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Don't know what to do... Don't know what to do...

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  #1  
Unread 04-30-2003, 03:05 PM
Don't know what to do...

Hi Everyone!

I am 35 and had my third laporoscopy for endometriosis in March (6 weeks ago). They had to remove my right ovary and tube during that surgery. I have had severe pain in that area since the surgery. It is a sharp, stabbing pain that comes and goes. About 3 weeks ago I also started having intestinal pain, especially after I eat. My dr. has run several tests (C/T scan, barium enema and IVP- which looks at the bladder and kidneys). All of the tests have been normal. Has anyone else had any trouble like this? I am sometimes in such pain that it makes me cry.

My husband talked to an ob/gyn friend of his. He said he would have strongly advised not to leave anything if there was a need to remove the ovary. He said he has seen patients who have trouble if they only do partial hyst. and that it is better to just do the whole thing while they are in there.

The nurse at my drs. office said it may be adhesions from the surgery where they removed the ovary. The only way to fix that is to go back in. My husbands friend said to give it 3 months (from surgery date) and if I still hurt I should have a total hyst. Any words of advice?

Thanks in advance!
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  #2  
Unread 04-30-2003, 04:10 PM
Don't know what to do...

Hi (((Kim))), I'm so sorry you're still having such troubles! I was reading your post, and before I got to the bottom I was thinking, I bet it's an adhesion involving her colon... and sure enough you mentioned that the nurse thinks that's what it is.

I'm almost five weeks post a colectomy and having those after eating pains... they are from the fecal mass passing through the areas that were worked on and they are sometimes a stabbing type of pain. My DR told me to keep moving, lots of slow, fluid movements to reduce adhesion formation... no sudden fast movements and no sitting around doing nothing for long periods.

As far as reducing the likelihood of adhesion formation, I'm with you on the 'get it all done in one surgery versus several separate surgeries' approach.

s,
-Linda
  #3  
Unread 04-30-2003, 06:34 PM
Don't know what to do...

(((Kim))),
I'm so sorry your going thru soo much Unfortunately, in many cases a Hyst will not cure Endo..we have several ((Sisters)) here suffering from some very severe Endo many months & yrs Post-Op... OTOH, we have some that are pain free post op..*yeah*( Here is some excellent info that has some good info that will hopefully be of some help in your decision

Indications for Hysterectomy:

  Quote:
Hysterectomy is the surgical removal of the uterus. By age 60, 25% of American women have had this procedure. More than 500,000 hysterectomies are performed each year in the US, which is the highest rate among any nations with published data on this procedure. It is twice the rate of hysterectomies in English women and four times the rate in French women. Studies report that between 11% and 19% of all hysterectomies are performed to treat extensive endometriosis. Having endometriosis plus severe symptoms is, in fact, a major risk factor for eventually requiring a hysterectomy. It should be noted that hysterectomy does not necessarily cure endometriosis. One study reported that endometriosis reappeared in 13% of women within three years of a hysterectomy and in 40% after five years.

Most women are satisfied with the procedure. A major analysis of evidence on hysterectomies reported that symptoms related to menstrual problems decline significantly in most women, although none completely disappear for all women. The majority of women also experience improved quality of life and emotional functioning, although 8% of women who were not depressed and 12% of women who were not anxious before the procedure developed these emotional states afterward.

Still, one study suggested that 70% of recommendations for hysterectomies did not meet the standard of care as determined by expert groups. In such cases, patients were not given alternative choices or adequate diagnostic evaluations. Any woman, even one who has reached menopause, who is uncertain about a recommendation for a hysterectomy for fibroids should certainly seek a second opinion.
Surgical Procedures for Intestinal or Urinary Tract Endometriosis

What are Adhesions?

  Quote:
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.1 _


_
The Problem of Adhesions

The incidence of adhesions is overwhelming. Adhesions develop in 93% of patients following abdominal and pelvic surgery.2

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.

Seprafilm Adhesion Barrier: Proven Adhesion Prevention:

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.

Seprafilm Bioresorbable Membrane from Genzyme Biosurgery is an absorbable adhesion barrier that separates the traumatized tissue surfaces while the body's normal tissue repair process takes place. In a randomized, double-blinded, multi-center clinical study, Seprafilm prevented adhesions in 51% of patients. In the same clinical trial, only 15% of Seprafilm patients had dense adhesions.
http://www.genzymebiosurgery.com/opa...el=2&opage=268

  Quote:

  Quote:
TREATMENT
Treatment is aimed at reducing the symptoms of endometriosis, usually either pain or infertility. Treatment is divided into three paths - observation, medication, or surgery.

OBSERVATION: IS ANY TREATMENT NEEDED FOR ENDOMETRIOSIS?
Women who have minimal or mild endometriosis and do not have pain may not require any treatment other than careful follow-up. In practice, however, if the diagnosis of endometriosis is made during laparoscopy, most gynecologists will burn or cut away these cells. However, a few studies have demonstrated that this treatment of mild endometriosis does not enhance fertility. For women with mild endometriosis, fertility rates are good even if no treatment is performed._

CAN MEDICATION BE USED TO TREAT ENDOMETRIOSIS?

It is known that estrogen causes endometriosis to grow. Endometriosis is extremely rare before a young woman begins to produce estrogen and starts to have periods and the disease usually disappears after menopause, when estrogen production stops. Therefore, one goal of treatment with medication is to lower, or stop, the production of estrogen. Reducing the levels of estrogen "starves" the endometriosis and causes it to shrink and sometimes even disappear. Two classes of drugs have been developed which lower the amount of estrogen in a woman's body - Danocrine and GnRH agonist (see details in our book). Progesterone can also be used to treat endometriosis._

WHAT IS CONSERVATIVE SURGERY?

Conservative surgical treatment is considered when a woman needs surgery for pain or infertility associated with endometriosis, and she desires to preserve her pelvic organs. The goal of this approach is to remove as much endometriosis and scar tissue as possible and restore the uterus, tubes, and ovaries to their normal positions. Conserative surgery can be performed using laparoscopic surgery or an abdominal incision. Newer modalities involving laparoscopic surgical techniques and use of instruments such as lasers have allowed for surgery to be performed through very small incisions with the benefit of a shorter hospital stay and quicker recovery time._

However, laparoscopic surgery requires special training, expertise, and experience on the part of the surgeon. Conservative surgery may provide a cure, but it may also provide only temporary relief of symptoms. A woman may elect to have conservative surgery in order to complete her family, and then, at a later time, she may elect to undergoing radical surgery. And, some women may require more than one conservative surgical procedure before they need to have, or are willing to consider, a more extensive operation. Yet, for some women, multiple conservative operations may provide relief of symptoms._
B]Should I Keep My Ovaries?[/b]
http://drn4u.com/keepovaries.htm

Hysterectomy-Leave the Ovaries-Gabe Mirkin, M.D.
http://www.drmirkin.com/women/W126.htm

What is the Medical Treatment for Endometriosis?

  Quote:
The progression of endometriosis is estrogen dependent. Treatment with continuous progesterone can shrink endometriotic implants. Overall, the treatment that causes significant decrease in estrogen levels (pseudomenopausal state) is more effective than measures involving prolonged progesterone effect. Agents with prolonged progesterone effect such as provera may be given by mouth or by injections. Prolonged progesterone effect can also be achieved with birth control pills which contain estrogen and progesterone, taken continuously for six to eight months. Such treatment may relieve pain; some endometriotic implants may resolve and/or decrease in size. Agents that suppress ovarian estrogen production include Danazol, a weak androgenic (male) hormone, and GnRH agonists such as Lupron. These agents are more effective than progestins in suppressing symptoms and reducing implants. However, their use is limited by side effects which resemble those of menopause. The low estrogen state leads to hot-flashes, bone demineralization, increase in "bad" cholesterol (LDL) and decrease in "good" cholesterol (HDL). The latter changes increase the risk of cardiovascular disease. Therefore, these agents are rarely prescribed for more than six months. Usually, the beneficial effects do not last very long after the cessation of treatment. At times a course of a GnRH agonist is prescribed in preparation for surgery or as adjuvant treatment after surgery.
What is the Surgical Treatment for Endometriosis?

urgical treatment of endometriosis is indicated when medical treatment fails, when large endometriomas (ovarian chocolate cysts) are present, or in the treatment of infertility.
The role of surgery, via laparoscopy or laparotomy, is to resect or destroy endometriotic implants, remove an endometrioma, remove pelvic adhesions and repair obstructed fallopian tubes (tuboplasty.)
Removal of the uterus, alone or with the ovaries and fallopian tubes, should be considered only when it has been established that the ovaries or uterus are the source of the symptoms and that all other treatment modalities have failed. The last requirement is critical. "Failed treatment" is a relative term and depends to a large extent on the dedication, expertise, surgical skills and motivation of the treating physician to spare the involved organs. Meticulous surgery including microsurgical technique in resecting endometriotic implants, lysis of adhesions and pelvic reconstruction may achieve better and more lasting results than less sophisticated surgical techniques. Combining medical and surgical treatment may also be helpful.
A special procedure to relieve pain caused by endometriosis is LUNA (laparoscopic uterosacral nerve ablation.) It involves the destruction of many nerve fibers that provide sensation to the cervix and lower uterine segment. The effectiveness of this procedure in relieving menstrual pain is variable (50-75%). Another procedure known as presacral neurectomy involves severing the nerve fibers which convey pain sensation from the uterus and pelvic floor and is more effective in relieving pain. If presacral neurectomy is performed meticulously it may give long term relief from pelvic pain even if the endometriosis progresses. In my experience hysterectomy with or without ovarian resection is necessary in only a very small percent of patients with endometriosis. [u]It should be emphasized that hysterectomy is not a foolproof treatment for the symptoms of endometriosis. The rate of recurrent symptoms is high (up to 63%) after hysterectomy; after hysterectomy and bilateral oophorectomy recurrent symptoms appear in a significant percent of women (10%)[/].
http://www.althysterectomy.org/endometriosis.htm
http://www.centerforendo.com/QandA.htm
www.endometriosistreatment.org
http://www.drcook.com/
http://www.endometriosistreatment.o.../reprints1.html
http://www.womenssurgerygroup.com/c...is/overview.asp
http://www.usdoctor.com/endo.htm

***excellent article***
http://www.reutershealth.com/wellconnected/doc74.html
http://www.womens-health.com/
http://www.gynsecondopinion.com/endometriosis.htm
http://www.lifesciences.napier.ac.uk...iosis/doc1.htm
http://www.obgyn.net/cfm/endo.cfm?ID=5243
http://www.angelfire.com/mi/jenneybean/
http://homepage.psy.utexas.edu/homep...terectomy.html


Endo support:
http://www.endo-online.org/family.html
http://www.geocities.com/fightendo/treat.html

recurring Endo-Q&A:
http://www.endometriosis1.com/indexj.html
http://www.angelfire.com/fl/endohystnhrt/resource.html
https://www.hystersisters.com/vb2/sho...threadid=81855
http://forums.obgyn.net/forums/women...0202/1958.html

Endometriosis Conquering The Silent Invader:
http://www.ivf.com/ch17mb.html

Recurring Endo at the Center For Endometriosis Care:
ttp://www.centerforendo.com/news/recurrance/recurrance.htm

Endometriosis-Dr. Stanley West:
http://www.repmed.com/endo.html

Hysterectomy & Endometriosis Questionnaire:
http://www.angelfire.com/fl/endohystnhrt/quest.html

Post-Op Ovarian Suppression:
http://www.centerforendo.com/news/ov...n/ovarysup.htm

Incisional Endometriosis:
http://www.facs.org/dept/jacs/lead_a...apr00lead.html

Endometriosis Research Center:
http://www.endocenter.org/

Radical Endometriosis Surgery:
http://www.reproductivecenter.com/radical.html

Surgical Procedures for Endo:
http://www.universityobgyn.com/laparosc.htm
http://www.umm.edu/surgery-info/methods.htm
http://www.kenes.com/cogibook1999/Me...rine_Bleeding-
_Does_Hysterectomy_Still_Have_a_Place_in_Modern_Management.html
http://www.gyndr.com
http://www.reproductivecenter.com/radical.html
http://www.drdeljuncojr.com/surgicalprocedure.html
http://www.kumc.edu/instruction/medi...endometr4.html

Endo Specialists & Resources:

http://www.hcgresources.com/resources.htm
http://www.geocities.com/friday_sfws/ind.htm
http://www.endoangels.com/links.html
http://www.lupron.com/

Painful Signs of Endometriosis Should Be Taken Seriously:
http://www.nytimes.com/2002/07/09/he...th/09BROD.html

Hysterectomy~risks, complications:

http://www.obgyn.net/women/articles/...anter_0512.htm
http://www.wdxcyber.com/nbleed13.htm
http://www.gynalternatives.com/hysterec.htm
http://www.findings.net/positive-exp.html
http://www.gyndr.com/hysterectomy.htm
http://www.oxford.net/~tishy/hystasm.html
http://www.nlm.nih.gov/medlineplus/n...ory_10679.html

Outcomes Similar After Total, Partial Hysterectomy: http://www.nlm.nih.gov/medlineplus/n...ory_10040.html
http://hcd2.bupa.co.uk/fact_sheets/m...terectomy.html
http://www.vagisil.com/frame_general_surgical.html
http://www.estronaut.com/a/hysterect...ternatives.htm

Reducing Complications At Laparoscopic Hysterectomy:
http://www.reproductivecenter.com/reducing.html
http://www.lucanus.co.nz/Ops.htm#Laparoscopic Hysterectomy

Supracervical hysterectomy versus total abdominal:
http://www.biomedcentral.com/1472-6874/2/1/abstract

Nerve-sparing Hysterectomy:
http://www.newshe.com/articles/hysterectomy_3.shtml

If you are facing surgery:
http://www.gynsecondopinion.com/surgery.htm

Surgical Menopause:

http://www.hormonejungle.com/privacy.htm
http://www.surgimenopause.com/
http://www.helioshealth.com/menopause/surgical.html
http://www.menopausehysterectomy.com/Menopause.htm
http://webmd.lycos.com/content/article/1680.50792
http://my.webmd.com/content/dmk/dmk_article_5963052
http://members.tripod.com/fiona_51/faq.html
https://www.hystersisters.com/surg.php

HRT: The Whole Story:
http://health.discovery.com/centers/...hrt_whole.html

The role of ovarian hormones upon brain:
http://www.bbsonline.org/Preprints/O...bbs.fitch.html

Old Ovaries-still of value?
https://www.hystersisters.com/vb2/sho...threadid=10987

Myths vs. Facts about Hysterectomy:
http://www.mayohealth.org/mayo/9406/htm/myth_sb.htm

http://www.womenshealth.org/ask/hyst.htm

Benefits vs. Side Effects of Hysterectomies:
http://www.usatoday.com/life/health/...r/lhwhy002.htm

hormone replacement after complete hysterectomy: http://www.medicinenet.com/script/ma...MNI&qakey=2339

Surgery: Alternatives to Hysterectomy:
http://womenshealth.miningco.com/msub9.htm

Vaginal Hysterectomy Assisted with Laparoscopy:_
http://www.bewell.com/hic/hysterecto...copy/index.asp

Making The Choice:
http://www.denver-rmn.com/health/ar-pc-hy.htm

Hysterectomy: when is it necessary?
http://www.healthgate.com/healthy/woman/1998/hys/

Hysterectomy: Know Your Options:
http://www.healthywomen.org/qa/hysterectomy.html

Hysterectomy Guidelines:
http://www.usatoday.com/life/health/...r/lhwhy003.htm

Hysterectomy: Get the Facts Before You Act:
http://www.plainsense.com/Health/Womens/hystrctm.htm

A Quality of Life Issue:
http://medseek.com/glennbradley/newsdetail.cfm?ref=251

Menorrhagia: When Periods Are Too Much:
http://www.womens-health.com/gyn_health/gyn_md_men.html

Chronic Pelvic Pain Diagnosis and Management: http://www.obgyn.net/displayarticle....ter/cpp_carter

The Endometriosis Association Houston Support Group:
http://www.endohouston.org/

Endometriosis Symptoms and Treatments: http://womenshealth.about.com/librar.../aa102400a.htm

Understanding & Managing Endometriosis:
http://www.endometriosis.org.ausavvy...ndoBro_web.pdf
When is hysterectomy a woman's only option for treating endometriosis?

  Quote:
Hysterectomy used to be a much more common treatment for endometriosis than it is today. However, it may still be necessary when other avenues of treatment have failed. Many times, physicians will also recommend removal of both ovaries (bilateral oopherectomy) at the time of hysterectomy because some studies suggest this results in greater long- term pain relief.used to be a much more common treatment for endometriosis than it is today. However, it may still be necessary when other avenues of treatment have failed. Many times, physicians will also recommend removal of both ovaries (bilateral oopherectomy) at the time of hysterectomy because some studies suggest this results in greater long- term pain relief.

If you spend any time with women who have this disease, you realize what a difficult decision this is. I've heard positive hysterectomy stories as well as negative ones. At our most recent meeting, one member told me she felt that having a hysterectomy was the only way she could get her life back. Another member had a different opinion and felt she had traded one set of problems for another. Unfortunately, there are no right or wrong answers with endometriosis treatment, only difficult decisions.

Having a hysterectomy is often very emotional because women may view it as a loss -- not only of reproductive organs, but also as loss of control over our bodies and this disease. Even after definitive surgery, many women still have health- related issues to contend with, the most significant of which is hormone replacement decisions. There is a theory among some endometriosis specialists that hormone replacement should be delayed for a time following hysterectomy and removal of ovaries to allow the endometriosis lesions to "die out." (Estrogen is usually thought of as the hormone that influences the growth and development of endometriosis.) But other specialists don't agree, and begin hormone replacement immediately in order to take advantage of estrogen's heart- protective and bone- protective benefits. Women in the support groups have discussed the merits of natural hormone replacement for endometriosis, but little data exists on this topic.

There is also the question of whether hysterectomy is the answer for everyone. In our support group, we have a few members who continue to suffer with continued symptoms and documented existence of the disease even after hysterectomy and bilateral oopherectomy.

http://womenshealth.about.com/librar...y/aa030898.htm
Endometriosis Despite Hysterectomy:
http://www.stanford.edu/group/whpu/qa/07,09,99.html

Good Luck w/ everything Pls know your ((Sisters)) will be here for support in whatever your desicion may be....my prayers will be with you that it will bring you some much B]What is the Surgical Treatment for Endometriosis?[/b]

urgical treatment of endometriosis is indicated when medical treatment fails, when large endometriomas (ovarian chocolate cysts) are present, or in the treatment of infertility.
The role of surgery, via laparoscopy or laparotomy, is to resect or destroy endometriotic implants, remove an endometrioma, remove pelvic adhesions and repair obstructed fallopian tubes (tuboplasty.)
Removal of the uterus, alone or with the ovaries and fallopian tubes, should be considered only when it has been established that the ovaries or uterus are the source of the symptoms and that all other treatment modalities have failed. The last requirement is critical. "Failed treatment" is a relative term and depends to a large extent on the dedication, expertise, surgical skills and motivation of the treating physician to spare the involved organs. Meticulous surgery including microsurgical technique in resecting endometriotic implants, lysis of adhesions and pelvic reconstruction may achieve better and more lasting results than less sophisticated surgical techniques. Combining medical and surgical treatment may also be helpful.
A special procedure to relieve pain caused by endometriosis is LUNA (laparoscopic uterosacral nerve ablation.) It involves the destruction of many nerve fibers that provide sensation to the cervix and lower uterine segment. The effectiveness of this procedure in relieving menstrual pain is variable (50-75%). Another procedure known as presacral neurectomy involves severing the nerve fibers which convey pain sensation from the uterus and pelvic floor and is more effective in relieving pain. If presacral neurectomy is performed meticulously it may give long term relief from pelvic pain even if the endometriosis progresses. In my experience hysterectomy with or without ovarian resection is necessary in only a very small percent of patients with endometriosis. [u]It should be emphasized that hysterectomy is not a foolproof treatment for the symptoms of endometriosis. The rate of recurrent symptoms is high (up to 63%) after hysterectomy; after hysterectomy and bilateral oophorectomy recurrent symptoms appear in a significant percent of women (10%)[/].
http://www.althysterectomy.org/endometriosis.htm[/url]
Should I Keep My Ovaries?
http://drn4u.com/keepovaries.htm

Hysterectomy-Leave the Ovaries-Gabe Mirkin, M.D.
http://www.drmirkin.com/women/W126.htm

What is the Medical Treatment for Endometriosis?

  Quote:
The progression of endometriosis is estrogen dependent. Treatment with continuous progesterone can shrink endometriotic implants. Overall, the treatment that causes significant decrease in estrogen levels (pseudomenopausal state) is more effective than measures involving prolonged progesterone effect. Agents with prolonged progesterone effect such as provera may be given by mouth or by injections. Prolonged progesterone effect can also be achieved with birth control pills which contain estrogen and progesterone, taken continuously for six to eight months. Such treatment may relieve pain; some endometriotic implants may resolve and/or decrease in size. Agents that suppress ovarian estrogen production include Danazol, a weak androgenic (male) hormone, and GnRH agonists such as Lupron. These agents are more effective than progestins in suppressing symptoms and reducing implants. However, their use is limited by side effects which resemble those of menopause. The low estrogen state leads to hot-flashes, bone demineralization, increase in "bad" cholesterol (LDL) and decrease in "good" cholesterol (HDL). The latter changes increase the risk of cardiovascular disease. Therefore, these agents are rarely prescribed for more than six months. Usually, the beneficial effects do not last very long after the cessation of treatment. At times a course of a GnRH agonist is prescribed in preparation for surgery or as adjuvant treatment after surgery.
Good Luck Kim in fnding some much needed answers & relief to your pain Pleese keep us posted..(((hugs)))
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  #4  
Unread 05-01-2003, 09:46 AM
Don't know what to do...

Thanks so much for both of your help! I have my follow-up exam in the morning. I will see wha the says and what my options are.

I will keep you posted!
  #5  
Unread 05-03-2003, 07:39 AM
Don't know what to do

Hi Ladies!

I went for my 6 week follow-up exam yesterday. The dr. feels like my pain is due to adhesions from the removal of the ovary and tube. He said we need to go back in and he can take care of it. I asked if we should just go ahead and take everything else at that time. He said he doesn't see any need to do that right now. He thinks, with my history, I can wait quite a few more years. It has been 8+ years since my last laporoscopy. He said that if he gets in there and I have adhesions all over the place, it would be wise to go ahead and do the hyst. at that time.

I am just ready to feel better! We are scheduled for another lap. on May 15th to fix the adhesions. He said there are preventative measures they can take this time so hopefully I won't have any more adhesions after this one.

Thanks for you advice and for listening!
Reply

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