The following chat transcript courtesy of obgyn.net
Prior Chat Transcripts
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
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
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
mary_s Hmd, are you able to exercise at all?
Hmd I can't say that I have deliberately made an attempt
mary_s Christine, how long ago was your surgery and
what was done?
Drwiseman Christine: Has the doctor suggested a program
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
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
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
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
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
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
Drwiseman That's my first question too. Adhesion barriers
are not 100% effective, but they are certainly better
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
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
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,
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
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
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
Abracadabra You have quoted me in your article - "hopeless" should
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
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
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
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
Drwiseman Bye y'all
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