reply to Bev about PT

From: ZIMLICKI,PAULA M (MKT-PMZ@womans.com)
Wed Oct 25 12:02:50 2000


A note: I wrote this reply on Tuesday, October 24, 2000, before Beverly put in the postings her fear that a "marketeer (sic) I fear we have a marketeer looking for some business with a group of people in pain.." As I said in a posting earlier today, I am not a marketer looking for business. I am a fellow sufferer from adhesions who is only trying to pass along information that helped me, and I hope will help you. I thought that was the purpose of these postings. If anyone would like to talk to me or send me email, please do so. I ask that you send to my home email of pmzim@msn.com. Thank you.

Dear Beverly, Thanks for your reply. I would be glad to answer all your questions. I want to be sure to answer all your questions (they are all very good questions). But, briefly, I have had three laparotomies for Stage IV endometriosis, two laparoscopies, a hysterectomy/oophorectomy done through laparotomy at age 30, and another laparotomy for adhesions. I have suffered from abdominal adhesions since 1987 and from pelvic pain since the age of 15 (I am now 47.) I make my living as a medical writer who specializes in women's health issues. I am a member of the American Medical Writers Association. I have been a volunteer for the Endometriosis Association for 18 of the 20 years the organization has been in existence. I am cofounder of the Boston Chapter of the Endometriosis Association and ran its support/education group for six years.

You are correct in that treatments need to be studied and confirmed through scientific studies, and that using physical therapy for abdominal adhesion treatment is not a well-known treatment. You are absolutely right in that comments about treatments need to be substantiated. I hope this discussion helps to do that. One way in which treatments that are considered experimental finally become standard is through controlled studies. However, to get to a controlled study, often it is the voices and experiences of people who have suffered from a condition that get medical researchers to consider other treatments. Just as not all medications help all people with the same disease, just as surgery does not help all people with the same disease, the same can be said for physical therapy.

When I used the word "soften" in my previous post, I was not using it as a medical term, but as a means to describe how I feel my adhesions have become through physical therapy, exercise, and Yoga. Believe me when I say I have been through the medical mill and back with endometriosis, infertility, and adhesions. I am a skeptic by nature, too.

Let me take your comments one by one. Your comment: Adhesions are located deep within the abdomen and many surround the intestines, as time goes by the adhesion tissue toughens thus constricts the intestine or pulls other attached organs out of position more and more, how can PT help in that process? How does a therepist massage adhesion on the bowel? What about in the deep abdomen? There ia the large thick rectus muscle as well as a layer of fatty tissue between the surface of the abdomen and the adhesions, how are the adhesions massaged?

What you describe above is exactly how my adhesions were. They had constricted my bowel to the point that having a bowel movement was painful and almost impossible. That is when I had my surgery. Things were fine for awhile until the pain returned again. I did not want more abdominal surgery as my abdomen already looked like a road map with multiple incisions, and the risk of bowel and urethra damage were high. Desperate to avoid surgery, I decided to try physical therapy. The way my PT massaged my adhesions was by massaging the scars to which they were stuck. She did this manually through a massage technique called "myofascial release" that stretches specific tissues and scars, and through ultrasound. The physical therapist also used heat on my abdomen before and after simple stretching movements to help with pain.

In the beginning, I saw the physical therapist twice a week. Gradually, exercises (not aerobic or anything that causes jolting movement) were introduced into my program. These exercises involved very gentle movement, and anything that caused pain was not included as part of the program.

Your comment: A TENS unit is a nerve stimulator, how would that be of benefit on adhesion tissue as there is no nerves in adhesion tissue? And where would a TENS be placed on a person for abdominal adhesions, as without a laporoscopic surgery, it is unknown where the adhesion are and what they are attached to?

While there may not be nerves in adhesion tissue, there are nerves in the pelvis. The TENS unit did not "get rid" of my adhesions (nor did physical therapy) but what the TENS unit did do is help me with the pain. Because I had had laparoscopic surgery, I was fortunate in knowing where my adhesions were located. You are right in that only through laparoscopy can abdominal adhesions be diagnosed. My statements were meant as suggestions for people in whom abdominal adhesions had been diagnosed. Since the physical therapist could refer to my medical records in knowing the location of the adhesions, she was able to place the TENS unit on my abdomen in optimal location to help relieve pain from the nerves.

Also, let me emphasize, that all the treatment my physical therapist did was done in conjunction with a physician's order, and regular updates were given to my physician on my treatment and condition.

Your comment: Excersise that cause pulling of the organs that adhesions are connected to will increase inflamation thus pain, if a person cannot bend or sit for long due to the intestines not being able to move up and to the back of that person becasue they are attched to the peritoneum ( inner abdominal wall ) wouldn't excersise create even more pain? At times even movement while riding in a car can cause pain simply from the motion of the moving vehicle.

You are absolutely correct that exercise can pull pelvic organs, thus increasing pain. I did not say that all people with pelvic pain are candidates for trying PT. What I did say is that PT might be a viable option for some people to try, depending on where they are with treatment of whatever disease process is causing their pain. My adhesions were attached to my bowel, to the cul de sac of my pelvis, to the scars from previous surgeries. Even movement in a car caused pain if that part of my body was jolted. I benefited from the one adhelyosis I had had, but I still had adhesions.

It had been years since I was able to do any type of exercise as most movement caused pain. My body felt as though it had folded in on itself and was becoming more and more inflexible and rigid as I tried to protect myself from pain from the abdominal adhesions. Physical therapy helped me become less rigid and more flexible.

Your question: Have you seen adhesion of the bowel or pelvis?

Yes, I have in my work as a medical writer, from observing surgery in the OR, from attending certified medical education programs for health care workers, and from researching the medical literature. I have published an article on adhesions (1988) that appears in the book, The Endometriosis Sourcebook.

Your comment: It is imarative that comments of this nature be substantiated for those who are desperatly looking for medical intervetion and it is also important for them not to pay money they do not have in treatments that will be ineffective for this disease...it is my opinion that PT will not help adhesion sufferers other then to empty the pocket books. BUT...show me proof of all that was discribed here and I will be very willing to research it.

My ONLY goal here is to offer a possible option for those who have tried other options that have not worked. I obviously disagree with your comment about PT not helping abdominal adhesion sufferers other than emptying their pocket books.

All of this treatment took time. Nothing about it was magical. I had to commit to seeing a physical therapist twice a week in the beginning. After a few months, my appointments were weekly, and then, every other week. I was very fortunate to have insurance that covered most of the cost of this treatment, which is expensive.

I am no longer in treatment. I continue to do my exercises, use TENS and heat when I need it. Three months ago, I began taking a Yoga class, and that has helped me. However, I would not have been able to take Yoga at the beginning of my treatment because of the pain and inflexibility caused by the adhesions.

Let me emphasize that I know what it is like to live with daily, unrelenting pelvic pain. I know what it is like to not be able to do the things you want and to not be able to exercise because any movement causes pain. I know the hopelessness and anxiety that can be created when nothing seems to help the pain. I know what it is like to be exploited in my efforts to find treatments for my pain.

Yes, not much has been written in the medical literature on using physical therapy to treat pain from adhesions. But, if a person has tried all else, I firmly believe trying physical therapy as a viable option for abdominal adhesions with a physician's order, as I did. I am living proof, and believe me, I am as skeptical as anyone when it comes to treatments that aren't supposed to work. Paula M. Zimlicki mkt-pmz@womans.com

> -----Original Message-----
> From: Bernie and Beverly Doucette [SMTP:bnb@cybrzn.com]
> Sent: Tuesday, October 24, 2000 2:30 PM
> To: Multiple recipients of list ADHESIONS
> Subject: Re: How do I prevent them from coming back?
>
> Please send substantiating information as to how PT can soften adhesion
> tissue?
>
> Adhesions are located deep within the abdomen and many surround the
> intestines, as time goes by the adhesion tissue toughens thus constricts
> the
> intestine or pulls other attached organs out of position more and more,
> how
> can PT help in that process?
> How does a therepist massage adhesion on the bowel? What about in the deep
> abdomen? There ia the large thick rectus muscle as well as a layer of
> fatty
> tissue between the surface of the abdomen and the adhesions, how are the
> adhesions massaged?
>
> A TENS unit is a nerve stimulator, how would that be of benefit on
> adhesion
> tissue as there is no nerves in adhesion tissue? And where would a TENS be
> placed on a person for abdominal adhesions, as without a laporoscopic
> surgery, it is unknown where the adhesion are and what they are attached
> to?
>
> Excersise that cause pulling of the organs that adhesions are connected to
> will increase inflamation thus pain, if a person cannot bend or sit for
> long
> due to the intestines not being able to move up and to the back of that
> person becasue they are attched to the peritoneum ( inner abdominal wall )
> wouldn't excersise create even more pain? At times even movement while
> riding in a car can cause pain simply from the motion of the moving
> vehicle.
>
> Are there brochures or information on these treatmenst? What has the
> history
> been as far as success? How is this success tracked if there is statistics
> on PT & Adhesion disease?
>
> Have you seen adhesion of the bowel or pelvis?
>
> It is imarative that comments of this nature be substantiated for those
> who
> are desperatly looking for medical intervetion and it is also important
> for
> them not to pay money they do not have in treatments that will be
> ineffective for this disease...it is my opinion that PT will not help
> adhesion sufferers other then to empty the pocket books. BUT...show me
> proof of all that was discribed here and I will be very willing to
> research
> it.
>
> Your new here, and we are happy that it worked for you, Paula, and who did
> your surgery? How many surgeries have you had and how may years have you
> suffered with adhesions? Did you have endo as well my dear? Thank-you for
> sharing this and we look forward to hearing more on this and answers to
> these questions as well.
>
> Sincerely yours
> Beverly

>> ----- Original Message -----
> From: ZIMLICKI,PAULA M <MKT-PMZ@womans.com>
> To: Multiple recipients of list ADHESIONS
> <adhesions@mail.medispecialty.com>
> Sent: Tuesday, October 24, 2000 12:10 PM
> Subject: RE: How do I prevent them from coming back?
>
> > I suffer from adhesions due to so much abdominal surgery. I had one
> surgery
> > for the adhesions, which I always found ironic since surgery is what
> caused
> > them in the first place! The second time the adhesions began giving me
> lots
> > of pain I tried physical therapy, and it worked. The pain was so severe
> that
> > it woke me up whenever I turned over at night. It's important to get a
> > physical therapist who has received specific training in abdominal
> > adhesions. The American Physical Therapy Association, which has a
> website,
> > can give you information as to whether a PT in your area is available. I
> > encourage all of you to try this. Through the use of ultrasound, scar
> > massage, heat, TENS unit, and exercises tailored toward the adhesions, I
> was
> > spared another abdominal surgery. The PT treatment does not get rid of
> the
> > adhesions but can soften them enough so that they don't cause the pain.
> It
> > spared me another abdominal surgery! I would be glad to answer any
> > questions.
> >
> > Paula M. Zimlicki
> >
> > mkt-pmz@womans.com
> >
> > > -----Original Message-----
> > > From: acinom@primenet.com [SMTP:acinom@primenet.com]
> > > Sent: Sunday, October 22, 2000 9:09 PM
> > > To: Multiple recipients of list ADHESIONS
> > > Subject: How do I prevent them from coming back?
> > >
> > > Hi everyone! I just stumbled upon this site tonight, I have yet to
> join
> > > the forum, but I was wondering if anyone could help me. I have endo,
> I
> > > had 2 laps in 99, and I have another one scheduled for October 30th.
> > > Each of the last times they found more problems with the surgical
> > > adhesions from an appendectomy back in 88 with minimal endo. The
> amount
> > > that came back in just 4 months was amazing. Well, the pain is back,
> > > and again I suspect it to be adhesions rather than endo, but who is to
> > > know for sure which is causing the pain since I have both problems? I
> > > dont want to take Lupron or any other hormonal treatment other than
> > > bcp's particularly because I fear the big problem is the adhsions so
> why
> > > mess with endo drugs if that isnt the issue? Anyway, my questions for
> > > you are these:
> > > Have any of you tried Acupuncture? Either to relieve pain or to keep
> > > adhesions from reforming (is this possible?)
> > > Is there anything I can do after this surgery to retard the growth of
> > > this stuff?
> > > Please email me at acinom@primenet.com if you can be of any
> assistance.
> > > I appreciate it more than you can imagine!
> > > I hope this finds you all pain free and blessed with love and laughter
> > > *HUGS*
> > > Monica
> > >
> > > to the unsubscribe form at
> http://www.adhesions.org/forums/listcmds.htm
> >
>


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