Kits with mesh to be an experimental procedure. He sits on the board that certifies doctors in female pelvic medicine and reconstructive surgery.
The admirable actions by Dr. Veronikis took the POP Kits off the table at Mercy Hospital in St. Louis. As a result of his actions, POP Kits cannot be used in his hospital at all now, by any doctor with privileges there. That is a demonstration of his care and character as a physician. He is in a position of authority, and he used his position within his sphere of influence to make things better. If we’d only had more people on the manufacturers’ side of the equation making small steps towards the right direction, things would probably be quite different.
According to Dr. V., “Any overseeing medical board will not tell any hospital what they can or cannot do in their credentialing, Dr. V informs me. Boards use the ‘Practice Bulletin’ – as the official published communication, which creates the acceptable “Standard of Practice.”
In the experience of this patient advocate, this “Standard of Practice” is a code most doctors follow rigorously, as it comes with the support of their credentialing authority, in this case, The American Board of Obstetrics & Gynecology. The many and varied medical boards across the nation are very, very powerful, and doctors pay a fee to belong to the boards and retain their credentials. For purposes of discussion and elucidation only, you can think of any medical board as a “doctors’ union” of sorts, just as an easy comparison. If a doctor is following his or her credentialing board’s “Standard of Practice,” then in my experience, the doctor does not feel it necessary to question that standard, for example by questioning the still-sanctioned Suburethraeal Retropubic Sling procedure, which can and does use any number of mesh/synthetic polymers. I believe it also adds to the psychological belief held by many doctors that they need not do or accept further study or research on any procedure or device, because if it’s sanctioned by a “Practice Bulletin” than research could only serve to strengthen the view that is already held, or conversely, present unanswerable questions which cannot be answered by a “Practice Bulletin.” I assume that could be an uncomfortable place for a doctor to be in – go along with the flow, or create a decision point, a fork in the road between what the doctor may think is the best course of action for any treatment and what the accepted “Practice Bulletin” says is best. It’s at least a good question to offer you, my reader, in my opinion.
Whether a product is “safe” or “effective” beyond any board’s “Standard of Practice” is at the discretion of any singular doctor or hospital alone to decide. As in the case of Dr. Veronikis, any doctor can approach his/her employer and appeal to them that a specific procedure or product used hospital or practice wide is an issue. But again, to do so, can be out of alignment with the accepted boards “Practice Bulletin,” which remember defines the “Standard of Care” for the bulk of doctors. Doctors making decisions outside the “Practice Bulletin” are taking some measure of risk to do so.
So, the battle for us, as patients and patient advocates, is to know the right questions to ask and to try our best to find out by any means possible:
1) Does our doctor think hard enough about the scientific and engineering questions like if the use of polymers is appropriate in humans at all?
- 2) What is the quality and quantity of research available and has my doctor reviewed it?
- 3) Was the research conducted according to solid scientific principles (Tier 1 Eithics) and using a diverse population that all demographics including both genders?
It seems to me that this level of participation and education regarding device manufacture and outcomes of procedures is knowledge a bit too in depth to require of any patient. These are complex issues, rigorously debated topics, even amongst scientists, physicians, and now attorneys. To require this amount of knowledge by any patient is quite unrealistic I think, especially since the patient is already ill and dealing with pain and suffering while trying to research and make an informed decision about a life-altering procedure that may be 4-6 hours in the OR for the doctor, but a lifetime of pain and suffering for the patient. All of these issues combined is why I think individual patient advocates and the notion of patient advocacy, as a career, WILL and SHOULD make its way into our healthcare system as an accepted and justified position very soon. My hope is that my work as The Mesh Warrior and as founder of The Mesh Warrior Foundation for the injured will hasten that day.
Still, Dr. Veronikis says, “The OB/GYN credentialing board is working on these issues, commenting that, “We need to create a fourth subspecialty.”
The board created a subspecialty last year last year for the first time ever. Dr. Veronikis tells me he took the credentialing exam, as did Dr. Tom Margolis of Bay Area Pelvic Surgery. “We passed, but we didn’t need to take it.”
THE ROAD AHEAD AS DR. VERONIKIS SEES IT
Subspecialties will begin to be more and more required by the board certification authorities within any specialty including female pelvic health. He offers his thoughts about what subspecialties could be credentialed to ensure the right type of specialized physicians are well trained and prepared to perform specialty procedures. He gives some good examples off the top of his head to round out our discussion:
- Board Specialty in Female Pelvic Medicine & Reconstructive Surgery with further refinement by also requiring a fellowship in Urogynecology
- Board Specialty in Robotic Surgery
- Credentialing by Experience, i.e.
- How much mesh do you remove?
- What kind slings do you remove?
- What is the depth and breadth of your removal experience, etc.
MY ADDITIONAL INTERVIEW QUESTIONS and
MORE PATIENT COMMENTS
“There is much confusion among the mesh injured about which doctor to go to (besides Dr. Raz of UCLA and yourself) because the cost of the trips is prohibitive for many. Is there any other doctor who you would personally and confidentially recommend for someone in this situation?”
“The more doctors we can find who do full explants, the more chance there is that woman can afford to travel for surgery. (Author’s note: *See Part I of my interview with Dr. V for two suggestions, Dr. Issac Schiff in Boston, MA and Dr. George McClure in Tacoma, WA)”
“Do you have any recommendations (besides narcotic medication) about how to control/minimize the chronic pain that is so often one of the main complications of mesh implant (could include books, specific doctors or specific therapies)?”
“By far and large, the vast number of patients have the pain cycle stop. Botox to paralyze muscles and nerves. I call the patient’s pain management doctor and tell them why they have pain, and where it is coming from.”
“Have you confirmed any medically-resistant strains of bacterium in women with system infection or localized infection around the mesh?”
“Removing the mesh is stirring the pot, making it an acute inflammatory response again. Your body recognizes the invader and recruits the immune system response and a brand new immune response begins: macrophages, polymorphonuclear cells, NK – natural killer cells, and these cells release a whole cascade of your body’s own chemicals and starts a whole new war. In this way, the infections leave with the mesh.”
“Have you tested the infection for type of bacterium?”
“No. After the first surgery, it becomes a real battle with the body. Tissue dies, bacteria feeds on it, then bacteria feeds on the necrosis [dying/dead tissue in the body].”
“Would you be amenable to performing such tests routinely when it is apparent that there is infection? Would you be willing to share your finding informally with me [without patient-identifying information of any kind]? Some in the injured community have been diagnosed with very rare anaerobic bacterial infections, not usually seen at all within the human body. For example, some in our community have been diagnosed with a rare and resistant, but active Actinomycosis bacterial infection.”
(Source added by author: http://www.nlm.nih.gov/medlineplus/ency/article/000599.htm).
A Patient treated by Dr. Veronikis
“I had Dr. Veronikis remove my mesh. He was very rude to my spouse and I at the initial preop consult. He was very arrogant and insisted that he had women much worse off than me. He repeatedly asked my husband what he meant by, “he could feel it.” I understand that my being a nurse he might have thought he didn’t understand anatomy but for lack of a better way to put it that had been his playhouse for 24+- years! He told me he, ” would remove it if I insisted on it but he didn’t see how the mesh could cause what I was describing.” He told me that he refused to do repair w fascia because it shrank up too much and he would have to repair it again. (that was one of the biggest reasons I chose him. That and location.) He said that it would be different if he put mesh in because he would do it right. He jokingly told my husband he would see if he could tighten things up a bit. We went back to Haven House and were discussing packing up and going home! I decided since so many arrangements had already been put into motion for this to happen that if he would just remove the mesh I would see if I could find someone more local that will do a fascia repair. The day after surgery he came to discharge me to go home. When he showed me the picture of the mesh he removed he explained the process as follow: “on the right side it was stuck to the pelvic bone and was about like trying to remove bubble gum from the back of a chair you’re sitting in. The left side was the most extensive repair. The mesh was deep into the muscle and nerves to your leg, but basically that means I took care of your pain for you.” I asked him to please email me the picture he had just shown me. He told me that he didn’t want me to post it on the internet because he wouldn’t want anyone to steal his technique.
At that point I just wanted to go home finally mesh free! My mesh was done through my groin instead of suprapubic so this was how he had to remove it. I had 3 stitches vaginally and about a 3-4 inch incision in each groin w about 20 stitches each. But I was mesh free!
I returned for my pistol visit and he was bragging about a website or something he was developing to direct more women to him. I was very rushed w a quick 2 second finger probe and asked if it hurt and not even really given time to answer. He asked if I was leaking and I told him no more than I had prior to surgery. He said, “I didn’t think you would after surgery from me.” Then laughed and asked me if I was a satisfied customer. I very sarcastically said, “I asked you to remove the mesh and you DID REMOVE IT!” Either he didn’t hear or chose to ignore the sarcasm. He told me something about a heart. He told me, “write like your initials and surgery date something to identify you and you can write how much you love me, how I saved your life something like that.” There were a crowd of people in the check out area. I very illegibly scribbled, “thanks for removing my mesh.” Put it in the clear container and left.
I still have SUI but I WILL not have it repaired anytime soon and most definitely not by him! I would like to remain anonymous since my case is still not settled. I spoke with Jane shortly after my surgery and after our conversation she said she was going to remove him from her site. I understand that every case and everyone’s experience is different but this is my story as I lived it.
I just pray one day this whole nightmare will be over, and my body will stop fighting me everytime I get out of bed.”
A Patient Treated by Dr. Veronikis
Dr. V. does go through many leaps and bounds to remove the poisonous mesh that has ravaged our bodies for years which I’m sure is a very complicated and tedious job for him. He works tirelessly to help us in many ways. He is a very unique doctor that does not give up on removing the most complicated of mesh messes. He removed my mesh when I have had many doctors say that they would not touch me even when it was eroding and plainly needed to come out. I drove from my hometown in Louisiana all the way to St. Louis just to consult with him. Upon consultation with him, I just knew he would be able to remove my mesh! I had lots of faith and the utmost respect for him. I was also having rectal pain and asked him if he thought that it would resolve with mesh removal and he truthfully said “no”. I was not happy with that answer but who would not be?? I needed to come to terms with that answer which I did. It is not Dr. V’s fault that the rectal pain did not resolve and I know that. I can say that he did remove all of my mesh and for that I am very thankful. Yes, I still have the pain but I believe that it is nerve related and am pursuing other avenues with a specialist that deals with the nerves in the pelvic floor area. No, I am not 100% because my pain was not resolved but according to Dr. V. I am mesh free! Everyone has their own opinions on every situation dealing with mesh, I mean look at Dr. V., he still puts it in. God has given us the free will to do what we want and if women want the mesh then it is their decision although I would try to persuade them not to have it done with every caring inch of my heart. Every woman has their own experience with Dr. V., it might not be all rosy but at least he is truthful. I did not like some of the things he said to me on my followup visit but it was the truth and I know that I have to come to terms with that. There is one thing I can say about Dr. V. and it is that he is only HUMAN just like the rest of us. It is okay to tell the truth even if your experience was not a good one. I believe that it is not bashing him but just getting someone else’s perspective on the whole situation. We are all suffering and Dr. V. is our glimmer of hope. My overall experience with Dr. V. is that he tells the truth which we do not want to hear because we just want to hear that we will be whole again which can be impossible for one doctor but at least he was willing to remove my mesh mess so for that I am very thankful. I love all of my mesh sisters! I will always respect those who respect me and others. I believe that we should live by Gods word to be kind to others and live our lives loving others. I always want to find as much information on mesh as possible and that is why I would love to read the Mesh Warrior’s interview with Dr. V. When I was implanted with this disgusting stuff, I did not know a thing about mesh but sure wish I would have done my homework. I trusted my doctor and now my body is ruined. Unfortunately, we have to become our own advocates and do our own research and if it was not for the information from other women on these pages with their stories and information we would be alone in that cold dark place called depression. We could all use more information. I will not give up on my endeavor to become pain free so that my husband could get his wife back and my children can get their mother back! Much love to the Mesh Warrior and to all of the ladies on here! May we all become mesh free and pain free so that we can be free!
MY ADDITIONAL QUESTIONS THAT DIDN’T MAKE IT INTO OUR INTERVIEW. OBVIOUSLY, MY CONVERSATION WITH DR. V PROVED TO BE VERY RELEVANT AND INFORMATIVE DESPITE THE FACT THAT WE NEVER MADE IT PAST QUESTION #3.
THIS FACT REALLY SERVES TO PROVE HOW MUCH THERE IS TO DISCUSS BETWEEN DOCTOR AND PATIENT, BETWEEN DOCTOR AND PATIENT ADVOCATE.
- I know that every person is different, but if there are some conditions which you KNOW will prohibit you from safely attempting an explant, what would those be (e.g. uncontrolled diabetes, etc., etc.)
- Anecdotally and within the mesh-injured community, it seems to be the consensus that a PARTIAL EXPLANT is MUCH worse than a FULL EXPLANT. What is your medical opinion on that subject?
- For full disclosure, are you currently consulting to any of the mesh manufacturers? If so, which ones and why?
- How many fellows or residents do you have in training under you, if any? Given your the as-of-now very uncommon and highly-sought-after expertise for this kind of surgery, many of the mesh-injured fear there are not enough doctors to handle the hoards that coming.