Your Questions About Scar Tissue After Shoulder Surgery

Mandy asks…

Scar Tissue (Kelloid) removal?

I have a kelloid on the top of my left arm, below my shoulder. I have also heard of Bio-Oil that is supposedlly effective in removing (or rather, reducing the appearance of it).

Does anyone know any products or of Bio-Oil indeed works? I’m not adamant to REMOVE the scar tissue, but just to reduce the size, redness of it..

Thanks!

admin answers:

No treatment for keloids is considered to be 100% effective. Some of the treatments that are currently available are described below. These treatments have varying degrees of effectiveness. All the invasive methods of treatment like surgery carry a serious risk of the keloid recurring and becoming bigger than it previously was.

Contractubex® Gel / Hexilak® Gel – These gels contain Allium cepa extract, Heparin and Allantoin. Developed for the treatment of post-thyroidectomy scars, these gels are now indicated for the treatment of all post traumatic (burns, acne, piercings) or post surgery scars and keloids. Treatment is simple but requires a lot of perseverance. Has shown exceptional results, especially in newer scars. The earlier the initiation of treatment, the better the prognosis. This is now the first line of approach in conservative treatment of keloids.[citation needed]
Surgery — Surgery requires great care during and after the operation. Keloids that return after being excised may be larger than the original. There is a 50% chance of recurrence after surgical removal. However, keloids are less likely to return if surgical removal is combined with other treatments. Surgical or laser excision may be followed by intralesional injections of a corticosteroid. Plastic closure of the skin including techniques such as v-plasty or w-plasty to reduce skin tension are known to reduce recurrence of keloids following excision.
Dressings — Moistened wound coverings made of silicone gel (such as Dermatix) or silastic have been shown in studies to reduce keloid prominence over time. This treatment is safe and painless, although some patients may experience increased itchiness from wearing the dressing for an extended period of time.
Steroid injections — Steroid injections are best used as the scar begins to thicken or if the person is a known keloid former. A series of injections with triamcinolone acetonide or another corticosteroid may reduce keloid size and irritation. However, injections are often uncomfortable and in large and/or hard scars can be difficult to perform, requiring local anesthetic for people over 16, and full anesthetic for people under. The treatment area can become very painful as the anesthetic wears off.
Compression — Compression bandages applied to the site over several months, sometimes for as long as six to twelve months, may lead to a reduction in the size of the keloid. This is the best treatment for preventing new scars.
Cryosurgery — Cryosurgery is an excellent treatment for keloids which are small and occur on lightly pigmented skin. It is often combined with monthly cortisone injections. The use of cryotherapy is limited since it causes skin blanching. It freezes the skin and causes sludging of the circulation beneath, effectively creating an area of localized frostbite. There is a slough of skin and keloid with re-epithelization.
Radiation therapy — Electron beam radiation can be used at levels which do not penetrate the body deeply enough to affect internal organs. Orthovoltage radiation is more penetrating and slightly more effective. Radiation treatments reduce scar formation if they are used soon after a surgery while the surgical wound is healing. This is one of the most effective procedures.[1]
Laser therapy — This is an alternative to conventional surgery for keloid removal. Lasers produce a superficial peel but often do not reduce the bulk of the keloid. The use of dye-tuned lasers has not shown better results than that of cold lasers.
Newer treatments — Drugs that are used to treat autoimmune diseases or cancer have shown promise. These include alpha-interferon, 5-fluorouracil and bleomycin. However, there is a need for further study and evaluation of this treatment technique.

Lizzie asks…

how do i know if i’m having an ectopic pregnancy?

i’ve been quite ill over the past month, i’ve been in hospital with suspected appendicitis but turned out to be possible kidney stones which they didn’t follow up. i’m quite a worry wort so i looked up ectpic pregnancy and i’ve got alot of the symptoms, if not all including the irregular bleeding on occasions. can someone please advise me what to do?

admin answers:

Ectopic means “out of place.” In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes more than 95% of the time. This is why ectopic pregnancies are commonly called “tubal pregnancies.” The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies.

None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother’s life. A classical ectopic pregnancy never develops into a live birth.

What Are the Signs and Symptoms?
Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination.

Pain is usually the first red flag. You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis, and it may come and go or vary in intensity.

Any of the following additional symptoms can suggest an ectopic pregnancy:

vaginal spotting or bleeding
dizziness or fainting (caused by blood loss)
low blood pressure (also caused by blood loss)
lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy results from a fertilized egg’s inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube may have partially or entirely blocked it. Pelvic inflammatory disease (PID) is the most common of these infections.

Endometriosis (when cells from the lining of the uterus detach and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg’s progress.

How Is It Diagnosed?
If you arrive in the emergency department complaining of abdominal pain, you’ll likely be given a urine pregnancy test. Although these tests aren’t sophisticated, they are fast – and speed can be crucial in treating ectopic pregnancy.

If you already know you’re pregnant, or if the urine test comes back positive, you’ll probably be given a quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin (hCG), which is produced by the placenta. The hormone hCG appears in the blood and urine as early as 10 days after conception, and its levels double every 2 days for the first 10 weeks of pregnancy. If hCG levels are lower than expected for your stage of pregnancy, doctors are one step closer to diagnosing ectopic pregnancy.

The doctor will also give you a pelvic exam to locate the areas causing pain, to check for an enlarged, pregnant uterus, or to find any masses in your abdomen. You’ll probably also get an ultrasound examination, which shows whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area. But the ultrasound may not be able to detect every ectopic pregnancy.

A less commonly performed test, a culdocentesis, may be used to look for internal bleeding. In this test, a needle is inserted into the space at the very top of the vagina, behind the uterus and in front of the rectum. Any blood or fluid found there likely comes from a ruptured ectopic pregnancy.

Even with the best equipment, it’s hard to see a pregnancy that’s less than 6 weeks along. If your doctor can’t diagnose ectopic pregnancy but can’t rule it out, he or she may ask you to return every 2 days to measure your hCG levels. If these levels don’t rise as quickly as they should, the doctor will continue to monitor you carefully until 6 weeks, when an ultrasound can be used.

What Are the Options for Treatment?
Treatment of an ectopic pregnancy varies, depending on its size and location and whether you want the ability to conceive again.

An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which dissolves the fertilized egg and allows your body to reabsorb it. This nonsurgical approach minimizes scarring of your pelvic organs.

If the pregnancy is further along, you’ll likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring general anesthesia and a large incision across the pelvic area. This may still be necessary in cases of emergency or extensive internal injury.

However, the pregnancy may sometimes be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes a small incision in the lower abdomen and then inserts a laparoscope. This long, hollow tube with a lighted end allows the doctor to view internal organs and insert other instruments as needed. Sometimes, a second small abdominal incision is made for the instruments. The ectopic pregnancy is then surgically removed and any damaged organs are repaired or removed. General or regional anesthesia may be used.

Whatever your treatment, the doctor will want to see you regularly afterward to make sure your hCG levels return to zero. This may take up to 12 weeks. An elevated hCG could mean that some ectopic tissue was missed. This tissue may have to be removed using methotrexate or additional surgery.

What About Future Pregnancies?
Approximately 30% of women who have had ectopic pregnancies will have difficulty becoming pregnant again. Your prognosis depends mainly on the extent of the damage and the surgery that was done.

If the fallopian tube has been spared, the chances of a future successful pregnancy are 60%. Even if one fallopian tube has been removed, the chances of having a successful pregnancy with the other tube can be greater than 40%.

The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.

Who’s at Risk for an Ectopic Pregnancy?
The risk of ectopic pregnancy is highest for women who are between 35 and 44 years old and have had:

PID
a previous ectopic pregnancy
surgery on a fallopian tube
infertility problems or medication to stimulate ovulation
Some birth control methods can also increase your risk of ectopic pregnancy. If you get pregnant while using progesterone-only oral contraceptives, progesterone intrauterine devices (IUDs), or the morning-after pill, you’re more likely to have an ectopic pregnancy.

When Should You Call Your Doctor?
If you believe you’re at risk for an ectopic pregnancy, meet with your doctor to discuss your options before you become pregnant. There’s nothing anyone can do to prevent ectopic pregnancy, but you can make sure it’s detected early.

You and your doctor may want to plan on checking your hormone levels starting at 10 days or scheduling an ultrasound at 6 weeks to ensure that your pregnancy is developing normally.

Call your doctor immediately if you’re pregnant and experiencing any of the signs or symptoms of ectopic pregnancy. When it comes to detecting an ectopic pregnancy, “better safe than sorry” is more than just a cliche.

Http://kidshealth.org/parent/pregnancy_newborn/pregnancy/ectopic.html

Maria asks…

Question about breast reduction?

I have very large breast and Im tired of my back hurting all the time and I am really considering having a breast reduction. Im worried about scarring. I don’t want big ugly scars on my breast. I want to hear from women that have had the surgery and what your results were.

admin answers:

I did it 3 yrs ago this December. Scars look different, depends on how large you are and what you go down to. I was told I’d probably be a C (small, average or full C, but a C), but I’m a small D. But I was a 36G or larger on a size 6 or 8 size body, that is a lot. I had back pain, shoulder pain, etc. Mine was covered by medical ins. It was day surgery (8 hrs in and out total) and they took off a total of about 3.5 lbs of tissue between the two. Scarring is inevitable and I scar easily. So I couldn’t fairly say what it is like. They had to do the most comprehensive reduction because of my size so my incisions go pretty far onto the side of my torso. I had a friend who had it done and she showed me her scars 5 yrs after so I could have an idea and I could **barely** see them, her incision scars were much smaller and shorter. Another friend did it and the incisions were far less than what I had, hers looked way better one week after she had it done(she showed me). I’d do it again in a heartbeat for the confidence I finally have and “feeling within the realm of normal” for a woman’s figure. It’s life altering. I feel attractive now, not googled at by men. And scowled at by women. What size are you now?

Ruth asks…

can you help me with these questions please?

i have some questions that i need the answer to if you can please help me with them

1. synovial fluid is not found in all the joints. explain why it is so important in some joints but not in others?

2. joint injuries often shorten the career of athletes. explain the advantage of key hole surgery on damaged joints , such as knee , compared with traditional surgery.

3. briefly explain type-2 diabetes and the methods of treatment.

Thanks =)

admin answers:

1)Synovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its yolk-like consistency (“synovial” partially derives from ovum, Latin for egg), the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement.

There are two major types of joints: synarthroses and diarthroses. Synarthroses are joints connected by fibrous tissue.
Diarthroses are synovial joints, where two bones are bound together by a joint capsule, forming a joint cavity.
In synovial joints, there is a nourishing lubricating fluid called synovial fluid…viz., ball and socket joint..in case of shoulder ,also knee joints…to reason it..it is important in joints where..the bone tips are in contact continuously….inorder to prevent friction in such cases and improve free movement…
These are absent in the lateral plane where motion is not often required

http://en.wikipedia.org/wiki/Synovial_joint#Structure

http://www.leeds.ac.uk/chb/lectures/anatomy4.html

In Laparoscopic or Keyhole Surgery a telescope is introduced into the body cavity through a 0.5cm opening. The area is viewed through a CCD video camera attached to the monitor. Surgeons can perform any type of surgery by viewing the monitor. Because of the smallness of the opening, this kind of surgery is called Keyhole Surgery, Minimal Access Surgery, or based on the equipment used, Laparoscopic or Endoscopic Surgery.

Small Incision, Minimal Pain and No Large Exposure – so chances of infection are almost nil. Keyhole surgery is cosmetically acceptable and allows quick recovery – You’re back in the gym after a major Laparoscopic Surgery in 24 hrs.In case of bones..2 yrs are very far more time for 100% knee usage…

There are many advantages to the patient undergoing keyhole surgery when compared with an open procedure

Reduced blood loss: reduces the chance of needing a blood transfusion.

Smaller incision: reduces pain and shortens recovery time.

Less pain: so less pain medication needed.

Reduced infections: due to reduced exposure of internal organs to the possible external contaminants, risk of acquiring infections is reduced.

Relatively small scar: Since the keyhole surgery involves a small opening it leaves relatively very small scar in the body.

No cutting of muscles and tissue: So quicker scope of healing

Though procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to the routine life.

Http://www.miothospitals.com/surgical_procedures_and_specialities.html

http://wessexhipunit.co.uk/kneeservice.html

http://www.merckmanuals.com/home/special_subjects/surgery/surgery.html(drawbacks of keyhole)

Diabetes type-II
DM-II is a condition .. Having higher than normal levels of blood glucose with very little energy to go about their tasks. Generally known as non-insulin dependent diabetes, diabetes type 2 is usually a condition wherein one’s body, after a while, becomes proof against insulin. This brings about a increased level of glucose levels.
India and China together hold the largest number of diabetics with India being known as the Diabetes Capital of the World.

Http://www.medicinenet.com/diabetes_mellitus/article.htm(simple n nice)

http://www.nlm.nih.gov/medlineplus/ency/article/000313.htm

http://en.wikipedia.org/wiki/Diabetes_mellitus_type_2

Nancy asks…

Help! Question about a dogs broken leg?

My dog got out of the yard and was hit by a car on Tueday evening. On Wednesday morning we took him to the vet and we found out his left front leg was broke up past the joint but not quite the shoulder. His vet wasn’t in and won’t be for a few weeks and so I took him to a new vet. I didn’t like this guy not one bit. I thought he was nothing but a money scheme. He told us on Wednesday that Our dog needed surgery (1200-1500) amputation (500-600) or euthanize him. He isn’t a surgeon so he referred us to one. He told me that our dog would need to stay over night then the next be transferred to the other vet. It couldn’t wait to have the surgery because if scar tissue grew it would cost more. Then when I called Thursday to see if I could come and get him and transfer him he said the other vet couldn’t do the surgery until Monday morning, but the dog needed to stay in his care with restricted movement and pain meds, well hello! I can do that at home! I have a cage for him, in a room by itself so its quite for him and I can give him pain meds like they were cause they never put in an IV. When I got down there to get the dog and when I saw the room they had him in I started crying. He was laying in his own urine and feces. There were bags of feces everywhere in there and the smell was awful! So I brought my dog home. Is it safe for him to wait until Monday for this surgery? He doesn’t seem to be in pain between his doses of meds and a few times he has yelped out moving around in his cage. We let him out every couple of hours to do his business and eat. I’m not sure why the vet wants to wait so long on his surgery instead of telling us to find another surgeon but this is total bull. When I went in to pick the dog up he said he was nervous about letting him come home, blah, blah, blah but there he has not called 1 time to check on the dog, is there anything extra I should do to keep him comfortable?

admin answers:

If that happened to my dog, I would not take him back to that vet! If that’s how he maintains dogs, who knows if he maintains a sterile field in the surgery???

I’d report him to the state veterinary board, and find another vet.

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