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update and questions... update and questions...

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  #1  
Unread 03-14-2003, 02:53 PM
update and questions...

hi, i had posted yesterday at the end of my previous post but I guess that had got long and boring and nobody read it LOL don't blame you.

Anyway hope its OK to repost as a new thread as I do have some questions...

When I talked to Pete while they were setting me up and he seemed quite sure I'd come out of there with one ovary.

Well he took both after all as both were totally glued up with adhesions - (wonder what they were stuck to???)

That's all I remember him saying when I was in recovery, he said lots but I have NO idea what as I was totally out of it on demerol. He said something about rectal/vaginal/cuff adhesions but I CAN'T REMEMBER what!!!

I asked the nurses a bit later but they couldn't (or wouldn't?) tell me much, only that I have a estradiol 2mg to start on Sunday. So now I am wondering... don't some docs say wait a while before starting HRT if you have endo???

I see Pete Tuesday to get stitches out so by then my brain might be working again so I can ask what he did and what he plans for me.

I felt all the good hystersisters wishes with me when I was in there - thank you all

my second q was this..

When I checked into the hosp I saw on the paperwork I was scheduled for hysteroscopy and lap - I thought it was to be just lap.

I forgot about it but I just remembered that when I came round the nurse was checking my pad. I found that hilarious at the time and told her there was no way I needed it since I had a hyst! The nurse didn't say much except that he had done a "lot of messing about in there". I wonder if ""messing about" is a proper medical term???

I forgot all this in the haze of the demerol but am now remembering. Weird!

Is it even possible to have a hysteroscopy if you have no cervix to go up through??? Maybe it was a mistake on the paperwork but then why the pad? I am really so sore right now that its hard to tell exactly where pain is coming from!!

Steph
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  #2  
Unread 03-14-2003, 03:02 PM
You ask good questions

Yeah, I'm trying to imagine a hysteroscopy with no cervix . . . . . . . don't quite get a picture that makes sense.

Yes, you're right, there are doctors who don't start hormones if there was endo. You might want to talk to your doctor about that. There seems to be some controversy about it, so it would be interesting to get his/her perspective.

Joselle
  #3  
Unread 03-14-2003, 09:58 PM
update and questions...

The hysteroscopy with no cervix must be a new method, because I have never heard of it either. I would ask your Dr at your follow up though..

As for your endo, just go and read a few of my posts. I had my hyst almost 2 years ago and he did not remove any of the endo and put me on HRT

Well, in turn I am off for another lap because he thinks it is still growing.. I would definetly ask him about that as well. HRT will feed the endo. I am still confused as to why my Gyn did what he did, but it is a little too late now to ask why. I really wish I knew then what I know now!! He is a great Gyn and I love him dearly, but I still dont get it..

I also had a pad after mine, I did have my cervix removed as well as everything else, I dont know if there is a difference that would require a pad though...

I also do not remember anything the Gyn said right after my surgery, that is why I had my DH and my friend there to remember for me. Of course my DH thought I had 2 uteruses,
so he was really useless.. It helps to have someone else there to catch what you dont, especially while on demerol. I even take my friend that is a RN with me to all of my appts because I am constantly doped up on pain meds and it is like an overload of information and I catch half of it most of the time.

I will pray you have a speedy recovery, keep us posted on your progress!!



Pam
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  #4  
Unread 03-15-2003, 10:01 AM
update and questions...

Welcome home ((Steph))
I'm thinking the *Hysterscopy* might be a mistake I would call your Dr & ask for some more details as well as your concern of taking HRT w/Endo...
I do hope this surgery will finally bring you some much needed relief Pls get lots of rest & dont forget to be a good Princess
((hugs))
  #5  
Unread 03-15-2003, 11:58 AM
update and questions...

I, too, would say that the hysterscopy part was a mistake. "Hyster" refers to the uterus...not the cervix. Hysterectomy being the surgical removal of the uterus. If you have already had that how can you have a hysterscopy (veiwing of the uterus by a scope)? I'd put in a call to the
  #6  
Unread 03-15-2003, 12:12 PM
update and questions...

Steph,
Welcome home! I hope that you're being a good and getting lots of I'm sorry if I missed the update on your other post. I've got out of town company so I haven't been around as much as usual.

I didn't have endo and don't have alot of experience in that area, however from what I've read here doctors do differ on how they handle hrt after removal of endo. Some doctors will wait a bit to start and others start it right away.

I would suggest that you check out the pull menus at www.hormonejungle.com and also the Hormone Jungle message forums https://www.hystersisters.com/vb2/for...p?s=&forumid=5

I'm sending some s for you Steph. I hope your recovery goes smoothly and soon you will be off this place we call the Road.
  #7  
Unread 03-15-2003, 01:50 PM
update and questions...

Steph, did you actually have a hysterectomy (removal of the uterus) or did your surgeon just remove or repair some other organs and leave the uterus?

Either way, the pad makes sense, even though you won't actually get menstrual periods after a hysterectomy. If you've had a hysterectomy, or many other types of gynecological surgery, you will probably have a discharge for a while. Like any other surgery, yours will cause slight bleeding, and this will continue while any stitches dissolve. I even had to wear a pad for a few days after my laparoscopy in January (my uterus wasn't opened during that procedure, and I wasn't menstruating). I just had a checkup Thursday, 9 days after my hysterectomy, and my doctor says that the discharge will continue for at least a couple of weeks.

You'd be surprised by what an ovary can adhere to. :-) One of mine was pretty well glued down with endometrial tissue that extended to the bladder and abdominal wall. I also had to go for a test called an IVP before surgery, to make sure that my surgeon would be able to feel and see my ureter (the tube that carries urine from the kidney to the bladder) and not injure it during surgery. The abdominal cavity is a busy place, especially in us females!

Different doctors have different opinions on whether to prescribe estrogen after endometriosis surgery. Some (like mine) prescribe it but not until a few months after the surgery. Some endo patients seem to have problems with estrogens; others take it right after surgery and never have problems again. So, it's important to ask questions now, and more questions if you have concerns about whether your estrogen prescription is right for you.

I know that it can be hard to put thoughts together while on narcotic pain meds, especially if you're still recovering from general anesthesia. The night of my surgery, while still on IV morphine, I thought I was alert enough to read a book, but when I opened it -- gibberish! I was on Vicodin tablets for about a week; great for pain, but it wasn't until I was off it that my head completely cleared.

Anyway -- hope you're feeling better now! You may want to write down your questions about your surgery and your future treatment as you think of them, and then bring the questions to the doctor for your follow-up visit. Sometimes it helps to bring along a family member or friend who can help keep track of questions, especially if your doctor tends to be in a hurry.

Best wishes,
Juliepede
  #8  
Unread 03-15-2003, 05:59 PM
update and questions...

thanks for the good wishes, I am sore but feeling a little stronger all the time. I have a slight fever but not enough to concern me - probably just a "healing" fever right?

Julie - I had a hysterectomy back in 2001 (LAVH) so have no uterus or cervix. That is why I was baffled by the supposed hysterocopy and the pad - I wondered if he had gone back inside through the "cuff" somehow, but I have had no spotting or bleeding.

I am pretty sure I had adhesions in that area and it sure feels sore and there is a little tugging kind of pain like the cuff stitches I had after hyst. It is certainly a lot more discomfort than I ever felt from 3 previous laps for endo etc.

I guess I'll find out on Tuesday when I can ask all my q's! I already have a list. Can't wait to find out what was stuck to what!!!

thanks again for the support, love to you all,

Steph
  #9  
Unread 03-16-2003, 09:06 AM
update and questions...

(((Steph))),
Here is some info I found on Post-op Ovarian suppression from Dr Redwine's site:
  Quote:
Ovaries Post Op: Suppress Them or Not?

by Robert B. Albee, MD
Let me begin by explaining what I mean by the term 'post-op ovarian suppression'. When I say this, I am talking about using a medication to make the ovary inactive for a period of time immediately after surgery. In most cases a birth control pill is used because it is the least expensive and has the fewest side effects for most women.
The Pill uses one estrogenic compound and one progestagenic compound to raise blood levels. When the hypothalamus in the brain senses the presence of these hormones, it does not signal the ovary to begin the egg-development process. This normally occurs through the release of FSH and LH.

The end result is a quiet ovary that does not ovulate or produce the normal ovarian hormone contribution. Thus, we trade the ovary’s normal hormones for the low-dose, well-regulated combination of hormones that come from the pill. Although this explanation is a little simplified, I think it does explain the basic process.
What Others Do:

Some physicians prescribe post-op ovarian suppression routinely. Although it is inappropriate for me to imply that I know the reasoning of every surgeon, I will list the reasons that I hear most often at meetings, on medical records, and from the patients of those physicians.

Prevents more endometriosis from returning as quickly as it otherwise would.

Allows more complete healing of the injured tissues before allowing the next ovarian cycle.

Minimizes stimulation of the endometriosis they left behind.

Is good practice to keep patients on some form of suppression unless they are actively trying to conceive.

What I Used to Think:
I have discussed post-operative ovarian suppression before in this newsletter. It had been my belief that if all a woman's endometriosis has been completely excised, there was no real reason to recommend suppression as a form on ongoing treatment after surgery.

Therefore, I have consistently used simple ovarian suppression with oral contraceptives only when contraception was the objective. I do not use the stronger drugs (Lupron, Synarel, Danazol, RU-486, Zoladex) for this purpose at all.

Avoiding the unnecessary use of medications saves money, prevents side effects, and gives the patient a better opportunity to evaluate the improvement in her pain after surgery at the Center for Endometriosis Care.
What I Think Now:
It had been my policy to not suppress a patient post-op, except for contraceptive reasons. However, I have begun to prescribe a short-term interval of post-op ovarian suppression for a period of two to three months, in specific situations and for a specific benefit.
As we have followed our patients through the first three months after their surgery, we have observed that women who had certain procedures experienced much more pain during their first months of recovery. These procedures are the excision of an ovarian cyst or a cystectomy.

Some of these individuals do well at first, but then start their menstrual period before the expected time. This may greatly increase the pain they are experiencing. When I reviewed the charts for these patients, I found that many of them had a cyst removed from an area of the ovary where the developing follicle or corpus luteum was, and so it was removed as well. This stops the production of estrogen and progesterone, and so menses began.

Another group of women seems to be recovering nicely, then have a sudden increase in their pain around the time of expected ovulation in the first or second cycle after surgery. This may be due to an interruption in the capsule of an ovary recently operated on. The ovary is still swollen and injured from the recent cystectomy. It is extremely tender. Some of these ovaries generate a very small amount of internal bleeding, which is almost always temporary but extremely painful.

Because of these experiences, I now consider the amount and nature of ovarian surgery I have performed before I make a recommendation regarding ovarian suppression.

I believe that if cystectomy is required in order to completely excise a woman’s endometriosis, the use of oral contraceptives for the first three months post-op may help avoid unnecessary pain as related to the events described above.
http://www.centerforendo.com/news/ov...n/ovarysup.htm
  Quote:
Established Treatments for Endo:
Danazol:
Danazol is related of testosterone (male hormone). It is an effective medication for suppression of endometriosis, but it has been plagued by significant side effects. This drug suppresses endometriosis by two separate mechanisms. First it will decrease estrogen production in the ovaries, by suppressing FSH & LH production. The second mechanism is direct effect on the implants of endometriosis causing them to shrink (atrophy). Danazol will relieve pain in up to 90% of women undergoing six months of therapy. After stopping the treatment there may be recurrence of pain within one year in up to 35% of individuals. The side effects of Danazol include weight gain, acne, hot flushes, increased hair growth and decrease in breast size.
GnRH Agonists:
GnRH agonists cause pseudomenopause by suppressing production of FSH and LH by anterior pituitary. There are three commercial preparations available in US Lupron Depot (Leuprolide acetate) given in monthly injections, Zoladex (Goserelin acetate) inserted under the skin every 28 days, and Synarel (Nafarelin acetate) used as intranasal spray twice a day. GnRH agonists provide effective pain relief for most of the women suffering from endometriosis by producing menopause like state causing endometrial implants to shrink (atrophy) secondary to the lack of estrogen. After stopping the treatment there will be recurrence of pain within one year in up to 50% of individuals. The side-effects of GnRH agonists include hot flushes, vaginal dryness, decreased sexual desire, irregular vaginal bleeding, depression, sleep disturbances, joint stiffness and skin changes. The other concern is that of possible osteoporosis associated with prolonged use. This problem was recently addressed by adding small dose of estrogen to the treatment regimen.This add-back therapy seems to diminish symptoms associated with pseudomenopausal state.
Oral Contraceptives:
It has been known for the long time that use of oral contraceptives by women suffering from endometriosis will diminish their pain during menstruation. Continuous use of birth control pills without pill free week for menstrual period will produce the state of pseudopregnancy decreasing pain even further. Use of birth control pills appears to be less effective in women suffering from deep fibrotic endometriosis and endometriomas. The side effects of continuous birth control pills therapy include weight gain, irregular bleeding and headaches. This regiment should not be used in women with history of liver disease, blood cloths in their legs, suspected breast malignancy and women who smoke.
Progesterone Derivatives:
Oral progesterone preparations (Amen, Cycrin, Provera) and megestrol (Megace) used on daily basis for up to six months and depot medroxyproesterone (Depo-Provera) injections every three months has been used to suppress endometrium both in the uterus and in the sites of endometriosis. They produce significant pain relief in patients with mild to moderate endometriosis and without evidence of endometriomas. The side effects include irregular bleeding, nausea, weight gain, fluid retention and depression.
Pain Medications Non-narcotic:
Motrin, Anaprox and Ponstel belong to the group of nonsteroidal anti-inflammatory drugs. These drugs were initially developed to treat pain associated with arthritis. Shortly after their development they were found to be quite effective controlling pain associated with menstruation. They also decrease pain caused by endometriosis. The action of these drugs is related to their ability to interfere with production of prostaglandins (hormones released during inflammatory reaction). These drugs are the most effective when they are used in anticipation of the future pain, as it can be done prior to the beginning of the menstrual period. They can also be used daily for prolonged period of time to diminish chronic pain, as in women suffering from endometriosis.
Pain Medication Narcotic:
Use of narcotic pain medication to control chronic pain has been always controversial, because of the issue of the drug addiction. Periodic and occasional use of narcotic pain medications on the other hand can be helpful in dealing with sudden worsening of the chronic pain, as during menstrual period in women suffering from endometriosis, or during occurrence of ovarian cyst.Such a use should be planned for a limited time and there should be other plans to manage underlying cause of the pain, by medical or surgical means.
Intensive Psychotherapy:
Women suffering from endometriosis are facing daily pain. Despair accompanies pain. Helpful interventions include therapy that improves woman self-esteem. Psychotherapy by a well-trained mental health professional is necessary to treat depression when it occurs, in addition to any other interventions.
Antidepressants:
Low dose of antidepressants has been used for quite a while in management of chronic pain. Their action is thought to be related to their effect on pain perception in the central nervous system (brain and spinal cord).
Physical Therapy:
Physical therapy is quite useful in helping to manage chronic pain in many women suffering from endometriosis.Women suffering from chronic pain will develop ways to minimize the pain. They will walk differently; they will tense certain muscles during intercourse, bowel movement, bending and other activities. These will cause certain muscle groups to be in continuous spasm, which in turn will produce additional pain related to this spasm. The role of physical therapy is to identify these painful areas and to work with women helping them to stretch and relax theses muscle groups.
Exercise:
It is well known fact, that aerobic exercise is associated with release of endorphins (morphine like substance), which decrease pain perception. The pain induced during high impact and jarring movements prevents many women from continuing their usual exercises.
Exercises specially designed for women suffering from pelvic pain, will avoid aggravation of the symptoms and will allow achievement of aerobic state with its beneficial effects.
Dietary Considerations:
There are two kinds of dietary considerations: general considerations common for every one and individual considerations varying from person to person. Most of the food we consume is processed to enhance its appearance, storage time, and sometime taste. To achieve these effects food manufacturers have to use many different chemical compounds. For women suffering from endometriosis I would suggest diet similar to that used for patients with chronic fatigue syndrome. This includes avoiding of fast food, processed food, food with high content of sugar and other carbohydrates (sweets, pastries, sodas, etc.) and increase fish, chicken (free range), turkey (free range), lamb, salads, legumes, olive oil, flaxseed oil. The individual considerations will vary from person to person depending on their tolerance of diary products, citrus and other different kinds of foods, which may need to be avoided.
Endometriosis Angels:
http://www.endoangels.com/links.html

eMedicine - Endometriosis : Article by Manuel Hernandez, MD http://www.emedicine.com/aaem/topic181.htm

Radical Endometriosis Surgery:
http://www.reproductivecenter.com/radical.html

Jenny's Endo page:
http://www.angelfire.com/mi/jenneybean/

Endo Association family program:
http://www.endo-online.org/family.html

Theories of origin:
http://www.endometriosisusa.com/theories.html

New and Emerging Treatments for Endo:

  Quote:
Danazol Vaginal:

This appears to be a new and very promising method of suppressing pelvic endometriosis. The treatment plan I use is based on data from studies by a Japanese research group lead by Dr Masao Igarashi.

Danazol was one of the first drugs used to suppress endometriosis. Although it provided good suppression, its side effects: weight gain, acne, hot flushes, increased hair growth and decrease in breast size caused us to abandon it in favor of GnRH agonists. Vaginal Danazol suppresses endometriosis without causing any of the above-mentioned side effects. It gets absorbed directly to the pelvic tissues through the wall of the vagina. The only side effects experienced by my patients using Vaginal Danazol include some vaginal irritation and occasional constipation and those effects are easily corrected. I use Vaginal Danazol after removal of endometriomas and laparoscopic resection of fibrotic endometriosis to suppress any residual and microscopic endometriosis. I am also evaluating the use of vaginal Danazol prior to operative laparoscopy, especially in women with endometriosis involving their bowels. The hope is that pretreatment will decrease size of the fibrotic lesions, making less extensive surgery possible.

Progestagen Releasing Intrauterine Device:

European centers are evaluating intrauterine device containing a slowly released progesterone like, drug. Patients using these devices seemed to have less painful periods and less menstrual flow.

Antiprogesterone Drugs:

GnRH Antagonists:

These drugs are used in Europe to treat endometriosis. They are comparable in their effectiveness to GnRH Agonists.

Vessel Growth Factor Agents:

Agents that affect the growth of new vessels in our body are being tested in cancer therapy. I am not presently aware of the results of any studies in US in patients suffering from endometriosis.

http://www.endometriosisusa.com/endonew.html

  Quote:
There may be no significant symptoms of implants on the surface of your ovary unless there is the formation of adhesions. You may, however, experience pain on the side of the pelvis where the implants are present. The pain might be a continuous ache or burning, usually worse during menstruation. Additionally, you may feel pain deep in the pelvis or inside the vagina during sexual intercourse, this pain also will intensify during menstruation. During pelvic examination, your physician can likely reproduce some of the pain when he or she palpatesand move the affected ovary.
Treatment: Laparoscopic CO2 laser vaporization or harmonic scalpel destruction of the implants is the optimal surgical treatment for you because neither of these causes significant damage to the ovary itself.If you do have adhesions between the ovaries and the surrounding organs, they should be resected by use of CO2 laser, harmonic scalpel, or laparoscopic scissors with only minimal use of electrocautery. In some cases Lupron Depot suppression for six to nine months may be effective, but you should be aware that it will not affect already formed adhesions. As an additional option you may want to consider suppression using Danazol vaginal suppositories.

Endometriosis inside the ovary:
Description: Endometriosis inside your ovary is usually transformed into the cystic structure within your ovary called endometrioma (chocolate cyst).The endometriotic implant within your ovary or the surface implants burrowing into your ovary are surrounded by ovarian tissue. A small amount of fluid and blood produced by the implant during each menstrual cycle cannot escape that enclosure and it will accumulate within your ovary, forming a cyst (fluid filled space) called endometrioma.The inside of the cyst provides the surface for the endometriosis to spread and grow. This in turn makes the volume of fluid produced with each menstrual cycle greater and makes the cyst grow larger.There are occasional breaches of the wall of the cyst, which allows some of the bloody fluid to escape into your abdomen and pelvis. This in turn causes an inflammatory reaction (irritation) within your abdomen and the formation of scar tissue around the leak as your body tries to prevent wider spread of this irritating material.
You should note that endometriosis of the ovary is almost always a benign condition, and only very small number of endometriomas will show malignant changes.

Symptoms: Pain in your lower abdomen is a common symptom of endometrioma. It is usually chronic and more pronounced on the side of the cyst, sometimes it will radiate to your lower back. You will find that the pain is usually worse around the time of menstruation and on occasion it will become quite severe.There also may be deep pain during sexual intercourse.If you have this condition pelvic examination will usually reveal an enlarged ovary, which may be quite tender and often times is immobile.

Diagnosis: While the combination of your symptoms and a pelvic examination, are often enough to make a diagnosis, you should likely also get an ultrasound in order to identify the cyst within the ovary.Vaginal ultrasound usually provides significant detail as to the appearance of the cyst and aids toward fuller diagnosis of endometrioma. Ultimately, only Laparoscopy and surgical removal of the cyst wall provide a definite diagnosis as to the kind of cyst. Note that CT scan and MRI scan can usually identify cystic masses in your pelvis but they are not as helpful as ultrasound in providing details of its internal appearance.

Treatment: Aspiration of the bloody or chocolate fluid from the cyst is not an effective treatment because the entire lining of the cyst, including all of its endometrial implants, is left behind and ready to form a new cyst.

Laparoscopic resection of the endometrioma is the most effective minimally invasive method of treatment.Because most of your ovary and its function, including all of its eggs, is located on the surface of your ovary, your physician safely proceed to the inside of the cavity of the cyst and remove the entire wall of the cyst, leaving your ovary and its function preserved. Laparotomy alternately and resection of the endometrioma does remove the entire lining of the cyst, but it adds the element of an open abdominal procedure that may be associated with increased formation of new postoperative adhesions and longer recovery.

There are other methods of treatment; these include destruction of the lining of the cyst with CO2 laser, argon laser, YAG laser, electrocauthery, harmonic scalpel and heat probes.It is also possible that a combination of aspiration of the endometrioma followed by Lupron Depot suppression of the endometriosis can be effective in treating endometriomas.

Removal of the ovary containing endometrioma is quite a radical approach and you should consider this if you are not contemplatingfuture pregnancy, if you have massive adhesions around the ovaries that failed previous attempts of conservative surgical treatment or if there is a possibility of ovarian malignancy.

Endometriosis of the fallopian tube:

Description:
Endometriosis implants can be present on the surface of your fallopian tube, your mesosalphinx(connection between the fallopian tube ovary and the pelvic side wall) or within the wall of your fallopian tube. Endometriosis of the fallopian tube can play a role in infertility.
Symptoms: Your symptoms will be the same as those of endometriosis of the ovary.

Endometriosis of the pelvic sidewall:
Description:Your pelvic sidewall is covered by a peritoneal layer and faces the front and sides of your ovaries. It contains large blood vessels, nerves and your ureter.This is one of the most common locations for endometrial implants and adhesions.

Symptoms: Pain (burning and aching) in the right or left lower quadrant of your abdomen and on the right or left side of your pelvis is a common symptom.The pain usually worsens before and during menstruation. The pain may also increase with walking or physical activity, especially if there are lateral pelvic wall adhesions between the enlarged endometriotic ovary and peritoneum of your pelvic sidewall.
Treatment: Reestablishment of your normal pelvic anatomy and removal of all endometrial implants is the goal of the treatment.If adhesions are present between your ovary and your pelvic sidewall, the adhesions will need to be divided before your entire pelvic sidewall can be evaluated for the presence and extent ofendometriosis.Your physician may use one of many methods to divide the adhesions between your ovary and pelvic sidewall, including dissection with scissors, CO2 laser dissection and harmonic scalpel dissection.

With your ovary freed up, your peritoneum is exposed such that the extent of endometriotic lesions can be assessed.The most effective method of treatment in this area is to resect endometriotic lesions together with the area of your peritoneum through which they are growing.The key to successful treatment is for your surgeon to identify the course of your ureter (the tube that carries urine from each kidney to the bladder) that traverses just below the peritoneum of your pelvic sidewall. The other important structures that your surgeon needs to identifiy include large blood vessels and nerves that are located in your pelvic sidewall.

Once these structures are identified, your surgeon will inject normal saline solution below your peritoneal layer, which elevates your peritoneum and endometrial lesions away from these vital structures. This produces a safe buffer zone where the laser, harmonic scalpel, or scissors dissection can be carried out.In dissection I try to avoid using unipolar electrocauthery which, although it provides for bloodless resection, it uses high-density electrical current. The surge of electricity can theoretically damage sub-peritoneal mesothelial cells, which are essential for reconstruction of a normal peritoneum within seven to ten days after surgery.To control bleeding points, your surgeon may use CO2 laser, harmonic scalpel, or bipolar electrocauthery.Note that resection of the lesions of the pelvic sidewall is greatly preferred over their destruction by laser, harmonic scalpel, or electrocauthery, due to the fact that destruction is often incomplete (it does notdestroy the lesion deeply enough).

Additional postoperative therapy with GnRH agonists (Lupron Depot, Synarel, etc) or Danazol may improve the effectiveness of the surgical treatment. As an additional option, you may want to consider using Danazol vaginal suppositories.

Endometriosis of the bladder area:

Description:
Your bladder occupies the space in the front of your uterus and is loosely covered by peritoneum, allowing it to expand as it fills with urine.This expansion process should be totally painless. Endometriosis of the bladder area usually begins with superficial implants; many of them remain as such, causing local irritation and superficial scarring.On occasion, the implants will start growing into the deeper layers of your bladder wall, creating artificial attachment of your superficial peritoneal lining to your bladder wall.

Symptoms: Low abdominal and pelvic pain, usually in the middle, is the most common symptom. Your pain may be aggravated by bladder distention and by sexual intercourse.In the case where your bladder wall is actually penetrated by endometriosis, your symptoms may include pain with urination and the presence of blood in your urine, especially during menstruation.
Endometriosis of the posterior cul-de-sac


Description:The posterior cul-de-sacis the space behind your uterus. It is surrounded by your uterus in the front, pelvic sidewall and ovaries on the side, and your sigmoid colon in the back. The floor of your cul-de-sac contains your uterosacral ligaments, your rectum and the upper portion of your vagina.The posterior cul-de-sac is one of the most common locations of endometriosis in the pelvis.Most of the time, the implants are quite superficial, but in a number of women they will invade deeper into the tissues. They may form nodules within your uterosacral ligaments, they may cause attachment of your sigmoid colon and rectum onto the posterior wall of your uterus. This causes the most extreme form of the involvement, cul-de-sac obliteration.

Symptoms: Constant pelvic pain/ache is the most common symptom.The pain is usually more severe during menstruation and is usually located in your lower abdomen and lower back. Pain may extend to your upper thighs and your rectum and there may be deep pain in your vagina during sexual intercourse, many times preventing normal sexual relations.There also may be pain with bowel movements.

Endometriosis of the bowel:
Description:Your sigmoid colon (lower portion of the large bowel) and your rectum are pelvic organs which are anatomically associated with areas that are common sites of endometriosis.In some patients, especially those with severe endometriosis, there is extensive involvement of the bowel wall.Most commonly, the endometriotic bowel implants will be restricted to the surface of you bowel and adhesions around your bowel. In more severe cases, the implants may involve the entire thickness of your bowel wall.Your appendix is part of your bowel and on occasion it will become a pelvic organ. The appendix is involved in approximately one percent of patients with endometriosis.

Symptoms:
Themost common symptom associated with endometriosis of the bowel is cramping and diarrhea during menstruation (many patients will be incorrectly diagnosed as having irritable bowel syndrome).Minimal and superficial endometriosis of your bowel does not have any specific symptoms different from those of the endometriosis of the cul-de-sac.But severe endometriosis infiltrating deep into your bowel wall is usually associated with chronic pelvic and back pain and painful bowel movements, generally worse before and during menstruation. In endometriosis that has penetrated your bowel wall completely, you may note rectal bleeding or some blood covering the stool during menstruation. In such case, you will likely suffer from extreme pain during bowel movement.

Endometriosis in remote locations:
Description:Endometriosis can implant itself in any number of locations outside of your pelvis.It might involve your omentum(fatty apron lying loosely in the abdominal cavity), small bowel, umbilicus, surgical scars, diaphragm, lungs, kidneys and many other organs and locations.The symptoms will usually be specific to the site involved and generally will be worse during menstruation.

http://www.endometriosisusa.com/endodetails.html
Hysterectomy & Endometriosis Questionnaire:
http://www.angelfire.com/fl/endohystnhrt/quest.html

Endometriosis Conquering The Silent Invader:
http://www.ivf.com/ch17mb.html

Recurring Endo at the Center For Endometriosis Care:
ttp://www.centerforendo.com/news/recurrance/recurrance.htm

Endometriosis-Dr. Stanley West:
http://www.repmed.com/endo.html

Endometriosis Treatment Program @ St. Charles Medical Center-Bend, OR-Dr. David Redwine:
http://www.endometriosistreatment.org/

Hysterectomy & Endometriosis Questionnaire:
http://www.angelfire.com/fl/endohystnhrt/quest.html

Incisional Endometriosis:
http://www.facs.org/dept/jacs/lead_a...apr00lead.html

Endometriosis Research Center:
http://www.endocenter.org/

Radical Endometriosis Surgery:
http://www.reproductivecenter.com/radical.html

Talking To Your Doctor About HRT:
http://www.aeron.com/new_page_21.htm

Endometriosis Despite Hysterectomy:
http://www.stanford.edu/group/whpu/qa/07,09,99.html

The Great Debate on Endometriosis is back! http://www.endozone.org/display.asp?...SRM2002-Ledger

A War With Endo:
http://geocities.com/cgizhpito/endowar.html

Endometriosis Angels:
http://www.endoangels.com/links.html

Good Luck on Tues ((Steph)) Pls post when you can & let us know how it went
((((hugs))))
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