Tuesday, June 25, 2013

How Is Adenomyosis Diagnosed?

"How Is Adenomyosis Diagnosed?

The diagnosis can only be proven by the pathologists. This requires the microscopic evaluation of the uterus or tissue taken from the uterine wall.

Although it is possible for a surgeon to make the diagnosis by core-type needle biopsy, the sensitivity is very low. Unless an adenomyoma changes the natural contour of the uterus, the surgeon has no visual clues as to where the adenomyosis is. Therefore, accurate diagnosis would require multiple biopsy sites going deep into the uterus, plus a generous helping of luck.

Lately, we have heard the claim that MRI can diagnose adenomyosis.
MRI should be expected to be excellent in recognizing uterine masses like fibroids, cysts, and adenomyomas if they reach 5 mm. or greater in size. We expect that it will also add to the ability to differentiate among any of the above. MRI may be able to lead us to expect adenomyosis if the myometrial thickness is increased or the consistency of the myometrium is changed.
Unfortunately, this type of information will probably remain quite nonspecific. We are not hopeful that we will soon be able to rely on it to diagnose the isolated, scattered areas of glands lost among the muscle cells because of their small size. Much work is ongoing to get more information as to the diagnostic accuracy of this technique.

Ultrasonography or MRI may identify glandular islands in the myometrium. But as with pelvic endometriosis, the ultrasound can't usually be specific enough to diagnose endometriosis to the exclusion of other possibilities. A good gynecologist may suspect adenomyosis based on the clinical factors described below, but the final diagnosis usually has to wait until hysterectomy is performed." -- http://www.advancedobgynassociates.com/adenomyosis.htm

Friday, June 21, 2013

Videos of Excision

Robotic surgery for Stage 4 Endometriosis:  http://www.youtube.com/watch?v=91TwVHkRtCg

Excision of Stage I and II Endometriosis by Michael East, MD: http://www.youtube.com/watch?v=OWAiw0f65HY

Robotic Excision of Endometriosis. Monopolar Energy vs. CO2 Laser (no voice): http://www.youtube.com/watch?v=6bljCFnRzuU

Medical Conference 2012 - Charles Koh, MD (good info on surgical techniques and data showing what works best):  http://www.youtube.com/watch?v=z-snTaTzeT0

Thursday, June 20, 2013

Gentle Flow Yoga Sequence

Gentle Flow

I find this video helpful in releasing my hips and back. Have a couple of yoga blocks and a yoga strap or a belt handy for it.

Wednesday, June 19, 2013

Spinal Cord Is Key to Chronic Pain

New Research Confirms Spinal Cord Is Key to Chronic Pain

Pauline Anderson
Apr 15, 2013
Fort Lauderdale, Florida — For the first time, researchers have demonstrated the involvement of the spinal cord in chronic pain.
Using resting-state functional MRI of participants in whom central sensitization had been induced and who were not experiencing pain, researchers showed the spread of functional connectivity in the spinal cord.
Although this spinal cord component had been shown in animals, this was the first time that spinal involvement in pain has been shown functionally in the resting state in humans, said Brittney R. Reyes, research assistant in the laboratory that carried out the experiments. The lab is led by Sean Mackey, MD, PhD, professor, pain medicine, anesthesia, and chief, Pain Management Division, Stanford University, California.
The new study helps contribute to the "whole picture" of chronic pain, rather than just the brain component, said Reyes. "This is the start of what will likely be a lot of spinal cord research," she told Medscape Medical News. "I think that we're going to find that the spinal cord is as important as the brain is in terms of pain."
She presented the findings here during the American Academy of Pain Medicine (AAPM) 29th annual meeting.
Brittney R. Reyes
Whole Picture
The study included 2 groups, each with 8 healthy volunteers. In the first group, researchers induced central sensitization by first applying heat for 5 minutes to the left lower forearm of each participant, after which they measured the area of mechanical hyperalgesia. They then applied a cream with capsaicin (a substance that blocks a chemical involved in transmitting pain signals to the brain) to the forearm for 30 minutes. When the cream was removed, they administered the heat again for another 5 minutes and then remeasured the area of mechanical hyperalgesia.
"The spread in the mechanical hyperalgesia, or secondary hyperalgesia, was seen as a sign by us that we had induced central sensitization," said Reyes.
In another nonsensitized group, researchers applied heat to the left forearm of each participant for 30 seconds and followed this with 40 seconds of rest, repeating this process 7 times. Participants in this group did not receive the capsaicin cream.
All participants had 2 scans: a "heat pain" scan that was used to functionally define the dorsal horn and a "resting state" scan during which the participants were asked to lie in the scanner without completing a task. Participants in both groups reported having no pain before or during the resting-state scan.
Dr. Sean Mackey
The resting-state scans allowed the researchers to assess spontaneous low-frequency fluctuations in signals in the spinal cord. They were looking for functional relationships between regions, or areas that act similarly, that may reflect direct or indirect relationships between regions.
"The idea behind functional connectivity is that just because a subject isn't performing a task does not mean that communication between different regions or within the central nervous system ceases," said Reyes.
The task-related heat pain scans from the nonsensitized group defined the region of interest. Researchers used this region of interest to extract time courses from the resting-state scans. "We put these time courses into our analysis as a regressor, and basically asked our model to look for areas in the spinal cord that acted similarly to this original time course."
It's believed that areas that act similarly in the spinal cord indicate functional connectivity when the subject is at rest.
Spreading Connectivity
The analysis of resting-state scans showed that the functional connectivity in the nonsensitized group was limited to a specific area in the C6 region of the spinal cord. However, the functional connectivity in the sensitized group extended into adjacent spinal segments, spreading from C6 to C5 in regions of the dorsal horn. This was the spread that was measured the second time in this sensitized group.
"We found that central sensitization results in a spread in functional connectivity within the spinal cord, even when subjects report having no pain," said Reyes. "Given the incidence of hyperalgesia (hypersensitivity to pain) and allodynia (sensitivity to touch) experienced by patients with chronic pain, the implication for the role of the spinal cord is very important."
The lab at Stanford is among the first to do functional imaging in the spinal cord, said Reyes. "It took a lot of technological advancements to get to this point because it's difficult to image the human spinal cord."
After the presentation, Wally Smith, MD, professor, medicine, and chair, Division of Quality Health Care, Virginia Commonwealth University School of Medicine, Richmond, complimented the team for a study that he found was "elegant, complex, and meaningful."
However, Dr. Smith asked whether functional connectivity is "a basic human trait" or whether the mechanism differs depending on the presence and type of disease. Senior author Dr. Mackey responded that this is not yet known.
"These are just the first baby steps," he said. However, he added that the team will test patients with fibromyalgia to see whether they have the same type of enhanced synchrony and connectivity across spinal cord segments.
Asked how long it takes for get central sensitivity, Dr. Mackey noted that it probably occurs rapidly, judging by the nature of the capsaicin model causing mechanical hyperalgesia outside of where the cream is applied.
"I think that for the first time we're actually showing how and where it's occurring, and at least part of the mechanism behind it."
This study was supported by the National Institutes of Health.
American Academy of Pain Medicine (AAPM) 29th Annual Meeting. Abstract 107. Presented April 12, 2013.


Angiogenesis in endometriosis

Here is information on the role of angiogenesis (formation of new blood vessels in endometriosis): http://www.hindawi.com/journals/ogi/2013/859619/

Tuesday, June 18, 2013

Adhesions and Myofascial Release

One of the big concerns with endometriosis (and with multiple surgeries) is adhesions. Those nasty little bands of scar tissue that can reduce mobility, cause muscles to not contract well, pull on tissue and nerves causing pain, even cause bowel obstructions...need I go on? Here's a good rundown on adhesions in general: http://www.nlm.nih.gov/medlineplus/ency/article/001493.htm

So. What can we do about them? Obviously, the first line of defense is prevention. Like what? Adhesion barriers? Good surgical technique (like getting all the blood out before closing)? Getting all the endo out of our bodies as much as possible? Here's a nice article about adhesion prevention:  http://www.centerforendo.com/articles/adhesionsupdate.htm

Okay, so what about the ones you already have? Is there a way to improve mobility, possibly help with pain? One thought is the use of myofascial release. What's that? I'm glad you asked.
"Myofascial therapy can be defined as "the facilitation of mechanical, neural and psycho physiological adaptive potential as interfaced by the myofascial system" with the "purpose of deep myofascial release is to release restrictions (barriers) within the deeper layers of fascia. This is accomplished by a stretching of the muscular elastic components of the fascia, along with the crosslinks, and changing the viscosity of the ground substance of fascia."

Anyone else hear the crickets chirp after that? In short, it's a technique to loosen or break up scar tissue to help with mobility & pain. (Here's a more simple explanation:  http://www.peaksportschiropractic.com/treatments/myofascial-release-technique)   It requires special training. It is often used as a part of pelvic physical therapy. As far as studies that show it to be effective in chronic pelvic pain, the very limited ones I've found state that it helps temporarily and is best used as part of a multi disciplined approach. (see
http://link.springer.com/article/10.1007/s11916-004-0066-0 and the article below*).

*No link for this one, so I had to copy and paste it all.

Prevalence of Pelvic Floor Dysfunction in

Patients with Interstitial Cystitis
Kenneth M. Peters, Donna J. Carrico, Scott E. Kalinowski, Ibrahim A. Ibrahim,

and Ananias C. Diokno
OBJECTIVES To evaluate the prevalence of pelvic floor dysfunction in women with interstitial cystitis (IC).

METHODS Women with IC and pelvic pain were referred to the Beaumont Women’s Initiative for Pelvic

Pain and Sexual Health program. A comprehensive patient history and pelvic examination were

completed by a certified women’s health nurse practitioner.
RESULTS Seventy women with a mean age of 45 years were evaluated. Of these 70 women 87% had levator

pain consistent with pelvic floor dysfunction. The mean levator pain score was 4.48 out of 10.

Nearly two thirds of these women (64%) had their pain for 5 years or more, whereas one quarter

(24%) had their pain for 1 to 3 years. Half of the women reported irritable bowel syndrome, and

more than one third (36%) reported urge urinary incontinence.
CONCLUSIONS Women with IC may have pelvic floor dysfunction, as noted in this population in which 87


had levator pain upon examination. If pelvic floor dysfunction is diagnosed in IC patients, then

therapy targeting the pelvic floor musculature may be considered as part of a multimodality
approach to treating IC. UROLOGY 70: 16–18, 2007. © 2007 Elsevier Inc.

Interstitial cystitis (IC) is a debilitating bladder syndrome

characterized by urinary urgency, frequency,

and pain. The National Institute of Diabetes and

Digestive and Kidney Diseases definition has been expanded

to include not only those with bladder ulcers or

glomerulations identified on cystoscopy and hydrodistention,

but also those with only symptoms of urinary urgency,

frequency, and pelvic pain who had identifiable

causes ruled out, such as urinary tract infections, bladder

cancer, and endometriosis. Currently medications, hydrodistention,

intravesical therapies, physical and behavioral

therapies, and neuromodulation are used to decrease

IC symptoms. Unfortunately, even in conjunction these

therapies are often suboptimal in alleviating these symptoms,

perhaps in part because the true cause of IC is
unknown.1 Many IC patients also suffer from pelvic floor

spasm, which causes pelvic pain, dyspareunia, and urinary

hesitancy. Myofascial pain and hypertonic pelvic floor

dysfunction are present in as many as 85% of patients
with IC and/or chronic pain syndromes.2 The purpose of

this article is to report clinical findings related to pelvic

floor dysfunction in women with IC.
Seventy women diagnosed with IC by cystoscopy and hydrodistention

and ongoing pelvic pain were referred to the Beaumont

Women’s Initiative for Pelvic Pain and Sexual Health

program. These women had been evaluated and treated by

gynecologists, gastroenterologists, and other medical specialists

without resolution of their pain. Our evaluation included a

comprehensive history and a pelvic examination performed by

a certified women’s health nurse practitioner. The pelvic examination

included assessment of levator pain on the right and

left sides at the ischial spines (as noted in the comment section).

Pain was quantified on a 10-point visual analogue scale

(VAS) by the patient. A retrospective chart review was done to

gather additional data. Descriptive statistics were used to describe

the sample and the distribution of the variables of interest,

such as demographics and pain levels.
Seventy women with IC and pelvic pain were evaluated.

The mean age was 45, with a standard deviation of 12

years. More than half of the women were married (65%),

had more than 12 years of education (54%), were not

working outside the home (52%), or were menopausal

(55%). Nearly two thirds (64%) had their pain for 5 years

or more, whereas one quarter (24%) had their pain for 1

to 3 years. The vast majority of the sample had levator

pain (87%) and dyspareunia (71%). The average levator

pain score 4.48 out of 10. Interestingly, the average score

on the left side was greater than on the right side (4.75

vs. 4.2). Eleven women (16%) had an Interstim device

(Medtronic, Minneapolis, Minn) and 1 had a bion mi-
K.M. Peters is a paid consultant and funded investigator for Medtronics and Advanced


From the Ministrelli Program for Urology Research and Education (MPURE),

Department of Urology, William Beaumont Hospital, Royal Oak, Michigan.

Reprint requests: Donna J. Carrico, N.P., M.S., Department of Urology, William

Beaumont Hospital, 3535 West 13 Mile Road, Suite 438, Royal Oak, MI 48073.

E-mail: dcarrico@beaumont.edu

Submitted: September 14, 2006; accepted (with revisions): February 28, 2007
16 © 2007 Elsevier Inc. 0090-4295/07/$32.00

All Rights Reserved doi:10.1016/j.urology.2007.02.067

Monday, June 17, 2013

Another excellent resource blog

I'm a nerd. I'm geeky. I like the scientific articles explaining the technical details related to endometriosis and all the new studies that are published. I like to analyze them, study them, make a mental pro/con list. However, some are much too technical to correctly understand.

Which I why I enjoy this blog: http://endo-update.blogspot.com/

It's very scholarly but explains studies in an excellent, easy to understand, sometimes humorous way. Also along with it, there is a free endo library of previous articles. You can find it by clicking above and clicking "The Free Endo Library" tab or if you prefer it easy, here ya go:  http://endo-update.blogspot.com/p/the-free-endo-library.html

Darn Things Won't Pin!!!!

I started an Endometriosis board on Pinterest to keep up with articles, diet, exercise, and all things endo related. But I've been running into a problem. Darn scientific articles don't have pictures that will "pin"!!! My solution is this blog. I mostly want to be able to keep up with this data and have it available online in case I can not to get to my own computer. I hope if you are searching for information about endometriosis that this will be a good reference for you too.

So here's my first article to "pin." It is a release from the National Institute of Health (from 2002) stating that women with endometriosis have a higher occurrence of other diseases such as allergies, chronic fatigue syndrome, fibromyalgia- indicating the need for further research into the immune aspect of the disease. Here's the link to the website (article included below): http://www.nih.gov/news/pr/sep2002/nichd-26.htm

Women with Endometriosis Have Higher Rates of Some Diseases
Women who have endometriosis are more likely than other women to have disorders in which the immune system attacks the body's own tissues, according to researchers at the National Institute of Child Health and Human Development (NICHD), the George Washington University, and the Endometriosis Association. The researchers also found that women with endometriosis are more likely to have chronic fatigue syndrome and to suffer from fibromyalgia syndrome — a disease involving pain in the muscles, tendons, and ligaments. Women with endometriosis are more likely to have asthma, allergies, and the skin condition eczema. The researchers surveyed 3,680 women who said they had been surgically diagnosed with endometriosis. “This study indicates that women with endometriosis may be more likely to have a variety of diseases involving the immune system,” said Duane Alexander, M.D., Director of the NICHD. “Further study of the immune system in endometriosis may yield important clues to identifying the causes and treatment of the disease.” In women who have endometriosis, tissue like the lining of the uterus — the endometrium — grows in other parts of the abdominal cavity. The endometrial tissue may attach itself to the ovaries, the outside of the uterus, the intestines, or other abdominal organs. Endometriosis affects an estimated eight to ten percent of reproductive age women. It may cause infertility or pelvic pain, although researchers believe that some women with the disease may not experience symptoms. In addition, the researchers found that family members of women with endometriosis more commonly had the disease, as reported by others. The researchers published their findings in the October 2002 issue of Human Reproduction. Roughly 99 percent of the women in the study said they had experienced pelvic pain for about 10 years before they were diagnosed with endometriosis. The women in the study reported that their pain began shortly after their first periods. The researchers do not know whether endometriosis actually occurs at the first period or if it develops over time. It is also unclear whether treating pain early could prevent chronic pelvic pain from developing in these women. For this reason, the study authors suggested that physicians treating patients with pelvic pain — particularly adolescents — consider whether endometriosis might be causing the problem. Ninet Sinaii, MPH, of NICHD’s Pediatric and Reproductive Endocrinology Branch, and her colleagues analyzed information from a 1998 survey of members of the Endometriosis Association. The researchers focused on the 3,680 women who said they had been surgically diagnosed with the disease. The study authors compared the likelihood of women with endometriosis having a variety of disorders to the likelihood of women in the general population having these same conditions. These included:

  • Autoimmune diseases — disorders in which the immune system attacks the body's own tissues.
  • Chronic fatigue syndrome — a strong feeling of fatigue that lasts for at least six months without letting up.
  • Fibromyalgia — a recurrent pain in the muscles, tendons, and ligaments.
  • Endocrine diseases — disorders of the glandular tissue
  • Atopic diseases — such as allergies or asthma
The researchers found that women with endometriosis were at greater risk than were other women for such autoimmune diseases as systemic lupus erythematosus, Sj√∂gren’s Syndrome, rheumatoid arthritis, and multiple sclerosis. The women in the study were over a hundred times more likely to experience chronic fatigue syndrome than the general population of U.S. women. The women with endometriosis were more than twice as likely as other women to experience fibromyalgia. In addition, 20 percent had more than one other disease, and up to 31 percent of those with more than one disease had also been diagnosed with either fibromyalgia or chronic fatigue syndrome. Hypothyroidism — an underactive thyroid gland — was seven times more common in the endometriosis patients. In many cases, hypothyroidism may also be an autoimmune disorder, resulting from an immune system attack on the thyroid gland. The researchers also found that the rates of allergies and asthma were higher among women with endometriosis than among women in the U.S. population, and higher still if they had other diseases. The researchers found that 61 percent of the women with endometriosis reported allergies (as compared to 18 percent of the general female population) and 12 percent had asthma (as compared to 5 percent). If a woman had endometriosis and an endocrine disease, the percent with allergies rose to 72 percent, and if a woman had endometriosis plus fibromyalgia or chronic fatigue syndrome, the rate for allergies rose to 88 percent. Two-thirds of the women reported that relatives also had diagnosed or suspected endometriosis, suggesting a familial basis for the condition. The study authors cautioned, however, that the study may not be representative of all patients with endometriosis. First, the women may have joined the Endometriosis Association because they were experiencing pain from their condition and so may not be typical of all patients with endometriosis. Also, such self-reported surveys may be more open to error than are surveys taken by a trained interviewer. For example, some of the women who answered the survey may have misinterpreted questions, may not have recognized the names of specific diseases, or may not have accurately reported conditions experienced by their family members. The women who responded to the Endometriosis Association survey were predominantly white (nearly 95 percent) and educated (90 percent had at least some college education), and ninety-one percent were of reproductive age (15-45 years old). To compensate for such possible sources of bias, the researchers conducted a type of statistical test known as a sensitivity analysis. This analysis helps to confirm that even if a disease is underestimated in the general population and overestimated in the study sample, the rates of the various conditions reported in women with endometriosis are probably still significantly higher than in the general population. “These findings suggest a strong association between endometriosis and autoimmune disorders, chronic fatigue syndrome and fibromyalgia" said Ms. Sinaii. “Health care professionals may need to consider endometriosis when evaluating their patients for these disorders.” More information about endometriosis is available from the NICHD publication, Endometriosis, at http://www.nichd.nih.gov/publications/pubs/endometriosis.pdf. Information about endometriosis is also available from the Endometriosis Association, 8585 North 76th Place, Milwaukee, WI 53223; phone, 414-355-2200; http://www.EndometriosisAssn.org/ The NICHD is part of the National Institutes of Health, the biomedical research arm of the federal government. The Institute sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. NICHD publications, as well as information about the Institute, are available from the NICHD Web site, http://www.nichd.nih.gov, or from the NICHD Clearinghouse, 1-800-370-2943; e-mail NICHDClearinghouse@mail.nih.gov.