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Hello Everyone,

MALE 55, J-Pouch 85' Dr John Pemberton (Retired) Mayo Clinic

I am praying that I can get some support because I feel like I'm going to have a breakdown.   I am a patient of Dr Shen now at Columbia and previously at C.Clinic.

Saw Dr Shen about 4 years ago and diagnosed with mild Afferent Limb Syndrome. (Told to monitor it with him).

Jan 24' Extreme gas and bloating and extreme pain when passing stool.   So bad I thought I was obstructed.   Defography as per radiologist at Columbia is normal.  Shen states it is not normal and I am not emptying properly.   Recommends pelvic floor excersies/ biofeedback and possible banding procedure.   I am having severe pain when passing stool.  I describe it as 'passing glass' and I am MISERABLE.    Typically courses of Flagyl or low dose Tinizadole relieve this pain and discomfort both inside and out and keep in manageable but now that's not happening.  

Feb 24' SHEN POUCHOSCOPY  RESULTS:   - Angulaton at the inlet, "At the pouch outlet, there is a prolapse posterior".   Pouch mucosa was normal.    Tells me my anus is very tight.   So the "floppy pouch' angulation is a bit worse than 4 years ago but not horrible.  The prolapse is new and should be addressed.   We decide to fix the 'structural portion" first through banding and then down the line do the biofeedback/ pelvic floor therapy.  

Mid May 24" Dr Shen installs 14 of the 'newest' clips / bands.  Advised to do biofeedback in Edgewater/ Fort Lee NJ in the future after healing to help the procedure.   I am now 2 months post procedure and I am still in unbearable pain when trying to poop.   Nurse tells me she suspects a 'fissure' 2 weeks ago and recommends that I have an anal exam.   I go to my local GI in Morristown NJ (he is excellent).  NP feels around with a glove / rectal exam and I see stars.   Tells me that I most likely have a fissure and to use psyllium and insert Calmoseptine inside the anus and pouch.   Dr Shens nurse sends in a compounded Rx called Diltiazem 2% ointment and I am to insert a pea sized amount 3x daily.  I start using the ointment despite it being very painful and I actually feel one of the 'pins' from the banding procedure in my anus pinching me and the pain is excruciating!    I actually feel it move from the pouch to my anus and then back again and my anus is is spasm - clearly from the pain.    I email Dr Shen and his nurse and inform them what's happening and tell them I can't handle the pain begging them and asking for a follow up pouchoscopy.   Shen responds and says clips can be "passed."  I tell them I know my body and that I have only passed about 3 clips since the procedure and the ones I passed were within the first month.   I ask if this one could be stuck and need to be removed though pouchoscopy??     I get no response but to be told to use UCERIS FOAM.     Last week my ass was on such FIRE that I TOLD my local GI to prescribe CIPRO to see if I could get some relief.  Local GI said they would scope me or reach out to Shen.  I am still waiting to hear back.   I'm now  4 days into a week of CIPRO and the external 'burn" is definitely improved but still not acceptable.   Still having the same 'passing glass' pain and difficulty pooping.  Going in small amounts and having to wipe out the stool because it oozes out.    I don't get that feeling of passing gas like I used to with my noisy pouch and pooping.   Tried pepto bismol chews, Gas-x ,- everything you could think of (mostly on my own) with marginal improvement.   Every barrier ointment imaginable!  No wiping - just dabbing.   Hypoallergenic baby wipes to dab with.  It's a literal 'SHIT SHOW'!!         (I also do probiotics RENEW LIFE and RISAQUAD).  Both have helped over the years for sure.    

My experience with Columbia has been a nightmare.   Neither Dr. Shen or his staff even informed me post banding procedure that I could poop out these 'pins' and that I could have bloody stools afterwards etc.   Even my General Practitioner was on a Zoom call with him and never told of any expectations post procedurally.   I suffered through the post procedure process with HUGE anxiety and it was SO UNNECESSARY.   And to this day, it's very unclear.   I'm told 'you call poop out all 14 pins or you can poop none".  It's SO EVASIVE.     Response time is UNACCEPTABLE.  I never had this with C.Clinic or Mayo Clinic.  I would put a call into Dr. Pemberton in any type of distress and get a call back in 10 minutes.      

I am BEYOND depressed and don't know where to turn to.   Dr. Pemberton is retired and not reachable and I am in bed daily sleeping.   Can't cope.   Any advice would be so much appreciated.  I feel like I'm dying a slow torturous death.    I am sick since I'm 8 years old and I'm tough but this is beyond challenging.    

Sincerely,
Mike

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I am very sorry that you are suffering, I know that life is not fair. Unfortunately, I would have no idea what to do in this situation. The only thing I can offer is empathy and to let you know that I hear you and I see you. I am here for you as well. I am sorry the doctors are not listening, that is very selfish of them. Some people only have cognitive empathy instead of emotional empathy and its very sad. If you keep bothering the doctors, I think eventually they will hear you, if not- it might be best to find a new doctor. I have had to do that a lot in the past. You should not have to do that but unfortunately sometimes that is needed.

@Sara Marie posted:

I am sorry for your very real and urgent pain and I find it unacceptable that you are suffering this way under the care of your doctors.  I used to be jealous of those who had access Dr. Shen, who is rumored to be one of the best in the field.  Not anymore.

Exactly what I was thinking. I am surprised by his behavior

Thank you very much Pouchomarx!    Does anybody know of another doctor that is familiar with this procedure?   I will travel anywhere to either CLEVELAND or Mayo Clinic.   Has anyone had any experience with banding for prolapse/floppy pouch/ afferent limb syndrome?  I’m not sure if I should see another G.I. guy or if I should be seeing a surgeon for options at this point.    

Last edited by Jersey Shore

Thank you very much Pouchoscopy!    Does anybody know of another doctor that is familiar with this procedure?   I will travel anywhere to either CLEVELAND or Mayo Clinic.   Has anyone had any experience with banding for prolapse/floppy pouch/ afferent limb syndrome?  I’m not sure if I should see another G.I. guy or if I should be seeing a surgeon for options at this point.    

Someone had a whole thread on this site about floppy pouch. A couple of people commented that they had it.  The only thing I remember from that is that one person said you're more likely to get it if you're a slender woman.  I was like, Uh-oh.  Check out the search:

https://www.j-pouch.org/search...yString=floppy+pouch

Omgoodness.

I feel for you.

Just the passing feeling like glass.

Unbearable after a short period. But being so long it definitely starts affecting oneself mentally.

I am not familiar with the procedure.

Just sending empathy your way as others have.

It sounds terrible.

Stay strong. As strong as you can. Don't let it beat you down. It will. If you let it. I know that's hard.

I can only hope you get answers and relief very soon.

Keep bugging those Dr's!

R.

Last edited by Mysticobra

Thank you very much Pouchomarx!    Does anybody know of another doctor that is familiar with this procedure?   I will travel anywhere to either CLEVELAND or Mayo Clinic.   Has anyone had any experience with banding for prolapse/floppy pouch/ afferent limb syndrome?  I’m not sure if I should see another G.I. guy or if I should be seeing a surgeon for options at this point.    

I think what you said about seeing a surgeon is genius! I think i would do the same at this point.

How are you feeling now???

Dr Schen misdiagnosed me and was going to put clips in. I’m glad I didn’t go forward with him. Yes it was a nightmare speaking to his office.

i have floppy pouch. I needed a resection. Also, my bio drug stopped working and needed to switch. My life too has been a nightmare.

you can try the IBD clinic at Cornel or Dr Millsom surgeon also at Cornel.

@AllyKat posted:

Dr Schen misdiagnosed me and was going to put clips in. I’m glad I didn’t go forward with him. Yes it was a nightmare speaking to his office.

i have floppy pouch. I needed a resection. Also, my bio drug stopped working and needed to switch. My life too has been a nightmare.

you can try the IBD clinic at Cornel or Dr Millsom surgeon also at Cornel.

Thank God!!!! I am happy you did not continue with Dr. Shen too. I thought he was perfect! I am starting think otherwise now.

I wonder how floppy pouch even happens???

I am glad this person will see your post, I think this post will give him more validation and others about Dr. Shen.

I’ve had several endoscopic interventions with him including banding. I passed the clips over time but never felt it—I was having serial imaging for a sinus tract and they commented on fewer and fewer clips over time. They are incredibly tiny so unlikely to cause pain. A fissure on the other hand can be excruciating! The post-op bleeding was likely from band placement, not from damage to your anus from shedding the clips. Shen cut into the back wall of my pouch (sinusomoties) during each procedure so more bleeding from that but not painful either.

I’m sorry you’re going through this Jersey. Regardless of the cause of the pain and bleeding better communication is needed and would have likely allayed some of your fears and provided options for fissure treatment. I found it very difficult to reach anyone at Columbia. I went months without any return of my calls. @AMB was helpful (thank you) but it shouldn’t require a special “in” with the office. The only time I got a quick response was when I wanted to schedule a procedure. I was booked, no questions asked except for my insurance info and promise to pay.


Dr. Shen is the best at what he does (endoscopic pouch procedures) and pioneered many of the techniques used today. He’s not a miracle worker and some issues are likely beyond endoscopic fixes and require surgery. He will do anything to save the pouch and avoid surgery, and will keep trying as long as you let him. This determination is admirable but not always in the best interest of the patient. He is also at Columbia which is a highly regarded shit show. The ED is a nightmare and the medicine wards and clinics are understaffed, over worked and have some of the oldest, crumbling infrastructure I’ve ever seen.  

Jersey, if you still want to pursue endoscopic procedures (banding, etc) then I would research those trained by Dr. Shen that now work at better run, better equipped facilities. Shen is still the best in my mind but Columbia leaves a lot to be desired and I hope to never return!

I agree that communication channels are challenging.  The phone system is just bad and best avoided.   But I've have had only had excellent results with Dr Shen.  And while the  NY Presbyterian hospital facility itself is not new and not pretty,  I'd take it over my shiny new local hospital for quality of care any day.  I have had the highest quality of care from doctors, nurses, and all providers, and a high level of professionalism from administrative staff at all levels from my pre-operative visits and work-up, in-patient hospital stays for surgery x2 with the wonderful Dr. Kiran, and multiple outpatient pouch procedures and  tele-health appointments with Dr. Shen.   I too, hope never to have to face another in-patient stay.  But I'll return annually for pouchoscopy screening and banding as needed as well as medical management. If my experience changes, I'll update this review!

Last edited by AMB

reach out to Dr Remzi, pretty sure he can help.

I feel for you as I had similar experience on glass coming out a few weeks ago…pretty sure it’s a fissure. I used cipro flagyl and solved it. Key is to bulk up the stool and avoid and watery stool after…also it seems like if cipro flagyl is working then keeping it as a maintainece drug is totally acceptable..

Hi all - I'm new to this group and I'm sorry to see that there are so many unsatisfactory outcomes here.

I had a j-pouch procedure for UC done in 1986 and have had pretty much every complication over time - pouchitis, obstructions, fistula. About a month ago, after being unable to pass much of anything, I was diagnosed with a "floppy pouch". Dr Shen at Columbia did a scope and inserted some bands but there's really been no improvement in my situation. Like many of you, I'm miserable - just cramped and fatigued all the time, unable to eat or sleep much. I'm supposed to begin biofeedback, but I'm pretty skeptical about it.

Have any of you that have dealt with this problem had a successful outcome? If so, what worked? Meds, surgery, exercise, biofeedback, just the passage of time? I'm hoping for some encouragement!

Thanks!

J-pouch 86 in NY

I have floppy pouch. I needed a resection to fix the issue. And at the same time my bio drug stopped working. I’ve been pretty sick.
I went to Dr Schen for a second opinion. He actually misdiagnosed me. He wanted to put those clips in. After talking to my GI and surgeon I refused and now glad I did.
Go see Dr Milsom at Cornell. He’s very experienced in floppy pouches. And My GI is Dr Scherl at the IBD center. Message me if you even want to use my name.

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