| The following chat transcript courtesy of obgyn.net
now Medispecialty.com
Prior Chat Transcripts
Prevention of Post-Surgical Adhesions
David Wiseman, PhD
Wednesday, March 24, 1999
Drwiseman "Hi, are you here for the adhesions
chat?"
Jeffsbaby "My name is Becky (jeffsbaby) am I
finally at the right place?"
Drwiseman "Do you want to talk about adhesions?
Then you are in the right place."
Jeffsbaby "Yes sir, I do."
Drwiseman "Well what would you like to know?"
Jeffsbaby "I am post op TAH/Bso/ appendectomy
5 months....and"
Jeffsbaby "This constant chronic pain in my abdomen...have
had cat scan with contrast x2 and shows nothing"
Drwiseman "What did your doctor say?"
Jeffsbaby "I have a drs appt. tomorrow with my
surgeon, and he wants to do a laparoscopic to dx. possible
adhesions...I am in constant pain, exacerbated by sex
as well..."
Jeffsbaby "Have never had abdom. surgery prior
to this, and never had adhesions...I am frightened
about the possibility of adhesions for I know they
come back after they are removed...??"
Jeffsbaby "Can adhesions be diagnosed any other
way then a lap?"
Jeffsbaby "What questions should I ask my surgeon?"
Drwiseman "The possibility of recurrence is reduced
(but not eliminated) if an adhesion barrier is used.
you should speak to your doctor about that."
Drwiseman "You should ask him/her what s/he will
do if they find adhesions - will they cut them, leave
them etc. you should also ask about endometriosis."
Jeffsbaby "I read my path. report from my hyster.
and no endometriosis was mentioned....but if they are
left how do you manage pain?"
Drwiseman "You need to work with a pelvic pain
specialist. There are a variety of methods, but I have
no way of saying which one you should try first. I
would ask your doctor tomorrow if s/he can map your
pain during the laparoscopy. It seems important to
determine if you have adhesions, whether they are the
cause of the pain. Sometimes they are not."
Jeffsbaby "Map pain?"
Jeffsbaby "Do they not show right up, easily
visible via lap? clear cut diagnosis?"
Drwiseman "Basically the laparoscopy is done
under local anesthetic and the surgeon is able to determine,
with your cooperation, the exact source of the pain.
Sometimes this is an adhesion and sometimes it is not.
Adhesions show up - you can see them straight away."
Jeffsbaby "Well that's good, easily diagnosed.
Do they form this quick...post-op 5 months, pain for
about 3 weeks solid?"
Drwiseman "Adhesions certainly do form that quickly.
They do not always give rise to pain or other problems,
and they do not always do so straight away."
Jeffsbaby "Wonder what else could be the source
if the CAT w/ contrast was clean? (broad question I
know)"
Drwiseman "That will be for your doctor to figure
out."
Drwiseman "You should ask your doctor to list
the most likely causes in your case."
Jeffsbaby "My pain is like a twist feeling, a
cramp-like feeling, a knot feeling? Sound like adhesions
to you?"
Drwiseman "Knot twist: it certainly matches other
people's descriptions of adhesion related pain, but
again it matches other kinds of pain too."
Jeffsbaby "Do you have to have a lap to dx. adhesions?"
Drwiseman "We have no way of diagnosing adhesions
indirectly e.g. by x ray, cat scan etc. The only way
is to to a laparotomy or laparoscopy."
Jeffsbaby "What is an adhesion barrier...and
how are they removed ...cauterized, cut, what? In how
many percentages does a person have to have repeat
surgery for adhesions? I don't mean to be taking up
all your time, anyone else please jump right in!"
Peggyk "I had one laparoscopy in Oct. which revealed
severe adhesions. Dr removed what he saw but I still
have all the pain."
Peggyk "He is prescribing another lap in April."
Peggyk "Is there any other way?"
Caprine_latte "Sorry, every time I hit the backspace
button I am booted - this is the mailing list Karen"
Peggyk "What causes the adhesions"
Peggyk "Is it poor surgical technique?"
Drwiseman "Good questions: an adhesion barrier
is a device - a kind of band aid used inside the body,
that is placed over the organ where surgery was done
to protect it from forming adhesions. The barrier is
left in place because it dissolves by itself after
a few days. About 3% of patients overall may need repeat
surgeries for adhesions - although this is a very difficult
number to explain."
Drwiseman "Hi everyone else: welcome to Karen
our mailing list guru!"
Jeffsbaby "So the barrier should have been used
during my hyster. to PREVENT the adhesions?!"
Caprine_latte "brb - trying to help someone log
in with out being booted. Excuse the typos - I cannot
fix them."
Drwiseman "I feel that adhesion barriers should
be used on most occasions in order to reduce adhesions."
Jeffsbaby "No adhesion barrier was noted in my
operative report."
Guest22 "Can adhesions actually "crowd out" organs?"
Drwiseman "Peggy: sorry did not get to your question:
what causes adhesions? Poor technique: it seems that
technique is very important. However even the best
surgeons still get adhesions."
Jeffsbaby "I am taking motrin 800mg. for the
pain, are narcotic-type meds suggested or normal for
adhesion pain, I feel I need more pain relief?"
Peggyk "Poor technique can cause but no way to
really prove it?"
Drwiseman "Peggy: currently the only way to treat
adhesions is to cut them and to use an adhesion barrier.
This will cut down the chance of recurrence, but will
not eliminate it. You need to speak with your doctor
about that."
Guest22 "Y, can adhesions actually "crowd
out" organs?"
Drwiseman "Peggy: poor technique can cause -
but no way to prove it - that's right."
Caprine_latte "I take a lot of narcotic pain
meds...they don't make me drowsy, I don't take more
than prescribed, I'm not a druggie, and they help but,
they don't come close to taking pain away although
I can live a semi-decent life now."
Peggyk "I did speak to my dr. about this and
he told me that adhesion barriers can't be used on
large areas"
Jeffsbaby "This is horrible.....after all I went
through with my TAH/BSO/appendectomy and all the complications
post surgery then to get adhesions...."
Drwiseman "Can adhesions crowd out? In a certain
sense they can."
Guest22 "I have had several laps to remove adhesions
from my intestines to the wall of my stomach."
Jeffsbaby "And guest....do you still have the
pain?"
Drwiseman "Peggy: adhesion barriers on large
areas: there is no basic objection to using them over
large areas other than we have no data to support (or
to refute) this idea. Most of the studies that have
been done have been over relatively small areas."
Jeffsbaby "My pain NEVER leaves....worsens and
lessens but never leaves ...is this the case with you
all too?"
Guest22 "But now they tell me that the problem
is that the adhesions have built up behind my intestines
and they are crowding my organs out, is this possible?"
Guest22 "The pain is absolutely terrible!"
Drwiseman "Guest 22 : yes that is possible"
Jeffsbaby "What do you take guest...I'm gonna
ask my dr. tomorrow for something stronger than this
motrin...I can't take much more...have only been married
less than 2 years and sex is so painful..."
Caprine_latte "My pain changes over the course
of a day...and over the course of weeks...it gets to
a point of me not being capable of function...I have
other changes with the pain too.,"
Guest22 "I take several different things..."
Caprine_latte "If it were not for pain med ...there
would be no sex."
Jeffsbaby "So Drwiseman what is the solution
to the adhesions...it sounds like a never ending circle
of debilitation?"
Jeffsbaby "Just give me an idea of what helps
you (meds) so I may ask my dr. tomorrow..."
Guest22 "Fentanyl for long term relief, short-term
demoral, 750mgs Robozin, and 10mgs of Bentyl"
Peggyk "Dr. Wiseman, I had a post operative infection.
Would this be a main factor for adhesions?"
Jeffsbaby "Thanks guest....I wrote them down."
Jeffsbaby "Has anyone else here developed adhesions
from hysterectomy?"
Jeffsbaby "or appendectomy?"
Guest22 "Is it true that if you've tried adhesion
barriers and had no positive results the only thing
left is to keep taking pain medication and only do
laps when absolutely necessary until something new
comes out on the market?"
Drwiseman "What is the answer to adhesions? I'm
afraid there isn't one yet. The best solution right
now is for doctors to use careful technique and then
to use an adhesion barrier if possible."
Guest22 "My adhesions are from a hyst."
Guest25 "Drwiseman, it's Jonesy, hi. Any idea
yet more definitely when the Intergel will be available?"
Drwiseman "Post-op infection: that is certainly
a factor as infection can increase the possibility
of adhesions."
Peggyk "Right now I am taking hyphen 7.5/500
2 every 4 hrs. along with naproxin 500 1 every 8 hrs.
and this seems to be working for me."
Jeffsbaby "Oh my gosh guest...I'm so scared,
mine haven't been dx. yet, go to dr. tomorrow."
Caprine_latte "I've tried toradol (helps headaches),
some kind of epilepsy drug, amytriptiline, naprasyn,
vicodin, tylenol 3, and many other meds over the course
of several years...I currently take 7.5 Lortab (and
worry about tylenol risk)...aspirin (plain), when intolerable
- morphine."
Drwiseman "Jonesy: INTERGEL: the company has
submitted their data to the FDA. If everything goes
smoothly then they may have approval by the end of
the year."
Guest22 "I've tried all of those you listed,
about the only thing that works for me is the "hard" stuff"
Guest25 "So, the time I heard about June or July
is probably not going to happen ?"
Guest22 "I haven't been able to keep anything
solid down for over a month."
Drwiseman "June/July is unlikely to happen."
Guest22 "Since my hyster. I've lost over 100
lbs"
Jeffsbaby "Dr Wiseman, do you routinely give
narcotics for this pain and do you do repeat surgeries
for adhesions."
Guest25 "Dr., anything we can do, to help them
hurry along?"
Jeffsbaby "What exactly about 'technique' can
cause the adhesions?"
Peggyk "I was really happy to find all the information
about adhesions on the internet I thought that I was
going crazy with having this pain until I read about
all the other people that suffer with adhesions like
I do."
Caprine_latte "I cannot have any more surgery
unless it is a life threatening emergency...I've had
fecal purulent peritonitis twice now, do have a question
though..."
Drwiseman "Jeffsbaby: please note that I am not
an MD and do not treat patients. Narcotics are given
by many doctors."
Jeffsbaby "I'm sorry ....."
Drwiseman "Can we hurry things along (with INTERGEL)
: I don't thinks so, the answer is in the hands of
FDA."
Guest25 "Thanx, Dr......."
Drwiseman "If you want to help research into
adhesions directly you should email me (synechion@aol.com)
and we can talk about it further."
Drwiseman "Karen: what do want to ask?"
Caprine_latte "I've begun to have "bowel" changes...I'm
losing weight...pain (different)...wondering if it
could be the adhesions...it's happened over a long
period of time but now is causing a problem...I feel
like swearing off eating."
Guest22 "I was told that about the only thing
for those of us that have tried everything out there
so far is to get on a research list at a research hospital;
however, if your body reacts as crazy as mine does
to a lot of things then there is no way they would
put you on a research list."
Guest25 "Research list, as in guinea pigs??"
Jeffsbaby "Me either guest 22"
Drwiseman "Karen: if you are losing weight, there
could be a number of causes of that. You should get
a check up."
Guest22 "yes"
Caprine_latte "Well, they have to test it somewhere
and if you hurt like this...it's an option that begins
to look appealing."
Lauri "-Hi, My Name is Lauri, I keep getting
these banner ads , and then it cuts me off. Help???"
Guest25 "I understand."
Lauri "I have had five abdominal surgies, last
one TAH/BSO."
Jeffsbaby "I got along just horrible with my
hyster...from start to finish, and am a reasonably
healthy emotionally stable woman."
Jeffsbaby "oh my Lauri..."
Lauri "I think I have adhesions constant pain."
Guest25 "Drwiseman, is that info. on Lifecore's
page, about Intergel?"
Jeffsbaby "do you have the adhesions...."
Vhc "Hi everyone! I've had a TAH/BSO and one
year later another lap was done to remove adhesions
that were twisting my colon...three months later I'm
doing well...how long will that last?"
Drwiseman "Guest25: I'm not sure where that info
is. You should check out LCBM's page and press releases."
Caprine_latte "Doc thinks it is adhesions but
no way other than surgery to tell...I have severe dense
adhesions...that is a known...but it's like putting
together a mystery...symptoms are not bad enough for
me to warrant surgery (doc would like it though)...could
adhesions play havoc on a colostomy (I don't have any
intestinal diseases)?"
Jeffsbaby "that's what I' m dealing with too
Lauri, haven't been dx. yet...TAH/BSO/appendectomy
now, constant pain in abdomen."
Drwiseman "Jeffsbaby: no I don't have adhesions."
Guest22 "What is this you're saying about technique?
I have done quite a bit of research and this is the
first time I've heard about technique causing them."
Vhc "Doctor...in what cases do you think additional
surgery is warranted?"
Lauri "What are the pain symptoms of adhesion
pain?"
Jeffsbaby "No, not you Dr. Wiseman...tee hee....Lauri...sorry..
tee hee (this chat thing gets confusing sometimes)"
Lauri "I do not know yet, one dr. wants to do
a pelvic cat scan, but I heard that is not a way to
dx. adhesions."
Jeffsbaby "Dr. Wiseman said technique can be
responsible for adhesions....guest 22"
Drwiseman "Technique: it is quite well accepted
(at least by Gyn doctors) that careful surgical technique
can reduce adhesions. There are certainly some doctors
who have a very gentle and meticulous technique and
who seem to get fewer adhesions than others. Among
general surgeons, this is not as well understood."
Vhc "Lauri....I've had several cat scans and
they did not show my adhesions"
Drwiseman "Please understand though that even
the doctors with the best and most gentle technique
can still have adhesions in their patients."
Guest25 "Drwiseman, thank you for the info concerning
the Intergel."
Jeffsbaby "Me too, had 2 cat scans with contrast,
pelvic ultrasound...showed no adhesions...have to have
a lap for that ...Lauri."
Drwiseman "Cat scans do not show adhesions"
Lauri "Again I ask I have constant pain in the
lower pelvic area, is adhesion pain that way, I always
have had endo too"
Guest22 "I understand now, they say mine isn't
due to technique but from blunt abdominal trauma less
than a week after my hyster."
Drwiseman "Sorry Lauri: adhesion pain can present
in a variety of ways. There is no "one" type
of adhesion pain"
Lauri "I thought my hysterectomy was going to
be my answer to end my pelvic pain."
Drwiseman "I'm sorry it wasn't."
Peggyk "Me too Lauri"
Jeffsbaby "Amen to that Lauri ...me too...I wish
I had never had it (hysterectomy)."
Lauri "Is a diagnostic lap the only way to dx.
adhesions?"
Vhc "I'll third that Lauri....when I found out
I should have more lap surgery this last Dec. talk
about frustration!"
Peggyk "I have more constant pain now than before
the hyster"
Caprine_latte "I've read that some people who
have never had surgery have formed adhesions...they
don't seem to know why...also, doc said that a ct or
mri could only show say, a twisted bowel (possible)
or something wrong with the loops of bowel which he
infers could be the result of the adhesions...but they
can't see them unless it's with their eyes."
Guest25 "Bye, all, God bless, and Good Luck."
Jeffsbaby "Me too Peggy...oh this is getting
depressing..."
Lauri "Me Too, although it has helped my back
pain and period pain, now my mind crazy!!!"
Vhc "Doctor.....have any studies proven that
exercise helps with adhesion pain?"
Jeffsbaby "hey guest?"
Peggyk "At least we're not alone in this."
Jeffsbaby "Are you familiar with the hystersister
mailing list?"
Drwiseman "Lauri: a diagnostic lap is the only
way to diagnose adhesions. Whether they cause adhesions
is another matter."
Jeffsbaby "Can laps themselves cause adhesions
too?"
Guest25 "which guest?"
Jeffsbaby "Well either one of you, the one that
was leaving, I was gonna tell her about it...the list..."
Drwiseman "Exercise: I know of no studies that
show this. I have heard from some people that certain
kinds of exercise (aerobics, jazzercise, etc.) can
help, but nothing scientific."
Vhc "Jeffsbaby....I belong to the hystersister
list"
Lauri "What is the hystersister list?"
Jeffsbaby "Oh who are you...I do too...if you
wanna tell me that is...vhc?"
Guest22 "Question, those of you that are having
problems with adhesions, what is your age...I'm only
28 and can't seem to find anyone my age that is going
through this."
Jeffsbaby "I think I may know who you are."
Caprine_latte "I know there are exercises that
cause excruciating pain...like the trampoline."
Peggyk "I can't even go for a walk without the
pain intensifying."
Vhc "Doctor...I have been exercising five days
a week for two months and my pains/twinges have eased
substantially.....coincidence?"
Guest25 "Jeffsbaby, what list?"
Drwiseman "Any operation has the potential to
cause adhesions. with a simple diagnostic laparoscopy,
the risk is fairly minimal because no surgical procedure
(other than the laparoscopy) is being done."
Guest25 "Peggyk, I know what you mean!"
Peggyk "It really stinks."
Vhc "Jeffsbaby....my name is Verna....I'm one
of the originals...and you are ?"
Drwiseman "Vhc: it may be coincidence, we can
never know."
Guest25 "Yeah, I know......"
Vhc "Doctor...what is your opinion of Seprafilm
and other such efforts?"
Caprine_latte "I'm 36 and have been dealing with
this for quite a while...all ages are affected though."
Jeffsbaby "Lauri...the hystersister list is an
email group for support of women who have had hyster....go
to onelist.com and look for it,, hystersisters@onelist.com
and chatsisters@onelist.com or email me...mcnally@preferred.com"
Drwiseman "Seprafilm: has made some important
strides in adhesions. However it cannot be used by
laparoscopy and is difficult to handle. There are other
things on the horizon that have benefited from the
experience of Seprafilm."
Lauri "Thanks, I can't believe there are so many
women still in pain."
Peggyk "When is this chat on again?"
Drwiseman "OK folks: I'm going to have to go.
One more last question?"
Guest22 "I have had Seprafilm put inside of me,
it slows the adhesions down but they still come back"
Peggyk "Thank You Dr. Wiseman hope to talk to
all again."
Jeffsbaby "Guest 25, did you see my response
to Lauri about the hystersister list?"
Vhc "What in your opinion is the most promising
new technique?"
Jeffsbaby "Thank you Dr. Wiseman, you have given
me great info. for my drs appointment, thank you for
your invaluable time!"
Lauri "Thank You!"
Drwiseman "vhc: there are some drugs and devices
in development that I think will do very well. One
is ADCON P, but it will not be around for some time.
Another is INTERGEL and another is Sepragel. We will
still need something stronger than all of these, but
it is too detailed for me to give you a simple answer
right now."
Lauri "How do some of you convince your Dr. that
your in pain again after a hysterectomy?"
Drwiseman "I'm logging off now. Thank you all
for a lively discussion."
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