Tag: Women’s Health

International Mesh Awareness Day – 1st May

Posted on April 30, 2017

Monday 1st May is International Mesh Awareness Day, the start of Mesh Awareness month.  It highlights the complications suffered by women who have had mesh implants to treat stress urinary incontinence and pelvic organ prolapse.

You may have seen a recent episode on The Project which highlighted the little known reality that when a urogynecological mesh implant goes wrong, it can go badly wrong, with life-changing effects for the women affected.  It has taken the recent media activity on the topic for some women to recognise the symptoms in themselves. And despite what Waleed Ally stated in the final moments of the Project episode on the topic, complications can occur quite some time after implanting, and only partial removal options exist for women.

 

The use of mesh is now the subject of a federal Senate Inquiry, which is taking submissions until the 31st May 2017. The Inquiry’s title “Number of women in Australia who have had transvaginal mesh implants and related matters” highlights that we simply don’t know how many women have had these implants, and how many of them have suffered complications.

 

Health Issues Centre Victoria hosted a Facebook Page “Understanding pelvic mesh implants and impacts on women in Australia”. This page is part of a united response by health consumers councils across Australia to ensure women’s voices are at the heart of the Senate Inquiry Submission. It links to an anonymous survey where women and their families are able to provide feedback to inform the joint Submission. The page will be active until the Inquiry Submission deadline of 31st May 2017.

 

Pictured: Caz Chisholm holding both her awards

 

Here in WA, on Thursday 27th April, the Health Consumers’ Council announced our Health Consumer Excellence Awards. The winner of the Health Consumer Award, and the Rosemary Caithness Award to acknowledge outstanding service to health consumers was the same person – Caz Chisholm. Caz is one of the founders of the Australian Pelvic Mesh Support Group, a Facebook page which has grown from 39 members two years ago to just under 600 members in the last week, after the airing of the Project episode. She has spent significant time and energy raising awareness for women about the issue and providing essential peer support. She was also directly responsible for ensuring that the Senate Inquiry was successfully advocated for by Senator Hinch in the first place.

 

For women and families affected by pelvic mesh, we urge you to have your say to ensure the consumer voice is central to the Submission. Check the Having A Say section lower down on this page for the links to the different ways to provide your feedback.

 

Please also note that the health consumers councils across Australia have developed a Consumer Information Sheet which appears below and is also available as a PDF. Please contact us on info@hconc.org.au or 9221 3422 if you have any comments or concerns.

 

Consumer information

For women who have had, or are considering having surgery to treat stress urinary incontinence and pelvic organ prolapse

If you have been diagnosed with pelvic organ prolapse or stress urinary incontinence, the likelihood is that you will be offered surgery once non-surgical options such as physiotherapy have been exhausted.

 

Surgery for these two conditions are usually involves a mesh insertion or implant. It might be called tape or a sling. It is all the same from a consumer perspective and these products are collectively known as mesh. The Therapeutic Goods Advisory Website has an updated list of complications associated with surgery using mesh. https://www.tga.gov.au/alert/urogynaecological-surgical-mesh-complications

 

Mesh implants have been offered to women since the late 1990s. The procedure is considered to be only partially reversible, and some women have travelled to America at their own expense to have mesh removed.

 

Before you consent to any surgical procedure, it is important to ask all the questions you need so you understand what you are consenting to. The Choosing Wisely campaign has created these questions to help you get started. http://www.choosingwisely.org.au/resources/consumers/5-questions-to-ask-your-doctor

 

1.      Do I really need this test or procedure?

Tests may help you and your doctor or other healthcare provider determine the problem and the procedures that may help to treat it.

2.      What are the risks?

Will there be side effects? What are the chances of getting results that aren’t accurate? Could that lead to more testing or another procedure?

3.      Are there simpler, safer options?

Sometimes all you need to do is make lifestyle changes, such as eating healthier foods or exercising more. Another option to ask your doctor about is native tissue repair.

4.      What happens if I don’t do anything?

Ask if your condition might get worse — or better — if you don’t have the test or procedure right away.

Stress urinary incontinence is not a life-threatening condition so consider carefully before undergoing any surgery. Do not consider surgery until all non-surgical options have been exhausted.

5.      What are the costs?

Costs can be financial, emotional or a cost of your time. Where there is a cost to the community, is the cost reasonable or is there a cheaper alternative?

 

What help can I access?

  • There is a Facebook group called the Australian Pelvic Mesh Support Group which can connect you with women who have had these procedures.
  • Shine Lawyers is one of the firms that is currently undertaking class actions in relation to mesh
  • Take this information sheet to your trusted health provider to discuss your current or future options

 

Having A Say

 

Complications associated with use of Pelvic Mesh

These are listed on Australia’s Therapeutic Goods Administration (TGA) website as follows: https://www.tga.gov.au/alert/urogynaecological-surgical-mesh-complications

  • punctures or lacerations of vessels, nerves, structures or organs, including the bladder, urethra or bowel (these may require surgical repair)
  • transitory local irritation at the wound site
  • a ‘foreign body response’ (wound breakdown, extrusion, erosion, exposure, fistula formation and/or inflammation)
  • mesh extrusion, exposure, or erosion into the vagina or other structures or organs
  • as with all foreign bodies, mesh may potentiate an existing infection
  • over-correction (too much tension applied to the tape) may cause temporary or permanent lower urinary tract obstruction
  • acute and/or chronic pain
  • voiding dysfunction
  • pain during intercourse
  • neuromuscular problems including acute and/or chronic pain in the groin, thigh, leg, pelvic and/or abdominal area
  • recurrence of incontinence
  • bleeding including haemorrhage, or haematoma
  • seroma
  • urge incontinence
  • urinary frequency
  • urinary retention
  • adhesion formation
  • atypical vaginal discharge
  • exposed mesh may cause pain or discomfort to the patient’s partner during intercourse
  • mesh migration
  • allergic reaction
  • abscess
  • swelling around the wound site
  • recurrent prolapse
  • contracture
  • scarring
  • excessive contraction or shrinkage of the tissue surrounding the mesh
  • vaginal scarring, tightening and/or shortening
  • constipation/defecation dysfunction
  • granulation tissue formation.

 

Author: Pip Brennan, Executive Director of the Health Consumers’ Council. Consumer Member on the Australian Commission on Safety and Quality in Health Services Reference Committee.

Pap smear costs- a storm in a teacup?

Posted on January 7, 2016

The announcement slipped in easily enough just before Christmas. On December 15, in its mid-year budget update, the Federal Government announced that they would scrap the incentive payments for pathologists for bulk billing of tests, because the rate of bulk billing had not increased. In other words, the measure appeared to have failed.

This announcement reflects the work being undertaken in the Medicare Benefit Schedule (MBS) reform process which was established in April 2015. The MBS is a list of more than 5,500 item numbers against which medical practitioners can bill the federal government for payment. It is the basis of business models for public, private and not for profit health services. It includes clinical items as well as this type of incentive payment.

Queue then the entrance of the Royal College of Pathologists, and the Australian Medical Association. In other words, organisations whose bottom line is affected by this change. In some online and newspaper reports, figures were put on the cost to consumers of a pap smear  at around $30. On 6th January an article appeared on Mamma Mia’s website, and a petition about the cost of Pap Smears and pathology tests was launched by Change.org. Signatures are nudging very close to 150,000, and rising as this blog is being written. Yet the incentive payment being scrapped was in the region of $1.30-$1.40 according to the Federal Government. In the short discussion I just had with the media spokesperson for the College of Pathologists, the position of the College seems to be a reluctance to nominate an actual figure to be passed onto consumers. So is this an issue, or isn’t it?

I would venture to suggest that it is not. Change is always a difficult phenomenon to manage, and communication seems to have contributed to the backlash the Federal Government is experiencing. The real story is the reason behind the MBS Review and why it is so important for Australians that this happens. Here are some terrifying facts and figures about the MBS provided by our national body The Consumers Health Forum:

  • Until 1 January 2010, there was no clear process for adding new items to the MBS.
  • There was also no clear, consistent system for identifying and removing items from the MBS when they were no longer considered best practice or effective.
  • There was no consistent and formal process in place to test or review items already on the MBS, or new items coming onto it, to ensure they were doing what they were intended to do and were safe and cost effective.
  • Only three percent of items have been assessed for safety, effectiveness and cost-effectiveness. 

You read that right. Only three percent.

So the MBS Review team are carrying on their work, amidst the media cacophony. They are still very keen to hear from the community, but many people find the topic inaccessible and can fail to see how this may affect them. Perhaps this controversy will raise awareness of this enormous and much-needed reform currently unfolding. It is unfortunate that this Review is always going to get caught up in economic rationalist arguments and the undeniable need for our country to reduce its health costs. Public scrutiny will be important to ensure that the focus is on eradicating inefficiencies, duplication and waste rather than diminishing access to quality health services. But let’s ensure that this is a patient centred discussion, not a vested interest centred discussion.

Just before Christmas the MBS Review Taskforce released a new consultation has to look at obsolete MBS items, with feedback invited until 8th February 2016. If you are brave to work your way through the consultation documents, feel free to have your say.

Written by Pip Brennan, Executive Director of the Health Consumers’ Council of WA.