||| June 05, 1999 10:51 PM
I am sure by educating ourselves as to the etiology of this disorder, we will be better prepared to address our treatment and even dictate what we think must be done to us in the event we choose to have an adhesiolysis done. I think I DO know a fairly correct theory on the etiology of adhesion formation.
||| July 8, 1999 12:03 PM
Having had long discussions with pathologist friends of mine as well as surgeons, it is perceived that the peritoneum will generate pain ... but there doesn't appear to be pain pathways on the external intestines. I feel that this is a true perception as I did not experience any other pain at any time throughout my 14 years with adhesion disorder.
In my two previous adhesional lysis, I experienced pain always in the lower right quadrant; and in each of those operational reports, I have ONE attachment to the peritoneum in that area!
I ask you all to secure your own operative reports for your own study, to acclaimate yourself to the PROBABLE adhesion attachment sites that you have; and then compare those sites to your pain area. This will give you a semblance of awareness of why you suffer the symptoms that you do.
Keep in mind, each consecutive surgery might produce more adhesions; but you will probably be able to get a decent idea of your adhesional involvement
||| June 08, 1999 10:38 AM
Dear Friends,
I am sharing my experience of surgery performed under Dr. Harry Reich of New York City; since a number of you asked about it in greater detail. Please keep in mind that this is MY surgery and that each one of us has a case history unique to each one of us. I also am stating MY interpretation of how the body responds to and creates adhesions, as I understand that physiological process.
Previous to consenting to Dr. Reich's adhesional lysis procedure, I requested a copy of it so that I could determine for myself what was being done differently than the other adhesional lysis, which I had. I also checked out his credentials with the AMA - all very outstanding recommendations. I then asked for statistics of the surgery; and, even though he has not kept a following of his patients, he does have some figures on it and it looked to be the higher % of success for non-reforming adhesions with his procedure.
I also was put in contact with a woman who had undergone his lysis last June. We talked at great length ( e-mail ) and we continue to do so. She was a wealth of information and encouragement for me...and you can be assured that I am watching her case closely as it parallels my adhesional history very closely. Dr. Reich also videotapes his entire surgery for you.
Dr. Reich's theory regarding non-reforming adhesions is: "The solution to pollution is dilution!" And he stands by that phrase yet today.
This procedure is done through a minimally invasive route. One small incision in the navel for camera, two 1" to 2" incisions on each side of the lower abdomen for instrument use. Dr. Reich is the only ambidextrious surgeon in the United States - and that is a plus for us!
He does a diagnostic look-around upon entering the cavity -- looking for any invasive pathology besides adhesions. He evaluates the situation and then determines his plan of treatment. In the event that there are dense adhesions, he proceeds to dissect (separate) them. This is not an easy process and is very involved.
I can understand why most doctors do NOT want to challenge themselves doing a lysis, which is dangerous and tedious - as the doctor is working right up against and around the intestines, etc.
Based on Dr. Reich's vast experience with laparoscopic surgeries, he has developed a technique like no other surgeon in the world! That is why he has the reputation as being the best laparoscopic surgeon in the world!
It was the clean-up at the end of his surgery that impressed me the most; and was also the reason that I chose to go to him and have this done! He cleans out almost EVERY piece of clotted blood that is in, around, under, and virtually all over in the abdominal cavity following the surgery! He feels that it is this residual clotted blood that the anti-bodies in an adhesion-former's system respond to as "foreign" -- and thus creates an adhesion over it to protect the internal organs! Now, this is exactly how our bodies defense system works!
Think about your getting a sliver (externally, of course). What does our body's defense system do to that foreign body? It sends out the leukocytes and creates an "infection" to get rid of it -- right? Internally, one of two types of defense systems kick in when there is a problem:
1.) If our appendix ruptures, we get peritonitis ( an internal infection -- like pus or white blood cells that spill into the cavity ). Those white cells are responding to an inflammation in the appendix and build up and burst; but it WAS a defense mechanism as well. Peritonitis can kill us as the body has no way to rid itself of that infectious drainage; and it infects the surrounding internal organs as well. In defense our body sends the leukocytes ( white cells ) to the area of "infectious drainage."
2.) Because there is an active infectious foreign body in the abdominal cavity, our body will attempt to "CONTAIN" that poison to protect the other internal organs from damage! These white cells form a material called "fibrin," which is the sticky stuff in the blood. The fibrin starts to cover the infectious material and then you have what is called an "ADHESION!" Now, adhesion means "to stick together." In the abdominal cavity -- filled with lots of organs in very close proximity to one another -- what do you think will happen? Abdominal organs become attached to one another -- everywhere that the infectious drainage touched!
Let's look at that same reaction now using the clotted residual blood following your internal surgery. Blood is found throughout the cavity from any area of surgery or ischemia ( areas scraped or cut -- causing an area that bleeds ). In the cavity this blood dries very fast -- VERY FAST!
Now, 99.9% of surgeons DO NOT clean up the residual blood clots thus leaving that in, around, and under your internal organs. Your body sees this blood as a foriegn body and sends out the leukocytes and thus forms adhesions wherever these clots of blood are. Because fibrin is sticky, some of these organs become attached to the peritoneum ( innermost tissue of the abdominal wall ) causing pulling and inflammation at the attachment sites -- thus causing PAIN and eventually a decrease in our physical mobility. That pain is from the attachment to the peritoneum. Other organ to organ attatchments, if any, don't cause pain; but these other organ to organ attachments can cause:
1. Bowel obstructions
2. Painfull and difficult bowel movements
3. If some adhesions attach the bowel to the vaginal wall, these can cause painful intercourse as well.