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5 Things About Adhesions

WeGo Health HAWMC 2013

The prompt for Day 2 of the Health Activist Writer’s Month Challenge is “5 Things About My Condition.” I just spend the last month talking about my journey with endometriosis so I would like to share some information about adhesion related disorders (ARD) which is a complex of symptoms related to adhesions. Over the last nine years, I have had six surgeries total. The first five were directly related to endometriosis and the last was due to a small bowel obstruction that was a direct result of adhesions. It was by far the most invasive and the most difficult surgery to recover from. I also have a 12 inch scar (that I affectionately call Frank) to remind me of last summer.

Unfortunately, I still have a lot of problems with chronic abdominal and pelvic pain which my doctors believe is a result of the combination of endometriosis and adhesions and because of my surgical history we are currently at a stand still with how to proceed.

Since ARD is often hard to diagnose and not often discussed (and is a new part of my life), I wanted to share 5 things you need to know about adhesion related disorders (source):

  1. Adhesions are abnormal attachments between the organs in the abdomen and are usually composed of scar tissue. Adhesions can present in various ways from loose, filmy, and flexible to dense, leathery, and hard. Common causes of adhesions are previous surgeries as well as endometriosis and other diseases.
  2. Adhesions can cause problems as the body is designed to move freely, including internal organs. When adhesions form between the organs, movement is lost and normal organ functions (such as digestion in the intestines) and normal body movement (such as bending or twisting) can cause pulling and tugging which can cause pain. More severe symptoms can include twisting, punching, and obstructions.
  3. In addition to pain, symptoms of ARD include constipation (sometimes alternating between constipation and diarrhea), changes in menstrual cycle, infertility, and pain with intercourse.  Dr. Clark Gerhart states, “Symptoms of ARD will often be attributed to other abnormalities. Patient will often carry multiple diagnoses including chronic fatigue syndrome, endometriosis, irritable bowel syndrome, fibromyalgia, depression, anxiety, along with a whole host of other possible syndromes. While multiple disorders can certainly exist in one patient, the confusion over which abnormality is truly causing the symptoms adds to the frustration of ARD. This, unfortunately, adds to the discomfort experienced by those who suffer with adhesions”.
  4. Diagnosis of ARD includes examinations, x-rays, MRIs, and a careful review of medical history. Diagnostic laparascopy is another means to identify (and treat) adhesions.
  5. However, because adhesions are often the result of previous abdominal surgeries, performing surgery (often referred to as adhesiolysis) to remove adhesions is often ineffective as adhesions will simply reform. Laparoscopic surgery should be performed by a skilled ARD surgical team to minimize chances of recurrence.

Resources for ARD:

Dr Clark Gerhart, MD

International Adhesion Society

Adhesion Pain

I hope you found this information helpful!

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Back in the treatment saddle

Yesterday was the first time that I saw my rheumatologist since my surgery. His first remark was about my weight loss which I’ve come to accept as a bonus. When I wasn’t able to eat at all, I would have rather had my twenty pounds back and been able to hold down something more than jello but at this point, now that I’m able to eat at least a little bit more, I’m quite content maintaining that twenty pound loss. The next topic, of course, was my surgery and the nice string of hospitalizations. It was if he looked me in the eye and knew what I was feeling perfectly. He asked if I had just been in one major flare mode since then and I could have kissed him. Its nice when you get to a point with a doctor where they just know. I explained the joint and muscle pain as well as the crazy hypersensitivity and as I explained, he nodded.

We then went over my history of what worked and didn’t work and together we worked out a plan of action. After nine years of chronic illness, a doctor that invites you to be a participant in your care is one of the good ones. One of the treatments that I had the most success on was Savella. I had really good results for about two years (I was even running again!) before it started to become less effective. I went off this treatment almost 18 months ago so we decided to give it another whirl and keep our fingers crossed that it would once again be effective. The only thing I dread is the initial three or four days as the nausea is absolutely dreadful. We are hoping that by easing in over a period of a week instead of starting at a full dose with help. Either way I am waiting until Friday to start in case I still have those side effects which makes work almost impossible.

This morning I met with my pain specialist and requested changing from pain pills to a patch to see if it will lessen the effects on my GI tract. I am not sure he was upset at my request or if it was just his usual less-than-sunny personality. Either way, he agreed and handed me a new prescription and an appointment to follow up in a month to see how things are progressing.

I know I’ve been on the path to recovery for awhile know but now having a plan to attack my illnesses outside of the surgery/adhesion issues feels really invigorating. Now if I can get some sleep I’ll be golden!

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My Hospital Saga – Part 2

Yesterday I headed to Charlotte with my husband for my follow-up visit with my gastroenterologist after my weekend trip to the ER. I wasn’t able to see my primary GI doctor because they wanted me to get in as soon as possible so my appointment was set up with one of his associates so I really wasn’t sure what to expect.

Right off the bat, they ruled out pancreatitis. While I had slightly elevated levels, it was nothing close to what would indicate pancreatitis so we were able to mark that off the list. We next did a brief overview of my medical history. He immediately apologized when I told him about my journey with endo. He said that endometriosis is like the black plague for women. I have never heard a better description. That man deserves a medal.

We went over the blood work taken at the ER and compared it to my blood work done at my previous visit. My liver enzymes are a little up but not anything crazy – just something to keep an eye on. He sent me for more blood work as well as an abdominal xray and then met me back in the office. At my latest EGD, they discovered my gastroparesis. After confirming with the xray, it seems that its not only my stomach that is paralyzed but pretty much my entire GI system. This coupled with existing chronic pelvic pain (endo/adhestions/etc) was probably the source of my severe abdominal pain.

So the plan is to attempt to jump start my GI system with back-to-back bowel preps (I started the 2nd this morning). I will also start a new medicine that will try to help stimulate my system which will help the gastroparesis as well. We also dropped to the two new medications I started last week as they were likely adding to the irritation.  Not sure what that will mean for my pain levels but hopefully once things get moving again I will notice a big difference!

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