Wait-and-see idea a smart way to go

Dear Dr. Gott: I’m 65. I developed occasional abdominal discomfort last summer that was attributed to scar tissue resulting from a hysterectomy I had in 1982.

Imaging studies have ruled out cancer.

My 95-year-old aunt recently required surgery to release adhesions caused by a hysterectomy performed 45 years ago. As you can imagine, this procedure was an exceedingly trying experience.

My family doctor indicates that I need do nothing until a critical situation occurs. But not knowing what may happen and when is, to say the least, discomforting.

Dear Reader: Any operation in the abdominal cavity can lead to webs of scar tissue called “adhesions.” Although adhesions do not ordinarily cause symptoms, they can wrap around a loop of bowel. This event causes severe abdominal pain and – on occasion – intestinal blockage that usually requires surgical release.

To my knowledge, there is no therapy to prevent abdominal adhesions, and no treatment (short of surgery) to prevent them from causing symptoms.

Consequently, I agree with your family physician that a “wait-and-see” approach is appropriate. I can certainly understand your frustration and concern. But look at the problem in an optimistic light: you may be in the lucky majority of patients who have no (or few) problems with adhesions.

To give you related information, I am sending you a copy of my Health Report “An Informed Approach to Surgery.” Other readers who would like a copy should send a long, self-addressed, stamped envelope and $2 to Newsletter, P.O. Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Dear Dr. Gott: Because of depression and a lack of energy, my 14-year-old son recently had a battery of blood tests. Alkaline phosphatase was the only element out of range. Should I get another opinion? The doctor said only to check the level again in six months. Has he missed something?

Dear Reader: He is missing only the obvious. Alkaline phosphatase is a liver enzyme that also indicates bone growth. Thus, in normally growing teens and pre-teens, alkaline phosphatase levels are invariably above the normal range. In fact, when I work with such patients, I expect the elevated levels and worry if they are “normal.”

Of course, liver disorders can also raise the alkaline phosphatase level. If other liver enzymes were tested and were normal, I would divert my attention away from the blood tests and focus on your son’s depression, which – in adolescents – is often associated with fatigue and lack of energy. Perhaps he needs some counseling or antidepressant medication. Ask his doctor about these concerns.