Re: ~Please read~Clare responds to 'Dr. Moore Responds'

From: Sally Grigg (LostCst@mcn.org)
Fri Jan 10 13:02:09 2003


At Thu, 9 Jan 2003, clareS wrote: >
>Dear Dr. Moore:
>
>Okay, okay, I wasn't going to jump into this as I'm busy enough as it
>is, but hey, there's some things I really gotta say here :o)
>
>Perhaps I might suggest that you put your credentials on the figurative
>table here, and no, I'm sorry but a bit more than "OB/GYN" and "all lot
>of experience" would be appreciated.
>
>You stated that "A real scientific experiment involves a placebo arm,
>where patients are given similar treatment but without the "magical"
>cure or medicine. Because as all of you know some people don't form
>adhesions- this means that sometimes "nothing" works to prevent
>adhesions. And that's where barriers like Intercede (and probably this
>Spraygel) failed."
>
>Perhaps you are not aware that trials for SprayGel have been quite
>successful overseas, and that there are ongoing clinical trials (yes,
>with a placebo arm) currently underway in the USA as I type. I went to
>the PUBMED site that you laud, and I simply typed in SprayGel, and lo
>and behold this is what I found!!
>
>"1: Hum Reprod 2001 Dec;16(12):2718-23 Related Articles, Links
>
>Evaluation of a sprayable polyethylene glycol adhesion barrier in a
>porcine efficacy model.
>
>Ferland R, Mulani D, Campbell PK.
>
>Women and Infants Hospital, Providence, RI 02905, USA.
>roger_ferland@brown.edu
>
>BACKGROUND: The formation of adhesions following pelvic surgery remains
>one of the leading causes of infertility, small bowel obstruction and
>re-operation for pelvic pain. A novel hydrophilic polyethylene glycol
>based adhesion barrier (SprayGel) is formed by simultaneously spraying
>two liquid precursors onto surgical sites. The liquids polymerize to
>form a gel that effectively coats and adheres to tissue. After about 5
>days, the hydrogel layer is absorbed and subsequently undergoes renal
>clearance. It is believed that the presence of such a barrier would
>inhibit the formation of adhesions following surgical insult. METHODS:
>A porcine adhesion model was developed wherein bilateral uterine horn
>transection and re-anastomosis, along with peritoneal side wall excision
>was performed via laparotomy. In each animal (n = 10, including the
>pilot study) one pelvic side wall was treated with adhesion barrier,
>while the contralateral side remained untreated. RESULTS: At second
>look laparoscopy, 90% of the untreated sites had adhesions, compared
>with 30% of the treated sites (P = 0.006). Also observed were
>statistically significant reductions in the adhesion extent (P = 0.029)
>and adhesion severity scores (P = 0.023) at the treated sites. However,
>if the pilot study was excluded (n = 8) the differences obtained were no
>longer significant. CONCLUSIONS: Polyethylene glycol (SprayGel) merits
>further investigation as an effective barrier to the formation of
>post-operative adhesions in this porcine model.
>
>PMID: 11726601 [PubMed - indexed for MEDLINE"
>
>~And~
>"1: Fertil Steril 2001 Feb;75(2):411-6 Related Articles, Links
>
>Evaluation of the SprayGel adhesion barrier in the rat cecum abrasion
>and rabbit uterine horn adhesion models.
>
>Dunn R, Lyman MD, Edelman PG, Campbell PK.
>
>OB/GYN Associates, PA, 7550 Fannin, Houston, Texas 77054, USA.
>obgynassociates.com
>
>OBJECTIVE: To evaluate the efficacy of a new adhesion barrier in the
>prevention of postoperative adhesion formation. DESIGN: A double-blind
>controlled study of the efficacy of SprayGel in reducing postoperative
>adhesion formation in two animal models. SETTING: Animal care facility
>of a contract testing laboratory. ANIMAL(S): Sixteen Sprague-Dawley
>male rats were randomly allocated into two groups in the cecum abrasion
>model. Twenty New Zealand white female rabbits were randomly allocated
>into two groups in the uterine horn abrasion model. INTERVENTION(S): In
>the rat model, the cecum was abraded with gauze and the abdominal wall
>was abraded with a scalpel. Treated animals received SprayGel coating
>on injured surfaces; control animals received no treatment. In the
>rabbit model, uterine horns were abraded with a scalpel. Treated
>animals received SprayGel coating on injured surfaces; control animals
>received no treatment. MAIN OUTCOME MEASURE(S): Postoperative adhesion
>formation. RESULT(S): In the rat model, SprayGel was found to
>significantly reduce the incidence of adhesions, which formed in 7 of 8
>control rats compared with 1 of 8 treated rats. In the rabbit model,
>SprayGel was found to significantly reduce both the extent and severity
>of adhesions. CONCLUSION(S): Application of SprayGel in two animal
>models reduced formation of postoperative adhesions. Further
>investigation in large animal and clinical settings is warranted.
>
>PMID: 11172849 [PubMed - indexed for MEDLINE]"
>
>There you have 2 studies, one on humans sitting right there in front of
>you! With all due respect, I suggest that you, Dr. Moore could have
>done the same, and got the identical results. The clinical trials on
>Spraygel are not anecdotal, and the results are not "magical" - the
>results are a significant reduction of adhesions at second look
>laparoscopy which merits more studies (currently underway).
>
>I find your suggestion that we do our own research high-handed, and
>insulting. Obviously, you have very little idea whom you are addressing
>with such a sweeping assumption. I find your comments regarding Dr.
>Krschinski in Germany ("Dr. K should remember the first rule of
>medicine, Primum non nocere- first do no
>harm. And if his treatment works, then prove it. It's quite simple to
>prove medical therapies work, I would love to start using his techniques
>tomorrow if they worked.")
>simply deplorable, as well as unprofessional. That is why I ask you to
>put your credentials on the table - I have a difficult time believing
>that you are who you say you are, and not some bored troll. These Drs
>in Germany have proven that their medical treatment works (at least as
>far as significant reduction of adhesions is concerned) so you'd best do
>your research and get busy!
>
>On a more basic note, Dr. Moore, people with problematic adhesions deal
>with very real issues, and it is Drs who believe only what they have
>been taught who do us (and all of their patients) a disservice.
>
>Best wishes.
>Clare
>
>At Thu, 9 Jan 2003, Dr.Moore wrote:
>>
>>Some pretty harsh responses from this board. I suspected that would be
>>a likely response. I have had a lot of experience with adhesions and it
>>is a very frustrating problem. And I have done a lot of surgery to
>>remove adhesions (in fact I did a laparoscopic lysis of adhesions
>>today), with mixed results.
>>
>>To dispel a few incorrect statements-
>>1) I am only 33, so my knowledge is not outdated. I finished residency
>>in 1999.
>>
>>2) Never did I say "Go home and deal with it" although this may be
>>better advice than that given by some of the people on this website. You
>>see the problem with "I did this and now I'm better" advice (called
>>anecdotal evidence in medical terms) is that it just isn't valid.
>>
>>A real scientific experiment involves a placebo arm, where patients are
>>given similar treatment but without the "magical" cure or medicine.
>>Because as all of you know some people don't form adhesions- this means
>>that sometimes "nothing" works to prevent adhesions. And that's where
>>barriers like Intercede (and probably this Spraygel) failed.
>>
>>I always tell my patients that if a treatment is not proven to work, but
>>works for them (eg herbal supplements) they should do it. As long as it
>>is not super expensive (eg flying to Germany and paying out of pocket
>>for surgery) and isn't harmful (like surgery can be). Dr. K should
>>remember the first rule of medicine, Primum non nocere- first do no
>>harm. And if his treatment works, then prove it. It's quite simple to
>>prove medical therapies work, I would love to start using his techniques
>>tomorrow if they worked.
>>
>>Finally, do your own research. THE PLACE for researching medical
>>literature is PUBMED. Here is the website, search for your self- the
>>website gives you abstracts (short summaries of the experiments/clinical
>>trials) and the original source so you can go to the library and look at
>>the original articles. Here is the website:
>>
>>http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
>>
>>Oh, one last point- The "you don't know what we're going through"
>>argument also doesn't work in medicine. I don't know Dr. K's story,
>>but I doubt he has pelvic adhesive disease. And I assure you that to be
>>a good cardiologist you don't have to have a heart attack and to be a
>>good neurosurgeon you don't have to have a brain tumor.
>>
>>At Wed, 8 Jan 2003, Koolinsask@aol.com wrote:
>>>
>>>Dear Dr.Moore, yes, I would have to agree with Sally, the sad part is, you
>>>nor any doctor out there, can relate to what pain we go through, the daily
>>>struggles, the depression, some of us are unable to work any longer, many of
>>>us are very young, with very young children, just beginning our lives!!!!!
>>>Only to be stripped of a "normal life". Too many doctor's tell us to go home,
>>>suffer, sorry there is nothing we can do! This attitude has got to stop, we
>>>need help, and we for so long have relied on our caregiver's to educate
>>>themselves, to help us......well, it hasn't happened, we have come together
>>>here on this forum, to help one another, to give support, to FIND help...if
>>>that means spending money, money in which, is nothing when it comes to one's
>>>health, then so be it!!!!!! I would also advise yourself, and hundreds of
>>>other's out there, to please consider, researching, and try to understand
>>>what it is that each and everyone of us is going through, it's an utter
>>>nitemare!!!!! Please, i am not trying in anyway shape or form, to discredit
>>>anyone doctor out there, but rather, pleading with you , to learn more, and
>>>instead of telling us to go home, tell us, you are trying, you are
>>>researching, and that you CARE, AND UNDERSTAND!!!!! We are all human, just
>>>like your' wife, your' daughter, son , husband, mother , father etc......we
>>>want to live, we want to see our children grow up, we want to take care of
>>>our children, and get through our day's , just like you do!!!!!!!!!!! Thank
>>>you for at least dropping in, and maybe reading through some of our stories,
>>>that is a very nice first step....please, come back, and inform us, of any
>>>new happenings that you may find out there!!!!!!
>>>
>>>Cherryl

--
God Bless You Clare, we're not idiots here, even though
most doctors treat us as if we were. Love, Sally

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