Interview with
ARD Patient & Dr. Wiseman in "The Union
Leader", newspaper, New Hampshire USA,
December 24, 2007 edition.
Read the latest press on Adhesions & ARD from
one of our members & ARD patient, Christine Damon
and Dr. David Wiseman, PhD, MRPharmS, Founder, International
Adhesions Society.
For woman with adhesion disorder,
only pain ahead
By GRETA CUYLER
Union Leader Correspondent
Monday, Dec. 24, 2007
EPSOM – Christine Damon has always been in pain.
As a teenager, she sought medical treatment for abdominal pain, back pain and
vomiting. Doctors dismissed it as a "woman problem" and didn't
take her seriously until a doctor finally diagnosed her with endrometriosis,
a chronic disease in which the tissue lining the uterus begins growing in
other parts of the body. In her early 20s, Damon underwent her first surgery
to remove the tissue.
She's now 44 and has had 14 surgeries because the adhesions keep growing back.
Damon suffers from Adhesion Related Disorder, in which internal scars --
caused by trauma - bind organs and tissues not normally connected. Ninety
to 100 percent of surgery patients develop adhesions, said David Wiseman,
who conducts research on ARD.
continued.......Click
here.
IAS
announces world's first comprehensive "Adhesions-CAPPS
Clinic"
The IAS is proud to announce its role in the opening
of the world's first center for the integrated diagnosis
and treatment of Adhesion Related Disorder (ARD) at
Florida Hospital, Celebration Health, Celebration,
FL. The founders of this clinic include our long time
friend, Dr. Jay Redan, and the IAS’ very own,
Dr. David Wiseman.
Although we have dreamed about this clinic since the
beginning of the IAS in 1996, the idea began to take
root about four years ago when Dr. Redan invited Dr.
Wiseman to make a presentation to Celebration Hospital’s
management about establishing a center for Adhesion
Related Disorder.
Dr. Wiseman recounts:
“As a result of the research done through the
IAS web site we realized that the problems of the ARD
patient extend well beyond those of adhesions. An ARD
patient will have some or all of a number of issues
including chronic pelvic and abdominal pain, bowel
and bladder disturbances as well as spiritual and psychological
imbalances.
There was no one place for long-suffering ARD patients
to turn that could tackle these issues in a coordinated
manner. Dr. Redan arranged for me to present a proposal
to Celebration’s management that would change
all of that. What impressed me was the forward-thinking
way that Celebration Health conducted every aspect
of the patient experience, from the location to the
décor of the radiology department to the scent
wafting through the air conditioning system. This hospital’s
approach may be close to Walt Disney World, but it
was no ‘Mickey Mouse’ Since that initial
presentation, I have been working closely with Drs.
Redan, McCarus and a whole project team that has brought
us to this launch.”
But there was a problem in the way the world thinks
about this condition. As a result of Dr. Wiseman’s
work it became apparent that adhesions and ARD are
part of a wider set of overlapping and coalescing conditions
including endometriosis, pelvic pain, Interstitial
Cystitis (IC), Irritable bowel syndrome (IBS) and even
fibromyalgia.
It was just not good enough to think just about adhesions,
or just about chronic abdominal pain, or even bowel
or bladder problems. We needed to think about it all.
Together. And so was born the term "COMPLEX ABDOMINAL
AND PELVIC PAIN SYNDROME (CAPPS)" defined as:
“a syndrome, of non-malignant origin consisting
of a complex of symptoms of the abdomen or pelvis
that includes pain, bowel or bladder dysfunction,
of at least 6 months duration.”
Attempting to treat these individual symptoms or conditions
as separate entities for the most part is an exercise
in frustration. Although they may start out as separate
conditions, they end up as essentially one condition
- CAPPS.
Now we understand the disease we can get to work to
prevent it and to treat it using the multi-disciplinary,
integrated and holistic approach that the CAPPS Center
is all about.
The Florida Hospital Center for CAPPS (www.adhesionscenter.com)
consists of: Dr. Jay Redan (General, laparoscopic surgeon),
Dr. Steve McCarus (Gynecologic Surgeon), Dr. Kathy
Jones (Urogynecologist), Dr. David Wiseman (Consultant,
Scientific Advisor) backed by a team that will ultimately
include care coordinators, specialist nurses, physical
therapists, nutritionists, psychologists, social workers,
exercise physiologists, psycho-spiritual counselors,
pain management specialists and neurologists.
As a separate endeavor, the IAS will establish a sister
organization, the:
International Society for Complex Abdomino-Pelvic & Pain
Syndrome (ISCAPPS) www.iscapps.org
Please visit the new CAPPS center at: www.adhesionscenter.com
PAX
Conference to be held in Belgium, September 2006
Learn more about the PAX
Society conference being
held in Belgium 27-29 September.
This conference highlights:
Adhesion Formation, Tumor
Implantation & Mesh Biology.
Visit the website by clicking
the link above or review the
conference brochure (pdf).
"Crazy
Glue", an article
in the New York Daily News
regarding adhesions on
28 June 2005.
New
York Daily News
Crazy Glue
By RANIT MISHORI, M.D.
Tuesday, June 28th, 2005
[Click
here for full version]
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
Eachempati, "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, 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."
President
Clinton to Undergo Medical
Procedure on 08 March 2005.
Statement From The Office
of President Bill Clinton
From: www.clintonfoundation.org
President Bill Clinton will
be undergoing a medical procedure
this week to remove fluid and
scar tissue from his left chest
cavity. The procedure, which
is a recognized, occasional
consequence of open-heart surgery,
will take place Thursday at
NewYork- Presbyterian Hospital/Columbia
University Medical Center and
he will remain in the hospital
for three to ten days.
The procedure is known as
a decortication, and will require
general anesthesia. The scar
tissue developed as a result
of fluid and inflammation causing
compression and collapse of
the lower lobe of the left
lung. The surgery will be done
either through a small incision
or with a video-assisted thoracoscope
inserted between ribs. The
fluid buildup and lung collapse
has caused the President some
discomfort in recent weeks,
but he has otherwise been in
very good condition, recently
passed a stress test and is
walking up to four miles a
day near his home in Chappaqua,
NY.
The risk of the procedure
is low, and once fully recovered,
President Clinton is expected
to resume his work without
limitations.
IAS
Supports HONcode Initiatives
The IAS has received official
notification that our application
has been accepted by the Health
on the Net Foundation (HON)
and that our website complies
with the major HONcode principles.
The HONcode initiative is
dedicated to improving the
quality of medical & health
information on the internet.
As a qualifying member, the
IAS can now proudly display
the HONcode seal on our website.
This seal means,
- that the IAS has submitted
a formal application for
membership and after a detailed
review process, has been
accepted.
- that Adhesions.org maintains
constant compliance with
the HONcode requirements.
- that the IAS is committed
to observing the HONcode
principles.
Learn more about the HONcode
Foundation or read the HONcode
of Conduct Principles.
Adhesions
recognized at the NIH
Follow this link to
read what the NIH and
National Digestive Diseases
Information Clearinghouse
(NDDIC) have to say about
Adhesions!
Adhesion
Related Disorder (ARD) -
Recognized by United States
Congress.
The Committee on Appropriations
for the House of Representatives
has recognized the significance
of ARD and has encouraged the
National Institute of Diabetes
and Digestive and Kidney Diseases
(NIDDK) division of NIH to
investigate this disease and
to support research into its
causes and treatments.
Specifically their report
regarding FY2006 (p78) states:
“Adhesion related disorder.--This
little known condition commonly
leads to abnormal attachments
between the organs inside the
abdomen. The adhesions generally
are composed of scar tissue
resulting from previous operations.
Very little is known about
why adhesions form more aggressively
in some people. Diagnosis of
the disease is typically difficult,
and surgical correction is
often unsuccessful. The Committee
encourages NIDDK to investigate
this disease, supporting research
to find treatments and understand
causation and to communicate
these findings to broaden knowledge
of the disease in the medical
community.”
The report, dated September
7th 2004 may
be viewed here.
Although the report does not
earmark any funds for this
research, it represents an
important milestone in our
campaign of awareness and research
into ARD, a term first used
by the IAS.
It represents the tireless
efforts of many IAS volunteers
who have written to their legislators,
newspapers and TV stations
about ARD and its devastating
consequences.
As part of the budgetary process,
all government agencies that
may be affected by recommendations
made by the Committee on Appropriations
are required to respond regarding
the action that they will be
taking. Accordingly, in their
Congressional Justification
2006, stated
“Future plans for NIDDK
research on IBD and other adhesion-related
disorders will include the
continued pursuit of new drug
therapies, the development
of surrogate markers of disease,
the maximization of research
investment in animal models
of disease, and the establishment
of a repository that will collect
and make available to investigators
various types of human samples
including blood, biopsied tissue,
genetic material, and datasets.”
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