News for May 8th 2009
CAW ENDOMETRIOSIS SPREAD DURING SURGERY?
In her letter to me, a twenty-eight-year-old Grand Rapids high school teacher wrote of her fears about undergoing surgery. It seems that Marilyn’s reservations about having surgery—even though it was tor diagnostic purposes only —win based on a misinformed connection to cancer. She wrote:
“My doctor feels I have endometriosis, but he wants to do surgery to confirm it. I’m worried that if I have surgery, the disease will only get worse. I have heard that endometriosis acts just like cancer. If you cut into it, the disease can spread because (1) some cells can get free from the tumor and infect other organs and (2) the cells arc stimulated Co grow from the oxygen in the air. Is there a way to confirm my endometriosis without the risk of making it worse?”
Marilyn’s questions touch on two important issues involved in understanding and treating endometriosis. The first is the reason tor surgical diagnosis, and the second involves the confusion between the pathology of cancer as one type of disease and endometriosis as another.
A woman’s medical history in combination with her doctor’s clinical findings might clearly indicate endometriosis, thereby making surgical diagnosis unnecessary. But this cannot always be the case. If a doctor is unsure of the diagnosis (especially when endometriosis is at an early stage of growth and docs not yet produce large masses), or if he is unable to determine the nature of the tumor he feels while giving his patient an internal examination, he will want to do a laparoscope Although this is minor surgery (it will be discussed and illustrated in the next chapter), it is for Marilyn and women like her, still an operation wherein something might go amiss.
There has been some documentation of endometriosis spreading as a result of laparoscope but this is rare and is most likely to occur when there is a history of repeated laparoscopics. In these cases, the endometriosis grows internally around the area of incision and implants itself in the scar, and a second or third incision in the same scar could free some cells. In a few cases, women who underwent surgery for hernias were later found to have endometriosis in the scar tissue.
If Marilyn’s doctor feels that laparoscopy is called for, and there is no emergency, he might prescribe the medication Danocrine renders endometriotic cells inactive. Taking Danocrine for a two-month period preceding laparoscopy should be sufficient to halt the growth of Marilyn’s endometriosis, as well as lay to rest her Sears about contamination during the procedure.
Cancer and endometriosis do not have much in common, other than their methods of invasion in the body. Cells of either type may use similar channels to reach internal organs such as the lymph system or the blood, or, after implanting themselves, cells may metastasize, or grow into a cyst or tumor. Endometrial cancer and endometriosis are not the same disease, although it has been found that childless women tend to be vulnerable Co both conditions and that a great percentage of women with endometrial cancer suffer from menstrual irregularities.
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Edited: May 8th, 2009
SKIN INFECTION: SCABIES
The most common parasitic infestation of man is by the mite Sarcoptes scabei. The mite is less than half a millimetre long, and barely visible to the naked eye. The female is fertilized on the skin surface and then burrows into the skin, depositing eggs on the way. The eggs hatch in four days, the larvae maturing on the surface ten days later. As the life cycle is completed on the skin, the untreated scabies infection will persist indefinitely.
Human scabies has played a modest but not insignificant role in history. Severe infestations have lowered the morale of armies in the field, contributing to major military defeats. The world incidence shows an interesting cyclical pattern which is not completely understood. Scabies is usually transmitted by close personal contact, usually in the warmth of a bed. Indirect spread is relatively rare. The mite cannot survive for more than a few days away from the skin. The connection between promiscuity and scabies is indicated by the very similar age end seasons} incidence of scabies and venereal disease (that is, both occur most commonly in young people in the 16-25 age-group, particularly in the summer months) and the fact that those with scabies are not infrequently found to have venereal disease as well.
The lesions of scabies are mostly a manifestation of allergy to the mite or its products. With a primary infestation symptoms do not appear for weeks after contracting the disease. If, however, a person has been previously affected, he or she will develop spots and itching within hours of contracting the disease. The commonest and most disabling symptom of scabies is an intractable, generalized, unrelenting itch. It is markedly worse at night. Examination of the webs between the fingers, of the wrists, the breast or penis, may reveal the classical burrows where the mite has gained entry. Secondary lesions, however, account for most of what is seen. These consist of various lumps, bumps, pustules, crusts, and scratch marks. Only rarely is the face or neck involved. The areas most commonly involved are the hands, the breasts, the buttocks, and the genitals. Confirmation of infection is by microscopic identification of the mite, its eggs or its droppings. They are usually found in one of the burrows.
Treatment involves the whole family and all intimate contacts. The whole skin below the chin must be treated, not just the areas which appear involved. After a hot bath and scrub, 25 per cent benzyl benzoate emulsion, or 1 per cent gammabenzene hexachloride cream should be applied. Twenty-four hours later, this should be repeated without bathing between times. The clothing and bed linen must then be changed. Normal laundering or hanging up of the clothes for a week will destroy the remaining parasites and larvae. The treatment may if necessary be repeated once after two weeks. Extra applications should be avoided because of the irritant effect of the applications.
Scabies is by no means rare these days. It can be very difficult to diagnose, however, in the well-groomed and well-washed individual who is often. In fact, the sufferer of this complaint.
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Edited: May 8th, 2009
NUTRITIONAL ASPECTS OF APPETITE CONTROL
The concept of the satiety cascade implies that the effect of any given food will depend on its own unique nutrient composition. This poses a number of questions;
• how do the different nutrients in food contribute to satiation and satiety by suppressing hunger?
• will the suppression of hunger reduce energy intake or cause a compensatory increase at meals eaten later?
• do different nutrients affect fat loss or gain?
Keep in mind that many of our ideas about the nutritional aspects of appetite control come from studies on laboratory rats. These can be far removed from the real world of takeaway pizza, so we need to be cautious when extrapolating these animal findings to humans.
Unlike excess dietary fat intake, which has a clearer relationship to gains in body fat, the various factors that influence appetite may vary greatly between individuals. Let’s look at the evidence for different nutrients.
Myth-information. Meal replacement biscuits are generally high in energy and fat. They would only work if they could control the intake of food later in the day—and they don’t!
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Edited: May 8th, 2009
FEELINGS AND EMOTIONS IN CASE OF ENDOMETRIOSIS: FRUSTRATION
Before you were diagnosed many questions no doubt regularly crossed your mind, including:
Am I neurotic
Are these symptoms all in my head
Is there anything really wrong with me
Do I have a low pain threshold
Why am I unable to cope with period pain when my friends have no trouble
Why do I have to spend so much time laid up in bed suffering
Will I have to suffer and tolerate this period pain until I reach menopause.
These questions probably bring a wry smile now, but when we consider the difficulty many women with endometriosis had in getting a doctor to acknowledge that something was really wrong, it can be seen that pre-diagnosis is an extremely difficult and emotional time.
Those suffering dyspareunia often ask what causes them to have pain during intercourse. Those who are infertile cannot understand why they cannot get pregnant.
It is common to feel frustrated with your partner, family and friends before endometriosis has been diagnosed because you are unable to tell them what is wrong with you, why you are in so much pain, why you are feeling tired and depressed.
Some women are in pain for just a few days each month and look perfectly well for the rest of the time, and it can be difficult for those close to you to accept that there is something wrong. They may not take your pain seriously or may misinterpret your inability to take part in social gatherings and leisure activities, labelling you as lazy or trying to opt out. Sometimes your pain may have been interpreted as a quest to get sympathy and attention. Some may have accused you of being lazy because your pain has rendered you tired and incapable of doing your usual daily chores.
Students have found that they have been accused of trying to get out of school work, study or exams. Few of us have been lucky enough to escape those days when the pain has disrupted time at work, school or home. Unfortunately, teachers, employers and partners may not be sympathetic to your illness and you feel frustrated and isolated.
There are also times when doctors have frustrated us because they have refused to take our symptoms seriously by saying: ‘It’s a woman’s lot’ or ‘You’ll just have to learn to live with the pain’ or ‘It will get better once you have a baby\ Then there is always: ‘You won’t have any more period pain once you reach menopause’. Not reassuring news!
None of these quotes will be of any comfort to those wanting an answer to a problem that could well plague them for their reproductive years.
Partners too can be frustrating at times. Even those who are understanding and have the best of intentions can drop the odd stinging remark here and there. Some ask if you really love them because you have refused intercourse — yet again — because you are simply in too much pain. Or perhaps you are not in pain and would like to keep it that way for at least one night!
For those women who already have children, endometriosis can put a strain on their relationship. No child likes to see its mother unwell and in pain. For younger children it is difficult to understand why mummy is grumpy and moody; for the older ones it can be annoying when mum is out of action and not available to tend to their needs.
It is important that you continue to seek a correct diagnosis. You know your own body, and you are the best person to recognise if there is something wrong. Do not be fobbed off. Try not to be discouraged. Keep searching and exploring until you have an answer.
And if that means that you have to insist on investigations and tests to reveal the problem, insist!
You must remember that severe period pain, painful intercourse, backache and heavy bleeding are not normal. You do not have to put up with it.
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Edited: May 8th, 2009
HOW IS ENDOMETRIOSIS DIAGNOSED: CA-125
CA-125 is a substance known as cancer antigen 125 which is produced by the endometrium and is found in the blood. It was discovered while researchers were trying to find a test for ovarian cancer.
Researchers found although it was present in extremely high levels in some women with ovarian cancer, raised levels were also found in some women with a range of gynaecological conditions, including endometriosis, adenomyosis, pelvic inflammatory disease, unexplained infertility and during pregnancy and menstruation. In an attempt to find a reliable blood test for endometriosis researchers have been investigating the levels of CA-125 in women with endometriosis. They have found that the levels in women with minimal and mild endometriosis are no different to those found in women in general but the levels in women with moderate and severe endometriosis are generally significantly higher.
Unfortunately, the CA-12 5 test is not yet sufficiently accurate to replace laparoscopy as a general test for the diagnosis of endometriosis because the levels are not raised in all women with endometriosis and because the levels are raised in a range of conditions other than endometriosis.
For now, the most useful role of the CA-125 test appears to be in monitoring the progress of the disease after a definite diagnosis has been made. The levels of CA-125 appear to rise as the disease worsens and fall as the disease improves. Therefore, it may be possible to use repeated CA-125 tests to help determine the real effectiveness of drug treatment or to determine whether or not the underlying disease has worsened, improved or recurred, thereby avoiding the need for repeat laparoscopies.
The CA-125 test offers the most promise as a diagnostic test for endometriosis but further work is necessary before it will be accurate and reliable enough to be used by gynaecologists for the diagnosis and monitoring of endometriosis.
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Edited: May 8th, 2009