WOMENS-HEALTH Messages for June, 2000: Re: On behalf of a dear friend in severe pain!!

Re: On behalf of a dear friend in severe pain!!

From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Wed, 28 Jun 2000 09:42:34 -0500 (CDT)

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In reply to: anonymous: "On behalf of a dear friend in severe pain!!"

At Tue, 27 Jun 2000, anonymous wrote: >
>Hi! I hope someone can answer me or give me some direction!
>I have a friend who has had numerous gyne problems. She has had a
>TAH/BSO and multiple surgeries for adhesions, one in which the bowel was
>punctured and she ended up with a colon resection. She has had ongoing
>pain for years, increasingly worse since her last laparoscopy 4 years
>ago, which was negative. She has been to many general surgeons, gyne
>surgeons and GI doctors. Since this past Sunday, she can't get the pain
>under control and has been vomiting with it. She is now on a fentnyl
>patch which is not working, just making her very dizzy thus increasing
>the vomiting. She has talked with her gyne surgeon whom she has been
>"begging" for the last 4 months to do a scope on her...he refuses,
>saying he doesn't think he'll find anything and it won't help. She just
>wants him to go in just see if there is anything, he will not. He
>recalls the day that he accidently punctured the bowel and has been
>reluctant to do anymore surgery on her. He also says that he thinks she
>just needs to manage the pain...she is trying, but it is not
>working..she has been to a pain management specialist who suggested a
>slow release morphine...she doesn't want to do that, she said that it
>will affect her on the job performance (she is an RN in a surgical
>unit)...do any of the doctors here feel that a laparoscopy or laparotomy
>would be appropriate?? Also, could this be a sign of a partial bowel
>obstruction?? Thank you in advance.

This is an incredibly difficult issue. On one hand, it makes sense to find out if there is anything significant inside causing the problem (kinda sounds like she has a partial small bowel obstruction). On the other hand, every time you enter the abdomen, no matter how meticulous you are, there will be adhesions from that surgery. This then has the potential to cause more problems.

Given the fact that the pelvis is "cleaned out", I would suggest that she get the opinion of a general surgeon who has not previously been involved in her care. This way you get a fresh opinion and review of the history which results in new perspective... Lynn

--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana

**Note:  Opinions expressed here are for educational purposes only and, as such, do not constitute a physician-patient relationship.  This information is not intended to supplant the need for you to consult with your physician prior to choosing therapeutic options and/or interventions.

**Private e-mails cannot be entertained due to time constraints, consequently no private e-mails will receive a response.

**Thank you for your understanding ;-)

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In reply to: anonymous: "On behalf of a dear friend in severe pain!!"

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