The following chat transcript courtesy of obgyn.net
Prior Chat Transcripts
Prevention of Post-Surgical Adhesions
David Wiseman, PhD
Wednesday, December 16, 1998
Guest9 "Good Evening Dr. Wiseman!"
Drwiseman "Hi who have we here?"
Guest9 "Has anything new happened in the world
Drwiseman "OK folks what do want to know about
Drwiseman "Guest 9: do you want to introduce
yourself or to ask a question?"
Guest9 "Sorry, I'm new! ok what I would like
to know is whether there are any new products re: adhesions?"
Guest9 "Dr. Wiseman, do your guests suffer from
endometriosis and adhesions OR just adhesions?"
Drwiseman "Good question: Genzyme has just released
a new version of their Seprafilm product in Europe,
called Seprafilm 2. It won't be available in USA for
some time. INTERGEL has just finished enrolment in
one of their US trials but this product is not likely
to be approved for another 2 years or so."
Guest9 "What is the difference between the 2
Drwiseman "Our guests have adhesions due to a
variety of causes, including endo"
Drwiseman "There is little difference between
the products except that Seprafilm 2 is more flexible
and easier for the surgeons to handle."
Guest9 "Are they gels?"
Drwiseman "They are films, rather like a dried
Guest9 "A man who has children!"
Drwiseman "Indeed: or a man with a sweet tooth!"
Guest9 "How is the efficacy of these products?
Are they similar to Interceed? If not, what is the
difference between all of these 3 -- or are the 3 simply
from different corps?"
Doz "I had a lapo for removal of adhesions, in
April, they are already back, also have adhesions from
Drwiseman "Seprafilm 1 and 2 are from the same
company: Genzyme. Their efficacy should be about the
same although Genzyme will need to prove that in order
to gain approval. As far as their equivalency to INTERCEED,
we do not have any side to side comparisons, but from
animal studies they seem to be about the same."
Hoopie "I'm having a total abdominal hysterectomy
on Friday and would appreciate any advice."
Drwiseman "There are some subtle differences
that might make one product preferable over another
in some situations."
Doz "What can I do other than more surgery, or
prevent them from returning?"
Guest12 "Dr.. Wiseman - Do you know of a GOOD
doc in Houston, Texas that knows about adhesions?"
Drwiseman "Doz: tonsillectomy: not much has been
done to prevent adhesions here, although clearly the
site is more accessible than in the abdomen."
Guest9 "Of all the products, which yields the
best results -- if you are at liberty to say?"
Guest12 "Every doc I go to tells me adhesions
do not cause bowel problems!! I know different!"
Doz "The adhesions on uterus and abdominal wall
are the painful ones. Do you know anyone in Cleveland,
Hoopie "So how can we prevent adhesions? I seem
to get different advice from different people. Too
much exercise is bad, too little is bad..."
Guest9 "Yes guys. Drs. have also told me that
adhesions don't cause pain BUT nobody knows what it
feels like until it happens to them!"
Drwiseman "Hoopie: I would certainly ask your
doctor about adhesion formation after hysterectomy:
they can certainly occur and in a small number can
lead to problems. Although INTERCEED and Seprafilm
should be useful in this situation but neither have
been studied there. If it is a laparoscopy, seprafilm
cannot be applied there (too difficult) and INTERCEED
can be used although is not approved."
Hoopie "What are those, Dr.. W?"
Guest9 "Dr. W - what about the gel?"
Drwiseman "This chat is going fast and furious:
who asked me about Houston and Cleveland: I know doctors
in both places: please email me afterwards (email@example.com)
and I will give you some suggestions."
Hoopie "Are these standard treatments?"
Guest12 "That was me that asked about Houston
Doz "I'm near Cleveland, thanks will email later"
Guest12 "Thanks doc David, I'll e-mail you."
Drwiseman "Which products yield best results?
We don't have any head to head comparisons in humans,
but INTERCEED and Seprafilm appear to be about the
same with some subtle differences."
Hoopie "What are INTERCEED and Seprafilm? Are
they standard treatments? My dr. is at Camb. Hospital./
Harvard MS. What should I ask her?"
Guest12 "I need to hear at least "ONE" doctor
say I'm not crazy". Adhesion do cause bowel blockages!
Am I right?"
Drwiseman "G12 first: I'm not a doctor (MD) at
least, but you are definitely NOT crazy"
Guest9 "Guest 12, I believe you"
Hoopie "Dr.. W, do you do medical research on
Guest9 "Drs. often think we're crazy unless they
can "see" the problem."
Guest12 "Can you have adhesions around your heart?
Sometimes I feel I'm having a heart attack - such pain."
Drwiseman "Hoopie: INTERCEED and Seprafilm are
both barriers that are placed at the site of surgery
in order to prevent scarring (adhesions). You should
ask your doctor about adhesions and what s/he uses
to prevent them. Yes, I do research on adhesions."
Guest9 "Dr. W, what about the gels?"
Drwiseman "You should also ready the article
I have on adhesions A Patient's Guide to Adhesions
and Related Pain
Hoopie "Are they standard treatments?"
Hoopie "i.e., are they commonly used at major
Barbaran "Guest 12: Why not contact Joseph Feste,
MD? He's at Methodist, in the Fanin Bld. His CV is
on OBGYN.net. Do a search with his name."
Drwiseman "They are standard treatments in some
hospitals only, not everywhere. Some major hospitals
use them and some do not. Some have never heard of
them and some do not think they work."
Guest12 "By the way doc, I read your article
and I found it to be very informative. Thanks.."
Drwiseman "Guest9: Gels: there are 3 main gels
under development: INTERGEL: Sepragel and Flogel. None
of them are approved yet. INTERGEL ins approved in
Drwiseman "Guest12: many thanks"
Drwiseman "Houston: There are several doctors
who know lots about adhesions: Drs. Feste, Randy Dunn,
Robert Franklin (all at Fannin) and Russel Malinak
Guest9 "Dr. W, Ditto Guest12 on your article.
Are these 3 gels from separate companies? Are they
all equally good? If not, which is best? Or does it
all go back to Drs. skills and inflammatory events
in our bodies?"
Drwiseman "Gels: we don't yet have a good handle
on how well these gels work alone or against each other.
There are no data available except for a little on
INTERGEL, which is really too little to draw any major
Guest12 "From Houston - thanks I will check them
out....I have been (I thought) to every doc on Fannin
and Main St.....they are the ones that told me they
don't cause bowel obstruction!!! I'll check them out...thanks.."
Drwiseman "Adhesions around the heart: Yes, adhesions
do form around the heart after heart surgery, but they
should not cause pain. If you are experiencing "heart
attack" pain then you MUST see your doctor immediately."
Hoopie "How about Harvard MS? used here? Also,
is the research just on the gels, or other factors
related to developing adhesions, risk factors, etc."
Mary_s "Dr. Wiseman, it's too bad something couldn't
be created in a spray form to coat the organs and prevent
adhesion formation. I know this sounds kind of crude...but
something like Pam spray."
Hoopie "actually, maybe I'll try to access the
site, read the article, and then ask questions"
Drwiseman "Harvard: I don't know anyone from
there off the top of my head."
Mary_s "Coat the organs yet not interfere with
Drwiseman "PAM spray: there are people working
Drwiseman "YUP: a little more viscous perhaps,
but that kind of idea."
Guest12 "From Houston - He did check my heart
out. All he found was a prolapse. I have had the pain
for approx. 8mos now."
Guest12 "Sometimes the pain shoots under my arm."
Drwiseman "Guest12: Better safe than sorry. I'm
not an MD, but it sounds like you need to see a cardiologist."
Hoopie "At what hospital do you do your research,
Guest12 "That was a cardiologist!"
Guest12 "Doc Wiseman, I have to pick up my son
from church. I'll e-mail for more info. Thanks for
being here. I REALLY appreciate you! :)"
Drwiseman "I have my own company and I work with
a number of companies on developing anti-adhesion products."
Drwiseman "Guest12: nice to chat with you. Good
Hoopie "Thanks for the info. I will read your
Drwiseman "Thank you. By the way please email
me so I can add you to our adhesions mailing list.
We are getting ready to launch the "International
Drwiseman "OK, who is keeping track of the questions:
which questions did we not answer yet?"
Drwiseman "Hi Guest 16: how are you?"
Guest16 "good...although experiencing problems
with the computer"
Drwiseman "It seems that everyone is today"
Guest9 "Gee, I was away for a few minutes and
now I missed the mystery guest 12! I experience the
same symptoms re heart and underarm shooting pains.
some of the girls on the endo net experience the same.
we thought it was perhaps endo related since so many
of us have had this since endo problem"
Guest16 "How is the adhesions society coming
along? By the way, this is Karen in AZ"
Drwiseman "Hi Karen: our star web designer!!
I have called almost everyone - still a few people
to go and I think I have someone to do almost everything
we need. I hope to finish this up over the holidays"
Drwiseman "Guest9: did you have heart surgery
Guest9 "Dr. W,, do you ever publish updates on
your site or is that what the chat is for?"
Drwiseman "I have not made an update to the main
adhesions article yet, but we hope to have an International
Adhesions Society Page up and running in a few months
where we will have updates."
Guest9 "Heart surgery! No way. I did have a scary
experience in May where I felt severe tightness in
the chest, nausea, dizzy, numb arm - went to emergency
and the doc said I had esophageal spasm but that I
should check up with cardio doc just to confirm heart
Drwiseman "We will also have a page at OBGYN.net
where more frequent news will be posted."
Drwiseman "Guest9: well any kind of chest pain
should be checked out properly: again I am not an MD,
but you need to see one if necessary"
Drwiseman "Any more questions?"
Guest9 "Laparoscopically, are you saying that
we have to wait for the gels?"
Guest9 "I mean for the pelvic region"
Drwiseman "You must wait for the gels for laparoscopy
Guest9 "Not what I wanted to hear!"
Drwiseman "Pelvic and other kinds of surgery"
Guest9 "Which gel does your company produce?"
Guest16 "What happens over time, say 20 years,
to adhesions (severe adhesions) that are left in place...and
by this I mean of the troublesome type that cause a
lot of pain"
Barbaran "OK gals I didn't want to announce it
but, OBGYN.net's new Special Section will be Chronic
Pelvic Pain and we will be including Adhesions, Endo
and anything else that causes it. I do know there will
be some Big Names in these areas of medicine on the
Editorial Advisory Board. Watch for the announcement
the first of the year."
Drwiseman "I do not produce any gel: I collaborate
with people who do. The companies that are in development
with gels are: Sepragel (Genzyme), INTERGEL (Eticon'Lifecore
biomedical) and Flogel (Alliance). Gliatech have a
liquid called ADCON P which looks promising. There
is a version of this called ADCON L which is used to
prevent spinal adhesions."
Guest9 "Dr. W will you participate in this new
section? Do you collaborate with all of these companies?"
Drwiseman "What happens in time?: adhesions just
stay there: they may grow thicker. sometimes people
have adhesions for many years before a problem arises."
Drwiseman "I believe that I will participate
in this section. And yes I collaborate with some of
Mary_s "Are there any other adhesion questions
this evening for Dr.. Wiseman?"
Mary_s "Thank you for hosting tonight, Dr.. Wiseman!"
Guest9 "Thank you Dr. W for your time this evening"
Guest16 "Thank you Dr.. W."
Drwiseman "Thanks everyone. Have a nice holiday."
Barbaran "Dr.. Wiseman has been invited by OBGYN.net
to join the Editorial Advisory Board for Pelvic Pain
and I "think" he just gave me his Yes..........
Tell him He Needs to be on the board!"
Mary_s "Goodnight everyone, we'll see you next
month here. Have a nice holiday."
Guest16 "Yes, I believe he does!!"
Guest9 "And thank you for dr. recommendations
which you made to me in the past. You have helped me
more than you will ever know!"
DISCLAIMER: Please note that all information
provided on this web site, or in response to any communication
with the International Adhesions Society, is not intended
nor is implied to constitute professional medical advice
nor does it substitute for professional medical advice.
Always seek the advice of your physician or other qualified
health provider prior to starting any new treatment
or regarding a medical condition or its current treatment.