Rest in Peace Carol 1965 - 2006

Ms Carol J Howland, Patient Account Representative



I had adhesions for 2 Years before detection
Diagnosed on March 12, 2005
My Birthday is Wednesday, April 14, 1965
I live in Norwood, Massachusetts USA
I had my tonsils removed when I was 5. Then I was diagnosed with hereditary spherosytosis at the age of 15 after a sports injury. I had my gallbladder removed due to this disease and eventully my spleen removed ten years later in 2001. My spleen was 4 to 5 time larger than normal and producing new blood cells at an extremely dangerous rate. 26 months later I was admitted for what was though to be gastroenteritis. It was later confirmed 2 days later that I had a small bowel obstruction. 2 days later I taken into surgery where it was found that dense adheisions had fromed and strangled the small intestin. My physician was so good that the small bowel and intestine were untouched and had come back after removing all adheisions from the abdomin surrounding the splenectomy surgery. I hope this never happens again, not that I had any of the excruating pain at the time. ( NO REALLY I HAD NONE)!!!! But I would not hesitate to go back to him, but I would also would be very willing to use Celebrex to try to stop the adheision growthes from coming back. Please be aware that I knew I was going to have to have my gallbladder out and spleen removed, I was also aware that if splenules were remaining that they could act just like my spleen another operation could come in the future, I did have in good authority that they had checked for those and removed them if they were there, but I was very unaware of adheisions. I have alot of surgeries in the past besides these, though everytime I am very afraid of going under, I never realized that I should now be very afraid of having more surgery to remove adheisions. I trust all my physicians that I have asked in the past and thought I knew all the important questions to ask, How is your infection rate? How many times have you performed this particular surgery? But never have I asked how many patients receive adheisions and who could most likely get them. Guess we will really never know the answer to that one, but maybe one day some knowledgable researched will be able to provider that very important answer.

Miss you my friend. D

Before you have any surgery

ARDvark Blog Medical News

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New Study Gives Hope for Fibromyalgia Sufferers

A new study just released by NuScience Corporation shows a significant decrease in some of the symptoms related to Fibromyalgia. The study done by Professor Roberto Marcolongo at the University of Siena, Italy, looked at the efficacy of treating patients diagnosed with Fibromyalgia with a specific blend of 129 nutrients called CELLFOOD.
Las Vegas, NV (PRWEB) November 29, 2006 -- A new study just released by NuScience Corporation shows a significant decrease in some of the symptoms related to Fibromyalgia. The study done by Professor Roberto Marcolongo at the University of Siena, Italy, looked at the efficacy of treating patients diagnosed with Fibromyalgia with a specific blend of 129 nutrients called CELLFOOD.In the study, CELLFOOD effectively reduced pain associated with Fibromyalgia by more than 31% over a 90-day period. CELLFOOD was also shown to decrease specific tender point pain by up to 40% during that same period. "Needless to say, the results were dramatic and very encouraging. Based on the results of this preliminary study, a third study has been initiated increasing the dosage of CELLFOOD as well as the length of the treatment period" said David McKinney, Vice President of NuScience Corporation, the makers of CELLFOOD. "CELLFOOD is a nutritional supplement in a colloidal solution based on oxygen, trace minerals, amino acids and enzymes. It emanates H+ ions (used for metabolic normalization of the acidosis) and O- ions that react with oxygen free radicals, and leads to the forming of molecular bio-available oxygen. CELLFOOD, which causes the elimination of oxygen free radicals, produces rising oxygen and provides optimal cellular nutrition." According to the study, "this new therapeutic approach could effectively provide an important contribution in the treatment of patients afflicted with Fibromyalgia syndrome; both from chronic pain and from chronic fatigue symptoms associated with FMS, therefore reducing the need to explore more complex pharmacological solutions."This is good news for the hundreds of thousands of people diagnosed with Fibromyalgia, suffering from painful symptoms. Fibromyalgia (FM) is an increasingly recognized chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. The most common sites of pain include the neck, back, shoulders, pelvic girdle and hands, but any body part can be involved. Fibromyalgia patients experience a range of symptoms of varying intensities that wax and wane over time.OxyWave LLC has been an online provider of Cellfood nutritional products since early 1998. A free copy of the Fibromyalgia study can be downloaded at: http://www.oxywave.com/.
http://www.prweb.com/releases/2006/11/prweb484627.htm

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A Single Intraperitoneal Dose of Carbon Monoxide-Saturated Ringer's Lactate Solution Ameliorates Postoperative Ileus in Mice.

Nakao A,
Schmidt J,
Harada T,
Tsung A,
Stoffels B,
Cruz RJ Jr,
Kohmoto J,
Peng X,
Tomiyama K,
Murase N,
Bauer AJ,
Fink MP.
Department of Critical Care Medicine, 615 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261. finkmp@ccm.upmc.edu.
Treatment with inhaled carbon monoxide (CO) has been shown to ameliorate bowel dysmotility caused by surgical manipulation of the gut in experimental animals. We hypothesized that administration of CO dissolved in lactated Ringer's solution (CO-LR) might provide similar protection to that observed with the inhaled gas while obviating some of its inherent problems. Postoperative gut dysmotility (ileus) was induced in mice by surgical manipulation of the small intestine. Some mice were treated with a single intraperitoneal dose of CO-LR immediately after the surgical procedure, whereas other mice received only the LR vehicle. Twenty-four hours later, intestinal transit of a nonabsorbable marker (70-kDa fluorescein isothiocyanate-labeled dextran) was delayed in mice subjected to intestinal manipulation but not the sham procedure. Gut manipulation also was associated with increased expression within the muscularis propria of transcripts for interleukin-1beta, cyclooxygenase-2, inducible nitric-oxide synthase, intracellular adhesion molecule-1, and Toll-like receptor-4, as well as infiltration of the muscularis propria with polymorphonuclear leukocytes and activation of mitogen-activated protein kinases and nuclear factor-kappaB. All of these effects were attenuated by treatment with CO-LR. The salutary effect of CO-LR on gut motility, as well as many of the anti-inflammatory effects of CO-LR, was diminished by treatment with a soluble guanylyl cyclase (sGC) inhibitor, suggesting that the effects of CO are mediated via activation of sGC. These data support the view that a single intraperitoneal dose of CO-LR ameliorates postoperative ileus in mice by inhibiting the inflammatory response in the gut wall induced by surgical manipulation, possibly in a sGC-dependent fashion.
PMID: 16943253 [PubMed - in process]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_
uids=16943253&query_hl=2&itool=pubmed_DocSum

Abdominal Sounds

Definition
Abdominal sounds are the noises made by the intestines.
Alternative Names
Bowel sounds
Considerations
Abdominal sounds (bowel sounds) are made by the movement of the intestines as they push food through. Since the intestines are hollow, bowel sounds can echo throughout the abdomen much like the sounds heard from water-pipes.
The majority of the bowel sounds are harmless and simply indicate that the gastrointestinal tract is working. Abdominal sounds are evaluated by listening to the abdomen with a stethoscope ( auscultation ).
While the majority of bowel sounds are normal, there are some instances where abnormal bowel sounds provide valuable information about the health of the body.

Ileus is a condition in which there is?a lack of intestinal activity. Many medical conditions may lead to this but it is important to evaluate it further because gas, secretions, and intestinal contents can accumulate and rupture the bowel wall. The doctor may be unable to hear any bowel sounds when listening to the abdomen.

Reduced (hypoactive) bowel sounds include a reduction in the loudness, tone, or regularity of the bowel sounds. They indicate a slowing of intestinal activity. Hypoactive bowel sounds are normal during sleep, and also occur normally for a short time after the use of certain medications and after abdominal surgery. Decreased or absent bowel sounds often indicate constipation.

Increased (hyperactive) bowel sounds are sometimes heard even without a stethoscope. Hyperactive bowel sounds reflect an increase in intestinal activity. This can sometimes occur with diarrhea and after eating.
Abdominal sounds are always evaluated in conjunction with symptoms such as nausea, vomiting, presence or absence of bowel movements, or gas. If bowel sounds are hypoactive or hyperactive, along with abnormal symptoms, continued evaluation by a health care provider is important.
For example, absent bowel sounds after a period of hyperactive bowel sounds are significant and can indicate that rupture of the intestines, or strangulation of the bowel with subsequent death ( necrosis ) of the bowel tissue may have occurred.

Common Causes
Most of the sounds you hear your stomach and intestines make are due to normal digestion and are no need for concern. Many conditions may cause hyperactive or hypoactive bowel sounds. Most are harmless and require no treatment.
The following are a list of more serious conditions that can cause abnormal bowel sounds.

Hyperactive, hypoactive, or absent bowel sounds:
Mechanical bowel obstruction is caused by hernia , tumor , adhesions , or similar conditions that can physically block the intestines.
Blocked blood vessels prevent the intestines from getting proper blood flow. For example, blood clots can cause mesenteric artery occlusion .
Paralytic ileus is a problem with the nerves to the intestines. Reduced nerve activity can result from infection, overdistended bowel, trauma, bowel obstruction, vascular obstruction, and chemical imbalances such as hypokalemia .

Other causes of hypoactive bowel sounds:
Drugs that reduce intestinal movements such as opiates (including codeine), anticholinergics, and phenothiazines
General anesthesia
Spinal anesthesia
Irradiation of the abdomen (radiation therapy for cancer)
Surgery in the abdomen (may cause reduced bowel sounds for 1 to 5 days)
Other causes of hyperactive bowel sounds:
Diarrhea
Crohn's disease
GI bleeding
Ulcerative colitis
Food allergy
Infectious enteritis

Home Care
Call your health care provider if you experience any symptoms such as nausea, vomiting, prolonged diarrhea or constipation, bleeding from your rectum, or any other symptoms that are not normal for you.

What to expect at your health care provider's office
The doctor will perform a physical exam and ask you questions about your medical history. You may be asked:
What other symptoms are also present?
Have you noticed any abdominal pain?
Have you noticed any diarrhea?
Have you noticed any constipation?
Have you noticed any abdominal distention ?
Have you noticed any excessive or absent gas (flatus) ?
Have you noticed any bleeding from the rectum or black stools?

Depending on the findings of your physical exam, the doctor may order further tests. Tests may include:
Blood tests
Abdominal x-ray
Abdominal cat scan
Endoscopy
If there are signs of an emergency, you will be sent to the hospital.?A tube will be placed through your nose or mouth into the stomach or intestines. This empties your intestinal contents. Usually, you will not be allowed to eat or drink anything, so your intestines can rest. You will be given fluids by IV.??
You may be given medication?to reduce symptoms and to treat the cause.
(The specific medication depends on the situation.)
Surgery may be immediately needed?in some cases.
http://www.nbc17.com/encyclopedia/6863989/detail.html

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Types of Hernias

INCISIONAL or Ventral Hernias may occur in the area of any prior surgical incision, and can vary in size from very small, to very large and complex. They develop as the result of disruption along or adjacent to the area of abdominal wall suturing, often subsequent TENSION placed on the tissue or other inhibition to adequate healing (infection, poor nutrition, obesity, or metabolic diseases). These hernias present as a bulge or protrusion at or near the area of the prior incision scar. Virtually any prior abdominal operation can subsequently develop an Incisional Hernia at the scar area, including those from large abdominal procedures (intestinal surgery, vascular surgery), to small incisions (Appendectomy, or Laparoscopy). These hernias can occur at any incision, but tend to occur more commonly along a straight line from the breastbone straight down to the pubis, and are more complex in these regions. Hernias in this area have a high rate of recurrence if repaired via a simple suture technique under tension and it is especially advised that these be repaired via a TENSION FREE repair method using mesh These hernias may develop soon after the original surgery, or at any time thereafter. Incisional Hernias gradually increase in sizeonce they develop and become progressively symptomatic. A bulge may not be evident at the hernia site initially, and pain may be the only early hernia symptom. These hernias develop in many cases as a result of too much tension placed when closing the abdominal incision, as stated above. Tension creates poor healing, swelling, wound separation and eventual Incisional Hernia formation.

INGUINAL or 'groin' hernias are by far the most common site for hernias to develop in adults, and are second only to Umbilical Hernias in infants and children. While a bit more common in men, they do occur in women as well. These hernias will develop as the result of a weakness, tear, gap or opening in the muscle wall of the lower abdomen or groin, in a region called the Myopectineal Orifice. As a result, the contents of the abdomen, such as intestine, may protrude through the opening creating a pain and a bulge. The pain and bulge may be constant, or intermittent in duration. Inguinal Hernias are located in the lower abdomen (right side, left side or both), just above the leg crease, near or adjacent to the pubic area. Inguinal Hernias can occur on both sides ('Bilateral') in about 8-10% of patients. INGUINAL HERNIAS may be CONGENITAL (present since birth) yet may become evident with pain or as a bulge at any time during life. They can also be ACQUIRED, the result of repetitive pressure, strain or injury to the muscles of the abdominal wall. This can be acute and occur abruptly, or develop over a long period of time. Congenital Hernias are usually called"INDIRECT" hernias, whereas Acquired hernias are referred to as "DIRECT" hernias, and are so called because of their anatomic direction of travel into the area known as the Inguinal Canal. These hernias frequently show up as a lump, swelling or "bulge" which gradually increases in size and become progressively more uncomfortable. Sometimes only a mild pain, ache or burning in the groin area may occur prior to the development of an obvious bulge. This pain, again often described as an ache or burning sensation, may not only be present in the inguinal area, but may also radiate into the hip region, back, leg or even down towards the genitalia region. Called "REFERRED PAIN", this discomfort can be quite bothersome and at times severe. In addition, in the absence of a bulge, the diagnosis of the cause of this pain may be delayed or mistakenly and incorrectly ascribed to other causes such as muscular groin strains, epididymitis, prostatitis or orchitis etc. These diagnoses may be maintained erroneously until the bulge develops, thereby heralding the real cause of the pain...a hernia. The discomfort with hernias usually is initiated by or increases in severity with activity, then becomes relieved, although not always completely, with rest.

UMBILICAL Hernias, and nearby hernias called "Paraumbilical Hernias" develop in and around the area of the umbilicus (belly button or navel). A Congenital (present since birth) weakness in the naval area exists. This was the area at which the vessels of the fetal and infant umbilical cord exited through the muscle of the abdominal wall. After birth, although the umbilical cord disappears (leaving just the dimpled belly-button scar), the weakness underneath may persist. Hernias can occur in this area of weakness at any time from birth through late adulthood. The signs and symptoms include pain at or near the navel area as well as the development of an associated bulge or navel deformity. This bulge pushes out upon the skin beneath or around the navel, distorting the normal contour and architecture in or around the navel (creating an 'OUTIE' instead of a normal 'INNIE').Although often appearing at or just after birth, these hernias can also occur at any time during later life. In INFANTS, these hernias may gradually close by age 3 or 4 and surgery can often be delayed until then, unless the hernias are causing problems or enlarging. This decision should be made after examination by a Pediatrician or skilled Surgeon. In ADULTS however, umbilical hernias cannot "heal", and do gradually increase in size and often become problematic. Incarceration or Strangulation may occur.

FEMORAL hernias, like Inguinal Hernias develop in the groin area, but occur about 5 times more commonly in females than they do in males. These hernias develop at or very near the leg crease itself, but in an area somewhat lower than the more common Inguinal Hernia. In fact, it is often difficult to differentiate clinically between these and Inguinal Hernias on examination by those not experienced in hernia evaluation. The defect itself occurs in an anatomic triangular-shaped "gap", located between the following 3 structures:
1. the inguinal ligament (a tendinous cord that creates the leg crease),
2. the lower side of the pubic bone, and
3. The femoral vein (the major vein of the leg).This gap is somewhat larger in famles due to the shape and angle of the pelvis, therefore making femoral hernias more common in females. NOTE: the congenital gaps and weak areas of the inguinal canal are somewhat larger in males, making Inguinal Hernias more common in men. The findings of an acutely painful lump or bulge on the leg crease, adjacent to the pubic region (especially in females) suggests a diagnosis of a Femoral Hernia. The femoral hernia defect is very close anatomically to that found in Inguinal Hernias. Examination by a Hernia Specialist is often needed to confirm this particular diagnosis. Often, a Femoral Hernia can occur simultaneously with an Inguinal Hernia, and be overlooked at surgery using 'conventional' repair techniques. FEMORAL hernias are much more common in females, but can occur in males as well. These hernias are more prone to develop INCARCERATION and/or STRANGULATION as an early complication than are Inguinal Hernias. Therefore, early repair once these hernias are diagnosed is very strongly advised before such complications occur.

SPIGELIAN hernias are ventral hernias occurring through the spigelian fascia along the Spieghel’s semilunar line and lie under the external oblique aponeurosis just outside the outer border of the Rectus or "six-pack" muscles. They commonly occur at a level referred as ‘spigelian hernia belt’ which is a transverse band between the level of umbilicus (navel) and the line joining both anterior superior iliac spines (Photo). Rarely they can occur above or below this level. Spigelian hernias are more common in women and have a peak occurrence around 50 years of age. The symptoms may vary from well-localised constant abdominal pain with or without palpable lump to vague inconstant ache. Clinically it is difficult to feel a definite bulge or a hernial defect as they are typically submuscular. Therefore, imaging studies are frequently necessary to make or confirm the diagnosis. They often develop complications like incarceration due to delay in diagnosis. Ultrasound or CT Scan are the goldstandard investigational imaging studies used for the diagnosis of Spigelian hernia in patients suspected of having these often occult hernias. Once diagnosed, surgical repair using an "open" Tension-Free technique, similar to that used for ventral/insisional hernias is extremely effective, well tolerated and is therefore highly recommended to prevent complications.

. DIASTSIS RECTI is not a hernia. Although often confused and at times mis-diagnosed as an epigastric hernia, which it is not, these abdominal wall protrusions occur due to a widened band of non-contractile fascia or tendon normally present between the rectus musles. There is no defect or true hernia present in a normal Diastaasis Recti. Since this fascia does not contract as does normal adjacent muscle, when individuals with DR strain (e.g., do a sit-up), an elongated bulge in the upper abdomen, tappered at each end will appear. This non-tender bulge extends from just below the breast bone, down to the navel. Unlike Epigastric Hernias, a Diastasis Recti is not localized along the linea alba line, but involves the entire space between the breast bone and the navel. They are likened to a narrow foorball in shape. There is no pain associated with this bulge and it is not apparent when standing or walking, but is evident only when straining (sit ups). This is a variant of normal anatomy and Diastasis Recti is not a hernia. Surgery is not indicated for this condition and we disuade ill-advised attempts at surgical correction.

EPIGASTRIC hernias develop in the mid upper abdomen, anywhere along a line drawn from the lower point of the breastbone straight down to the Umbilicus. They rarely deviate to any extent away from this straight-lined area, but can occur at any point along it. These not-too-uncommon hernias arise in a defect of the mid-line fascia or tendon that is present between the two rectus or six-pack muscles (called the linea alba). These hernias are generally small in size and localized, rarely larger thatn the size of a golf-ball. Because of the small defect, the contents are easily pinched and these hernias therefore can cause a great deal of pain. Epigastric Hernias are extremely well suited for repair using a Tension Free method. Epigastric Hernias should not be confused with a condition called DIASTASIS RECTI (DR)

http://hernia.tripod.com/types.html

Happy Thanksgiving

Peace

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This is quite a story.....
Five Have Kidney Transplants In One Go

Chronic Pain : One in five, UK ~ One in four U.S.

Pain :: Americans suffer from long term chronic pain - CDC
One in four U.S. adults say they suffered a day-long bout of pain in the past month, and one in 10 say the pain lasted a year or more, according to the government's annual, comprehensive report of Americans' health, Health United States, 2006, released today by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics.
Read more


~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

One in five of us is living with pain. Surely there’s a way out? UK
Whether it's a dodgy knee, a throbbing shoulder or an aching back, unremitting daily pain is wrecking lives. One recent survey suggested 20% of Scots suffer from some form of chronic pain. Indeed, recent statistics showed back pain alone being responsible for the loss of 4.5bn working days each year in the UK - at an annual cost of £5bn.Yet the provision of services appears not to address the issue, with many parts of Scotland not offering specialised pain services.It's not simply a lack of funding, says Mick McMenemy, lead clinician with the Glasgow Back Pain Service and chairman of the north branch of the UK's Physiotherapists' Pain Association, but a lack of understanding about the problem."Chronic pain can turn people's lives upside down, with many struggling to hold down a job," he says. "Some sufferers are bounced around different departments and clinics for years, sometimes achieving short-term relief, but not a cure, because often, chronic pain can't be cured."The incidence of self-reporting suggests one in five of us has ongoing pain, other reports put this figure at 7% or 10%. Whichever statistic you choose, the fact is there is a huge problem with people suffering daily."We need a shift in how our health services respond and the key to this is that pain, particularly chronic pain, is poorly understood. Many health professionals don't recognise it, never mind know how to treat it, and that's an educational challenge."There are ways of managing pain, but if you don't recognise the problem in the first place, you won't be able to help."If you ask most health professionals, they will tell you there is no provision for this at university level.
Read More

Keizer woman grows her ownto combat chronic pain

Grace Smith associated smoking pot with losers for the better part of her 36 years.
"I grew up in a scary Stepford town in Colorado and that was the way I was raised. One equaled the other," said Smith, a Keizer resident and medical marijuana cardholder.
Smith is not her real name. Her true identity is being withheld to protect her from possible backlash for a legal activity: growing marijuana for medical use in her own home. She agreed to tell her story in the aftermath of a recent drug bust in Keizer in which more than eight pounds of marijuana was taken from the home of a couple with medical marijuana cards.
Smith is the single mother of two boys and one of the few constants in her life is pain.
She was in a car crash at the age of 10 in 1978. The crash took her father's life and broke both sides of Smith's jaw and injured a knee as well.
"I wasn't wearing my seat belt, basically because I wasn't listening to my mother," she said.
More than 25 years later, Smith said the pain is nearly unbearable most days.
"I have a permanent migraine, which makes me grind my teeth to the point that they shatter, which makes me curl up into uncomfortable positions, which makes the pain that much worse. It's a real nasty cycle," she said.
Light and sound aggravate the condition. Her face is partially paralyzed. Her physical pain leads to mood swings that have kept even her closest family members on their toes.
Between the ages of 10 and 30, Smith was prescribed a laundry list of painkillers that could quell the pain, but often left her unable to care for her children or perform routine tasks that are taken for granted by others, which includes holding a regular job.
At its worst, she took in 21 mg of Percoset each day to take the edge off.
Smith said she was scared the first time she smoked marijuana to relieve her pain at age 30. She did so at the coaxing of friends who thought it might help her relax.
"I was really afraid, but I was desperate," she said.
What she found was that smoking marijuana helped her cope with the pain in a way she hadn't known before trying the drug.
She describes the effect as taking away the fear of looking at something in the mirror she didn't want to see.
"The pain was still there, but the marijuana helped me relax and continue to do the things that every normal person does," she said. "It takes away the fear of that first look in the mirror and allows me to get on with me life."
It also halved her daily intake of Percoset.
She began using marijuana illegally for medicinal purposes, but when medical marijuana use was approved by Oregon voters, she seized the opportunity to work within the established program.
"I'm one of those law-abiding citizens. I wasn't trying to break the law, but the pot was helping," she said.
What she encountered struck her as odd.
"No one in the area would sign the paperwork for a first-time card. I had to go to Portland," she said.
Read More

Nerve Pain ? ~ Look at Lyrica

Some folks we know are reporting reduction in their pain symptoms.

Find out more................

Click to go to mfg. website.

Ask your doctor.

Remember we are patients, not doctors.

Comprehensive Review Published on FzioMed Technology for Postsurgical Adhesion Prevention

Nov 16 2006, 8:00 AM EST
BIOWIRE
FzioMed, Inc. reported today that a review of the company's technology for postsurgical adhesion prevention has been published in The Journal of Biomedical Material Research, Wiley Periodicals, Inc.
The article, "A Modern Biomaterial for Adhesion Prevention" (J Biomed Mater Res Part B: Appl Biomater, 2006 DOI 10.1002/jbm.b.30659), describes FzioMed's proprietary biomaterials platform, known as Oxiplex(R), and the promising clinical results using Oxiplex products for adhesion prevention in gynecologic and spine surgery.
Postoperative adhesions are abnormal bands of scar tissue that can form inside the body after surgery. Adhesion formation is considered the single greatest complication of surgery. Adhesions form in nearly all patients undergoing gynecologic surgery and lead to increased rates of reoperation, postoperative bowel obstruction, infertility and chronic pelvic pain. Adhesions following spine surgery cause recurrent back pain and weakness and can compromise an otherwise successful outcome.
FzioMed's technology is based on the patented combination of two safe, absorbable medical polymers, carboxymethylcellulose and polyethylene oxide. The company combines these materials to create products customized for different body cavities and surgical applications.
FzioMed's adhesion prevention products are injectable gels used intraoperatively to coat tissues and reduce the extent and severity of adhesions. The gels are easy to use during surgery in the peritoneal cavity as well as the lumbar spine and clinical studies found both peritoneal and peridural formulations to be safe and effective. The article concluded that FzioMed products have "provided a benefit to patients undergoing surgery where postsurgical adhesion formation is a concern." In addition to their benefits as devices, the gels may also be effective vehicles for drug delivery for many unmet problems of surgical therapeutics.
About FzioMed
FzioMed is a medical company developing and commercializing absorbable, surgical biomaterials based on the company's patented Oxiplex science. Oxiplex is an innovative medical polymer technology with uses in a variety of specialties including orthopedics, spine, gynecology, general surgery and aesthetic surgery. FzioMed products include the leading adhesion barrier for spine surgery currently marketed outside of the United States as Oxiplex(R)/SP Adhesion Barrier Gel and as MediShield(TM) Anti-Adhesion Gel, Oxiplex/AP adhesion barrier for gynecologic and general surgery, and Laresse(TM) cosmetic dermal filler. FzioMed products are for investigational use only in the U.S. Go to www.fziomed.com.
FzioMed(R), Oxiplex(R) and Laresse(TM) are trademarks of FzioMed, Inc., and MediShield(TM) is a trademark of Medtronic Sofamor Danek.
http://www.genengnews.com/news/bnitem.aspx?name=8967635

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A "Primer" on Asherman's Syndrome

Frequently Asked Questions

Welcome to the Asherman's Syndrome Online Community! As the size of our community of Asherman's sufferers has grown, we have discovered that women who have recently been diagnosed with this Syndrome often have the same questions that we had when we first started our own "Asherman's Journeys". We have created this listing of "Frequently Asked Questions" ("FAQ's") in the hope that it will help provide our new members and visitors with at least a basic understanding of this Syndrome and some suggestions for the "first steps" that might be appropriate in investigating treatments for Asherman's.
What causes Asherman's Syndrome?The short answer is, there is no single cause but rather a number of them that seem to contribute to the development of Asherman's. Asherman's appears most frequently in women who have had a "D&C" (dilation and curettage) for the removal of retained placenta after birth of a child, to clear the uterus after miscarriage of a child, or for purposes of aborting a pregnancy. Performing a D&C on a "recently pregnant" uterus often result in the development of Asherman's Syndrome, but not always. The prevalent theory is that a D&C on a recently pregnant uterus will cause Asherman's only in cases in which the D&C is "overly aggressive" which is any case in which the doctor performing the procedure scrapes the uterine walls with too much force. Because a post partum uterus is very soft and fragile, D&C's should be performed as gently and carefully as possible which unfortunately doesn’t always happen. The risk of Asherman’s also seems to be increased by the use of a sharp instrument to perform a D&C unless the D&C is performed by a doctor that specializes in the treatment of Asherman’s.
I've never had a D&C - could I still have Asherman's?Yes. Asherman's can also be caused by other sources of "trauma" to the interior of the uterus including cesarean-section, uterine infection including certain sexually transmitted diseases and other types of uterine surgery such as myomectomy.
I still have a period each month, does that mean I don't have Asherman's?Not necessarily. Some women with moderate to severe cases of Asherman's may experience amenorrhea, (the cessation of menstrual cycles) but others with milder cases may still have a period but will often notice their cycles are much shorter and/or lighter than they were previously. This does, however, mean your cervix is open and you could still become pregnant which is inadvisable while you still have scar tissue in your uterus. Please see FAQ #13.
How can I be sure that I actually have Asherman's Syndrome?The best way to diagnose Asherman's Syndrome is by visualizing the interior of the uterus. This can be accomplished using a diagnostic hysteroscopy or through the performance of a hysterosalpingogram ("HSG"). A diagnostic hysteroscopy involves the dilation of the cervix and the insertion of a tiny scope that enables the doctor to see inside the uterus directly. An HSG is a more “indirect” method of diagnosis and is performed by inserting a small catheter about the width of a ballpoint pen into the cervix and then injecting radioactive dye through the catheter and up into the uterine cavity while performing an x-ray. Using this procedure, the doctor can get a very detailed picture of the interior of your uterus and can note any areas of scarring. In some cases, however, the scarring is so severe that the dye simply will not flow into the uterus at all because it is blocked with scar tissue. It is also not uncommon for a woman with Asherman's Syndrome to have a cervix that is so scarred that the catheter is not able to be inserted at all in which case a diagnostic hysteroscopy is recommended. Some doctors have suggested the use of sonohystograms (an ultrasound that is performed after sterile saline has been flushed up into the uterus similar to an HSG) but the general consensus seems to be that although this method can certainly reveal the presence of scar tissue in a general manner, it lacks the clarity and specificity provided by an HSG.
Does having a hysterosalpingogram hurt? What do I need to know about it?Having an HSG can be quite uncomfortable, especially for those women with significant amounts of scarring present in their uterine interiors. It does seem to be less painful for those women with milder cases of Asherman's. It is advisable to take an anti-inflammatory a few hours before your procedure (such as ibuprofen) and you may also want to ask your doctor about pain medication if you have a low pain threshold. You will experience some uterine cramping and discomfort for anywhere from a few minutes to a few hours after an HSG.
I’ve had my hysterosalpingogram and have “officially” been diagnosed with Asherman’s. What questions should I be asking my doctor now?Even once you have an official diagnosis of Asherman’s, there is still a lot of information you will need to know in order to make some informed decisions about your treatment. You should ask your doctor:
-What is the severity of my Asherman’s, mild, moderate or severe?-Is my cervix open?-What percentage of my uterine cavity appears to be open?-Where in my uterus are most of the adhesions located?-Are my tubes currently open?-Is there any endometrium visible and if so, what is its measurement?-What course of treatment does the doctor recommend?-What instrumentation does the doctor use for his/her treatments?-How many cases of Asherman’s has this doctor treated in the last year?
Who should I see for treatment of my Asherman's? Should I continue to see my current OB or Reproductive Endocrinologist?There are certainly some general practice obstetricians and some reproductive endocrinologist who may be qualified to handle mild cases of Asherman's. For those with moderate to severe scarring, however, it is recommended that they see a surgeon that specializes in Asherman's Syndrome. Asherman's surgery is a VERY delicate and difficult surgery and even surgeons who have experience in other types of uterine surgery may not have the requisite skill or experience level to treat Asherman's successfully. Many of us in the group have made the mistake of being "loyal" to our original doctors who assured us they could help and in the end have actually ended-up making things worse. A poor Asherman's surgery has the terrible potential of actually making your condition worse (see question #11 for more information on this) which is why it is SO VITALLY important. The first restorative surgery is the best chance to restore the uterus and should be done by the most experienced doctor possible.
What is the "usual" treatment to repair Asherman's Syndrome?Treatment methods do vary from doctor to doctor, but the most common course of treatment is an operative hysteroscopy using microscissors to remove the adhesions, followed by a uterine balloon which is traditionally left in-place for 7-10 days after surgery. Another well-respected method is to skip using the balloon and instead have frequent office hysteroscopies in which any tiny adhesions that reform are snipped with the microscissors in the doctor's office. Surgery is normally followed by a course of antibiotics, (especially when a uterine balloon is used which carries with it a slight chance of infection), as well as a course of estrogen followed by progesterone.
My doctor has suggested that we perform a D&C to try and repair my Asherman's but isn't that was caused this in the first place?Unfortunately, there are still some poorly trained doctors that believe that the proper treatment for Asherman's is another D&C. We now know that this is the WORST possible treatment for Asherman's and will only worsen your condition, possibly irreparably! If a doctor suggests this to you, it is a good sign that he or she is not properly qualified to treat your condition. Please see question #11 for more information about the damage that can be caused by such overly aggressive treatment of Asherman’s.
My doctor says he wants to use a laser to remove my adhesions? Is this a good idea?Although a few exceptionally experienced doctors have used lasers successfully, the general consensus seems to be that anything that introduces heat into the uterus like a laser should be avoided due to the potential for actually incurring new damage to the endometrial lining. Destruction of any areas of the lining can be permanent and will make it difficult if not impossible for an embryo to ever implant in the uterus.
I've been diagnosed with Asherman's Syndrome and have been told to forget about ever having a baby. Is this true?No one can tell you that for sure as it depends on so many factors. We do know that many members of our online community have gone on to have children after surgery to repair Asherman's Syndrome but there are also many who have not. It depends on factors such as the severity of your scarring, the skill of the surgeon who performs the corrective surgery, the amount of healthy endometrium still remaining in your uterus and many other factors. The most important factor does seem to be the skill and experience level of the surgeon that performs your surgeries which is why we urge you to seek out a doctor on the main Ashermans page "A" list. Even with the best doctor - while there is hope for a child after Asherman's there are no guarantees. It is true that in some cases, there truly is no hope for a biological child after Asherman’s. This occurs when the endometrial lining that remains after the removal of all scar tissue is either extremely thin and/or is in islets instead of being continuous. This condition is most often the aftermath of a D&C or adhesion surgery that was so aggressive that the basal level of the endometrium (the level of cells that are responsible for the regrowth of the endometrium each month) has been cut away or damaged beyond repair. To date, there are no treatments that have been proven to repair such damaged basal endometrial cells but research into this area does continue. This once again is why it is so important to find a doctor with extensive Asherman’s experience. Even the most well-intentioned doctor can unintentionally and irrevocably damage your endometrium if they lack the proper skill and experience level to treat this very complicated condition.
How do I know how if I have “enough” endometrium left to carry a child?The optimal measurement for endometrial thickness is 8mm or more at mid-cycle which is Cycle Day 12-14 in a 28-day menstrual cycle. This can most accurately be measured using an ultrasound, often an intravaginal ultrasound which uses a small wand inserted in the vaginal canal to perform the ultrasound. The exact thickness of your lining may not be that crucial. There have been pregnancies carried to term by members of this group with linings as thin as 4-5mm. In fact, many doctors feel that once your uterus is free from scar tissue, the exact measurement of your lining is not as important as your having a normal period. The other important factor is whether the endometrium is continuous or is in “patchy” islets which can hinder the ability of an embryo to implant. Islets of endometrium can sometimes be visualized during an ultrasound, but the only reliable way to tell if your endometrium is continuous is through a hysteroscopy.
I’ve been diagnosed with only MILD Asherman's Syndrome, can I get pregnant without having surgery to remove the minor adhesions I have?The real question here isn’t "can" you, but SHOULD you. It is certainly possible for an Asherman's sufferer with an open cervix to get pregnant but it is a risky thing to do. There are numerous risks to both you and the baby should you get pregnant with significant scar tissue present in your uterus. You would be at a higher risk of miscarriage, placenta previa, placenta increta, bleeding during pregnancy and stillbirth. It is recommended that women with Asherman's NOT attempt pregnancy until they have had their scar tissue removed. This is why it is advisable to use birth control until you and your doctor are confident you are scar-free.
Do I need to have my Asherman's "repaired" if I don’t plan on having any more children? Is there a risk in leaving it untreated?The primary reason that women have surgery to remove the scar tissue that results from Asherman's Syndrome is to prepare their uterus for possible pregnancy. If no pregnancy is planned for the future, there may be no need to undergo reparative surgery and the scar tissue can usually be left alone. This is true for all those women who do not have "cyclic pain" i.e. monthly pain and cramps that normally accompany a menstrual cycle. For women that do have such monthly pain (whether or not they have actual periods) it may be advisable to have corrective surgery, despite not having the wish for a child, due to the risk of endometriosis.
How is endometriosis linked to Asherman's Syndrome?If there is sufficient scar tissue in the cervix to “seal” it closed, this leaves no channel for any shedding endometrium to take in leaving the uterus. This means that the only way “out” for that endometrium is to flow backwards or to be reabsorbed. If endometrium flushes backwards through the fallopian tubes and empties into the abdominal cavity it can lead to endometriosis which can cause damage to surrounding organs like the ovaries, bladder and intestines and which is reportedly very painful as well. This is why even those who don’t wish to have more children may want to have their Asherman's repaired to help reduce the risk of developing endometriosis.
What does it mean if I have had an operative hysteroscopy but my periods still have not resumed?It is possible that you have some reformation of scarring in your cervix or uterus that is blocking your menstrual flow. The presence of any “new” scarring can be confirmed using an HSG or a sonohystogram. An additional hysteroscopy will usually remove these “fresh” adhesions without difficulty. The common school of thought is that these reformations are not, in actuality, “new” scarring but rather the regrowth of scarring that wasn’t completely removed during the first surgery. The removal of scar tissue from the interior of the uterus is a very difficult task. The surgeon must go “deep enough” to remove the base or “source” of the scarring, but not so deep as to damage the endometrium. An experienced Asherman’s surgeon will err on the side of caution and not cut too deeply into the uterus. This means that is it quite common for some minor regrowth to occur from the few adhesions that were cut at a point “above” their base level. Such regrowth is not difficult to remove and can usually be accomplished quite easily.
Is it possible to have Asherman’s Syndrome symptoms and yet not have the condition?If you are suffering from light or absent menstrual periods following a D&C or other uterine surgery, then it is definitely possible that you have developed Asherman’s Syndrome. However, it is also possible that something else might be the source of your amenorrhea or hypomenorrhea. Oligomenorrhea (periods which occur at prolonged intervals) may also occur simultaneously with or separately from hypomenorrhea. Individually or jointly, they may indicate an endocrine disorder. For some women following a pregnancy or miscarriage, the body takes longer than we would normally expect to get back to a normal state. This is especially true in women who have a history of irregular menstrual cycles or endocrine disorders. People with these conditions are likely to have them throughout life. While hormone levels can be altered through the use of medications, these conditions are considered managed, not cured. If hormone levels do not return to a normal state following uterine surgery, especially if it was pregnancy related, then women may think they have Asherman’s when they truly do not. Some things that you might want to ask your doctor to check while he/she is also attempting to rule out Asherman’s are serum levels for prolactin, thyroid stimulating hormone (TSH), thyroxine (T4), follicle stimulating hormone (FSH), and estradiol (E2). If these levels are outside the normal range, then your amenorrhea, hypomenorrhea, or oligomenorrhea may be explained by a condition other than Asherman’s. Please be sure to discuss your concerns regarding Asherman’s with your physician so that it, along with any other condition, can be appropriately diagnosed or ruled out.http://www.ashermans.org/faq.shtml

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How to Evaluate Health Information on the Internet

Millions of consumers are using the Internet to get health information. And thousands of Web sites are offering health information. Some of those sites are reliable and up-to-date; some are not. How can you tell the good from the bad?
First, it's important to carefully consider the source of information and then to discuss the information you find with your health care professional. These questions and answers can help you determine whether the health information you find on the Internet or receive by e-mail from a Web site is likely to be reliable.
Qs & As: Evaluating Internet Health Information
1. Who runs the Web site?
Any good health Web site should make it easy to learn who is responsible for the site and its information. On the U.S. Food and Drug Administration's (FDA) Web site, for example, the FDA is clearly noted on every major page, along with a link to the site's home (main) page, www.fda.gov.
Information about who runs the site can often be found in an "About Us" or "About This Web Site" section, and there's usually a link to that section on the site's home page.
2. What is the purpose of the Web site?
Is the purpose of the site to inform? Is it to sell a product? Is it to raise money? If you can tell who runs and pays for the site, this will help you evaluate its purpose. Be cautious about sites trying to sell a product or service.
Quackery abounds on the Web. Look for these warning signs and remember the adage "If it sounds too good to be true, it probably is."
Does the site promise quick, dramatic, miraculous results? Is this the only site making these claims?
Beware of claims that one remedy will cure a variety of illnesses, that it is a "breakthrough," or that it relies on a "secret ingredient."
Use caution if the site uses a sensational writing style (lots of exclamation points, for example.)
A health Web site for consumers should use simple language, not technical jargon. Get a second opinion. Check more than one site.
3. What is the original source of the information on the Web site?
Always pay close attention to where the information on the site comes from. Many health and medical Web sites post information collected from other Web sites or sources. If the person or organization in charge of the site did not write the material, the original source should be clearly identified. Be careful of sites that don't say where the information comes from.
Good sources of health information include
Sites that end in ".gov," sponsored by the federal government, like the U.S. Department of Health and Human Services (www.hhs.gov), the FDA (www.fda.gov), the National Institutes of Health (www.nih.gov), the Centers for Disease Control and Prevention (www.cdc.gov), and the National Library of Medicine (www.nlm.nih.gov)
.edu sites, which are run by universities or medical schools, such as Johns Hopkins University School of Medicine and the University of California at Berkeley Hospital, health system, and other health care facility sites, like the Mayo Clinic and Cleveland Clinic
.org sites maintained by not-for-profit groups whose focus is research and teaching the public about specific diseases or conditions, such as the American Diabetes Association, the American Cancer Society, and the American Heart Association
Medical and scientific journals, such as The New England Journal of Medicine and the Journal of the American Medical Association, although these aren't written for consumers and could be hard to understand.
Sites whose addresses end in .com are usually commercial sites and are often selling products.
4. How is the information on the Web site documented?
In addition to identifying the original source of the material, the site should identify the evidence on which the material is based. Medical facts and figures should have references (such as citations of articles in medical journals). Also, opinions or advice should be clearly set apart from information that is "evidence-based" (that is, based on research results).
5. How is information reviewed before it is posted on the Web site?
Health-related Web sites should give information about the medical credentials of the people who prepare or review the material on the Web site.
6. How current is the information on the Web site?
Web sites should be reviewed and updated on a regular basis. It is particularly important that medical information be current, and that the most recent update or review date be clearly posted. These dates are usually found at the bottom of the page. Even if the information has not changed, it is helpful to know that the site owners have reviewed it recently to ensure that the information is still valid. Click on a few links on the site. If there are a lot of broken links, the site may not be kept up-to-date.
7. How does the Web site choose links to other sites?
Reliable Web sites usually have a policy about how they establish links to other sites. Some medical Web sites take a conservative approach and do not link to any other sites; some link to any site that asks or pays for a link; others link only to sites that have met certain criteria. Look for the Web site's linking policy, often found in a section titled "About This Web Site."
8. What information about its visitors does the Web site collect, and why?
Web sites routinely track the path visitors take through their sites to determine what pages are being used. However, many health-related Web sites ask the visitor to "subscribe" or "become a member." In some cases, this may be done so they can collect a fee or select relevant information for the visitor. In all cases, the subscription or membership will allow the Web site owners to collect personal information about their visitors.
Many commercial sites sell "aggregate" data about their visitors to other companies—what percent are women with breast cancer, for example. In some cases, they may collect and reuse information that is personally identifiable, such as a visitor's ZIP code, gender, and birth date.
Any Web site asking users for personal information should explain exactly what the site will and will not do with the information. The FDA Web site, for example, spells this out in its Privacy Statement. Be sure to read and understand any privacy policy or similar language on the site, and don't sign up for anything you don't fully understand.
9. How does the Web site manage interactions with visitors?
There should always be a way for visitors to contact the Web site owners with problems, feedback, and questions. The FDA's Web site provides contact information on its Contact Us page.
If the site hosts a chat room or other online discussion areas, it should tell its visitors about the terms of using the service. Is the service moderated? If so, by whom, and why? It is always a good idea to spend time reading the discussion without joining in, to feel comfortable with the environment, before becoming a participant.
10. Can the accuracy of information received in an e-mail be verified?
Carefully evaluate e-mail messages. Consider the origin of the message and its purpose. Some companies or organizations use e-mail to advertise products or attract people to their Web sites. The accuracy of health information may be influenced by the desire to promote a product or service.
11. Is the information that's discussed in chat rooms accurate?
Assessing the reliability of health information that you come across in Web discussion groups or chat rooms is at least as important as it is for Web sites. Although these groups can sometimes provide good information about specific diseases or disorders, they can also perpetuate misinformation. Most Internet service providers don't verify what is discussed in these groups, and you have no way of knowing the qualifications or credentials of the other people online. Sometimes people use these groups to promote products without letting on that they have a financial stake in the business. It's best to discuss anything you learn from these groups with your health care professional.
Here's how the federal government protects consumers from false or misleading claims posted on the Internet:
The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective. The FDA's Buying Medicines and Medical Products Online Web page and "Buying Prescription Medicines Online: A Consumer Safety Guide" give guidance to consumers shopping for health care products online. "Tips for the Savvy Supplement User" gives advice about how to evaluate claims about dietary supplements and what to look for in Web sites selling them.
Food and Drug Administration5600 Fishers Lane Rockville, MD 208571-888-INFO-FDA (1-888-463-6332) (toll-free)www.fda.gov
The Federal Trade Commission (FTC) enforces consumer protection laws. As part of its mission, the FTC investigates complaints about false or misleading health claims posted on the Internet. The FTC's Operation Cure-All page has information to help evaluate health product claims.
Federal Trade CommissionConsumer Response Center CRC-240 Washington, DC 205801-877-FTC-HELP (1-877-382-4357) (toll-free)TTY: 1-866-653-4261 (toll-free)www.ftc.gov
Related Resources
HealthfinderA DHHS site that is a gateway to consumer information. Its goal is to improve consumer access to selected health information from government agencies, their partner organizations, and other reliable sources that serve the public interest.
MEDLINEplus A consumer-oriented Web site established by the National Library of Medicine, the world's largest biomedical library and creator of the MEDLINE database. It offers health, drug, and disease information.
MEDLINEplus Evaluating Health Information
MEDLINEplus Healthy Websurfing
ClinicalTrials.govA site created by the National Institutes of Health and the Food and Drug Administration to provide patients, family members, and members of the public with current information about clinical research studies and clinical trials.
National Institutes of Health How to Find Medical Information
A Quick Checklist
You can use the following checklist to help make sure that the health information you are reading online can be trusted.
Can you easily see who sponsors the Web site?
Is the sponsor a government agency, a medical school, or a reliable health-related organization, or is it related to one of these?
Is there contact information?
Can you tell when the information was written?
Is your privacy protected?
Does the Web site make claims that seem too good to be true? Are quick, miraculous cures promised?
Source: FDA Website Management Staff

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Chronic pelvic pain: aetiology and therapy.

Cheong Y,
William Stones R.
School of Medicine and Biomedical Sciences, Academic Unit of Reproductive & Developmental Medicine, Level 4, Jessop Wing, Tree Root Walk, Sheffield S10 2SF, UK.
Chronic pelvic pain (CPP) is a common condition in women and rates of consultation for CPP in general practice are similar to those for asthma and migraine. US and UK population-based studies, together with data from UK hospital settings demonstrate a substantial impact of CPP on health-related quality of life. In this review, we will examine the current evidence on the aetiology and management of CPP, focussing on the randomised controlled trials (RCTs) that are available to date. CPP is a heterogeneous condition and causation is often unclear. There are associations with specific pathological processes but a barrier to understanding is that many studies have data that are not comparable. In the community setting, as many as 60% of women with CPP have not received a specific diagnosis and up to 20% have not undergone any investigation. The factor most commonly associated with CPP in the community is irritable bowel syndrome, although in a tertiary setting with laparoscopy, pathology associated with CPP in ascending order of frequency is endometriosis (33%), adhesions (24%) and 'no pathology' (35%). Current RCT evidence provides some support for the use of ultrasound scanning as an aid to counselling and reassurance, progestogen (medroxyprogesterone acetate) or goserelin for pelvic congestion and a multidisciplinary approach to assessment and treatment. Adhesiolysis is not shown to be of benefit other than in women with extensive adhesions. While studied in relation to dysmenorrhoea rather than CPP, the short term results for presacral neurectomy (PSN) and laparoscopic utero-sacral nerve ablation (LUNA) seem to be similar, although PSN has better results in the long term. Selective serotonin reuptake inhibitor (SSRI) antidepressants have not been shown to be of benefit in CPP. Most of these conclusions are based on the outcome of single randomised trials and therefore need replication.
PMID: 16765092 [PubMed - in process]
Best Pract Res Clin Obstet Gynaecol. 2006 Oct;20(5):695-711. Epub 2006 Jun 9

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The Most Common Medication Errors

Medical Author: Melissa Conrad Stöppler, MD Medical Editor: Jay W. Marks, MD
Approximately 1.3 million people are injured annually in the United States following so-called "medication errors". The National Coordinating Council for Medication Error Reporting and Prevention defines a medication error as "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer…related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use."
The U.S. Food and Drug Administration(FDA) currently reviews medication error reports that come from drug manufacturers and through MedWatch, the agency's safety information and adverse event reporting program. The agency also receives reports about medication errors from the Institute for Safe Medication Practices (ISMP) and the U.S. Pharmacopeia.
What kinds of errors are most common?
In a study by the FDA that evaluated reports of fatal medication errors from 1993 to 1998, the most common error involving medications was related to administration of an improper dose of medicine, accounting for 41% of fatal medication errors. Giving the wrong drug and using the wrong route of administration each accounted for 16% of the errors. Almost half of the fatal medication errors occurred in people over the age of 60. Older people may be at greatest risk for medication errors because they often take multiple prescription medications.
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Understanding colic surgery Horse

Debbie Archer MRCVS
1 November, 2006
Colic surgery is a potentially serious operation that presents a significant challenge for all concerned A horse's chances of surviving colic surgery have improved greatly over the past 35 years. Significant improvements have been made. Earlier referral of cases for surgery, specialist training of surgeons and anaesthetists, developments in anaesthetics and advances in post-operative care have bettered the outcome for horses with colic. The end result is that surgery is performed more commonly and the patient's chances of survival have improved significantly.
What does surgery involve?
Fortunately, of all the horses with colic, less than 10% require surgery to save their lives. However, when colic surgery is required, it is a major job involving a team of skilled surgeons, anaesthetists and nursing staff. Severe colic can occur at any time of day or night, so a trained team needs to be available 24hr a day, 365 days a year, which is why this type of surgery is performed in a relatively small number of equine hospitals.
Colic cases needing surgery present a challenge, as they usually need to be
operated on quickly and kept under anaesthesia for as short a time as possible. The risks associated with anaesthesia in horses are greater than in humans or dogs, and these risks are even greater with colic, due to the harmful effects of toxins released from the intestine.
In many cases, it is impossible to know what the exact problem is until surgery is under way and the abdomen can be examined properly. In some instances, such as when intestine has ruptured or when severely injured intestine cannot be removed, the chances of recovery may be so small that the surgeon may advise that the patient be euthanased while under anaesthesia.
Post-operative care
Following colic surgery, some horses make an uneventful recovery and can return home within five to seven days. For others, it may be a roller-coaster ride of ups and downs, requiring several days of intravenous fluids and intensive medical care — or, in the worst cases, repeat surgery.
The most common problems encountered in the first few days after surgery are:
the effects of endotoxaemia (toxins released by damaged gut)
ileus (where the intestine becomes "paralysed")
continued abdominal pain.
In common with humans, adhesions (scar tissue) can be a major problem following abdominal surgery in the horse and these may go undiagnosed. These adhesions have the potential to cause signs of colic in the weeks or months after surgery.
Once discharged from the hospital, colic patients require several weeks of box-rest to allow the abdominal incision to heal, followed by periods of controlled turnout and gradually increased exercise. Most patients can return to gradually increasing work within four to six months.
Success rates
Currently, around 80% of horses undergoing colic surgery at specialist clinics will return home and research has shown that the prognosis may be just as good for an older pony as a fit, young Thoroughbred.
The prognosis for individual patients will vary depending on the type and severity of the problem, and mortality rates are highest in the first few days after surgery.
Several studies have shown that horses suffering from severe endotoxic shock beforehand stand less chance of survival following surgery. Typically, they have severely damaged intestine that requires removal and colic will have been going on for many hours. In addition, reduced survival has been associated with resection of intestine, post-operative ileus and repeat abdominal surgery (laparotomy).
Once horses have recovered from the effects of surgery and the incision has healed fully, there is no reason why they cannot return to their previous jobs. There are many examples of horses who have recovered from colic surgery and have gone on to compete internationally in all disciplines.
Research has shown that the most common problem encountered after ischarge from the clinic is colic, so one or more episodes in the year after surgery may not be unexpected. Many of these episodes are minor and cause no further problems, but some may be more severe, requiring further surgery or euthanasia.
These episodes are usually thought to be associated with adhesion formation, particularly after small intestinal surgery, or recurrence of the problem (more common in certain large colon disorders).
So is colic surgery worth it?
The prognosis is good for most horses and ponies undergoing colic surgery, provided it is undertaken early. A delay of several hours in a horse with intestinal strangulation — where the blood supply to the intestine is lost — can change the prognosis from good to extremely poor.
The costs involved are anything from £2,000 upwards, depending on various factors. This is due to the number of skilled personnel required and the expense of medical therapy; for example, anaesthetics and intravenous fluids are more expensive for a horse than a much smaller animal. Invariably, the horses that are extremely sick when they arrive at the clinic tend to require more intensive — and expensive — care following surgery, but, even in horses that appear to stand a good chance of survival, unexpected complications may occur.
Unfortunately, there is no guarantee of success and an owner may be left with a large bill and no horse. Good communication between owners and carers of horses undergoing colic surgery, the hospital team and the referring vet is vital to discuss the patient's chance of survival, likely complications, costs and aftercare following discharge from the clinic.
Continued research will further improve survival rates following colic surgery and, in common with humans, some focus will be on minimising the harmful effects of endotoxins and preventing adhesions forming. However, the single most important factor in giving a horse or pony the best chance of survival following colic surgery remains early referral.
This veterinary feature was first published in Horse & Hound
http://www.horseandhound.co.uk/horsecare/1370/99155.html