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Speaker 1 (00:00:10):
Hi everyone, it’s Dr. Towfigh. Welcome to Hernia Talk Live. I’m your host, Dr. Shirin Towfigh. I am your hernia and laparoscopic surgery specialist. Thanks to everyone who’s joining me on Twitter and Instagram and Hernia Doc. Many of you are here live as a Facebook Live at Dr. Towfigh, or you’re here with a Zoom link I’m super excited about today. We’ve been planning to have our guest for the past year. His name is Martin O’Neill. He comes to me from Europe, which is why we’re doing this kind of this earlier time than usual. He is a patient advocate, but n Mesh injured, and he’s got a great story. You can follow him on Twitter at O’Neill Mar O-N-E-I-L-L-M-A-R. I follow him. He follows me. It’s been great. Welcome, Martin. I’m so happy to have you.
Speaker 2 (00:01:07):
Hi, Dr. Towfigh. Thank you for having me. Exciting. So
Speaker 1 (00:01:10):
We’ve interacted. We’ve interacted on social media before. Yes. But I had the pleasure of meeting you almost exactly a year ago.
Speaker 2 (00:01:19):
Yes, yes. Strangely enough, yes, in Manchester. It was a wonderful time,
Speaker 1 (00:01:27):
A wonderful time. I was so privileged. It was a great opportunity. I’m glad that you were able to make the time, because for those of you listening, the European Hernia Society meeting last year was held in Manchester, and it was hosted by the British Hernia Society. So I flew to London, and then Manchester was my first time in the UK, and I fell completely in love with it. Can I tell you that so much? So I want to go back and a little bit about my story about that, and I reached out to some people that I knew and said, Hey, I’m going to be in town. It’d be great if I could meet you and Martin’s like, I’ll be there. So maybe you explain, because you don’t live in Manchester, you had to
Speaker 2 (00:02:10):
fly in. No. Yes, yes. I live an island called Jersey, which is 14 miles off the coast of France. We are own island. There is a bailiwick. There’s a certain, there’s about five or six other islands around it. And when you asked to come, I was like, amazing. I’m off. Because I was in a very fortunate position that I’ve met wonderful surgeons like you, Dr. Wick and beyond, and I’ve gathered quite a lot of information and friends along the way. So meeting you was amazing because prior to mesh removal, I sat and watched Hernia Talk Live, many nights, many times. And the hope that I think most of his whom were Mesh damaged are all hoping that we get to Dr. Towfigh because you have the most prominent surgeon whom speaks out openly around what’s happening in the
Speaker 1 (00:03:11):
Mesh. Yeah, yeah, yeah. You have a great story. I really want to delve deep into it. Deep. So deep. You flew in
Speaker 2 (00:03:22):
To, I flew to Manchester Directly to Manchester. Yeah. Just for
Speaker 1 (00:03:27):
That one day, right? Or did you stay
Speaker 2 (00:03:28):
For the Yeah, I stayed for two days in the end, but it was just the two days. But the first day to meet you the second day. A couple of others then go. Yeah. But you’re
Speaker 1 (00:03:42):
Scottish, right?
Speaker 2 (00:03:43):
Yes, I’m Scottish. So my father moved here when I was four. I moved here just before I was 20. So unfortunately, Jersey now has a channel, Highlander and myself. So yeah, it is been a wonderful journey living here within Jersey, and particularly the last sort of 10 years I’ve found both sides of Jersey, I’ve found that the horror of obviously the lack of medical, what we need here, what we actually physically need on island, and equally, the benefit from everyone. The people here in Jersey are something else. They’re wonderful, wonderful people.
Speaker 1 (00:04:31):
I come visit, I’m coming back for the European Society meeting next year, which is in prod, but I plan to do a little stuff on London as a follow up to what we were discussing earlier. I
Speaker 2 (00:04:46):
Would love you to come to J and hopefully, and hopefully meet some of our team here within the surgical community. That would be wonderful.
Speaker 1 (00:04:57):
Yeah. Yeah. I’ll definitely, okay. I’ll definitely put that on my list.
Speaker 2 (00:05:03):
Yes.
Speaker 1 (00:05:04):
Yeah, absolutely. I personally love the international aspect of Hernia surgery. I don’t know that any of the other specialties have such a robust family of surgeons that internationally, we all know each other. We hang out with each other, we together. I love learning and seeing new cultures part of the surgical experience. Yeah, it’ll definitely,
Speaker 2 (00:05:34):
For sure. Sorry, I’ve lost connection here, so I missed half of what you said. My apologies. I didn’t hear anything of what you said there.
Speaker 1 (00:05:45):
Oh, can you hear me? Can you hear right now? Let’s see. Can you hear me now? There we go. Now you can hear me. Can you hear me now?
Speaker 2 (00:06:14):
Hello?
Speaker 1 (00:06:15):
Now you can hear me?
Speaker 2 (00:06:16):
Yes. Yes, I can hear you now. I’ve got you back now. Yes,
Speaker 1 (00:06:20):
It’s a damn computer. Okay. See, now that I have a link, there’s someone there. I will definitely add you to my list of places to visit. And I always joke, people go to see museums and stuff. When I go to different countries, I go and see hospitals, operating rooms. That’s like my museums.
Speaker 2 (00:06:42):
Well, I’m pretty sure our surgeons would love to have you over here to speak with in all manner of capacities. Yeah, that’d be wonderful
Speaker 1 (00:06:54):
For sure. Okay, so I would like to hear your story. I kind of know your story a little bit, but maybe we can start with you sharing. Why did you even have a hernia surgery?
Speaker 2 (00:07:10):
I had it because I was told that I needed it. I was told that it was needed. I was told it was a gold standard. They were done set. Did you have a mesh?
Speaker 1 (00:07:26):
Did you have groin pain or a bulge
Speaker 2 (00:07:28):
Or what? I had a groin pain. Didn’t have any bulge, didn’t have anything. It was found by accident. Coincidentally, I had lifted something at work and I damaged the groin.
Speaker 1 (00:07:42):
What kind of work were you doing?
Speaker 2 (00:07:43):
I worked on the docks here at the harbor, so Oh, the docks? Yeah. I lifted a heavy box, you see, and that’s where it started from.
Speaker 1 (00:07:52):
And did you have pain just in the groin or did it radiate to your inner thigh or lower back?
Speaker 2 (00:07:57):
Just in the groin. Just in the groin. Just in the
Speaker 1 (00:07:59):
Groin,
Speaker 2 (00:08:00):
Yeah.
Speaker 1 (00:08:01):
And they said you have a Hernia or you might have a hernia. How was that diagnosed?
Speaker 2 (00:08:07):
Six, six weeks after the initial injury. I went back to the GP, the doctor, three times within the six weeks. And that’s after the six weeks. That’s when we had a scan and we found the hernia. So the pain I had was then blamed upon the hernia.
Speaker 1 (00:08:27):
Was that an ultrasound or
Speaker 2 (00:08:30):
Ultrasound?
Speaker 1 (00:08:31):
Ultrasound Found
Speaker 2 (00:08:32):
Ultrasound, yeah.
Speaker 1 (00:08:33):
So one thing I’ll comment is there are plenty of people out in the world that have hernias. It’s one of the more common diagnoses, but what’s really key is to make sure the hernia is the cause of the pain. So I see a lot of patients that have hernias, but it’s not the cause of their pain, but it’s an obvious thing. They go exam, I heard I kind of have pain here, like, oh, there’s this bulging hernia, it must be it. And then they have surgery, and it was probably not from that. It was like they had a hip disorder, let’s say, or they have back problems. And so what ends up happening is the original cause of the pain is not addressed, but then now they have a complication from the hernia repair. And so now they have two problems that they have to deal with.
Speaker 1 (00:09:18):
Whereas before there was one. So I’ll tell you, we have something coming up, hopefully by the end of this year, we call the hernia score. So this is free. You can go on, our websites not ready yet, but by December, hopefully it will be you plug in all your symptoms and it’ll spit out a score as to the likelihood that those symptoms are due to a hernia as opposed to, like I said, a hip disorder or maybe ovarian cyst in women or something like that where yeah, you have a hernia, but does fixing the hernia really is that going to address your pain? And depending on those two, it’s a very, very valid and highly reliable scoring system that we’re going to launch in about a month.
Speaker 2 (00:10:06):
It’s because it’s much needed. It’s much needed, I believe,
Speaker 1 (00:10:11):
And it can help you as a patient can go online and do it. Or maybe a doctor doesn’t know scratching their head, why is this patient having pain? I don’t know. They put the score in, they’re like, oh, it’s because of a hernia. So it can help people who have obvious hernias be guided as to whether a Hernia repair will fix their symptoms. But it also, reversely will help people that don’t have an obvious Hernia put Hernia into their diagnosis instead of being told, oh, it’s on your head. It’s mostly women. a lot of your head or there’s,
Speaker 2 (00:10:48):
I’ve had
Speaker 1 (00:10:49):
All of this, your appendix.
Speaker 2 (00:10:53):
The difficulty is upon this pain side of things equally, post-op, after the hernia is repaired, this is what I’ve found. I’ve spoken, I’ve been blessed to speak to over 250 men globally now. So most of these men will not speak in public. 99% of them in fact, will not speak. In fact, that’s pretty much the way, as for most men, they just be quiet. They take it on the chin. Sorry, my phone just went. And they just get on with it. Now, post-op pain, when we wake up and we’re in a lot of pain, most men say that immediately when they’ve woke up, they’re in so much pain, but nothing happens because it’s classed as post-op pain. So this is where the points early on. This is early on, yes, immediately after surgery, this is where we should be. There should be a type of process involved in here, which could help diagnose either a complication from where the has been situated, something around that, because that’s what men seem to come across with, is immediately when they wake up, that’s when they find that worse than what they were before, which is not the way to be.
Speaker 1 (00:12:28):
And that’s one of your passions, which you first told me, is that the women have done a good job even eventually getting information out there about the pelvic mesh, the transvaginal mesh, and therefore that proactiveness on the women’s part has been able to kind of trickle over to the Hernia mesh world. But I agree with you. Most people who have problems with hernia mesh are men, not women, because they’re just more men having hernia surgery than women. I think statistically, if you look at chronic pain, more women have chronic pain, percentage wise, more chronic pain risk than men with hernia repairs. However, a dramatically higher number of men, something like five to seven x of men have hernias repaired than women. So pure numbers basis, more men are affected. And what you’re saying is very valid, which is perhaps men being men don’t complain as much, at least not publicly. And then when they go see their doctor, they’re told to just suck it up and be a man about it. And you just had surgery, you stop being a kid.
Speaker 2 (00:14:03):
That’s what I was told immediately. I woke up and I was told there was four other men whom had the surgery stop being a baby. I will say this, when I left the hospital, my girlfriend at the time, who is no fool, she doesn’t suffer pain, et cetera, and she was just astonished that that was even allowed to go home. But I was basically kicked out and told there’s nothing wrong with it. So that has to filter down equally from surgeons down into the team who are the nurses on the ground. You see,
Speaker 1 (00:14:49):
And you have people that are watching right now that are saying one’s from South Africa saying that men in her country or in his country are very silent about mesh complications. And that’s probably true.
Speaker 2 (00:15:00):
It’s everywhere. Dr. Towfigh. I’ve spoken to men from America from, shall we say, eastern block communities or countries? It’s everywhere. Everywhere. I’ve spoken to 70 year old men whom I’ve not told their wife.
Speaker 1 (00:15:22):
Same story. Yeah.
Speaker 2 (00:15:23):
Yeah. It’s horrid. It’s horrid.
Speaker 2 (00:15:26):
And to think that the beauty within it is that women have paved the way, and they’ve done it coincidentally, sorry, through a different avenue. It was vaginal mesh that was getting spoken about mostly, but then everyone else sort of piled in. But what we need is more men within this space because they are there. They are there. Even if it’s privately, there are other men like me, et cetera, whom would speak with them privately. They don’t have to be involved in the groups or anything, even if it’s someone to talk to in order that they can get their help and equally get what’s on their chest off it.
Speaker 1 (00:16:04):
So what kind of repair did you have done? Do you
Speaker 2 (00:16:07):
I had open lichen st stain,
Speaker 1 (00:16:10):
Open Lichtenstein. So open incision in the groin, and then you had a flat Mesh put in? Yes. No plug or anything like that?
Speaker 2 (00:16:18):
No, no plug. No. Just a flat mesh.
Speaker 1 (00:16:20):
And how were you the first, let’s say three days or four days after surgery,
Speaker 2 (00:16:25):
And I couldn’t walk. Couldn’t walk,
Speaker 1 (00:16:26):
Couldn’t walk,
Speaker 2 (00:16:28):
Couldn’t walk.
Speaker 1 (00:16:29):
And you couldn’t walk because you had pain, swelling or your weight bearing with your leg would
Speaker 2 (00:16:37):
Hurt. Pain was ferocious. Every step I took the pain within the groin. Just imagine if a sore tooth with a hammer at the dentist, every step by you get that even now to this day. So it’s painful. It’s extremely painful.
Speaker 1 (00:16:56):
And did you get very bruised?
Speaker 2 (00:16:58):
Yes. Yeah, very
Speaker 1 (00:16:59):
Bruised. Bruising is a part of any surgery, but sometimes I gauge either how big the hernia was or how complicated the surgery was, or sometimes how heavy handed the surgeon was based on how much bruising people get. Yeah, it happens. But if you see someone complicated with pain and then you think back and they’re like, oh, I was so bruised. My entire scrotum was purple and my penile shaft was purple, and my whole upper thigh was purple, then sometimes you wonder if it was more of a surgical technique issue than just a big hernia, let’s say.
Speaker 2 (00:17:43):
That’s the other complication that I was hoping to address would be the technique and the way that it’s approached and the sheer, for want of a better word, lack of guidance around us. This is where surgeons like you are key globally. Surgeons whom remove mesh, whom are not a general surgeon who specialize in hernia. I absolutely believe wholeheartedly that hernia surgery should be a principal surgery, the same as a heart surgeon, et cetera. That would be ideal. Yeah. Yes, it would be ideal. It really would be because it would protect the surgical community. And they don’t have thousands of people like me and all the women coming in and saying, let’s mesh, and then we are left in limbo because they don’t know how to remove it. And what happens then? It just becomes cost. Everything’s cost. We absorb more time with different consultants, so we then take more money from everyone else and everything that’s needed within the care, multiple psychiatrists, multiple surgeons, even sometimes equally, it’s a difficult thing.
Speaker 1 (00:19:02):
Okay. So then let’s go forward maybe between two and four weeks after surgery. Did you get better? A little bit.
Speaker 2 (00:19:10):
I was able to walk, but I couldn’t take stairs. I still can’t take stairs. I avoid them like they play because it’s the spasm effect and the lifting the leg up and then weight bearing. See weight bearing on the right leg. Weight
Speaker 1 (00:19:28):
Bearing on that foot. Yeah,
Speaker 2 (00:19:31):
It’s hard.
Speaker 1 (00:19:32):
And going hills and
Speaker 2 (00:19:35):
My right leg constantly wants to give way. When I put pressure onto the right leg when it’s horrible, I have to force it though, because if I didn’t go walking Dr. Towfigh, I would’ve nothing in my life. So I have to force the walk you sea. Whereas before, I loved it. I love swimming. I love cycling. I can’t cycle, can’t just,
Speaker 1 (00:19:59):
Yeah, cycle.
Speaker 2 (00:20:00):
Pubic bone pain
Speaker 1 (00:20:01):
Was sitting more difficult back then, or
Speaker 2 (00:20:04):
Was it Standing setting is still difficult. Yeah, I constantly ft. Constantly fi. Constantly ft.
Speaker 1 (00:20:11):
Yeah. And did you have any pain that radiated into your inner thigh during the early stages?
Speaker 2 (00:20:19):
No, not from the early stages. Later, yes, the more handled I became when I was walking the hip pain was ferocious. It’s still as bad, but on balance of everything, pain is pain in a sense. We have to take it. What comes?
Speaker 1 (00:20:43):
Any testicular pain in the early stages?
Speaker 2 (00:20:46):
Yes. Immediately on the right side, add testicular pain. The testicular pain then went into constant infections within the test, swelling within the EPIs infection, within the epididymis infection around the groin. And predominantly on the right side where the mesh was implanted, it just became horrible. The touch to touch the test, it was excruciating. So we elected to remove it to make things better. And
Speaker 1 (00:21:24):
Since it’s got a hell of a lot of loss, oh, you’re that doesn’t work.
Speaker 2 (00:21:27):
Nah, nah,
Speaker 1 (00:21:28):
That’s not the, oh my Lord, that’s the wrong decision.
Speaker 2 (00:21:32):
But this is prior to me gaining all the knowledge, which I only started gaining after all of this. We enter into a situation where we elect to have the tested removed. I develop a massive hematoma reaction. It becomes almost septic. I nearly died. We have three surgeries in the space of a week. We get through the next sort of, this is in the August week. We come to October near the November time before I’m in hospital basically for that whole period. It was like the odd few days or week out, and then I would be back in again.
Speaker 1 (00:22:19):
So a couple comments on what I’m thinking. What happened to you at that time? So some people throughout the term Lichtenstein know you had a Lichtenstein hernia repair, and sometimes we actually read the opera report and it’s kind of like Lichtenstein. Lichtenstein, sorry, Lichtenstein. But it’s not the true Lichtenstein technique because a true latency technique, you need to have an appropriate size mesh. Some people use too small of a mesh, so it actually becomes too tight of a repair. It’s like trying to fit you into a two size is too small, but outfit. And then the sutures, where they place the sutures is very important. You don’t want to place sutures anywhere that they can damage nerves. I just took out a mesh and they had sutures into the nerve and suture into the vessel. Literally, I had to take suture out of a vessel.
Speaker 1 (00:23:17):
I just don’t have enough words. Cool. And then the other thing too is mesh. So there’s different types of meshes and there’s lightweight meshes and heavyweight meshes and medium weight meshes. So the heavier weight, the Mesh, the more inflammatory response to it, number one. So more swelling potentially in the area. And if you’re already a heavy handed surgeon and you’re causing a lot of tissue damage and inflammation, then you slap on a heavyweight Mesh, that kind of multiplies the reaction. And then also mesh shrinks. So all synthetic Mesh shrinks the lightweight mesh shrinks about 10%, and the heaviest weight Mesh is shrink about 25%. So the surgeon should understand that. So when they put in the mesh, it can’t be placed perfectly. It’s like a T-shirt. If a cotton, if you wash it, it’s going to shrink. You want to buy one size higher. So the same is true for Mesh.
Speaker 1 (00:24:20):
You don’t want to put mesh in perfectly flat and T because within about three weeks and maximum six weeks, it’s going to shrink. So whereas it looked great during surgery, it looked perfectly flat like a fitted sheet on your mattress. By the time your body reacts to it, it’s now 25% shrunken. So when I hear stories, I couldn’t raise my leg. Going upstairs is difficult. Sitting is difficult. I wonder if you had too tight of a repair. And also the testicular symptoms sounds like you had a lot of, I’m calling it obstruction. So it was not only too tight where it was sewn, it was also wrapped too tight around your spermatic cord, which is the blood flow to your testicle and the flow of sperm out of your testicle towards your prostate. So if it’s too tight at the groin level, it’s like a vase, right?
Speaker 1 (00:25:23):
Like your groin is in a vase, you can’t function. You can’t actively flex your hip and bring your knee to chest and go upstairs and can’t hardly do anything. Cross your legs, for example, is another difficult one. Couldn’t do that. Getting in and out of chair chair is difficult. So that’s too tight of a repair. And it’s also too tightly wrapped around the spermatic cord. And there are techniques to prevent that. The amid modification of the Lichtenstein repair, which is by Dr. Harvey Amid, who’s a mentor and great friend of mine who fortunately lives in Los Angeles, his modification allows it so that it can never be too tight around this spermatic cord. But not everyone follows that technique because they don’t know. But if you make it too tight, then the blood flow to the testicles is usually okay, but the blood flow out, the venous blood flow is blocked, and so you get swelling and pain in the testicle. And then potentially also the blood, the spermatic flow out of the testicle can also be blocked because the mesh is eroding into the vas deferens, which is what carries a sperm. And so it’s very painful to ejaculate, for example.
Speaker 2 (00:26:47):
That’s why I was having pain on ejaculation when I was able to have sex. It was horrible. It was horrible. I remember
Speaker 1 (00:26:58):
That’s all obstruction at the insulin ring. No amount of amount of what we call or acting or taking out the test will help set. And it’s basically looking at freeway traffic and seeing that there’s so much traffic and not understanding there’s a car crash up front that you need to address. You don’t need to address the cars that are backed up. The main problem is the car crash up front,
Speaker 2 (00:27:22):
Which would have been the mesh, coincidentally, which is
Speaker 1 (00:27:25):
The mesh through repair.
Speaker 2 (00:27:27):
But all this in hindsight can be said now. But at the time, and this is what I would like to iterate into this, is that when we are going for these surgeries, all of us are around the world. When they’re putting mesh inside of us, we have to ask the questions, which I didn’t ask because it was sold to me. It was sold to me like a car. What happens when it goes wrong? How are you implanting it? What way? What method, what mesh? What particular type? Have you removed it before? These are questions that are only prominent now because of people who have spoken up and people who are still speaking up. But this is where we have to get to. We have a position where the patient is involved and we are given both scenarios. You can have a natural repair, an open shoulder dice repair, which may cause pain, et cetera. Or you can have a Mesh, which could possibly all the symptoms that come with it. I was never told that.
Speaker 1 (00:28:30):
Yeah. But also it’s
Speaker 2 (00:28:32):
Placement has to come into this equally. Sorry, Dr. Towfigh. I know. But placement has to come in, and this is where surgeons like you, your information is invaluable. Dr. Wick’s information, et cetera. When a general surgeon is implanting a mesh, it should really consult before he does it, an expert like yourself, whom is schooled and nothing but hernias, because then we can reset nails. We can move what doesn’t belong there, we can move out the way. And then when the mesh shrinks or it does what it does, none of that’s there. We’ve created a system where the cat is before the horse, and now we’ve got tens of thousands, if not hundreds of thousands of people mesh damaged, whom are screaming for people like your help. And there’s less. But
Speaker 1 (00:29:27):
How could you, this is the issue I have. There’s plenty of surgeons that I know that when they talk, you’re like, wow, he really knows what he’s talking about. And then you see them operate and you’re like, oh boy, I don’t want them on
Speaker 2 (00:29:40):
Me.
Speaker 1 (00:29:41):
And I learned this mostly not just through personal contact, but we did a paper that’s got some good press about it where we reviewed the top 50 YouTube videos on Anglo hernias. Right? Okay. Yes. And if you listen to the video, they’re saying exactly what you’re supposed to do. Great. You’re supposed to do this, do that. Be careful here. Don’t hit the nerves. And then if you watch the video, you’re like, I was getting palpitations and PTSD because it was so scary watching some of these videos posted on YouTube, how crazy the operation was. So the issue that I can’t resolve is even if you query the surgeon about their technique and how they do it, how can you be assured that the average general surgeon, that there technique at your operation is going to be the right technique that doesn’t hurt you.
Speaker 2 (00:30:41):
That’s why it’s so imperative and fundamental that herniate becomes a principal surgery. That is why that’s the whole, it stops. It stops the fighting, it stops the harm, which is the most dangerous part out of this. We’ve got men all over the world and women all over the world implanted with mesh who can’t have sex, can’t have children whom can’t walk. I mean, I’m lucky I can get out some days. There are women who just can’t. There are men who have got dual bilateral hernias and me, sorry. And I’ve had conversations with these men where even I have been like, this is beyond, and there’s nothing that any of these surgeons were told. It comes partly from manufacturer. Equally, manufacturers should be actively explaining to surgeons when they sell this mesh, there’s a possibility that this could happen. We must acknowledge that, that nothing is perfect in the surgical realm. We must acknowledge that harm come.
Speaker 1 (00:31:49):
And we don’t even know that these mesh should shrink until surgeons like Dr. Amit and others figured it out.
Speaker 2 (00:31:55):
Yes.
Speaker 1 (00:31:56):
Here’s a question
Speaker 2 (00:31:57):
For it. Yeah, sorry.
Speaker 1 (00:31:58):
Here’s a question. It says, what about cases where in addition to the hernia defect, there is an attenuation bulging of the inguinal floor that’s a direct inguinal hernia defect, compressing the inguinal nerve and the bolt. And the goal is to flatten the inguinal floor to relieve compression in addition to repairing the defect. If the mesh is too loose, will it not accomplish the goal of flattening and reinforcing supporting the in floor? So what you’re talking about, this question is about direct inguinal hernias to do a good direct inguinal hernia repair. I just did one yesterday and another one last week where actually this was not done. One of that was not done. What you’re supposed to do is you’re supposed to take that attenuation and bulging and weakness, and you tighten it, not too tight, but just you have to flatten it and not be a bulge.
Speaker 1 (00:32:46):
And then you place the Mesh on top of that, and by placing the mesh on top of that, you’re encouraging the Mesh. And now stick to your tissue repair, which was the tightening of the loose al floor. But you still don’t want that to be tight. You don’t want tight. Tight is not good. Tight is not good. When it comes to shoes, tying it tie is not good. When you’re wearing a jacket or a dress or underwear or anything tight is not good. So if you’re wearing braces, you don’t want it too tight. Nothing needs to be tight. It just needs to be adequate so you don’t have bulging of the intestines. And I hope that helps answer. So during your journey, sounds like one treatment that was given to you was removing your testicle, which I assume did nothing.
Speaker 2 (00:33:37):
It made it worse. It made it worse. When my testicle was removed, I have to explain. Excuse me, Dr. Towfigh, I was in a band whilst I was working. When I was working, I would probably be working about 90 to a hundred hours a week. Upon average. I was a lead singer and a band also. All of that has gone,
Speaker 1 (00:34:04):
Generates a lot of abdominal pressure. If you have too tight inguinal hernia repair, you can’t even talk loud, let alone sing.
Speaker 2 (00:34:12):
The singing was brutal. It was brutal. 2017, I gave up thinking I’ll be back within six months a year. We’ll slow down with the band. We’ll come back, can’t. The beauty of it is after Dr. Muschaweck’s repair, Dr. Muschaweck removed my mesh in Germany, and then I had a Muschaweck repair, actually, Dr. Muschaweck’s repair system, which is wonderful. But I’m taking lessons now to actually learn how to sing, and it hops like crazy, but I love it. I don’t care. So because of the journey I’ve been through now, people find me walking down the street singing and they’re like, is this man drunk or has I lost these marbles? And this is my way of kind of getting back to normality, reclaiming what was taken from my life. It’s a difficult process.
Speaker 1 (00:35:14):
So she removed all of your mesh?
Speaker 2 (00:35:16):
Yes. Yeah, all of it.
Speaker 1 (00:35:18):
And then what did she do with your nerves?
Speaker 2 (00:35:22):
Dr. Muschaweck took them out. So I’m left with just the genital, which has now given me problems because the genital, no, sorry, the femoral side of the genital femoral. The femoral is giving me issues because I’m getting shooting pains from the groin right down into the large tone backup. So I know it’s the femoral nerve.
Speaker 1 (00:35:49):
Got it, got it, got it.
Speaker 2 (00:35:50):
It’s horrid. I get spasms equally within the groin, which I’ll just, you’ve seen them when I was in Manchester, Dr. Towfigh.
Speaker 1 (00:36:00):
You were not sitting. So we had a handful of people I was meeting with, and everyone was sitting around and Martin was standing, and he kind of hid yourself behind a chair, holding onto a chair acting like everything’s fine. But I did notice that you were standing because it was painful to sit. Yeah. So let me ask you this question. So Dr. Muschaweck, as you know, she was a guest on the Hernia Talk Live earlier this year.
Speaker 2 (00:36:29):
I watched that with Ernest. So I really, yeah. So she
Speaker 1 (00:36:33):
Removed your mesh and did what’s called the minimal
Speaker 2 (00:36:37):
Repair. Repair. Repair, yeah. Called
Speaker 1 (00:36:38):
The minimal repair. And then she cut, sounds like at least 2 nerves, the ilio, maybe ileal hypogastric.
Speaker 2 (00:36:48):
The ilio on the genital, but attached to. So I had to come out, but in essence, it did make it better. I have to explain this because there’s a lot of people saying, Martin, before I went to Dr. Muschaweck, I couldn’t walk. I couldn’t walk. I was barely able to walk. The pain I was in was just obscene. I was taking 270 milligrams of Oxycontin a day. I was on multiple benzodiazepines. It was palliative care pain. What Dr. Muschaweck found was that my mesh had fused to my pubic bone, and it had fused to the inguinal on the other side. So what Dr. Muschaweck done, sorry, was she stopped me from deteriorating the possession. And removal of mesh is a difficult thing because even if I came to you, Dr. Towfigh, we’d still be in the same predicament. I believe I was in the best hands in the world with Dr. Muschaweck. I firmly, I’ve said that, and I still believe that Dr. Muschaweck,
Speaker 1 (00:38:01):
You traveled to Germany to see her. I think she comes to London too. Yeah.
Speaker 2 (00:38:05):
What happened was I was in talks with our government here and with the surgical fraternity, shall we say, and upon cost, it was cheaper to go to Germany because of all the additional stuff that the London hospitals were asking for. So one cost that was actually cheaper.
Speaker 1 (00:38:26):
Interesting.
Speaker 2 (00:38:27):
Really interesting. Because for a lot of patients, I’ve sent to Dr. Muschaweck since they couldn’t get to Germany because of the COVID situation, you see?
Speaker 1 (00:38:40):
Oh, the COVID situation.
Speaker 2 (00:38:42):
So we went to Germany. We arrived into Germany, myself and my auntie, my aunt came with me. We arrived there on the Sunday. On the Monday it was lockdown. So we had 14 days mandatory lockdown, which no one knew about. Not even the hospital here, neither obviously the German government did. But Dr. Muschaweck’s husband was fighting to still have the surgery, and it was just told no, it wasn’t happening. So I had to wait two weeks in Germany, then another 10 days. It was a crazy journey. Have
Speaker 1 (00:39:24):
You had any more surgery since then?
Speaker 2 (00:39:27):
I’ve not. Remember, we approached around an MRI scan that we approach privately. I’ll put this publicly. I’m still, I think I’ve re herniated. I’ve approached Dr. Muschaweck. I wanted to go and see her. I can feel it internally, but equally, I’ve just moved house. The house takes all the money. I have to wait. We have to get this MRI scan done and wait for the results from that
Speaker 1 (00:39:57):
Yes. So one of the thoughts behind, so if you did great with the Muschaweck operation, but then kind of had a setback, the first thing that comes to my mind is if you have a hernia recurrence. So that can happen when you remove mesh and do a tissue repair, which is completely a good option. The main risk with that is the tissue repair is not adequate because we already know, even in normal tissues, the tissue repair is a higher recurrence rate. And then you add to that, the additional operation of having had mesh removed, which can make things complicated. So the MRI, specifically with Valsalva, so with the bare dus, not a regular MRI where you just laying flat, you got to push out to recreate the abdominal pressure you get when you’re singing and when you sit and when you bend and so on. That will help determine if you have a recurrence. And then the discussion is how to repair that, number one. And that’s very treatable. Having a recurrence is your only complication is very treatable.
Speaker 2 (00:41:06):
It’s another trip to Dr. Muschaweck for another natural repair, because I’ll not have another, meh.
Speaker 1 (00:41:13):
You need a laparoscopic repair. You need a laparoscopic repair for that
Speaker 2 (00:41:18):
Laparoscopic. There’s a lot of, a lot of issues around the laparoscopic in the sense when the inputting, when the mesh insertion, and it comes to removing the mesh, laparoscopic, from what I’ve seen through groups and through the data and speaking to some surgeons, not all the Mesh can come out.
Speaker 1 (00:41:42):
A hundred percent can come out. I’ve never had a situation
Speaker 2 (00:41:44):
Where I haven’t. So it’s down to, well, that’s the thing. So it’s down to skill set. So this is why it’s imperative that you and surgeons like you teach that you have to lead the field. And we as patients have to beg for this and fight for it and ask for it around the world that surgeons like you are invited to Scotland, Jersey, England, wherever, because your skill set is needed. It is needed. It is needed globally.
Speaker 1 (00:42:20):
But more important than that is the skill of putting the mesh into the first place, number one. And in you, it’s possible that you overly react to synthetic Mesh. And so maybe a less synthetic mesh, like a hybrid mesh or something where there’s less synthetic and it would be a good option for your laparoscopic.
Speaker 2 (00:42:38):
I wouldn’t trust that. Again, because of what it’s done. It’s not a cultist position to adopt that. It’s the trust that’s been destroyed in me over the six years of fighting. It’s the being told that mesh can’t do what it’s done yet, obviously has done what it’s done. It’s all of that. It’s unfortunate because it’s left a bitter taste to win, for argument’s sake, when I’m 60 or 70, and I need a Mesh because I have to have one. Dr. Towfigh, we’ve spoke many times, and you’ve showed me instances of where Mesh has to be used. I bowed down to the complete ban of it and went, okay, mesh has a place. It has a position. But no, the way that every surgeon at the moment is going to is like a go-to thing. It’s like we are losing the skill sets that you have. You’re losing the skill set of the shoulders. How can you be a surgeon if you cannot do everything that you can do? Sorry. But if I was a surgeon in the hernia world, I would want to know everything. Everything about it shows how you become the best
Speaker 1 (00:43:53):
Hernia. Surgeons don’t even know how to do the shouldice.
Speaker 2 (00:43:57):
And the Shouldice is the Shouldice is one of, if not the best, go-to starting position. It’s part
Speaker 1 (00:44:06):
Of the boards. If you take the American Board of Surgery, you have to at least conceptually understand how to do it. But if you ask any of those surgeons to actually do it, they will say they’ve never done it.
Speaker 2 (00:44:15):
I watched a wonderful YouTube video before I went to Dr. Muschaweck. It was done by a husband and wife team called Sue and Peter Jones. Unfortunately, both of them have since retired. But both of these surgeons have an incredible position because both of them know the so dice method, they know how to remove the Mesh. I believe they were in the first predicament arguing against the use of Mesh predominantly when it first came out. But equally, these surgeons were fighting for acknowledgement around the mesh and the problems that it can cause, and that as surgeons, they’re losing that skill set. I mean, it’s silly. It really is. Because if you’re a surgeon and you need see to do an adapted natural repair, if you’ve not got that skill, what if the patient has autoimmune syndromes or symptoms? I’m now left with autoimmune conditions around my body. So that’s another reason why I can’t have a Mesh also.
Speaker 1 (00:45:24):
Yeah, yeah. Do you think you reacted to the mesh, like the actual physical particles of the mesh or was a surgical
Speaker 2 (00:45:32):
Technique issue? Yes. I’ve got fatty lipomas all over my body, all over it. Dr. Towfigh, I’ve got skin conditions. I sweat. I can’t stop sweating. I’ve got rashes. There’s weird smells. I’m probably giving too much over, but it’s just the truth. It’s the truth. Do you think
Speaker 1 (00:45:56):
All of your vegetables not removed? Is there some in you?
Speaker 2 (00:45:59):
No. I believe it was all removed. I absolutely, because I’ve seen the pictures of it. I know Dr. Muschaweck bless mesh. Yeah. My last words to Dr. Muschaweck, and it’s a scary situation equally because when we’re going for mesh removal, we are equally told if we can’t do a natural repair, you may still have to have a mesh. But at least if that’s a position, it’s done by one of the world’s best leading surgeons. So I accepted that fate and went, I’m in God’s hands now. This is where we go with that. Got it.
Speaker 1 (00:46:38):
Yeah. I wish we had, well, we need better surgical technique.
Speaker 2 (00:46:45):
Yes. Better guidance,
Speaker 1 (00:46:47):
Better tools, better
Speaker 2 (00:46:48):
Guidance. Yes. Equally, what we need is the patient. We need the patient involved. Dr. Towfigh, there is patients all over the world, this whom are campaigning and activists, and we want a better surgery. We want surgeons to be better. We want our hospitals to be better. We want the techniques to be better. We also want the data collected. We want what you guys want. I believe now, as a patient advocate that we should be using the patients to collect all this data and within what they’re harmed with in and around the mesh, or a criteria that every patient advocates for, they should be involved in the process, direct knowledge. And equally apart from that, seeing the vaccines where we could have teams of people like that, collecting the data, guided by doctors, guided by healthcare assistants, and it gives us the patient a focus. It gives us a new lease of life, a drive to become human again. Because that’s one thing I lost was I felt that, sorry. I didn’t feel it was actually true. I wasn’t part of society. I didn’t work, couldn’t work. I lost everything. Self-respect at all.
Speaker 1 (00:48:15):
So what’s out there available as a support group for specifically the men? I have a patient who is young
Speaker 2 (00:48:23):
At the moment. There’s nothing for the men. Before I joined with the Scottish Global Mesh Alliance, we created this group together.
Speaker 1 (00:48:32):
Scottish
Speaker 2 (00:48:33):
Global Alliance. Yes. We specifically made this that we bring everyone together because Mesh has been gentrified. Now we’ve got men and women separated by mesh. We’ve got men and women separated by the device type by where the mesh was implanted. And this creates, all it’s doing is creating further the division. And what we need is everyone together, everyone, we need to speak. Men and women. Women are so much better than men at being truthful and standing up for yourself. Sorry. But you really are. If it wasn’t for the women, I say this, I always say this. If it was not for the women, all of us, including the men, including the women with abdominal mesh, et cetera, it wasn’t the vaginal women standing up, none of it would’ve had a voice. So it’s so integral. It
Speaker 1 (00:49:29):
May be true about that. So
Speaker 2 (00:49:31):
Integral up together
Speaker 1 (00:49:32):
For men to share their stories.
Speaker 2 (00:49:35):
If men would like to contact me through mesh or Twitter or her, yes, Scottish global mesh lines, contact myself personally through Facebook. The groups that we are in, they’re all safe. No one speaks about it. I’ve had men contact me and they just call me, and they’re not even involved in the groups. They just give me a call when they want to, and I speak to them and listen to them. That’s mostly what they like. It’s
Speaker 1 (00:50:05):
Just a a lot of, yeah, but as an advocate, that’s your,
Speaker 2 (00:50:10):
That’s part of, it’s a blessing. It’s very
Speaker 1 (00:50:12):
Powerful. Yeah, it’s a blessing. A couple comments. Let me read those two. One’s telling you so proud that you speak out Martin. And also thanks for having us, allowing us to have a voice and educating. Another wrote, I had left al hernia surgery with mesh and a plug eight years ago. I’ve had pain since day one. Why is the plug used? I have three more hernias, but I’m afraid of surgery. I wish I could have come surgery with you. Yeah. So the plug, I just took one out yesterday. We recommend not using the plug anymore, but it’s still a very commonly used technique. It’s just another technique,
Speaker 2 (00:50:52):
But equally so that’s been recommended and yet it’s still being used. So is this a lack of speed with information getting to surgeons? No.
Speaker 1 (00:51:02):
I’ll tell you what it is. The company is afraid of removing it from the market, especially in the United States, because that will trigger lawsuits saying, oh, you are admitting that it’s a problem. Whereas that’s my impression. My impression is the company is refusing to remove that from the market because it would be admitting that there’s a problem with that design, and therefore they would be held liable and
Speaker 2 (00:51:29):
They’ll just
Speaker 1 (00:51:31):
Lawsuits.
Speaker 2 (00:51:32):
And what happens then is thats still order. Its still use it because they don’t know. They’ll
Speaker 1 (00:51:36):
Still use it.
Speaker 2 (00:51:37):
So we are in a catch 22 that equally, when we go back and say to surgeons, you guys don’t know, we are looked at as if we are the plague. We are looked down upon, we are slandered. Everything is then used against us as a patient. It’s pretty disgusting. When you
Speaker 1 (00:51:59):
Go patients, and if you talk to your surgeon and you’re asking the questions, you’re telling them to ask and they say they’re going to use a plug, either ask ’em not to use a plug or get another surgeon. All of the guidelines now, the European Hernia Society guidelines, the International Hernias Surgeon Group guidelines, all say, do not use the plug. There is no reason to add the risk of a plug to a Hernia repair. It doesn’t add or make the hernia any better than a traditional lichen study. Here’s another question. My surgeon said he will use a double breasted inguinal hernia repair. So that’s a Shouldice repair. But again, I’ve read opera reports where they claim they did s Shouldice, and you read the report, they didn’t do a Shouldice. They said, oh, we did a two layer of Shouldice. There is no such thing. We did a three layer of Shouldice. There is no such thing. So
Speaker 2 (00:52:49):
Either it’s Shouldice, a Shouldice, it’s just Shouldice. I’ve seen people saying, we’re doing a laparoscopic robotic shoulder dice. It’s like you’re doing a lot. A shoulder dice is open. So it’s an adaptive method. So this again comes down to surgeons, the terminology, the woefulness in their head to think it’s fine to do that. It’s not. You’re gaslighting the patient and equally you’re destroying good work as surgeons like you’re doing.
Speaker 1 (00:53:25):
Doing, yeah. Another one says, I’m in the same boat as Martin. I have a recurrent Hernia from a car accident a month after removal of my mesh. I don’t trust the system to have it repaired. It’s a problem.
Speaker 2 (00:53:35):
I may not have a recurrence. I’m only, that’s, we still have to day that show.
Speaker 1 (00:53:45):
Yeah. Only two surgeons in Sydney, Australia can do the shoulderice and Maloney Hernia repair. I wish you were in Australia. Thank you, Martin for sharing your story and helping others be more informed. So many are on this right now. Martin. Very nice.
Speaker 2 (00:54:00):
I’ve been very blessed, Dr. Towfigh, sorry to interrupt. To meet people from all over the world. Doctors, surgeons, patient advocates. It’s a blessing. It’s an absolute blessing. But we struggle. We really struggle. Sorry, I’m thinking. I’m thinking of a patient at the moment. It’s hard because I know where I was and within this journey, the suicidal want, it’s not an emotion. It’s a want. You want to die. You do not want to live. It’s a want. So when I hear patients whom are crying, et cetera, men grown men, it’s disturbing. It’s heartbreaking, but it’s a blessing. It’s an absolute blessing.
Speaker 1 (00:54:53):
Yeah. Here’s another one. I’m with you, Martin. I would never have Mesh again. Even when Mesh is removed, you cannot undo the damage cause and no matter how skilled the surgeon is at implanting, you cannot predict the autoimmune response. That’s true. No, that’s, I personally met with Peter Jones, who you have mentioned, and he told me he stopped using mesh in 1990s because he did regular and thorough follow ups with his patients, and he saw too many cases of autoimmune issues.
Speaker 2 (00:55:22):
He’s, he’s a wonderful, wonderful man, Dr. Jones. Peter Jones. Jones, yeah. Wonderful.
Speaker 1 (00:55:28):
Yeah. Another comment, I also have a hernia, and I’m not trusting my doctors ever again. They ruined my life with putting this Mesh. Now I’m needing a hernia pair. Another comment, the sad fact is that the governments appear to care. They commend our advocacy and they note our requests, but the ministers are going on what their advisors tell them, not us. Apparently, native tissue repairs are nowhere in the literature. That’s so not true. It’s all over the literature.
Speaker 2 (00:55:57):
Well, this is the difficulty. We’ve got civil servants directing private healthcare once within a public realm, which have adverse reactions. It’s a different healthcare system, you see? So we need government to listen to us all over the world, not just in Scotland, England, et cetera. We need them all over the world because us as patients, we are not crying about this because it’s a willy-nilly feeling. It is something that is, it’s unnatural. That is the only way to explain this. I’ve had broken Rives. I’ve had all sorts of different pain, but this pain is unnatural. It is something that does not stop. It’s incessant. And
Speaker 1 (00:56:46):
Governments and suicide or feeling suicidal is definitely a part of
Speaker 2 (00:56:50):
This. Dr. Towfigh, I tried six times. I tried six times. I wanted to die a clear want. God has kept me here for something, and I believe that that’s something is to open the voice up and to bring us all together. I’m not saying this, that I’m the person to do it. There is lots of people who are doing this. I’m just one amongst many, but we need government to listen and to pay attention to the people and not the people whom are harmed and not the people whom are pushing contracts that involve millions of pounds. This is the difference. It’s a clear and definite cry for help that everyone in government goes, don’t want. It’s sad.
Speaker 1 (00:57:45):
Oh boy. Here’s another point. Go through these comments. In my country, our parliament members lied and said they removed the mesh from the market. When I did the investigation, I found out until today, it’s used among patients. Here’s another comment. Yes. My surgeon said his double breasted repair Shouldice is the two layer repair. I’m glad I came on here and now I’m worried. Yeah. Shouldice is not two layers. Shouldice is, no.
Speaker 2 (00:58:11):
Yeah,
Speaker 1 (00:58:13):
I can’t handle
Speaker 2 (00:58:14):
This. You see the terminology within this and how the patients are getting gaslighted. Dr. Towfigh, you see, this is why it is so important that it becomes a principal surgery. And to be honest with you, I’ve been working around costs. So when a mesh injured patient is there and prevalent, the anti quarterly rate expands by five times the volume. So I cost my government in 2020 with admissions, et cetera, just admissions over a hundred thousand pounds in one year. So have to face for sure. I have to face cost as well. That doesn’t
Speaker 1 (00:58:57):
Weren’t you in the intensive care unit for a while.
Speaker 2 (00:58:59):
19 times. I’ve been admitted to that
Speaker 1 (00:59:01):
19 times from pain
Speaker 2 (00:59:02):
Control, control to control the spasm and
Speaker 1 (00:59:05):
Spasms
Speaker 2 (00:59:06):
And spasm. Yeah. The pain is unbelievable and better now. The pain is better now, but it’s the spasm. The spasm is horrendous. It’s the worst thing that came around. All the surgeries after 2017, the spasms became,
Speaker 1 (00:59:27):
I can see you’ve fidgeted throughout this hour and you look like you want to stand up.
Speaker 2 (00:59:33):
No, no, no. I’m fine. Honestly, I’m fine. I had a little walk before just to clear the head. I had a little walk. So yeah,
Speaker 1 (00:59:45):
The hour went by very quickly.
Speaker 2 (00:59:48):
Mark, we need to do another one.
Speaker 1 (00:59:50):
We should do another one.
Speaker 2 (00:59:53):
I would love to do another one with other patients and other surgeons. But this is the thing I love about speaking with you, Dr. Towfigh, because I can be harsh and say the truth, but it’s respectful. I’ll always say it respectfully and equally back from you. It’s been the same, but I think we started speaking in 2019 on and off through hernia talk, et cetera. Yeah, and that’s the thing where we’ve built bridges, and I think if we can do this around the world, everything and every service of healthcare, it does nothing apart from get better. It just gets better when we speak about it, when we open it out and look for the bad, actively look for it. Not in a derogatory way to blame anyone. It’s to say we need to make it better. That’s all that is.
Speaker 1 (01:00:48):
I agree with you. I agree with you, and I do feel in the past decade where I’ve been doing this, where I’ve included patient advocacy and discussion forums, I do feel that the sentiment has improved a little bit on both sides. I feel the surgeons are now less afraid of patients and more likely to include patients in their research studies and their meetings and their societies and have the patient voice. And I feel that patients are less likely to just say, you’re an evil doctor, and more likely to listen a little bit and give a little bit more respect to doctors who are,
Speaker 2 (01:01:32):
And it’s needed from both sides. Yeah. We need to understand your position. You have legal positions as surgeons, and it’s different all over the world. And not to mention the position and duty of care that you adopt as a normal person towards a patient. And there’s all of that to consider. Equally costs, directions from the bosses. Everything has to come into play. But if the patient’s involved and we’re all talking and the communication is free flowing positive, free flowing information, we’ll always make things better. In my view,
Speaker 1 (01:02:10):
This is true. I’m glad we’re moving in the right direction at least, and if we can just improve the products that are out there as well with industry, which I think we’re slowly doing, will go a long way.
Speaker 2 (01:02:22):
I believe you have been an integral part to me, becoming what I’ve become, but equally around the world, a lot of patients listen to you. They admire you, they admire that. You’re honest around it, as honest as you can be because obviously the surgical fraternity who may have words against what you’re saying, but it’s the truth. The truth is the truth. And you have opened and opened it up and shone a light inside. And a lot of people do love and respect and they’re absolutely grateful for what you do. I am one of these people and we have others on celebrated heroes like Dr. Muschaweck whom, whom just grace life and go forward and don’t hear anything of the good that they’ve done. You see, so keep going Dr. Towfigh, and I think the patients will stick
Speaker 1 (01:03:25):
Behind you. Thank you very much. Thank you for your time. I know it’s evening there already and I appreciate you agreeing to come on Hernia talk and share your story, and I do hope that this becomes one of our more popular episodes. You can follow it and watch it on YouTube. It’ll be there in about a day at Hernia Doc. I have a podcast now, so it’ll soon be on my podcast. It’s already on Facebook Live and we’re prerecorded, so everyone, if you can just follow, that’d be great. And don’t forget, I do have this patient survey you guys can all fill out. Just go through either herniatalk.com or any of my social media. It’s on my Instagram. It’s posted. I have an implant survey, so please, please take that so we can learn more
Speaker 2 (01:04:11):
About that. We’ve been posting it around.
Speaker 1 (01:04:13):
Oh, I love
Speaker 2 (01:04:14):
It. Thank you. We have been posting it around, so perfect. It’s not going unnoticed.
Speaker 1 (01:04:20):
On that note, I hope to see you again in person, Martin.
Speaker 2 (01:04:23):
Yes, absolutely.
Speaker 1 (01:04:24):
Would we get your MRI, send it to me so I can read it for you.
Speaker 2 (01:04:27):
Lovely. Will chat again. See you
Speaker 1 (01:04:30):
All next week. Thank
Speaker 2 (01:04:31):
You. Lovely. Thank you. Thanks guys. Bye Dr. Towfigh.
Speaker 1 (01:04:35):
Bye everyone.
