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Boston Scientific on Hot Seat Amid Chinese Mesh Allegations

marion scott 2 april 2016Mesh News Desk, May 14, 2016 ~ It’s been a circuitous route.

The latest news that mesh maker Boston Scientific (BSC) used substandard polypropylene resin smuggled in from China to make its pelvic mesh, comes all the way from Scotland.

Award winning reporter, Marion Scott writes, It was always scandalous. Was it criminal? in the April 24 pages of Scotland’s Sunday Mail.

Scott reports, “The firm, who supplied Scottish hospitals with Obtryx, Pinnacle and Advantage implants, have confirmed that all mesh products they have made in the past three years contain the Chinese resin.”

Reporter Scott says the quote in the story was directly from the company.

While BSC stands by its mesh, this is the first confirmation from BSC that it made pelvic mesh implants with Chinese-sourced resin.

Meanwhile publicly Boston Scientific clings to its many mottos – “Nothing is more important than women’s health,” and “Excellence is inherent in everything we do.”

The Mostyns

The Mostyns

 

MOSTYN FIRM- OLD EVIDENCE, FRESH EYES

By his own admission Steve Mostyn was late to the game of pelvic mesh litigation.  Focusing primarily on natural disasters and insurance companies reluctant to pay, Mostyn Law of Houston is headed by Steve and his wife Amber. Media coverage shows they’ve been successful and effective.

 

God knows what Action Required emailLate one night several days before Christmas 2015, Steve was reviewing some of the ten million pages of documents produced so far in pelvic mesh litigation.

“I came across an email titled ‘Re: Counterfeit material from a supplier you use – ACTION REQUIRED.”  [LINK] There was an email from another division engineer saying their supplier attempted to sell them counterfeit goods and said God only knows what’s in there.’ I was shocked by this email.”

He spent most of the night digging further and the story emerged.

Further inquiry showed Boston Scientific had smuggled some grade of polypropylene (PP) out of China with no paperwork, no oversight and certainly with no approval. What was in this product? God only knows was right.

Plastics recycling, Guangdong Province, China

Plastics recycling, Guangdong Province, China

 

 

CHINESE RESIN- The Latest Assault

What the Mostyn firm has uncovered has ignited a new controversy in this ongoing defective product litigation that threatens Boston Scientific and its $120 million a year pelvic mesh business.

Documents showed BSC turned to China as a supplier between June 2011 and the fall of 2012 after former supplier, Phillips Sumika refused to sell to BSC “at any price.”  Phillips knew it product was being used for implantable medical devices and wanted no part of it.  Fearful its PP resin supply would dry up, BSC bought enough Chinese resin, 34,000 pounds of unknown quality to make pelvic mesh implants into the year 2032.

The supplier, EMAI Plastics Raw Materials Inc., located in Guangzhou, Guangdong Province was a known supplier of counterfeit products. China, with little environmental and consumer products regulation, has sent toxic dog treats to the U.S. and fed melamine-tainted milk to its infants, both with fatal results.

Not surprisingly, some of the resin was discovered by the firm to contain high levels of selenium, a trace element toxic in high levels. What did this mean for women implanted with mesh made from raw resin allegedly transported loose amid the debris and droppings on the floor of a rail car?

Yimao Plastic Molding

Yimao Plastic Molding

 

Protesters, fed court Charleston WV

Protesters, fed court Charleston WV

RICO ACTION

Teresa Stevens, 46, a West Virginia native, was implanted with a Boston Scientific pelvic mesh, the Obtryx-Halo Urethral Sling System made of Marlex in October 2014, to treat incontinence. Soon afterward she began having complications – urinary tract infections, shooting pains in her abdomen and painful sex.

She grew despondent, not unlike many of the 55,000 other women who receive a BSC pelvic mesh every year.

But Teresa Stevens v. Boston Scientific Case no. 2:16-cv-00265, stands out from the 91,000 other defective product cases filed in multidistrict litigation in West Virginia.

In January, the Mostyn firm, along with the Bell Law firm of Charleston, WV, filed a federal racketeering class action lawsuit against Boston Scientific – the first RICO lawsuit filed in transvaginal mesh litigation. RICO alleges fraud and the Racketeering Influenced and Corruption Organization statute (RICO), has long been used to target organized crime such as the Hell’s Angels, the Gambino family and even pedophile priests.

Leading a class action of injured women, Stevens, alleges for the class that BSC engaged in a pattern of unlawful activities including fraud, intentional misrepresentation, and negligent misrepresentation, violations of WV trade or consumer practices, and unjust enrichment.  It seeks unspecified damages on behalf of the women who would have received a BSC pelvic mesh made since September 2012, the date after which Boston Scientific allegedly defrauded the women by using the fraudulently obtained polypropylene resin to make its mesh.

RICO lawsuits can level both civil sanctions and criminal penalties and jail time, not to mention threefold the damages if successful.bs logo


CITIZEN’S PETITION

Knowing the FDA has the ability to issue a recall, the Mostyn firm did what no other has – file the first Citizen’s Petition to seek an immediate Class I recall of the BSC products and to quarantine the Chinese resin so no future products would be made from it.

The U.S. Food and Drug Administration has the power to revoke or amend its Federal Food, Drug and Cosmetic Act which oversees the fast-tracking of pelvic mesh to market.

On March 30, 2016, the petition was filed on behalf of Ms. Stevens containing a 35-page narrative of Boston Scientific’s alleged misconduct in sourcing PP resin in China and asks the agency to seek out the source of the raw material. Judge Joseph Goodwin overseeing 21,000 cases against BSC, was asked to move to restrain BSC from marketing or selling the mesh.

But instead of taking action, Judge Goodwin deferred the case to the FDA under primary jurisdiction doctrine. Ultimately, he decided, the FDA was best equipped to determine the safety and efficacy of the Boston Scientific mesh implants.

Saying it wasn’t aware of any safety issues, the FDA made a lackluster announcement on April 1, agreeing to let Boston Scientific investigate the safety and effectiveness of the its own products,

while acknowledging BSC urogynecologic surgical mesh “may” contain counterfeit raw material.

Steve Mostyn on 60 Minutes

Steve Mostyn on 60 Minutes

Sort of like asking drug dealer to determine if the cocaine he was caught selling was really cocaine,” says Mostyn.  “I believe we will find there is no consistency in the product at all. With that province, a garbage dump for all sorts of industrial plastics, the FDA is not acting on behalf of the public and is abrogating its duty to public health and safety by giving Boston Scientific a pass.”                                                                                                                           ~ Steve Mostyn

In an April letter to FDA commissioner Dr Robert Califf and Health and Human Services Secretary Sylvia Mathews Burwell, Amber Mostyn urged the FDA to step up its investigation into criminal conduct and not allow Boston Scientific to simply compare new mesh implants to old ones.

Does the FDA believe equivalence is a defense to trafficking of counterfeit raw material in violation of 18 U.S.C. § 2320 (Trademark Counterfeiting Act)?” she asked.  

 

GRAND JURY INVESTIGATION

Advantage Fix mesh, BSC

Advantage Fix mesh, BSC

Largely due to the new revelations uncovered by the Mostyn firm, federal prosecutors have now impaneled a grand jury to launch a criminal investigation into charges of fraudulent activity by Boston Scientific Corp.

Criminal penalties for smuggling counterfeit material and endangering public health can range from 20 years in prison for serious bodily harm, to life in prison for death and a $15 million fine for a company.

The grand jury in Charleston, W.Va., has sent out multiple subpoenas in recent months, one of which was obtained by the Boston Globe (here).

The investigation will determine whether Boston Scientific engaged in deceptive trade practices by receiving the substandard materials which it fraudulently sold to health care providers and ultimately implanted in unsuspecting women like Teresa Stevens.

Boston Scientific, responding to an inquiry by the Globe, denied it uses counterfeit or adulterated materials in its medical devices.

“Boston Scientific has a robust quality system and dedication to patient safety. We stand behind out products, the materials used in those products and our commitment to women’s health,” said a spokesperson. BSC has not responded to an inquiry by Mesh News Desk.

 

GREEN LIGHT TO MORE DISCOVERY

In the latest turn, on May 5th, in the court overseeing transvaginal mesh medical products cases in California, Judge William F. Highberger denied Boston Science’s motion to bring a halt to future discovery into the Chinese resin issue.

Additional depositions and discovery will be conducted of Boston Scientific’s current and former employees, people in the know.

In making the ruling Judge Highberger ruled, “If the product is equivalent chemically but counterfeit in terms of its actual producer source, that raises legitimate questions as to why a manufacturer of products intended for human implantation would resort to such ruses to obtain needed raw material.  Plaintiffs so far “have made a sufficient showing that it has a reasonable potential for relevance, at least as to the issue of punitive damages.”

Steve Mostyn says in many ways the story of the entire mesh mishap is just beginning to be told. They’ve identified 10 prior manufacturers from 2003 to 2010 who refused to sell PP for use in implants. Why did those manufacturers shy away from the transvaginal mesh business? Mostyn’s instincts are still kicking in.

Steve Mostyn, Mostyn Law

Steve Mostyn, Mostyn Law

“The reality is you must have this fundamental information before you can evaluate the cases we have found many things that do not relate to China but are highly relevant and we are now on a systematic review of all ten million pages and have requested additional documentation to fill in the holes.”

I believe we will find chemists within the company said you can’t put this stuff in the body,” he says.

The implications for all manufacturers in the mesh mess are huge.

“It was a straight up experiment.” Mostyn says. “That’s the core of it. I think synthetic polypropylene meshes for vaginal use should be off the market. Period.”

On Monday, April 16 Figueroa v. Boston Scientific will begin in a Dallas court before Judge Ken Molberg. Ms Figueroa was implanted with a Boston Scientific Solyx SIS mesh for incontinence in June 4, 2011, the same month the company allegedly began sourcing its pelvic mesh resin from China.

**UPDATE**  As of Friday, May 13, 2016, the Figueroa v. Boston Scientific trial has been rescheduled (again) to September 12, 2016. #

37 Comments

  1. Don't give up says:

    I hope they nail them and who ever is responsible gets jail time and lots of it,sure makes you think why was so many documents destroyed by another big pharmaceutical company the truth is coming out there is always a paper trail somewhere,and there is always someone who will talk if implicated to save there own ass.
    They had a chance to do what was right but now they are going to pay for it,like I said I hope everybody involved with any pharmaceutical company if found guilty of the same thing if it goes that far goes to jail for a long long time.

    • Susan says:

      I’m with you! I hope they not only get serious jail time but that BSC gets completely shut down all together. They have ruined me and so many others and stolen our lives.

  2. Janis Urban says:

    Talk about Dragging Feet??? It’s Criminal! It’s Bigger than what we all thought! You can’t make any of this up in this Mesh Debacle!!! Even if I was not injured by mesh and had access to the limited amount of information available about the Mesh and the Twists & Turns Injustices Denials etc. I would be intrigued &digging into it. Unbelievable…What a Story! Thanks Jane, Marion Scott & The Mostyn’s.

  3. Bonnie says:

    So what does this mean for women like myself, who have been implanted with this Boston Scientific mesh? It has ruined my livelihood already, and I am only 26. I will never be able to afford getting this mesh explanted, let alone further surguries to repair the disaster that is left in my groin. The government will take a fat paycheck and Boston Scientific will go along without criminal charges and/or jail time?! While we women are left to die from this mesh nightmare??? Is this the American dream? When are our elected officials and judicial system going to stand up and protects us and the future generations of Mothers, sisters, and daughters? Would things be going differently if this massacre had be waged on the men of our country???

    • Jane Akre says:

      Do you have an attorney? I certainly hope so IF you have complications. Congress are you listening to the people not the industries who give you money? Let me know janeakre@meshnewsdesk.com and there might be some docs that are convenient to you.

    • jan says:

      Irs all sad, but this is our justice system. . It’s like your taxes they take before anything. . They do not care as long as they get theres..
      We eill never see a thing with any of these manufacturers
      I have been in this fight since 09 still nothing ..

  4. Teresa says:

    What an excellent attorney. Finally, the criminality of the manufacturers are being addressed. So many lives destroyed.

  5. Cheryl says:

    Why is it deemed unsafe for vaginal use but ok for use in other parts of the body such as the abdomen? If it has the same chemical makeup it would have the same traumatic results.

    • Jane Akre says:

      I believe some day we will determine that the chemical composition of polypropylene for use as mesh along with its mechanical properties will deem it unsuitable for the human body except in rare cases where everything else fails… Even now there is work trying to incorporate stem cell technology to make the mesh more compatible with the body Meanwhile medical schools would be wise,in my opinion, to go back to teaching suture skills and making it mandatory not optional for the newest doctors so they are not so reliant on the newest technologies backed by industry. Every day I am hearing from hernia folks asking for a lawyer…. every day! Please folks, if you are considering a hernia repair with polypropylene mesh ( ask, look at the label) consider a suture only repair if you are a candidate. No one knows which of you will have life altering complication… no doctor can tell you that! in my opinion.

  6. Nameless says:

    Human subjects. Dr. Mengele. Does the name sound familiar. Did experimentation on women and others in concentration camps during WWII. The world was outraged at this breach in humane treatment of ppl. Drs’s Mengele seem to have slipped back into our midst. These are extremely strong accusations by Mostyn et. al. How many of us are terribly sick as a result of not only over sold polyprolene but after uncovering this information – if found valid at what point do physians become complicitious?

  7. jan says:

    I will be having the rest if my mesh removed very soon
    I am asking my physician to please send some if this mesh to lab and test for any if this..I had this
    Orybtrx and 1 other by Boston scientific. .
    I just can not understand why anyone company would want to destroy womens lifes like this and the sad part is they new what they were doing
    Thy really need to start settling our nightmares so we can take care if what they did to us
    They need to be serving time

    • Jane Akre says:

      The mesh from Chinese resin purportedly would have been made after June 2011, certainly after the summer of 2012… just FYI…

  8. Nameless says:

    Everything about this story is so ify? My polyprolene sacrocolpopexy was done 9/23/12. The articles state that the rogue mesh would have entered the consumer market in Septrmber 2012. This is not a small unimportant piece of information. Certainly, I would think, most facilities had some stock on hand, Or not. So, should I be even more concerned than I was before. This is really cruel. The steps of informational revelation regarding this mesh become more gruesome as it develops. Shouldn’t there be a data base being put in place to facilitate the care, treatment and follow up of those who may have been implanted with a potentially dangerous substance? The polyprolene is questionable if not down right injurious. Add in an unregulated raw substance covertly purchased from within a country known in the past to have poisonous substance in manufactured goods. Do you remember melamine in milk reportedly the Chinese gave to their own citizens. This is the point at which our government should step in to provide protective oversight. I know this is a lot to expect given our representatives response to first responder health issues at ground zero. There too, ppl were exposed to carcinogenous substance and it seems those in leadership did not step up to recognize the danger, provide medical assistance, or family services. People in that instance, were allowed to suffer and die excruciatingly painful deaths. While similarly denying that s problem existed. Those suffering were isolated and their treatment, if any, was for the most part kept out of the public domain. Every once in awhile a small article would appear that made slight reference to the dead persons exposure to carcinogens and rare obscure deadly medical issues. The families were rarely if ever compensated for the true monetary cost of care. Needless to say, emotional needs were not even in view. I can remember the governor of New Jersey stating that the sir was safe to breathe and ppl should not be afraid to enter the area in order to work. How then can we expect a medical or judicial group to recognize us? Perhaps sanctioning the medical profession, that encouraged placement of this garbage, and to take responsibility for their actions. Provide medical assistance to those of us that have embedded in our bodies potentially life threatening but highly remunerative unregulated, illegally imported, toxic plastic garbage. We need a data base that has the ability to ferret out those individuals that may have received the Chinese mesh. Throwing out a random date that may or may not be the time frame for any given recipient to have had this material implanted is not enough. My implantation was done the alleged month that the material hit the market place. That does nothing to reveal whether I have rogue contaminated polyprolene sewn into my bowels or not. The powers that be, have shown themselves for what they truly are, by allowing the company that is allegedly guilty to oversee their own judgement. Just as in the post 9/11 failure to protect and assist they are repeating their past lassitude and down right criminal negligence. The fact that we are all running around helter skelter bankrupting and using up any savings, borrowing, in debt without any sound help from our representatives is unacceptable. Is it me? Is it me? Do I have it? Where will I get the money? Who will take care of me if I have yet another major surgery? Will I die during the surgery? How can anyone in the medical profession continue to hold high their esteem? Let alone lie like a rug – over and over. Are we going to be left uncared for? I don’t have a lot of political savy. The landscape is not looking very optimistic at the moment. At this time, Mostyn and company stand between a major life long catastrophe for us and/or our families. No matter how big that firm is they are s ship in a very big ocean. The evidence they present rests on their ability to see it through and influence the outcome of many of our lives. I am looking at a potential permanent colostomy as a result of these implantations. I don’t know them nor them me. Yet, that firm, at this time, is the only venue through which the truth may surface. There are many forces that would like to see their efforts stopped. Once again, I will say, how will we know if it’s us/you/me that has this poison emplaned. Who will help us find out – before it’s not too late!

    • Jane Akre says:

      Your complaint should be firmly delivered to Boston Scientific who continues to deny the problem except to Scottish media. How can there be a database when the first step is acknowledgement of a potential problem? Not all of the discovery has even been completed because BSC is fighting this. It’s hard to believe a company that has any compassion at all would treat its patients this way. You didn’t say if you have complications?

      • Nameless says:

        Yes. Many complications. Many of which you have heard numerous times. I’m going to loose the use of my rectum as a main issue. Significant pain. I don’t wish to reveal all my personal damage. I will tell you without a data bank of some sort to track those who may have had BSCs present implanted someone like myself would not have been notified. I would not have had any validation regarding my stmoptoms. All three top surgeons that I have had shrug and look stupid. BSC doesn’t have to be found guilty to instigate an investigation into who may have been implanted. If they were selling spinach with salmonella the FDA would bend over itself to identify who infected the spinach and where had it been distributed. That’s part of what they are supposed to do. Every woman implanted with this crap has left a paper trail. Unfortunately, for some of them they are going to die and not no why. Don’t make excuses for why this couldn’t be done. If you believe the story that should be enough to go on to reach out and find the victims. This isn’t about money any more. We have all been potentially poisoned.

  9. Nameless says:

    My complaint. I should do what. If I make it to the grocery store and out of bed I’ve had a full day. I’m afraid you’re asking the wrong one to shoulder this baby. I’m probably going to be dead soon.

    • Kitty says:

      Nameless I hope u save any mesh if u have explant. My heart goes out to u

      • Nameless says:

        Thank you. I was just thinking last night that we should all make sure that the explant should be saved for analysis. After its out its called evidence.

        • Still Standing says:

          Nameless, Im so sorry you are in such bad shape. As far as preserving the explant…there was a court order under my mdl that tissue HAD to be preserved. They even specified exactly how that should be done and who stored the specimen, and where it would be stored. Also there was request for pictures of the specimen as soon as it was explanted. In the OR. So, once again, this is something your attorneys should do. All I had to do was tell them when, where, and what doctor was doing the surgery, they took care of notifying the doctor and hospital with their specific requirements. They coordinated the entire process. Heavens, wish things were being done across the board for every single mesh patient. Thought that was the purpose of having an MDL.

          • Nameless says:

            Just as in most things in life there is nothing across the board here. I have some kind of representation here but nothing like that which you describe. I am sure if a settlement were to happen I am hardly on the page. I think I need to call those lawyers up catch them up on this meshed up body. Thanks for the info.

        • Sherri says:

          Thank you Steve and Amber Mostlyn my attorney, and Jane.

  10. Louise says:

    So, because I had my Mesh Surgery in 2008, does it mean that I won’t get compensation? Ever since I had this surgery my incontinence was worst a week after and I developed Stool incontinence.Then I developed Severe Psoriasis and I had IV and had to be in a wheelchair, and nurses came home for dressings and IV…Another time I developed another infection and nurses came again…I had Groin problem so I had a Hip Replacement Surgery in 2015…An infection and abcess occured & I had to be reoperated and had IV at home for 2 months
    .Almost a year, I developed another infection and abcess.Nurses come home for dressings and still are…Just had a lot of tests for the last 2 weeks, now and I’m waiting for results, soon

    • Jane Akre says:

      Do you have a lawsuit filed on the basis of product liability also known as defective product? Thatw ould be filed by your law firm in the MDL in Charleston, WV or in your state court. This is a separate action, not product liability, to therefore should have no bearing at all on your lawsuit. This class action lawsuit alleges fraud and racketeering, different actions.

  11. Still Standing says:

    Louise, i also had my surgery in 2008. Here is the troubling thing about how long it has been since your surgery. Every state has different statute of limitations on filing for permant implant defective product.. Some are 2 years,msome 5 or maybe more. That means in order to file a defective product lawsuit ,you have to have filed within that time limit. However, the court has allowed not the time of implant, but the time that you realized that the mesh was causing your problems as the start date. Have you contact a product liability attorney and have they advised you about this requirement? No,this does not apply to the class action stated in the article above, you really dont have to file for a class action,, but compensation tends to be very minimal in class action suits. You should contact an attorney regarding an individual case.

  12. Vickie says:

    Jane. Was there a trial against Boston scientific that started last week? If so is there an update?

    • Jane Akre says:

      Hi Vickie- You are very smart… the case was Figueroa v. Boston Scientific. It was set to begin May 16th in Dallas. It has been moved to September 12th. Dallas, Judge Molberg. It will be a good one I believe. It should be ago this time. That following the Edwards case in Charleston August 12 with jury selection. There will be a rally there then. I put the update in the Boston Sci story on Chinese mesh…but it is worth a separate story, thanks.

  13. jan says:

    This is really getting very old. . Boston scientific knew but yet they keep lying about it. They also stated they want to settle cases, well when 3020 .. there are no cases for Boston scientific in west Virginia for this year.. are the playing more games to keep it held as far as they want..
    This manufacturer should settle and let us move on
    Them and Johnson & Johnson brag in the media how much it has been costing to fight
    So they spend Billions to fight lose cases still losing Billions
    So why not take the billions and do what’s right for all us women and just move on with life..
    I am so glad I am not a stock holder in that company. . I would be hanging my head very low at what and how they handled all this

    • Still Standing says:

      Jan, if your case is filed in West Virginia, go to the Boston Scientific MDL page. You can see that BS has reached a settlement agreement with plaintiffs from three law firms, one in December 2015 and two this year. So, even while waiting for the srart of the trials, some firms have been able to negotiate a settlement. What you cant find, however, is how much each firm negotiated.

      • Jane Akre says:

        And what we’ve found from the AMS settlements is that the negotiated settlement amounts will differ among law firms as well. So one settlement’s number do not fit all!

  14. Deborah J says:

    Thank you, Mr. and Mrs. Mostyn…I was implanted with BSC Advantage in November 2014, after another mfg mesh on 2009; have had 2 surgeries in the last 3 weeksd…I am in pain and overwhelmed by what BSC has subjected me and thousands of women (and men) to -definitely a criminal act! Once again, thank you!

  15. Sea says:

    Is anyone having problems with either leg? Had BS implant removed but doctor left some mesh/arm in left leg. Now I can barely walk? Thanks everyone ..

    • Jan says:

      Yes I fall alot it’s like my legs give out I have like a pulling sharp pain in my groin area through my vaginal area
      I have fallen out the garage door 4 steoa down on concrete when
      it had happened .. and also fallen in the yard and in public
      It’s sad never had these issues before the mesh
      And I also have 2 of Boston scientific meshes they were place in vaginal
      Our lifes have changed forever

    • Still Standing says:

      Sea, it is possible that your mesh arm has migrated into your thigh. That happened to me several years after having the mesh arms cut to relieve extreme pain. It is not a fun surgery because these arms just cant be located and pulled out like a string. My surgeon described it as fileting it out like fileting a fish. It did, however improve my leg pain. You may ask your doctor if this is a possibility. Your physician may say it is not possible, but rest assured it is.

  16. D.S. B says:

    Had my Pinnacle mesh in 2009. It was horrendous from the moment I woke up in recovery!! My pain was way beyond “10” on the scale. Pain Meds IV barely touched it. The Dr. was unsympathetic stating “if we didn’t do a good job it wouldn’t hurt” as I watched him walk out of my room! He continued to be nonchalant about my complaints. My pelvic area,buttocks, lower abdomen, and legs were in so much pain. My right leg is worse than my right. I too have become clumsy with 3 falls. I had a partial mesh removal in 2012. It brought minor relief. Had a horrible infection 4days post op-102 degree fever
    for 2 1/2 days, then another long car ride to the specialist. I could no longer do my job. I’m am disabled. In 2 weeks I’m having all of the remaining mesh removed. I hope it relieves some of the constant burning pain….. I wonder what poison my mesh is made of?

  17. Adrianne C says:

    Thank God I found out why I’m having all this pain my doctors couldn’t figure why now I’m about to have this mesh removed

    • Jane Akre says:

      Please be careful, you want to have as few surgeries as possible and most docs can’t do full removals. If you can do a few consults with expert docs you’ll have a better assessment of your situation.

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