Adhesions can obstruct the intestine
DEAR DR. DONOHUE: This past spring, I suddenly became sick with stomach pains that doubled me over. Then I started vomiting. I couldn’t hold even a few sips of water. My wife got me to the hospital, and I was seen by a doctor almost immediately. The doctor thought I had a bowel obstruction and called two surgeons. They agreed. One wanted to wait and see what would happen; the other wanted to take me to surgery right away. They compromised and waited two hours, but I ended up with surgery for a bowel obstruction from adhesions. I had an appendectomy when I was 36. I am now 46. The doctors thought that my adhesions came from that surgery. I’m not too clear about all this. What are adhesions? — P.G.
ANSWER: The abdominal organs — including the small and large intestine — don’t like being pushed around. No matter how careful and delicate surgeons are when they enter the abdomen, it’s inevitable that moving structures to expose the trouble spot gives rise to deposits of sticky protein, called fibrin. Fibrin, in turn, invites the laying down of collagen, another protein, the stuff of which scars are made. Strands of collagen form thick bands that bind adjacent organs or encircle the intestines. Those scarlike bands are adhesions.
When a band of adhesions wraps around the intestine — most often the small intestine — it can obstruct the passage of undigested food. The part of the intestine lying before the obstruction becomes distended with fluid and partially digested food. That’s the cause of the crampy abdominal pain and vomiting. The obstruction makes bowel movements and gas passage impossible. The intestine can become so distended that its blood supply is cut off, and it can rupture.
Prior surgery is the chief cause of adhesions, but it’s not the only cause. Infections within the abdominal cavity also can cause them. So can abdominal radiation.
Attempts to prevent adhesion formation are ongoing, but a surefire preventive hasn’t yet been devised.
DEAR DR. DONOHUE: Would you please explain just what the cause of osteomyelitis is? What can be done for it? My friend has had to have toes on each foot amputated because of it. Will it happen to every toe? Will this person eventually lose feet and legs? —Anon.
ANSWER: Osteomyelitis (OS-tee-oh-MY-uh-LITE-is) is bone infection. Bacteria (germs) cause it. Germs get to a bone through the bloodstream from a distant infection, from an adjacent infection like a skin ulcer, from trauma that pushes dirt and germs deep under the skin or from a blocked blood supply that causes the death of bone and nearby tissue.
Does your friend have diabetes? Diabetics are prone to osteomyelitis of the feet and toes, because their circulation is bad. Bad circulation promotes infections. They also often lose sensation and are unaware of foot and toe sores that admit bacteria to the bones.
Antibiotics are the treatment for osteomyelitis. Dead bone has to be removed, or the infection won’t get better, even with antibiotic treatment.
Unless your friend suffers from extremely poor circulation, he or she isn’t likely to lose other bones to osteomyelitis. Even with poor circulation, treatments exist to restore blood supply, for many.
DEAR DR. DONOHUE: My doctor told me I have meralgia paresthetica. I’ve never heard of it. Can you explain it and how to treat it? — L.B.
ANSWER: You told your doctor you have meralgia paresthetica by telling him your symptoms. He just gave it a name. A nerve in your upper thigh, around the pocket area of a man’s pants, is being squeezed. It might be scar tissue, a tight belt or tight clothes. If it’s from constricting garments, the answer is to loosen them. If a deposit of fat is compressing the nerve, weight loss relieves the compression. If scar tissue wraps around the nerve, an injection of cortisone might solve the problem. Sometimes surgery to remove the entrapping material is necessary.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.