| The following chat transcript courtesy of obgyn.net
now Medispecialty.com
Prior Chat Transcripts
Prevention of Post-Surgical Adhesions
David Wiseman, PhD
Wednesday, November 24, 1999
Drwiseman "Ann - do you have any questions?"
Mag "Ok, I have been researching "standards
of care""
Drwiseman "Go ahead"
Mag "What is different about adhesion prevention/removal
in Sweden?"
Mag "How important is controlling bleeding during
abdominal surgery in a patient with a history of severe
endometriosis and adhesions?"
Pudy "Dr. Wiseman is there any test that can
be done that will show adhesions? Such as a CT scan?"
Drwiseman "It is important to control bleeding
for two reasons. 1. The obvious - you don't want the
patient to bleed to death. 2. Blood increases the likelihood
of adhesions. Infertility surgeons know all about this
and attempt to achieve meticulous hemostasis."
Drwiseman "Pudy: there are no definitive tests
for adhesions other than direct observation e.g. laparoscopy."
A_parker "This is my first time here, but I have
been dealing with adhesions since 1987...'"
A_parker "with my last surgery a year ago this
week."
Drwiseman "I see that you are into ultrasound."
Mag "Dr. Wiseman, please go ahead.. Pudy - I
had a PETscan done today, and it will show sites of
inflammation, but not adhesive tissue."
A_parker "And of course, as I sit here and type,
the pain has come back again."
A_parker "Yes, I am a sonographer. :)"
A_parker "So I scan my self ALOT."
A_parker "I was wondering if a cat scan would
show anything."
Pudy "I had a CT scan done hoping that it would
show the adhesions in my bowels, or what is going wrong
with them."
Mag "Ann, do you see any patterns that relate
to your pain?"
A_parker "Yes, where my worst pain is.... there
are very dense sonographic echoes."
Drwiseman "Mag - so to conclude - it is very
important to get as good hemostasis as possible - but
that is not always possible."
A_parker "I assume that is the adhesions.. reflecting
the sound waves back to me."
A_parker "Pudy did the ct scan show anything?"
Drwiseman "I have seen some x-rays and CTs of
adhesions. The X-rays were with obvious cases of adhesion
related obstruction. The CTs were in thoracic adhesions
and in ultrasound some adhesions to the incision line
may be detectable by a technique called "visceral
slide" - have you heard about this Ann?"
Pudy "I haven't got the report back yet, I had
it done on Sunday. The stuff going through me though
was the worse pain I had had."
A_parker "No, I have not heard of that technique..
visceral slide..."
Mag "Recent hysterectomy for endometrial cancer:
my uterus was adhered to the last two sections of my
colon and bladder. Surgery ended before adhesions were
all lysed by unspecified bleeding. My research shows
that there are products (Tisseel) that stop the"
A_parker "So Dr Wiseman, how do I get rid of
these adhesions? There has to be a secret to it, somewhere.
The repeated surgeries don't seem to help. :)"
A_parker "And the doctors are getting tired of
seeing me.. except they always tell me afterwards...
gosh.. you WERE full of adhesions."
Mag "Ann - if we are patient, there seems to
be significant cell biology research that could be
a breakthrough."
Mag "in 5-10 years"
Drwiseman "Ann - basically an US of the bowel
beneath the incision line is taken. The patient is "wobbled" caudally
and cranially and if there are no adhesions, the look
of bowel is expected to move a certain distance. If
there are adhesions, the bowel's movement is limited
to a centimetre or two. Obviously this only works for
adhesions near the incision line, and not those elsewhere."
Pudy "Patience is hard when you live with pain
day in and day out."
A_parker "Also, are adhesions genetic? My sister
after her hyst was back in the operating room in 3
months with awful adhesions."
A_parker "Hmmm, I am going to try that on myself.
Thanks Dr."
Drwiseman "Mag: there are a number of products
available for hemostasis, including Tiseel. without
seeing the actual operation it is difficult to know
why it was stopped early."
A_parker "Oh I am patient, just frustrated, as
we all are. And sad that this something we have to
deal with."
Mag "Dr. Wiseman: I work for a Finnish company
- a colleague had minor outpatient surgery and they
used some sort of adhesion barrier. Is it standard
in the Nordic countries?"
Drwiseman "Here is the reference for the technique:
1. Uberoi R, D'Costa H, Brown C, Dubbins P. Visceral
slide for intraperitoneal adhesions? A prospective
study in 48 patients with surgical correlation. J Clin
Ultrasound 1995; 23:363-6."
Pudy "What I don't understand is why I have good
days and bad days, good hours and bad hours. And why
after 2 years are they now so unbearable. What happened?"
A_parker "Thanks very much for the reference."
Drwiseman "I don't know how standard it is there
- but I know that INTERCEED and Seprafilm are available."
A_parker "I wish I could answer that for you
Purdy. I keep telling myself this time I just will
live with it and then when my quality of life becomes
interfered with and I am back at the surgeon begging
for the lysis even though I know it wont last forever,
but any relief is always wonderful."
Pudy "Can adhesions grow?"
Mag "The gynecological oncologist surgeon didn't
believe me when I told her pre-op that laparoscopy
had diagnosed the complete adhesion to my colon - no
plane for the laser to lyse it- in 1988 - so it looks
like she was only going to deal with the cancer."
Drwiseman "Can adhesions grow? They don't grow
in the sense that a cancer grows. Adhesions are scars
which undergo a maturation process. They go from filmy
web like things to thick tough bands or attachments."
A_parker "Dr Wiseman.. some doctors tell me to
get up soon after surgery, that will help the adhesions
from reforming. Some tell me to lay still for weeks
that will keep it from reforming. That some doctors
say do a lysis, then six weeks later another one....
it is so confusing."
Pudy "What is a lysis? This is a good question."
Mag "After four hours, she decided the bleeding
was reason to end the surgery."
Drwiseman "Mag - why didn't the gyn believe you
- surely the info was in the notes?"
Drwiseman "Lysis = cutting adhesions"
A_parker "I had one doctor get mad at me after
one surgery when he stuck the trocar of the laparoscope
into my bladder, because it had been moved because
of the adhesions and said he would NEVER operate on
me again. What is up with that? I just think doctors
get frustrated because they have no answer."
Pudy "In what ways can adhesions be cut and what
are the best ways?"
Mag "No notes - the referring gyn (very prominent)
was new since 1994 when menopause became my problem.
He referred me to surgeon., but I gave her the name
of 1988 gyn."
Drwiseman "Ann - movement - I don't know that
anyone has studied this in the abdomen, but it would
seem to me that movement is a good thing. We know that
for adhesions in the limbs movement is definitely a
good thing - and this may also help in the abdomen.
Many years ago people tried eating iron filings and
then moving a magnet around the belly to keep the bowels
moving."
Mag "She complained about HMO reimbursement,
so I figure she cut time - pre-op prothrombin time
was very high and she ignored that, too."
Drwiseman "Regarding early laparoscopy, there
is some benefit of doing early lysis of adhesions because
they will be easier to cut than later."
A_parker "Dr Wiseman I am new here.. so tell
me.. how did YOU get interested in this subject.. and
I am appreciative that someone is."
Drwiseman "Doctors get just as frustrated with
adhesions as you do. Mainly because they cause so many
problems and they can do little about them."
Pudy "Does anyone try any supplements to deter
the formation of adhesions. I seem to be getting relief
from the supplement MSM. I have been feeling alot better
lately and I have been increasing the dosage."
A_parker "What is MSM?"
Drwiseman "One of the biggest problems with adhesions
is the risk of doing some damage at a reoperation -
as occurred in your case."
Drwiseman "MSM - I have had one or two people
tell me about MSM and they have reported that it may
do some good. Tell me more about how much you take
etc."
A_parker "Yes, that is one of the risks and I
do understand that."
Drwiseman "Perhaps you could email me afterwards
with some information."
Pudy "I already have Dr. Wiseman."
Drwiseman "Perhaps it was you I was thinking
about."
A_parker "Is MSM a vitamin?"
Mag "Dr. Wiseman, would the Joint Council of
Hospital Accreditation be a place to start "lobbying" for
standards of care for adhesions during surgery?"
Drwiseman "How did I get interested in this?
I started working on this about 12 1/2 years ago -
and haven't stopped. It is clearly an important medical
problem. Many people write to me about it and I am
happy to try to help them."
Mag "But what vitamin?"
Drwiseman "MSM is some type of dietary supplement
- I don't know much about it."
Mag "There seems to a lot of research on preventing
adhesions during brain, heart, and orthopedic surgery."
Pudy "MSM is a organic sulfur, that is stored
in every cell of the body. It reduces scar tissue by
altering cross-linkages which contribute to scar formation.
It reduces pain and inflammation."
Drwiseman "Methyl Sulfonyl Methane - I think
I have found your email."
Pudy "Yes."
Pudy "I get mine at the Health food store."
Drwiseman "It was you."
Drwiseman "Mag - the most research is actually
done in pelvic surgery"
Mag "Glad to hear it, thank you."
Pudy "I have done more research and am convinced
that after my next surgery to correct bowel problems
I am going to be sipping MSM and taking the tablets
when able."
Drwiseman "Has any one tried anything else -
homeopathy for instance?"
Pudy "No."
Drwiseman "How much is a bottle of MSM - what
does it come in - tablets, liquid?"
A_parker "I haven't tried anything but Motrin
and it keeps it tolerable."
A_parker "But the fatigue that I feel at the
end of the day is what drives me to distraction. I
know I am so tense all day trying to cope that I am
just worn out at night."
Drwiseman "How quickly did you get a response
from the MSM - how long did you have to take it?"
Mag "I've been drinking chapparal tea most days
since surgery in July, but can't tell if it's helping
because I think it's pretty bad in there, because of
the bleeding but at least I can tolerate the pain,
so far. There is a herb, yellow parilla, which is supposed
to inhibit formation of scar tissue."
Pudy "It comes in a 8 oz powder form at $16.00
and 60 tablet form at18.00."
A_parker "Does it taste bad? The powder."
Pudy "I started to feel better in about 4 days,
but I was pretty bad. My husband, when the scar tissue
in his knee acts up I put it in his drink and it takes
about 3 days."
Drwiseman "If you stop taking it what happens?"
Mag "But yellow parilla can be toxic to liver,
and not available. Source: Indian Herbalogy of North
America, Hutchens."
Pudy "It doesn't have much taste in juice - he
didn't know for awhile . It is supposed to inhibit
and reduce scar tissue formation and help with the
inflammation. It seems to have helped me. I just wish
I would have known about it earlier. I stopped taking
it and decrease"
A_parker "That is very informative purdy. I think
I will look for it in the health food store here."
Drwiseman "What does "stop taking it and
decrease mean?""
Pudy "Sorry.. I stopped taking it about 6 months
ago when I felt better and it has come back with a
vengeance."
Drwiseman "How quickly did it come back?"
Mag "Yes, thanks pudy"
Pudy "That means my hands are quicker than my
head."
Pudy "In 5 months."
Pudy "I am now functional - still in pain but
at least I have good days and bad days, good hours
and bad hours."
Drwiseman "Perhaps it means you need to take
it for longer? How long did you take it for (did I
ask you that?)"
Pudy "I took it for about 3 months. I don't want
to ever go off of it if it means this again. I think
my bowels are so screwed up now surgery is the only
answer, then the MSM."
Mag "Do women with a history of endometriosis
tend to have worse levels of adhesions?"
Pudy "GOOD QUESTION!"
Pudy "Can the endo and adhesions be intertwined?"
Mag "Is there any relationship (bad adhesions/endo)
with exposure to dioxin or other environmental toxins?"
A_parker "Well I did have endometriosis also."
Mag "Pudy, I think so, in terms of severity of
adhesions. They are so common, but we have our lives
altered."
Drwiseman "Adhesions are associated with the
more severe forms of endo. In that sense they are intertwined.
The adhesions that form are the result of endo rather
than surgery."
Pudy "Something that helps me with the pain is
Advil and a product called APS-II. It is a Nature's
Sunshine product with White Willow Bark, Lettuce Leaves,
Valerian Root, and Capsicum. The combo helps the pain."
Drwiseman "If the patient comes back for surgery
the question is - if endo is present will the reformation
of adhesions be worse than if there is no endo - I
suppose that it might be but I don't know that anyone
has proven that statistically."
A_parker "well, when i first started with this
mess I had endo but it is all gone now and I still
get the adhesions and the pain."
Mag "Really? Any correlation with ovulation,
the release of the egg creating an adhesion (women
with prior endo) my endo did not recur (allergy diet
for 5 years)."
Pudy "Sorry if I sound like a salesman, just
trying to help."
Pudy "What did your allergy diet include or exclude?"
A_parker "Oh no purdy... you don't sound like
a sales person, just a nice person trying to share."
Drwiseman "The disappearance of endo will not
make the adhesions go away. If adhesions are lysed
they will inevitably come back - and so will the pain
(remember that not all adhesions cause pain and not
all pain causes adhesions)."
A_parker "Well, hmmm.. I would like to request
the adhesions that don't cause pain.. :) where do I
sign up?"
Pudy "My gyno wants to take my last ovary. He
says that the hormone flux is causing some of the problems."
Drwiseman "I don't think there is a relation
between ovulation and adhesions - I think that during
ovulation - enzymes are released that limit adhesions
- although perhaps in some people this goes wrong."
Drwiseman "We will have to go in a few moments
- any last questions?"
Mag "Also, endo replaced by adhesions, which
are far worse. Pudy, white willow bark is like aspirin
it was the Candida diet - no dairy, no grains, nothing
fermented, no sugar, no caffeine + green tea. acidophilus,
anti-fungals."
A_parker "Thanks everyone.. and thanks to you
Dr. Wiseman."
Pudy "Pretty much the diet I put myself on."
Mag "And my hypothyroidism was finally diagnosed
and treated."
Pudy "Thank you Dr. Wiseman you are a big help."
Drwiseman "Keep in touch and if you haven't done
so already visit http://www.obgyn.net/adhesions.asp
- you can sign up for the Int Adhesions Society (IAS)
at the end of the article on " A patient's guide
to adhesions"."
A_parker "Thanks.. and goodnight."
Drwiseman "Signing off...."
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