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What causes high fever post septicemia?

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Posted on Wed, 30 Jul 2014
Question: Dear Dr. XXXXXXX
I am hoping that you will be able to help me, as I have come up against a XXXXXXX wall. Forgive me, but you are my last shred of hope!
I understand my problem is a complex one, in view of all the surgeries I have had. So here goes...
I had a total hysterectomy (for endometriosis/chronic peritonitis/septicemia)) in March, 1977 with just chips of the ovaries remaining as I was only 29 at the time. This was followed by two further laparotomies in 1981 to remove the chip/cysts, and a final laparotomy in 1987 to remove the remaining chip/cyst, which had grown to the size of a full-grown grapefruit. I've had two other peri-umbilical surgeries (1987 for hernia/2002 for nerve entrapment).
I understand from the various tests (plus an RF-Proctogram) that I now have an enterocele and rectocele, and severe rectal tear. Of the 4 surgeons I have seen in Calgary, none of them are keen to operate on me, saying I have already had too much surgery. The one gynie who does prolapse repairs, does not cut open the abdomen and is afraid that if he does surgery his way, I will still be left with the low pelvic floor pain. So he sent me to another gynie for his opinion. This specialist, from what I can gather, is saying that the nerves and muscles still think I have diseased ovaries, and that because of the state of the sphincter muscle I will always have to bear down to pass stools even were I to have surgery for the prolapse - and that I will always have chronic pelvic floor pain. He shudders at the idea of my having further surgery and instead is recommending that I have a pessary fitted (even though I have no cervix), which makes no sense to me as bearing down to produce stools would surely push out the pessary?
As things stand, having to strain to produce stools is causing terrible pain to the vagina (and of course the rectum) and sometimes brings on the lower pelvic floor pain, which is not dissimilar to the pain I had with endo/chronic peritonitis. This specialist did not discuss the possibility of chronic peritonitis.
My own simple thinking is that, as everything is stuck down together in the abdomen as a result of sticky scarring from the endo and the surgeries, if the colon and small bowel have prolapsed, perhaps something tore as a result of the prolapse? In Feb/March this year, the pain was excruciating, but the pelvic floor pain has since backed off considerably, which would indicate perhaps that that possible damage is healing?
I am 67 years of age, been happily married for 43 years (albeit we can no longer have sex), am a devoted mother to our two grown sons, and devoted grandmother to our 6 grandchildren. I am still enjoying working (as a legal assistant in a law office, and writing books in my spare time). As to my current state of health, not only is the having to strain to pass stools weakening me, but some days I feel nauseous and I certainly have no appetite (although I continue in eat in small amounts to keep up my strength). I bought a simple thermometer to check my temperature which seems reasonably normal, fluctuating from 35.9 to 36.6 in a day. Having said that, I don't ever remember suffering from a fever when I had the septicemia / chronic peritonitis all those years ago.
I am not afraid of having surgery, I just long to be rid of this miserable pain. Please help me Dr. XXXXXXX I would greatly appreciate your take on this whole sorry mess!
My apologies over the lengthiness of this email, and I thank you sincerely for taking the time to read it.
Yours truly, XXXXXXX XXXXXXX
doctor
Answered by Dr. Aarti Abraham (39 minutes later)
Brief Answer:
SURGERY SHOULD BE DONE.

Detailed Answer:
Dear XXXXXXX
Thanks for trusting us with your health concern.
I am Dr. Abraham, OB - GYN Specialist, and would be glad to assist you with your concern.
At the outset, I laud you for your positive attitude and willpower, as anybody else having had so many surgeries would be wallowing in self - pity, but your intelligence, logic and positivity stand out.
WHy did you have the septicemia / peritonitis in the first place ?
And chronic peritonitis is definitely ruled out because you have no fever or other signs of infection anywhere.
Prolapse repairs ARE to be done vaginally , that is the best approach, and cutting open the abdomen after 4 laparotomies does not make sense, as everything would be stuck in the approach itself.
You just need to seek a higher centre / more willing and bold surgeon, as you cannot possibly live with an enterocele and rectocele.
Also, a pessary would be undoubtedly expelled when you strain at stool, and a pessary corrects cervical / uterine prolapse, not a bowel one.
And chances of adhesions ( what you would call everything sticking together ) in that area are in fact low, because things were XXXXXXX enough to come down and prolapse, I hope you understand what I mean.
Nothing can tear there as you think, pain always eases after the prolapse, because organs prolapse when there is increased pressure and the ligaments and nerves cannot cope up with the strain.
Once the actual prolapse occurs, pain eases out.
Peritonitis is not a possibility in my opinion, and surgical correction vaginally is the way forward, in the hands of an experienced and less daunted surgeon.
Am open to further discussions.
Given your quality of life in your mind, soon your body will follow, I applaud you for your positivity and energy.
All the best
Please feel free to discuss further.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (1 hour later)
Dear Dr. XXXXXXX

Very many thanks for your kind response, all of which you have explained so well that it makes good sense to my simple way of thinking, and is very much appreciated. I just need to find myself a good surgeon then, one who will be willing to take me on! Thank you too for comforting me over my chronic peritonitis concerns.

God bless and thank you!
XXXXXXX
doctor
Answered by Dr. Aarti Abraham (3 minutes later)
Brief Answer:
WELCOME AND TAKE CARE.

Detailed Answer:
Dear XXXXXXX
Thank you too for your kind words of appreciation.
I am sure that once you find the right surgeon, you would be considerably relieved after appropriate surgery.
Do not worry about the chronic peritonitis, it just does not fit in the picture.
Also, I would be praying for you.
Take care, and anytime you wish to reach out, just write directly using the following link -
http://doctor.healthcaremagic.com/doctors/dr-aarti-abraham/64623
God bless you too.
Good day.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (21 minutes later)
What a dear and blessed man you are, Dr. XXXXXXX .. and I am so happy to have heard back from you, and thank you sincerely for your prayers!
doctor
Answered by Dr. Aarti Abraham (7 hours later)
Brief Answer:
TAKE CARE.

Detailed Answer:
Just one small correction, I am a female ( see profile picture ).
Glad to hear from you always though !
Take care, dear.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (11 hours later)
Oh Dr. XXXXXXX
My sincere apologies, I should have looked at your profile picture. And dare I say it, I might have known you are a lady doctor! A very dear and blessed lady doctor I have to tell you again!!
I remembered last night, I forgot to answer your question as to why the chronic peritonitis. As it was explained to me, each time I had a period, so did the endo outside of the uturus, and with nowhere to go, the bleeding lay inside the abdomen and healed with a sticky scarring. Each time I went into labour (3 times), as the uturus contracted, so it broke apart the sticky scarring. Eventually, septicemia set in. That's the explanation, as I remember it... some 37 years ago. So I may not have it fully accurate. And incidentally, I have an amazing (clinical) story to tell you about the birth of our third son... but maybe another time.
I have thought of a few further questions: (a) Will the surgeon who cuts me vaginally also be able to repair the large rectal fissure that I have, and the large skin tag? Or will the fissure automatically heal itself as I won't be having to strain to pass stools? - and is it okay to have such a large skin tag at the entrance of the rectum?
(b) While I can understand how the "large enterocele", which is apparently pressing against the vagina, can be repaired vaginally - would the surgeon also be able to repair, vaginally, my "moderate to large anterior rectocele" and the "posterior rectocele in the neutral position, which was not felt to be clinically significant at the end of defacation"?
So many questions... forgive me, dear Dr. XXXXXXX
I look forward to hear back from you. XXXXXXX
doctor
Answered by Dr. Aarti Abraham (2 hours later)
Brief Answer:
TAG CAN BE CUT, FISSURE WILL HEAL

Detailed Answer:
Thank you again for your very kind words.
The explanation and the logic for septicemia does not convince me, am sure there is some lag in the memory or at the doctors' end, however, you can lay to rest the scare of peritonitis , it is just not applicable in your case.
I would love to hear about the birth of your third son, it would be a pleasure and privilege am sure.
Regarding your questions, no many are too many !
That is what I am here for, it is my vocation as well as my hobby, and I would be a happier soul if I can assist others by sharing my knowledge.
Whenever I hear from you, it reaffirms my belief in myself, it is that simple !
SO here goes
1. The large skin tag can be dealt with surgically, The fissure will heal automatically once you stop straining. Can you upload photos if you do not mind so that I can estimate how bad ( or good ) it is ?
2. Enterocele refers to bowel prolapse, rectocele refers to the prolapse of the rectum, which is situated lower down compared to the bowel.
So yes, rectocele can be surgically approached easily compared to the enterocele by an experienced operator.
Take care XXXXXXX
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (50 minutes later)
Dear Dr. XXXXXXX
Thanks so much for your caring response. I guess there is something missing in the old memory banks regarding the reason for the peritonitis! :) Thanks again for your reassurances as far as a likelihood of this not being the current problem.
1) When you say that the large skin tag can be dealt with surgically, do you mean that the gynie-surgeon who cuts me vaginally will be able to take care of that too, or will it have to be a different type of surgeon? Here in Calgary, Canada, each surgeon is very specialized, dealing with just one small aspect. Alas I don't have photographs and I can't figure out a way to get them. I use an ordinary camera... not quite into the 21st century with all the more modern technology!
2) The current gynie-surgeon also sent me to a general surgeon who deals with rectal issues. He said I don't have a rectal prolapse (i.e. the rectum has not come outside of the body - which is what I had thought, when I saw the skin tag hanging down). He was the one who sent me for the proctogram... and it is the proctogram that revealed the enterocele and rectocele. The doctor who did the proctogram may have been trying to simplify things for me, but I believe he said that an enterocele is when the small bowel (the small intestines) become prolapsed, and the rectocele is when the large colon becomes prolapsed.
In any event, in view of our specialists here being so specialized, would the gynie cutting me vaginally be able to deal with the enterocele, and the rectocele and the skin tag - all three problems? Or would another type of surgeon need to be involved?
I'll remember to tell you about my third delivery, next response! XXXXXXX


doctor
Answered by Dr. Aarti Abraham (8 hours later)
Brief Answer:
ALL 3 CAN BE DEALT WITH BY 1 SURGEON

Detailed Answer: XXXXXXX
Hi again !
Yes, the skin tag would be dealt with vaginally, as it would be on the external surface.
You can try taking snaps with an ordinary camera too, and emailing or sending them across as attachments, the customer response team at Healthcaremagic would help you .
The enterocele refers to small bowel prolapse, and the small bowel is higher up than the large bowel, the large bowel ( of which the rectum is a part ) is lower down ( more proximal to the vagina ).
Yes, a competent gynecological surgeon can deal with the enterocele, rectocele and the skin tag vaginally.
Looking forward to hearing from you again.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (8 hours later)
Dear Dr. XXXXXXX
Thanks again for your comforting and clear response. oxo
Here’s my story! For someone suffering from extensive endometriosis and continuous ovarian cysts, I understand that makes it a good one for the medical records.
In 1971 we had our eldest son, our first baby boy. He weighed 8 lbs. 12 oz and was 24 ins long (quite the record in those days). Although 120 lbs now, at the time I only weighed 103 lbs (I am 5 ft 3 ins tall). I managed to have a natural birth, although I tore badly at the front of the vagina.
Then we had our second baby, born 15 months later (8 lbs. 9 oz and 22 ins long) - again a natural birth delivery. He dropped to 7 lbs 8 oz and never gained his birth weight. He was born with the valve leading from his bladder, inverted, and he only had one kidney. The urea content in his little body was way off the chart. Once we were made aware of the problem, we did agree to have his ureters brought to the surface so that he didn’t have to struggle to pee. We were told he would never live beyond the age of 5. In fact, he only lived to 10 weeks before God took him. He died at 9:07 pm on a Saturday night. I emphasize that day and time – you’ll understand why in a minute.
We were told I could not have any more children, that my health wasn’t strong enough. But I woke up one morning suddenly yearning for another baby (predominantly so that our first boy would have a brother or sister). So I prayed. Before the month was through, I believed I was pregnant. I went to the doctor to confirm the pregnancy. He told me the good news was that I was expecting, the bad news that I also had a very large ovarian cyst which would be competing for room with the growing baby. He wanted to perform surgery to remove the cyst, but as he told me the likelihood was that I would lose the baby, I refused. So baby and cyst grew together. I looked like I was expecting twins!
In the last few weeks of the pregnancy, my ankles swelled – I can’t remember the name of the condition. It necessitated that the birth be induced. I ended up being 48 hours in labour. My blood pressure dropped too low for me to have a C-Section as the specialist believed I would not survive the anaesthetic (back in 1974, general anaesthetics were still being used). In the last few hours, as I was growing weaker, he fitted me to a drip which he said would bring on the delivery more rapidly. In fact, in the final stages, the nurses had to rush the gurney into the delivery room, only just clearing the doorway. I’m not sure how the ward sister knew (the specialist had gone home for a late dinner) but she said my contractions were very strong and she gave me a morphine injection (in my butt). I was later told that that shot should have killed the baby as he was already coming through the birth canal. He came face up, and not the usual way. But he survived! When I awoke at 2:30 am, still in the delivery room, the two nurses standing by my bedside told me I had had a beautiful baby boy the night before. Said the one, pulling up the chart from the end of the bed: “8 lbs. 8 oz, and 20 ins. long. Born at 9:07 pm, Saturday night”.
See why I highlighted the death of our second baby boy??
Not only was our beautiful boy born alive and well – but they said that I had nearly died in the birth process. In fact, when they were rushing the gurney to the delivery room, I knew I was going and pleaded like never before that God would not take me! When I finally had the hysterectomy in 1977, the two surgeons who worked on me told me afterwards that they couldn’t figure out how I had conceived nor how I had carried. All the ligaments holding up the uturus were completely buckled and distorted and I had acquired a second large ovarian cyst.
Have you got goose bumps, my Kindred Spirit??
doctor
Answered by Dr. Aarti Abraham (4 hours later)
Brief Answer:
AS BELOW

Detailed Answer:
Hi,
Thank you for trusting me and enriching me with this piece of your heart and your life ( I would not belittle it by calling it a story at all ).
It just reaffirms my faith , and justifies why you call me a kindred spirit.
Further enamoured of your fortitude and strong spirit.
Can also empathize because I had twins a year back ( a boy and a girl ) born 2 months premature, and my son spent 17 critical days inhabiting the grey zone between life and death on the ventilator, because of his prematurity.
God blessed me too, and he survived, and I now mother two vibrant, energetic one year old children !
He always cares.

Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Aarti Abraham (4 hours later)
Dear Dr. XXXXXXX
Just arrived home from time with our one son and three grandkids, to find your most welcome response.
Thanks be to God that your baby son survived his nightmare - and what a great blessing that you now have two healthy one year olds! They are clearly blessed too, having a Mom like you (not hard to tell !).
I too am one of twins... my twin sister ended up living far away from me, in Central XXXXXXX (Zambia) but we are always close at heart and thanks to the telephone and email, are able to maintain good contact. She is a nurse... although is retired and now sells medical insurance, part-time.
I am happy that you enjoyed my recounting and that it, too, reaffirms your faith and justifies our being kindred spirits. I shouldn't use the word story I know. I am an author of three adult books and lately two children's books - not that I write 'stories' per se, but only based on fact (lots of research!).
God most assuredly cares and always responds to our prayers even if sometimes not quite the way we want, eh.
I thank God for our newfound friendship. You will always be in my thoughts and in my prayers, dear Kindred Spirit!
Love & blessings, XXXXXXX
doctor
Answered by Dr. Aarti Abraham (8 hours later)
Brief Answer:
AS BELOW

Detailed Answer:
Hello
Am honoured to be friends with an author, I too am an ' aspiring ' one, and someday, I hope that the demands of home and profession will slacken enough to allow me to paint my own paint - canvas.
Would be happy to go through your books, which ones are they ?
Yes, God weaves the patterns, we can only unravel them one skein at a time, and myopic as we are wont to be, open fail to fathom the grand design the Master Weaver has in mind !
I too would be praying for you always.
Take care.
Above answer was peer-reviewed by : Dr. Prasad
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Follow up: Dr. Aarti Abraham (8 hours later)
Dear XXXXXXX would that I could write as you do! When I read your email just now, it gave me goose-bumps!
Thank you for your kind words - but don't feel honoured, my friend. The work that you do far outweighs anything I could ever achieve!
And you will paint some day, you've clearly been gifted with imagination. It's just a matter of time. I didn't start writing books until 2008. For me, it wasn't a matter of time but more about inspiration. I've led a life filled with excitement and adventure, yet never felt inspired to write about myself. Then I awoke one morning, after helping a young friend who has since died of cancer, and knew I what I had to do. I wrote my first book within 2 weeks from that moment ("The Story of Mary-Mother of Love").
I write under the name E. XXXXXXX XXXXXXX Simple recountings of the events of the Bible using imagery to bring them to life. Hence all the research. While accenting on the New Testament, my next project will be the Old Testament. No doubt more children's books.
So far, those published are "Christmas Begins with C" / "Easter Begins with E" (children's books) / "Via Dolorosa" (Christ's Passion) / "The Story of Mary-Mother of Love" / "Mary, Mother of Sorrows" (an attempt to bring XXXXXXX through the tears).
I have a further six manuscripts in the publishing queue...
Thank you for your prayers!
God bless you always. I hope we can stay in touch. Kindred spirits for all time! XXXXXXX
doctor
Answered by Dr. Aarti Abraham (5 hours later)
Brief Answer:
AS BELOW

Detailed Answer:
Well, thank you for the heartening words, we each fulfill our unique pre ordained roles in this universe.
THank you for also believing that someday, I will put pen to paper and pour out my heart.
FOr me too, am waiting for the Muse and the Moment both !
Will look forward to soliciting your work and reading it.
We sure shall stay in touch, that is what kindred spirits are supposed to do !
Take care too.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (5 hours later)
Lovely to hear again from you!
You may prefer to use my email address for our personal correspondence ( YYYY@YYYY ) and then, in your professional capacity, I can let you know how I am doing re the surgery via this website? I don't mind either way. We can continue corresponding this way if you would prefer.
Have a wonderful evening my kindred spirit. Bet you have lots of fun with your two, a year is such a precious age! Mind you, every age is precious... even when they grow up and become adults!
God bless, XXXXXXX
doctor
Answered by Dr. Aarti Abraham (4 hours later)
Brief Answer:
AS BELOW

Detailed Answer:
I know, they are live energy balls, rushing helter skelter, curious about everything under the sun, extremely alive and responsive.. it is a blessing to have them.
You too take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Aarti Abraham (19 hours later)
It sure is!
Will keep you posted as to how I get on with my surgery! XXXXXXX
doctor
Answered by Dr. Aarti Abraham (3 hours later)
Brief Answer:
TAKE CARE.

Detailed Answer:
THanks , please do that.
Take care.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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What causes high fever post septicemia?

Brief Answer: SURGERY SHOULD BE DONE. Detailed Answer: Dear XXXXXXX Thanks for trusting us with your health concern. I am Dr. Abraham, OB - GYN Specialist, and would be glad to assist you with your concern. At the outset, I laud you for your positive attitude and willpower, as anybody else having had so many surgeries would be wallowing in self - pity, but your intelligence, logic and positivity stand out. WHy did you have the septicemia / peritonitis in the first place ? And chronic peritonitis is definitely ruled out because you have no fever or other signs of infection anywhere. Prolapse repairs ARE to be done vaginally , that is the best approach, and cutting open the abdomen after 4 laparotomies does not make sense, as everything would be stuck in the approach itself. You just need to seek a higher centre / more willing and bold surgeon, as you cannot possibly live with an enterocele and rectocele. Also, a pessary would be undoubtedly expelled when you strain at stool, and a pessary corrects cervical / uterine prolapse, not a bowel one. And chances of adhesions ( what you would call everything sticking together ) in that area are in fact low, because things were XXXXXXX enough to come down and prolapse, I hope you understand what I mean. Nothing can tear there as you think, pain always eases after the prolapse, because organs prolapse when there is increased pressure and the ligaments and nerves cannot cope up with the strain. Once the actual prolapse occurs, pain eases out. Peritonitis is not a possibility in my opinion, and surgical correction vaginally is the way forward, in the hands of an experienced and less daunted surgeon. Am open to further discussions. Given your quality of life in your mind, soon your body will follow, I applaud you for your positivity and energy. All the best Please feel free to discuss further.