Dr. Harry Reich, M.D. New York City

From: Beverly J. Doucette 
Date: June 08, 1999 10:38 AM

Dear Friends 

A number of people have asked me go into greater detail about my experience of having had an adhesiolysis procedure -- with Dr. Harry Reich of New York City as my surgeon.  Please keep in mind that this is MY surgery -- and that we each have a case history which is unique.  I also am stating MY interpretation of how the body responds to and creates adhesions -- as I understand that physiological process.

Previous to consenting to Dr. Reich's adhesiolysis procedure, I requested a copy of it so that I could determine for myself what Dr. Reich was doing differently from  other adhesiolysis procedures, which I had had.  I also checked his credentials with the AMA -- all were very outstanding recommendations.

Then I asked Dr. Reich for statistics of his adhesiolysis procedures;  and even though he has not keep a following of his patients, he did have some figures on it.  His procedures had a high percentage of success for non-reforming adhesions.

Dr. Reich also referred me to a woman, who had undergone his adhesiolysis procedure last June.  We talked at great length by email; and we continue to do so.  She was a source of much information and much encouragement for me;  and you can be assured that I am watching her case very closely as it parallels my adhesion history very closely. Dr. Reich also videotapes his entire surgery for you.

Dr. Reich believes that "The solution to pollution is dilution!"  He stands by that phrase yet today!  In other words:  By using copius amounts of fluid to cleanse the abdominal organs and tissues during the surgical procedure itself;  and also instilling the patient's abdomen with ringers lactate solution, he believes these steps will prevent adhesions from re-forming.

Dr. Reich's procedure is done through a minimally invasive route.  One small incision in the naval for the camera and two 1"- 2" incisions on each side of the lower abdomen...for instrument use. Dr. Reich is the only ambidextrous surgeon in the United States and that is a plus for us!  He does a diagnostic look around upon entering the cavity;  and looks for any invasive pathology other than adhesions. He then evaluates the situation and determines his treatment plan.  In the event that there are dense adhesions, he proceeds to dissect them ( separate ).  This is not an easy process and can become very complicated.

I can understand why most Drs. DO NOT want to challenge themselves during a adhesiolysis procedure;  which is dangerous and tedious for the surgeon as he/she is lysing adhesions next to and around the intestines etc.

Based on Dr. Reich's vast experience with laparoscopic surgery, he has developed a technique like no other surgeon in the world!  That is why he is recognized as being the best laparoscopic surgeon in the world!  It was the clean-up at the end of his surgery that impressed me the most; and was also the reason that I chose to go to him and to have my surgery done!  He rinses and cleans out almost EVERY piece of clotted blood that is in...around...under...and virtually all over the abdominal cavity following the surgery!  He believes that it is this residual clotted blood that the anti-bodies -- in an adhesion former's system -- respond to as a " foreign enemy"...and in its defense the anti-bodies create an adhesion over it to protect the internal organs!  Now, this is exactly how our bodies defense system works!

Think about getting a sliver ( externally of course ). What does our body defense system do to that foreign body?  It sends out the leukocytes and creates an "infection" to get rid of it, right?  Internally, one of two types of defense systems kick in when there is a problem:

1.) If an appendix ruptures, we get peritonitis ( an internal infection like pus or white blood cells that spill into the body cavity.  The white cells are responding to an inflammation in the appendix...and build up and burst.  But it WAS a defense mechanism as well! This can kill a person!  Because the body has no way of ridding itself of that infectious drainage -- which then infects the surrounding internal organs as well.  In defense our body sends the leukocytes ( white cells ) to the area of "infectious drainage"

2.) Since there is an active infectious foreign body in the cavity, our body will attempt to "CONTAIN" that poison in order to protect the other internal organs from damage! These white cells form a material called, "fibrin," ( the sticky stuff from blood ).  Then this fibrin begins to cover the infectious material; and you have what is called an "ADHESION!"  Now, adhesion means "to stick together."  As we know, the body cavity is filled with many organs in very close proximity to each other. What do you think will happen?  Organs will become attached to one another -- everywhere that was touched by the infectious drainage!

Let's look at that same reaction now -- using the clotted residual blood -- following internal surgery.  As a result of any surgical procedure, blood is found throughout the body cavity -- in every area involved;  or from ischemia ( areas scraped or cut -- opening an area that bleeds ). In the body cavity, this blood dries very fast...VERY FAST! 

Now, 99.9% of surgeons DO NOT clean up the residual blood clots -- thus leaving the residual blood clots in and around and under all of the internal organs.  The body sees this blood as a "foreign body" and sends out the leukocytes and thus forms adhesions wherever these clots are.  Because fibrin is a sticky substance, the organs will become attached.

When the peritoneum (innermost tissue of the abdominal wall) is involved, some organs will become attached to it -- thus causing pulling and inflammation at the attachment sites...PAIN...and eventually a decrease in our physical mobility.  That pain is from the attachment to the peritoneum. The other attachments, if any, (organ to organ) don't cause pain; but can cause bowel obstructions, painful and difficult bowel movements.  If adhesions attach the bowel to the vaginal wall, painful intercourse can result, as well.  Am I losing you?  If I am, please let me know and I will be less medical. (I sense that you are perfectly capable of understanding every word of this!) 

Dr. Reich uses a procedure called "aqua" surgery.  He constantly flushes the body cavity with ringers lactate solution ( a compatible fluid to the human body, like saline ); and he looks for the fibrin stings and removes them...bit by bit...a wonderful clean-up job ( on my video ).  If someone would have told me he could clean up that body cavity as good as he did -- and I HAD NOT seen him do it -- I wouldn't have believed them!  So, if you want a copy of my video, I'll send it to you!

His theory is that "if the clotted blood is cleaned from the cavity, the body's defense system will have less to react to -- thus reducing and possibly stopping  the reformation of PAINFUL and destructive adhesions.  He also leaves 3-4 liters of ringers lactate solution in the abdomen at the conclusion of his surgeries -- which takes about 48 hours to dissipate from the body (lots of peeing goes on).

I was not shaved! I did not have a urinary catheter in place -- or a gastric nasal tube when I woke in recovery.  Five hours of surgery...then to the recovery room;  and in less than 4 hours, I was back in our suite.  Sure, I had surgery pain; but I also had both ovaries removed...and two tumors removed! One very large tumor had attached the right side of my colon to the left side of my peritoneum.  My colon was totally twisted over and attached.  No wonder I hurt -- and couldn't have a bowel movement on my own!

How am I now? I'm a tiny bit sore on the lower right; but that is from having an organ removed.  NO ADHESION PAIN!  NO BACK ACHES! NO PAIN PILLS!  And a smile on my face that only a crow bar could remove! 

I had been on pain medication and anti-inflammatory medication ( which you need AT LEAST 1500mgs each day, if you're suffering from adhesion pain ) to help combat the inflammation from the pulling of the organ at the attachment site. You can bet you have something attached to the peritoneum at this time -- and it is pulling and doesn’t like that!  Anti-Acids ( from irritation of the esophagus and stomach -- from years of drugs, sleep/pain meds at night ).  And last, but not least...laxatives ( you know what that was for )..NO MORE!!  I take a 500mg chewy for calcium and Vitamin E for heart muscle;  because I refuse to go on hormone replacement therapy until I present with symptoms;  and I have none yet! 

Dr. Riech will state that his procedure IS NOT a sure thing; but, statistically, his adhesiolysis patients have shown a great reduction in reforming adhesions following his procedure.  I discussed Dr. Reich’s procedure with a local surgeon as well as a pathologist, who our son works with, before I agreed to have it done.  I also sent them my post operative reports that defined the locations of previously lysed adhesions in both my abdomen and pelvic cavity. 

During a routine autopsy, they instilled 3-4 liters of ringers lactate solution to raise the abdominal wall away from the intestines in order to determine if, in fact, an adhesion from the intestine could actually REACH and attach itself to the abdominal wall -- and reform --when that much ringers lactate solution is in the body cavity. (That type of attachment was the ONLY cause of MY pain.)  When an organ attaches to the peritoneum, you have pain!  (I had that in both of my previous lysis.)  It did raise the abdominal wall a good 3" to 4"; and in all probability, an adhesion WOULD NOT be able to attach. 
 

1.) Women's Surgical Group 
http://www.womenssurgerygroup.com/ 
~ ~ ~ ~
2.) International Pelvic Pain Society 
http://www.pelvicpain.org/

Many times a Dr. is as afraid and frustrated as we are -- as to what to do for a person who suffers from adhesions! 

Also re-evaluate your medications.  You MUST be taking an analgesic ( pain med ) on a regular basis for it to be effective in combatting the pain in your system. It is also imperative that you be taking an anti-inflammatory medication. 

Regarding an MRI, Cat Scan or any other high-tech medical test for a person with a history of adhesions, I feel it is a waste of money and time.  A simple ultrasound and abdominal x-ray will detect any abnormal pathology in the abdomen.  If you feel that you are suffering from the same kind of pain in the same region as with your previous adhesion problem, then you surely don't need anymore tests...if an ultra sound proves to be negative!  All other tests will be negative too!!  Your Dr. will not be able to diagnose adhesions as the cause of your pain -- unless he/she performs a diagnostic laparoscopic...a surgical procedure. 

Your Dr. will not be able to say that your pain is caused by your adhesions -- until he/she actually sees them.  But you can be pretty much assured the pain is from  adhesions, if you have had adhesions before...and if all of your tests are negative.  You can tell your Dr. that adhesions are causing your pain -- and not have to worry about getting sued.  BUT your Dr. can't!! He may think that adhesions are your problem; but he really, really cannot say it until he has proven it!! 

BUT...as long as all medical tests rule out abnormal pathology, you DO have CHRONIC PELVIC PAIN; and that IS recognized as a medical condition.  So make sure that you get on a pain management routine; and take it from there!  A Dr. HAS TO respond to your request for that!! There ARE NO other effective ways to manage chronic pain ( when adhesions are the cause ).  Massage is ineffective;  because adhesions are located too deep within the body cavity to be massaged.  There are NO linaments or balms that will reach or penetrate the peritoneum; because the peritoneum tissue is there to PROTECT against invasion...and that IS OUR problem to begin with! 

So please be careful folks with spending money for things that sound good...but which WILL NOT work for adhesions!  Relaxation, massages and such WILL HELP relax the adhesion sufferer;  and there is something to be said for treating the emotional as well as the psychological self.  In fact, it is imperative to do that;  and include therapy for family members...support...education...and ideas as to how to live with one who is suffering this very painful and debilitating disorder.  The impact that adhesion-related disease places on a family is no different from a diagnosis of Cancer, Muscular Dystrophy, Multiple Sclerosis, or any other debilitating disorder.  Except that the focus is just beginning to be on adhesion-related disease!! And how much focus it gets, is up to each one of us!!  So learn about it and educate your spouse.  Don't be afraid of it because it is possible to live effectively with it...and THERE IS HOPE!!

If a Dr. DID NOT perform medical tests on a patient presenting with complaints of pain -- and assumed that the patient's symptoms WERE due to adhesions ( because the patient had a history of adhesions ), what would happen if the patient DID actually have a tumor or cancer -- and it went undetected because a Dr. wrote the patient's symptom of pain off as due to adhesions without checking into it?  I'd be pretty miffed! 

My recent contacts with the Mayo Clinic indicated to me that a number of the Drs. DID ,in fact, feel that adhesions do cause pain.  Like almost everywhere else though, the Mayo Clinic has not come up with a treatment or surgical procedure that would benefit an adhesion-former. The Mayo Clinic will work with an adhesion patient through pain management.  I started my pain management through them.  I cannot see a basis for an "investigation" into the Mayo Clinic or any other medical facility because they perform medical tests on those of us who have a history of adhesions.

TWO tumors were found as a result of the adhesiolysis, which I elected to have done in New York City with Dr. Reich as my surgeon!  If he had not found them, who knows what might have happened to me. At that time I would not allow any local Drs. to perform anymore tests on me -- as I was convinced that ALL of MY pain was from adhesions -- and that there was NO valid reason to put myself through testing that would have negative results for abnormal pathology...let alone have to pay for tests over and over again.  Boy was I wrong!!! 

So, I have to advise all of you, for what it's worth, that testing is necessary and could save your life!  If all tests have negative results for abnormal pathology, then it is probably adhesions.  It is then up to you to determine the next step...surgery or try pain management and live with them.

I believe that the more educated one becomes about their medical condition (such as adhesions, for example), the better prepared you will be to discuss treatment with a Dr. -- including even what needs to be done in a surgery, if you elect that route! I also believe that an adhesiolysis performed in a certain way, CAN reduce the amount of reformed adhesions -- and in all probability decrease the formation of DeNovo (new adhesions )adhesions.

I firmly believe that there are NO barriers that will be effective in dealing with adhesions...and I mean NONE!  Once you learn what type of procedure is best for an adhesiolysis, you can discuss it with your surgeon.  You can even dictate how and what you wish to have done for you and this disorder! 

Remember these words: "YOU ARE NOT ALONE!" If anyone thinks that adhesion disorder can't kill, ask Dr. Wiseman who the second victim of Dr. Kavorkian (Dr. Death) was. Well, I'll tell you...it was a 56 year old woman, who suffered chronic pelvic pain!!!  Our disorder...OURS!!! 

I suffered and still suffer from this disorder...surgery or not.  At this time I am addicted to pain meds and am withdrawing from them.  I am scared to death every time I eat because I think I'll get constipated and I will suffer such horrible pain BEFORE, DURING and AFTER I defecate.  Yes, have a bowel movement. Yes, I live with fear that I'll start to pee my pants again like I did for 10 years...and I am ONLY 48 years old ( I was 38 years old when this nightmare with adhesions began.)!!  Disease respects NO age, trust me on that!  Every little pain I get in my abdomen fills me with fear that the adhesions are back;  but then I talk to myself and review what I have learned about OUR disorder and I settle myself down and I am better...better for awhile.

Because I have educated MYSELF about adhesion disorder, I will make it through this part of it as well; but I will always live with the fear of them reforming.  It is ever present in the back of my mind; and I find myself feeling anxious at times to live every minute that I have right now...and I will!  I share only from experience and what I have learned as a result of living with the pain of adhesions.  I don't know anything any better than the rest of you -- maybe just from a different perspective, that’s all.  I need to hear your perspectives also.  NO not for personal gains, not for any study, not really for any other reason than the fact that you have what I have; and I am so grateful for the sharing on the International Adhesions Society Message Board because that to me IS a way for me to educate myself on all  of this new information.