Brief Answer:
Please upload reports.

Detailed Answer:
Hello,

Thanks for posting your query.

I have gone through the detailed course of events described in the attachments. Please upload the reports also.

From the picture and the history, it appears as though several situations happened. The marks on the abdomen appear to be inflamed stretch marks, perhaps due to some vasculitis. The pain may have several reasons ranging from cut nerve endings secondary to surgery, induration, formation of hematoma, infection, adhesion and so on.

The intra-abdominal symptoms could mean decreased bowel movements, perhaps secondary to anesthetic effect and/or improper electrolyte balance. You would need medication and dietary regulation to restore the function.

The palpitation, numbness etc. perhaps are related to the general weakness. You would also need an opinion by a general physician.

Hope I have answered your query. Please feel free to contact for further clarifications. I will be happy to help.

regards,
Shanti.V.

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Brief Answer:
Postoperative changes likely.

Detailed Answer:
Hello Ms. XXXXXXX

Thanks for writing back.

I have gone through all the reports. Most of them are normal. The low end values on the hemogram, mostly are due to iron deficiency. Serum iron binding capacity and total iron may be done to detect deficiency, though it is mostly not needed in the current scenario. The fact that you have undergone surgery recently and also are a delivered woman nursing the baby implies that you could have nutritional deficiencies. You can make it up with supplements.

The lipid profile is mostly normal and so is the liver profile and urinalysis. The MRI is suggestive mostly of postoperative changes though involvement of bowel should be kept in mind considering your bowel symptoms. I would suggest a clinical evaluation by a gastroenterologist. Please do not go for further investigations and medications unless clearly indicated.

Here, I would like to answer your queries posted in one of the attachments.
1. If it were a stitch giving away, your symptoms would be intense since any break in the stitch line would mean blood loss and resulting detectable abnormalities in the vital data.

2. Any undetectable bacterial growth would result in noticeable symptoms like fever, malaise, positive samples in body fluids and abnormal blood counts etc.

3. The fact that your symptoms remain the same even after receiving so many antibiotics points to the fact that you may not need any antibiotics in the first place and/or were not given the needed combination.

4. Some women, after delivery, can experience intense bloating of the bowels as the hitherto size of the abdomen occupied by the uterus is suddenly left void leading to release of the pressure. This could also be due to the hormones released during delivery and effect of the drugs used during surgery. Though, I would say thrombosis and possibility of an embolism should always be kept in mind in such a situation, especially if there is no movement of the body, this is an unlikely possibility in your case to account for the symptoms of palpitation etc.

5. Since it has been more than two months after the surgery, post-surgical bowel palsies can be ruled out. Other possibilities are physiological like inadequate and improper diet or the rare possibility of a bowel adhesion. Please try to include more fiber in your diet, take food at regular intervals and in smaller frequent doses.

Hope I have answered your query. Please get back if you need any more help. I will be glad to do so.

regards,
Shanti.V.

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Brief Answer:
Lactobacillus can be taken as long as needed.

Detailed Answer:
Hello,

Thanks for writing again.

The stretch marks and also the striae seem to be related not to the antibiotic use. You can get hormone profiles done to see if any abnormality is seen in the thyroid and adrenal function. I do not feel they could be due some infection; yet, I would suggest an inspection by a physician or a dermatologist.

The palpitations and tremors may also be related to the salbutamol intake. The pain could be nonspecific, muscular, postural or due to the over stretched abdomen. An examination of the lung function helps to rule out organic causes.

Lactobacillus can be taken as long as needed. You may need it for prolonged period since you have been on antibiotics for so long. Personally, I am not in favor of using so many antibiotics, especially if you are feeding the baby.

For the treatment of asthma in my patients, I would prefer using low doses of steroids as preventive instead of prolonged use of bronchodilators. Usually, a short course of 15 days or one month of low doses of steroid in the aerosol form helps to relieve the symptoms thus decreasing the need for regular bronchodilation. Please ask your doctor for further suggestions.

Overall, I feel you have been taking too much medication while the exact cause has been masked by several factors. Please get a proper evaluation by a physician before ingesting any further antibiotics.

Hope I have clarified your query. Please get back for further information. I will be available to help.

regards,
Shanti.V.

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Brief Answer:
Can go for a pelvic MRI.

Detailed Answer:
Hi,

Thanks for writing back.

I can completely understand the agony you are facing right now. In the current scenario, I would not suggest going for further medication. You can go ahead with the pelvic MRI to look for the possibility of adhesions. You would need a dermatologist to manage the abdominal marks. I have not received any further reports, so please check. Elevated ESR in itself is a non-significant finding and can be seen in many conditions.

Hope your query has been clarified. Please contact if you need any more help. I will be glad to do so.

regards,
Shanti.V.

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Brief Answer:
No inonising radiation.

Detailed Answer:
Hi,

Thanks for posting your query.

MRI does not use ionising radiation and hence is safer for use. In the current scenario, this may be the choice to know what is wrong with your pelvic organs instead of trying to open up again, which I do not think is needed. Also, the striae may get reddened because of the surface warmth caused by MRI and please keep this in mind. For your information, I am giving you a few links below.

http://info.shields.com/bid/39056/Will-I-be-exposed-to-radiation-if-I-have-an-MRI

http://www.fda.gov/Radiation-EmittingProducts/RadiationEmittingProductsandProcedures/MedicalImaging/ucm200086.htm

Hope these will help to relieve your doubts. Please get back if you need any more information.

regards,
Shanti.V.

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Brief Answer:
Likely, with inflammation around.

Detailed Answer:
Hi,

Thanks for writing back.

With some inflammation around, not necessarily due to infection, these striae can become very sensitive to touch, especially when the abdomen is distended. Local application of ice packs can help to some extent. Local application of anticoagulant ointment may also help. If the inflammation is due to the MRI, it subsides in some time. If not, the cause of this inflammation should be found out and it is better done by a dermatologist.

Hope this helps. Please get back if you need any more help.

Wish you good health.

regards,
Shanti.V.

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Brief Answer:
Possibility of lowered muscle tone.

Detailed Answer:
Hi,

Thanks for your query.

From the pictures I have seen, I feel that the muscle tone has not returned to normal after delivery and to attain this, you need to do postnatal exercises that include building up the perineal floor and also the abdominal tone.

Simultaneously, you should eat a healthy diet and avoid eating fatty, fried and baked foods. Eat more of fruit and fresh vegetables. Maintenance of a proper posture also is necessary.

The use of pressure during delivery of the baby is done to see that the baby passes out of the uterine incision without much difficulty as the impact of natural contractions is not seen in an abdominal delivery. This does not cause any after effects. If the abdomen is fatty, it feels flabby after delivery as the skin is sagged during pregnancy.

Hope this helps. Please contact if you need any more suggestions. Take care.

regards,
Shanti.V.

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Brief Answer:
Need improvement of the general condition.

Detailed Answer:
Hi,

Thanks for writing again.

Distended stomach is an enlarged stomach either due to enlarged size or distension. It can be made out on an abdominal sonogram.

Your diet should include high protein, low fat and moderate carbohydrate with plenty of minerals and vitamins. You should drink milk twice-a-day with some added protein supplement. Apart from this, if you are a non-vegetarian, you can have a couple of boiled eggs per day. Eat small and frequent equally spaced meals. Include green vegetables, pulses, fish and fresh fruits.

I have given a link below that will help with your exercises, but please start them only after approval by your consultant.

https://www.youtube.com/watch?v=rCv7Tx8l_y4

You should also try meditation, pranayama and relaxation techniques to help you breathe better and raise your immunity.

I do not think another blood test is needed. If the pain is bothering you, see a physician for treatment.

Hope all your queries have been clarified. Please contact if you need any more help.

regards,
Shanti.V.

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Brief Answer:
3.0 T would be safer.

Detailed Answer:
Hi,

Thanks for your query.

3.0 tesla unit would be better suited as the exposure time is short and the signal intensity is more thus giving a better picture. The modern units have arrangements to maintain the heat and noise within safe limits. Though, clinical effectiveness of the 3.0 T over the 1.5 T has not been proved.

Hope your query has been answered.

regards,
Shanti.V.

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