The following chat transcript courtesy of obgyn.net
Prior Chat Transcripts
Prevention of Post-Surgical Adhesions
David Wiseman, PhD
Wednesday, March 15, 2000
Drwiseman "Hi everyone: welcome back after such
a long time!"
Klip "Hi Drwiseman."
Klip "I just had my fourth laparoscopy for endo
a week ago."
Drwiseman "Where do you live?"
Drwiseman "Have we met?"
Klip "It revealed very extensive adhesions on
my left side, binding together my left ovary, uterus,
cul-de-sac, and bowel."
Klip "I live in Wisconsin, and no, we haven't
Drwiseman "What did they do about your adhesions?"
Drwiseman "Are you in pain right now?"
Klip "My doctor completely removed all of the
adhesions, including the filmy ones on the right as
well; and he put in Interceed on the left side."
Drwiseman"Why not on the left?"
Klip "He did put it on the left, where things
were really bad. The right side had filmy adhesions
which he cut in a matter of two minutes."
Drwiseman "I see - what about the pain?"
Klip "He also performed a uterine suspension.
Before all of this was done, he first performed a microlap
with pain mapping."
Klip "I am still in pain a week post-op. It is
so frustrating. He has me on Vicodin. I try to take
as little as possible, but find I still need it."
Drwiseman "That's good - where did he localize
the pain to?"
Klip "He said that both ovaries were extremely
sensitive, and the right one had hardly any adhesions.
I told him, though, that even if they showed pain to
save them if at all possible."
Drwiseman "Has the pain got better/worse?"
Klip "You see, I want children really badly."
Klip "The pain has gotten much better over the
last week, but is probably worse than it was before
the operation at this point."
Drwiseman "Understandable - did he save both
Klip "I had lots of problems with weeks of diarrhea
and negative bowel workup that led me to surgery. Yes,
he saved both ovaries."
Klip "And, my diarrhea was immediately gone after
the surgery. A barium enema I had a week before surgery
had me crying out in pain, so I figured the bowel had
adhesions or endo."
Drwiseman "What about endo - did he remove any
endo - especially on the ovaries? Was there endo within
any of the adhesions?"
Drwiseman "Good - at least the surgery accomplished
Klip "I'm not sure. I have not had my post-op
appt. yet, where he will have the pathology reports.
The last time I had surgery, a 3 cm fibrotic lesion
with endo in it was removed from my cul-de-sac."
Klip "I saw my surgery videotape, but as a layperson
could not really see if there was endo or not, but
the adhesions were sure obvious!"
Drwiseman "So what next? What does he suggest
Klip "Yes, I am glad the surgery accomplished
something. Even though I have a very well renowned
surgeon now, I am worried about adhesion recurrence."
Drwiseman "I guess they really have to decide
where the endo was - if it was as extensive as you
Klip "He has suggested possible treatment with
Lupron and add-back therapy, provided I had active
endo, and provided my hematologist gives it the OK."
Drwiseman "Adhesions will probably recur although
hopefully in a fewer number of places than before."
Klip "I have Essential thrombocythemia as well,
which is controlled by meds, but my platelets still
have the potential to cause clots or bleeding."
Klip "I am only 30, and do not look forward to
always needing surgeries. Is there anything that I
can be doing to prevent adhesion formation?"
Drwiseman "I wonder if that can make adhesions
worse? It is fairly rare, I think."
Klip "Yes, ET is very rare, especially in my
age group. How could it make the adhesions worse? By
Klip "I was off of my aspirin therapy before
surgery, and still am at this point because I am afraid
of excessive bleeding during healing."
Klip "My bleeding time the day before surgery
was 8 minutes."
Drwiseman "If there is some bleeding - which
inevitably there will be - I would GUESS that the number
of platelets may cause clotting to occur more rapidly
and to form tough adhesions more rapidly - I don't
know for sure but I would be interested in the path
Klip "My platelet count was 202,000 at the time
of surgery, thanks to Anagrelide and Hydrea, which
control my counts."
Klip "With ET, abnormal clotting or bleeding
can occur, but I tend to have clotting problems even
at high normal platelet counts."
Klip "I get dizzy, have headaches, tingling hand
and foot, etc"
Drwiseman "Sorry - wrong way round - the low
platelet numbers will mean that there is more fibrin
around and thus the possibility of more extensive adhesions
- especially in the cul de sac - I think you mentioned
a large fibrotic lesion there on a previous surgery."
Drwiseman "I would still be interested in the
Klip "Yes. Why would there be more fibrin with
a lower count? If that is the case, you would think
it would be better to go thru surgery with a high count,
but then I run into other problems."
Klip "What sort of things can be learned from
the path report? I have a wonderful doctor, whom I
am sure will answer any questions."
Drwiseman "With a lower count it means that bleeding
is prolonged - the longer the bleeding the more blood.
The more blood - the more fibrin."
Drwiseman "I don't know - the pathologist may
notice some differences in the adhesion tissue compared
with non-ET patients?"
Klip "I wonder what could be done to help me,
then. I need the low counts, but then I don't want
Drwiseman "What do you think I can help you with
- remember that I am not an MD."
Klip "I thought you were an MD. I know you have
a web site about adhesions, right?"
Drwiseman "I'm not saying that this is the case
- but it may be an additional factor."
Drwiseman "I certainly do: http://www.obgyn.net/adhesions.asp"
Klip "What brought about your interest in adhesions?
Are you a researcher in the area of adhesions?"
Drwiseman "Yes - I have been studying adhesions
for nearly 13 years - I have been involved in the development
of several anti-adhesion products."
Klip "Is there a good success rate with Interceed?
Also, I was given antibiotics during surgery. I understand
this can help prevent adhesions by preventing post-op
Drwiseman "I have studied Interceed extensively
- basically without it each organ has a 75% chance
of reforming adhesions. With Interceed - the rate is
reduced to 50% - this assumes that the dr. was able
to stop all the bleeding."
Drwiseman "Infection should obviously be avoided
- but it can also make adhesions worse - I assume that
you were given them by iv or orally?"
Klip "I wish the success rate was better, but
I'll take 50% over 75% chance any day."
Drwiseman "Yes, we still have along way to go
- to reduce lower than 50% - that's why we're still
working on it."
Klip "I was given IV antibiotics."
Drwiseman "I am assuming that you have no signs
of post-op infections."
Klip "As I said before, I have a top surgeon,
and I carefully watched the video of my surgery, and
he carefully stopped the small bleeders, and rechecked
after flushing with fluid several times."
Klip "I have no signs of a post op infection:
no fever, and the incisions look good. I assume pain
bad enough to need painkillers is normal at this point
in my recovery."
Drwiseman "Sounds like he did a great job - even
in the hands of the best surgeons, adhesions are inevitable."
Klip "I know, that is what has me worried. My
last surgeon is also one of the pioneers in laparoscopic
surgery, and I still got adhesions again."
Klip "I left my last surgeon because he treated
me like a disease, not a patient. I think he wants
his success rates to look good."
Drwiseman "I would be interested to know who
were your surgeons - you can email the details privately
firstname.lastname@example.org - or if you have other
Klip "He didn't even care that I had diarrhea,
and denied my endo could be causing it. He also refused
to give me painkillers of any kind, even non-narcotic
ones that my haematologist would be safe to take with
my platelet problem."
Drwiseman "That doesn't sound so good."
Klip "I really like my current surgeon. He is
very personable, and treated me as a person with complex
problems, and is working with my other doctors."
Klip "I will definitely E-mail you their names.
I feel that a truly good surgeon is also a good doctor
who cares about his patients, as well as being surgically
Klip "I learned about both of them through the
Endometriosis Association. I like to keep up with my
diseases, and be an involved, educated patient."
Drwiseman "I agree - I hope this has been helpful
and I look forward to hearing from you. Is there anything
else you would like to ask before we log off"
Klip "Thank you so much for all your help and
advice. It has felt good to talk out this past week
Klip "I think you have answered all of my questions.
Thank you for your time, and good-bye."
Drwiseman "No problem - in fact we have a support
group in Wisconsin that I can put you in touch with
- I think that may be very useful."
Klip "When I E-mail you, you can E-mail back
Drwiseman "Logging off - we'll continue by email
- nice to chat with you."
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