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Suggest Treatment For Chronic Pain And Incontinence Caused After Colorectal Surgery

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Posted on Thu, 29 Jan 2015
Twitter Thu, 29 Jan 2015 Answered on
Twitter Thu, 19 Feb 2015 Last reviewed on
Question : I've not received an answer so wil ask again - I had a SPEC CT and the radioactive solution pooled; did not go through entire areas. Would this be conclusive? I can't waste my time going to places that don't advise a patient of this. Your opinion, please?
doctor
Answered by Dr. Ajit Naniksingh Kukreja (6 hours later)
Brief Answer:
Why a colostomy ?

Detailed Answer:
Hi

Thanks for remembering me again

No, the Spec CT would not be of help at this stage. I would prefer a good high resolution ultrasound instead.

Why a colostomy, you are incontinent and need to care for your perineum and a colostomy will need a lot of care equally? That is not going to end the problems.

Yes, no patient needs to suffer the complications but we need to work out something concrete will will make your life pleasant and not miserable.

A good mood elevator may help at this stage.

Regards
Wishing you a very healthy life ahead
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja (15 hours later)
You ARE A WISE MAN. I HOPE BY NOW YOU UNDERSTAND THAT THE SURGEON WHO DID THE SURGERY AND LEFT ME LYING IN A MESS W/O CHANGING BANDAGES AND CAUSING AN INFECTION, (I'm sorry, I'm not yelling) is a quack and has been under investigation. My husband called him because we are repeatedly told to contact the surgeon as nobody "wants to deal with this mess"
A very wonderful Uro Gyn dr is our confidante; he also knows this surgeon truly messed up and agrees with you. Puzzle?
My abdominal wall is coverd by mesh; the resection is on side of rectum; pain is at this area; but, it's complex so you understand how I must confuse you. I'm hoping to get a clearance on the "Chronic Pain" so I can get looked at without that hanging over me - hysterectomy, repair a year later with bladder sling; atrocious surgery with infection and hernia with mesh covering entire abdominal wall. I don't know that any one doctor can put this altogether; I've been treated for chronic pain for so long (because of MVA four years ago) this is all coming to light, I hope. You are a man of knowledge; this doctor won't go near me and, he mentioned the colostomy a long time ago even though he agreed I could have done physical therapy instead of surgery. I know you cannot help but think I'm a nut case - I've wondered, but, I guarantee you, if I couldn't back something up with records, and my symptoms, I would not tell you. I'm sure you can see why it's complicated but, the big shame is that I reported additional symptoms after surgery (incontinence and pain) yet, treated only for Chronic Pain - I'm sorry to bother you with all the issues not related to your specialty, but you verified what our friend said. Crying myself to sleep after hearing the colostomy part - that's nonsense news to you, but thank you for verifying. Sorry to fill this up with information that's not relevant. I'm so appreciative of your knowledge and kindness. Wish you knew me prior as you'd know I'm just a regular human being trying to get answers and help who misses her grandchildren so very much. Blessings to you. Your knowledge is so valuable.
doctor
Answered by Dr. Ajit Naniksingh Kukreja (12 hours later)
Brief Answer:
Thanks for the kind words

Detailed Answer:
Hi

Thanks for the kind words

If you could share your location with me, I will try to find a friend in your region who can clinically examine you and discuss with me.

You would be surprised to know our best investigation is clinical examination, a good number of patients can not afford reports to the extent you have gone to, so we use our clinical diagnosis to manage our patients.

One golden statement I teach my students is - Patient is never wrong, give a good listening ear to the patient and you would arrive to a clinical impression from the history itself.

Do keep me updated
Regards
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja (9 hours later)
Oh how right you are and last night I had an episode that has my body screaming. I do not if I told you when I was at Mayo for diagnosis of back pain, I explained the pain was not as it was after MVA; much lower; he said "it's still back pain" At the time I didn't consider what the surgeon had done and didn't give it another though. A hernia was forming where the infection was so an appointment made and surgery with mesh covering majority of abdomin. I repeatedly told dr about new symptoms and, as you know, was treated with Chronic Pain and opiates. Last night was almost a god send as, I had movement and, not many people can tell when it is in transverse colon and descending, but it stretches so drastically I was in agony. From the time I had the hernia repair, I have not been able to wear a bra nor anything tight around mid section; my blood pressure dropped to such a low during repair I was held in ICU; next time I had anethesia, same thing happend. I feel like I ripped my insides out - everything involved in surgery (colorectal) is covered with mesh and, restricts to the point last night I had so much pain here I would have been told to go to ER - Er's give drugs;so I "gutted" through it. Passing it once it's down past re-section, is nothing and consistency is normal. My breathing is restricted if I have anything around midsection and if I lie flat. This has not been addressed, except, as you know "chronic pain."
We live in San XXXXXXX TX. Our insurance is a blessing because we'd be in the poor farm with all the tests. Seems that once diagnosed with Chronic Pain from MVA, nobody, to date hears the issues I've talked about for less than two years. I have an appointment with a recommended doctor, but, with your qualifications and believing me - one doctor asked if I'd seen a Psyhiatrist; I am seeing one only because I asked for safe withdrawal from Xanax. He's not a pain Pshyciatrist, however, and "deals with meds" so, he's a means to an end. We are fortunate enough to be able to go just about everywhere as long as Medicare and Tricare 4 Life is accepted. A doctor's visit we can pay out of pocket, but tests etc would be covered by insurance.
Thank you so very much for looking into this and for believing in me, staying with me, a being so diligent. I believe what I've reported will now be obvious after last night and the resection area plus what was compromised under mesh has to be scrutinized as, since last night, I might as wel just not move. I'm so very grateful that you have stuck with me. Should I ask a general surgeon about the hernia repair? The area he removed the colon is near navel and I eel a pull.
How many people can actually feel the evacuation as it goes through? Pretty rare, is my guess. If you have a colleague you highly recommend, we will make seeing him happeonr.n.
My mind wants to go and go, but, I suffer just by walking; resection feels like something is restricting movement - right near tailb
Again, thank you for believing in me. How many days do you teach? You also practice, don't you. I';m sure you are sensitive to pain with what you have dealt with and tylenol celebrix in place of oiates is a joke so I don't take it. Do you have many online requests? I know I take up a lot of time and hope you understand how truly appreciative I am. Like to send something to you from US - can you think of something you'd like or is it inappropriate? Bless you, kind man.
doctor
Answered by Dr. Ajit Naniksingh Kukreja (12 hours later)
Brief Answer:
Send me your blessings

Detailed Answer:
Hi

I can understand your situation

I am in to active practice five days a week
I teach in workshops and conferences not a full time teacher

The instance of last night might have disturbed you, yes most patients do not feel the evacuation, but again it is not abnormal to sense the peristalsis, but the pain associated is not normal

Seeing a surgeon for hernia re-occurrence may help, let him examine clinically and opine, Pain in midsection also could be evaluated by the surgeon clinically

A good counselor will take care of the functional component, as usually surgical complications end up in psychosomatic disorders so keep strong and have faith in Almighty

I will look for a friend whom I can rely in your region and get back to you

I have adequate online requests and I reply them daily between 4 and 6 pm IST or after midnight once I am done with the day

Please do not hesitate, though it takes time going through detailed queries but information is essential to help out a patient

Just keep sending your blessings
Thanks for all the kind words and the faith expressed in me
Regards



Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Follow up: Dr. Ajit Naniksingh Kukreja (13 hours later)
For 20 mos I reported additional pain/issues to provider but the chronic pain from accident got in way. How many doctors, do you think, have a patient who has had a hysterectomy, anterior vaginal wall repair, rear ended, back pain ignored except with drugs and, scared into colorectal surgery that I didn't need; infection; hernia repair; return of prolapse and pain so awful I feel like I've ruptured something between mesh and whatever lies beneath. The pain where the colon was removed is obvious unless it's the transverse colon, but, I finally wrote to the Commander, very nicely, said, let the past be gone, I need to be understood that my new symptoms (over 22 months, now) were addressed as chronic pain and chronic pain only. I am not going to fight to get help; could we please move forward and, Mayo, having gone to have surgery side effects checked, totally dismissed me before tests were done (firing of nerves when I had the manomotry and defecating proctogram) because the doctor thought I was there for incontinence/stimulator. Dr. K (I hope it's ok to use "K" it is unconsionable that anyone can endure so much pain; the area of rectum where the colon was placed, when I pass, starts nerves to fire; and, the pain, as I said, under mesh which is secure with tissue by now, immediately created pressure where wearing anything around mid-section caused breathing issues. It is so ridiculously crazy, the doctor I saw last week who said he didn't want to get mixed up in my mess is probably one smart doctor. I'm a strong person. I have endured drs with mindsets of Chronic Pain for so long how could they be objective? I'm grateful for the doctor (URO GYN) who did hysterectomy, wall repair, bladder sling, who understand what the Colorectal surgeon was saying - the wall is thin; separates, I understand, the rectum from the vaginal area.
I know this; to treat new symptoms after two major surgeries with drugs; to have to request safe withdrawal from them because I thought perhaps I'd have more credibility, is beyond my imagination. I can't even imagine what lies ahead to help someone who has had so many surgeries - hysterectomy and bladder sling; then a repair and, the dreadful colorectal surgery causing me to have the hernia repair. Who would want to tackle this? I don't even know if I have back pain; certainly the sacrum is part of the back, but, the pain I had after the MVA is not apparent but one's brain can only focus on so much; take away one pain, the brain focuses on the other. I wish I could explain the pain/friction from end of tailbone area through to abdomen; and, my insides are screaming after several days. I can't just lie here and take it any more hence the note that the Military doctors who didn't address new issues contact the surgeon at Mayo and explain that my intestinal issues became chronic pain because nobody would listen.
I don't know if you get feedback from moderators, but I was compelled to write to them to praise you for your advise and for sticking with me. I made sure to tell them, so that there is no responsibility on your part, that I didn't use your advise soley, but, you are remarkable. A doctor here would never take the time and put in the effort you have. I'd be locked up. Fortunately I gave up opiates; I am being weaned from awful Xanax, and, if I don't move, pain, in sacrum area is tolerable, but, after the incident a few days ago, my insides feel like a war is going on. I told the Commander that I want to let the past go, but, in some way, communication with Mayo must be such that my reports of new issues after surgeries went ignored; drugs only answer. Do you see how crazy this is?
I saw a Psychiatrist at Mayo; probably best appointment I have had as he heard how, after the MVA, I was sent to hormone replacement; told everyone my age has bulging discs, etc; and, then the drugs and injections. He said to be sure and have help with safe withdrawal from Xanax and to "Err on the side of searching." It is not easy to go to a doctor and know he/she thinks this is the craziest story they've ever heard; it is, but, one thing I still have is stubborness and faith in what I feel; and, I have too much to fight for. The pain can drive me nuts so I see why you said to look into a mood elevator - I've tried anti depressants; not good for me; I've gone to pain counselors and ended up being the counselor; how much can one endure? But, you,kind doctor, have my blessings and my gratitude because you think outside the box and, I believe, you believe in me. Who could make this stuff up?
I am grateful, although I don't mean to be unkind, that the surgeon who did this to me (said a colostomy is next step) is being investigated as I don't want anyone to endure his knife.
Monday is going to be a big day with the military staff; I don't want to blast them any more; my case got so out of hand; the ones who tossed me to the drugs are no longer there; I just want to move forward.
You need to be paid as a psychologist - I wouldn't insult you by saying psychiatrist as the one I'm seeing here to help with the safe withdrawal of Xanax would up the amount or, as he said "Drugs are my business." Is this healthcare that you know? Fortunately, I am very healthy; extremely so, but, pain takes over every aspect of my life and I pray I will get through this and then, I will help others avoid this type of situation.
I'll tell you something that will make you be sure I'm a "Murphy's Law" A pain management doctor prescribed a Fentanol patch; the only time I ever went over what I was on was after an SI injection - had put myself from 50mg patch to 25 but the SI injection did something that had my nerves so fired I was shaking so I put on the 50. He wasn't the one to even prescribe it, but, he was so worried about his liscense he was upset. I got home, put the written prescription in with a note only to find that somebody had had it filled - fraud - I've reported to the police and to the Pharmacy; someone had my birthdate and other information. I have the signature card; neither my husband nor my signature. So now I'm on a mission to see this doesn't happen again. Most people don't read their insurance statements, but I had been charged by doctors I had never heard of so I happen to see the controlled substance paid and knew I had not picked it up.
Do you see what I'm up against? I think the Almighty has a purpose for me when I'm better as I've experienced negligence; failure to address new symptoms; and, I can be a patient advocate and spare even one person, this is good.
I do send my blessings. You are a blessing to me because,not only are you focused, haven't thought I was nuts, and, an obviously truly fine man. I'll forever remember the doctor I happened to first go to on this site which is a blessing in itself. I pray continued good things go your way.
Forgive my lengthy comments, but, it's a short version of my journey and, can anyone possibly put together this puzzle after surgeries - only one was necessary; had to be repaired, but that happens and it's this doctor who is my condidante and super advisor to the military general who, also, is trying her best.
Thank you, thank you. I will appreciate it if you do hear from someone but, as you can see, I've become a very complicated individual. There's always hope and you give it to me every time I hear from you.
My fingers are faster than my brain hence the long communication.
Take care of yourself. Do any of the doctors you train ever come to the United States? I don't blink if I hear a doctor is from XXXXXXX because I believe, after communicating with you, their training is excellent and money doesn't drive thier train.
I'll close; sorry. Sending many prayers and blessing your way as I know you have struggles, also.
I hope the moderators don't shut me out and I hope they let you know about my praise.

doctor
Answered by Dr. Ajit Naniksingh Kukreja (12 hours later)
Brief Answer:
DO not hesitate to write back

Detailed Answer:
Hi

Indeed it was a lengthy communication

I am sure it is matter of time only that you will come out of this so called mess

You do not need to persuade the moderators to praise me nor will they ever block you, I have earlier also requested them to pass your communication to me and otherwise also this is one of the most reliable online consultation site

I have been in practice for last 27 years and am an author to a 544 pages textbook on anorectal diseases , I have always stressed that a patient needs enough time, in two sessions of two hours each I see only six patients giving them a minimum of 20-25 minutes each as all intestinal disorders have a psychosomatic component

Give me some time and I will share contact details a reliable clinician in your region

Till then keep yourself morally boosted and do not hesitate to write back again

Above answer was peer-reviewed by : Dr. Vaishalee Punj
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Follow up: Dr. Ajit Naniksingh Kukreja (4 hours later)
I did not need this surgery; that weighs heavily on my judgement; there was a time, in my generation, we trusted our doctors. After the infection and the surgery, I had major issues (Incontinence and more paint) and he recommended a colostomy back then. Looking back is something I tend to do - what if?......but, reporting the problems for 20 plus months and only getting meds it's hard for me to accept I am almost a recluse. I don't deal with pain well; I don't even know if the L4, L5 S1 is part of the pain because there is no continuity of care. I would like your attitude; mine is getting less and less positive; it's hard to put faith in to this mess.
Blessings and have a good week. I do have one question, however; the site he pulled the colon (near navel) is painful; there is no denying this. And, knowing I had a doctor who is questionable, I can't help but be concerned but one tends to shy away from telling doctors here because indeed, I sound like a hypochondriac. You mentioned CT - tomorrow I have an appointment with a holistic doctor who believes in referring but, from my understanding, she listens intently. I feel for her. Thank you, kind doctor. I will wait for your reply. Psychosomatic? Who wouldn't have issues havinga surgery that was unnecessary; I had never had any gastro issues; pain in abdomen; function of bowels questioned. I ask why? what is the lesson in this? I do not say "why me" many suffer, but 2 years of this mess and only drugs were the answer. Forgive? That's a hard one, but, I imagine an easy one for a man of your strength. Blessings and I'll wait.
doctor
Answered by Dr. Ajit Naniksingh Kukreja (17 hours later)
Brief Answer:
It is not you but the pathology which is Psychosomatic

Detailed Answer:
Hi

I am sure I did not intend to hurt you with the terminology

Most lower GI symptoms are psychosomatic so please do not take it otherwise, as I said the counselling will help take care of the functional component , the organic needs to be addressed

Corrective surgery is what we offer if there is any pathology that can be corrected irrespective of the fact that it is caused by nature or by a human being

Medicines help control the symptoms but can not correct the pathology

Will await your CT report, it may also reply yo your only question asked in this communication

Regards

Above answer was peer-reviewed by : Dr. Ashwin Bhandari
doctor
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Follow up: Dr. Ajit Naniksingh Kukreja (8 hours later)
No, I understood your comment; I've questioned my sanity, also; anyone would, but, the knowledge I have from the surgeries and still being treated as chronic pain patient, I have no doubt in my mind that soon someone will listen to what happened during surgery and the hernia repair; it's a matter of time and it is fortunate I am absolutely confiednt that Chronic Pain label and fear of being sued got in my way. Now that the statute of limitations is up, surgeon was willing to talk more and the hospital where I had the surgery is going to sit with us. I see a new doctor tomorrow; no more band aids and future help. Thank you for sticking with me; you have heard more about the puzzle pieces than one doctor so it is understandable that I'm complex. I will keep you informed and continue wishing you good health and blessings. Thank you seems rather trite, but you know I am grateful for your patience and knowledge; kindness, also.
doctor
Answered by Dr. Ajit Naniksingh Kukreja (6 hours later)
Brief Answer:
Wishing you a very healthy life ahead

Detailed Answer:
There is always a ray of hope at the other end of the dark tunnel

We just need to wait for that moment to come

I am sure the time will start changing for you, keep me informed about the developments

Wishing you a very healthy life ahead
Regards
Note: For further follow up on digestive issues share your reports here and Click here.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Answered by
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Dr. Ajit Naniksingh Kukreja

Gastrointestinal Surgeon

Practicing since :1984

Answered : 924 Questions

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Suggest Treatment For Chronic Pain And Incontinence Caused After Colorectal Surgery

Brief Answer: Why a colostomy ? Detailed Answer: Hi Thanks for remembering me again No, the Spec CT would not be of help at this stage. I would prefer a good high resolution ultrasound instead. Why a colostomy, you are incontinent and need to care for your perineum and a colostomy will need a lot of care equally? That is not going to end the problems. Yes, no patient needs to suffer the complications but we need to work out something concrete will will make your life pleasant and not miserable. A good mood elevator may help at this stage. Regards Wishing you a very healthy life ahead