Adhesions OT

[Guest guest]

Dear or a...do you know if there are any new treatments for the

prevention of adhesions? I remember someone else here having a lot of

difficulty with them...just wondering if there is anything that may stem their

tide.

Love...

Tess

[Guest guest]

Tess,

Seprafilm is being used as a barrier to prevent adhesions in abdominal

and pelvic surgery.

http://www.seprafilm.com/home.asp

Here is an article from adhesions.org that may help:

Crazy Glue

By RANIT MISHORI, M.D.

Tuesday, June 28th, 2005

[Click here for full version]

On most days, de los Reyes, a Port Authority lawyer, feels the

pain. " It's like someone's hand is in my guts, squeezing them to

death, " she says.

It's been like this for 13 years now, ever since she had a

hysterectomy, which went smoothly. But then a complication set in, one

of the most common but least ­talked about side effects of surgery for

millions of American men and women — something doctors call

" adhesions. "

Getting an adhesion is like having a not-so-elastic band suddenly

­materialize inside your body cavity and connecting ­internal organs

that are not normally connected — like loops of intestines, with your

uterus at one end and a bend in the fallopian tubes at the other, or

joining your intestines and the walls of the abdomen.

The growth can play havoc with your organs, causing excruciating pain

and, when the small intestine is involved, ­bowel blockage and

obstruction. Says Wiseman, a researcher and doctor of

pharmacology from Dallas, an ­expert on adhesions: " It's like taking a

ball of string that you let the cat play with, and get it all knotted

up and tangled, and then you pour glue on it and let the glue stay. "

Common in men, more so in women

Like hardened glue, adhesions are tough and inflexible, which is why

­doctors liken them to scar tissue. ­Physically resembling plastic

wrap, and composed of a tissue called fibrin, they can create a range

of different problems. Studies show adhesions can account for up to 74%

of small bowel obstructions, up to 20% of female infertility cases, and

­between 20% and 50% of chronic pelvic pain cases.

What's remarkable is how high the risk is for getting adhesions in the

first place. They can develop after any surgery — former President Bill

­Clinton developed a ­pleural adhesion that required a separate surgery

after his bypass operation. Data show they develop in at least 55% of

patients who undergo surgery. The number is as high as 90% for certain

types of surgeries, like hysterectomies and C-sections, which is why

the majority of patients suffering from adhesions are women.

The truth is that adhesions, first recognized when surgery entered

mainstream medicine in the early 1800s, are still not well understood.

The best guess is that they result from a kind of overreaction by the

body. Dr. Soumitra Eachempati, assistant professor of surgery at Weill

Medical ­College in Manhattan, says: " After any type of tissue injury,

your body would have an inflammatory response. The more ­vigorous the

response, the more likely the adhesions would form. "

Some people, he says, are more ­unlucky than others and have " an

­exceptionally vigorous response. " They're the ones who get severe

adhesions and may suffer from chronic pelvic or abdominal pain.

De los Reyes is one such ­patient. Like many who suffer from

­adhesions, her difficulties with the ­condition began as she recovered

from a ­hysterectomy her doctor ­recommended in response to fibroids

growing in her uterus. Pain (resulting­ from multiple ­episodes of

­bowel obstruction) was the main ­symptom — pain she says she can

­never get away from for long, even 13 years ­later. " It is basically a

day- to-day thing to see what I can do to alleviate — at least to some

extent — the ­discomfort. "

In addition to having had multiple surgeries for bowel obstruction and

what doctors called " adhesiolysis " — cutting of adhesions — she has

tried a lot of things to ease the pain, including prayer and

meditation. She has even — and she says this seriously — tried jumping

up and down on a ­trampoline. Sometimes these measures have helped, but

only temporarily. " I'll get relief for a little while, " she says, " but

sooner or later I wind up having problems again. "

Suffering from a lack of belief

Some 35% of all patients who undergo abdominal or pelvic surgery end up

back in the hospital because of this recurring pain, with the usual

result that they require surgery to remove the adhesions.

It's not just pain that's at issue. ­Certain adhesions can act to

tangle up a ­woman's fallopian tubes and ovaries, causing ­infertility.

Others can cause obstructions in the bowel. In these cases the only

­solution is to " go back in " and try to cut the ­adhesion or even cut

out the affected part of the ­organ. " If you liken your intestines to a

long garden hose, " explains Eachem­pati, " then there's a part that's

kinked, and we'd try to find that part and cut away the scar tissue

that is compressing it. "

But even that's not a sure thing. As de los Reyes has learned,

adhesions can be cut, but like bad weeds, they can spring up again. She

has undergone 14 ­surgeries to deal with her adhesions.

" It's a tremendous emotional toll, " she sighs, then mentions the part

of the ­experience that really gets to her: " You start to doubt

yourself. " It's a doubt that comes from having been told, too many

times, by too many doctors that " there can't possibly be anything wrong

with you. "

Indeed, the medical system seems to be in a certain amount of denial

about the problem of adhesions. Despite their frequency, few surgeons

ever bring them up as a risk factor in pre-surgery discussions with

patients. Afterward, once the pain begins, many patients ­encounter

scorn and disbelief from the medical ­system.

Wiseman is one of the ­sympathetic ones. President of Dallas-based

Synechion, Inc., a consulting company that handles the science and

business of adhesion prevention, he also runs a resource Web site,

www.adhesions.org. He's heard the lament from patients over and over

again, he says. " 'No one believes me…everyone says it's in my head…

everyone thinks I'm making it up, " he says, reciting a long list of

patient complaints when they bring up their post-surgery suffering.

Sometimes, he says, all the patient needs is someone to speak to her

nicely and say " 'Listen, you do have adhesions, you're not making this

up, it's not in your head.' "

That's the " good " news. Here's the bad news Wiseman has delivered again

and again: " There's not much we can do about it, but let's plan your

life. "

A more comprehensive approach is what Wiseman and Dr. Jay Redan, a

surgeon who is an expert on adhesion ­diagnosis and treatment, believe

that ­patients need.

" No one's really looking at the whole picture, " says Wiseman. In the

fall, the two ­hope to launch what they say is the world's first

comprehensive integrated clinic for patients with adhesions, chronic

pelvic pain and related problems. The ­center, housed at Florida

Hospital Celebration (Fla.) Health in Celebration, will feature a

multidisciplinary team of ­surgeons, ­gynecologists, nutritionists and

urologists, among others. This has come out of the realization that

patients such as de los Reyes need more than just pain management or

repeated operations.

The medical world keeps waiting for the breakthrough that will prevent

adhesions from forming in the first place. Laparoscopic surgery, which

allows surgeons to make tiny incisions, has not proved to be that

advance. In fact, research shows adhesions are just as likely to form

after keyhole surgery as conventional surgery. Some companies are

trying to develop what are called barrier agents, such as ­Seprafilm, a

kind of plastic sheeting put in place during surgery to keep the

various loops of small intestine from coming into contact with other

organs and each other. It has been available in Europe for some time

and approved by the FDA in 2002.

Wrapping up a better solution

Other researchers are working on gels and solutions, such as Adhibit

and Adept, that insulate body parts against physical contact with one

another. Like the barrier agents, these products have reduced the

severity of adhesions without eliminating them. Also available in

Europe, their use in the U.S. is pending the results of clinical

trials.

There's also evidence that a ­surgeon's actual technique may matter.

Studies show the risk of adhesions may be reduced when surgeons handle

tissue carefully, use powder-free gloves, dissect ­gently, control

bleeding, prevent infection, and keep tissues moist, among other

measures.

Finally, there is much interest lately in the use of -2 inhibitors

(such as Celebrex), the anti-inflammatory drug recalled not long ago

for its adverse side effects. A recent study showed a " dramatic "

reduction in adhesions in mice treated with -2 inhibitors. According

to a press release, investigators Dr. Mark Puder and Dr. Arin Greene

from Boston's Children's Hospital are preparing to set up a clinical

trial of ­Celebrex in adult surgical patients.

Until more is learned and new ­products become available, de los Reyes

hopes more people become aware of the ­issues surrounding surgery and

­adhesions. She teamed with some of her doctors and has been talking to

others in her situation.

" Helping other people… really makes a difference. It distracts me from

myself, " she says. " If I can tell my story and help somebody, at least

I am not going through this agony for nothing. "

a

On Jul 7, 2005, at 12:03 PM, Grammi B wrote:

> Dear or a...do you know if there are any new treatments for

> the prevention of adhesions?  I remember someone else here having a

> lot of difficulty with them...just wondering if there is anything that

> may stem their tide.

>

> Love...

>

> Tess

>

>

>

[Guest guest]

Tess,

Seprafilm is being used as a barrier to prevent adhesions in abdominal

and pelvic surgery.

http://www.seprafilm.com/home.asp

Here is an article from adhesions.org that may help:

Crazy Glue

By RANIT MISHORI, M.D.

Tuesday, June 28th, 2005

[Click here for full version]

On most days, de los Reyes, a Port Authority lawyer, feels the

pain. " It's like someone's hand is in my guts, squeezing them to

death, " she says.

It's been like this for 13 years now, ever since she had a

hysterectomy, which went smoothly. But then a complication set in, one

of the most common but least ­talked about side effects of surgery for

millions of American men and women — something doctors call

" adhesions. "

Getting an adhesion is like having a not-so-elastic band suddenly

­materialize inside your body cavity and connecting ­internal organs

that are not normally connected — like loops of intestines, with your

uterus at one end and a bend in the fallopian tubes at the other, or

joining your intestines and the walls of the abdomen.

The growth can play havoc with your organs, causing excruciating pain

and, when the small intestine is involved, ­bowel blockage and

obstruction. Says Wiseman, a researcher and doctor of

pharmacology from Dallas, an ­expert on adhesions: " It's like taking a

ball of string that you let the cat play with, and get it all knotted

up and tangled, and then you pour glue on it and let the glue stay. "

Common in men, more so in women

Like hardened glue, adhesions are tough and inflexible, which is why

­doctors liken them to scar tissue. ­Physically resembling plastic

wrap, and composed of a tissue called fibrin, they can create a range

of different problems. Studies show adhesions can account for up to 74%

of small bowel obstructions, up to 20% of female infertility cases, and

­between 20% and 50% of chronic pelvic pain cases.

What's remarkable is how high the risk is for getting adhesions in the

first place. They can develop after any surgery — former President Bill

­Clinton developed a ­pleural adhesion that required a separate surgery

after his bypass operation. Data show they develop in at least 55% of

patients who undergo surgery. The number is as high as 90% for certain

types of surgeries, like hysterectomies and C-sections, which is why

the majority of patients suffering from adhesions are women.

The truth is that adhesions, first recognized when surgery entered

mainstream medicine in the early 1800s, are still not well understood.

The best guess is that they result from a kind of overreaction by the

body. Dr. Soumitra Eachempati, assistant professor of surgery at Weill

Medical ­College in Manhattan, says: " After any type of tissue injury,

your body would have an inflammatory response. The more ­vigorous the

response, the more likely the adhesions would form. "

Some people, he says, are more ­unlucky than others and have " an

­exceptionally vigorous response. " They're the ones who get severe

adhesions and may suffer from chronic pelvic or abdominal pain.

De los Reyes is one such ­patient. Like many who suffer from

­adhesions, her difficulties with the ­condition began as she recovered

from a ­hysterectomy her doctor ­recommended in response to fibroids

growing in her uterus. Pain (resulting­ from multiple ­episodes of

­bowel obstruction) was the main ­symptom — pain she says she can

­never get away from for long, even 13 years ­later. " It is basically a

day- to-day thing to see what I can do to alleviate — at least to some

extent — the ­discomfort. "

In addition to having had multiple surgeries for bowel obstruction and

what doctors called " adhesiolysis " — cutting of adhesions — she has

tried a lot of things to ease the pain, including prayer and

meditation. She has even — and she says this seriously — tried jumping

up and down on a ­trampoline. Sometimes these measures have helped, but

only temporarily. " I'll get relief for a little while, " she says, " but

sooner or later I wind up having problems again. "

Suffering from a lack of belief

Some 35% of all patients who undergo abdominal or pelvic surgery end up

back in the hospital because of this recurring pain, with the usual

result that they require surgery to remove the adhesions.

It's not just pain that's at issue. ­Certain adhesions can act to

tangle up a ­woman's fallopian tubes and ovaries, causing ­infertility.

Others can cause obstructions in the bowel. In these cases the only

­solution is to " go back in " and try to cut the ­adhesion or even cut

out the affected part of the ­organ. " If you liken your intestines to a

long garden hose, " explains Eachem­pati, " then there's a part that's

kinked, and we'd try to find that part and cut away the scar tissue

that is compressing it. "

But even that's not a sure thing. As de los Reyes has learned,

adhesions can be cut, but like bad weeds, they can spring up again. She

has undergone 14 ­surgeries to deal with her adhesions.

" It's a tremendous emotional toll, " she sighs, then mentions the part

of the ­experience that really gets to her: " You start to doubt

yourself. " It's a doubt that comes from having been told, too many

times, by too many doctors that " there can't possibly be anything wrong

with you. "

Indeed, the medical system seems to be in a certain amount of denial

about the problem of adhesions. Despite their frequency, few surgeons

ever bring them up as a risk factor in pre-surgery discussions with

patients. Afterward, once the pain begins, many patients ­encounter

scorn and disbelief from the medical ­system.

Wiseman is one of the ­sympathetic ones. President of Dallas-based

Synechion, Inc., a consulting company that handles the science and

business of adhesion prevention, he also runs a resource Web site,

www.adhesions.org. He's heard the lament from patients over and over

again, he says. " 'No one believes me…everyone says it's in my head…

everyone thinks I'm making it up, " he says, reciting a long list of

patient complaints when they bring up their post-surgery suffering.

Sometimes, he says, all the patient needs is someone to speak to her

nicely and say " 'Listen, you do have adhesions, you're not making this

up, it's not in your head.' "

That's the " good " news. Here's the bad news Wiseman has delivered again

and again: " There's not much we can do about it, but let's plan your

life. "

A more comprehensive approach is what Wiseman and Dr. Jay Redan, a

surgeon who is an expert on adhesion ­diagnosis and treatment, believe

that ­patients need.

" No one's really looking at the whole picture, " says Wiseman. In the

fall, the two ­hope to launch what they say is the world's first

comprehensive integrated clinic for patients with adhesions, chronic

pelvic pain and related problems. The ­center, housed at Florida

Hospital Celebration (Fla.) Health in Celebration, will feature a

multidisciplinary team of ­surgeons, ­gynecologists, nutritionists and

urologists, among others. This has come out of the realization that

patients such as de los Reyes need more than just pain management or

repeated operations.

The medical world keeps waiting for the breakthrough that will prevent

adhesions from forming in the first place. Laparoscopic surgery, which

allows surgeons to make tiny incisions, has not proved to be that

advance. In fact, research shows adhesions are just as likely to form

after keyhole surgery as conventional surgery. Some companies are

trying to develop what are called barrier agents, such as ­Seprafilm, a

kind of plastic sheeting put in place during surgery to keep the

various loops of small intestine from coming into contact with other

organs and each other. It has been available in Europe for some time

and approved by the FDA in 2002.

Wrapping up a better solution

Other researchers are working on gels and solutions, such as Adhibit

and Adept, that insulate body parts against physical contact with one

another. Like the barrier agents, these products have reduced the

severity of adhesions without eliminating them. Also available in

Europe, their use in the U.S. is pending the results of clinical

trials.

There's also evidence that a ­surgeon's actual technique may matter.

Studies show the risk of adhesions may be reduced when surgeons handle

tissue carefully, use powder-free gloves, dissect ­gently, control

bleeding, prevent infection, and keep tissues moist, among other

measures.

Finally, there is much interest lately in the use of -2 inhibitors

(such as Celebrex), the anti-inflammatory drug recalled not long ago

for its adverse side effects. A recent study showed a " dramatic "

reduction in adhesions in mice treated with -2 inhibitors. According

to a press release, investigators Dr. Mark Puder and Dr. Arin Greene

from Boston's Children's Hospital are preparing to set up a clinical

trial of ­Celebrex in adult surgical patients.

Until more is learned and new ­products become available, de los Reyes

hopes more people become aware of the ­issues surrounding surgery and

­adhesions. She teamed with some of her doctors and has been talking to

others in her situation.

" Helping other people… really makes a difference. It distracts me from

myself, " she says. " If I can tell my story and help somebody, at least

I am not going through this agony for nothing. "

a

On Jul 7, 2005, at 12:03 PM, Grammi B wrote:

> Dear or a...do you know if there are any new treatments for

> the prevention of adhesions?  I remember someone else here having a

> lot of difficulty with them...just wondering if there is anything that

> may stem their tide.

>

> Love...

>

> Tess

>

>

>

[Guest guest]

Seprafilm is used along with a few other products. They are placed

surgically, though. The best treatment for adhesions is to have

them surgically released (lysis of adhesions). Depending on the

extent of them, it can be done through a laporascope or with an open

incision. Seprafilm is then placed to prevent the adhesion

formation. It isn't used regularly, but in someone who is an

adhesion former, it works well.....Marina

>

> > Dear or a...do you know if there are any new treatments

for

> > the prevention of adhesions?  I remember someone else here

having a

> > lot of difficulty with them...just wondering if there is

anything that

> > may stem their tide.

> >

> > Love...

> >

> > Tess

> >

> >

> >