WOMENS-HEALTH Messages for April, 1998: Re: Endo/Massive Adhesions

Re: Endo/Massive Adhesions - Help!

From: Kelly Shanahan, MD (anonymous@obgyn.net)
Thu, 2 Apr 1998 20:20:49 -0600 (CST)

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Reply: Karen: "Re: Endo/Massive Adhesions - Help!"

At Thu, 2 Apr 1998, Karen wrote: >
>I'm 40 yrs. old, had a lap a few weeks ago and was diagnosed with endo
>on one ovary. I also had a lap 12 yrs. ago and the surgeon unknowingly
>cut the ureter when excising adhesions that were present at that time. I
>developed peritonitis and appendicitis (as a result of the infection) -
>it was about 5 days until they discovered the peritonitis - I was taken
>for emergency surgery to repair the ureter and have an appendectomy. I
>have had chronic bowel and pelvic pain since that time. My last lap
>revealed massive adhesions - all of my organs are bound to the abdominal
>wall and covered with adhesions so much that the doctor could not even
>see the organs so we don't know if there is any endo there. He was
>unable to proceed with the surgery as planned because of the adhesions.
>He would like to do a radical hysterectomy. For the past few months I
>have been suffering from increased pelvic and back pain that does not
>subside, along with pain that radiates all the way down both legs in the
>front. I am nearly incapacitated with pain and exhaustion. Even
>stronger pain meds such as Percocet do not alleviate the pain. I saw a
>new endo specialist yesterday - but she does not believe in prescribing
>anything stronger than Aleve! I'm concerned and frightened about the
>pain getting out of control. She painted a very bleak picture for my
>future health - she says that removal of adhesions is not practical as
>they would grow back with more intensity and quickly, within 10 days.
>She says I will be worse than I am now (although that's hard to
>imagine). She can not tell if the pain I am having is primarily from
>the endo or adhesions, but suspects the adhesions are causing the most
>trouble. She also told me adhesions from peritonitis can never be
>repaired as they are so extensive. She has ordered an upper and lower
>GI, IVP and ultrasound for me to see if there is any blockage. Also I
>have a cyst on one ovary for which she has put me on BC pills for 1 mo.
>to see if it shrinks. I almost don't want to bother with additional
>tests; there seems to be no hope for me and I am at the end of my rope,
>barely hanging on by a thread. I need HELP - is there ANYTHING I can do
>to have a life that has quality?? How can I get relief? She says
>Interceed and other topical solutions used in surgery will not help me.
>PLEASE - any info you can give me would be extremely valuable. I need
>to know that I don't have to live the rest of my life this way...thank
>you......

While it is true that adhesions are a complication of surgery, the risk of recurrence can be minimized by gentle handling of hte tissue, meticulous hemostasis (contol of bleeding) and use of substances such as Interceed.

Another possibiltiy, which will help with endo but not with adhesions, is going on a GnRH agonist such as Lupron. This puts you in a "false menopause" and can supress endometriosis -- it will help pain caused by endo, but will not do anything about adhesions.

A hysterectomy is ONE of your options. Another is to try Lupron and pain medications (I'd use Lortab -- hydrocodone). A third is to have surgery (etiher laparoscopic with a very experienced endoscopic surgeon) or via a tradtional incision to remove the adhesions that are curretnly present.

I suggest a second opinion from another expert -- if you are near Atlanta or San Francisco (actually Stanford), I'd recommend the Nezhats

--
Kelly Shanahan, MD, FACOG
S. Lake Tahoe, CA

note: Opinions here are for educational purposes only. This information is not intended to supplant the need for you to consult with your own physician. It cannot take the place of a face to face consultation and examination.
Sorry, but private e-mails will not be answered.

Next message: Kelly Shanahan, MD: "Re: Alesse birth control pill and use while breast feeding"
Previous message: Kelly Shanahan, MD: "Re: Clomid: days 3-7 or 5-9? AND Progesterone interpretation"
In reply to: Karen: "Endo/Massive Adhesions - Help!"
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