IAS & Adhesions -- In the New York Daily News on June 28th. Read all about it!
From: International Adhesions Society (tracy.joslin@adhesions.org)
Wed Jun 29 18:15:31 2005
New York Daily News - http://www.nydailynews.com
Crazy glue
By RANIT MISHORI, M.D.
Tuesday, June 28th, 2005
http://www.nydailynews.com/city_life/health/story/323416p-276464c.html
On most days, Maria de los Reyes, a Port Authority
lawyer, feels the pain. "It's like someone's hand
is in my guts, squeezing them to death," she says.
It's been like this for 13 years now, ever since
she had a hysterectomy, which went smoothly. But
then a complication set in, one of the most
common but least -talked about side effects of
surgery for millions of American men and women
- something doctors call "adhesions."
Getting an adhesion is like having a not-so-
elastic band suddenly -materialize inside your
body cavity and connecting -internal organs
that are not normally connected - like loops
of intestines, with your uterus at one end
and a bend in the fallopian tubes at the
other, or joining your intestines and the
walls of the abdomen.
The growth can play havoc with your organs,
causing excruciating pain and, when the small
intestine is involved, -bowel blockage and
obstruction. Says David Wiseman, a researcher
and doctor of pharmacology from Dallas, an
-expert on adhesions: "It's like taking a ball
of string that you let the cat play with,
and get it all knotted up and tangled, and
then you pour glue on it and let the glue
stay."
Common in men, more so in women
Like hardened glue, adhesions are tough
and inflexible, which is why -doctors liken
them to scar tissue. -Physically resembling
plastic wrap, and composed of a tissue called
fibrin, they can create a range of different
problems. Studies show adhesions can account
for up to 74% of small bowel obstructions,
up to 20% of female infertility cases, and
-between 20% and 50% of chronic pelvic pain
cases.
What's remarkable is how high the risk is
for getting adhesions in the first place.
They can develop after any surgery - former
President Bill -Clinton developed a -pleural
adhesion that required a separate surgery
after his bypass operation. Data show they
develop in at least 55% of patients who
undergo surgery. The number is as high as
90% for certain types of surgeries, like
hysterectomies and C-sections, which is
why the majority of patients suffering
from adhesions are women.
The truth is that adhesions, first
recognized when surgery entered mainstream
medicine in the early 1800s, are still not
well understood. The best guess is that
they result from a kind of overreaction by
the body. Dr. Soumitra Eachempati, assistant
professor of surgery at Weill Medical -College
in Manhattan, says: "After any type of tissue
injury, your body would have an inflammatory
response. The more -vigorous the response, the
more likely the adhesions would form."
Some people, he says, are more -unlucky than
others and have "an -exceptionally vigorous
response." They're the ones who get severe
adhesions and may suffer from chronic pelvic
or abdominal pain.
De los Reyes is one such -patient. Like many
who suffer from -adhesions, her difficulties
with the -condition began as she recovered
from a -hysterectomy her doctor -recommended in
response to fibroids growing in her uterus.
Pain (resulting- from multiple -episodes of -bowel
obstruction) was the main -symptom - pain she
says she can -never get away from for long,
Even 13 years -later. "It is basically a day-
to-day thing to see what I can do to alleviate
- at least to some extent - the -discomfort."
In addition to having had multiple surgeries
for bowel obstruction and what doctors called
"adhesiolysis" - cutting of adhesions - she
has tried a lot of things to ease the pain,
including prayer and meditation. She has
even - and she says this seriously - tried
jumping up and down on a -trampoline. Sometimes
these measures have helped, but only
temporarily. "I'll get relief for a little
while," she says, "but sooner or later I
wind up having problems again."
Suffering from a lack of belief
Some 35% of all patients who undergo abdominal
or pelvic surgery end up back in the hospital
because of this recurring pain, with the usual
result that they require surgery to remove the
adhesions.
It's not just pain that's at issue. -Certain
adhesions can act to tangle up a -woman's fallopian
tubes and ovaries, causing -infertility.
Others can cause obstructions in the bowel. In
these cases the only -solution is to "go back in"
and try to cut the -adhesion or even cut out the
affected part of the -organ. "If you liken your
intestines to a long garden hose," explains
Eachem-pati, "then there's a part that's kinked,
and we'd try to find that part and cut away the
scar tissue that is compressing it."
But even that's not a sure thing. As de los
Reyes has learned, adhesions can be cut, but
like bad weeds, they can spring up again. She
has undergone 14 -surgeries to deal with her
adhesions.
"It's a tremendous emotional toll," she sighs,
then mentions the part of the -experience that
really gets to her: "You start to doubt yourself."
It's a doubt that comes from having been told,
too many times, by too many doctors that "there
can't possibly be anything wrong with you."
Indeed, the medical system seems to be in a
certain amount of denial about the problem of
adhesions. Despite their frequency, few surgeons
ever bring them up as a risk factor in pre-surgery
discussions with patients. Afterward, once the
pain begins, many patients -encounter scorn and
disbelief from the medical -system.
Wiseman is one of the -sympathetic ones. President
of Dallas-based Synechion, Inc., a consulting
company that handles the science and business of
adhesion prevention, he also runs a resource Web
site, http://www.adhesions.org. He's heard the lament
from patients over and over again, he says.
"'No one believes me.everyone says it's in my head.
everyone thinks I'm making it up," he says, reciting
a long list of patient complaints when they bring
up their post-surgery suffering.
Sometimes, he says, all the patient needs is someone
to speak to her nicely and say "'Listen, you do have
adhesions, you're not making this up, it's not in
your head.'"
That's the "good" news. Here's the bad news Wiseman
has delivered again and again: "There's not much
we can do about it, but let's plan your life."
A more comprehensive approach is what Wiseman and
Dr. Jay Redan, a surgeon who is an expert on
adhesion -diagnosis and treatment, believe that
-patients need.
"No one's really looking at the whole picture,"
says Wiseman. In the fall, the two -hope to launch
what they say is the world's first comprehensive
integrated clinic for patients with adhesions,
chronic pelvic pain and related problems. The
-center, housed at Florida Hospital Celebration
(Fla.) Health in Celebration, will feature a
multidisciplinary team of -surgeons, -gynecologists,
nutritionists and urologists, among others. This
has come out of the realization that patients such
as de los Reyes need more than just pain management
or repeated operations.
The medical world keeps waiting for the breakthrough
that will prevent adhesions from forming in the
first place. Laparoscopic surgery, which allows
surgeons to make tiny incisions, has not proved
to be that advance. In fact, research shows
adhesions are just as likely to form after keyhole
surgery as conventional surgery. Some companies are
trying to develop what are called barrier agents,
such as -Seprafilm, a kind of plastic sheeting put
in place during surgery to keep the various loops
of small intestine from coming into contact with
other organs and each other. It has been available
in Europe for some time and approved by the FDA
in 2002.
Wrapping up a better solution
Other researchers are working on gels and solutions,
such as Adhibit and Adept, that insulate body parts
against physical contact with one another. Like the
barrier agents, these products have reduced the
severity of adhesions without eliminating them.
Also available in Europe, their use in the U.S.
is pending the results of clinical trials.
There's also evidence that a -surgeon's actual
technique may matter. Studies show the risk of
adhesions may be reduced when surgeons handle
tissue carefully, use powder-free gloves, dissect
-gently, control bleeding, prevent infection, and
keep tissues moist, among other measures.
Finally, there is much interest lately in the use
of Cox-2 inhibitors (such as Celebrex), the anti-
inflammatory drug recalled not long ago for its
adverse side effects. A recent study showed a
"dramatic" reduction in adhesions in mice treated
with Cox-2 inhibitors. According to a press release,
investigators Dr. Mark Puder and Dr. Arin Greene
from Boston's Children's Hospital are preparing to
set up a clinical trial of -Celebrex in adult
surgical patients.
Until more is learned and new -products become
available, de los Reyes hopes more people become
aware of the -issues surrounding surgery and
-adhesions. She teamed with some of her doctors
and has been talking to others in her situation.
"Helping other people. really makes a difference.
It distracts me from myself," she says. "If I can
tell my story and help somebody, at least I am
not going through this agony for nothing."
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