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Having pain over the scar on bladder. Injected with kenalog steroid shots. Suggested botox injections. Or Medco to cover nerve pain?

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I have been injected with kenalog steroid shots along horizontal scar and down the vertical scar that is over the bladder but does not penetrate the peritoneum. This latter scar is the product of an abscess in the middle of the horizontal scar, used to remove ruptured teratoma. The scar over the bladder is in an area that is highly innervated, and embeds some really painful nerves. Have received kenalog shots in pain clinic for over two years,(last ones in Oct. 2012, 80mg and then Nov. 2012 40mg.) I have not had any since then, and these nerves are extremely irritated. I take Ultram now normally three times a day, but have found I need to take four or use a lidoderm patch over this area to lessen the pain. Kenalog injections do lessen the pain, but these after effects are gruesome. Also notice on left side a lot of pain after defecation in scars of resected colon at sigmoid. Kenalog has also been used here. The scar over the bladder was made worse by a plastic surgeon who said he could fix it. However, the wide scar was seen during an adhesiolysis surgery using "Sprayshield" which finally got rid of my XXXXXXX adhesions through the transparent peritoneum. This scar does not penetrate the peritoneum, but does go down over the under pubic symphesis over most of the bladder. It has been suggested that I use botox injections instead, but I worry about bladder implications. It has also been suggested that I use an instrument invented by Medco, that would cover the now exacerbated nerve pain with a buzz. I am ready to quit, and just live on 1200 mg of gabapentin, three 50 mg ultram and a lidoderm patch, and three 1 mg of clonazapam which relaxes the muscles. Any suggestions? By the way the teratoma was located on the left fallopian tube, the bladder and the intestine, I had pelvic peritonitis, which resulted in infertility and organs adhered to the sidewall and each other by
adhesions. I had many operations here, due to the pain of adhesions. The original surgery was done in Germany in 1966. However, Sprayshield is now being marketed in Europe, and is proving to be a very good XXXXXXX barrier.
After a laparatomy for an abdominal abscess, a multitude of failed adhesiolysis surgeries in the U.S., all of which failed, because we do not have a good XXXXXXX barrier that allows the raw, sticky tissue to heal, before it readheres. "Sprayshield" is put out by an American pharmaceutical company's subsidiary called Covidien. They
were present for my final adhesiolysis in Germany in 2010, and for a second look four weeks later where no adhesions were found. I had a colonoscopy recently, and my G.I. found a colon that was completely freed up,
but with an unnecessary resection that could have been avoided had I known this "sigmoid kink" had been caused by adhesions. Why is it that M.Ds are not beating on the FDA's door for this product??? I finally heard one surgeon say, "I wonder when Sprayshield will finally get to the U.S. Although Tyco is an American pharmaceutical company, as is its subsidiary Covidien. They have now chosen to market it only in Europe, because they were unable to get enough gynecological candidates for its trial here. So, American women keep getting mutilated, because they continue to get repeated adhesiolysis surgeries here, that for the most part don't work, and many times colons, etc. are removed, because the surgeons here don't know what else to do. I know because I get many emails, writing just that. Why does the medical community here not get behind this product???? Even the German gynecolical surgeon in Germany cannot understand why we don't have "Sprayshield".
Posted Wed, 26 Jun 2013 in Skin Hair and Nails
Answered by Dr. Johny Chacko 1 hour later
Hello Ms XXXXXX,
Welcome to healthcare magic
Thanks for the detailed history. At present the pain you are feeling is over the scar and not XXXXXXX Is that true ?
You have a feature to upload the images of your scar at the right side of the query page, please utilize that so that I can answer your query better.
The tablets you are taking for pain is quite a lot and long term use of these is not recommended.
I am waiting to see a picture of the scar.
Wish you good health
Above answer was peer-reviewed by
Follow-up: Having pain over the scar on bladder. Injected with kenalog steroid shots. Suggested botox injections. Or Medco to cover nerve pain? 9 hours later
Dear Dr. Chacko,
What you will see is a nicely flattened horizontal scar, and part of the vertical
scar that goes down over it through the middle. I had an abdominoplasty, as I told you, and the vertical scar has been covered up. I only wanted him to fix the scar that is not visible but was a function of the original horizontal scar getting an abscess in it. Instead, he made an abdominal horizontal scar that goes over the
original, and covered the vertical scar that goes from my navel over the horizontal
scar. At the same time, he dug deep into the area below the horizontal scar, and
tried to fix the scar made from the abscess only to make it wider. If you look
from the surface, everything looks to be cleaned up very nicely. You can only see
a small portion of the scar that starts at the horizontal scar and proceeds downward over the bladder. It was seen by the German M.D., and my friend who is an operating nurse, and Covidien. Their response was that "this is really bitter sweet." Sprayshield has removed the XXXXXXX adhesions, but Dr. Pagels said that there is no cure for scarring above the peritoneum. In conclusion, I do not have pictures of what they saw during the adhesiolysis procedure looking up through the transparent peritoneum. However, it is this wide scar over the bladder giving me the most problems, because it goes so low down over the bladder. The nerver innervation in this area is very high. I do have pain also over the horizontal scar, because it was used twice, and the vertical scar at the area of
the crossroads over the horizontal scar. This scar was used twice, once for a laparotomy to drain an abdominal abscess after I returned to the U.S. (late 1960's) and once in the 1980's when a hysterectomy was performed to try to alleviate some of the pain caused by adhesions. The latter would not have been necessary in this day and age, since Sprayshield could have separated the uterus successfully from the sidewall. All of this information is superfluous, and it is only written to describe to you that a ruptured teratoma (complete with hair, nails, epidermal tissue) and enough pus, etc. to cause a severe case of pelvic peritonitis, keeping me in a German hosptial for three months changed my entire
adult life. Unfortunately, Dr. Pagels describes the successful adhesiolysis, but does not say too much about the scar above the bladder, only that I should go to a pain clinic for help in the U.S. As I stated before, there is not cure for scars
above the peritoneum. I was still in pain after the first operation in spite of a
successful adhesiolysis. Now, we know the reason why. It comes from the scar
that goes down over the bladder and the continual use of same scars over and over in the pelvic area. The anesthesiologist in the pain clnic here, injects all the way down to the peritoneum, because that is where there is the most scarring,
and the interaction of the bowel underneath with these embedded scars in spite of the fact that the colon is now freed up. One more point, the scarring is so severe that I feel absolutely nothing when he is injecting. There is only a small amount of feeling at the bottom of scar above the bottom of the bladder. It is the movement of the colon, and this area that cause the pain in the pelvic region. I can withstand the pain coming from the colon, but not the pain over the bottom of the bladder. Enough explained, what you read were the last operative reports done in Germany. You can see from these how many unsuccessful and needless surgeries have been done over the last 40 some years. I am finally free from XXXXXXX adhesions, but I caution American patients who write to me, if you have had one adhesiolysis, and it wasn't successful in alleviating your pain, then go to Germany, where Sprayshield can release the
adherence before you have anymore needless surgery, that may also cause problems above the peritoneum that cannot be fixed, and this scarring can also
cause pain from embedding nerves. It may look very nice from the top. However, that does not mean that underneath, the embedded nerves are not giving pain, especially over the bladder. Enough... I just need your opinion about the best way to handle this problem at this point.
Answered by Dr. Johny Chacko 16 hours later
Hello Ms XXXXXX,
Thanks for the details.

Kenalog injections help for the scar as well as for the neuropathic pain. As it is given over the site of scar and as it is a depot preparation which is released slowly the side effects are less. I think continuing kenalog injection is not a bad option but only thing which makes me re think is that you have been taking it and still you require so many pain relieving medicines. Lidoderm patch is safe for long term and quite affordable as well.

Botox has been tried recently for pain relief and lot of people are getting good results. The advantage is that systemic side effects are almost nil and the effect lasts for 4-6 months. The only dis-advantage is its cost. As it is not yet approved by US-FDA for chronic pain, I am not sure whether your insurance will cover it. But if you can afford it, go ahead and give Botox a try.

I am not so familiar with this Medco device and my internet search did not give any results.
Usually as years progress such nerve pains diminish in intensity, so be strong and do not lose hope.

Hope I have answered your query. If you have any further questions I will be happy to help.
Above answer was peer-reviewed by
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