Drwiseman "OK folks it looks like it's just the three of us. Marykate do you have any questions?"
Marykate "Hi, this chat is about post-surgery complications, pain, etc...?"
Marykate "If you develop adhesions do they "grow", or after you heal it that pretty much it?"
Drwiseman "Yes, the main thing we are dealing with here is adhesions, one of the biggest complications. But we can have a bash at some other things and try to point you in the right direction."
Drwiseman "You got your question in first. Good. Let me answer it."
Drwiseman "Adhesions do not seem to "grow", they may however become tougher with time."
Marykate "Can the pain feel like cramps? sharp pain? All the time or sometimes or both?"
Drwiseman "Depending on where the adhesion is the pain can manifest itself in a number of ways (and also several at a time). Also remember that there are other causes of pain too."
Drwiseman "Are you having problems with adhesions?"
Marykate "What is done during a surgery to reduce the risk of adhesions from happening?"
Drwiseman "The main things are: 1) the surgeon needs to use very delicate technique 2) S/he needs to use an adhesion barrier: the two available in the USA are INTERCCED (Johnson & Johnson) and Seprafilm (Genzyme)."
Marykate "How does the barrier work? Who originally developed the technique?"
Drwiseman "The idea of using a barrier has been around over 100 years when they tried all kinds of things: sharks membranes, gold foil, and other delicacies. The barrier is basically placed on the organ judged to be at risk of adhesions. It then acts to physically block their formation. The barriers I mentioned only need to be there a few days until the critical time period is over."
Marykate "What are they now made of? Something like KY jelly?"
Marykate "Is it fabric?"
Drwiseman "INTERCEED is made of a special type of rayon (rayon is a cotton like material used in all kinds of textiles) that dissolves in the body. INTERCEED looks and feels like a piece of knitted cloth. Seprafilm is made of hyaluronic acid and carboxymethylcellulose and is essentially like some dried KY Jelly"
Marykate "What's the worse case you've seen?"
Drwiseman "Remember that I am not an MD, but I have nonetheless seen live as well as on video and photographs some pretty bad cases involving large lengths of the intestine. This was in a lady who had had several operations previously."
Hmd "Hi! I have about 5 minutes until I leave for choir."
Marykate "What if a barrier isn't used, will you always get scarring?"
Drwiseman "Let me introduce Helen: the queen of our International Adhesions Society mailing list!!"
Hmd "Ha! Ha!"
Hmd "People are asking me "How soon?""
Drwiseman "Marykate: depending on the type of surgery, adhesions will occur in 75-90% of the sites. With a barrier this may be reduced to 40-60%."
Drwiseman "Helen is asking me about the International Adhesions Society IAS. This is a stop and go thing right now. I had a flurry of activity at the beginning of the month and now have 2 big projects to do, so I can't make any promises."
Drwiseman "This is the first time I've let myself out to work on something else."
Marykate "Why do they happen? Because of air and blood?"
Drwiseman "Helen do you have any adhesions questions or thoughts before you go to choir?"
Hmd "By the way there is no problem with the onelist group. I heard from them only once. No time for comments now. Thanks, and have a good session!"
Drwiseman "Why do they happen? This is a NORMAL process of healing. When we injure ourselves the body has a NORMAL process of repair which involves scarring. It needs to repair quickly and cannot deal with the long term consequences."
Marykate "What's the onelist group?"
Drwiseman "A message board somewhere for people with adhesions. I've only just heard about it and don't know too much about it right now."
Moe22 "Trying to get some info on laser adhesion removal."
Drwiseman "What in particular would you like to know?"
Moe22 "Wanted to know who, in my area, specializes in this type of procedure."
Marykate "Does massage, exercise, help with them not forming?"
Moe22 "And do the Interceed barriers really help them from coming back again?"
Drwiseman "Moe22 you should email me with your city and then I will see if I know anyone there who has dealt with adhesions. synechion@aol.com. For now you might like to describe your problem."
Drwiseman "Massage etc. I have been told that certain forms of massage and exercise help reduce adhesions as well as reduce the problems that they cause once formed. This is only hearsay though. In other kinds of surgery (e.g. hand surgery) exercise definitely helps"
Moe22 "Had Myomectomy in 1989, TAH in 1990 - adhesions formed from first surgery very much. After the second surgery, the pain was awful. I still can't stand or walk for extended periods of time from the pulling pain in my lower back and lower abdominal area."
Drwiseman "INTERCEED does reduce the REFORMATION of adhesions. Johnson & Johnson have plenty of data on that in humans. I just published an analysis of much of the INTERCEED data."
Drwiseman "Moe22: have you been diagnosed with adhesions?"
Moe22 "yes"
Mary_s "Is laparoscopy the only way to diagnose adhesions?"
Drwiseman "Well the alternatives are probably 1) live with it 2) have them removed, but make sure a barrier is used. It does not guarantee that they will not came back, but it will reduce the chances of it."
Moe22 "I was afraid to have them removed because I thought they'd just come back again. I've been told they've "matured" now and should feel better, but they don't!"
Drwiseman "Laparoscopy is the only way to do this definitively because there are no imaging methods (e.g. CT, MRI etc.) that can do it."
Mary_s "Seems like you risk getting more adhesions to see if you have them in the first place."
Moe22 "What size incision? How long recovery?"
Drwiseman "I'm not sure that mature adhesions are any better than "juvenile" ones. You are correct to fear recurrence of adhesions."
Drwiseman "The incision will depend on where the surgeon needs to operate. It may be possible to do this by laparoscopy in which case recovery will be shorter. Seprafilm cannot be used by laparoscopy and INTERCEED is not indicated by FDA for laparoscopic use although many surgeons do use it that way."
Drwiseman "Diagnostic laparoscopy without any surgical treatment does not seem to induce adhesions by itself, not in great numbers."
Mary_s "That's encouraging."
Drwiseman "How does that sound so far?"
Moe22 "So, the only prescribed way to use the barriers is through conventional "cutting" surgery?"
Marykate "Are some women more likely to get them? fair skin, dark, etc...?"
Drwiseman "Moe22: Yes, although many surgeons use INTERCEED anyway."
Marykate "If they can happen during a lap surgery, and the Interceed could be used with that type of surgery, is it helping, and why doesn't the FDA approve?"
Drwiseman "Marykate: we cannot predict who will get problems due to adhesions. Most people will get adhesions."
Moe22 "What would your recommendation be: conventional surgery with barrier or laparoscopy w/o barrier?"
Marykate "Is it frowned upon using a barrier with a lap surgery? If it helps, why don't more doctors do it?"
Drwiseman "Marykate: that is a long story you will have to ask Johnson & Johnson. They needed to perform a controlled clinical trial in that area which they have not yet completed. If they have completed it the FDA will be reviewing it and they have not yet finished doing so."
Marykate "Do they use the barriers w/lap surgeries in Europe? Is this just in the U.S. that they don't use it?"
Drwiseman "Moe22: tight call: I would say surgery with a barrier. I think the choice is against laparoscopy with a barrier. Unless you are desperate I would not do surgery without a barrier. Again you must see a doctor who can review your case. My "recommendation" is hypothetical and assumes everything else is equal, which invariably it isn't."
Drwiseman "It is not frowned upon to use barriers (INTERCEED) in laparoscopy: many doctors do it. Seprafilm cannot be used like that because of the way the product is made. It is just in the USA that INTERCEED is not approved for laparoscopic use: this is an FDA thing."
Marykate "Are new ideas coming to the forefront beside barriers?"
Marykate "or in place of barriers?"
Drwiseman "There are two companies developing liquids: Lifecore/J&J have a liquid gel called INTERGEL which is available in Europe and is undergoing the last stages of study. It may be available in the US in 1-2 years. It is also out in Canada. Another product is ADCON P, by Gliatech which is currently undergoing clinical study."
Drwiseman "ADCON P is a liquid."
Marykate "INTEREED is used in other countries with lap surgeries? And it works well? If it's not causing harm why doesn't the FDA allow it?"
Drwiseman "Again that's a long story that you will need to ask J&J about. Note that despite this FDA thing many doctors choose to use it anyway."
Marykate "And these products are non-toxic? What are they made of?"
Drwiseman "INTERCEED has a pretty good safety record and is made of a special type of Rayon which degrades into sugars which are then excreted. Seprafilm is made of something else which seems to have a good safety record."
Marykate "What could the side effects of these barriers be?"
Drwiseman "There are really very few, but the main ones seem to be that they could cause a foreign body reaction. I don't think this has been proven."
Drwiseman "There are other things that can happen if the barrier is used inappropriately: for example if INTERCEED is used before bleeding has been stopped then there could be more chance of a foreign body reaction and granuloma."
Marykate "Dr. Wiseman, thank you very much for your time. It's been very educational."
Drwiseman "Thank you for your questions. Good luck"
Drwiseman "We're almost going home now. Any last minute questions, otherwise email me synechion@aol.com"
Mary_s "Looks like everyone is leaving. Thank you for your time and answers this evening!"
Drwiseman "Goodbye: keep well"