I Will Not Suffer In Silence

Let’s start with a review:

My second laparoscopy was December 17, 2010, in which I was diagnosed with new endometriosis growth, and put at Stage I.

My surgeon found endometriomas on both ovaries, and cleaned out as much as she could. She removed a 1.4cm endometrioma from the right ovary, and had to leave the endometrioma in the left ovary, because it was too deeply embedded, and I did not want to lose my ovary. There were adhesions pulling the left ovary back towards my uterus again, just like in 2007, so she cut away the adhesions and repositioned the left ovary as best she could.

I spent the next three months healing from the surgery, and still experiencing debilitating pain. However, between pain cycles in May and June 2011, I experienced 20 and 17 consecutive pain-free days respectively – the highest number of consecutive pain-free days EVER since I began meticulously recording my cycles.

In fact, for the entire year of 2011, I never fell below 10 pain-free days in a single monthly cycle, which was an improvement over the year before.

Beginning in April, 2012, I experienced moderate nausea on the 14th, 17th and 19th (throughout my cycle). I had to take ginger tea, the nausea was so intense. This to me usually signals an ovarian cyst, so I called my surgeon and scheduled an ultrasound.

Then, on May 3, 2012, something unexpected happened, that has (I think) nothing to do with the endometriosis.

On May 2, 2012, the workplace had the carpets cleaned as per routine, but when I walked in the building on the morning of May 3, I immediately had respiratory distress. Now, I have a history of breathing problems and chemical sensitivity dating to 2009, when the interior of my apartment was sprayed by an exterminator for ants at the landlady’s request. But I’d never had wheezing issues or felt like I was drowning in lung fluid before.

On May 3, my breathing got worse over the time I was waiting for a backup assistant to come into the classroom, and by the time someone arrived, I was a sobbing basket-case from not being able to breathe. The director of the school drove me to my doctor’s office, where I had some preliminary tests run, and was given an albuterol inhaler and an epi-pen. I was told I probably have asthma.

Three weeks later, I finally got to see my allergist, who ran me through a computerised breathing test, and detected a ‘lung blockage’ and gave me a steroid inhaler. Within 2 days on the steroid, I had ‘roid rage’ and discontinued it. I continued taking the albuterol inhaler, though. Four weeks after that, I was given another computerised breathing test, and nothing had changed. I was given another steroid, and this one worked for about three weeks, at which time I became clinically Manic on the stuff, so discontinued it. I have used the albuterol throughout, as a ‘rescue’ inhaler.

So the ovarian cyst took a back seat to a new health condition; asthma.

I researched whether asthma is also an autoimmune disease, and was dismayed to find that people don’t really know much about how asthma develops. Even my own asthma specialist doesn’t know if asthma is autoimmune.

The reason I want to know is twofold: first, endometriosis is autoimmune, and when a person has one autoimmune disease, it means they have other concurrent as well as other undiscovered autoimmune diseases.
Second, there have been cases of lung endometriosis.

My family has a history of bronchitis, emphysema and endometriosis, so this is something I should be concerned about. I’ve never smoked cigarettes, but I did grow up in a heavily industrial and polluted area with pack-a-day cigarette smokers. I’ve always been sick with sinus infections and bronchitis every winter and/or spring.
Oh and hey, as of a 2010 study, it appears that emphysema may be autoimmune. File that away for potential future reference…

In the meantime, my periods were getting worse, and I was back to being fully bedridden during each cycle – something I’ve not had happen regularly since before surgery in December, 2010.
This means I had just over a year and a half of slightly improved health from surgery. That is to say, I had a longer uptime between periods, and one or no bedridden days per cycle, BUT I am still getting up to 7 or 8 on the pain scale at times, I am still experiencing heavy bleeding, and I am still consuming Tylenol 3.
Basically, it boiled down to “I’ll take what benefit I can get from the surgery.”

Once I was being treated for the asthma, I went back to address my worsening symptoms, still suspecting an ovarian cyst. On July 11, 2012, I saw my surgeon, who performed a vaginal ultrasound. She detected a 7mm (0.9cm) endometrioma on my right ovary.

For those who are questioning, YES, it IS possible to detect endometriomas through vaginal ultrasound. My surgeon visualised the 1cm endometriomas on both ovaries in September, 2010; three months before my surgery (more on sizing in a moment).

So my suspicions are correct in that I once again have an ovarian cyst, but I had not anticipated an endometrioma. I thought it was just an ordinary cyst, and I wanted to get specs on it to make sure it wasn’t too large to reabsorb.

What I got instead was really bad news; an endometrioma does not reabsorb or go away.

Ovarian cysts are formed when the egg doesn’t fully release from its follicle, and just keeps growing inside of the follicle. The cyst can live in or on the ovary, or in the fallopian tube, and most often goes away on its own, despite causing some nasty pain and/or nausea while it is present.

An endometrioma is “a tumor containing endometrial tissue.” Endometriosis has traveled outside of the endometrium and has embedded itself onto or into the ovary, where it begins to grow. It is called an endometrioma when it goes from being an embedded implant to a growing, swollen, fluid and blood-filled foreign mass. It is now called a tumour.

I’m told that endometriomas are not considered a threat under 4cm in size. Past that, one should be closely monitored in case the tumour turns malignant.

We discussed how to manage the endometrioma and the endometriosis in general for the long term. My surgeon knows I will not take hormone therapy. I made it clear to her that I also do not want any further surgery unless my life depends upon it. I told my surgeon that I just want to be made comfortable til I hit menopause. I want pain medication and pain management. I’ve already put myself back into acupuncture, massage and naturpathy for alternative healing.

My surgeon exclaimed that it’s such a long time before I hit menopause. I told her no, my Ma hit menopause by age 43. My surgeon has referred me to a pain management clinic, and is still urging me to try the Mirena IUD, which puts out a small amount of levorongestrel (the same ingredient as in emergency contraception called Plan B). Due to my extreme sensitivity to hormones in the past, I don’t care how small the dose is, I’m not touching any further hormonal therapies.

I had a phone call with my Ma today, and confirmed that she hit perimenopause by the time she was 40, and was definitely in menopause by the time she was 43. She said her mom also had early menopause.

So that’s where I am at…waiting for menopause to hopefully burn the endometriosis out. It’s a hope, with full knowledge that it might not work.

I’m up to my eyeballs in work and school responsibilities right now, so I’ve not kept up with blogging in my usual narrative style. Sorry about that.

This is just a list – a run through of the past month. It will be TMI. I’m still experiencing some of the same things as happened before surgery.

Sunday, March 27, 2011: The usual pre-menstrual anal bleeds, which warn me that my period is on its way. It’s not always painful – it’s just alarming to see that much bright blood with a bowel movement. It happens every month right before my period.

Monday, March 28, 2011: Continued anal bleeds.

Tuesday, March 29, 2011: Moderate low back pain

Wednesday, March 30, 2011: Intermittent uterine cramps throughout the day.

Thursday, March 31, 2011: Very painful cramps which woke me at 3:30am. Took 1/2 T3. Cramps present again at 7am. Still bicycled to work because I’d missed my bus. Meanwhile, still dealing with bronchitis and had to use my inhaler when I got to work. Vaginal mucosa changed that afternoon to a pale pink.

Friday, April 1, 2011: George arrived. Still went to work for a full day. Hung out with friends at their house that night, eating tons of junky food.

Saturday, April 2, 2011: Day 2 of george. Took public transit to get my hair cut by a friend, then took transit home, then went and visited father-in-law in hospital rehabilitation.

Sunday, April 3, 2011: Day 3 of george. Bad pain day.

Monday, April 4, 2011: Worst pain day – called in sick to work. While sitting on the couch with heating pad, I turned to my side while in the midst of a violent coughing fit, and it felt like I broke a floater rib on my right side. The pain was excruciating.
Apparently this was the last of my coughing fits, and it really went out with a bang! I called the doctor, who said it’s likely a strain, not broken, cuz there’s no external bruising.

Tuesday, April 5, 2011: went back to work, still bleeding but the worst pain was over. Now dealing with the very painful rib strain. On 1,200 – 1,600mg Ibuprofen, taking Tylenol 3 at night to sleep through the rib pain.

Wednesday, April 6, 2011: Spotting. Still dealing with the very painful rib strain. On 1,200 – 1,600mg Ibuprofen, taking Tylenol 3 at night to sleep through the rib pain.

Thursday, April 7, 2011: Spotting. Still dealing with the very painful rib strain. On 1,200 – 1,600mg Ibuprofen, taking Tylenol 3 at night to sleep through the rib pain.

Friday, April 8, 2011:

Because my first pre-op appointment three years ago was not documented, I give you… super long ass detailed entry for this pre-op appointment!

I woke this morning around 6:30am in debilitating pain. I estimated I was 7.5 on the pain scale. Getting out of bed ramped it up to 8 on the pain scale. I wolfed down some cereal and took 1.5 Tylenol 3 in an effort to whack the pain.

Just after 7am, we loaded the wheelchair into the car and were on the road. I was nauseous and shaking from the pain – about an 8.5 on the pain scale. I cried on the way to the doctor’s office.

The pain meds kicked in about 30 minutes after taking them. I became chatty and felt alright. We were on the Bay Bridge, just approaching the toll booth at that time.

Then it went aweful again.

I became really dizzy and nauseated from the Tylenol 3. It occurred to me then that this had happened before – on the drive back from our one year wedding anniversary in Mendocino, California last year. I was on Vicoprofen at the time, but the results are similar enough – I was severely nauseated and dizzy and hunched over in the seat to try not to vomit.

So I noted out loud that when I am on codeine, I must not be in a moving vehicle, nor should I be ambulatory.

The visit itself went well. Nurse Jessie could see that I was poorly, so she ushered me into the room she usually reserves for me when I visit. She had me lay on the exam table and put a blanket on me. She got me a cup of hot water to drink.

My husband was with me the whole time. I was able to snooze for a few minutes, and then Dr. Giudice and her assistant, Dr. Skillern, came in to start the visit. At first Dr. Giudice described the general procedure and what to expect. She let Dr. Skillern talk a few times. After a few minutes, I said I was confused – I thought Dr. Wang was going to assist. Dr. G and Dr. S looked at each other, then back at me, and Dr. G simply said, “she was, but no.”

Oooooookay then! Wonder what untimely end her employment met!

At this point, I gruntled and shifted and forced myself to sit up so I could take notes, because I noticed my husband was not writing down anything on the questionnaire I had typed up. My surgeon took the 3-page document and we went over it together, twice, just to make sure everything was covered.

You really should copy these questions for your own surgeon interview. I got the questions from various places on the web, as well as using my own questions.
The questions are barely in any ordered format.

1) How many pelvic laparoscopies for endometriosis have you performed?

Well over 500 since 1987.

2) How many in the past month?

Dr. Giudice is a big ‘ol rock star now, so she often travels for seminars and such. She said that 93-95% of her surgeries per month are specifically for endometriosis.

3) How many had complications during the procedure?

She hates to jinx herself, but she says only one complication, and it was a fibroid issue – she discovered it was embedded in the uterine wall when she tried to take it out….

4) Do you have rectal surgery experience?

Yes, but it depends on how serious the endo is in that region.

4a) If not, will you have someone on hand in case there is rectal involvement?

No – she said that if adhesions to the rectum and intestines are found, they’ll do what they can within reason. However, if it requires a bowel surgeon, it’ll have to be yet another surgery. They just don’t have the surgeon on standby like that. Ugh.

5) Do you have intestinal surgery experience?

No

5a) If not, will you have someone on hand in case there is intestinal involvement?

See 4a above.

6) How much experience with pelvic laparoscopy for endometriosis does your assistant have?

More than 84 laparoscopic hysterectomies.

7) How many staff will be in the operating room with you, and what are their jobs?

Roughly six people: surgeon, surgeon’s assistant, anesthesiologist, anesthesiologist technician, scrub tech, and a circulation nurse.

8) Will you please correct my retroverted uterus?

Sadly, she cannot. She said the uterus is already held in place by a series of ligaments, and to push it into a position it was never in, even if it’s the “right” position, can lead to tissue damage and serious side effects. She said she’d see what she can do while she’s in there – perhaps she can put some sort of material between the uterus and the bowels so that it’s not gluing itself to the bowels anymore…

9) What sort of preparation is necessary for this surgery?

She wants me to do a bowel prep. HUGE SAD FACE.

10) What kind of anesthesia will be used?

General – I will be intubated.

11) Will I be given Versed?

I can ask for it at time of surgery.

12) How long do you expect the procedure to take?

Two and a half hours.

13) If one or both ovaries are badly damaged from the endometriosis, will you take one or both out, and what are my next steps (even if it’s just one ovary that has to be taken out)

It is not her intent to take anything. She only intends to treat surface disease and excise the endometriomas.

14) Will there be photos or video of the surgery?

Photos.

15) If a biopsy is done, when can I expect to receive results, and will my doctor call me?

Ten days post-op, though the holiday may delay until after Christmas (unless it’s bad news, then I’ll be notified immediately). The doctor herself will call me in either case.

16) I do not plan to take hormonal suppression after surgery – will this prolong healing time?

Not per se – taking hormonal suppression only serves to help prevent regrowth.

17) What vitamins/supplements should I avoid just prior to and after surgery?

Everything on my vitamin and supplement list is safe to take up to the day before surgery.

18) What foods and drink should I avoid just prior to and after surgery?

No food, drink or vitamins after midnight the night before surgery – otherwise, just stick to my current diet.

19) I know that being overweight can make me more high risk during surgery. How much weight should I lose in the next two weeks?

Not necessary to lose any weight (I am 5’5″ and weigh 166lbs and Dr. Giudice says it is not considered dangerous or obese for the surgical procedure).

20) What areas of my body need to be toned up in the next two weeks?

Nothing I can do will matter for this type of surgery, says Dr. Giudice, but if it will make me feel better, go for it.

21) Would a tubal ligation help in any way towards the “hormonal suppression” idea, or is it merely a birth control move?

It is merely a birth control move.

22) How many menstrual cycles do I need to give it before I declare this surgery a success?

It’s always hard to say. The risk of this surgery is that I might not experience any pain relief at all, just as with the first surgery. I was told not to be so hard on myself. I was told that they hope that I would have immediate benefit from surgery, but giving it 3-6 menstrual cycles is also rational.

23) When can I return to work as a preschool teacher?

Six weeks, preferably. Four weeks is okay with restricted movement.

24) When can I resume bicycling?

Four weeks.

25) When can I resume sexual intercourse?

Four to six weeks.

26) What results can I expect from this surgery?

Find the scar tissue and fix it. Correct the pulling on the right side.

27) What is the next step if this surgery does not work?

The Mirena IUD will once again be suggested, along with seeking help for Chronic Pain Syndrome, and continued pain management therapy.

Notes:
I’ve been worried about sleep apnea and heart murmur again, because I often get up multiple times during the night to urinate, and I often have a racing heartbeat in the middle of the night. This has been going on for about a year, but I’ve been too stubborn to accept a new medical issue. Now that I’m facing surgery, I’m concerned. I would like to push for an ECG, to see if the murmur is stable since my last exam, which was in August, 2001 at CPMC.

I was told to talk to my primary doctor. I called my insurance and they said I can self refer, so I’ve got a call in to a cardiologist.

Other notes to doctor:
Please be super careful when intubating me, because last time, my lower right inside gums/jaw was scraped open. I had a gash to worry about healing in my mouth, on top of the pelvic wounds. It took weeks for my mouth to heal up.

I was told to tell this to the anesthesiologist.

Other notes to doctor:
Please be super careful when catheterising me, because it took me several months after surgery last time to regain muscle strength to stop leaking urine.

She had her assistant note this, and said they will use a pediatric cath this time.

After the appointment, which I ended because I really needed to use the bathroom, I dreaded the walk back to the car. The Tylenol 3 was still coursing through my bloodstream, so even the elevator ride back down to the main floor made me wanna hurl. Once outside, I was off balance and shuffled a lot. I had a fixed gaze and probably a stupor to my face the whole way back to the parking garage. I did not use the wheelchair, though, because I felt that sitting and being pushed would be like being driven in the car, and that made me super nauseated.

The car ride back home was just as nauseating as the car ride to the appointment, but with the added hell that the pain relief part of the medication was wearing off. I felt every single bump in the road, and yelped continually. I declared that we are renting a Lincoln Continental or similar for surgery day. I want something comfortable and quiet to ride in. Hubby said no problem. ;)

I had blood work to submit, so my husband took me to the lab in our town. It’s not usually busy. I staggered in and filled out the paperwork, and waited. There was one guy ahead of me, rattling off all the names of people close to him who’ve died in the past year. So sad. He was getting blood work to rule out some kind of illness – he was saying he hoped he’d get good news back. I hope he does, too.

The phlebotomist I had was horrible. I think she was still rattled from the last guy, cuz when she emerged from drawing his blood, she looked like a deer caught in headlights. And she was young. She asked me what my blood draw was for and when I told her, she had no idea what endometriosis was, and told me she hoped the surgery lasted so that I’d never need another. Feh. That’s not how endometriosis works, but thanks.
She stuck the needle in without first securing the tourniquet or even telling me to squeeze my fist. Then she moved the needle around confusedly when the blood didn’t start pouring into the vial. I squirmed and yelped and whined, just as my husband returned with his coffee and said ‘Hi!’ … then he went grey and backed away into the waiting room.
The phlebotomist apologised but kept at it. A few seconds more and I could take no more. I told her to stop. She looked defeated. I told her to try the other arm, and not until the tourniquet was on for a moment, and not until I was squeezing my fist. She obeyed, and the blood squirted forth into the vial.

When we got back from the lab, I got into my pajamas, ate a couple of potato chips and went to bed. I was only able to sleep for about 45 minutes before I woke starving. I ate some pumpkin pie and something else – I forget.

I was unable to go back to sleep, but at least the pain had gone back down to a 4. I was still pretty high from the one morning dose. I kept trying to nap, but it wouldn’t last long. Around 3pm, I finally fell asleep for an hour and a half. The only reason I woke was that my cat had knocked against the inside of the closet. The noise alarmed me, which alerted me to the fact that my bladder/uterus was screaming to be emptied. I also noticed at that point that I was insatiably thirsty. I went through a pint and a half of water in minutes. This of course led to me having to pee every five minutes for the next two hours…

At about five minutes to 5pm, while bedridden and hanging out on the laptop, a new round of cramps appeared. I had the webcam on while chatting with my husband, so he got to see the change in my face, and he mentioned it. The cramps ramped up immediately from a 6 to an 8. I whimpered and yelped and tried to breathe. I took a full Tylenol 3, cursing the entire time, as I had only had one half hour of lucidity all damned day, and now I had to start a new round of being high on pain meds.

No position was comfortable. I stood up. I squatted down. I got on hands and knees. I stretched up, then down. I tried heating pad on the front, then on the back. I sat on my knees. It wasn’t until the Tylenol 3 kicked in and I had some dissociation that the intensity calmed down. Now I can feel the stinging pain, but at a distance. I have low level nausea from the meds and all the blood. And if I wasn’t already tired, I’m more tired. When my husband gets home, we’ll have Indian food delivered and then I’ll go to bed for the night, and hope I wake up pain-free tomorrow.

Here we are, once again, with the waiting game, and all the uncertainties of moment-to-moment planning.

I could blame it on all the sugar and alcohol (sake) I’ve consumed over the past four days. I could blame it on the blasted endometriomas on both ovaries. I could blame it on being stressed out by work, unfinished summer school homework, and my upcoming surgery. I could blame it on me being 39 years old. I could blame it on the overall illness itself: endometriosis.

But the fact remains that George was due on Saturday, and there’s still no flow, yet.

It’s the same thing I’ve ranted about, before:

I feel like I’m in limbo whenever my period is late. I go through each minute of each day knowing I should have been bedridden already. I’d already planned for the time off work. I’d already stocked up on groceries and tried to prep the house for my descent to the underworld. And then george is a no-show and I’m left biding my time, Waiting For It.
I’m in that special hell where I cannot exert myself too much because it causes pain…but I’m not in debilitating pain. And I’m super tired – I want to sleep all day and all night. And yet because there is no constant gnawing pain and/or bleeding going on, I feel like I’m expected to BE somewhere and DO something productive. But my body isn’t up for it. But my mind is restless. So the guilt sets in. I have video blogged about the guilt before, but it’s so hard to LEARN the lesson and just be okay with whatever my cycle is doing – just roll with it.

And now, the TMI part. It’s for science! It’s for education! It’s because there is no owner’s manual so I try to create it as I go!

On Saturday, I experienced low back and pelvic pain throughout the day – I was at a 3.5 on the pain scale for much of the day. It was annoying pain, but not debilitating. My mid to upper back kept trying to seize up, though, and this got worse by 10pm, when my vaginal mucosa changed from clear to pinkish. I contemplated taking a Tylenol 3, but I’m running low on it, so I didn’t take any. I did however consume 1,200mg of ibuprofen that day.

This morning (Sunday) I began spotting – it is dark brown and sticky, which is why I’m blaming all the sugar and alcohol intake. The spotting never ramped up the entire day, but the pain has been like a yo-yo. I took a total of 1,200mg ibuprofen again, and ate half a Tylenol 3 during the afternoon, which surprisingly made me quite loopy when I ran some errands with my husband. Thankfully, he was the one driving!

I was hoping that since I’ve been in moderate pain for the past week that I could at least have had my period by now, but noooooooo. The spotting that was happening has since disappeared since my shower this evening.

I’m setting my alarm for the usual time tomorrow, because I have no idea if I’ll be in any shape to go in to work or not. Had everything happened on time yesterday, I’d have spent half of yesterday in bed, all of today in bed already, and would be on Day 3 by tomorrow already. But noooooo. I get to start off at Day 1, Take Two, tomorrow.
Maybe.

This has officially entered into NOT OKAY territory.

I continued to have pelvic pain throughout the day and evening on Sunday. I forgot how much Advil I ingested, but I know I took half a Tylenol 3 Sunday night before going to a friend’s house to hang out.

Yesterday was my first day back to work after missing two and a half days late last week. I bicycled to work, because I was excited to no longer be bedridden, and the cramps and bleeding had gone away. Or so I thought. :(

I experienced intermittent, sharp pain in the low uterus and on the right ovary throughout the day. The pain got really bad when I pedaled hard from work to my psychology appointment (ONE MILE), then pedaled hard to get home (HALF a mile!) so I could make it to my naturopathy appointment in time.

These are short distances I pedaled, on level ground. To be in a lot of pain like that threw me for a loop, but it’s not the first time. It happened to me back on September 20, while bicycling to my psychology appointment after work. I experienced pulling, stabbing pain in my right ovary. The pain lasted for several minutes after I climbed the two flights of stairs to my shrink’s office. Same thing again yesterday, but it was both the low uterus and the right ovary.

I have had the usual “OMG I’M SO TIRED” post-menstrual cycle thing going on, only it’s exacerbated by the fact that we just observed Daylight Saving Time this past weekend. So this fatigue thing will last through the next cycle for me, at least. :(

Last night we hung out at another friend’s house, so we could watch the second episode of The Walking Dead (it’s awesome, btw). Once again, I needed Advil (400mg) and Tylenol 3 (half a pill) to get through the evening. It was much worse to be standing or walking. The pain was likely a 5.5 on the pain scale when it struck throughout the day, spiking to 7 when I was riding my bike. The pain dropped to a 3 on the scale when I was sitting, though every muscle in my body was tense again, steeling against pain.

I got home from the shrink last night and then hopped in my car and drove over to the dispensary to attend my first Naturopathy class. Like most things, I’ll try it once and see how it goes. The naturopathic doctor I saw knows what endometriosis is, and seems confident she can help alleviate some of my pain. She is realistic and knows that the condition is currently without a cure, and very tricky to control. For that, I am retaining her. I like smart doctors who aren’t arrogant or cocky, or who promise me a cure *coughchoke*doctorkateo’hanlan*cough*

This brings us up to today. The pelvic pain is STILL with me. I had intermittent pain throughout the day again, and it got to stabbing level, spiking to a 7, when I ran half a block from my car to my home to catch the FedEx person in time. Once again, standing is worse than sitting. I’m about to head out with my husband for some groceries and supplies based upon my visit to the Naturopath last night, so we’ll see how bad the pain gets. :(

Going back to the Naturopath for a moment – she has several things for women with endometriosis to try. I am sharing these things here for women who do not have a Prop 215 card and/or who cannot afford to see a Naturopath:

• Drink half your body weight in ounces each day to facilitate elimination.
• Use castor oil packs over the abdomen and pelvic region every day for 20 minutes (see instructions below).
• Buy the Anti-Inflammation Diet and Recipe Book, by Jessica Black, ND
• Take 20,000iu of Vitamin A in palmitate oil daily (DO NOT TAKE THIS AMOUNT IF YOU ARE TRYING TO BECOME PREGNANT, AS IT CAN CAUSE BIRTH DEFECTS)
• 1oz vitex agnus-castus (chasteberry) twice daily via dropper or mixed into food
• 15 drops of seroyal chelidonium plex twice daily
• Seed cycle: From Day 1 of menses to Day 15, take 1tbsp daily of ground flax and ground pumpkin seed. From Day 16 back to Day 1 again, take 1tbsp daily of ground sesame and ground sunflower seed.

To create the castor oil pack, you will need:

• unbleached, non-dyed cotton, wool or flannel cloth, about 15″ – 20″ in size
• plastic wrap (or wax paper)
• glass dish with lid
• small bath towel
• hot water bottle or heating pad
• 6oz castor oil

Directions for the castor oil pack:

• Pour enough castor oil onto the fabric to saturate the cloth.
• Lie down and place the oil-saturated cloth directly on skin over treatment area.
• Castor oil stains! You may wish to cover the saturated fabric with a piece of plastic wrap or wax paper.
• Place the bath towel over the plastic wrap. If using heat, apply it now (medium warmth).
• Rest. :) You can rest for 20 mins or leave the pack on overnight.
• When you are done, store the oil-saturated fabric in a glass container with a lid. The fabric and oil can be used for months this way. Add more castor oil as needed. If you take a break in treatment days, just store the container w/ fabric in the refrigerator.
• To remove the castor oil from your skin, wash with a solution of 3tbsp baking soda per quart of water. You can use the same solution for washing castor oil out of linens and fabrics. Keep in mind that castor oil WILL stain cloth!

It seems like a lot, but I’ve done a lot more for other regimens, elimination diets, and detoxes/flushes.

It’s one more thing I have to say, “Hey, I tried it.”

Back on September 13th, I said we could not afford a second surgery for me until sometime next year.

Well, I forget, but it was sometime last week that I called my husband’s health insurance company to find out exact costs and co-pays for a second pelvic laparoscopy.

To my utter surprise, it appears that we have already met the deductible for the surgery, and some of my regular visits to the UCSF campus for pain management have been applied to the overall co-pay.

So the expected $1,400 co-pay for surgery is actually just under $300!

I had another talk with my husband, and asked if he could *please* put money away at each pay period through December to help me go through with this surgery.

I also asked what kind of surgery Dr. Giudice prefers. The staff asked for me, and I got a call back telling me that she prefers electrocoagulation type laparoscopy, and will do that for part of my surgery. BUT where it comes to the ovaries, she prefers to excise the endometriosis. I was told that she will use her best judgement and likely do both electrocoagulation and excision wherever necessary during my surgery.

She is not afraid to tackle the endometriosis on the bladder reflection, but will be cautious.

She is not afraid to check in the recto-vaginal canal for endometriosis, which she thinks was missed during my first surgery (and is very often easily missed because it is hard to visualise in the laparoscope).

So…that’s that. I will continue to avoid Dr. Cook for the time being, who is too good to take health insurance. Much of my costs at UCSF can be covered with my insurance through Aetna with a famous and renowned surgeon who does both electrocoagulation and excision surgery.

Pre-op is set for December 1, 2010.

Surgery is set for December 17, 2010.

No, going through one surgery does not make it easier to go through a second surgery.

I am terrified. I have lots of little fears and ‘what ifs’ as to things that could go wrong. That never changes.

And now I’m faced with having to possibly have no choice in taking a mood stabiliser, because I may have to go on hormonal treatment again after this second surgery. I don’t want to be more unstable than I already am, but I might have to go through it anyway (re: trying out the lamictal) – Just In Case surgery comes along and says ‘sorry, had to take an ovary’ or ‘sorry, killed the ovary by accident’ or ‘I don’t want you menstruating for three months post-op’. Any of those scenarios could happen. And I will need to be on mood stabilisers already -stuff that has been tried and trusted by the time of surgery – already in my system – so the synthetic hormone therapy doesn’t make me whacked and seriously With A Plan suicidal like it did back in 2007.

There is just too much on my emotional plate.

Too much.

Too much.

I should start noting my mental state here. I’ve been seeing a psychologist, and I saw a psychiatrist on September 14. Both think I may be bi-polar, but they do not agree on which type of bi-polar I am.

The psychiatrist gave me a prescription for abilify, but I refused to take it. I asked for and got Lamictal, instead. I still haven’t taken it, though. I am afraid of more side effects. I’m done with more and more mental stuff going wrong with me.

I’ll restate what I said in my previous entry –
Because I’ve not really enjoyed a pain-free or sick-free or allergy-reaction-free day in about seven weeks, I have hit my breaking point emotionally.

I’ve already been wrestling with what I call ‘dangerous depression’ since the end of July.

Well, it’s getting louder in the head, and more externally vocalised.

I went with my husband to a Victorian-era home showing that happens every year in our city. There were eight homes on the bill to walk through. I did not enjoy it this year. It was painful to move. My low back pain crept back in to flare with the trapped nerve in the shoulder, every time I had to climb stairs, or really move at all. And I was still in pain from one visit to the gym last Thursday.

I was super depressed.

I guess it doesn’t help that I’ve been on Soma (muscle relaxer) for two weeks, and I know from experience that it adds to my depression. I have not had a dose of it today and will refrain from taking any more of it.

After the home showing, there was the annual parking lot sale over at the famous tiki bar in town, so we went on over.
I immediately went for the booze. First time in 51 days that I got absolutely full on drunk. My husband had gone off to his sacred game night, leaving me in the company of friends still at the tiki bar. I was still going when his game session got out around 10pm. He picked me up and took my sorry ass home. Thankfully, no tears or puke or hangover this time. I drank lots and lots of water, thanks to a very attentive bartender, and was a good girl and drank lots of water when I got home, and took vitamins and advil.

I remain dangerously depressed.

Today at work, while rocking a child at naptime, I got stabbing right side ovarian pain that lasted for about five minutes. It went away until now. I’m just sitting on the couch, typing, and the ovary is pulsing a low stabbing pain. Today is Day 10 of the new cycle, so I guess it’s mittelschmerz, which usually happens at Day 8 of the cycle, but has been off by a day or three for a few months, sometimes not happening at all. I blame it on the endometriomas on both ovaries.

I bicycled home from work in 95°F heat – thankfully the ovary did not stab me on the ride home.
But I am wiped out after spending some time in the outdoors at work today. Ugh.

So this mental health thing. The meds. I’m so tired of meds. Today I started a detox diet – the one I tried to start back in July or August and didn’t keep up with. So I started it over today. Lots of supplemental pills to take with every meal.
And then either tonight or sometime this week, I might begin taking the Lamictal. I’m terrified of it. Read all the horrific side effects here. If you think that looks bad, read the side effects for Abilify, which is what the psychologist originally wanted me on and I said no way.

Now, let me tell you again what I’ve said before. I have been going through what I call dangerous depression since the end of July, 2010, because of all my pain conditions and reactions to medications.

This is also known as, yes I will spell it out and face up to it: suicidal ideation.

I have wrestled with suicidal ideation for much of my life, so this is nothing new. The frequency is what is worrying me.

But look here, if I take Lamictal or Abilify, the warning is basically the same:

Patients, their caregivers, and families should be counseled that AEDs, including LAMICTAL, may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Behaviors of concern should be reported immediately to healthcare providers.

Why would I want to take a drug that will make me MORE suicidal than I already am?

I already went down that road once, with SSRIs (Paxil), back in 2000.

Honestly, I probably won’t take the medication. I’ll get my diagnosis officially recorded as bi-polar something and then I’ll manage it myself. I’ve lived this long…

I tried to go back to work on Thursday, September 16, but the Last Gasp happeed two hours into my workday and so I took a whole Tylenol 3 and came home. Thankfully, by Thursday night, that was the end of the major pain and bleeding.

I went to work on Friday and was able to complete a full day of work – the first all week. I never need this much time off this job for the pain, which tells me either the endo really is getting worse, or I’m becoming a wuss to the pain after enduring it for 25 years. I worked a total of 10 hours that week. Ugh.

Friday was not only my first day back to work, it was also my birthday. After work, my husband took me to a very nice sushi dinner, where I stuffed myself until it hurt, heh. I don’t think we went out that night – I was still too tired from just having spent a week bedridden. That’s how it goes.

Saturday, September 18, set the clock! Go out and have fun til the next endometriosis attack! We went to a nightclub down in Menlo Park to support the scene down there. I didn’t really have a good time, but we did get a nice picture taken of us:

On Sunday, we joined up with a fellow birthday girl for her annual Ice Cream Crawl, which took place in Oakland and in Berkeley. Around stop #6, I decided to eat sorbet instead of ice cream, which had given me a tummy ache, no matter how much lactaid I had ingested. The sorbet was raspberry chocolate flavour. To my dismay, it was full of raspberry seeds. I shared the sorbet with people in our group, and we all winced at how seedy the sorbet was.

Within twenty minutes, my throat began to get dry, then swell up.
Great.

So now I’m allergic to raspberry seeds? Wonderful. It’s in the same salicylate family with peach skins, grape skins, apple skins, apricots – all the stuff that also hates me either orally or intestinally.

I took a children’s benadryl but it did nothing, so I took a adult dose of benadryl on top of it – 36mg total. This of course made me a zombie, and so my husband ended our Ice Cream Crawl and took us home for the day. The swelling did not abate all day and all night, but I refused to go to E.R., because the last time I did, they told me they could not visualise the swelling, so it must just be me having a panic attack. To which I’d replied, “I know what a fucking panic attack feels like, and this is not it.”

I get the same throat swelling when I eat eel. Actually it’s the uvula that swells up. Same thing happened with the raspberry seeds, only not as horrible as it does with eel, thank [insert deity here].

I refused to go to E.R. because I cannot afford further debt with them – still haven’t paid off the June debt I incurred with another oral allergy attack. And I refused to use my epi-pen because you HAVE to go to E.R. if you use it. So I was kinda stuck. I knew I wasn’t gonna die, or at least I hoped I wouldn’t die choking on my tongue.

I made it through the night and the swelling went down by morning.

What a sucky end to my birthday weekend, though.

All through this whole time, I was still dealing with having to be on muscle relaxers for the trapped nerve in my shoulder. So I was quite the grump.

Monday, September 20, while bicycling to my psychology appointment after work, I experienced pulling, stabbing pain in my right ovary. This is not a good thing to be going through while pedaling. The pain lasted for several minutes after I climbed the two flights of stairs to my shrink’s office. Ugh.
The pain went away, though. Thankfully. But I was not even a full three days into my new cycle when that pain hit. The endometrioma is doing bad things to me. :(

I was able to bicycle to work for most of last week. I even made it to the gym on Thursday, September 23, for the first time in 146 days. I did the 2lb hand weight workout exercises as prescribed by my trainer, and then I did 14 minutes on the elliptical machine.

The pain from the workout did not hit until Saturday, just in time to help my friends move in 85°F heat. I designated myself cleaning lady that day, because on top of the workout pain, I slept wrong again and the trapped nerve issue in the neck/shoulder flared up real bad again.

On top of all of this, I’ve been bruising the hell out of my legs by running into the coffee table repeatedly, as well as the child-sized furniture at work. I have bumps and bruises and scrapes. I think the clumsiness is due to the muscle relaxers.

Because I’ve not really enjoyed a pain-free or sick-free or allergy-reaction-free day in about seven weeks, I have hit my breaking point emotionally.

It’s not fair that I can’t enjoy my 11 – 20 days between endometriosis pain cycles being totally free of any other sickness or pain.

It’s always something. :(

My period came yesterday and I’ve been home and bedridden ever since. On top of it, last night my neck/shoulder went out because I slept wrong. I wanted my husband to stay home with me today but he wouldn’t. I hitched a ride to the doctor via my neighbor and got some muscle relaxers. I took a whole Tylenol 3 and shuffled home because I did not have exact change for the bus and can never remember how much it is, anyway. It is a 0.4 mile walk, but a bit harrowing when in pelvic pain and trapped nerve pain in the neck/shoulder.

The thing I’ve been saying to my husband since last night is that I just want to be put out of my misery. I told him repeatedly that I need a caregiver, but he needs an equal partner. I told him for that reason, the marriage probably isn’t working out in his favour. He insists he wants to keep me around, but I don’t see the point. I don’t want to be disabled. I don’t want to be needy. My body is broken and has other plans for me.
He won’t take me out back and put me down, though. I told him he’s selfish for that.

Then again, I’m selfish for wanting him to do the deed. But I won’t do it, myself. I told him it’s a really good thing I’m seeing a psychiatrist, today, because between the trapped nerve in the neck and the ongoing/worsening endometriosis pain alone, I NEED the psychiatric help right now.

My psychologist has ideas about what my diagnosis is, but I’m going to wait til the psychiatrist has also evaluated me before I start educating myself on how to care for myself with yet another diagnosis.

And a large part of me wonders why I keep seeing specialists for all these problems. It does nothing but take my money and insurance, and makes me miss more work because of the appointments, and none of this has actually HELPED or CURED me, anyway. I should just go on like all the other broken people in the world, until I decide like a lot of them that I’m DONE and just hit the reset button on my own, in peace.

On Friday, September 10th, I started feeling low pelvic discomfort/fullness. I had the need to ‘check’ myself all day to see if menstruation had begun.

Saturday morning, my husband and I were intimate, and I experienced pain as I often do. :( I noticed bright red bleeding right afterwards. I assumed this was just the little pool of blood that sometimes leaks out from the cervix and sits at the end of the vaginal canal right before menstruation begins. Within half an hour of intimacy, I experienced uterine cramps which lasted all day. However, as I had hoped, the bleeding turned to spotting quickly enough, and then stopped by afternoon. For the pain, I took 600mg Ibuprofen in the late morning, then took half a Tylenol 3 and more Ibuprofen in the late afternoon.
My husband and I went to a housewarming party that night, and I brought my heating pad with me. I did need it. :( I took another half a Tylenol 3 around 9:45pm, and got all the codeine effects – dizziness, fuzzy-headed, super sleepy, heightened sensitivity to light and noise, etc. Those things don’t mix well with a very alcohol-ladden house party. We were home a few minutes before midnight…on a Saturday night…because of my pain. LAME.

The night out, despite the pain, was not too bad. I had my usual bout of social anxiety, and I was a bad girl and took a few sips of whiskey (it had honey it it, how could I not?). As we were saying we wanted to leave, the hostess said she needed to re-introduce me to a friend of hers, who also has endometriosis.

So I talked with another endo sister and stayed awhile longer at the party. ;)
She highly recommends Dr. Cook down in Los Gatos. He’s the guy who only accepts one’s money, not insurance, but the woman I talked to last night is three years post op and says the pain has not returned. She had stage IV endometriosis, and had to have one ovary removed, as well as part of her vagina, her cervix and her uterus. She also had to have part of her bowels resected, because of the endometriosis. Really bad stuff. I asked a lot of questions about the one ovary thing – since I am convinced that I’ll have to lose my left ovary eventually (this is twice now that it’s been pulled by adhesions to my uterus).
She told me that because she had so much removed, her body freaked out. She told me that although the endometriosis pain disappeared, she had to contend with nerve damage on her bowels, and all of her organs trying one by one to shut down on her. She ended up with asthma and skin lesions and extreme fatigue and all sorts of stuff, which took over a year to clear up, and only with the help of some kind of metabolic therapy. She said she was dying a slow death. To this day, three years later, she still has issues with either keeping in or letting out a bowel movement, I forget which.
Despite such horrific issues, she says she’s glad she had the surgery.

My opinion is: given the choice between knowing the behaviour of my illness and not knowing if I will die from all the pain and suffering caused by a surgery such as described above, I will always choose my illness. Given the choice between a one year recovery and my current illness, I’ll take my current illness because I miss less time off work and thusly less money. Given the choice between possible permanent nerve damage from surgery and my current illness, I might prefer my current illness. Depends on where the nerve damage, is, I guess. I don’t think I would like to have to live with bladder or bowel control issues for the rest of my life. That stuff isn’t supposed to happen until I’m elderly. :p

For over a year now, I’ve been going on about needing excision laparoscopy to properly treat my pain, and now that I’ve talked to a woman in person who has had excision done, now I am chickening out. This is silly. I can easily get just as much nerve damage from electrocoagulation surgery as I can from excision surgery. Hell, I can get organ damage just from the laparoscope going into me. So this fear stuff needs to stop.

…there’s something else. When I did a search on my blog for how many times I mentioned ‘excision’, I read back through my entries and got really mad. You know, the human brain forgets things, and there’s something to be said about that. I feel like had I just left all those feelings forgotten, then I wouldn’t be so angry as I am right now with doctors who wrote me off, with all the time I waste trying to find the right specialist, only to be slapped in the face by people saying stuff like, “DO YOU LIKE BEING IN PAIN? THEN GO GET ANOTHER ELECTROCOAGULATION SURGERY” or “I TOLD YOU ABOUT THIS PERSON A YEAR AGO, WHY DIDN’T YOU LISTEN TO ME”.

If I hadn’t read through my old blog entries, then I might not be so mad as I am right now at my husband. But the thing is, forgetting also destines one to repeat history. And this is recent history – the blog entry I’m referring to is from February – only seven months ago. We’re in a cycle, and it does no good to keep forgetting that the finances issue is a HUGE issue. I DID go to school this summer after my husband insisted that I go, and insisted that our tax return money would cover it. When the tax return money ran out towards the end of the summer and my husband had to foot $1,000 more of his own money, all hell broke loose. We’re still reeling financially and emotionally, and then I get told I must have another surgery ASAP.

Back on February 4, I said I could EITHER have surgery OR go to school because we don’t have enough money to do both. This was before our tax return. Once we got the tax return filed on February 20, my husband said I should go back to school, and I agreed. We both thought at that point that surgery could wait.

Who knew that surgery would be deemed necessary the same year? There was no way of knowing that.

But the same frustrations I expressed about our finances are still at the forefront of our relationship today. We did have that talk back in February, and he did say that he would support and help me and that he would stop being wishy-washy. The one point we did not cover was him also promising not to be grudging or angry when I need money. He never made that promise and his behaviour is still that of grudgingly handing over money when I need it.

Last Wednesday, when I got the surgery summons, I told my husband we needed to talk about finances and planning for the surgery. Friday night, we had that talk. Once again, we got into our modes. He wanted to pledge chivalrous yet ambiguous support for me during and after my surgery. I wanted to run the numbers. I broke out the calculator and my recent timecard and compared it to my earnings before summertime to get an estimate of money that could be saved between now and December, while telling my husband about bills and groceries and things that would need to be taken care of. He sat there, eyes glazed over, zoned out, then began playing a video game on his iPhone.

While running the numbers on my end, and noting his lack of engagement after he initiated the talk, I kept working but did not look at him as I spoke, telling him, “Here’s what I need for you to be doing. I need you to go through your bills and expenses and the last three months of the grocery bills, and tell me roughly how much money you have at the end of the month each month, so that I know what you have to contribute towards the surgery, since you said you would in fact take care of me during and after surgery.”

He stopped playing his game, stared at me for a moment while I continued to work without looking at him. Then he got up in a huff and stomped off to the computer room to run his numbers in angry silence.

And this is how it always goes. He’s all talk and then when it comes time for action, he gets his panties in a twist.

He DID do his numbers and we DID compare things.

The end result of my own assessment was that I cannot afford to save money for surgery to cover the co-pay (up to $1,400 out of pocket) AND any post-op care, AND bills that will still be coming due after surgery while I’ve been off work without a paycheck.

My husband’s assessment showed that he was left with just over $200/mo out of his paycheck, if he had to continue to cover all of the groceries, cat maintenance, and all of my bills post op.
I asked if my husband could set aside money out of his paycheck every payday from now until mid-December in order to have that padding available – to cover all the expenses for up to 2 months post-op. He shared that he has about $1,476 left over after bills are paid each month. I asked if he could carve out $400/mo from now until mid-December (leaving him with $1,076 total in the bank each month, but saving $1,200 to cover me), since my bills due on top of everything else are about $316/mo ($632 if he had to cover me for 2 months).
He replied that he could logically swing it, but would feel uncomfortable doing so, in case other emergency expenses came up. He said it would be cutting it too close.
The end result of his assessment is that he cannot afford to save money now to cover me post-op in December.

This pushes my surgery out to either spring break, which is one week optional work in March, 2011 (holiday daycare week), or sometime in the summer 2011, which is a fixed amount each employee can work during the summer, anyway, due to low enrollment.

At first, I was silently very angry with my husband’s refusal to save $400/mo from now until December. But I calmed down and realised that yes, $1,076 really is in fact in the red for two people, should any tiny emergency crop up. It’s just not doable, and I have to accept that.

After doing our assessments on Friday night, I did not feel any better about how we both emotionally handle things related to finances. I still do not trust that my husband will make good on his word to be there for me. It’s all on me to save the money towards the surgery co-pay and taking care of myself after surgery. I have to start saving now.
When we got married, we agreed to keep finances separate. We only got the joint account to pool money for the honeymoon. That was the only reason we got that account. And even then it didn’t really work out so well – I still put a bunch of shit on my credit cards, and used my money, and he still used his money. The fact remains that he is very guarded over the ginormous amount of money he makes in a year, and is resentful that he has to foot all of the rent and groceries. He makes roughly sixty-five thousand dollars more than me each year, and so when he has to split his income in two to support both of us, he gets pissy.
I make sixty-five thousand dollars less than him each year, so when I easily run out of money and need something, I get all pissy when he won’t just provide the money. I don’t look at it as a spoiled princess or entitled bitch thing. I look at it as a fracking charity thing.

Another thing I found out from my assessment is that missing two or three days of work each month loses me roughly $4,000 every year at the current pay rate. At my highest earnings in the dotcom days, I was losing up to $7,200/year of my paycheck because of missing work due to endometriosis. I posted a study about this on the main Living With Endometriosis site back in April, 2010. My personal cost is much higher, but I don’t know if their costs were net pay or gross pay. My assessment was gross pay.

I still feel the same as I did back in February: “I think it’s best that I just go back to pretending that this is what all women go through every month, and stop trying to treat something which ultimately probably can’t be treated, anyway. I won’t die from my condition. No matter what I’ve tried in the last 23 years, nothing has worked anyway, so why bother to continue trying to fight it. I don’t have anyone but myself to help me financially and emotionally, anyway. Same as it ever was.”