Grey Power June 2016

12
national Greypower mAGAZINE » june 2016
Mobility scooter related trauma on the rise
Surgeons meeting in Brisbane recently
were told that mobility scooters can
pose a risk to their driver and the
general public, and related injuries are
on the rise.
Dr Edward Gibson,
an acute surgery
registrar at Adelaide’s
Lyell McEwin
Hospital who presented
at the Royal Australasian
College of Surgeons
(RACS) Annual
Scientific Congress, says
these devices have lim-
ited manoeuvrability,
no licence is required
for their operation and
training in their use can
vary.
“Purpose mobility scooters
are used for many reasons
such as disability and
decreased mobility and
with the ageing population
of Australia, the use of such
devices is increasingly common,”
Dr Gibson said.
Dr Gibson said because
of limited data concerning
mobility scooter related
trauma, he had undertaken
a retrospective audit
of emergency department
presentations between July
2010 and November 2015
relating specifically to mobility
scooter related injuries.
A total of 81 patients
were identified and the average
age was 68.2, with
the youngest being six and
eldest 90.
“The most frequent injuries
were head trauma and
fractures, 32.1 percent and
28.4 percent respectively.
“Gopher riders involved
in motor vehicle accidents
(MVAs) accounted for 12.3
percent while non rider injuries
were 14.8 percent.
“Overall 67 percent of
patients required an admission
or transfer to another
hospital.
“The overall result of
the study was that mobility
scooter related injuries
were likely to rise with their
increasing use and prevalence.
“This study also revealed
that due to a number of
injuries involving MVAs
to non-drivers, it would
suggest that visibility and
awareness of mobility
scooters may need to improve.
“Head trauma accounted
for almost a third of
scooter-related injuries and
further research may be
needed to address whether
helmets should be required
for scooter drivers,” Dr Gibson
said.
More than a thousand
surgeons from the Royal
Australasian College of
Surgeons as well as international
surgeons from the
Royal College of Surgeons
of England gathered at the
Brisbane Convention and
Exhibition Centre in May
for a series of workshops,
discussions, Plenaries and
masterclasses across a
broad range of surgical issues.
The conference brought
together leading medical
and surgical minds from
Australia, New Zealand and
the United Kingdom and
looked in greater detail at
surgery, technology and
communication.
The surgical mesh debate - what’s it all about
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The issue of surgical
mesh has increasingly
been in the media in
the last few years both
overseas and in New
Zealand.
Thousands of patients
worldwide have suffered
life altering complications
from having surgical
mesh procedures and
people are now advocating
for changes to be
made in the use of these
devices.
Since bringing the
mesh issue to the forefront,
gaps in policy and
the processes within the
New Zealand medical and
regulatory system have
been highlighted and it
is clear that these gaps
need to be addressed, and
quickly.
So what exactly is surgical
mesh and how do
I know if I have it?
Surgical mesh is used
to treat incontinence, pelvic
organ prolapse (rectal,
vaginal, uterine, bladder)
and for hernia repairs.
Gynaecologists, urogynaecologists,
colorectal
and general surgeons
provide these surgical options
So why is mesh a problem?
To gain an understanding
of the mesh
problem it is important to
know how these devices
came on to the market.
Surgical mesh made
with polypropylene was
first used in hernia surgery
before being adopted
into gynaecological surgery.
Due to a loophole in
the regulatory system of
the United States (FDA)
many surgical mesh products
flooded the market
before being properly
tested or researched.
It is now evident that
the approval of many of
these devices was given
with virtually no independent
testing.
The ‘proven’ safety of
these products has relied
on the testimonial of the
drug and medical device
companies who make
these devices.
New Zealand’s regulatory
agency (Medsafe) is
limited in its capacity and
funding and relies solely
on overseas regulators.
This means that they
are unable to independently
test or regulate any
medical devices or medicines
that come onto the
New Zealand market.
Surgical mesh made of
polypropylene was originally
thought of as inert,
meaning it does not move
or break down inside the
body.
New research and
growing evidence shows
that the polypropylene
used in surgical mesh
undergoes a biological
change (oxidation) and
can in fact affect the surrounding
tissues.
The long-term impact
on the auto immune system
is still unknown with
many mesh sufferers exhibiting
a new onset of
auto immune issues.
Initially the mesh
complications that surfaced
were blamed on the
inadequate training of
surgeons, but since then,
the safety of the products
themselves have been
called into question.
The role of the manufacturer
in selling these
products is now being investigated
both in litigation
and various government
inquiries overseas.
A New Zealand petition
was lodged in 2014
by Carmel Berry and
Charlotte Korte calling
for an independent inquiry
into the safety of surgical
mesh, this is currently
before the Health Select
Committee.
What information do
I need when having a
procedure with surgical
mesh?
Patients need to know
more about surgical mesh
risks before deciding
to go ahead with one of
these procedures.
There is huge concern
surrounding the lack of
informed consent by doctors
regarding surgical
mesh and many patients
are not always given accurate
information or
told of all possible risks
associated with these procedures.
This issue is now being
recognised by the medical
community.
The informed consent
information which
is given to patients for
uro-gynaecological pro-
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When these proposed
changes are adopted, it
will hopefully ensure that
patients will be able to
make a proper informed
choice.
It is crucial that these
changes in informed consent
processes are also
adopted by the general
and colorectal sector.
This problem has highlighted
the need for patients
to ensure they have
a more ‘in depth’ understanding
of any potential
surgical procedures.
This can be as simple
as knowing the right
questions to ask your
doctor, and if not, researching
it until you do.
Doctors are there for
us and willing to help,
but it is also up to us as
patients to make sure
we play a role in educating
ourselves and taking
ownership of that responsibility
too.
Questions to ask your
doctor if they propose using
mesh in your surgery.
• Do you have any written
information that
I can take away with
me?
• Will there be an opportunity
to contact
you with any questions
before signing the consent
form on the day of
the operation?
• Can you explain all my
possible options including
non-surgical,
surgical with mesh
and surgical without
mesh?
• Why is mesh being
suggested for me and
what are the benefits/
disadvantages over
non-mesh alternatives?
• What are the benefits/
disadvantages of having
non mesh surgery
over using surgical
mesh?
• What brand of mesh
will be used?
• How many mesh operations
have you performed?
• How many partial or
full removals of mesh
have you undertaken
and why?
• What side effects can
I expect after surgery
and what side effects
should I report to you?
• What happens if I experience
symptoms in
years to come?
• If there is a complication
will you be able to
completely remove the
device?
• What are my options
if this surgery does not
correct my problem?
• How will these long
term complications
impact on other body
symptoms or organs?
• What is the management
of these symptoms
once they occur?
How do I know if my
mesh is ‘that’ mesh?
Surgical mesh is
known by many names
and almost all the synthetic
mesh products
on the market today are
made from the same polypropylene.
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These medical implants
are made by many
different companies and
go by all types of names
ie TVT, Sling, Tape, Patch
or mesh.
If you are told by your
surgeon that the mesh
being used in your own
procedure is not one of
‘those’ meshes or that it is
“only a 15min operation”
this should be a red flag to
you so make sure you do
your homework.
Surgery should be a
last resort
There are other alternatives
to using mesh
which should be discussed
in great length
with your doctor.
Non-surgical options
should be the FIRST option,
such as physiotherapy
and pessaries and
there are also non-mesh
surgical options available.
It is important to understand
all advantages
and disadvantages of each
option so you can weigh
up the pros and cons of
recurrence against the
potential risk of suffering
with mesh injuries.
Surgical mesh injuries
can be extremely debilitating
and it is unknown
before implantation, who
will go on to develop complications.
I have a surgical mesh
device, should I be worried?
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