International Adhesions Society





Chat About Adhesions

The following chat transcript courtesy of now


Prior Chat Transcripts


Prevention of Post-Surgical Adhesions
hosted by David Wiseman, PhD
July 22, 1998

Drwiseman Christine, do you want to start? Do you have any questions?

Christine3 Yes. My question is: does walking loosen adhesions?

Drwiseman Good question. I don't know that anyone has documented the effect of any given exercise on pelvic adhesions, although it does make sense that certain exercises will stretch and loosen some adhesions. They certainly do in the hand. A number of people have written to me to tell me that various exercises (dance, walking etc.) help.

Christine3 The doctor told me that walking helps and I just did not understand how when it causes me so much pain.

Drwiseman Are you in pain only when you walk or the rest of the time too?

Christine3 All the time and when I do anything - sitting, walking, laying down.

Hmd In my case I find the adhesions to be most painful when I am sitting down.

Drwiseman Well depending on where the doctor thinks the adhesions are, s/he thinks that walking may stretch them to the point where they bother you less. It's a little like having a seized up muscle, it needs to be stretched before it can feel better. Obviously if the pain is going to make you faint, don't do it. Perhaps do some exercise under the supervision of a physical therapist.

mary_s Hmd, are you able to exercise at all?

Hmd I can't say that I have deliberately made an attempt to exercise.

mary_s Christine, how long ago was your surgery and what was done?

Drwiseman Christine: Has the doctor suggested a program of exercise?

Christine3 I had a TAH July 96 and had another surgery Jan 98 with the removal of my right ovary and left ovary lifted and freed from adhesions.

mary_s How soon did you develop adhesion pain?

Christine3 Right after my TAH in July.

Hmd This is probably changing the subject at a bad time; but here goes. I finally was able to view the video of my laparoscopy done August 1st of last year. This was a real eye-opener regarding the surgery that was done. I know that this doesn't probably fit in here since we are talking about Christine3's adhesion problems. What is a TAH?

Christine3 Now the doctors say I have pelvic adhesive disease.

Drwiseman TAH = total abdominal hysterectomy

Hmd Thanks Drwiseman!

mary_s Do your docs plan any treatment for you, Christine?

Drwiseman What can happen it that structures such as the small bowel can stick to the raw areas that were created when the uterus was removed. This can lead to pain.

Christine3 Not right now , just pain management.

Hmd What are you doing for pain management?

mary_s Can't the adhesions be cut? Or is their location an issue?

Drwiseman This is not an uncommon problem and other than pain management, some doctors will try to map the pain and release any adhesions if that indeed is the cause of the pain. There are other causes of pain too, such as trapped nerve etc.

Drwiseman Mary: Yes adhesions can be cut if they are accessible and if their removal does not endanger other things such as the ureters. But there is always the question of adhesion reformation which should be avoided as much as possible using adhesion barriers.

Drwiseman I'm interested in Hmd's comment regarding her video tape being an eye-opener. In what way?

Hmd I am seeing a psychiatrist on a regular basis for medication management. Right now I am taking 600mg carbamazepine and 100mg of amitriptyline. Regarding the video: it was weird to see how the surgeon tackled the adhesions...which were massive following a laparotomy in 1970.

Drwiseman Weird? How so?

Hmd I watched as he cauterized the adhesions side by side in two places and then he cut between these segments. The weird part was that when he did the cauterizing it reminded me of bacon frying.

mary_s Did you have general anesthesia for the surgery?

Hmd Of course, I had a general anesthesia. It was suppose to be same day surgery, but because of the extent of my surgery I was kept in the hospital overnight with intravenous pain medication.

Drwiseman Yes Hmd, cauterizing is exactly like cooking meat. It smells the same too.

Drwiseman I would like to add in an email that I received today which I was asked to include in this chat:

Drwiseman 1. My name is Jeanie. I just had my 2nd laparoscopy adhesiolysis last week. The result: I had more adhesions than the 1st one. The new adhesions extended to my liver. What happened? My previous surgery are under bikini line and isn't it suppose to be less and less adhesions after every adhesiolysis?

Drwiseman 2. My doctor's opinion: Cross the finger and hope! Both of us understand very well that my adhesions will come back, Why try to cover it instead of dealing with it? He is frustrated, may be nothing else can be done?

Drwiseman 3. For prevention: My doctor suggested some exercises (bend the head to the knees 3 times a day) to break out the new adhesions. Is there any other way?

Drwiseman 4. There was no discussion for further laparoscopy. I was too stressed out and too depressed. I forgot to ask. Does anyone think that another adhesiolysis in a very near future will help! When can we have a machine that can detect adhesions and when can we have the barrier or gel that will completely stop adhesions?

Drwiseman Before I comment, perhaps some of you would like to do so?

Christine3 So what will happen when you have another surgery and nothing is done to prevent more ?

mary_s First of all, her surgeon certainly *could* have used a barrier.

Hmd Toward the end of the laparoscopy I noticed that there was bleeding. Does this cause further problems with adhesions?

Drwiseman That's my first question too. Adhesion barriers are not 100% effective, but they are certainly better than nothing.

Hmd I have been reading on the Internet about the success that the Nezhat brothers have been having with videolaparoscopy. Is this possibly a better way of taking care of adhesions?

Christine3 I thought that if the adhesions are removed and nothing is done to prevent them then they come back, at least that is what happen to me. And the adhesions came back worst this time.

Drwiseman Hmd: Bleeding: it is always better to control bleeding because blood is a source of fibrin which causes the adhesions. Sometimes surgeons cannot get meticulous hemostasis but they should try their best. Of course any major bleeders should be dealt with immediately.

Hmd Thanks, Drwiseman!

Drwiseman Christine: There is at least a 75% chance of adhesions reforming at any one site. They common consensus is that they come back with a vengeance, unless something is done about it.

Christine3 That is true.

Endohost I had surgery 5 weeks ago, my 10th one for adhesions and endo is it not inevitable that I will have to have anther since the adhesions were so extensive? Dr. Redwine was unable to remove them, just separate them.

Hmd I have seen so many doctors over these past 28 years that I find it really difficult to continue trying to find THE ONE SURGEON who will be able to help me.

Drwiseman Hmd: Re: Nezhat brothers: These Nezhats are very experienced surgeons and have lead the way in this field for a number of years. Firstly, any technique is highly surgeon dependent and videolaparoscopy can be performed by experienced and less experienced surgeons with obviously differing results. The use of lasers is somewhat controversial. There are some who believe that other methods of cutting and/or cauterizing are just as good or better. I would say though that the overriding factor is the skill of the surgeon. Using laparoscopy should however cut down on the adhesions that occur at places other than the specific site of surgery e.g. the ovary.

Endohost I understand Hmd.

Christine3 I know that when I had my second surgery I had most of my pain on my right side. Now I have bad cramping and pulling and when I pee I have really bad pulling.

Endohost I am sorry, Christine, that must hurt. I have that around my bowels.

Drwiseman Endohost. Your persistence in trying to get into this chat is matched only by your persistence in having your adhesions dealt with. If you have additional endo that of course complicates things because endometriosis itself can cause adhesions. I would have to guess that you are likely to get some recurrence of adhesions, although you are in the hands of a very good surgeon, Dr. Redwine.

Endohost Yes, I would not have jumped head on into surgery so quickly had I not been obstructed.

Drwiseman Endohost: What does your doctor say about all of this?

mary_s Hi Jeanie! Dr. Wiseman presented your question.

Endohost BTW, I had a hysterectomy 3 surgeries ago, so nothing in there BUT adhesions.

Hmd I am trying to get up enough strength to give the Mayo Clinic one more try...but I just can't find the courage to ask my husband if he will support me in another trip down there. What really disappointed me the last time was that a surgeon told me that I would have to have another medical problem that required surgery. In other words surgery for adhesions was not an adequate reason.

Endohost Dr. Thank you for answering my question...Hmd, I had a similar problem there. Are you in pain?

Hmd All the time!

Abracadabra I have a question for the doc when there is a break.

Jeaniebui I am sorry! Can I still join in?

Drwiseman Let me throw in one of Jeanie's q's: 4. There was no discussion for further laparoscopy. I was too stressed out and too depressed. I forgot to ask. Does any one think that another adhesiolysis in a very near future will help! When can we have a machine that can detect adhesions and when can we have the barrier or gel that will completely stop adhesions?

Hmd From what I have heard tonight, my problem with pain is not as bad.

Drwiseman Jeanie's question has been brought up by others tonight (e.g. Hmd) and that is: Will surgeons operate unless there is a reason other than pain?

Hmd Like Drwiseman said, what matters is the surgeon's expertise. How does one find a surgeon who fills that criteria?

Jeaniebui Thank you Dr. Wiseman for helping me with my question. I finally know how to use chat. Thank you Mary for your instruction.

mary_s Does this get become an insurance issue? Meaning, will many insurance co.'s not cover repeat surgeries to remove adhesions and you need another reason for being operated on in addition to the adhesions?

mary_s You're most welcome Jeanie!

Drwiseman The answer to this is that some surgeons (e.g. some general surgeons) will not operate unless there is something like bowel obstruction. Some gyn's are more willing to operate for pelvic pain, particularly when they can try to map it.

Abracadabra I have 10 spinal hemangiomas, am in constant pain. Doctors won't operate because of my history of severe adhesions due to prior medical mishap. Radiation is recommended treatment but they don't want more adhesions. Related to endo? What to do?

Drwiseman Mary: I don't think it is just an insurance issue.

Hmd How can a person find a surgeon who is qualified to do pain mapping?

Endohost Yes, no one would touch me till I had the obstruction.

Abracadabra You have quoted me in your article - "hopeless" should sound familiar!

Hmd If only that magic gel would be available, this would be a beginning.

Drwiseman Abracadabra: Are your adhesions around the spine? This is a different story entirely?

Drwiseman Jeanie: anything to add?

Abracadabra No, pelvic adhesions. Due to peritonitis; but I have endo also.

Hmd Endo must really be a difficult thing to live with!

Endohost Thank you doctor, good night all!

Drwiseman Abracadabra: My guess is that because of peritonitis, the adhesions might be quite widespread and extremely difficult to operate on.

Abracadabra Correct - no surgeon will touch me. But I am in constant pain; cannot sit or lie down, and THEN there's the endo...

Drwiseman Hmd: Finding a surgeon: good question, other than referrals I think interviewing your surgeons about their attitudes and experience with respect to adhesion and their treatment would be helpful.

Drwiseman Abracad: I don't think so, although somewhere deep in my brain there might be some rare cases of endo around the spine. Your doctor needs to tell you this.

Abracadabra My doctor believes endo cannot travel; also doesn't believe in pain meds!

Hmd This hour has really flown by. Thank you Drwiseman and all those who have contributed tonight. Maybe I will have made that crucial decision before the next chat session. Goodnight to all.

Drwiseman I could be wrong about spinal endo: I'm not an MD.

mary_s Did everyone get their questions answered?

Abracadabra Darn time zones - I thought this was just starting!

Drwiseman Any more questions?

mary_s Amy, did you have a question?

Drwiseman Any comments from you AmyH

Amyh Not yet...1st time here:)

mary_s Welcome Amy!

Amyh But I do want to say to Abra: please hang in there & don't give up, ok? :-))

Abracadabra Forget it - it won't work - thanks anyway.

Drwiseman Abra: I checked out your web site: it's beautiful.

Drwiseman Bye y'all

mary_s Goodnight!




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