Hello and thankyou for approaching DoctorSpring with your query.
I have gone through your case and understand your concern. I can understand why your Doctors are fixed on a spine or hip problem. 9 out 10 cases the pathology will be in the bony skeleton when there is postural abnormality. But in your case extensive surgeries make the case different.
What you are suffering from could possibly be due to adhesions in your pelvis/abdomen or it could be due to contractures on your abdominal wall resulting from surgery. This occurs when a muscle contracts beyond its normal extend and stays contracted. Prolonged immobility, repeated surgeries etc are cause. The muscle tends to shorten resulting in reduced flexibility of the muscle as a result of which you can experience pain. As the muscle is not able to stretch to its original self, when you stand you feel it pull harder. It develops slowly over a long period of time.
Adhesion are unlikely to cause this.
Please can you give me for information to help me with your diagnosis.
Do you have severe abdominal pain or cramping even when you are at rest?
Do you have any nausea, vomiting or bloating?
Do you have loud bowel sounds or inability to pass gas?
Do you have constipation?
The reason I ask the above questions is to rule out adhesions.
I would advise you to get an Ulrasound to help with the diagnosis.
If there is muscle contracture , surgery will be required to lengthen / release the muscle.
Please reply as a follow up. And I will advise you accordingly.
Thankyou
Patient replied :
Hello Dr. Sebastian,
Answers to your questions
1) Do you have severe abdominal pain or cramping even when you are at rest?
When I get into bed and try to lie down, the same area (right side, lower abdomen) "spasms" making it very painful just to lie down. I always lie on my side because it is much to painful to try to sleep on my back. I'll fall asleep for usually less than 30 mins and the "spasm" or cramp starts. It is so violent that I instantly wake up - usually with a scream or two. At this point I have to get up because not only have I woken the entire house, it's as if I am scared to go back to sleep. Some times I will try to go back to sleep, but usually I migrate to my lounge chair and try to sleep sitting up. This happens night after night as it has for the last 25 years or so. Actually, this is so regular that when everyone goes to bed, 75% of the time I just head for the lounge chair and end up staying awake most of the night.
2) Do you have any nausea, vomiting, or bloating?
No, never.
3) Do you have loud bowel sounds or inability to pass gas?
No never.
4) Do you have constipation?
No never. Actually quite the opposite. All but about 5 inches of my colon was removed, and as I have gotten older, I have developed chronic diarreha. It got pretty severe in the 1990's, but by a fluke we have been able to somewhat control it. In the 1990's, I herniated disks in the lumbar region and same in cervial area (snow skiing and then had a traffic accident with a large 18 wheel truck on the interstate). After several surgeries on my lower back and neck, I was okay for a couple of years until I started developing bone spurs in my cervical region. I was referred to Hermann Hospital Center for Pain Medicine, where we tried epidural injections and all of the other current pain contol methods. One thing we did was to try several different pain medications and I ended up having the best response to methadone. Methadone worked really well for me for two main reasons; 1) Pain control without bad side affects that I got when taking something like morphine, oxycodone, or something similar. By this time I was well on my way to being very opiate tolerant since in addition to the neck and back problems, I was having my abdomen opened up on somewhat of a schedule (so it seemed) to cut away adhesions that twisted up my small intestine (2 or 3 times - can't remember). I also developed several fistulas that had to be repaired with surgery, again adhesions were supposed to have a part in fistula formation. This happened several times and each time needed surgery. My gall bladder became diseased and ruptured (more peretonitus, more infections). *** Stop ***
I'm sorry, I got off track and just kept rambling on with my entire health story.
4) Any constipation? No. The opposite - chronic diarreha. The reason I keep on with methadone is that it has worked wonders for me and kept me alive over the years. Despite how our government portrays narcotics, not all of them are bad and there are a great number of people who need them.
First - methadone controls pain well without many of the side affects of medicines like morphine, and the others. Morphine, oxycodone, and others severely fogged my head plus made me grouchy, and irritable. Methadone has never made me feel that way.
2nd reason; methadone's extremely long half life (28-36 hrs) and constipating side affect. This allowed me to have somewhat of a normal life (and still is). Instead of having to go to the bathroom 22 to 35 times in 24 hrs (I spent 4 weeks in a hospital being detoxed from methadone (took 2 weeks), then another 2 weeks to get data on the behavior of my digestive system, then upon being released - I was put back on methadone) it slowed my digestive system to where I was only going to the bathroom 7-8 times in the same period and it controlled my pain from lower back and neck.
To me methadone probably saved my life just as much as any of my surgery's. Before methadone, my gastro doctor was giving me all kinds of anti-diarrehal meds and I was constantly getting dehydrated, having electrolyte issues, occasionally passing out at work because I was
tired and dehydrated.
I apologize for all of the extra verbage and getting off track, I just can't help but talk about it. I get really mad when some fool says something like - Yeah but you are addicted to a narcotic... really? No. I am dependent on a drug to live my life. So is the guy who takes heart medicine to keep from having a heart attack.
Anyway, thank you for looking at my case, providing a diagnosis, and advice even though I took things off point - which was to answer your 4 questions.
Best regards,
Duncan Elliott
Hello Duncan,
Thankyou for replying to my questions.
It has helped rule out adhesions in the abdomen and intestine. From all the details you have given, it is probably muscle contractures only causing you the discomfort.
As I explained earlier, it is the repeated surgery that is the most likely cause of the contractures. Ruling out a bony problem would be the first step. (even though you do not agree with this, this will be a necessary step). Discuss with your Doctor the possibility of a muscle contracture. You will require to get an ultrasound of the abdomen done for a better diagnosis. A MRI might also be needed. Depending on which the surgeon will tell you what are your best treatment options.
I hope this has helped.
Feel free to ask followups
Thankyou.
Patient replied :
Doctor Sebastion,
One last question:
I have worked very hard to fix this... Extensive physical therapy, strict personal workout and stretching regimen that resembled religious fanaticism and although I might get some temporary relief, I could not make it go away permanently, and it has steadily gotten worse.
Also this is not something that gives me minor discomfort. When I attempt to walk, the distortion and "contracture" happens so fiercely that I am in tears in a matter of minutes and I am someone who has what I believe is a high tolerence for pain (remember - I have been through 35 surgeries - 7 on neck and back and the rest on my abdomen).
So what kind of doctor do I need to see, that will understand how this needs to be treated and what exactly is the treatment. If you tell me all I need is to take a couple muscle relaxers and sit in the hot tub... I'm going to come find you for a personal visit and show you first hand what Americans mean when someone says they are "Going Postal". I'm just kidding.
I brought that up because when this first began happening (years ago) a doctor said something similar (... take a couple muscle relaxors and ...) in jest. At that point - even I thought I just needed some good stretching and exercise, boy was I wrong.
I appreciate you thinking on this and look ford to your reply.
Thanks again.
Duncan W. Elliott
Hello Duncan,
I understand what you are going through.
You will need to meet a General Surgeon regarding your condition. You will require surgical procedures for lengthening or releasing the shortened muscle. These are not complicated procedures but might require more than 1 sitting.
For sure this is not something that a muscle relaxant or hot baths can improve, I agree.
It is a permanent defect that arises in healing process during trauma (in your case surgical scar) resulting in the muscle becoming short or rigid.
Only surgical treatment will help. I suggest you should not resists a axial skeleton evaluation (See whether there any problem with your spine or hip). As it the first concern. You should mention the possibility of contractures and your Doctor will run a couple of tests for confirmation. Further surgical options can be explored then.
Hope this has helped.
Good luck
Thankyou