tag:blogger.com,1999:blog-4968787219619380438.post1121704865290881452..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: Do postoperative adhesions cause abdominal pain?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-4968787219619380438.post-88975102298163375762019-02-04T08:53:51.498-05:002019-02-04T08:53:51.498-05:00Nerves are not found in adhesions. The bowel does ...Nerves are not found in adhesions. The bowel does not have pain nerves. You can open a colostomy with cautery at the bedside and the patient will not feel anything.<br /><br />Whether doctors live longer than the general public is debatable. You can find studies saying yes or no. Here's one that says they outlive other professionals https://www.ncbi.nlm.nih.gov/pubmed/11020591Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-25061621553334121582019-02-03T09:11:24.627-05:002019-02-03T09:11:24.627-05:00It's hard to believe today that this many educ...It's hard to believe today that this many educated people try to rely on past studies to answer an individualized cause / effect as destructive as bowel and abdominal adhesion causing pain.<br /><br />A scar on your wrist won't likely cause much pain, but then if you flex the wrist and attach the base of the thumb to the lower forearm, you'll know pain not long after as a result of musculature becoming altered, atrophied and dysfunctional not to mention tension and tearing on limited use or spasm.<br /><br />Now place that among musculature in the intestines and mobility as a function of digestion, then innervate the scar tissue with misaligned nerves attempting to reconnect across the formed collagen latices structures in scarring. When stricture or mechanical strain begin to constrict and strain other less innervated but encapsulated nerve bundles, do we really think this is going to be a benign result?<br /><br />It will be different for every patient and every surgery no matter how many (n) subjects one places into a follow up. The simple fact that there is greater post operative pain for surgeries as a whole is likely the most significant proof necessary, well before looking at bowel strangulation or loop fixations, etc.<br /><br />It's exactly this kind of broad spectrum thinking that western medicine contaminates by, giving rise to surgeon's lumping everyone into a categorical assignment which impedes progress toward an eventual FACTUAL finding and improved process. When you learn to think and are educated in a narrow, linear path, you make linear mistakes. Nature is NOT linear by any manner of perception.<br /><br />The follow on is doctor's justifying their adopted presumptions by leaning on their credentials as if those can some how justify an ignorant, categorical assumption; monkey see, monkey do medicine.<br /><br />These are some of the same specialists who still think chronic opioid use is a solution to chronic pain, absent the understanding of receptor evolution and the increased long term plateau of chronic rebound pain, worse than the initial pain. Most on opioid medication beyond 15-30 days learn this the hard way and many fail to ever escape, eventually elevated to the worst of the worst - methadone.<br /><br />I have to wonder how many posters here even ever really think through the response they wrote to measure if their reply makes sense or not. It's tantamount to breeding ignorance into the evolution of science to avoid the loss of chronic patients paying their office bills through socialized insurance in a debt based fiat economy.<br /><br />Just sad. One cannot justify false rationalization and above all we still "can't fix stupid". Perhaps this is why MD's as a whole tend to not live as long as the general population as a sound starting point of categorical observation.<br /><br />Woefully AnonymousAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-86781070368397121562018-02-28T07:43:14.228-05:002018-02-28T07:43:14.228-05:00The post is about operating on patients with abdom...The post is about operating on patients with abdominal pain only as a result of adhesions, not bowel obstruction. Here is what I wrote.<br /><br />"UpToDate, the online medical textbook, has a section on this topic. It doesn't address how adhesions cause pain but does discuss the evidence that reoperating on patients with adhesions is not worthwhile. <br /><br />"Although some observational studies claim that lysis of adhesions can decrease chronic pelvic or abdominal pain, at least three randomized controlled trials found little value in performing adhesiolysis except possibly in patients with vascularized adhesions, which would be difficult to diagnose preoperatively." Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-19235933534533844262018-02-27T21:46:43.223-05:002018-02-27T21:46:43.223-05:00adhesion is wide spectrum from causing nothing to...adhesion is wide spectrum from causing nothing to mils intermittent pain and discomfort to partial obstruction to complete obstruction .these symptoms are unpredictable can occur in days ,weeks ,months , decades after surgery .every case is different and the rules that apply to one case dosen't necessarily apply to other Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-4119573004890217322016-12-02T09:57:59.093-05:002016-12-02T09:57:59.093-05:00I'm voting for the latter.I'm voting for the latter.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-61347947909089753512016-12-01T21:15:56.290-05:002016-12-01T21:15:56.290-05:00Probably both, ScalpelProbably both, Scalpelartigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-36674238935202829062016-11-29T10:31:44.421-05:002016-11-29T10:31:44.421-05:00Are you serious or just trolling me?Are you serious or just trolling me?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-39697864614054448162016-11-29T10:20:41.853-05:002016-11-29T10:20:41.853-05:00I have had success softening scars and adhesions u...I have had success softening scars and adhesions using DMSO 50/50, high dose fish oil and juicing turmeric and ginger. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-90501951430676331442016-11-27T15:01:18.459-05:002016-11-27T15:01:18.459-05:00Anonymous Europe:Thank you very much for your adv...Anonymous Europe:Thank you very much for your advice. Looks like this is rather a personality thing...:)... I guess, I will just stick to surgery.:) Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85423450612575586162016-11-24T13:50:16.189-05:002016-11-24T13:50:16.189-05:00"How do you motivate yourself to do science?&..."How do you motivate yourself to do science?" Good question. Either you have a question that needs an answer and you want to find it out for yourself (better way) or you do it because it is required to advance your career (what many people do).<br /><br />I don't know if it gets better with time or not. It is useful to have a mentor who can stimulate and guide you through the process. I was fortunate enough to find such a person and he taught me how to do research and write a coherent paper.<br /><br />I think that if you do not start doing and publishing research as a resident, it is very difficult to try to start a a practicing surgeon with no experience with research.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-32820070316797328092016-11-24T13:09:22.285-05:002016-11-24T13:09:22.285-05:00Anonymous Europe: I did not know that. Wow...
Now...Anonymous Europe: I did not know that. Wow... <br />Now it is just the other way around.:D If you have any kind of US work experience, the market is yours in Europe. Especially if you did clinical work, not research..:) <br />BTW, how do you motivate yourself to do science? I am in love with staying in in the OR and rock it out (performing, assisting, I do not care as long as I am part of the team). But when it comes to science I just hate it, even though I have a PhD. Does it get any better with time? It is almost a physical strain for me to sit down and write a paper/ gather data. I just lack the motivation. <br />If you have any suggestions, I would be very grateful. Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-48013927993227744402016-11-18T14:16:54.638-05:002016-11-18T14:16:54.638-05:00I don't know about surgeons emigrating here fr...I don't know about surgeons emigrating here from Germany, but in the 19th Century, any surgeon who wanted to get ahead in the US spent a year working with surgeons in Germany or Austria.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-80920757484070776392016-11-18T13:38:29.189-05:002016-11-18T13:38:29.189-05:00Anonymous Europe: Guys, I learned a lot just from ...Anonymous Europe: Guys, I learned a lot just from reading your comments. I have to admit I cite Sceptical Scalpel a lot while I am working.:) I once took a look at the original colonisation/biggest minority' in each state map of the US, and found that a lot of the states were colonized by mostly Germans. It might also be that a lot of surgeons emigrated back in the day from Germany...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-27673331937725434082016-11-14T07:48:30.958-05:002016-11-14T07:48:30.958-05:00KJ, A brief search of the medical literature turne...KJ, A brief search of the medical literature turned up nothing about serrapeptidase or serratia peptidase and the treatment of adhesions.<br /><br />I can't conceive of any way that something you take by mouth would be absorbed intact into the bloodstream and go only to the abdomen to soften or dissolve adhesions.<br /><br />If it makes you feel better, by all means keep taking it.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-20187769512685575152016-11-13T19:11:35.099-05:002016-11-13T19:11:35.099-05:00I also do not believe surgery will usually fix the...I also do not believe surgery will usually fix the situation, although it may fix it in a small percentage of cases. I have read of some lucky people who did have the lysis and 10-20 years down the road, they are still ok. However, this is not the majority..not by a long shot, unfortunately. Of all the research I've done, there are 2 doctors that do enough of them to have the experience and technique to lead to more success than other docs. Way more research is needed not only how to get rid of them but also what the mechanism for pain is. There is no way that millions of people who have pain that came with the onset of adhesions (worldwide) are all wrong. <br /><br />What I have been told the working theory is that the nerves are signaling pain because the adhesions are causing organs to shift out of position and that pulling on the peritoneal wall and muscle triggers this as well. <br /><br />Interestingly, Eastern medicine seems to have some good information on how to prevent a lot of adhesions, but that discipline too is stumped when it comes to getting rid of them. <br /><br />Serrapeptidase is an enzyme thought to dissolved adhesions over time. It is marketed by US Enzymes, under the name Serraxyme. I am not entirely convinced that it does actually dissolve them. I am leaning toward the probability that it softens them enough that they become more pliable, so they don't shift things out of place as much. I am led to this thought because after observing their effects for over 2 years, the pain was still present, but less so. Also, when the enzyme was discontinued a few time for 4-6 week periods, the pain started returning after the first 2 weeks, then back to full strength by 4 weeks. No other medical regiments were altered in anyway. Any other thoughts regarding this? Would this enzyme have some affect on something else that causes this specific type of abdominal pain?KJhttps://www.blogger.com/profile/03104399252202355026noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-33546976447017607802016-11-13T12:54:26.492-05:002016-11-13T12:54:26.492-05:00It's a lot like operating on chronic back ...It's a lot like operating on chronic back pain, I guess. The choice of procedures is limited only by the imagination.William Reicherthttps://www.blogger.com/profile/10062067819184876941noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-16980057149618572392016-11-11T13:56:07.712-05:002016-11-11T13:56:07.712-05:00KJ, I am sympathetic to your situation. I agree th...KJ, I am sympathetic to your situation. I agree that we don't know enough about adhesions. It may very well be that they cause pain, but no one knows why. That's why I wrote the post. <br /><br />Cutter and Artiger have explained that doing more surgery can make things worse and I agree. I also agree that if a patient shops around enough, she will eventually find a surgeon who will operate.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-83274972631391845012016-11-11T11:14:02.722-05:002016-11-11T11:14:02.722-05:00I don't think anyone is arguing against causes...I don't think anyone is arguing against causes of adhesions, just the results of them. Still, without obstruction or ischemia, I'm not operating on someone who is convinced that they have pain due solely to the mere presence of adhesions. Just because someone at Mayo thinks so doesn't make it so. Still, for those who cannot be dissuaded, there is some surgeon out there who wants to try to be the hero. All you have to do is find him/her. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-24518577356607824172016-11-10T15:19:13.700-05:002016-11-10T15:19:13.700-05:00I always make sure to counsel patients that adhesi...I always make sure to counsel patients that adhesions cannot be "removed", only rearranged. When you divide the abnormal attachment between loops of bowel, you immediately create 2 raw surfaces that will likely attach to 2 new sites (essentially doubling the number of adhesions). This usually cuts through the illogic of operating on nonobstructive adhesions. Until the magic adhesion prevention/dissolving substance is invented, this is the state of affairs.<br /><br />In the early weeks/months after an operation, adhesions are actually at their worst (as any surgeon who has had to go back in the abdomen can testify). When patients report (transient) pain relief after empiric adhesiolysis, they are feeling their best when the recurrent adhesions are actually at their worst. Unfortunately, the chronic pain that prompted the re-operation typically recurs.<br /><br />Chronic, non-obstructive abdominal pain is a difficult problem that does not respond well to surgical intervention. If the chronic abdominal patient thinks they have it bad, they need to meet someone with an enterocutaneous fistula...<br /><br />My favorite quote:<br /><br />"There is no problem so severe that it can not be made worse with surgery"<br />Cutterhttps://www.blogger.com/profile/16936587161473819009noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-13983947291520215932016-11-10T14:07:06.368-05:002016-11-10T14:07:06.368-05:00In the case I am referring to, the cause was perit...In the case I am referring to, the cause was peritonitis, not one surgery that caused some scar tissue at a certain site. The description I posted was an almost direct quote from a top surgeon and top GI doc at the Mayo Clinic. Additionally, there is photographic evidence they exist because the surgery to remove the infection was done laparoscopically and several pictures were taken that show the adhesions forming everywhere. <br /><br />Definition: Adhesions are fibrous bands that form between tissues and organs, often as a result of injury during surgery. They may be thought of as internal scar tissue that connects tissues not normally connected. Another cause is infection, such as peritonitis.<br /><br />They attach normally separated organs to each other and can cause major problems for the affected patients by giving rise to small bowel obstruction, chronic pelvic pain, dyspareunia, infertility, and higher complication rates in subsequent operations. They are also a frequent source of medicolegal conflict. <br />-https://www.ncbi.nlm.nih.gov/pubmed/21116396<br /><br />This blog is a great example of the conflict in the medical field regarding adhesions.<br /><br />I did a quick pubmed search and found several other definitions for them as well. The articles I looked at state they exist, can cause a lot of problems or no problems and anywhere in between, and that no concrete agreed upon definition from the medical community exist yet. However, just because people don't think they exist or cause problems, doesn't mean they don't actually exist or cause problems. Hundreds of years ago, bacteria and virus existed caused illnesses, pain, suffering, and death, and yet no one knew of them. <br /><br />This holds true for doctors either not believing they are there, not wanting to try to fix the problem, and/or docs tired of getting referrals of patients who have them, etc. If you think it's frustrating as a medical professional to deal with them, try being a patient who does. It is a life sentence. There is no cure where the probable result is more adhesions<br /><br />What evidence does the medical profession need to believe that abdominal adhesions cause pain and suffering? The consensus seems to be that 50-100% of surgical patients will have adhesions as a result of surgical operations. What other possibilities are there that explain the pain and suffering? KJhttps://www.blogger.com/profile/03104399252202355026noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-78550390641830083642016-11-10T12:19:05.074-05:002016-11-10T12:19:05.074-05:00Kor, we all have our biases.
Artiger, I agree. We...Kor, we all have our biases.<br /><br />Artiger, I agree. We had a saying, "When you operate for pain, you get pain."Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-81461917721718867382016-11-10T12:06:09.542-05:002016-11-10T12:06:09.542-05:00Common referral to my office..."My doctor (or...Common referral to my office..."My doctor (or midlevel) said my stomach pain was from my adhesions". <br /><br />In the absence of obstruction, I tell them this is simply not true. I hate to say it, but it is sometimes an underhanded attempt to dish a patient away from the referring provider's care. You know, if you operate on them, every single problem thereafter is a byproduct of the surgery. No thank you. <br /><br />If I remember nothing else from residency, it was the following two quotes:<br /><br />"Operations for pain produce more pain...for both the patient and the surgeon."<br /><br />"There is no one more enthusiastic than a primary care doctor (provider) trying to convince you to operate."artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-76758790618112638372016-11-10T07:12:30.351-05:002016-11-10T07:12:30.351-05:00Skepto, yes I am very biased and freely admit it; ...Skepto, yes I am very biased and freely admit it; and, you may have noticed, it is a hobby horse.<br /><br />As for the 'gentle handling' and 'damp swabs', I learned this when working on the European continent. In the UK I'd never seen this done. When I returned I tried very hard to get juniors to do this; but they clearly felt I was a maverick, and when my back was turned they were all recidivists.<br /><br />(As an aside; much of what I saw on the Continent seemed very similar to US practice and surgical culture. I could never establish whether the US had learned from Europe, particularly Germany, or vice-versa.)Korhommehttps://www.blogger.com/profile/05497111884933914657noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-22047051531352331752016-11-10T06:28:29.383-05:002016-11-10T06:28:29.383-05:00KJ, if adhesions weren't attached to anything,...KJ, if adhesions weren't attached to anything, they wouldn't be adhesions. Adhesion (def): "an abnormal union of membranous surfaces due to inflammation or injury." They aren't giant cobwebs and they rarely strangle bowel.<br /><br />Kor, A belief is not a fact. If all it took to reduce adhesions were gentle handling and damp swabs, everyone would use those techniques. In fact, most surgeons already do. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9794823338282871502016-11-09T17:27:40.420-05:002016-11-09T17:27:40.420-05:00The false reasoning is of the 'post hoc, ergo ...The false reasoning is of the 'post hoc, ergo hoc' type.<br /><br />You have had an operation. [True]<br />You have therefore adhesions [Almost certainly true]<br />You have bellyache [True]<br />Therefore, your bellyache is caused by adhesions [False]<br /><br />I had a laparotomy nearly 70 years ago, for an intussception. Therefore I have adhesions. I don't have chronic belly ache. Why not?<br /><br />Sorry, you have touched a very raw spot in my psychology. I do believe that gentle handling of the bowels, and the use of damp swabs in all circumstances will reduce adhesions.<br /><br />Korhommehttps://www.blogger.com/profile/05497111884933914657noreply@blogger.com