| The following chat transcript courtesy of obgyn.net
now Medispecialty.com
Prior Chat Transcripts
PREVENTION OF POST-SURGICAL ADHESIONS
hosted by David Wiseman, PhD
August 19, 1998
Drwiseman "Well we're here to chat about adhesions.
Does anyone want to start the ball rolling"
Christine2 "I had a question, can adhesions resolve
on there own?"
Drwiseman "Only at very early times after surgery
can the filmiest of adhesions resolve (or at least
that is the theory based on animal studies). After
that once it is there, it stays there."
John-m "Do they continue forming even years after
the surgery?"
Drwiseman "Christine2: I guess you have adhesions:
can you tell us something about it?"
Idee "I read recently about a substance that
can prevent adhesions if applied during surgery. Can
you tell us something about that?"
Drwiseman "John: They probably do not get more
extensive, but they will mature. In other words tougher."
John-m "How will "tougher" manifest
in the symptoms?"
Christine2 "I started having problems after a
TAH July '96, had second surgery due to adhesions forming
on the cuff and have pain all the time."
Drwiseman "Idee: There are several materials
that are being used at the end of surgery that have
been shown to reduce the extent, and in some cases,
the severity of adhesions. They are INTERCEED and Seprafilm
(in the USA and Europe) and INTERGEL (in Europe only)."
Idee "Thanx"
Drwiseman "More about them later while I answer
John: "Tougher" may not manifest itself at
all. In fact no one has really correlated the "toughness" of
adhesions with the symptoms. Remember that many people
can have adhesions and not know about it."
Roberta "Dr Wiseman, how do you know if you're
likely to get adhesions. Are their any contributing
factors or warning signs?"
Drwiseman "Christine2's problem is not an uncommon
one. Adhesions form from the bowel to the vaginal cuff
(the part that is left after a hysterectomy). The only
things to do are: 1) endure the pain 2) have an adhesiolysis
with application of an adhesion barrier. Although this
has been done, I know of no data that says this is
effective (in other words I know of no study that has
shown this one way or the other)."
Drwiseman "Roberta: if you haven't had surgery
before there are probably no warning signs. However,
if you have had surgery and you begin to develop problems
due to adhesions, then that is a sign that this may
happen again. Not very predictive I'm afraid, but there
are people walking around who have had 10-15 operations."
Drwiseman "Remember, most people will form adhesions,
it's whether they are a problem or not that is the
issue."
John-m "I'll through this out for comment: I
had a yoga teacher in California who had previously
been a physician in the Soviet Union. She claims that
a form of yoga called "kriya yoga" can reduce
or eliminate adhesions. Kriya yoga involves visualization
and energy manipulations. It's not especially easy
to do every day, or else I might have been able to
offer an opinion on its efficacy. Any opinions?"
Drwiseman "Regarding contributing factors, infection,
endometriosis, cancer, use of intraperitoneal chemotherapy,
radiation, these are all things that will make the
likelihood of adhesions and therefore their problems
much worse."
Drwiseman "I've never heard of "kriya yoga" although
I'm not too up on any kind of yoga. However, I have
heard stories from individuals that certain exercises
can help to reduce or eliminate adhesions. Jazzercise,
aerobic and so on. I would certainly like to find out
more about this, perhaps you can email me with the
teacher's phone number: synechion@aol.com"
Drwiseman "Also the mental state that yoga may
put you in may help you cope with the effects of adhesions."
John-m "The more physical yogas involving stretching
and twisting the abdomen do help in my opinion. I do
the physical exercises (nearly) every day. I'll send
you the yoga teacher's e-mail later."
Drwiseman "John: So you feel somewhat better:
is this completely better, how long does the relief
last? How and where did you develop adhesions?"
Drwiseman "Christine: you mentioned that you
had TAH. What does your doctor suggest regarding the
pain/adhesions?"
Christine2 "First I just found out he (my doctor)
does not believe in the barriers. I will be starting
biofeedback and I will find out next month if pain
management will help"
Drwiseman "Not everyone believes in barriers.
That is a big problem."
John-m "The adhesions are from pyloric stenosis
and a ruptured appendix, many years apart. I believe
the yoga stretching helps because I'm staying out of
the hospital, and seem to feel better when I do the
exercises faithfully. I'm also extra careful about
what I eat, avoiding all raw fruits, raw veggies, and
nuts. They (the exercises) also help my back pain,
which is another reason to keep doing them."
Drwiseman "For the record: Helen (HMD) is a regular
visitor and correspondent. She has found some interesting
sites that I had not seen before."
Drwiseman "John: that seems good advice. What
kind of doctor do you see: GI, General Surgeon? This
is particularly interesting because it is not often
that we get men on this chat and we don't get a chance
to hear about their experiences."
Drwiseman "I'm going to try taking everyone to
a new web site I haven't seen before. If I lose you
I apologise."
Drwiseman "Oh well, that didn't work."
Christine2 "Hmd, if you don't mind could I get
the email addresses to some of them sites you found?"
John-m "My doctors in California were surgeons,
perhaps with GI specialties but I'm not sure of that.
They knew about the barrier studies that came out in
late 1996, and even offered to do an elective procedure
for me if I agreed. This is impressive for doctors
in an HMO to offer such a thing. I declined, feeling
that as long as I can control the worst symptoms (bowel
obstructions and bouts of vomiting) without another
surgery, I'd elect to do so. Also, I thought that I'd
wait until the new barrier technologies mature a bit
if I have that luxury."
Hmd "I found an article by the name of What You
Don't Know Can Hurt You: Knowledge Is Power In A Doctor/Patient
Relationship that I think everyone should read. The
URL is: http://www.obgyn.net/women/articles/comfort/comfort006.htm"
John-m "I forgot to add that I moved away from
California in the spring. I haven't found a doctor
here yet. Haven't needed one (knock on wood)."
Drwiseman "John: sounds like a good approach"
Roberta "How is Seprafilm different than Interceed?"
Drwiseman "INTERCEED vs Seprafilm: INTERCEED
can be used in laparoscopy, Seprafilm can't. INTRECEED
doesn't work well when bleeding has not been completely
controlled, Seprafilm probably does. Seprafilm is use
in general surgery, INTERCEED has shown no data for
that use. INTERCEED is a fabric easy to apply and handle,
Seprafilm is a sheet that is somewhat brittle (although
I understand that Genzyme are about to come out with
a version that is easier to handle, in Europe."
Roberta "Thank you so much Dr Wiseman for coming
to OBGYN.net and doing this chat!"
John-m "My HMO doctor in California had used
Seprafilm one time, the last I spoke to him. He said
that the woman patient had afterward gotten a massive
post-op infection, but that she recovered. That does
seem to be the big drawback with these new technologies,
isn't it?"
Drwiseman "John you raise a good point about
using new techniques. Although Seprafilm is regarded
as safe (otherwise FDA would not have approved it),
there is no way of knowing whether that lady would
have developed an infection anyway. This leaves a bitter
taste with the doctor nonetheless because s/he is never
sure that it was the Seprafilm or not. S/he is therefore
reluctant to use it again. That's why we need to rely
on properly controlled clinical trials."
Hmd "I had to shut down...I was in limbo and
had to go the scan disk process, etc. Christine 1 contact
me at: olddad66@runestone.net and I will send you a
list of URLS related to chronic pain and adhesions."
Hmd "Are you looking for Dr. Bradley's article
about pelvic adhesions?"
Drwiseman "Yes: I posted it above here: can you
see it?"
John-m "Nahhh! I must have something set up wrong."
Drwiseman "It might be me. John (and everyone
else) if you send me you email address I will put you
on the mailing list for future events re: adhesions"
Hmd "No, I can't. I have this article on my list
too. John-m: contact me for a copy that I have assembled
together."
Bruce "I believe the article URL is http://www.obgyn.net/women/articles/bradley/banter_0615.htm"
Hmd "Yes, that is the URL, Bruce."
Drwiseman "Well the hour is almost up: anymore
questions about adhesions?"
Hmd "What can you tell me about INCERT?"
Drwiseman "INCERT: is a material in the early
stages of development from a company called ANIKA.
They just published an animal study. They are a long
way off and won't start clinical trials until next
year."
Drwiseman "Back again in time for the end. I
hope that this has been helpful. Anymore questions
or comments?"
Drwiseman "Thank you"
Drwiseman "Thanks: Bye for now"
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