3 year anniversary appt with surgeon - gave me injection into scar tissue - what a difference

I went to see my see my surgeon and NUT yestarday for my 3 year follow up - was I glad I went.  First I saw the surgeon.  I hadn't seen him in quite some time since due to numerous complications last year (many of you already know about them) = he did the first of my 4 surgeries last October but when I went back in Nov he was out of town and ended up with his partner.  She did a great job and saved my life and was following up with her since then and she did the additional 3 surgeries as well.  I just had a bad experience with her a couple of weeks ago, that is story for another time, so I am back with my original surgeon for good now - thank goodness - he is much more experienced.

Just a brief synopsis - had surgeries for bowel obstruction, perforated colon - became septic, needed an iliostomy, G tube - lucky to be alive.  3  month later, the iliostomy was reversed.  That was in February.

Now, November and I am still in pain - never went away.  So, I did have a new CT scan 2 weeks ago to make sure no new bowel obstruction or anything and thank goodness all was fine.  So, surgeon did a very thorough exam of me and he said a few things - first off, he said I have an incisional hernia - he said since when CT scans are done lying down, our insides are all nicely lying flat and no incisional hernias are usually found.  They only come out when we are standing up and they don't do CT scan that way. So, when I was standing up = he could feel it and when I coughed it was very obvious.  Even I could feel it.  Not sure why the other surgeon never noticed it.  But, he said it isn't something that needs to be operated on right now and with my history it can wait.  I am  high risk for infection due to immune system problems - I just got out of the hospital last week after being septic from a kidney stone that decided to try to pass but was too big and got stuck right before my kidney stone surgery was scheduled.  I went in to have the surgery and had 102.7 and didn't even know it.  They cancelled the surgery to blast the stones but when they found out the stone was obstructing the ureter, they had to take me in anyway to insert a stent.  Now surgery is  next week.  My surgeon said I could wear a binder to hold the hernia flat if I want to, it might help the pain but I am leary since things pressing on my abdomen seam to hurt  more, so I will just live with it for now.

The best part of the visit was that I showed him where I have tons of pain - near the area where I had the iliostomy.  He felt around and said that there is alot of scar tissue and he can inject it to break up the scar tissue.  I was game if it would help. So, he injected with novacaine and steroids - then massaged the area for about 10 minutes and said to do that about 3 times per day for a few days and use a heating pad if needed. By massaging the area with the steroids you can actually break up the scar tissue - I had never heard of that but it is working - so far the pain is almost gone in that area. He told me if it comes back or if I have another spot in that area, to come back in 1 month and he can inject again.

So, anyone with alot of scar tissue - ask your surgeon for steroid injections directly into the scar tissue - then massage it for 10 - 15minutes atleast 3 times per day for a few days - it really works.

The NUT part of the visit was kind of useless - she is a great NUT don't get me wrong but I am in a strange situation.  Since my surgeries this past winter when they removed a large part of my colon and more of small intestines, I have severe malabsorbtion and have to eat enourmous amounts of foods in order to not lose too  much weight.  When I went into the hospital for the week, I wasn't doing my normal snacking and high calorie eating and I lost 10 pounds which I can't afford to do.  So, there isn't really much the NUT can do for me since I can't follow any normal post op WLS diet.  I feel guilty eating all the things I have been taught not to eat but that is the only way I can either stay at the same weight and in some cases I need to gain weight after boughts of weight loss.  I did get a slip for labs from her, so that was good since I don't see my Endocrinologist for another month and really need to get things checked.

So, although things are kind of crazy for me right now and have been for the past year, I did have some positive come out of yestardays visit.

Hey RBB!

Congrats on your 3 year surgiversary, although it is quite a story!

I am curious, after all you went through last year, do you still have no regrets for your original WLS?

It seems hard to wrap my head around what you've been through, and it kinda scares me too. We are so prone to complications that can possible be lethal, that I sometimes wonder if it's all worth it.

And having to eat that much food sure sounds attractive, but I am sure it is not.

Do you have any tips for us how to avoid or recognize certain things, lessons to be learned from your ordeal?

Glad your doc's injection helped some with your pains! keep massaging!

goood luck

Cat

There are definitely times I regret having the surgery - it has been 1 hell of a year and for the past 4 months,  I have been dealing with severe kidney stones as a result of the surgeries - a definite complication.  I had my urine tested and am starting treatments next week after the kidney stone surgery to try to prevent the stones from regrowing.  It isn't easy.

I never thought in my life that I would hate to eat.  I am never hungry and could go all day without eating but have to force myself to eat and high calorie foods.  2 weeks ago I was in the hospital for 1 week and lost 10 pounds just by eating normally and I can't afford to lose weight, I have gained half of it back - so it isn't that bad.

The best advise I can give you is to follow the your diet - eat 5 to 6 small meals a day, which keeps your metabolism at is best, maintains your blood sugar levels and keeps you from getting hungry.  Also drink as much as possible.  getting dehydrated is serious stuff plus it also causes kidney stones.  Make sure you take all your supplements - multi, calcium citrate, dry vitamin D, sublingual B12 or injections, vitamin B1, iron with vitamin C - these are the minimums to start and then you adjust based on your labs - make sure you get labs done frequently at the beginning - if your surgeon wont do them, get your PCP - I can send you more info after my surgery with detailed labs you need and amounts of supplements and where to get them, I just don't have time  right now, I go in tomorrow morning.

Then the big key to avoid major complications - DONT GET CONSTIPATED 

That is what got me into trouble.  I got severely constipated and waited too long to tell anyone and ended up with a bowel obstruction, which led to a perforated colon a week later and all hell broke lose. If you can keep your bowels going, you should be okay.  there are no guarantees - as we lose weight, our bowels can twist, we can get adhesions causing them to twist - there are lost of scenarios but just make sure when you get any pain, or changes in your bowels, you tell your surgeon.

Also, make sure you take a PPI for the first 6 months to a year to prevent ulcers and reflux.  You have a newly forming pouch that needs to be free from acid completely, then after some say 6 months, my surgeon says 1 year - if you are symptom free, you can try a 1 month vacation from the PPI and see if you are symptom free - if so, then you can stay off of them.  If the symptoms appear, then you need to go back on them.  The majority of gastric bypass patients don't need them after the year.

You also need to ask for Actigall for the first 6 months to a year if you have a gallbladder.  It prevents gallstones from growing due to rapid weightloss. If you can get your surgeon to remove your gallbladder that would be great since so many end up needing it out anyway but Actigall can prevent it.  You should go for a Sonogram of your gallbladder preop  to make sure you don't already have stones, if you have stones already, then you need to have it out at your surgery.

I wish you luck and feel free to PM me with any questions and when I get home from the hospital  I will write you back - hopefully I will be home in  a day or 2.  If not, good luck and I will talk to you after your surgery.

 Interesting about the massage part.  I had two steroid injections into the area of my multiple open incision line for mild pain (when my RNY surgeon was apparently unconvinced that I could tell the difference between superficial and deep pain!) and it didn't help the pain much but the pain mgmt doc who did them did not mention adding massage after the steroids.  Wish I had known that then.  My massage therapist has been massaging the midline incision lately because after my August open surgery to finally fix the pain issue (4th open midline incision in 4 years), the incision has been VERY tight.  Not sure how much it's helping, but it took several months of massage to loosen up the scar tissue in my armpits after my brachioplasty.

I hope you stay out of the OR for a while and give your body a chance to heal fully and rejuvenate.

Lora

The midline incisions = after 4 open surgeries this winter is where I have the incisional hernia and he basically said to leave it alone for now - I am too high risk for surgery right now and unless it is an emergency, he doesn't want to operate and I dont' want him to either.  I can deal with that pain - I just walk around with my pants open and low cut underwear and long shirts to cover the open pants.  The area of scar tissue is on the right side where I had the ileostomy - it is a tiny 1 in*****ision on the outside but alot of work was done on the inside.  There were 2 surgeries - it had the iliostomy with a stoma connected to a bag and then after 3 months, they went back in and reversed it.  There was tons of inflamation.  So, he pressed in about 5 different spots and I hit the roof in about 2 of them - they all hurt but he picked the one that hurt the most and injected there and tried to hit a couple of spots - as he injected - not the needle but the fluid being pushed in, he said if it hurt, he had most likely hit the spot. So, he said if I massaged it a few times per day - it would break up the scar tissue but I had to do it for 15 minutes immediately after the injection and then 2 more times that later that afternoon and night - and again the next day.  I have to say, it is amazing.  Yes, I do still have some pain but it is so much better.  I now wake up in the morning and I don't take pain medication where I used to roll over first thing and reach for the pain med bottle.  Now, I can go until the afternoon without taking pain meds and then it is usually my back or the kidney stones.  I will say, after I eat I do still get the abdominal pain.

You might want to ask your surgeon about it.  I swear by it now.  He said if I need it, I can come back next month if I need it in another spot since the area was kind of large and he could only do a real specific area.

I do have to say, when he was injecting me - I immediately thought of you.

 I'm certainly glad it has helped your pain and lessened the need for painkillers.  Hopefully, you will continue to heal and your body can regain its strength.  You have been through SO much!

If the massage alone does not help the scar tissue, I will definitely ask my RNY surgeon for another referral to the pain mgmt doctor and ask him about the combination.

Lora