Preview Newsletter
Ethicon Media Monitoring 2/4/2019
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As Pelvic Mesh Settlements Near $8 Billion, Women Question Lawyers’ Fees
Feb 1, 2019 | The New York Times
By Matthew Goldstein
When Sherise Grant filed a claim against the manufacturer of her pelvic mesh implant, she hoped to use the money from a settlement to pay for its removal. -
Donald Trump, Cory Booker, Super Bowl: Your Friday Evening Briefing
Feb 1, 2019 | The New York Times
By Remy Tumin and Elijah Walker
...Seven manufacturers of pelvic mesh are paying $8 billion to resolve more than 100,000 claims from women. But lawyers have found ways to take big chunks of their payouts. -
Class fights to use settlement evidence in Ethicon pelvic mesh case
Feb 1, 2019 | Lawyerly
By Miklos Bolza
A class action against Ethicon over allegedly faulty pelvic mesh implants wants introduce confidential evidence from prior settlement negotiations as it attempts to shut down... -
J&J Unit to Appeal $41M Pelvic Mesh Verdict
Feb 1, 2019 | Bloomberg Law
By Julie Steinberg
J&J unit Ethicon Inc. plans to appeal a Philadelphia jury’s $41 million award to a woman harmed by an Ethicon pelvic mesh product. -
Pelvic mesh MDL judge grants $366 mln fee award to main plaintiffs' lawyers
Feb 1, 2019 | Reuters
By Tina Bellon
The federal judge overseeing several multidistrict litigations against manufacturers of allegedly defective mesh implants on Wednesday granted a request by the lead plaintiffs’ lawyers for $366 million in legal fees out of a total $7.25 billion settlement. -
Vaginal Mesh Lawsuit Ends in $41 Million Jury Verdict in Pennsylvania
Feb 1, 2019 | The Daily Hornet
The lawsuit was filed by Suzanne Emmett, a woman who suffered through multiple unsuccessful surgeries in an attempt to fix problems with her mesh implant eroding into her vagina. -
Philly jury hands out $41 million to woman in pelvic mesh case; Verdict to be appealed
Feb 1, 2019 | The Pennsylvania Record
By Nicholas Malfitano
After a trial lasting five weeks, a Philadelphia jury awarded a $41 million verdict to a Lancaster woman who says she suffered permanent, scarring injuries to her genitalia after the installation of a pelvic mesh implant manufactured by Johnson & Johnson subsidiary Ethicon, Inc. -
Pelvic mesh ruined my life and cost me my job - now the law needs to change
Feb 2, 2019 | Cambridgeshire Live
By Anna Savva
A campaigning mum who had her life ruined following a routine operation is calling for a change in the law to prevent others from suffering the same fate. -
Way More Women Are Peeing Their Pants Than You Think
Feb 1, 2019 | InStyle
By Elizabeth Kiefer
...Treatment for urinary incontinence varies depending on the patient, from noninvasive interventions to oral medication to pelvic-floor therapy with a physical therapist to surgery (which includes the controversial transvaginal mesh you may have heard about). -
How to Deal With Bladder Leaks
Feb 2, 2019 | Consumer Reports
By Hallie Levine
It’s embarrassing and uncomfortable to leak urine when you sneeze, or to race to a bathroom only to experience an unexpected gush as soon as you unbutton your pants.
Client Attorney Privileged/Attorney Work Product/At Request of Counsel
Online Sources
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As Pelvic Mesh Settlements Near $8 Billion, Women Question Lawyers’ Fees
Feb 1, 2019 | The New York Times
By Matthew Goldstein
When Sherise Grant filed a claim against the manufacturer of her pelvic mesh implant, she hoped to use the money from a settlement to pay for its removal.
Ms. Grant, 51, was among the millions of women around the globe whose urinary problems were treated with pelvic mesh. But not only has the surgically implanted device done little to help her, it frequently causes Ms. Grant discomfort, including pain during sex with her husband.
But the settlement wasn’t enough. After lawyers’ fees and other expenses, the $12,000 payout was whittled away to only $3,500.
Ms. Grant said she had called her lawyer’s office to discuss those fees, and gotten nowhere. “They won’t let me talk to the attorney,” said Ms. Grant, of Hemet, Calif. “I just want everything to be fair. I think they took way more than they should have.”
Litigation over pelvic mesh, also called transvaginal mesh, ranks as one of the biggest mass tort cases in United States history, in terms of claims filed, number of corporate defendants and settlement dollars. Seven medical device manufacturers, including Boston Scientific and Johnson & Johnson, are paying nearly $8 billion to resolve the claims of more than 100,000 women.
A decade ago, doctors were quick to implant synthetic mesh to deal with health issues caused by a woman’s bladder pressing against her vagina. But then women began complaining of complications like bleeding and searing pain. Lawyers aggressively advertised for women who had received mesh implants, and they signed up women by the thousands to file claims against the device manufacturers.
The result is a supersized federal court litigation that hasn’t paid off as expected — the average settlement is less than $60,000, according to documents reviewed by The New York Times and interviews with more than a dozen women. That is less than settlements reached in other mass torts, even though the jury verdicts some women have won in pelvic mesh cases suggest the figure should be higher.
And those settlements are worth a lot less after the lawyers take their shares and other fees — cuts that became unusually hefty even for the world of mass tort litigation.
Retainer agreements and confidential documents permit some lawyers to take 40 percent of each settlement, and in some cases 45 percent. And generous expense provisions allow some firms to add costs not only for meals and hotel stays but travel by private plane. Some lawyers have found yet another way to pad their bottom lines: Hire companies they have a financial interest in to review a client’s medical records, a crucial part of assessing the potential value of a claim.
Now some women are considering suing their lawyers over how their cases were handled. Lawyers have begun scouting for women willing to sue, and a Dallas firm has set up a website seeking women who feel their lawyers didn’t drive a hard enough bargain.
“Eight billion dollars sounds like a lot in theory, but once you start divvying it up, it’s less so,” said Elizabeth Burch, a professor at the University of Georgia School of Law who specializes in studying mass tort litigation and is surveying women for their views on the litigation to be used in a study.
Lawyers in the mesh litigation defended their work. They said women with more severe injuries, which required the mesh to be removed in sometimes risky procedures, received the most money.
“We did everything possible to get as many cases to trial as possible,” said Clayton Clark, a partner with Clark Love & Hutson, which settled thousands of complaints and was involved in a half-dozen jury trials. “You see these giant verdicts in a number of places, and that sort of skews the thought process.”
Mr. Clark, whose firm used a retainer agreement that gives it the right to “lease private aircrafts” and employ a medical records review firm it had an ownership stake in, said the expenses charged to clients were fair. He said the fees were fully disclosed and generally reviewed by a special master working for the court.
The medical records review firm was not profitable and has since closed, Mr. Clark added. “There was no potential for double-dipping,” he said.
Pelvic mesh litigation began in earnest in 2011, the year the Food and Drug Administration issued a warning about complications with some products. Studies have shown at least 15 percent of women who had mesh implants encountered problems, and more are expected to develop them in coming years. The F.D.A. is continuing to evaluate the situation and is scheduled to hold a hearing on Feb. 12 on the “risks and benefits” of pelvic mesh. Though the device has not been banned, some manufacturers have removed versions of it from the market.
Settlement details are often kept confidential by gag orders, but some women have spoken out about the offers they received.
Michelle Hedgcoth, 43, who received her settlement in 2014, said she was fortunate that her $140,000 payout was at the higher end of the scale. But she said the implant and the surgery to remove it left her with permanent injuries and a compromised immune system because parts of the mesh are “embedded” in her body.
Ms. Hedgcoth, who lives in Manteca, Calif., with her husband and two teenage children, said that after fees and expenses, she had received about $50,000.
“The money we are being offered is not enough for the rest of our lives,” said Ms. Hedgcoth, who had to leave her job at a bill collecting company because of her injuries. She is now on disability.
Mass tort litigations can be difficult to compare. The complications experienced by patients can vary, and so can their outcomes at trial. But the mesh settlements are notable because of their size relative to the awards granted by juries, lawyers and experts said.
To date, 32 women have gone to trial in state or federal court, and 24 have obtained verdicts against mesh manufacturers totaling $345 million, for an average award of $14 million, according to court filings.
Ms. Burch said a 40 percent fee — at the high end of personal injury fees — might be justified for those cases, which went to trial and yielded multimillion-dollar verdicts. But for simply settling cases, that rate is on the high side, she said.
The settlement a decade ago over complications associated with the pain medication Vioxx is a good measuring stick, Ms. Burch said. Merck, the drug’s manufacturer, created a nearly $5 billion fund, which gave an average award of $147,000 to more than 30,000 litigants. The judge in that case capped the legal fees at 32 percent.
And higher fees are coming out of smaller settlements: Compared with other medical device settlements, the $60,000 average for mesh cases is on the low end. In 2015, Biomet paid an average of about $79,000 to settle just under 2,000 claims from people who had faulty hip implants, according to court filings. Six years ago, Johnson & Johnson settled claims arising from its flawed hip implant product for $2.5 billion — or roughly $250,000 a person.
In one pelvic mesh agreement between Boston Scientific and 3,400 women, the average payout before fees was $53,000, documents show. Just 800 had offers of $100,000 or more, while roughly half received offers of $13,000 or less. And in a $244.7 million settlement negotiated last year between Johnson & Johnson and 4,000 women, the average offer was $59,000, according to court documents.
Henry Garrard, a lawyer with Blasingame, Burch, Garrard & Ashley, an Athens, Ga., law firm that handled both trials and settlements and another firm that sometimes uses a private plane, said focusing on average settlements was “misleading” and ignored all the work the lawyers had done. Women who did not have the mesh removed got smaller offers because their injuries were less severe, he said.
Settlements in mesh cases have tended to be negotiated for a few thousand women at a time, as opposed to one big global deal. Most of the bulk settlements have played out in federal court under the supervision of a judge in West Virginia.
One lawyer who both took cases to trial and handled settlements said he believed many lawyers who settled cases in federal court took on too many clients to properly investigate their claims and push for adequate settlements.
“Never in the field of mass tort litigation has there been such a yawning gap between success in the courtroom and failure at the settlement table,” said Shanin Specter, whose Philadelphia firm, Kline & Specter, has won more than $140 million in jury verdicts in mesh cases.
On Thursday, Mr. Specter’s firm scored one of its biggest courtroom victories yet — a $41 million verdict against Johnson & Johnson.
Mr. Specter said he had settled about 1,500 cases at an average of $75,000, and estimated the average settlement reached in the federal court cases was closer to $40,000.
Given what he called the “puny” size of those settlements, Mr. Specter argued in court filings that lawyers should take less in so-called common benefit fees — up to 5 percent of the $8 billion that will be shared among the firms that did the most work on the federal litigation. But Judge Joseph Goodwin of Federal District Court in Charleston, W.Va., rejected that argument on Wednesday and approved the 5 percent fee request.
That pool of money — roughly $366 million — was taken out of the settlements before final checks are cut to clients, and will be split among nearly 100 firms in addition to the fees the clients paid directly.
Some law firms getting a big piece of the common benefit fund have said they will reduce the average fee they are charging individual clients to 36 percent. But that rate is still higher than the cap in the Vioxx case.
Ms. Burch, the professor surveying women involved in the cases, said some had told her that they felt pressured to accept a settlement and were not aware they could pursue their own lawsuits instead.
Barbara Shepard, 53, is considering doing just that.
She rejected a $100,000 offer because, she said, she would have been left with almost nothing after deducting lawyers’ fees and repaying the high-interest loan she took out to cover a mesh removal operation.
Ms. Shepard, who lives in Bradenton, Fla., and drives a school bus, said that her loan carried an interest rate of about 50 percent, and that she would owe $69,000 to the finance firm. She is considering suing the device manufacturer and replacing her lawyers.
“The mesh didn’t do anything,” said Ms. Shepard, who had mesh implanted to treat frequent urination. “Getting the mesh out has made it worse.”
https://www.nytimes.com/2019/02/01/business/pelvic-mesh-settlements-lawyers.html
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Donald Trump, Cory Booker, Super Bowl: Your Friday Evening Briefing
Feb 1, 2019 | The New York Times
By Remy Tumin and Elijah Walker
1. The Midwest is about to experience weather whiplash as parts of the region could see temperatures rise by 70 degrees within a few days.
The bitter cold lifted in the region after days of dangerously low temperatures left at least 29 dead and cities at a standstill. Detroit, above, hovered near zero degrees. But the thaw is setting in. The Chicago area may see a jarring 73-degree jump, from minus 21 on Thursday to possibly 52 on Monday.
The temperature swing will bring some relief and give cities and towns a chance to assess the damage. But it also brings a new set of worries: potholes, clogs, flooding and ice jams.
2. President Trump wanted to talk.
He initially invited A. G. Sulzberger, the publisher of The Times, to an off-the record dinner. Mr. Sulzberger declined, and instead requested an on-the-record interview including Times reporters.
What followed was an 85-minute interview on a range of topics, in which the president said he was moving forward with a wall along the southwestern border, brushed off investigations that have ensnared his administration, and sized up the 2020 competition. Here’s what our reporters learned from the exchange.
During the interview in the Oval Office, above, Mr. Sulzberger questioned Mr. Trump about his attacks on the press. The president called himself “a victim” of unfair coverage.
3. The U.S. suspended one of the last Cold War nuclear arms control treaties with Russia, setting the stage for a possible new arms race.
Secretary of State Mike Pompeo announced the suspension of the Intermediate-Range Nuclear Forces Treaty, after years of insistence that Moscow violated the Reagan-era agreement, declaring that “countries must be held accountable when they break the rules.”
But the Trump administration’s real aim is China: Constrained by the treaty’s provisions, the United States has been prevented from deploying new weapons to counter China’s efforts in the Western Pacific.
4. Representatives Rashida Tlaib of Michigan, above,and Ilhan Omar of Minnesota, the House’s first two Muslim women, have been celebrated as symbols of diversity. But on Israel, they have exposed a divide within the Democratic Party.
The debate pits the stalwart supporters of Israel against a wing of young liberals like Ms. Tlaiband Ms. Omar — including many young Jews — who are willing to accuse Israel of human rights abuses and demand movement toward a Palestinian state.
The tussle will take center stage next week as the Senate takes up a bill aimed to curb the Boycott, Divestment, Sanctions, or B.D.S., movement, which is intended to pressure Israel into ending the occupation of the West Bank. The bill is also intended to stifle voices like Ms. Tlaib and Ms. Omar that back it. It is expected to pass easily.
5. Today in 2020 news: Senator Cory Booker of New Jersey is the latest Democrat to jump into a presidential race that could include one of the most diverse primary fields in history.
Mr. Booker, the former mayor of Newark, is hoping to run on his signature upbeat message. In an early-morning email to supporters, the senator laid out his vision for a country that will “channel our common pain back into our common purpose.”
In other 2020 developments, Senator Elizabeth Warren apologized for her decision to take a DNA test to prove her Native American ancestry. The apology came as Ms. Warren is set to formally kick off her presidential run this month.
6. The U.S. economy added 304,000 jobs in January as employers appeared to shrug off the government shutdown.
January’s growth means that American employers have added jobs for 100 consecutive months, a record run. Unemployment ticked up to 4 percent, possibly a shutdown-related anomaly. Above, a T.S.A. agent working through the shutdown in January.
“This jobs report is showing no evidence of an economy slowing, certainly not falling into recession,” one economist said.
One industry did not fare as well: digital media. More than 1,000 employees were laid off at BuzzFeed, Vice, AOL, Yahoo and HuffPost in recent days. We take a look at what went wrong.
Separately, Foxconn said it was moving forward with a Wisconsin plantafter talking to President Trump. It previously sent mixed signals.
7. Seven manufacturers of pelvic mesh are paying $8 billion to resolve more than 100,000 claims from women. But lawyers have found ways to take big chunks of their payouts.
A decade ago, doctors were quick to implant synthetic mesh to deal with urinary issues. But when women began complaining of complications, lawyers signed up patients by the thousands to file claims against the manufacturers. It turned into one of the biggest federal court litigations in United States history.
But the average settlement is less than $60,000, which dwindles after retainer agreements allow lawyers to recoup 45 percent of the settlements they negotiated, plus reimbursement for expenses including private jet travel.
8. Much of this weekend’s sports news will be dominated by talk of the Los Angeles Rams’ young coach, Sean McVay, and New England’s favorite adopted son, Tom Brady, above.
But before we get to Sunday’s Super Bowl LIII, the lead-up to this year’s contest has no shortage of drama. We take an illustrative look at how we got here.
Whatever jersey you’re wearing, you’re going to need food. Or if you’re just here for the snacks, we’ve got you covered, too, with our best Super Bowl recipes.
9. Scott Joplin, a pianist and ragtime master. Zelda Wynn Valdes, a fashion designer who outfitted the stars of screen and stage. Gladys Bentley, a gender-bending blues performer.
These remarkable black men and women never received obituaries in The New York Times — until now. We’re adding their stories, along with 10 others, to our project about prominent people whose deaths were not reported by the newspaper.
10. Finally, we end the day with Day-Glo flying squirrels.
One spring night, a biologist saw a hot-pink squirrel fly by while he was outside with his ultraviolet flashlight. He wasn’t seeing things: A new study found that three species of flying squirrel turn hot-pink under ultraviolet illumination.
Scientists are still studying why the squirrels turn this vivid color. It could be ecologically significant to the species, one researcher said, or “it could just be a cool color that they happen to produce.”
Have a vibrant weekend.
https://www.nytimes.com/2019/02/01/briefing/donald-trump-cory-booker-super-bowl.html
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Class fights to use settlement evidence in Ethicon pelvic mesh case
Feb 1, 2019 | Lawyerly
By Miklos Bolza
A class action against Ethicon over allegedly faulty pelvic mesh implants wants introduce confidential evidence from prior settlement negotiations as it attempts to shut down...
Access to full text unavailable – subscription required.
Story can be found here: https://www.lawyerly.com.au/class-fights-to-use-settlement-evidence-in-ethicon-pelvic-mesh-case/
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J&J Unit to Appeal $41M Pelvic Mesh Verdict
Feb 1, 2019 | Bloomberg Law
By Julie Steinberg
J&J unit Ethicon Inc. plans to appeal a Philadelphia jury’s $41 million award to a woman harmed by an Ethicon pelvic mesh product.
The jury in the Philadelphia Court of Common Pleas Jan. 31 awarded Suzanne Emmett $15 million in compensatory damages and $25 million in punitive damages. It awarded her husband, Michael Emmett, $1 million on his loss of consortium claim.
Mesh products have been used to treat urinary incontinence and to support the muscles of the pelvic floor....
Access to full text unavailable – subscription required.
Story can be found here: https://news.bloomberglaw.com/product-liability-and-toxics-law/j-j-unit-to-appeal-41m-pelvic-mesh-verdict
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Pelvic mesh MDL judge grants $366 mln fee award to main plaintiffs' lawyers
Feb 1, 2019 | Reuters
By Tina Bellon
The federal judge overseeing several multidistrict litigations against manufacturers of allegedly defective mesh implants on Wednesday granted a request by the lead plaintiffs’ lawyers for $366 million in legal fees out of a total $7.25 billion settlement.
U.S. District Judge Joseph Goodwin, in Charleston, West Virginia, said the 5-percent contingency fee was merited because every plaintiff in the litigation benefited greatly from the work of the key attorneys, led by Henry Garrard of Blasingame Burch Garrard & Ashley. The judge noted they took countless depositions, prepared hundreds of motions and eventually assisted in settling many of the cases.
https://www.reuters.com/article/products-mesh/pelvic-mesh-mdl-judge-grants-366-mln-fee-award-to-main-plaintiffs-lawyers-idUSL1N1ZW20P
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Vaginal Mesh Lawsuit Ends in $41 Million Jury Verdict in Pennsylvania
Feb 1, 2019 | The Daily Hornet
The lawsuit was filed by Suzanne Emmett, a woman who suffered through multiple unsuccessful surgeries in an attempt to fix problems with her mesh implant eroding into her vagina.
The vaginal mesh she had implanted in May 2007 caused to her suffer from chronic discomfort, bleeding, pain during sex, infections, and other debilitating complications.
Overall, she underwent 9 surgeries and almost a dozen chemical cauterizations to address 14 mesh erosions, according to her lawyers.
Johnson & Johnson now faces 37,400 lawsuits related to vaginal meshes, which are used to treat urinary incontinence and pelvic organ prolapse.
Emmett accused Johnson & Johnson of intentionally concealing information about the high failure rate of its vaginal mesh products.
The company was also accused of failing to provide adequate warnings that the plastic mesh could repeatedly erode through soft tissue in the vagina and cause permanent scarring and other injuries.
Johnson & Johnson has now been hit with over $145 million in jury verdicts in Philadelphia over vaginal mesh lawsuits.
Another 90 mesh cases remain pending in Philadelphia County, while tens of thousands more lawsuits are centralized in a federal litigation in West Virginia.
The lawsuit is In RE: Suzanne Emmet et al. v. Ethicon Inc. et al. — Case No. 130701495 before the Court of Common Pleas of Philadelphia County, Pennsylvania.
https://dailyhornet.com/2019/vaginal-mesh-lawsuit-ends-in-41-million-jury-verdict-in-pennsylvania/
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Philly jury hands out $41 million to woman in pelvic mesh case; Verdict to be appealed
Feb 1, 2019 | The Pennsylvania Record
By Nicholas Malfitano
After a trial lasting five weeks, a Philadelphia jury awarded a $41 million verdict to a Lancaster woman who says she suffered permanent, scarring injuries to her genitalia after the installation of a pelvic mesh implant manufactured by Johnson & Johnson subsidiary Ethicon, Inc.
Plaintiff Suzanne Emmett, 60, sued for damages as a result of being implanted with the Prolift pelvic mesh device – which was manufactured and sold on the market for a seven-year period, spanning from 2005 to 2012.
In June 2012, Johnson & Johnson removed Prolift from the market, after the U.S. Food and Drug Administration ordered more testing of the device be conducted.
Suzanne received the implant in 2007 in order to treat prolapse, a condition where pelvic support muscles lose strength and put painful pressure on the vagina. But for the plaintiff, she alleged that her pain had only just begun after she received the device.
Suzanne claimed that the mesh had cut through into her vagina and resurfaced more than 12 times, forcing doctors to have her undergo nine separate surgeries to remove pieces of the broken device. She added this process caused her bladder contractions, incontinence and a damaging effect upon her sex life.
That effect was transferred to her husband and co-plaintiff, Michael Emmett, who said the “barbed wire”-like effect of the mesh caused damage to his penis during sexual intercourse with his wife.
The Emmetts’ attorneys claim the mesh implant device was defective, and that defendants committed negligence in both its manufacture and in failing to warn of its dangers.
Among the jury verdict funds are $15 million for compensatory damages, $1 million for a loss of consortium claim to Michael Emmett and $25 million for punitive damages.
A spokesperson for Ethicon, Inc. stated the company will appeal the verdict award, and that the pelvic mesh devices were in fact designed correctly and any risks were warned of appropriately.
“Ethicon intends to appeal this verdict as we believe it contradicts the evidence that the products were properly designed and that the company appropriately informed surgeons of known risks,” Mindy Tinsley said.
Tinsley added that pelvic organ prolapse and stress urinary incontinence are “serious and debilitating conditions” with “limited treatment options.”
“Scientists from around the world who have conducted and reviewed independent research on pelvic mesh agree it is an important treatment option for some women. All surgeries to treat these conditions have risks. While we empathize with those who have experienced complications, many women with pelvic mesh see an improvement in their day to day lives. Ethicon stands by, and will continue to defend, our pelvic mesh products in litigation,” Tinsley stated.
https://pennrecord.com/stories/511750691-philly-jury-hands-out-41-million-to-woman-in-pelvic-mesh-case-verdict-to-be-appealed
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Pelvic mesh ruined my life and cost me my job - now the law needs to change
Feb 2, 2019 | Cambridgeshire Live
By Anna Savva
A campaigning mum who had her life ruined following a routine operation is calling for a change in the law to prevent others from suffering the same fate.
Anne Cook, 63, from Royston, had to give up work and survives on a daily cocktail of painkillers after a pelvic mesh implant in 2012 left her in chronic pain.
She is one of a growing chorus of UK women calling for an 'outright ban' on pelvic mesh implants, used to treat common conditions such as stress urinary incontinence (SUI), which affects one in three women, pelvic prolapse and hernias.
Anne had her first operation at Addenbrooke's to treat SUI in 2012 and has been living with the consequences ever since.
Since being forced to retire on medical grounds Anne and her partner had to sell their home and downsize to make ends meet.
She has gone from an active mum to being unable to even go on a gentle walk without having to hold her husband's arm for support. p:nth-of-type(6)","type":"performPlaceholder","relativePos":"after"}" data-placeholder-placeholder="" data-response-start="4173.300000024028" data-type="placeholder" style="background: rgb(255, 255, 255); border: 0px; font-size: 16px; margin: 0px; outline: 0px; padding: 0px; vertical-align: baseline; color: rgb(20, 20, 20); font-family: "Open Sans", sans-serif;">
Thousands of women like Anne have joined mesh support groups, where they detail their daily struggles with the symptoms of chronic pain.
Anne is a member of the 'Sling the Mesh' campaign, which she launched alongside fellow sufferer Cambridgeshire journalist Kath Sansom in 2015.
Together they have helped put mesh on the agenda, with Kath actively lobbying for change with the All Party Parliamentary Group on Surgical Mesh Implants.
Following their efforts, the Government halted the use vaginal mesh implants last year, pending the outcome of a review into their safety.
Chaired by Baroness Julia Cumberlege, the Independent Medicines and Medical Devices Safety Review has been touring the country since mid 2018, collecting the oral testimonies of hundreds of women ahead of publishing its findings in April.
Anne's testimony
Anne rates her pain, which radiates from her pelvis to her legs, as as five out of 10 most days.
The retired administrator told Cambridgeshire Live: "I got it [SUI] because I had two big babies. It was pretty dreadful in work if I had to pick up heavy stuff or at home getting washing out of the machine .
"When I went to pick up my grandson out of his cot if they were staying, it was horrible and very embarrassing."
After being referred to a gynecologist Anne had 'transvaginal tape surgery', better known as 'sling surgery' – a plastic mesh inserted under the bladder that supports it like a hammock.
She said: "I knew when I woke up I had a problem.
"I was only in for a day, if that. I was sent home with a catheter, but I couldn't fit it myself so they got me back at 8am the next morning to be shown how to self-cathertise.
"I got one urinary tract infection after another and put on stronger and stronger antibiotics.
"When I kept saying this wasn't right I was told I was the only person who had a problem. The fact that it's such an embarrassing subject prevents people from coming foward.
Anne was soon in constant pain, unable to walk upright and bent over double. She was forced to take time off work.
She had "cotton wool brain" from all the pain killers to have 12 weeks off work.
She said: "I was so tired, but my consultant wouldn't believe I had a problem. "
It was Christmas 2013 when she says she had her "light-bulb moment" when she read an article in the Daily Mail detailing mesh complications, with concerns raised by Dr Suzy Elneil, a consultant at University College London Hospitals.
She emailed Dr Elneil and got a response 10 minutes later.
Anne said: "She said to get a referral from my GP and she would see me.
"I saw her in January 2014 and in May I had most of it removed. I had to have another in April 2015 because we had to let the inflammation calm down and had another bit of the mesh removed. "
Despite this Anne is still in chronic pain, varying from a five out of 10 most days to an eight out of 10 on bad days when she can't even get out of bed.
"So that's where mesh leaves you - basically on the scrap heap," she said.
She continued: "I am on a cocktail of drugs and when the pain gets bad I have to take 80mg of norplibaline.
"Compensation would be nice but we haven't done anything for money, but to stop other people getting it and to get it completely banned.
"I would like pelvic mesh banned completely so no one else goes through this -- it's dreadful. It is Russian roulette as to who suffers and who recovers.
"To see so many women who were healthy whose lives are ruined is deeply upsetting and heartbreaking.
"I have to keep the faith."
Mesh safety review
Anne submitted evidence to the review led by Baroness Cumberlege.
The campaigners will find out April of this year whether the use of mesh will be banned completely.
In Cambridgeshire, around 30 people attended a meeting at Homerton Conference Centre in July to share their experiences of surgical mesh.
Some of these, including Anne's testimony, have been recorded on film and are due to be published online.
In a recent newsletter Baroness Cumberlege wrote: "It is our plan to publish on our website the personal testimonies of a number of people who have volunteered to share their personal story on film.
"We hope that these videos, which we are truly grateful for, will give public voice to how the three interventions within the scope of our review have affected the lives of individuals, their family and friends.
"I recognise that there is keen interest in the outcome of our review, and that expectations are high.
"I am deeply conscious of the importance of getting this right, to ensure that our healthcare system learns the right lessons and improves outcomes for patients in the future. "
Kath Samson, who spearheaded the campaign to raise awareness of mesh complications, says she is proud of how far it has come.
When she founded the group in 2015 it had just 30 members, and now the group has more than 7,200.
Kath said: “Being at the coalface of so much suffering for 3.5 years is heart breaking for myself and our team of 14 voluntary admins.
“To see so many women who were healthy to now have lives that are ruined is deeply upsetting.
“We also have a growing number of men and women joining with hernia mesh complications and we are painfully aware that this problem needs tackling once the Baroness Cumberlege Review is complete in April 2019, when we hope she will announce a full ban on pelvic mesh.”
https://www.cambridge-news.co.uk/news/health/pelvic-mesh-implant-nhs-kathsamson-15569087
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Way More Women Are Peeing Their Pants Than You Think
Feb 1, 2019 | InStyle
By Elizabeth Kiefer
The first time Lily* thought something might be wrong was during college. She and her girlfriends often went out to the bars on Saturday nights in their small East Coast town, dancing and drinking. Afterward, they would hop on a public bus back to the dorms — and sometimes, Lily just couldn’t hold it. Buried in a photo album from those years, there’s a picture of her doubled over, laughing at the sheer ridiculousness of having peed her pants.
At first, Lily chalked her bladder issue up to the dumb stuff that happens when you’ve had one too many vodka sodas. But as time went on, the urge would arrive out of nowhere and she’d have to literally sprint to a bathroom. Lily’s job, in the medical technology industry, required her to be on the road a lot. Before getting in the car, she’d map out public restrooms where she could stop along the way, never knowing when she would need to pull off the parkway for an emergency pee.
The situation went from random and inconvenient to anxiety-inducing. She recalls, several years ago, being at a work function on a boat with 100 people and just one bathroom — a night that turned out to be the final straw. No one else noticed the urine trickling down her legs as she waited in line, but Lily was understandably mortified. Not long after that, she made an appointment with a urologist to talk about treatment options and was dismayed, though undeterred, by the doctor’s response: You’re very young to be having this problem.
At 30, Lily was young — and athletic, and healthy. She’d never been pregnant or suffered serious pelvic trauma. Nor did she fit the profile typically associated with incontinence symptoms. But, after switching doctors, she ultimately received a diagnosis of urge incontinence. “You see those commercials, you know, the ‘gotta go, gotta go, gotta go right now’ ones,” Lily says, referring to the Dexatrol LA medication ads that ran through the early-2000s. “It’s never women who look like me — they’re older. But that’s not always who it is.”
She’s right about that. One in four women over age 20 will experience at least one pelvic-floor disorder at some point in her lifetime, including urinary incontinence, fecal incontinence, and pelvic-floor prolapse, according to a 2013 study by the The American College of Obstetricians and Gynecologists. Dr. Marsha Guess, a Colorado-based urogynecologist, calls incontinence a silent epidemic, reflecting both the proportion of the population it impacts as well as the fact that sufferers are often too embarrassed to come forward about their symptoms. “Unless you had urinary tract infections as a kid, or some kind of neurological issue that brought you to a urologist, nobody really talks about this stuff,” adds Dr. Anika Ackerman, a urologist based in New Jersey.
In recent years, the taboo surrounding various women’s health topics has begun to abate, thanks to increased conversations about everything from breast pumping at work to infertility issues and period panties. Incontinence may be the last bastion of body-stigma — the one health conversation women aren’t having. But according to Guess and other experts, we’re overdue for a more open dialog about the “pee word,” too.
According to a survey conducted by the National Association for Continence, nearly two-thirds of women with incontinence symptoms have not discussed their concerns with a healthcare provider. On average, women wait 6.5 years between experiencing their first symptom and bringing the issue up with their doctor. Dr. Roger Goldberg, the director of urogynecology research at the University of Chicago North Shore University, cited on Parents.com, said: “Even a seemingly uneventful pregnancy and delivery can change urinary control for up to 50% of women.” That means half the moms in your life pee differently now than they did pre-kids, which is probably not something you’re talking about over cocktails.
So what is urinary incontinence? Put simply, it’s a loss of bladder control. There are two main types: The first, stress, is the most common, and it occurs when you put pressure on the bladder (while laughing, jumping, even running on the treadmill, for example). Stress incontinence is caused by laxity in the pelvic-floor muscles, and it's common among postpartum women as well as women of advanced age. It's the culprit behind that much-whispered-about pee-when-you-sneeze scenario. Urge incontinence, on the other hand, is the result of the bladder contracting when it shouldn’t — a.k.a. overactive bladder syndrome (or OAB). Then there’s mixed incontinence, which is a combination of the two.
The pelvic floor is a series of three layers of muscles. When functioning properly, they work in harmony with other muscle groups, such as your core, deep abdominals, and diaphragm. The vagina is what Guess calls a “supported structure” composed of three walls: the front (which supports the bladder), the top (which supports the uterus), and the back (which supports the rectum). Compromised pelvic-floor muscles can lead to incontinence, as well as organ prolapse (a more extreme result, when an organ slips out of place).
Treatment for urinary incontinence varies depending on the patient, from noninvasive interventions to oral medication to pelvic-floor therapy with a physical therapist to surgery (which includes the controversial transvaginal mesh you may have heard about). But it starts with recognizing the symptoms — and a willingness to bring them up with your doctor, which for many women is a not insignificant hurdle.
Dr. Kathleen Connell is Dr. Guess’s colleague at the University of Colorado Hospital, and specializes in female pelvic medicine and reconstructive surgery. Speaking on the phone earlier this month, she and Guess said they often tell patients to invite friends over for dinner and, after some wine, broach the topic of incontinence. “Nobody wants to cross that line because of social stigmas,” says Connell, “but once you start talking about it, people really open up. They think it’s an elderly person’s problem. But so many young women are incontinent, too.”
While childbirth and pregnancy play a part in incontinence among younger women, it’s also prevalent among people who have never had kids. Dr. Erin Weber, a Brooklyn-based physical therapist who specializes in pelvic-floor rehabilitation, sees women who range in age from their 20s to their 70s, plenty of moms and non-moms among them.
“Anyone who walks into a drugstore can see there are entire aisles dedicated to incontinence. Clearly, this is a problem for the masses, not just a few women,” she explains. But Weber worries that we’re conditioned to reach for products for symptoms instead of seeking out a solution for the root cause.
“People have said to me, ‘It’s just like, a normal amount of leaking after I run.’ They’re rationalizing that it’s normal to avoid addressing an issue,” Weber says. For new moms, she says it’s fine to have a little bit of leaking for up to three weeks after delivery. After that, she recommends seeing a physician or physical therapist to make sure those muscles are working correctly.
Behaviors and habits, some that might date back decades, can also play a role. “We learn as kids to void our bladders every time we leave the house, which can put us into this overactive bladder state,” she says. Ackerman, the urologist, adds that, frankly, some of us need to work on our pee posture. Sure, hovering can seem preferable to bodily contact with a questionable seat, but it also means that you’re clenching muscles that should be relaxed, which can lead to incomplete emptying of the bladder and even incontinence over time.
More transparency and education, say both Guess and Connell, are key, whether you’re a new mom, an older woman, or anywhere else on the spectrum. Rather than women working to bring up urinary issues when something is wrong, health professionals should create the opportunity for their patients to discuss this in a routine way.
“We can probably prevent a lot of incontinence by talking about it, and doing more preventative treatments with younger women,” says Connell. “These are symptoms that impact quality of life, that increase the risk of depression and social isolation, and decrease self esteem.” In other words: Nothing that women should have to just live with."It was not the sexy squirt."
At 37, Karen* cannot remember a time in her life when she didn’t experience any leakage; for decades, it was just something she dealt with. Bladder issues impacted her sex life with her husband — it didn’t matter if she’d gone to the bathroom seconds before hopping into bed, the second he touched her, she would leak.
“It was not the sexy squirt,” Karen says. “It was a gush. I actually bought waterproof bed pads because it would soak through a towel.” Her partner tried not to make her feel embarrassed, but the impact on their sex life was unavoidable. “Oral was completely off the table — I was too self-conscious — and it didn’t matter what he or anyone else said … the thought of not being able to control felt really unsexy.” Then, in 2018, while researching workshops on tantric orgasms, Karen came across a product that caught her attention: Yarlap, a device developed to help women strengthen and tone pelvic-floor muscles, which received a Women’s Health FemTech Award in 2018.
To use it, a woman inserts a tampon-sized wand into her vagina, which is attached to a small remote. Electrostimulation causes the muscles to contract, and, over time, get stronger. MaryEllen Reider, who co-founded the company with her father, Brent, a medical technology inventor, says that many women see a change in 12 weeks. Karen has been using it for about six months now and says that, for the first time in years, she is not constantly worried about proximity to a bathroom.
In fact, Yarlap is among a wave of new tech tools aimed at improving women’s pelvic-floor health (some of which also tout the added bonus of better orgasms). Some, like Yarlap, are FDA cleared, can be purchased with or without HSA or flex funds, and were specifically created for bladder control. Others, like Elvie(which was part of the swag bag at the 2017 Oscars) aid in bladder control, postnatal recovery, and even enhanced orgasms. (Elvie can be purchased for $199 out of pocket.) There are other options, too. Matriac, a free app aimed at new moms, contains daily workouts for pelvic-floor strength. Others provide straightforward Kegel routines you can do at your desk.
When I asked Connell and Guess about digital programs and devices, they were encouraging, particularly for people who would not regularly be able to go to physical therapy. With patients in their practice, they start with noninvasive behavioral modifications like Kegels, avoiding irritants like caffeine and nicotine, and referring patients to physical therapy. (Weber, the physical therapist, explained that pelvic-floor therapy is less invasive than an OB/GYN exam, adding that pelvic-floor muscles can be accessed rectally or vaginally but there are various options available for someone uncomfortable with an internal exam.) In recent years, other new innovations, including nonsurgical options like lasers, have helped women regenerate vaginal muscles; another option is tibial nerve stimulation, in which a physician uses an acupuncture-like needle to stimulate the tibial nerve to treat overactive bladder syndrome (OAB).
If behavioral changes, physical therapy, or nerve stimulation don’t work, Connell and Guess might prescribe medication. These drugs typically help relax the bladder muscle, in cases of urge incontinence. But, as Ackerman explained, they often come with undesirable side effects like constipation, dry mouth, and, in older people, potential cognitive dysfunction.
As for surgery for those with stress incontinence, the “gold standard,” says Ackerman, is a sling, or a small piece of mesh that’s placed underneath the urethra to help support it. She notes that this surgery uses a smaller piece of mesh than what is used for organ prolapse repairs, and the ongoing transvaginal mesh controversy has mostly centered on the latter. A recent report in the Washington Post found that 3 to 4 million women worldwide have had mesh implants for incontinence or prolapse issues, and about 5 percent experienced complications. The paper goes on to explain that many such complications are permanent. “The urethral sling is still the standard of care and the FDA has reported that it is a safe and efficacious procedure for the treatment of stress and urinary incontinence,” Ackerman wrote in a follow-up email. Nevertheless, the treatment has been banned in several countries.
Botox is another option for those with urge incontinence or OAB. This entails small injections through the urethra. “Just like it relaxes the muscles in the face, it relaxes the muscles in the bladder,” says Ackerman. Another therapy she’s recently started exploring is The O-Shot: an injection of platelets that help regrowth of vaginal tissue around the G-spot — tissue which also helps support the area around the urethra. “People are thinking that might be the next wave of treatment for stress incontinence,” she says. More women in the field, and an increased interest in women's health overall, has led to an influx of new technology, Ackerman says. But, there is still a long way to go.
As for Lily, a couple years ago, her medication for OAB stopped working. In a way, she was glad to get off it — the dry mouth it gave her was maddening. That’s when her Manhattan-based doctor suggested Botox. It’s not exactly painless (“I mean, it’s a shot in your bladder,” Lily says) but the whole thing is over in less than an hour. Most importantly: it helps. “I can drink a whole cup of tea in the morning and not stop on my way to work,” Lily says with a laugh. That’s progress.
Nighttime bladder issues are still a concern for her. On a bachelorette party trip with her girlfriends in the fall, she brought along pads, just in case. But she’s finally comfortable talking about it now, even with her girlfriends. And she urges other women to do the same. “Go to the doctor early, and have it checked out,” she says. If you do, you’ll find solutions are out there.
https://www.instyle.com/beauty/health-fitness/urinary-incontinence
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How to Deal With Bladder Leaks
Feb 2, 2019 | Consumer Reports
By Hallie Levine
It’s embarrassing and uncomfortable to leak urine when you sneeze, or to race to a bathroom only to experience an unexpected gush as soon as you unbutton your pants.
But more than half of adults 65 and older experience accidental urine leaks, according to the Centers for Disease Control and Prevention.
With stress incontinence, movement such as coughing, sneezing, or lifting puts pressure on the bladder, causing urine to leak.
With urge incontinence (sometimes called overactive bladder), the other main type, there’s a sudden, immediate urge to urinate.
Both are more common as we get older. “As people age, there’s a natural weakening of pelvic and bladder muscles over time, especially among women who have had vaginal childbirths,” says Vannita Simma-Chiang, M.D., a urologist at the Icahn School of Medicine at Mount Sinai in New York City.
That doesn’t mean you have to live with the condition.
“People just assume some leakage as they get older is normal, but it’s not inevitable,” says Yul Ejnes, M.D., an internal medicine specialist at Coastal Medical in Cranstone, R.I., and a former chair of the American College of Physicians Board of Regents. “If it bothers you, there are things you can do to improve it.”
Try the following strategies. Tell Your Doctor
“It might seem embarrassing to talk about,” Ejnes says, “but it’s important providers know, so they can make sure it’s not due to another condition, such as type 2 diabetes or a neurological condition such as Parkinson’s.”
Your doctor will perform a physical exam, ask about your medical history, and try to pinpoint which type of incontinence you have. (For example, leaking urine after you cough or laugh is more likely stress incontinence.)
He or she should also check your medication to make sure none is worsening the problem, and test your urine for blood, which could signal a urinary tract infection.
Your next step will probably be to keep a diary for a few days, writing down when and how much fluid you drink, when you go to the bathroom and how much urine you produce, and when leaks occur.Tweak Your Lifestyle
A few steps, along with a doctor’s treatment, may help ease incontinence.
Lose weight if you’re overweight. This can take pressure off your bladder, Simma-Chiang says.
Be savvy about fluids. Try small amounts at regular intervals throughout the day rather than a large amount all at once, which can overwhelm your bladder. Limit alcohol and coffee, which increase urine production.
Work on getting regular. If you’re chronically constipated, those “stuck” bowel movements can cause leaks by putting pressure on the bladder, says Carrie Pagliano, D.P.T., a spokesperson for the American Physical Therapy Association.
So get enough fiber. Women should get 25 grams per day; men, 38 grams. Talk to your doctor if this doesn’t help.Try Nondrug Therapies
Instead of medication, the American Urological Association and the American College of Physicians recommend pelvic exercises and bladder training first.
Postmenopausal women who did both weekly for three months had a 75 percent reduction in urine leaks, according to a study published in 2016 in the journal Menopause.
Physical activity can help normalize weight, which reduces pressure on the bladder. Many types, including brisk walking and yoga, appear to strengthen the pelvic floor muscles that help control the bladder’s actions.
Kegel exercises, which strengthen the muscles that control urination, are important for men and women, says Sandip Vasavada, M.D., director of the Cleveland Clinic’s Center for Female Pelvic Medicine and Reconstructive Surgery.
To do them, pretend you’re about to urinate, then tighten the muscles you would use to stop the urine flow. Hold for 3 seconds, then relax for a count of three. Work up to holding for 10 seconds at a time, with three daily sets of 10 to 15 repetitions.
If Kegels don’t help after several weeks, ask to be referred for pelvic floor physical therapy. Women who have this are about five times more likely to report full symptom relief, according to a 2018 review.
“We can watch them doing Kegels while we do an ultrasound to make sure they’re doing them correctly, and if they’re not, show them how,” Pagliano says.
Biofeedback, which shows you which muscles you’re using, can be useful.
A physical therapist can also work with you on bladder training, helping you to “teach” your bladder to hold more urine by going to the bathroom at specific intervals during the day and gradually increasing the time between trips.
For women with stress incontinence, a pessary, a reusable device worn in the vagina, can help support the bladder. Impressa, an over-the-counter pessarylike device, is also designed to reduce leaks.Be Cautious About Meds
Several medications are approved for urge incontinence, including mirabegron (Myrbetriq), oxybutynin (Ditropan XL and generic), solifenacin (Vesicare), and tolterodine (Detrol and generic).
Consider them only if incontinence symptoms interfere with a good night’s sleep or make you feel uncomfortable about leaving home, Simma-Chiang says.
Most (except mirabegron) are anticholinergics, which have been linked to dry mouth, blurry vision, constipation, dizziness, and confusion and dementia in older adults.
A large analysis published in 2018 in The BMJ found that these types of drugs are associated with a higher dementia risk even 20 years after use.
Mirabegron can cause dry mouth, raise blood pressure, and hike the risk of urinary tract infections and constipation.
For men whose leaks are related to an enlarged prostate, tamsulosin (Flomax), finasteride (Proscar and generic), and dutasteride (Avodart and generic) make it easier to fully empty the bladder. Tamsulosin can cause dizziness and headache; the others could reduce sex drive.Consider Other Options
If meds and nondrug therapies aren’t sufficient, there are other options, such as injections of botulinum toxin type A (Botox) into the bladder muscles. It’s very effective, but “about 5 percent of the time it can affect your ability to empty your bladder fully, so you may need a temporary catheter,” Vasavada says.
In sacral nerve stimulation, electrical impulses are sent to lower-back nerves that control bladder and pelvic floor muscles.
In tibial nerve stimulation, electrical impulses are sent from the tibial nerve to the spine, where it connects with nerves that help control the bladder.
Several surgical procedures are also available for stress incontinence. The most common is the urethral sling, where strips of synthetic mesh are implanted to support the urethra. It can be helpful but carries dangers, such as infection and worsening incontinence, and the risk of the mesh eroding.
https://www.consumerreports.org/medical-conditions/how-to-deal-with-bladder-leaks/
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