Bev's Adhesiolysis - with Harry Reich, MD as her surgeon

From: Helen Dynda (olddad66@runestone.net)
Fri Sep 6 00:22:40 2002


Who is Beverly Doucette? Many IAS members know who Beverly Doucette is - and for the benefit of those who don't: Bev is a former RN, from Wisconsin, who had to let her license lapse when she became so terribly ill as a result of adhesions. When Bev had her adhesiolysis on April 22, 1999 - she chose Dr. Harry Reich to be her surgeon. As a result of that surgery, Bev continues to be pain-free today!!!

Bev sent me a copy of the video from her 5 hour surgery - and I actually saw Dr. Reich slowly and very carefully lyse the mass of adhesions, which had enclosed and trapped her bowels. For the very first time I could really begin to understand how painful bowel adhesions must be. When the bowels are attached together - or attached to the abdominal wall by adhesions - this prevents the normal flow of digested food through the bowels causing problems such as constipation, nausea, and bowel obstructions.

In gratefulness to God and to Dr. Reich for having had her health restored, Bev has become a very active Outreach Worker for the International Adhesions Society!!! Many International Adhesions Society members can attest to the fact that Bev has been there to help them.

Bev posted the following messages on the International Adhesions Society (IAS) Message Board on:

X> 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 know a fairly correct theory on the etiology of adhesion formation.

X> 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 believe 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 adhesiolysis, 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 current adhesional involvement

X X X X X X X X X X

X> June 08, 1999 10:38 AM

Dear Friends, I am sharing my experience of having had 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 adhesiolysis procedure, I requested a copy of it so that I could determine for myself what was being done differently from the other adhesiolysis, 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 in June 1998. We talked at great length (by 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 the 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 by 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 I chose to go to him to 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 believes 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 body's defense system works!

Think about your getting a sliver (externally, of course). What does your 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 - because 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 them 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 and 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.

Dr. Reich uses a procedure called " aqua surgery." He constantly flushes the cavity with ringers lactate (a type of compatible fluid to the human body - like saline); and he finds the fibrin strings and removes them bit by bit - a wonderfull cleanup job (on my video). If someone would have told me he could clean up the cavity as good as he did - and I had NOT seen him do it - I wouldn't believe them!

His theory is that if the cavity is cleaned of the clotted blood, the body's defense system will have less to react to - thus reducing and possibly stopping the reformation of painful and distructive adhesions. He also leaves 3-4 liters of ringers lactate in the abdomen following his surgery. It takes about 48 hours for the ringers lactate to dissipate out of the body (lots of peeing goes on).

I was not shaved, had no urinary catheter in place nor a gastric nasal tube (when I awoke in recovery) following 5 hours of surgery; and I was back in our suite in less than 4 hours following the recovery room. Sure, I had surgery pain; but I also had both ovaries removed and two tumors! One very large tumor had attached to the right side of my colon on the left side of my peritoneum. My colon was totally twisted over and attached! No wonder I hurt and couldn't have a BM on my own!

How am I now? I'm a tiny bit sore on the lower right; but that is from an organ removal. No adhesion pain, No backaches, No pain pills; and a smile on my face that only a crowbar could remove! I had been on the following:

1.) Pain medication

2.) Anti-inflammatory medication - You need to be on at least 1500 mgs a day if you are suffering adhesion pain!! This medication is to help combat the inflammation caused by the pulling of the organ(s) at the attachment site(s). You can bet you have something attached to the peritoneum at this time - and it is pulling and doesn't like that!

3.) Antacids - for irritation of the esophagus and stomach from years of drugs.

4.) Sleep and pain meds at night

5.) Laxatives - and you know what that was for!!

No more!! I take a 500 mg chewy for calcium and Vitamin E for heart muscle; because I refuse to go on hormone replacement until I present with symptoms - and I haven't yet!

Dr. Reich will state that his procedure is not a sure thing; but statistically, his lysis patients have shown a great reduction in reforming adhesions following his lysis.

I discussed Dr. Reich's procedure with a local surgeon - as well as a pathologist, who our son works with - before I agreed to have it done. I also sent them my post-operative reports that defined the locations of previously lysed adhesions in both my abdomen and pelvic cavity. During a routine autopsy they instilled 3-4 liters of ringers lactate to raise the abdominal wall away from the intestines to determine if, in fact, an adhesion could reform and reach the abdominal wall - to attach itself from the intestine. When there is that much ringers lactate in the cavity (that type of attachment was the only cause of my pain); and when organ attachment involves the peritoneum, you have pain! (I had that in both previous lysis). It did raise the abdominal wall a good 3 - 4 inches; and in all probability, an adhesion would not be able to attach.

I hope this synopsis has provided you with helpful information. Please educate yourselves to all that you can about adhesion disorder; and then call for a sit-down consultation with your doctor to discuss all areas of adhesion disorder. Many times the doctor is as scared and frustrated as we are - as to what to do for you! So take information to your doctor!!

Also re-evaluate your medications!! You must be taking an analgesic (pain med) on a consistent basis for it to be effective in your system to combat the pain. It is also imperative that you take an anti-inflammatory.

As for an MRI, Cat Scan - or any other high tech medical test for a person with a history of adhesions - I believe it is a waste of money and time. A simple ultrasound and abdominal x-ray will detect any abnormal pathology in the abdomen. If you are suffering from the same type of pain in the same region - as with your previous adhesion problem, then you surely don't need anymore tests - if an ultrasound proves to be negative! Everything else will be negative too; and unless a diagnostic laparoscopy is performed, your doctor still will not be able to diagnose adhesions as the cause of your pain.

Your Dr. can't say that your pain is caused by adhesions - until he actually sees them; but if you've had adhesions before - and the results of your tests are negative - you can pretty much be assured that the pain is from adhesions.

You can say your pain is being caused by adhesions - and not have to worry about getting sued. Your doctor can't! He sure might think your pain is caused by adhesions; but he really, really cannot say it until it has been proven! As long as all medical tests rule out abnormal pathology, you do have chronic pelvic pain - and that is recognized as a medical condition; so get on a pain management routine and take it from there! A doctor HAS TO respond to your request for that!

There also isn't any other effective pain management for adhesions: NO massage therapies (adhesions are located too deep within the cavity for "breaking down," etc.) - NO linaments or balms that will reach or penetrate the peritoneum. The peritoneum tissue is there to protect against the invasion of infectious and foreign matter. That is our problem to begin with! So please be careful with paying out bucks for things that sound good - but will not work on the adhesions!

Relaxation, massage, and such will help relax the adhesion sufferer; and there is something to be said for treating the emotional as well as the psychological self. In fact, it is imperative to do that!! And therapy for family members - support, education, and ideas as to how to live with one who is suffering from this very painful and debilitating disorder. The impact that " Adhesion Related Disorder " places on a family is no different than a diagnosis of Cancer, Muscular Dystrophy, Multiple Sclerosis, or any other debilitating disorder. The only difference is: our disorder is just beginning to be focused on! How much focus it gets - is up to each one of us! So learn about it!! Educate your doctors about it!! Don't be afraid of it; because it can be effectively lived with - and, most of all, THERE IS HOPE!!!

If a medical facility did not perform medical tests on a patient who presented with complaints of pain - and just assumed that their symptoms of pain were due to adhesions (because the patient has a history of adhesions) - what would you do if YOU DID have a tumor or cancer and it went undetected because the doctor wrote your pain off as due to adhesions without checking into it? I'd be pretty miffed!

My recent contacts with the Mayo Clinic indicated to me that a number of the doctors did believe that adhesions can cause pain. Like almost everywhere else though, they have not come up with a practical treatment or surgical procedure that would benefit an adhesion-former. Mayo Clinic doctors will work with an adhesion patient through pain management. I did start my pain management through them.

At the time of my surgery, I was found to have two tumors as a result of the adhesiolysis that I elected to have done in New York City under Dr. Reich! If he had not found them, who knows what might have happend to me. I would not allow any local doctors to perform anymore tests on me; because I was convinced that all my pain was from adhesions. (There was no valid reason to put myself through testing that would have negative results for abnormal pathology - let alone having to pay for tests over and over again.) Boy was I wrong!!!

So I have to advise everyone, for what it's worth, that testing IS necessary and could save your life! If all tests have negative results for abnormal pathology, then it is probably your adhesions. It is then up to you to determine the next step - surgery for them or live with them and try pain management?

I do believe that the more educated one becomes to their own disorder, the better equipped they will be to discuss treatment with a doctor - even down to what needs to be done in a surgery, if you elect that route! I also believe that adhesiolysis - performed in a certain way - can reduce the amount of re-formed adhesions - and, in all probability, decrease the formation of de novo (new) adhesions.

Once you learn what type of procedure is best for an adhesiolysis, then you can discuss it with your surgeon - and even dictate how and what you wish to have done for you and this disorder!

Love, Bev

Remember these words: " YOU ARE NOT ALONE!!! "


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