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What Could It Be? What Could It Be?

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Unread 04-28-2003, 07:57 AM
What Could It Be?

Sisters, I had a full hysterectomy 2-1/2 years ago. About 2 months ago I decided to get into shape and started aerobic tapes with weights, plus had a marathon weekend in the garden. A couple of days later I began to be lightheaded, had a cold feeling in my arms and legs, and got what the doc called atrial flutter. I've had an aortic ultrasound, ekg, chest x-ray, stress test, then was sent to a cardiologist for a thallium stress and ECHO. The doc's have not found a cause, and all those symptoms seem to be subsiding. But now I have this burning pain on the right side of my waist/abdomen whenever I do heavy lifting or wear anything tight around my waist. But the doctors just ignore me when I mention these symptoms. It feels just like after my hysterectomy - like something is twisted or torn or missing . . . Could this be a torn muscle or incision, or a twisted colon, or something along those lines. Anyone else have a similar experience. Thank you. Nancy in Tennessee.
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Unread 04-28-2003, 06:58 PM
What Could It Be?

Your my neighbor..I live in Nashville

I am 3.5 yrs post and experience similar symptoms..mine are from extensie Scar Tissue & Adhesions(Scar Tissue)..it can form w/ surgery & can attach to various organs causing pain & other problems. I'm gonna list some info for you that might be of some help in finding some answers & relief to your pain

What are Adhesions?
*Adhesions: Fibrous Bands that Connect Tissue Surfaces that are Normally Separated*

Adhesion formation is a natural consequence of surgery, resulting when tissue repairs itself following incision, cauterization, suturing or other means of trauma. Even the most careful and skilled surgeon will inevitably effect tissues inside the abdomen during a surgical procedure. At the places where a surgeon has had to cut, handle, or otherwise manage parts inside the body, tissues which normally should remain separate will sometimes become "stuck" together by scar tissue, defined as adhesions. This process begins immediately and continues for up to 7 days following surgery

The Problem of Adhesions:
The incidence of adhesions is overwhelming. Adhesions develop in 93% of patients following abdominal and pelvic surgery.
Following surgery, adhesions may form, for example, between the incision in the abdominal wall and the small bowel, often causing small bowel obstruction. This obstruction can lead to vomiting and debilitating pain. In extreme cases, the bowel may rupture, necessitating emergency surgery for the patient.

How Adhesions Effect a Patient:

Adhesions can lead to serious complications including small bowel obstruction, female infertility, chronic debilitating pain and difficulty with future operations.

The consequences of adhesions can be substantial. Postsurgical adhesions cause up to 74% of bowel obstructions.3 Postsurgical adhesions are responsible for 20-50% of chronic pelvic pain cases.3 Adhesions also are a leading cause for female infertility, causing 15-20% of cases.3 Quality of life is also potentially impaired.

Quite often a patient will undergo surgery to lyse (cut) adhesions, only to have them re-form. Once a patient has undergone a colorectal procedure, the incidence of re-operation within two years is high - up to 20% of patients will have a subsequent colorectal procedure in that time.4 Many of these surgeries are to remove adhesions. Between 2.3 and 5% of patients will have to undergo adhesiolysis for bowel obstruction within two years of colorectal surgery.4

Re-operations are also complicated by adhesions. Surgeons have to spend a considerable amount of time, anywhere from 10 minutes to several hours, lysing adhesions before the new procedure can begin. This can prolong the patient's recovery time and increase the risk, cost and complexity of the surgery.

Adhesions can range from filmy to dense, with dense adhesions proving to be the most difficult for a surgeon to treat. The use of a physical barrier to separate the traumatized tissue from other tissues will decrease the risk of all adhesion formation.
Intra-abdominal adhesions are usually the result of surgical or gynecologic operations, pelvic inflammatory disease (gonococcal or chlamydial), appendicitis or endometriosis. Adhesions occur after abdominal surgery in more than 60 percent of cases, though less than 30 percent are symptomatic.

Adhesions may be responsible for chronic persistent abdominal pain without associated pelvic pathology. Clinically, adhesions present as chronic or acute abdominal or pelvic pain, partial or complete mechanical bowel obstruction, and infertility. Though adhesions probably cause pain by entrapment of expansile viscera, the relationship of adhesions to abdominal pain is still controversial. In contrast, mechanical small bowel obstruction after previous surgery demonstrates unequivocally the most severe effect of adhesions.

Patients with chronic or recurrent abdominal pain and a history of numerous abdominal surgical procedures are often denied treatment if they are not obstructed or symptomatic of intermittent bowel obstruction._This may be because, from the surgeon’s viewpoint, adhesiolysis is associated with low reimbursement for long operations with high medicolegal risk. Also, adhesions may recur, and the risk of enterotomy (a hole in the bowel) during surgery is very high.

While surgical therapy is withheld, multiple abdominal diagnostic procedures including abdominal CT scan are frequently ordered. The patients are then sent to chronic pain clinics for evaluation. Though few studies exist, a recent report suggests that women with severe, dense vascularized bowel adhesions have a significant reduction in pain after adhesiolysis.

Chronic pelvic pain and/or associated intestinal disturbance are a major cause of misery for thousands of patients._ Often in constant pain, the patient experiences loneliness, hopelessness, frustration and desperation with thoughts of suicide._ Family and work relationships are strained to the limit._ Although ADHESIONS are often (but not always) the cause of this pain, treatment for adhesions is not performed either because the surgeon does not believe that adhesions can cause the problem, or because lysis of adhesions is considered too difficult or futile.Adhesions are an almost inevitable outcome of surgery, and the problems that they cause are widespread and sometimes severe._ It has been said by some that adhesions are the single most common and costly problem related to surgery, and yet most people have not even heard the term._ This lack of awareness means that, excluding infertility, many doctors are unable or unwilling to tackle the problems of adhesions, many insurance companies are unwilling to pay for treatment and many patients are left in misery.

Adhesions and Chronic Pelvic Pain (CPP)

ADHESIONS are believed to cause pelvic pain by tethering down organs and tissues, causing traction (pulling) of nerves._ Nerve endings may become entrapped within a developing adhesion._ If the bowel becomes obstructed, distention will cause pain. Some patients in whom chronic pelvic pain has lasted more than six months may develop "Chronic Pelvic Pain Syndrome.”_ In addition to the chronic pain, emotional and behavioral changes appear due to the duration of the pain and its associated stress._ According to the International Pelvic Pain Society:
"We have all been taught from infancy to avoid pain. However, when pain is persistent and there seems to be no remedy, it creates tremendous tension. Most of us think of pain as being a symptom of tissue injury. However, in chronic pelvic pain almost always the tissue injury has ceased but the pain continues. This leads to a very important distinction between chronic pelvic pain and episodes of other pain that we might experience during our life: usually pain is a symptom, but in chronic pelvic pain, pain becomes the disease."

Chronic pelvic pain is estimated to affect nearly 15% of women between 18 and 50 (Mathias et al., 1996)._ Other estimates arrive at between 200,000 and 2 million women in the United States (Paul, 1998)._ The economic effects are also quite staggering._ In a survey of households, Mathias et al. (1996) estimated that direct medical costs for outpatient visits for chronic pelvic pain for the U.S. population of women aged 18-50 years are $881.5 million per year._ Among 548 employed respondents, 15% reported time lost from paid work and 45% reported reduced work productivity. Not all ADHESIONS cause pain, and not all pain is caused by ADHESIONS.Not all surgeons, particularly general surgeons, agree that ADHESIONS cause pain._ Part of the problem seems to be that it is not easy to observe ADHESIONS non-invasively, for example with MRI or CT scans. However, several studies do describe the relationship between pain and adhesions. According to an early study (Rosenthal et al., 1984) of patients reporting CPP, about 40% have adhesions only, and another 17% have endometriosis (with or without adhesions)._ Kresch et al., (1984) also studied 100 women and found ADHESIONS in 38% of the cases and endometriosis in another 32%._ Overall estimates (Howard, 1993) of the percentage of patients with CPP and ADHESIONS is about 25%, with endometriosis accounting for another 28%._ These figures must be understood in their context, and I recommend highly Howard's article.It is important to recognize that emotional stress contributes greatly to the patient’s perception of pain and her/his ability to deal with the pain._ Rosenthal et al. (1984) found that of the patients in whom a possible physical cause of pain (including ADHESIONS) could be identified, 75% had evidence of psychological influences on the pain.

rate of adhesion formation:

A Patient's Guide to Adhesions & Related Pain:

Burden of Adhesive Disease:

"Adhesive Disease is a consequence of abdominal surgery. The process begins immediately following the operation." Marvin L. Corman, M.D., University of California, Los Angeles.

Adhesion formation occurs during the natural and normal tissue repair process, when tissue surfaces that usually are separated adhere to each other. The body's cavities and internal organs are covered by membranes. In the abdomen and pelvis, this membrane is known as the peritoneum. The peritoneum protects and lubricates the external surface of the organs they cover. When the peritoneum is damaged, for example during surgery, a protein called fibrin can accumulate on the injured surface, making it sticky. This sticky surface can then adhere to other areas of peritoneum. These sticky bands are called adhesions.Adhesion formation occurs during the natural and normal tissue repair process, when tissue surfaces that usually are separated adhere to each other. The body's cavities and internal organs are covered by membranes. In the abdomen and pelvis, this membrane is known as the peritoneum. The peritoneum protects and lubricates the external surface of the organs they cover. When the peritoneum is damaged, for example during surgery, a protein called fibrin can accumulate on the injured surface, making it sticky. This sticky surface can then adhere to other areas of peritoneum. These sticky bands are called adhesions.

Under normal circumstances, fibrin present at the site of mesothelial damage is broken down by plasmin. Plasmin is derived from plasminogen, a protein found in the blood. Tissue plasminogen activators (released from mesothelial cells) convert plasminogen into plasmin. Through a process called fibrinolysis, the plasmin then breaks down the fibrin into a substance that is absorbed by the peritoneum. Permanent adhesions form when fibrinolysis does not occur following the formation of the fibrin matrix. In the setting of ischemia or inflammation, plasminogen is not activated and plasmin does not form. Consequently, the fibrin cannot be broken down and a permanent adhesion forms.

Adhesions can cause tissues or organs to adhere to each other, often limiting the mobility of organs and inducing pain. Adhesions are associated with chronic abdominal and pelvic pain, intestinal obstruction, female infertility and can make future operations much more difficult.

Adhesive Disease accounts for 49-74% of small bowel obstructions.

Adhesive Disease accounts for 15-20% of infertility cases.

Adhesive Disease accounts for 20-50% of chronic pelvic pain cases.

Adhesive Disease increases risk, complexity and complications during subsequent surgery:

One study showed a 19% rate of adhesion-related bowel perforation during subsequent/secondary operations.2
Bowel perforations occur even more frequently (33%) during surgery for SBO.2
Patients with adhesion-related perforations had significantly higher postoperative complications (leaks, wound infections, hemorrhages and length of stay).
A recent Medicare Database (HCFA) study on 18, 912 patients showed that nearly one in six patients were readmitted with an intestinal obstruction within two years.
Adhesive complications in the Medicare population.

Two-Year Medicare Study:
A recent analysis of claims data from the Federal Medicare program highlights the potential impact of postsurgical adhesions.1 Medicare provides health care coverage to nearly 40 million senior and disabled Americans. Medicare claims data are excellent sources for health outcomes analysis.

This analysis examined a randomly-selected 5% of the Medicare population and identified 18,912 patients who had colorectal surgery in 1993. The study tracked two-year outcomes for these patients after their initial surgery. The study revealed that a substantial percentage of patients were re-hospitalized for additional colorectal surgery or to treat bowel obstructions within two years of the initial procedures. These repeat hospitalizations likely were either directly caused, or complicated by adhesions formed after the initial surgery.

The Impact on Patients :
Impact of adhesions following initial surgery:

Small bowel obstruction: Adhesive Disease accounts for 49-74% of small bowel obstructions.<SUP class=footnote>1
Infertility: Adhesive Disease accounts for 15-20% of infertility cases
Chronic pelvic pain: Adhesive Disease accounts for 20-50% of chronic pelvic pain cases
Reduced quality of lifeLoss of work days and productivity
Increased risk, complexity and complications during subsequent surgery

One study showed a 19% rate of adhesion-related bowel perforation during subsequent/secondary operations.
Bowel perforations occur even more frequently (33%) during surgery for SBO.
Patients with adhesion-related perforations had significantly higher postoperative complications (leaks, wound infections, hemorrhages and length of stay).


Ten-year follow-up of postsurgical outcomes in the Scottish population.

The Scottish National Health Service (NHS) provides health care coverage to virtually all Scotland's population. The NHS has comprehensive, patient-specific longitudinal databases that are excellent sources for tracking outcomes after surgery.

A panel of prominent surgeons, chaired by Professor Harold Ellis, used Scottish NHS data to complete the Surgical and Clinical Adhesions Research (SCAR) study. The SCAR study examined the 10-year outcomes of 52,192 patients who underwent open abdominal and pelvic surgery.

Among patients who first had abdominal or pelvic surgery in 1986, 39 percent were readmitted to the hospital for additional surgery or treatment of a bowel obstruction within 10 years. The average readmitted patient was hospitalized 2.1 times over 10 years.

Of particular interest are the 12,584 patients who underwent open lower abdominal surgery in 1986. Among the 4,622 additional surgical procedures these patients required over 10 years, 48% of the reoperations occurred within just two years of the initial surgery. Given that nearly all patients form adhesions after lower abdominal surgery, adhesions may have complicated many of those reoperations. Furthermore, the 38% of hospital readmissions that were directly caused by adhesions occurred within two years of the initial procedure. These statistics confirm U.S. Medicare data showing that postsurgical adhesions are a significant near-term problem within two years of abdominal surgery.
Adhesions in the abdomen are basically bands of scar tissue that form after a surgical procedure is performed in the abdomen or pelvis. Most commonly they form after gynecologic surgery or a procedure involving the colon (such as colectomy or appendectomy). Factors that increase the likelihood that adhesions will form include abdominal infection, poor blood flow in the abdominal vessels and use of certain suture material.
Although these bands may involve any organ in the abdomen, the type of adhesions most likely to cause problems are those affecting the small intestine. Adhesions can cause an external obstruction of the small intestine by crossing over a loop of intestine and preventing intestinal contents from passing through. In fact, the most common cause of obstruction of the small intestines is adhesion formation. Patients who develop obstruction complain of a crampy, abdominal pain, often accompanied by nausea, vomiting and abdominal distention. An X-ray of the abdomen provides information to make the diagnosis.Patients with obstruction often improve spontaneously after treatment in the hospital with IV fluids and nutrition. However, in some cases, the obstruction is complete or persistent, resulting in "strangulation" of the bowel. These cases may require emergency surgery to remove the adhesions. Some patients may also suffer repeated, frequent episodes of obstruction. In these cases, elective removal of the adhesions is often recommended. This operation, typically done via laparoscopy, involves finding the adhesions and then cutting the bands to release the bowel loops they encircle.

Nerve damage after surgery:

Nerve Pain Expert Q&A:


adhesions on cuff:

Incapacitating pelvic pain:


rebounding pain:

Pelvic Pain Assessment Form:

Adhesions-type of scar tissue that results in the sticking together of some ..

dx~ nerve damage or entrapment?

Adhesions tug on the nerve during simple movements, causing pain...

Severe Neuropathy - Genitofemerol & Ilioinguial nerve entrapment: http://www.medhelp.org/forums/neuro/archive/9977.html

Abdominal Cutaneous Nerve Entrapment Syndrome (ACNES):


Acoustic neuroma


Symptoms of PPOD:

Pelvic pain
Bladder dysfunction
Bowel dysfunction
Gyn/Sexual dysfunction
Loss of vesical sensory perception
Excessive flatus
Anal sphincter spasm
Loss of rectal sensory perception
Spontaneous bowel discharge Miscarriage
Vaginal discharge
Vaginal spotting
Painful/Irregular menstruation
Menstrual migraine
Decreased genital sensitivity
Decrease or loss of orgasm
Genital Pain/Paresthesias
Pelvic pain on orgasm
Deficient (pre)coital lubrication
Depressed libido
Frequently, PPOD patients have been given multiple diagnoses representing a number of "abnormalities" that are felt to be responsible for the production of their wide range of symptoms. These diagnoses are usually based on the identification of (or in some cases lack of ability to identify) some type of pelvic "abnormality", which in many instances reflects nothing more than a normal variant of questionable significance detected on diagnostic examination. Once detected however, these "abnormalities" are typically viewed as the cause of the patient's complaints and carry the implication that to resolve the associated symptoms, treatment must be directed at correcting the local pelvic "disorder" felt to be responsible for these complaints. What is not readily appreciated however, is that in the majority of these cases (PPOD Syndrome), these "diagnoses" represent nothing more than symptomatic descriptors of the individuals present complaints or symptoms, and, do not indicate or identify the etiologic or causative factor underlying the production of their complaints. As a result, many PPOD patients strain under the psychological burdened associated with having been given multiple diagnoses, when in reality, their "disorders" represent the varying clinical manifestations of a common underlying mechanical disorder of the spine.

Chronic Pelvic Pain Syndrome, Levator Ani Syndrome and Vulvodynia, etc. are "diagnoses" that exemplify this point. These are terms that indicate the presence of pain at some location in the pelvis. These terms however, do not identify or implicate the underlying factor or mechanism producing the pain. While on the surface this realization may seem little more than an academic point, its significance is much greater than that. As without knowing the true cause of a given complaint, any attempt at treatment (whether medical or surgical) can only be directed at trying to suppress the symptom rather than eliminate or correct its true underlying cause.

As a result, many PPOD patients reveal a history of having undergone one diagnostic and/or therapeutic procedure after another, only to be left with continued persistent pain. Unfortunately however, usually, only after all therapeutic options have been exhausted, and all "abnormalities" have been "successfully" treated, they are then told that there is nothing further wrong (as all of the identified "abnormalities" have been addressed) and, nothing more can be done. While this is an extremely painful, expensive and frustrating experience to endure for one symptom alone (chronic pelvic pain), it is nothing short of devastating for patients who repeatedly undergo this exercise in a search to identify the cause of, and, treat multiple PPOD related complaints .

Chronic Pelvic Pain
Levator Ani Syndrome
Pelvic Floor Myalgia
Pudendal Neuralgia
Pelvic Congestion Syndrome
Pelvic/Ovarian Vein Varicosities
Proctalgia (Fugax)
Fibromyalgia/Myofascial Pain Syndrome
Trigger Points
(stress, urge, mixed, neurogenic, overflow)
Interstitial Cystitis
Urinary Retention
Non-bacterial cystitis
Irritable Bowel Syndrome
Colonic Inertia
(rectal, anal)
Chronic Constipation
Anorgasmy Frigidity


The typical mechanically induced PPOD patient is a woman of 20-55 years of age; however, men can also be affected. Not uncommonly, some of the PPOD symptoms may have had their onset in association with some type of injury, fall, pregnancy, or delivery. While many PPOD patients have a history of chronic or recurrent back and/or leg pain, the back pain component of their overall disorder may be overshadowed by the severe nature of the accompanying PPOD symptoms. Interestingly however, the mechanically induced PPOD Syndrome has been found to occur in individuals having no history of back pain as well. In addition, symptoms of fatigue, irritability, headache, neck and arm pain, as well as, symptoms of fibromyalgia are frequently found in the mechanically induced PPOD patient.

The usual course of PPOD involvement is that of gradually developing symptoms, which tend to become more severe and numerous over time. Many patients with long-standing PPOD involvement have undergone various diagnostic procedures, such as laparoscopy, sonography, CT scanning, MRI, cystoscopy, colonoscopy, etc., in an attempt to identify the cause of their complaints. Commonly however, they soon become frustrated by the inability to identify a specific cause for their complaints. As a result, the wide range of symptoms typically found in the mechanically induced PPOD patient are commonly attributed to "abnormalities" of questionable significance, which in some cases, bear little conceivable relationship to the individuals PPOD complaints. Yet despite the inability to specifically identify the cause of the complaints, symptomatic treatment, ranging from various types of medications to specialized therapy programs and invasive surgical procedures, is none-the-less tried. All too often however, these procedures have had little or no effect in resolving the wide range of symptoms associated with the mechanically induced PPOD Syndrome. Having exhausted all therapeutic options, the PPOD patient may then be told that there is nothing further wrong, and that their ongoing complaints, are most likely functional or psychogenic in nature, or, are probably related to "having children" or "getting older". Accordingly, with no other viable treatment options at hand, the frustrated PPOD patient is then referred for psychological counseling and emotional support. Devastated, they either accept a psychogenic basis for their ongoing complaints, all the while questioning their own sanity with respect to the reality of their condition, or, completely reject out of hand the notion that their pain, functional impairment, and physical deterioration could be psychologically induced. In either case, the mechanically induced PPOD patient frequently resorts to a life of quiet desperation, as they intuitively know there is in fact something physically wrong, but don't know where next to turn. Fortunately, a new approach to the treatment of this disorder has been developed.


Q.____ How is it that Doctor Browning, a chiropractor, can help me?_ I’ve been to so many different types of physicians and specialists, and have undergone every conceivable test and type of treatment, if they couldn’t help me how can he?

A._____ Although the mechanically induced PPOD Syndrome is caused by an “atypical” mechanical disorder of the spine, it manifests itself by producing a wide range of symptoms of bladder, bowel, gynecologic, and sexual dysfunction._ Because these symptoms cross the boundaries of several different medical specialties, PPOD patients have typically consulted several different types of specialists in an attempt to identify the cause of their complaints._ Given however, that the underlying disorder is of spinal origin, most attempts at treatment (medical or surgical treatment directed at suppressing or resolving the symptom rather than it’s cause) usually have little lasting effect. This fact is clearly illustrated in the histories of the accompanying case reports. Fortunately however, despite the lack of response to symptomatic medical treatment, once the underlying cause of the disorder has been accurately identified and appropriately treated, all PPOD related symptoms can begin to resolve. _

Q._____ If the mechanically induced PPOD Syndrome is caused by a spinal disorder, why hadn’t any of the many medical specialists I have already seen identified it?

A.____ In short, because this disorder falls outside of their area of expertise._ While the PPOD Syndrome typically causes symptoms of a urologic, gynecologic, enterologic and sexual nature, these disturbances very often mimic other conditions associated with internal disorders of the pelvic organs._ As a result, doctors who specialize in these areas of internal medicine, and, who typically have little training in dealing with mechanical disorders of the spine, commonly diagnose these complaints as being due to some type of local internal pelvic organ dysfunction or pathology. Having been so diagnosed, treatment typically proceeds along lines that further diverts attention from the true nature of the problem._ Furthermore, the “atypical” presentation of this condition so commonly encountered, tends to further complicate the picture by making identification of its true origin difficult even for those who
are trained in the diagnosis and treatment of the typical types of mechanical disorders of the spine. _

Q.____ Can I still be helped if I have undergone surgery for my problem(s)?

A._____ Yes._ As is apparent from years of clinical experience, as well as, the accompanying case reports, many PPOD patients have undergone prior (sometimes numerous and different types of surgeries in an attempt to resolve their complaints._ While often times these surgeries have provided no, partial, or only short term improvement in the disorder (or symptom) for which they had been performed, these surgeries generally have no significant effect at compromising the potential for recovery when treated properly. _

Q.____ I have undergone all kinds of diagnostic testing (laparoscopies, sonograms, CT scans, MRI, cystoscopy, colonoscopy, etc.), and everything is “normal”._ I’ve been told that “there is nothing wrong”._ If this is the case, why do I feel the way I do, and, if “nothing is wrong”, what can you do to help me?

A._____ This scenario, of having undergone numerous diagnostic studies in a vain attempt at trying to identify the cause of PPOD related complaints is a feature common to many PPOD patients._ This seems to be due to the fact that the diagnostic procedures used in the evaluation of patients with PPOD related complaints are designed to reveal pathological anatomy (abnormal changes in tissue structure) of the various organs assessed._ While these procedures can detect structural abnormalities, they are incapable of identifying the presence of abnormal function._ Most PPOD symptoms however, are the result of functional disturbances (abnormal functioning) of the pelvic organs, induced by a mechanical disorder of the spine._ As a result, despite the fact that the pelvic structures may appear “normal” from a structural standpoint, pelvic organ dysfunction typically remains undetected._ So, while there may be “nothing wrong” from a diagnostic (structural) standpoint, significant organicdysfunction can persist._ Once the underlying disorder has been properly identified and appropriately treated however, all associated symptoms typically begin to resolve.__ _

Q.____ Can my chiropractor treat me?

A._____ The mechanically induced PPOD Syndrome is a newly recognized disorder._ As a result, most chiropractors are not yet familiar with the diagnostic and therapeutic protocols necessary to identify and successfully treat this condition. In addition, treatment success is highly dependent upon the skilled application of specific procedures (not utilized or practiced by all chiropractors) in accordance with therapeutic protocols that have been developed and refined for maximum effectiveness when properly matched to the variant forms of this disorder._ Treated in the wrong way, symptoms may be aggravated, and the PPOD Syndrome may worsen. If your chiropractor has been following this work through published research, and, has treated sufficient numbers of PPOD patients to consistently get good results, then he or she may possess the background and experience necessary to effectively treat this disorder._ As there are not yet any programs in existence to train clinicians in the recognition, diagnosis and management of the mechanically induced PPOD Syndrome, there is no repository of names to identify individuals who are qualified in caring for this disorder._ The only way to locate a doctor who may be experienced in treating this disorder is to call their office and inquire specifically about their knowledge of, and experience in, treating the mechanically induced PPOD (pelvic pain and organic dysfunction) Syndrome._ If they aren’t familiar with the term (“PPOD Syndrome”), they probably are unaware of what it is and the proper treatment protocols utilized in its care.____ _

Q._____ Is there a doctor in my area that help me?

A._____ We do not have a registry of other doctors who may be familiar with the PPOD Syndrome. Your best bet is to call the offices of local chiropractic doctors and ask specifically if they are familiar with, and, experienced in treating the PPOD Syndrome. Please do not contact our office for assistance in this regard as we simply do not have this resource to provide.____ _ _

Q._____ I’m already seeing a chiropractor, and, either, a) haven’t noticed any change in my condition, or, b) my condition has gotten worse despite treatment?

A._____ As mentioned above, the success in treating the mechanically induced PPOD Syndrome is dependent upon two factors; 1) the identification of those individuals whoare in fact suffering the effects of this disorder, and, 2) the proper administration of appropriate therapeutic procedures following specific treatment protocols._ If your condition is due to the mechanically induced PPOD Syndrome, but the treatment you have been receiving is inconsistent with the protocols necessary to effectively deal with this disorder (wrong type of treatment, and/or inappropriate therapeutic/management protocol), a positive therapeutic response would not be expected to occur._ Success in treatment depends upon accurately identifying those individuals who do in fact suffer the effects of the mechanically induced PPOD Syndrome (which can only be determined by the results of specific examination procedures performed and interpreted by a clinician experienced in treating this disorder), and, the skilled delivery of treatment following the appropriate therapeutic protocol for the variant form of this disorder._ Fortunately however, most PPOD patients who have failed to improve while under prior “conventional” chiropractic treatment have demonstrated an excellent response once treatment and therapeutic protocols have been modified to appropriately treat the mechanically induced PPOD Syndrome. _

Q.__Must I come to Suttons Bay for treatment?_ Can’t you tell my chiropractor how to treat me?

A.___ Because of the complexity involved in assessing individual clinical needs, prescribing appropriate treatment and monitoring therapeutic response from a distance, we have refrained from trying to teach PPOD diagnostic and therapeutic protocols to inexperienced (relative to PPOD) practitioners over the phone._ However, because of the many requests we have had to provide a means by which PPOD patients could receive treatment by a chiropractor in their hometown, we will provide generalized therapeutic recommendations to confirmed PPOD patient shaving been examined by Dr. Browning in Suttons Bay (see SERVICES PROVIDED)._ These recommendations can be used to guide their hometown Doctor through appropriate PPOD protocols._ It should be realized however, that although this arrangement provides another option for PPOD patients, there is the potential for compromise in therapeutic outcome due to inexperience by the treating doctor, as the initial few weeks of treatment represents the critical period during which the development of complications requiring a prompt and precise therapeutic response or modification in treatment protocol are more likely to occur._ In the hands of an inexperienced practitioner, there is a possibility that things may go wrong._ A situation analogous to a heart patient being treated by a general practitioner as opposed to an experienced cardiologist._ Individuals however, who wished to take advantage of his many years of experience in treating the mechanically induced PPOD Syndrome, may stay in Suttons Bay and be treated by Dr. Browning during a four-week treatment rotation. _

Q.____ Will I be cured?

A._____ While in most cases a complete or significant resolution of symptoms can be achieved, most PPOD patients are not “cured” in the sense that there will be no tendency or likelihood that their symptoms may recur._ The reason for this is that the type of disorder underlying the production of the mechanically induced PPOD Syndrome is by its very nature, somewhat unstable._ In addition, some individuals have accompanying conditions or “factors” that can contribute to altering the stability of the condition._ As a result, although in most cases an excellent response can be anticipated, it may be necessary to receive periodic treatment (which should be able to be obtained close to home) to maintain stability and sustain your improved clinical state. ________
Q.____ Will my insurance company cover treatment?_

A._____ This is difficult to say as insurance coverage varies greatly from company to company, and policy to policy. Based on past experience, however, reimbursement for treating the mechanically induced PPOD Syndrome has ranged from none to significant._ In some cases, plans that typically provide for chiropractic coverage however, may limit or deny reimbursement for various reasons. Because of the difficulties and uncertainty in dealing with the many different insurance companies and their policies, we generally do not accept insurance assignment when treating or consulting on the mechanically induced PPOD patient._ All charges for all services are to be paid in full by cash, check, Visa or MasterCard._ We will provide you with the information necessary to file your own claim._ It is your responsibility however, to file your claims, and follow-up on obtaining any reimbursement from your insurance company.__________

Because there is no one single test that can diagnose the individual suffering from the mechanically induced PPOD Syndrome, a helpful means of potentially identifying individuals with this disorder has been by the use of a questionnaire which profiles some of the characteristics of the PPOD patient. Although this questionnaire cannot absolutely establish whether or not you are an individual experiencing the effects of this disorder, its use in the clinical setting as been found to be helpful at identifying those individuals most likely suffering the effects of the mechanically induced PPOD Syndrome. In using this questionnaire, read through each section and identify the symptoms you are currently experiencing, or in the case of the listed surgical procedures, have had performed in the past. Complete all sections to obtain your final score. This will determine the relative probability that you are experiencing the effects of the mechanically induced PPOD Syndrome. It is important to realize that many of the symptoms described in this questionnaire may represent other conditions requiring appropriate treatment. It is for this reason that the identification of any symptoms listed in the questionnaire should be followed by professional evaluation to more clearly establish their cause. If however, your history is typical of the mechanically induced PPOD Syndrome, and subsequent evaluation confirms its presence, help is available. Ongoing clinical research has led to the development of an effective treatment protocol to deal with the devastating effects of this disorder. PELVIC PAIN Pelvic pain has been and continues to be the enigma of gynecology. It is one of the most common and yet frustrating complaints seen in gynecological practice today. Typically, the pain is felt on one or both sides of the front of the pelvis (in the region over the ovary) or above the pubic area. In men, this pain may be thought to be due to a developing hernia and may also involve the testicle(s). Not uncommonly, sharp or burning pain can extend into the genital region (vulva and/or vagina) and in women is commonly diagnosed as "vulvodynia". The pain can be constant or intermittent, and may be increased in its intensity after physical exertion or sitting for long periods of time. Intercourse is frequently painful. Individuals who have had symptoms for a long period of time may reveal a history of having undergone various surgical procedures in an attempt to alleviate their pelvic pain. Frequently however, these procedures have provided little, short-term, or no significant improvement.

Unilateral (left or right sided) anterior pelvic pain Bilateral pelvic pain Pelvic pain above pubic bone Genital pain, numbness or tingling Laparoscopy without identification of specific cause for pelvic pain Partial or complete hysterectomy for pelvic pain without significant relief Hernioplasty or orchioectomy without significant relief of pain

Like pelvic pain, female urinary incontinence is a frequent and often frustrating condition encountered in urological practice. To emphasize this point, an editorial in the journal Obstetrics and Gynecology pointed out that "it is well known that most operations for urinary incontinence are successful for a few months only". Urological symptoms associated with the mechanically induced PPOD Syndrome frequently have their onset in association with pregnancy or delivery, but rather than resolving following the birth of the child, the symptoms continue and may progressively become worse. If the onset is unrelated to pregnancy, many times the individual can recall an accident; fall or some type of injury to the back that had occurred at about the time their symptoms began. Although there are many individual symptoms of bladder dysfunction associated with the mechanically induced PPOD Syndrome, the most commonly encountered and typically representative are those of frequency, urgency, dribbling, incontinence, sluggishness, and retention.


Urinary frequency
Urinary urgency
Urinary dribbling
Urinary incontinence
Urinary sluggishness
Urinary retention
Recurring urinary tract infections
Waking more than twice at night to empty the bladder
Wetting the bed
Normal urge to void replaced by supra pubic pressure or pelvic distention
Bladder surgery for urinary incontinence
Two or more bladder surgeries for recurring incontinence


The area of sexual dysfunction in the individual with mechanically induced PPOD has provided some of most thought provoking insight into the far-reaching effects of the mechanically induced PPOD Syndrome. Many symptoms of sexual dysfunction, of which mainstream thought currently regards as being psychogenic in nature, have shown dramatic improvement as a result of treatment of the mechanically induced PPOD Syndrome. And, as a result, implicate a physical, rather than psychological cause of these disorders. Symptoms of this type include; dyspareunia (pelvic pain during intercourse) and anorgasmy (diminished or loss of ability to achieve normal orgasm). In males, there may be difficulty or inability of attaining or maintaining an erection. Additional gynecological and sexual symptoms include; persistent vaginal discharge, deficient coital (sexual) lubrication and loss of libido (sex drive). Although other gynecological and sexual symptoms have been implicated in the mechanically induced PPOD Syndrome, those listed above are most likely representative of mechanically induced pelvic pain and organic dysfunction.

apals keep us posted....(((hugs)))

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