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Hoping I can get input. I have had two full rounds of J-pouch surgery, twice with ileostomy and two take-downs. I generally feel pretty good, but have had an issue with gas leaking from my pouch, causing very painful inflammation, quickly treated by Cipro and Flagyl, which I take in cycles. Apparently I have a very small hole and gas escapes. Obviously, more could escape, of course. My surgeon, who is fantastic, has suggested that I may have to go back to closed/final ileostomy, since two surgeries weren't totally successful.

I feel very, very good when I am off the antibiotics, 2-3 BMs a day, sleep all night, the whole nine, but as my surgeon put it, it is not a fix, just a Band-Aid. while on Antibiotics I am very tired and, surprisingly, it gives me lots of diarrhea/leakage, etc. He also asked if I'd consider a second opinion and I brought up Dr. Bo Shen. I notice he is not a surgeon, but from the input on this board has a great deal of experience with J-pouches that might be beneficial and looking for way to save my otherwise fantastic pouch!

Do you feel that Dr. Shen can add further potential solutions, other than a total take-my-chances third re-do (I'm not into it) or a final closed ileostomy, even though he is not a surgeon?

Thank you!

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Absolutely! If you have it within your means to see Dr. Shen, you should. Yes, he is a GI and not a surgeon, and that is precisely the reason to see him. He runs the Pouchitis Clinic at Cleveland Clinic, and has examined more problematic pouches than probably anyone else. So, he has pretty much "seen it all." He can tell you if there is a non-surgical or minimally invasive approach to your problem.

One thing he has a great deal of expertise in is pouch leaks, sinuses, and fistulas. He has successfully treated them, using "needle knife" procecures, performed through endoscopy.

Jan Smiler
Jan Dollar
Yes, if it is possible, go see Dr. Shen! I saw him last October for fistula problems. He did a pouchoscopy& during the pouchoscopy located the fistulas, injected them with something (can't recall exactly & don't have the notes nearby), & clipped them. Went back about a week ago for another pouchoscopy & he found that 1 of the fistulas (I have 3) has completely closed! I'm trying to avoid surgery at all costs & he is working very hard to help me prevent it. He injected & clipped the remaining fistulas & I will go back in Dec. for another pouchoscopy in the hopes I'll have the same great results. I was told he is the only one that does this procedure. Not sure if he'd do the same for you but I'd certainly give him a chance to help you before losing the pouch. Good luck!
A
Wow, thank you. I literally got chills reading your responses! We are gathering all the volumes of data/pictures/etc on what is my pouch story and hope to get it off to Dr. Shen here, soon.

You made my day. I am accepting that I may need to return to the bag since I felt very well .. but if I can save the pouch, I'm very excited. Appreciated.

I hope I can get an appointment!
aka KNKLHEAD
I had my surgeries at Cleveland Clinic and have been working w Bo on and off since my take down May 2012. They have a lack of bandwidth. Bo needs a good nurse practitioner or junior doc. Bo is good on email, but he will answer what he wants and leave you hanging. I think Bo is great, relative to the pack, but I would keep your hopes level and not get too excited.

One thing Bo will do that other GI/Surgeons have not done is go a couple layers deep. For example, I have PSC (liver) and therefore (due to Bo's local studies of his own patients) he knows patients w PSC and Jpouch don't react as well with antibiotics. So steroid / entocort was/is the go-to.

I've seen a couple other GIs and a surgeon at OSU and down in Athens, Ohio. They didn't recommend entocort, they went with the go-to cipro/flagyl.

It's worth a call. Teresa is his admin assistant. She is helpful.

Good luck {Smiler

RJ
Sundries
Actually Dr. Shen does have a physician's assistant, Geeta. She has been with him for probably about a year now. She communicates promptly via email. The key to emailing both or them is to keep things very brief and only bring up one or two issues/questions at a time.

also aka.. Dr. Shen injects either doxycycline or glucose into fistulas. He has had pretty good success with it. But oftentimes people need multiple treatments. He has done this for me for a very long sinus tract/unhealed wound resulting from jpouch excision surgery. Some success thus far.

aka I might suggest you call now and get an appt scheduled with him. It will probably be several months out, but better to get on the schedule sooner than later. Very doubtful they read much of anyone's files in advance. Also if you do send things in advance, be sure you also hand carry every single thing, particularly imaging done on CDs with you to initial appointments.
L
I agree with liz about carrying all files, cd's with you to the appt. with Dr.Shen. Even though I sent everything ahead of time, he did look at the hard copies. Even though I had several Cd's of previous CAT scans, i still had to do them again at CC. He felt their radiolgists were more familiar with pouches.
Once I got the initial appt, I called every day ( to GI office, not main CC appointment #) to see if there was a cancelation. Sure enough, I got in one month sooner. Just be persisstant. I waited until a few weeks before to make by airline reservations.
He does answer emails, but doesn't always answer every question in the email. You will get a CC patient #, and i always put that in the subject line with a few key words.
I did have to stay an extra day, and Dr. Shen will give you a copy of a letter to airlines explaining the medical neccessity for your stay. We did get the change fee refunded!
He really is amazing--we also recorded ( audio) the visit with our iphone.
He really is amazing and found a fecalith in my kock pouch! ( i had 5 previous scopes by other drs and he found it during first scope)
marz

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