Suggest Treatment For Severe Abdominal Pain After Redundant Colon Resection
Complicated issues need phase wise management
Detailed Answer:
Hi
Thanks for the information
I sympathise with you, but do not know what led to the redundant colon resection ? The operating surgeons decision on table and his expereince needs to be taken in to consideration
Having understood the procedures I would like to know the current status of the organs - Is it possible for you to go for a CT Scan or a MRI ?
Yes I can understand sacral plexus involvement - The pain could be because of the same if really damaged
Continue with Fetynol and add a Tablet of Gabapentine and Methylcobalamin twice a day
An Anal tonometry will help justify the severity of incontinence
Hope this helps
Do write back in case of concern
Wishing you a healthy life ahead
Long, three year story, but, after being rear-ended (and told I couldn't possibly have been injured) I tried everything suggested for low back pain (never had back pain prior) to include injections, prednisone, meds, Physical Therapy, Chiropractor. The meds, presumably, caused a prolapse and I was told I needed surgery because it could become an emergency; also told it could help w/back pain. I trusted the doctor, and anything that could help with back pain probably blinded me. Also, I had had a vaginal prolapse which required surgery and had absolutely no problems - I had a mesh bladder sling at the same time. A year later, however, I had to have a repair of the vaginal anterior/interior wall - then I was hit. Back to the colorectal surgery. I had no idea a resection was going to take place; on my admission form, I put prolapse and enterecele. Came out of what was to be a four hour surged 6 1/2 hours later minus 24" of colon. Discharged on third day; not once were the bandages changed; I had to call the doctor because I cleaned a mess I made enroute to the ladies room and showered, without supervision. Fortunately, my husband asked to check the site where the incision was made and it was beet red; packed for 6 weeks; hernia started - doctor acted like it happens all the time and told me not to let it interfere with an appointment I had at the Mayo Clinic to find out why I was having back pain. By the time the surgeon saw me and did the surgery, I looked three months pregnant....8.3 cm hernia. This is a person who, until the hysterectomy, had one other surgery in 1965 - an ovarian cyst. Now I'm filled with mesh; had a surgery I didn't need (which the doctor, to my XXXXXXX admitted) but that didn't help much. When I had the defecating proctogram and manometry tests as soon as the balloon hit a certain spot, the pain started and by the time I had the tube inserted for X-ray, I was in so much
"nerve pain" I was sobbing. This led us down a path thinking something terrible must have happened during the surgery - and, three opinions - mesh is not used to repair colon and redundant colon is common. He had retired from the Air Force and I think I must have been his first patient. I don't think he tried to harm me, but his carelessness and lack of attention after the surgery, has me in so much pain once I start walking as something appears to be pushing inside...it's difficult to explain. I'm stuck with mesh; less colon, and told that removing the mesh could cause more problems. So, I can be practically unable to move much without causing pain that brings me to tears??? I often wonder if he injured the wall that butts up to the vaginal wall but it appears there is no way to test this. What is Methylcobalamin? I tried Lyrica and Gabapentin and can't tolerate it; also tried Cymbalta.
With all this going on, my providers kept leaving, so I had no continuity in care. It just doesn't seem possible that I went from active, happy, involved, to being dependent and inactive. Is there no solution, in your mind?
I just appreciate being able to have the opportunity to tell this nightmare to a physician. I keep my hopes up only to hear what a disaster was done. If you can suggest anything that could be done, I'd appreciate it. By the way, what is the sacral plexus and could it have been damaged and cause excruciating pain? I"m sorry this is so lengthy. I so want my life back, but seeing doctor after doctor doesn't give me much hope. You have been very attentive, which is more than I've received in three years. Thank you.
Reassure Yourself
Detailed Answer:
Hi
Thanks for the kind words
Do not hesitate to give a detailed report of the events, It is OK with me and will help me come to some clinical impression
Treating a patient without physically exmining is the toughest job, yet will try to give justice to your problems
It is sad you had to go through unpleasent events, but going out of the track I will mention one small point, everything is destined for us, I had a major highway accident some four years back, have undergone five major operations on the same bone, was on a walker for 33 months and am on a crutch as on today, my flourishing career came to a standstill yet I have not given up hopes, have operated my patients going to clinic on a wheel chair
AM happy to know that you want life back, 27 years of my practice I find patients with positive approach getting better, Let us pray Almighty to guide and take care of your kind self
Sacral plexus is the nerve plexus which comes out of the last five fused sacral vertebra
There are remote chances it can be damaged during pelvic surgery, but can not stamp it on hisotry alone
Methylcobalamin is form of Vitamin B12 and which is active in central nervous system and is essential for cell growth and replication
Along with Gabapentine we find it great in neuropathy
What was the issue with Gabapentine ?
Let us take issues in a phase wise manner and try to resolve them for you
Hope I have replied to your queries satisfactorily
Would be glad to reply to any further queries
I'm trying to talk to those present during surgery because something that was to take 4 hours took 6 1/2. The doctor is no longer at that hospital, but, unless someone understand what mesh can do; putting the colon on side of rectum and the pain I feel, because there is friction/movement when I walk I absolutely cannot keep walking - it is unbearable. I am strong; I have spent three years being the wife/mother/grandmother I love being, but I cannot any more. Yesterday I stayed on my back the entire day and didn't think of pain until I got up to get ready for bed and my nerves were on fire.
Gabapentin; any antidepressant give me depression and such irritability and had no effect whatsoever. Please, if you understand how the sacral plexus is connected to the resection, would you mind guiding me so that I can at least get a doctor to think about this? Hope is one thing; but trusting the medical profession is another. There is little doubt that my major problems started after that surgery.
Are you aware what mesh can do to the body? And do you understand the vaginal wall repair area that butts up to the area the colorectal surgery took place. I'll fly to XXXXXXX if I have to because I am too important to my family and I have too much to live for. Nobody wants to take me on since the mesh was placed on colon. I am happy to hear that you are continuing to heal; you are a doctor and understand anatomy; much stronger than I have become. I literally cannot walk w/o the inside area nerves firing so much I have to lie down.....before, sitting still was something foreign to me. I sound desperate, but you are the first to understand the sacral plexus and the colon, so, if you can guide me, please help. If there is a bonus section, I'll be happy to give you a bonus. I've never pleaded before; I always appeared strong in front of the doctors, but I can't trust that anyone will look deep enough. Thank you and forgive me for begging. My best to you.The only neuropathic pain I have is in my right leg. The other pain is way beyond and is, as I described. If you had had a child, it would be easier to understand what I'm saying; having a child was a blessing; this is not and, I almost think, it's harder to withstand.
Thank you so much and continued healing for you. I think your patients are very fortunate.
Relax and Keep Cool
Detailed Answer:
Hi
Thanks for updating me in detial
Firstly let me tell you one thing there is no reason you need to plead we are human beings and need to pray Almighty the Super power
I have never accepted anything above what is agreed upon even in instances where the surgery would have turned out to be a complicated one
Coming to what I would like to look at in a CT or MRI - the surgery that was performed and any residual pathology
What I understand from your information is that a mesh would have been wrapped around the rectum to put it in place
Though very unlikely sacral plexus may have been eith involved in mesh repsir or otherwise
The hole in rectum and connecting [anastomosis] to colon is something I do not get why did the need arise
If you have Operative note for the same and the vaginal surgery it will help me help you out
Please scan and upload your MRI and CT reports along with operative notes
I would yet prefer you continue with Gabapentine it will take some time but surely help
For pain other than neurologic pain try using Tramadol 50mg twice a day with or without paracetamol, it should help relieve pain
Hope this helps
In the mean time please upload the reports
Am available anytime - may be would respond before End of the day
In case of emergency please mention it is urgent in your query
Just your thoughtfulness is overwhelming. If you still want to see everything, I will scan tomorrow when my husband is here to help. The other dr opinions are the same - why resection into side and mesh is not normally used in colon. I trusted him and don't understand how he could even remove healthy colon. Again, I will wait for your lead. Thank you so much.
For my knowledge Only
Detailed Answer:
Hi
Under no intention of calling you to XXXXXXX did I ask for the reports
It would enlighten me on the mishaps of surgery and I could teach my juniors the care they need to exercise while managing the case like that of yours
I would be keen on having the reports if it is Ok with you
Would be glad to assist you anytime in coming days to bring you out of the agony
Wishing you again a Healthy life ahead
No, I said "I'd go to India" if I has to. Misunderstanding.
You have given me hope.
I admire you for continuing to be a surgeon w/all you have been through.
Thanks so much. XXXXXXX
Thanks
Detailed Answer:
Hi XXXXXXX
Thanks for the kind words
Have been fortunate enough to have understanding patients who cooperate with me all these twenty seven years of my practice
Will wait for your report and provide you with my inputs so that you can decide on further course of management
Thank you for your patience.I don't know if the colorectal surgery is causing the abdominal pain; restriction deep inside which restricts movement. I have what feels like a deep rock inside which restricts movement from low right abdomen to inside low back/tailbone/rectum. It is confused by not having one doctor keep my records and many doctors injecting then the surgery which I didn't need.
I will send reports, regardless, because, I have had gastro problems since the surgery and so much abdominal pain through to inside. It is so hard to explain.
I just need your address. It is terrible to be so desperate in the US where medicine is supposed to be superior.
Thank you and bless you,
Had Been Out
Detailed Answer:
Sorry Had been away
You may please upload the reports here or mail me on YYYY@YYYY
I will respond to you one day old query once I have a look at the reports
Regards
Wondering if you found anything notable in reports.
Also, I feel off mattress into pool; struggled and pulled hernia which feels lose, and, a lot of movement. Is it unlikely to tear repair? Any need to have this checked and how would one check this?
Waiting to hear about the report.
Thank you,
Give me some time
Detailed Answer:
Hi
I received your reports. Bit I will need some time to go through. 20 Pages of detailed case history needs lot of time. I will get back to you in few days. I think you need to post a reminder follow up on Wednesday to allow me answer you.
Regards
I admire that you will take records from a stranger and do your best to see if there is an answer. God is good.
Thank you, kind sir. Perhaps there is hope; an answer as to what caused my bowels to function improperly and my entire area under the mesh from hernia all the way to low abdomen have such incredible pain-to include rectum. It's too complex and I'm so tired of searching.
If I could, I would do something for you. You seem like a very conscientious, kind doctor - rare, indeed.You asked that I remind you that I sent reports.
I have been my own advocate and today, I recalled the awful nerve pain after proctogram, SI injection, epidural and acupuncture. Put these together and called Neuro Radiolotist who immediately understood the test I need - it is unfortunate that the way the surgeon capped the colon and put a hole in the side of rectum; also unfortunate that I didn't have a doctor who could put all these experiences together; hence, prescribing drugs has been the only care for the last 8 months. Now, the mesh from the hernia repair is feeling loose and, I have extreme gastro pain with sweats and nausea. But, surgery complicated so many things it's difficult to focus on one area. Three 1/2 years of not connecting the dots, but, calling the neuro radiologist with symptoms, he immediately felt he knew what tests need to be done. I'd like your opinion, however, on the colorectal surgery as the surgeon will not respond to my calls. I also understand I'm asking a lot - and, if this is too complicated, I understand that you may have choose not to go any further with this. If I hadn't been so sure of the lack of communication and no follow through, I'd be on the couch with no life. It is good I trust myself; I know the pain; I know the errors and I am worth fighting for. I hope you are doing better each day. You are working under adverse conditions and your patients are fortunate.
Do Not Hesitate to Write Back
Detailed Answer:
Hi
I did go through the detailed procedure text and this is my interpretation, point out if I am wrong
2009 you were operated for hysterectomy and urethral sling surgery
2010 you were operated for cystocele and rectocele correction
2012 you were operated for Laparoscopic rectal prolapse and redundant sigmoid resection
When was the port hernia operated there is mention of the infected wound in one of the pictures but no history of the repair of the same ?
Unfortunately to be XXXXXXX I found the procedure done systematically the way they are mentioned
What I presume is that because of repeated surgery there could be intra abdominal adhesions
YOu need to go for a fresh ultrasound or a MRI of the abdominal organs to know the current status
In the mean time I would stop all medicines and see what happens. I do understand there will be pain etc but I need to know the course of events to help you out.
I am determined to sort out your issue, may be it will take some time to come to a conclusive clinical impression but am sure will be able to sort out.
Do not hesitate or feel guilty writing again to me
Have a healthy life ahead
Regards