| The following chat transcript courtesy of obgyn.net
now Medispecialty.com
Prior Chat Transcripts
Prevention of Post-Surgical Adhesions
David Wiseman, PhD
Wednesday, February 24, 1999
Drwiseman Hi everyone!
mary_s Hello Dr Wiseman!
Donna2000 Good evening Drwiseman.
Drwiseman Hi Y'all. Have we met before Donna?
Donna2000 No, first time visitor.
Drwiseman Good, well no pressure, but perhaps you
would like to ask the first question?
Donna2000 I have been subscribed to several forums
for a couple of weeks and saw the mention of this chat.
Donna2000 No pressure accepted. I'll go first.
Drwiseman What in particular interests you?
Donna2000 I had lap surgery in July 1997 for adhesions
resulting from endo, my left ovary and what is left
of my tube (tubal 4yrs ago) were adhered to my bowel.
As of Christmas, I was back in constant pain and am
headed back to the Dr in 2 weeks. I was told last time
that I may have to have surgery each year for adhesions.
That doesn't seem reasonable or a way to live.
Drwiseman No it doesn't. But many people are coping
with it.
Donna2000 How? I also feel that I have a lot of hormonal
imbalance happening - skin changes, moods, hot flashes.
Drwiseman A variety of ways. None is perfect but I'll
give it a bash.
Drwiseman TOP 10 Ways of Coping with Adhesions:
Donna2000 Some of what I am reading, says it may be
partially from the tubal?
mary_s Hi Jonesy. Welcome to the adhesions chat!
Drwiseman (The hormonal imbalances are unlikely due
to adhesions) Ways of coping with adhesions:
Jonesy Hi, it's Dee, but couldn't get in with my name!
Drwiseman 1. Get more surgery. This may result in
more adhesions, but with the proper use of adhesion
barriers, it MAY be reduced, but not completely eliminated.
Drwiseman 2. Pain medication. This is obviously not
preferred.
Donna2000 If I have another Lap, almost a certainty,
what should I be asking for and what can I do to decrease
adhesion problems?
Jonesy Dr. Wiseman, is Lubricoat the same thing as
Intergel?
Drwiseman 3. Physiotherapy/exercise: some patients
have reported benefits to having certain kinds of exercise.
Donna2000 I'm taking Indocin at the moment to function.
Drwiseman 4. (Lubricoat = INTERGEL) Have a proper
diagnosis to make sure that your problem really is
adhesions (sometimes other things may cause problems,
they go misdiagnosed and it gets called "adhesions").
Jonesy They have checked my colon and other areas,
and I have had adhesions removed 3 times already.
Drwiseman 5. Other medications: Indocin - I think
that is the same as Indomethacin - that is a powerful
anti-inflammatory drug. how is it working?
Donna2000 I just started it 2 weeks ago, I only take
it as a last resort because of effects on my head,
takes the edge off.
Drwiseman Jonesy: what kinds of problems are you experiencing?
Jonesy Extreme pain in abdomen, bloating, lots of
pain upon bowel movement, pain in my back, as well
as down my legs at times. Also terrible pain with intercourse.
They have me on pain meds. and I was told by the Dr.
you referred me to in Nashville, that I should wait
for the Intergel here.
Donna2000 Ditto, here.
Drwiseman 6. Speak regularly with similarly afflicted
people. Often people think that they are the only ones
who suffer from this problem. Merely knowing that you're
not and being able to talk to someone else takes the
burden off greatly. Many times the anxiety of feeling
isolated compounds the pain. Having a support network
reduces this burden and eases the pain.
Donna2000 Mostly on the left side, pulling around
to my back at times.
Jonesy His nurse told me that he was told today that
it would probably be June or July now, but who knows?
Drwiseman Jonesy: Has anyone suggested modifying your
diet to reduce solids in the bowel? This would be my
number 7.
Donna2000 Down the upper part of my leg.
Jonesy Yes, it is hard for others without this problem
to relate to it. Yes, he did mention that as well.
Donna2000 Sex has been non-existent around here since
before Christmas, as for support, some of the message
boards I've subscribed to at OBGYN.net have been wonderful!
Drwiseman I have heard a number of things about INTERGEL:
that it could be as early as June and as late as December.
I don't know if they have any data on reduction in
pain in these severe cases.
Drwiseman I'm glad the message board thing is useful.
Jonesy When INTERGEL is available here, then will
the Drs. know the data?
Donna2000 It's a help, my husband is wonderful and
patient, but he has a hard time relating to "female
problems".
Jonesy Ditto!!!!!!!! Donna!
Donna2000 The hard part is that with this go round,
I seem to have some depression, crying spells or on
the verge of tears, and rage spells at times. That
is hard on the family. I'm not sleeping well, and that
is not helping.
Jonesy Donna, probably part of it is the fact it IS
so depressing, at least I think so.
Drwiseman I should imagine that Ethicon/Lifecore will
make all the INTERGEL data available at that time.
I am not aware however that the studies that were done,
were done in these type of patients.
Donna2000 To make matters worse, my gyn, who I've
been going to for 12+ years has herself in over her
head and cannot take an emergency, so I've had to find
a new gyn. I've been told he is very conservative,
I'll see week after next.
Jonesy Because ours is severe, you mean?
Donna2000 My PCP has tried to do what he can, but
admits that endo is not "his thing". He gave
me the Indocin to try instead of the Anaprox which
wasn't doing much of anything. The only thing I've
noticed out of the indocin, is that I started it just
before this period, and although it didn't help the
heaviness, etc, it lengthened it, we are at 12 days
and counting. Down to a light flow at the moment.
Jonesy Drwiseman, I don't like to take the pain medication,
but it is the only thing to ease the pain at all. I
have been taking it for a couple months now.
Drwiseman Does it help?
Jonesy How bad is it to be taking pain meds. for this
long, and to continue until the Intergel arrives?
Donna2000 Dee, what are you taking?
Jonesy Lortab 7.5
Donna2000 I haven't heard of that.
Jonesy I kind of alternate the two, Lortab, and Darvocet.
It does ease the pain. But I wonder in the long run
what kind of price I'll pay for having to take it so
long.
Donna2000 I get tired of feeling like a pelvic cripple.
Jonesy Amen!
Donna2000 I want to be me again.
Drwiseman Lortab is hydrocodone. People can stay on
these drugs for a LONG time. If you have real pain
you should not become dependent. These drugs may have
an effect on the bowel causing constipation.
Donna2000 I'd like just to have sex again!
Jonesy Yeah, my son cried, the other night, saying
he wished I could be "me' again.
Jonesy That is good to hear , Drwiseman - the part
about not becoming dependent.
Drwiseman Regarding INTERGEL although the data may
be good (I haven't seen a great deal) it may still
not be the answer. If surgery is necessary at that
time and INTERGEL can be used then great, but, as with
any other treatment I do not want you to feel that
this will be the end.
Drwiseman It may not be.
Barbaran I would like to take a moment of everyone's
time to make an announcement. OBGYN.net is getting
ready tolaunch it's newest Special Section, Chronic
Pelvic Pain. Adhesions will be a part of this section
AND Dr. Wiseman is on the Editorial Advisory Board!!!!!!
Jonesy My dr. said he could not guarantee, of course,
but said that he felt, that this was my best alternative.
Drwiseman Regarding sex, unfortunately I can't help
there, other than to say that YOU are not alone and
if you feel isolated, then you are not.
Donna2000 I've read that it just seems some people
will form adhesions whatever is done.
Donna2000 Thanks for the info, Barbara. Will it be
posted on the obgyn boards when available?
Jonesy Drwiseman, I think my Dr. was saying that INTERGEL
had iron in it, or something, that was more helpful,
than some of the others, does that sound right?
Drwiseman Most people in fact do form adhesions. The
issue is which ones will develop problems.
Donna2000 What are your 8,9, & 10 suggestions,
Drwiseman?
Amylynn Dr Wiseman, What do you know about Metformin
and insulin levels. Is there a national standard for
insulin levels. I was just curious how the RE's and
OBGYNs are diagnosing Insulin Resistance.
Drwiseman About INTERGEL and Iron. I don't believe
that the iron has any medical effect. It basically
acts to delay the disappearance of the gel in the abdominal
cavity. The longer it is there (in theory), the more
chance it will have of working. The iron holds the
gel molecules
together.
Jonesy Drwiseman, you seem to "sound" very
skeptical about this...
Amylynn Dr Wiseman, my other question is what is the
safest surgical method to treat PCO? without creating
anyfurther trouble.
Drwiseman Amylynn: Diabetes. I am not up on the latest
in all that sort of thing. I am not an MD (medical
doctor) and cannot give you medical advice.
Drwiseman Skeptical: about the mechanism of action
of INTERGEL: no certainly not - I led the group that
did the initial preclinical studies. I have seen it
work in animals. If you mean about my comments on what
to except, I am not skeptical, just cautious - I have
seen too many people put their hopes on one thing.
Jonesy I understand .
Donna2000 Fair enough.
Drwiseman PCO: there are several ways of treating
PCO and several beliefs about what is the best treatment.
I'm afraid that beyond that I can't comment except
you will need to canvas a number of GYN's who deal
with it. Barbara: don't we have some kind of forum
or group for that on obgyn.net?
Amylynn Dr Wiseman I am the host of the PCO Chat!
I am just trying to get some additional information
on it. I have a notebook with about 250 pages of information,
I am just trying to get info on what the most effective
surgery would be.
Drwiseman I knew that (wink). I can say that the adhesion
formation after PCOD surgery appears to differ from
that which occurs after other surgery, e.g. endo, adhesiolysis
etc.
Jonesy Drwiseman, were you saying that it might not
work, in cases like mine, because it is so severe?
Drwiseman 8. Make sure you get a good doctor: I would
say that you need a doctor who a) understands that
adhesions can be a problem, b) who knows that some
things can and should be done (not always) c) who has
access to other specialists (GYN, general surgeon,
pain specialist, physiotherapist etc.).
Amylynn What do you all think could cause the least
problems? Ovarian drilling or wedge resection?
Donna2000 My Pcp is quick to pull out a medical book
if I ask a question that stumps him, or he calls a
specialist, not afraid to say I don't know. That seems
to be rare these days.
Drwiseman You mean INTERGEL: I don't want to pre-empt
the data because I haven't seen it. But my understanding
of the way most of these studies have been performed
(INTERCEED, INTERGEL, Seprafilm etc.) is that they
have not included patients with this severity of disease.
I may be wrong in the case of INTERGEL and for this
reason we need to see the data that is presented. At
the same time I have told a number of companies that
they need to start studies in patients with severe
disease.
Drwiseman Donna: you are lucky to have this type of
doctor. Although there are of course many good ones
out there, you need to hunt them down. Although it
is a question of finding one that you are suited to.
That is personal and does not reflect the doctor him/herself.
Jonesy No wonder they call you Drwiseman! (wink) Thank
you so much for helping me find a good Dr.
Drwiseman Jonesy: I just reviewed my email from you.
The doctor I told you about is highly respected, for
obviously good reason.
Jonesy Yes, he really seems to know what he is talking
about. And better, yet, he knows what I'm talking about!
Donna2000 My Pcp just feels bad because there isn't
anything more he can do till I get in to the gyn. He
did a pelvic and a bunch of tests so the results would
be ready when I get there.
Drwiseman 9. Be prepared to be in this for the long
run. Be persistent and don't give up.
Donna2000 Pain doesn't let you give up.......I just
can't let it get the better of me.
Drwiseman I guess one of the most important things
a doctor can do is not dismiss you like you are crazy.
That is not to say that in some patients, there is
not a large psychological element. But I guess the
presumption should be that the patient is another human
being with real feelings, pain and fears.
Drwiseman What is number 10? Any suggestions?
Donna2000 Keep talking in chat rooms??? number 10
Drwiseman That's it.
Donna2000 :) :)
Jonesy Good job, Donna! : )
Drwiseman Which brings us nicely to a close. Any more
last comments or questions?
Donna2000 Thanks
Amylynn Thanks for your help!
Jonesy Thank you ,Drwiseman for all you've done to
help us.
Amylynn Join us for a PCO chat on Monday evenings
if you can.
Donna2000 Thanks for your help, I'm sure I'll be back....have
a wonderful evening. Nite all!
Amylynn Nite!
Drwiseman Thanks everyone for your comments and remember...stay
in there. Mary will also get this transcript cleaned
up and posted in the next week or so so you can review
this chat. Good night everyone.
mary_s Goodnight and thank you Dr. Wiseman. I will
have this log up tomorrow.
Jonesy Good night, to all of you.
Drwiseman logging off. Goodnight..
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