From: Helen Dynda ; To: bbm1969@bellsouth.net ; Sent: Tuesday, January 14, 2003 11:39 PM ; Subject: bbm1969@bellsouth.net
Dear Dr. Moore,
I am one of the founders of the International Adhesion Society and a Patient Advocate. After the return of adhesions following my diagnostic laparoscopy in 1997, I made a decision to learn as much as I could about adhesions and everything related to adhesions. October 18, 2002 .. I was interviewed for a feature article about ARD and the International Adhesions Society. You will find this interview at the following website: http://www.adhesions.org/whatsnew.htm .
Since I did not respond to this message of yours on the IAS Message Board, I have inserted my comments within your message (below).
Regards, Helen Dynda
~ ~ ~ ~
X> My email to Dr. Moore:
Re: Who is going to Germany for surgery Jan 16,17 ; From: Dr. Moore (bbm1969@bellsouth.net) ; Wed Jan 8 09:19:53 2003
I am a physician who is quite puzzled by this website. I have much experience with adhesions and I see them quite often during surgery. I was taught (as were most physicians) that adhesions are caused by surgery and therefore doing surgery to correct them was circular logic (doing surgery to correct something caused by surgery could cause the same problem).
HD> Adhesions ARE caused by surgery! Adhesions can develop any time there is internal bleeding (from an injury or surgery). Any blood (including minute clots left within the abdominopelvic cavity) -- NOT meticulously cleaned up by the surgeon at the conclusion of the surgical procedure -- will cause adhesions to form. Commonly, adhesions result from the most routine activities of surgery including cutting, coagulation and suturing. Foreign materials such as sutures, lint from sponges or powder from surgical gloves can cause an inflammatory response that can result in adhesions. Finally, adhesions can form from anything that causes an inflammatory response, such as endometriosis, radiation therapy, ovarian cysts, pelvic inflammatory disease and infection. Adhesions can also result from a seat-belt injury!!
Now obviously there are less invasive surgical techniques (eg laparoscopy) to try and prevent adhesions, but there are no guarantees they won't reform.
HD> Even the best surgeons in the world cannot guarantee that adhesions will not reform!! However, surgeons in Europe - including Dr. Kruschinski - do give patients the best chance to become pain-free by using the following adhesion preventive measures: gasless laparoscopy, the application of SprayGel Adhesion Barrier, and a Second Look Laparoscopy (SLL) 7 days after the intial adhesiolysis procedure. If any adhesions are found during the SLL, the surgeon can easily lyse them and apply more SprayGel to the affected areas.
In addition, doing surgery on someone with adhesions is more difficult (organs can be 'adhesed' together and/or in the wrong place making injury to them more likely).
HD> This is very true!! Surgeons in Europe are not regulated/restricted by the government (like Medicare/Medicaid and managed care, HMOs in the U.S.) as to how much time they spend when performing difficult and lengthy adhesiolysis procedures. Therefore, surgeons in Europe are not pressured to perform surgery within a certain time frame. As a result, they can very slowly and methodically separate surfaces adhesed together by adhesions; and thus they are less apt to cause surgical trauma to the patient's internal organs.
HD> In the United States surgery for adhesions is a very poorly reimbursed surgical procedure - for surgeons, anesthesists, and for hospitals. Surgeons do not want to perform difficult and lengthy adhesiolysis procedures - knowing they will be reimbursed at the minimum rate; and hospitals - based on the minimum reimbursement they receive - do not want their operating rooms tied up for lengthly adhesiolysis procedures. This is a problem for surgeons, anesthesists, and hospitals in the United States; because when I had surgery in 1997, the surgeon, anesthesist and the hospital were reimbursed by Medicare for "less than half" of their actual bills!!!
I would like more information about this 'gel' the German doctor is using. There have been many attempts by pharmaceutical companies to produce a substance that prevents adhesions. The name "Intercede" comes to mind as one that was tried. Unfortunately, none have been shown in medical trials to work.
HD> Here is the website for Confluent Surgical, the company that makes SprayGel: http://www.confluentsurgical.com/spraygel/index.htm . Click: "International Visitors" for the most information about SprayGel. SprayGel was approved by the European Union in November 2001.
HD> January 2002 I went to Germany to have an adhesiolysis. Seven days later I was given a Second Look Laparoscopy (which is NOT offered in the U.S.). If any adhesions reformed during the seven days after surgery, the SLL gave the surgeon the opportunity to evaluate the results of the surgical procedure - as well as a chance to easily lyse any reformed adhesions. Both SprayGel and Intergel were applied following my surgery. It's been one year - and I am still free of pain caused by adhesions.
Believe me, it would be a medical miracle if someone could prevent adhesion formation. But as far as I know, no one can. I hate telling someone they have terrible pain that I can't do anything about, but that is the facts as I know them.
HD> SprayGel is showing much greater promise than any of the current adhesion barriers!! Time will tell just how successful SprayGel will be in the prevention of adhesions. I understand your comment, "I hate telling someone they have pain I can't do anything about." I realize that doctors/surgeons are just as frustrated as patients, who suffer from ARD. There IS something you CAN do for your patient. You can be honest with them; and you can refer them to a pain specialist (an anesthesiologist, who has a specialization in the treatment of chronic pain.) at a multidisciplinary pain clinic. In closing, I don't write this to dash anybody's hopes or cast doubt on any physician's credentials.
HD> Unfortunately, your messages to the Message Board did "dash anybody's hopes or cast doubt on any physician's credentials." Your messages did not offer hope; and you tried to cast doubt on Dr. Kruschinski's credentials. The IAS Message Board is meant to be a place where adhesion-sufferers can seek support and information. If you've taken the time to read their messages and/or their Adhesion Quilt stories, you would've learned that many of these women have been treated badly -- and so was I -- by those who took an oath to " first do no harm." Please remember this when you interact with patients of yours, who suffer from the pain of adhesions.
But beware false prophets- since the days of snake oil salesmen there have been all kinds of 'cures' for illnesses that later didn't pan out.
HD> We are living in a world where new products - such as SprayGel - are currently being rigorously tested in research and clinical trials. As of June 2002 SprayGel clinical trials are taking place at several locations throughout the United States. If you want more information about SprayGel - or if you have a patient, who is interested in becoming a participant in one of the SprayGel clinical trials - you can contact Confluent Surgical by email for information about SprayGel Clinical Trials..
I don't want to see anyone spend a lot of money on things that don't work and could potentially be harmful (such as unneccessary surgery).
HD> Seeking surgery with the surgeons at Duisburg, Germany or Frankfurt, Germany is surprisingly LESS expensive than having an adhesiolysis procedure (without a SLL) in the United States. I know; because I have done this!!
-Dr. Moore, OB/GYN