Andrew S. Cook's Blog
October 8, 2020
Miss USA contestant Joins the Fight for Endo Awareness
Vital Health patient Justice Enlow, Miss Tennessee USA 2020 fights for endo awareness as she strives to empower other women with endometriosis to find life-changing treatment as she did at Vital Health Endometriosis Center.
“I believe that every woman deserves a life ruled by their passions, purpose, and dreams rather than by pain.” — Justice Enlow, Miss Tennessee USA 2020
Justice suffered for 10 years with symptoms of endometriosis, including painful periods, digestive issues, chronic abdominal and pelvic pain, and extreme fatigue. She says, “The pain got so bad that I ended up on prescription pain medication and missed a significant portion of my college classes.”
Misdiagnoses are too common, but you can get your life back
In those painful 10 years, Justice sought treatment from her doctors and was misdiagnosed several times. Her life changed when she found Vital Health Endometriosis Center and internationally renowned endometriosis specialist Dr. Andrew S. Cook, M.D.
“Dr. Cook and the entire staff at Vital Health Institute were an answer to my prayers,” she says. “They were the first medical professionals that I spoke with who validated my pain but also gave me hope for my future. I am now almost 3 years post-op and can honestly say that Dr. Cook gave me back my life.”
Living her dream and using her platform to empower women with endo
Today, Justice is spreading awareness and fighting for other women with endometriosis in her role as Miss Tennessee USA 2020. And now, by competing in Miss USA 2020 pageant, she feels she has an even greater opportunity to raise awareness. Her platform is empowering women with endometriosis to be their own health advocates in finding treatment.
“I am living out my dream of competing for Miss USA because of the amazing care that I received at Vital Health Institute,” she says. Justice is also the founder of Justice For Women, a non-profit that believes “no person, prejudice, or health concern should stand between a woman and her purpose.”
Understanding the difference an Endometriosis Specialist makes
Endometriosis is a leading cause of chronic pelvic pain in women, and it can have a dramatic effect on all aspects of a woman’s quality of life. In addition to being misdiagnosed, many women, before being treated by Dr. Cook, have undergone one, and sometimes multiple, failed surgeries that use outdated techniques such as ablation. Dr. Cook has created a hashtag on Instagram called #BanTheBurn in an effort to bring awareness to and save women from the pain and trauma they are experiencing in these failed surgeries. Justice remarked “I will forever be grateful that Dr. Cook was the one and only surgeon that I saw.” Her fight to raise awareness will help combat the many myths that exist regarding endometriosis. On her website, she talks about her treatment journey in more detail, here.
Next Steps
Read more about “What it Really Means to have Endometriosis” and download the full PDF guide to share with friends and family here.
You may also request a screen-share virtual consult to discuss your specific case with Dr. Cook.
The Vital Health team wants to help you get your life back, just as we were able to help Justice and many other women like her. Use this form to request a complimentary record review.
Help Justice raise awareness by spreading the word.
Follow Justice Enlow on Instagram
Follow Vital Health on Instagram
Share this content on Facebook and help Justice raise awareness
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The post Miss USA contestant Joins the Fight for Endo Awareness appeared first on Vital Health Endometriosis Center.
August 25, 2020
Surgical Video: Adhesiolysis – Removal of Adhesions/Scar Tissue
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SOUND On!! Adhesions are scars that form within the body. They usually form in the abdomen or pelvis. Adhesions can develop after surgery as part of the healing process. If surgery is rough the chance is much higher than if good gentle techniques are used. They can also develop after infection or any other inflammatory process, such as Endometriosis. Lysis of adhesions is the process of cutting scar tissue within the body. This is done to restore normal function and reduce pain.
This clip shows how to remove scar tissue with minimal amount of trauma to the tissue. This patient developed adhesions (scar tissue) between the abdominal wall and the omentum, following a previous surgery. The abdominal wall or “tummy wall” appears at the top of the video (the ceiling if you will) since we are looking through the belly button inside of the abdomen. The omentum is a curtain of fat which is attached to the bottom part of the stomach near the level of our ribs. In this case the omentum became scarred to the abdominal wall following a general surgical procedure resulting in pain and discomfort.
Dr. Cook shows how to separate the adhesions using the Carbon 13 CO2 laser, which is one of the most precise and gentle surgical instruments available. He describes the procedure in detail and demonstrates important aspects of good surgical technique.
Did you develop adhesions from surgery?
From our Instagram
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A post shared by Dr. Andrew Cook | Vital Health (@vitalhealthendometriosis) on Aug 19, 2020 at 10:57am PDT
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The post Surgical Video: Adhesiolysis – Removal of Adhesions/Scar Tissue appeared first on Vital Health Endometriosis Center.
November 18, 2019
Going Through Hell and Not Back Yet
Going Through Hell and Not Back Yet
Are you one of the endo sufferers going through hell and not back yet?
If your family, career, sex life and ability to have children have been compromised because of endometriosis, keep reading.
There���s a video you cannot afford to miss. Literally.
Hell Hath No Fury Like the Pain of Endometriosis
You are not afforded the ability to live a meaningful life. In very basic ways.
In reality, it���s like you have tens or hundreds of excruciatingly painful blisters covering the inside of your pelvis.
You look fine on the outside.
You look ���normal.���
Whatever that is.
And people��� even your doctors��� doubt the severity of your pelvic pain. Because of endometriosis.
Why You Can���t Find Your Way Out of Endo Hell
A lack of awareness of the disease with which you are affected, leaves you where you are. Without a correct diagnosis and support from your Physician.
So, you are dealing with a lack of appropriate treatment for your pain. And an invalidation of your situation.
Your own family may not even believe the severity of your pain.
Your are, in effect, being held prisoner and tortured by her your body. And you cannot find anyone who understands your situation.
It seems like all hope is lost. Right?
What���s the Truth?
The U.S. medical system is failing you. But that���s about to change.
Thanks to Dr. Cook and other professionals like him, the face of modern medicine as you know it is changing!
Excellent news.
Especially for you. Because there truly is hope.
To learn more about:
Which endo treatment is best for you so you don���t waste more money and time on things that won���t help.
Endometriosis myths: Busted! So you don���t buy into the hype but understand how to help.
Why endo does not have to be a chronic, life-long disease. So you can get out of hell!
Watch this video and the related blog: How the Medical System is Failing Women with Endometriosis.
And remember there is Hope. There is life after this painful disease, endo hell doesn���t have to last forever.
The post Going Through Hell and Not Back Yet appeared first on Vital Health Endometriosis Center.
How the Medical System is Failing Women with Endometriosis
How the Medical System is Failing Women with Endometriosis.ld_spacer_5dd3b3ee6884d{height:32px;}
If you don���t know how the medical system is failing women with endometriosis, please keep reading. And share this post.
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What Does it Really Mean to Have Endo?
Quite frankly, the words on this page won���t convey what it���s really like for a woman to have endometriosis.
These words don���t truly relay how endo impacts a woman���s family and her career. Her sex life. Her ability to have children. Or her ability to live a meaningful life in very basic ways.
In reality, having endometriosis is like having tens or hundreds of excruciatingly painful blisters covering the inside of your pelvis.
For lucky women, the pain lasts just a couple of days, during their period. But in the worst cases, the pain is 24/7/365.
Women with endo usually look fine on the outside. And this fact can cause even well-meaning people to doubt the severity of endo pain.
How Does Endo Affect Women���s Lives?
Some women begin to have pain starting in elementary school. For others the pain begins in their teens.
While the timing of the pain is often similar to a woman���s period, the pain is completely different than menstrual cramps.
It is not uncommon for women to miss school and work several days each month.
A lack of awareness of this disease can leave these women without a correct diagnosis and support from their Physician. In turn, this can lead to a lack of appropriate treatment for the pain and an invalidation of the patient���s situation.
Her family many now be led to believe that psychological issues drive the severity of her pain. In this situation, she is in effect held prisoner and tortured by her own body, finding no one who understands her situation. And certainly no one who may help her.
What���s it Really Like to Live with Endo?
Symptoms progress as women age. The severity and duration of the pain increase. Non-functioning days increase.
The unpredictability of the increasing number of painful days makes it difficult to maintain a functional life.
She can���t make plans for the future.
Feeling like a vibrant, desirable woman becomes a fleeting thought.
Acting like the loving, compassionate woman she was created to be becomes increasingly difficult.
The stress of it all is unbearable.
She fights. Refusing to let endo take over her whole life. Even though it has taken some of the most precious parts.
You likely pass right by her in pubic. Having no idea of the devastation with which she is dealing.
Most days. She gets up. And puts on a brave face. She���s trying to live a normal life.
How the Medical System is Failing Women with Endometriosis and What Dr. Cook is Doing to Change the Face of Modern Medicine
For thirty years, Dr. Andrew Cook has witnessed pretty horrendous pain and suffering. Because of endo. And it���s gone under the radar way too long.
Dr. Cook openly shares his observations. And what he has learned throughout the years.
He, along with his team at Vital Health Institute, is committed to continued learning. So that you and others can receive better treatment in the future.
Dr. Cook knows there���s a disconnect. And it all starts with the actual definition of endometriosis.
What is endometriosis (endo)?
Endometriosis is a disease process whereby tissue similar to the lining of the uterus exists outside the uterus. Endo is difficult to understand and interpret. Plus, it affects every 1 in 10 to 15 women. That adds up to 7 million women in the U.S. and 176 million women worldwide.
What are the symptoms of endometriosis?
The two main symptoms are pain and infertility.
Pain typically manifests as constant abdominal pain during periods, painful intercourse and pain with bowel movements.
About 40% of women with endo have problems conceiving.
Other symptoms include headaches, pain with urination, fatigue and nausea, to name a few.
What are the Problems in the Medical System?
Misinformation. Even the President of the American College of Obstetricians and Gynecologists (ACOG) defines endo incorrectly. In March 2017, he defined endometriosis as the lining of the uterus growing outside of the uterus.
That���s incorrect.
A large majority of OBGYNs are uncomfortable diagnosing and treating endo, and as many as half are unfamiliar with the basic symptoms. Which sheds light on how little training is done on endo.
There are fundamental misunderstandings of the disease.
The medical system for the basic care (diagnosis and treatment) of endo and pelvic pain is broken. What���s being taught and shared is out of date.
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Stupid Things Women are Told About Endo and Pelvic Pain.ld_icon_box_5dd3b3ee6e03e .iconbox-icon-container{color:rgb(255, 255, 255);margin-bottom:26px !important;border-radius:px;}.ld_icon_box_5dd3b3ee6e03e:hover .iconbox-icon-container{color:rgb(120, 11, 238);}.ld_icon_box_5dd3b3ee6e03e h3{color:rgb(255, 255, 255);margin-bottom:20px;font-size:21px;}.ld_icon_box_5dd3b3ee6e03e:hover h3{color:rgb(30, 22, 102);}.ld_icon_box_5dd3b3ee6e03e{background:rgb(37, 44, 66);}.ld_icon_box_5dd3b3ee6e03e:before{background:rgb(255, 255, 255);}.ld_icon_box_5dd3b3ee6e03e:hover, .ld_icon_box_5dd3b3ee6e03e:hover p{color:rgba(30, 22, 102, 0.548);}
���I have cramps too.���
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���You���re overreacting.���
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���You just don���t want to go to school.���
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���You���re too young to have endo.���
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���You just need to have your uterus and ovaries removed.���
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Note: If you opt for a hysterectomy, you risk osteoporosis and other debilitating conditions.
Diagnosis
It���s a subtle disease. And we don���t have good tests for it. Patient can look normal on outside. No blood tests. No radiology detects it.
An accurate history of the symptoms prompts a laparoscopy. It���s the gold standard but it���s dependent on the skill of the surgeon. It has to be done thorough enough to find the endo. And this isn���t always the case���not always thorough.
But if you do find it. And take it out. Women do better.
Treatment
There are two basic categories for treatment: hormonal and surgical.
1) �� Hormonal
Big pharmaceutical companies push the paradigm that estrogen suppression is required for treatment of endo.
Problem is: endo can make its own estrogen.
Birth Control Pills can help get rid of some of the pain. It renders symptoms under control. But it does not treat endo or actually get rid of it. It may get rid of your period. Or get your symptoms under control. But being clear: it���s not a cure.
There are medications like Lupron and Orilissa that induce a Medical Menopause. But the side effects are worse than the benefits. Again, this controls symptoms. But it doesn���t cure endometriosis.
2) �� Surgical
Two basic kinds of surgeries.
�� Outdated cautery/burning surgery that���s easy and quick. But cure rates are low and recurrence rates are high. You leave traces of endo behind.
�� Wide Excision Surgery removes all traces of the disease and the tissues surrounding it. Lessening the chances of it returning. The cure rate is 80-85% with wide excision surgery. It gets all the disease out. The chance of endo coming back is 15%.
The only way to truly diagnose and treat endo is with laparoscopy and wide excision surgery.
Challenges with treatment
Beyond the issues with basic care for endo, you���ll find some endo patients have a complex and wide range of associated health issues and medical conditions.
�� ��Abdominal Wall Neuropathy
�� �� Addictions
�� �� Chronic Lyme Disease
�� �� Depression
�� �� Fibroids
�� �� Food sensitivities/allergies
�� �� Insulin resistance
�� �� Multi Symptom Dysfunction
�� �� Ovarian cysts
�� �� Pelvic Congestion
�� �� SIBO
And the list goes on.
Impact on Women���s Lives
�� �� Avoiding School
�� �� Financial Loss
�� �� Infertility
�� �� Invalidation
�� �� Isolation
�� �� Loss of Career
�� �� Loss of Relationships
�� �� Loss of Reproductive Organs
�� �� Loss of Sexuality
�� �� Multiple Surgeries
�� �� Pain & Suffering
And this list goes on as well.
Major Life Trauma
There are years of unnecessary pain and suffering, invalidation and hopelessness.
Often times people see women as whining because we can���t see the symptoms. They appear normal. Or maybe just stressed. Just complaining women.
There is suboptimal care. And a ten-year delay between the onset of symptoms and diagnosis. Multiple unsuccessful surgeries lead to more pain and hopelessness.
Physical effects include those on the neurochemical system. Brain size and communications systems are affected.
There are long-term changes in the brain circuits. Memory issues, and many others. Fear.
Endometriosis patients have been through hell. And not back yet.
The Domino Effect
�� �� Inadequate training
�� �� Lack and incorrect knowledge of endo
�� �� Lack of diagnostic and wide excision surgical skill
�� �� Suboptimal treatments provided
�� �� Semi acute situation becomes chronic
�� �� Medical condition degrades
�� �� Invalidation of the patient
�� �� Ever-increasing levels of trauma and associated health changes��
In identifying how the medical system is failing women with Endometriosis, we���re not pointing fingers. We���re calling out for help.
Let���s collectively reevaluate how we���re dealing with Endo.
Part of recovering from endo needs to include healing from trauma. Trauma is rarely recognized as a significant part of the disease.
As physicians and healthcare workers, we can help prevent the additional trauma often experienced during medical treatment of endo patients.
TRUTH, TRANSPARENCY & TRUST
Philosophically, we have to look at attitude and ethics. Be truthful with patents. Provide transparency in what is going on. Build trust.
Characteristics of a Healing Relationship
Valuing
Physician creates an emotional bond with a patient by being non-judgmental, empathetic and fully present, not distracted, dismissive or critical, the patients feel listened to, respected and valued
Appreciating Power
The physician/patient relationship is inherently asymmetrical. The physician usually has more knowledge and power in medical matters but manages his/her power in a way that���s beneficial to the patient.
Abiding
Physicians care over time shows commitment to the patient and letting them know they won���t be abandoned. This allows the patient to relax, trusting both doctor and treatment.
When all 3 aspects are a part of the healing relationship, the natural results are trust, hope and a feeling of being ���known.��� And that���s where healing begins. And continues.
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What You Can Do Today to Help
If you have a loved one, friend or co-worker who suffers from endometriosis, please remember to treat her with respect and compassion.
For more information:
��Follow us on Instagram
@VitalHealthEndometriosis
��Sign up for our e-mail list.
��Read Our Books:
Stop Endometriosis and Pelvic Pain
The Endo Patient���s Survival Guide
The Endometriosis Health and Diet Program
��Susbscribe to our channel on You Tube: https://www.youtube.com/channel/UCrub...
Don't miss out! Subscribe to our YouTube Channel
��And don���t miss the 15+ minutes of Q&A at the end of the video.
You���ll discover more!��
– �� �� �� Endo myths. Busted. So you don���t buy into the hype but understand how to help.
– �� �� �� Why the lack between the 1800���s, 1920���s, 60���s/70���s and now concerning common knowledge? And the push for awareness over the last 30 years.
– �� �� �� Why a grassroots movement is needed to help women with Endo.
– �� �� �� Why endo does not have to be a chronic, life-long disease.
– �� �� �� More about screening tests, blood tests and other methods of diagnosis. Which ones are effective? How to effectively diagnose.
– �� �� �� How to learn about the latest information and research.
– �� �� �� Fertility Index Findings: 3 out of 4 people get pregnant after surgery.
– �� �� �� Genetic connections
– �� �� �� Plus, more!
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The post How the Medical System is Failing Women with Endometriosis appeared first on Vital Health Endometriosis Center.
September 5, 2019
Video: Why Did My Endometriosis Surgery Fail – Part 1
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Why is it so common to have an endo surgery fail? Could it be traced back to the type of surgery that is being performed, whether it’s Coagulation Surgery or Wide Excision Surgery?
Sometimes, it’s unfortunately not until a person has had several failed surgeries that she finally asks what the difference is between Coagulation Surgery and Wide Excision Surgery? Or what the advantages and disadvantages of Coagulation Surgery and Wide Excision Surgery are? Below, we will answer all of these questions for you as we watch part 1 of 3 in the “Why Did My Endo Surgery Fail?” series from Dr. Andrew Cook.
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TRANSCRIPT
On average, by the time patients get to see me they’ve been through three or four surgeries previously. So a common question I get is “why did my surgery fail?” And, there’s a lot of reasons, but one reason that we – and the reason we’re going to talk about today – is that it was an outdated coagulation (or burning kind of) surgery. And so I want to talk briefly about
What is coagulation surgery? and What is wide excision surgery? and what are the differences between these two types of surgeries.
Coagulation surgery uses electrosurgery to burn the tissue. The problem with that is it’s very imprecise. There is also a lot of lateral spread of heat so the very center part (of the affected tissue) – it’s black – it’s a “crispy critter” (it’s dead). The tissue next to it there is what is called a “zone of necrosis”. It looks okay but it’s been heated enough that it’s dead. And so, in the pelvis where there’s endometriosis you have to make sure to stay away from any critical structure of the ureters blood vessels, bowel, bladder, that kind of stuff. And so the advantage of coagulation surgery is – “it is pretty easy, you just stick the thing in there and burn it a little bit and it doesn’t take too long”.
High recurrence rate and other disadvantages of coagulation surgery for endometriosis
The disadvantages are we now know that in the majority of cases it doesn’t remove all the endometriosis and so there’s a high recurrence rate with a coagulation surgery. It damages the tissue so the tissue that’s left behind is damaged, inflamed and – from what we’re starting to understand with how pain works with endometriosis – it may actually make that part of the condition worse (more painful).
What’s the difference between excision surgery and wide excision surgery?
Next, we’re going to talk about wide excision surgery. I’ve been asked, “What’s the difference between excision and wide excision?”
Excision means “to cut out or to remove”. Wide excision means we’re going to take a border of normal-appearing tissue. The inside of the body is lined by the peritoneum (you can think of it like Saran wrap that covers everything – there’s no skin inside) and if we had endometriosis, it could be thought of to be like chia seeds on the Saran wrap. Wherever the endometriosis has spread we need to make a cut surrounding all the peritoneum that has endometriosis, lift the edge up, and cut it out – that’s wide excision.
Just like if you had a mole, you know the doctor wouldn’t burn it or cut right around the little edge of it, but he’s going to take some normal tissue because if it (gets tested and) does come back as being cancerous, then we all want to know, “Did you get it all?”
And just so you know, endometriosis is not a cancer but we do have to get it all (to consider the surgery a success).
Why doesn’t everybody do excision surgery?
So why did why doesn’t everybody do wide excision surgery
There are several reasons:
Wide excision takes a much higher technical skill level
wide excision is not really a skill that’s taught routinely in that residency programs
wide excision surgery does take longer
The advantages of wide excision
lower recurrence rates of endometriosis
wide excision surgery usually gets all the endometriosis
there’s little or no conduction of heat so the tissue that’s left behind is good, healthy tissue and we’ve removed any excess nerve growth in the area.
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The post Video: Why Did My Endometriosis Surgery Fail – Part 1 appeared first on Vital Health Endometriosis Center.
July 25, 2019
Video: Key cause of pelvic pain for women with endometriosis discovered
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TRANSCRIPT: Key cause of pelvic pain for women with endometriosis discovered
Hi, I’m here with some exciting news. There was actually a study published earlier this month, that is showing one of the key causes of the reason for pelvic pain in women with endometriosis.��
This team focused on the type of immune cell white blood cell called the macrophage. And macrophage comes from Greek term, big eater, ���macro,��� big ���phage��� eater. And really, they’re kind of the garbage collectors, or they eat up different things actually I have a picture here of one eating some bacteria.��
And so the lead bacteria cells as they���re dying off, and a variety of other things, the macrophage kind of cleans up the place. And then, depending on where in the body and what the role is, they’ll actually release different substances that help someone in the case of there’s not enough oxygen and a tissue is trying to heal it will stimulate the new blood vessel. So they can really be good and helpful in the body. But It turns out that the local environment, the signals can change the behavior of these macrophages. And It turns out that they’re actually drawn into the endometriosis lesions, so if you look at the lesions themselves there is a pack full of these macrophages.��
��And It turns out, they’re kind of macrophages gone bad. Because it turns out that what they’ve discovered is that under the influence of endometriosis the macrophages and then producing what’s called insulin like growth factor 1 or IGF-1. And What that does is stimulate the nerve cells to grow and culture and actually becomes more sensitive. So it’s a way of creating oversensitivity, kinda like a sunburn inside. And so, this is a great understanding and again, macrophages, if you don’t remember the word, You’ve got ���MGB��� macrophages gone bad. So, you know, they can be good, but these are kind of turned into juvenile delinquents, and they’re raising havoc in the pelvis.��
��But part of the good news is that allows us a venue to study and to better understand and hopefully provide better treatment. So both pain relief and maybe even as a way to tag the endo so we can find it and get rid of it one way or another.
��So for you, geekoids out there, the title of the article:��
So let me know what you think. I know this is getting a little bit more technical, but I’ve always been of the belief that women with endo are very educated, very smart, and very capable. So just trying to pass this information on to you and I think it’s a great study. All right. Take care.
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Click here to read the study
The post Video: Key cause of pelvic pain for women with endometriosis discovered appeared first on Vital Health Endometriosis Center.
July 24, 2019
Video: Key cause of pelvic pain for women with endometriosis discovered
Breaking News:�� New study finds key cause of pelvic pain for women with endometriosis
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TRANSCRIPT: Key cause of pelvic pain for women with endometriosis discovered
Hi, I’m here with some exciting news. There was actually a study published earlier this month, that is showing one of the key causes of the reason for pelvic pain in women with endometriosis.��
This team focused on the type of immune cell white blood cell called the macrophage. And macrophage comes from Greek term, big eater, ���macro,��� big ���phage��� eater. And really, they’re kind of the garbage collectors, or they eat up different things actually I have a picture here of one eating some bacteria.��
And so the lead bacteria cells as they���re dying off, and a variety of other things, the macrophage kind of cleans up the place. And then, depending on where in the body and what the role is, they’ll actually release different substances that help someone in the case of there’s not enough oxygen and a tissue is trying to heal it will stimulate the new blood vessel. So they can really be good and helpful in the body. But It turns out that the local environment, the signals can change the behavior of these macrophages. And It turns out that they’re actually drawn into the endometriosis lesions, so if you look at the lesions themselves there is a pack full of these macrophages.��
��And It turns out, they’re kind of macrophages gone bad. Because it turns out that what they’ve discovered is that under the influence of endometriosis the macrophages and then producing what’s called insulin like growth factor 1 or IGF-1. And What that does is stimulate the nerve cells to grow and culture and actually becomes more sensitive. So it’s a way of creating oversensitivity, kinda like a sunburn inside. And so, this is a great understanding and again, macrophages, if you don’t remember the word, You’ve got ���MGB��� macrophages gone bad. So, you know, they can be good, but these are kind of turned into juvenile delinquents, and they’re raising havoc in the pelvis.��
��But part of the good news is that allows us a venue to study and to better understand and hopefully provide better treatment. So both pain relief and maybe even as a way to tag the endo so we can find it and get rid of it one way or another.
��So for you, geekoids out there, the title of the article:��
So let me know what you think. I know this is getting a little bit more technical, but I’ve always been of the belief that women with endo are very educated, very smart, and very capable. So just trying to pass this information on to you and I think it’s a great study. All right. Take care.
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June 24, 2019
Video: Endometriosis Diagnosis
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On average, it takes 10 years for a woman to get a diagnosis of endometriosis. Dr. Cook is here to set the record straight. Diagnosing endometriosis is 10 times easier than treating it.
For an endometriosis specialist, it’s not difficult to diagnose endometriosis. There are two tests currently for endo, one is a screening test and the other a diagnostic test. The screening test is like a pap smear and is a relatively inexpensive test. It is able to pick up most of the people who have endometriosis, but it will also pick up some that don’t have it. From there, a diagnostic test is performed through laparoscopic surgery to determine if endometriosis is present. Dr. Cook recommends doing a screening test first based on the case history and then move into diagnosis with laparoscopic surgery.
One of the most common stories from women who are eventually diagnosed with endometriosis is the change is their periods as they get older. A woman first gets her period and her cramps are mild or non-existent, but as she gets older, going through Junior High, High School, and College, the cramps are getting unbearable and the periods are getting worse and more prolonged. Pain with intercourse, pain with bowel movements, and lower back pain are classic endometriosis symptoms. If these progressive symptoms are something you’ve experienced, it almost certain that you have endometriosis.
Over the decades, Dr. Cook has heard so many similar stories that he has a 90% accuracy of diagnosing endometriosis before any tests are performed.
The screening test is much cheaper and can be done for everybody. The diagnostic testing is more expensive, but it is more accurate. The screening test will let Dr. Cook know if you should undergo a diagnostic test through laparoscopic surgery.
If you are in pain and suffering, and you’ve had a progressive degree of pain with your period, a progressive number of days that you’re in pain, pain with intercourse, pain with bowel movements, lower back pain, until proven otherwise, you have endometriosis. Don’t stop until you find somebody to work with you to figure it out.
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TRANSCRIPT
Hi guys, we’re here talking about the diagnosis of endometriosis and I’m super excited about this week’s topic. We’ve been going over this last couple of weeks talking about what’s the screening test, what’s the diagnostic test, and some of the different aspects of it. Today we’re talking about diagnosis of endometriosis. It’s easy to do, and we’re going to talk about how to get your doctor to do it. These are the basic steps so stay tuned.
Now, the laparoscope allows us to look inside, so we can see the endometriosis, so it’s not a question, we’re not guessing; it’s either there or it’s not.
Now, the screening test, the history, gives us the information to know if it’s medically indicated to do a diagnostic laparoscopy to look for endometriosis. I think part of the resistance is that we get into, “Should it be treated, how should it be treated, am I competent to treat it,” and all these things. So let’s separate that out. And I think at least demand to get a diagnostic laparoscopy with appropriate documentation. And what do I mean by that? Well, currently the standard is that the surgeon looks in and sees what they see, maybe does whatever procedures they do, and then they dictate it or they make a written documentation of the interpretation of what they saw and what they thought they saw, which may or may not be correct. So what needs to happen is adequate photo documentation. I’m going to show you what needs to be done today. So, if the proper photographs were taken then, anybody can go back and look at them and double check. And if the surgeon didn’t recognize endometriosis and overlooked it, then we can see that. I mean there’s no harm in that. If we can get the proper steps, then we can start to get the right information because, unlike a blood test that’s standardized we’ll get the same result every single time. With a diagnostic laparoscopy it’s highly dependent upon the surgeon and they know what they’re looking for. And so it can be very sensitive or it can be very insensitive. And it can provide the wrong diagnosis saying that you don’t have endometriosis.
So what I’m going to do is show you the basic steps that are required to diagnose and adequately document the endometriosis. With that, if you can get an agreement ahead of time, then we have the evaluation of your surgeon, and he can always get a second opinion to double check.
What we have is a drawing or picture of the pelvis here. This is kind of if you’re up above looking down into your pelvis, so if you could look through your belly button into the pelvis. What we have here is the pubic bone up front, we have the bladder behind it. This is the uterus, the right ovary and fallopian tube here, the left ovary and fallopian tube.
These are the uterosacral ligaments that have nerves that go to the lower back, so that’s why endo here causes lower back pain. This is the sigmoid colon coming down into the rectum. Now, from far away, it’s easy to miss endometriosis. So, with the photo documentation, what we have to do is, going close with the laparoscope, a picture needs to be taken of the left side of the bladder. And then we need a picture of the right side of the bladder. And ideally, some pictures as close as possible so we can see the detail. And then the left pelvic sidewall here, the ovary is connected up to the uterus and then it’s connected here. So it’s kind of like on a door hinge, the ovary flips up and you need to look at all this area under here, and get a close photograph of that. Now, the other thing I almost forgot to mention is, we don’t see any bowel in here. It’s all up above and that’s because the patient’s head is tilted down. You have to get all the bowel out of the pelvis, you see a lot of pictures of bowels in here. This area here, the pararectal space we need to look very closely in here, and very closely over on the right side, and then another photograph with the ovary flipped up. Ideally, looking at both sides of the ovary with photographs to see if there’s any endometriosis there. So, an overall picture is great, but we need a couple of the bladder, we need close up photographs with the right pelvic sidewall, left pelvic sidewall, left pararectal space including the rectovaginal area, and the right pararectal area.
And with all that, that’s how we can get good photographs from the surgery that you’re going through, to be able to double check this, and then they get the answers. And so, it’s just, it’s crazy. So if we take these basic steps we can get a proper documentation, we can start to get the answer. And then if you have the documentation, “Yes, I have endometriosis,” then we can start to go through step by step. What are the things that can be done to treat endometriosis? What are the different options? And so, hopefully this helps. I think if we implemented these few basic easy steps right now, we would be able to get rid of that 10 years of pain and suffering that women are going through so. Y’all have a great weekend and week, and we’ll talk later. Take care.
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May 9, 2019
Video: The Stages of Endometriosis explained by Dr. Cook
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TRANSCRIPT
Dr Andrew Cook: Hi guys, good morning, Dr.Cook. Today we’re going to talk about classification of endometriosis. I get a lot of questions asking “what stage is my endometriosis?” This is the ASRM, American Society for Reproductive Medicine classification system, and what I am going to show you, some high-tech video features here. This will be on the website also. This is the worksheet for endometriosis classification, and you can see we have stage 1, 2, 3, and 4. It’s a point system – the maximum number of points allowable is 150 so you can see stage 1 is 1-5, stage 2, 6-15, and stage 3, is 16 and above. Now, there are three basic categories, we have endometriosis in this upper dark box, adhesions or scar tissue is all down below and then there is the posterior cul-de-sac, so let’s go through it one section at a time.
I’ve often said that if it’s not in the ovary deep an endometrioma chocolate cyst, it cannot be any more than stage 2 and the reason is we have peritoneum for endometriosis and ovary, so there are two basic locations we are looking for endometriosis. Peritoneum can be superficial or deep and if we go over into each of these columns less than one centimeter, which is about 3/8 of an inch, 1-3cm. 3cm is a little over an inch and greater than 3cm. So if it’s all over the peritoneum, the peritoneum is the inside lining of the pelvis, if it all over the peritoneum and superficial it’s 4 points. So you only get 4 points if it’s just on the surface of the peritoneum.
If it’s deep, in other words, it goes a little bit deeper than the surface of the peritoneum, 6 points so that barely gets you to Stage 2. So again if you don’t have any scar tissue, don’t have endo in the ovaries, the most you can be is a 1 or 2, and we all know stage 1 or 2 can be more painful than a stage 3 or 4. Now for the ovary, superficial endometriosis on the surface of the ovary or deep an endometrioma, less than one centimeter 1-3 and greater than 3, so greater than 3 you get 20 points right there so if you have an endometrioma in 1 ovary and that’s it you are stage 3. So you have the right and the left. So for endometriosis, you can get a maximum of 46 points. That’s it, so yes you could get into stage 4 with that.
The posterior cul-de-sac, the area behind the uterus and the bowel, partial so you know it’s almost like a zipper so the bowel starts to scar to the back of the uterus and that’s obliteration of the cul-de-sac. Complete obliteration right there you get 40 points, right there you are stage 4.
Okay then we have adhesions and remember this was made to try to predict the chance of getting pregnant after surgery not the degree of pain and we know it does not do that. That’s what the EFI or Endometriosis Fertility Index is about. Ok adhesions/scar tissue, two areas, the ovary or Fallopian tube. You have filmy, which is kinda like spider webs, you know just thin stuff, dense, things are glued together so then it’s less than ⅓ enclosure ⅓-⅔ and greater than a ⅔ enclosure. So you can get a total of 4 points if your ovary has filmy adhesions all around it, if it’s encased in adhesions then that’s 16. So each right and left ovary scar tissue, Fallopian tube, right and left Fallopian tube, so you can see really we have the numbering – it depends on how much endometriosis you have but if it’s all over inside, you really are a stage 1, maybe a stage 2. That’s where they were trying to guess at the time what affects fertility and the thinking was if the ovaries or tubes are affected by endometriosis or scar tissue then it’s bad. So invasive endometriosis really stage 3 and 4, noninvasive stage 1 or 2.
So hopefully that helps, but I think part of what I want to do is educate you guys on how to do the staging, what is a proper diagnostic laparoscopy. And again we all know right now a lot of patients know more than their doctor, but let’s get the correct information so you guys are informed, smart consumers. And that’s how we are going to change the way endometriosis is treated altogether. Alrighty, have a great weekend talk to you later!
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Click here to download the ASRM Form
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May 2, 2019
The Durango Herald welcomes Vital Health to Colorado
Vital Health Endometriosis Centers has opened a new location in Durango, Colorado. Special thanks to The Durango Herald for helping to welcome us to the region in their very informative article about endometriosis. Durango is easily accessible from the Four Corners region with direct flights from Denver, Dallas, and Phoenix.
Visit the Durango location at 1199 Main Ave., Suite #217, Durango, CO 81301-4158.
Endometriosis is often misunderstood by many doctors and can cause years of discomfort and agonizing pain.
Dr. Andrew Cook of Vital Health Endometriosis Centers is an internationally known endometriosis specialist that works with women who have had endometriosis for years and gone through many failed surgeries.
Endometriosis is pretty common, affecting 1 in 10 women of the reproductive age in the U.S. This painful condition takes place when tissue appears outside the uterus in the body cavity and can cause infertility.
There are multiple types of endometriosis depending on where the tissue growth is occurring. It can be found on the ovaries, fallopian tubes, bladder, and tissue lining the pelvis.
Many doctors dismiss endometriosis sufferers, saying they are just having a painful period, the pain is in their heads, or they want to obtain pain pills.
But Dr. Cook listens to his patients and their symptoms to diagnose them correctly, often with endometriosis. He sees approximately 600 patients per year. Read their testimonials.
About 70% of Dr. Cook’s patients travel from around the world to receive treatment from him.
Endometriosis invades and destroys tissue, so Dr. Andrew Cook treats it similar to how cancer is treated, removing it completely. He cuts out the healthy tissue bordering the endometriosis to ensure that it doesn’t come back. Most doctors just burn away the endometriosis tissue, which later returns.
Of the surgeries that Dr. Cook performs, about 50% of patients are relieved of all their pain.
Vital Health Endometriosis Centers has locations in Los Gatos, California and now Durango, Colorado. Dr. Cook spends about 4 or 5 months a year in Durango.
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