Andrew S. Cook's Blog, page 3

Pelvic Pain Solutions ~ Products

Announcing ~If you are in need of convenient travel aids or just looking for general comfort with some of your pelvic pain, please check out the great products at Pelvic Pain Solutions … they were a well received co-sponsor for the Endo What ? film in SF recently. So happy to share these great products with you …. Visit Pelvic Pain Solutions

 

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Please join us for the Endo What? West Coast Premier on April 13th in San Francisco

Director and Producer Shannon Cohn announces the premier screening of her documentary film Endo What? this April 13th at the Delaney Street Theatre in San Francisco.  Please join Dr. Andrew Cook and Libby Hopton, Director of Research & Evidence Based Medicine, as we gather with a group of esteemed panelists to answer questions on Endometriosis, and discuss issues relating to public awareness of this disease. Don’t miss your chance to view this important film which includes heartfelt stories from patients and insightful commentary by world renowned Endometriosis experts and leaders in the field.  Tickets are available on the Endo What? website at  http://endowhat.com

 

Congratulations to Director and Producer Shannon Cohn, along with her production team : Patricio Cohn, Producer and Cinematographer, and Arix Zalace, Producer / Editor for this fine production.  We would like to extend a special thank you to the women in this film who so bravely and generously shared their stories and personal experiences. These testimonies have contributed greatly to the core content and are truly instrumental in depicting the impact of Endometriosis on women worldwide.  

 

 

 

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              Related StoriesKelly Heslin joins VHI for Public Health Masters InternshipTeen’s Tenacity Leads to Endometriosis Diagnosis: Video StoryManagement of Pelvic Pain in Women with Endometriosis 

Teen’s Tenacity Leads to Endometriosis Diagnosis: Video Story

Because so few people know that 70% of teens who experience chronic pelvic pain are later given an endometriosis diagnosis, many young women suffer years of pain when it’s overlooked as a potential diagnosis. Endometriosis is generally thought of as unique to grown women and not considered as a possibility for adolescents and teens.

One young woman, Erika, would like to change that lack of awareness for  young girls and teens experiencing chronic pelvic pain. Endometriosis Excision Ends Teen’s Years of Pelvic Pain is Erika’s video story of her four-year journey to reclaim her life without disabling pelvic pain.

“I just want other girls to realize that there is hope. You can regain your life. It’s not a life sentence of pain. If you get to the right surgeon you can regain your life and you can progress as a person without pain.”

Erika’s Endometriosis Diagnosis Mission

Erika has “gone public” with her story in the hope of helping other young girls and teens to avoid what she had to endure. Erika’s story recounts the battle she and her mother fought to overcome years of pelvic pain and misdiagnosis to finally reclaim her life.

Erika’s story – and her mother’s story – is a story of resilience and determination to find answers that would restore Erika’s life. Today, after her endometriosis surgery, she is without pelvic pain and living a normal life. Her message: “You can regain your life. It’s not a life sentence of pain.”

Erika had help – her mother, family and a streak of perseverance that finally got her a correct diagnosis of endometriosis. And she’s now just as tenacious in wanting young women and their families to insist on having their physicians consider the possibility of an endometriosis diagnosis in their diagnostic quest.

 

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              Related StoriesManagement of Pelvic Pain in Women with EndometriosisWhat is Hormone Therapy and Should it be Used to Treat Endometriosis?A Survival Guide to Bowel Preps 

Dr. Castillo Presenting at the Annual American Urogynecological Society in Seattle Oct 13-17

 

Dr. Peter Castillo will be presenting original research on Pregnancy following incontinence sling procedure at the American Urogynecological Society Scientific Meeting in Seattle this month, October 13-17.

AUGS hosting of PFD Week includes a broad range of scientific presentations, exhibits, and educational lectures catering to world class Urogynecological Specialists.  Dr Castillo’s presentation of clinical study is focused on patient outcomes relating to the efficacy of MidUrethral Slings throughout subsequent pregnancy.  This is important research as it relates to urinary incontinence postpartum.  His presentation will be publicly shared after his talk in Seattle this month.

 

Dr Peter Castillo offers a comprehensive range of leading edge in-office diagnostic, testing, and minimally invasive procedures for gynecological problems and pelvic floor conditions.   Find out more about his expertise in urogynecology by visiting his page :  Meet Dr. Castillo and also visit the Urogynecology Specialty Center on our home page.  Please feel free to call the office at 408-358-2511 for questions or scheduling.

 

 

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              Related StoriesNew Procedure ~ Mona Lisa Touch now offered by Dr. CastilloTreating Pelvic Floor Dysfunction in Women with Endometriosis & Other Pelvic Pain ConditionsVital Health Launches Endo Survival Guide! 

Endo Belly

The psychological trauma alongside the physical pain has become too much …


Yet my doctors aren’t that bothered about it…


I feel totally alone …Samantha

Are you sometimes so bloated that you feel like you are pregnant? Or even had people ask you if you are pregnant? Do you have an extra set of clothes set aside for those times when you are so bloated that it’s time for a wardrobe switch? Maybe you are like Samantha, a woman just trying to deal with this painfully inconvenient, embarrassing physical disruption, along with all of the other frustrating and painful effects of Endometriosis.

We met Samantha in a forum recently, and she agreed to share her story and photo. She says: “I now only go out to doctors/hospitals or dentist as I cannot cope with people thinking and starring at me thinking I am pregnant. Every doctor blames the bloating on something else, but no one has investigated or tried to do anything about it. I would be so grateful for any help, as I feel totally alone.”

The severe bloating that goes hand-in-hand with endometriosis is too often dismissed by doctors as a minor symptom. For the patient, however, this symptom can be emotionally and physically devastating.

Endo Belly is also an example of the wide array of symptoms endometriosis patients experience and one of the very common misunderstandings about this disease. Physicians, patients, and even endometriosis specialists often misunderstand the root cause of many “endo symptoms”.  Are they always a result of endo, or could there be other causes?

Good progress has been made on increasing awareness of endometriosis and optimal treatment. Proper surgical treatment of endometriosis requires wide excision of the endometriotic implants rather than just burning or cautery. Surgery that simply burns the surface of the implants leaving underlying disease behind is often associated with either continued symptoms or recurrence of symptoms soon after surgery.

This is not the full story, however, and to truly understand this condition, we need to raise awareness of the missing pieces in the puzzle. In my 25 years of practice specializing in endometriosis, I have come to appreciate the complexity of the pattern of symptoms many of my patients deal with. While approximately half of my patients are primarily affected by endometriosis, which is effectively resolved by excision surgery, the other half have other conditions or health problems that co-exist with their endometriosis. In this latter group of patients, while excision surgery provides the foundation of their treatment, complete resolution of their symptoms requires that we address additional health problems, including multi-systemic dysfunction. In these patients, it is a mistake to automatically assume that continued symptoms after surgery are due to persistent or recurrent endometriosis. The real problem may well extend beyond this diagnosis and often encapsulates other often-related health conditions that may masquerade or be overshadowed by the initial diagnosis of endometriosis.

“Endo Belly” can be the result of endometriosis implants and may get better after surgical removal of the disease. Endometriosis implants, however,


are not the only cause of “Endo Belly”.

One such example is the infamous “Endo Belly”. While “Endo Belly” can be the result of endometriotic implants, and may resolve after complete excision of all endometriosis, this is certainly not always the case and other health problems can also cause or contribute to those all-too-familiar flares of extreme bloating and distention. At our center, we therefore approach endometriosis and its associated health problems from a multi-disciplinary paradigm including traditional medicine (e.g., excision surgery), as well as a variety of integrative and holistic modalities.

Our approach is based upon the most recent scientific information. We treat the whole patient, not simply surgical removal of the endometriosis implants. One example of this is the role of the bowel, including the human microbiome (the bacteria that live in our bowel), in causing pelvic pain and other health problems. Danielle Cook, RD, MS will discuss below the importance of gut bacteria as a contributing causal factor in bloating and “Endo Belly”. This is a very brief overview and covers just a few of the important facts about the critical impact of our intestinal health on our overall health.

Best wishes,

Dr. Andrew Cook

Gut Bacteria & Endo Belly ~


Why You Look & Feel So Bloated

What does your gut bacteria have to do with that annoying bloating and gastrointestinal discomfort? A lot!

We have more bacteria living in our guts than we do human cells in our body. We have a balance of beneficial (commensal) bacteria and potentially pathogenic bacteria (disease causing unfriendly bacteria). This is actually one of the most complex ecosystems in nature. It is important to maintain a healthy balance of bacteria in the gut.

These beneficial bacteria are not simply along for the ride, but rather, they play a critical role in our health. For example, they are involved in digesting food that we eat, producing vitamins such as vitamin K2 and biotin, converting thyroid hormone into its active form, detoxification, reducing inflammation, reducing pathogenic forms of bacteria, and energy production. These are only a few of their important jobs! We also have yeasts and viruses in our guts. It’s important to keep a healthy balance of these microorganisms in our guts too.

Endo Belly is also an example of the wide array of symptoms


endometriosis patients experience, and one of the common misunderstandings about this disease.Danielle Cook, RD, MS

Gastrointestinal problems can be a result of bacterial problems in the small and/or large bowel. Most of the bacteria are in the large bowel. A little is in the small bowel, but not nearly as much as in the large bowel. Dysbiosis is a condition where an imbalance in beneficial and potentially disease producing pathogenic bacteria occur in the bowel. SIBO (Small Bowel Intestinal Overgrowth) is a condition where the bacteria from the large bowel migrate up into the small bowel. With SIBO, the over abundance of bacteria in the wrong location is exposed to undigested food, which it eats and turns into a large amount of gas (bloating, pain, indigestion).

Factors that may negatively alter the sensitive bacterial balance lead to dysbiosis or SIBO and include:

Antibiotics (with certain antibiotics it can take up to 2 years to regain a healthy microbial balance in your gut)
Chronic stress
Non-steroidal anti-inflammatories (NSAIDS)
Constipation
Standard American Diet (SAD diet – high in unhealthy fats, processed carbohydrates, and sugar and low in fiber and vegetables)
Food allergies and Sensitivities
A weakened immune system
Intestinal infections (such as yeast overgrowth) and parasites
Inflammation
Poor function or removal of the ileocecal valve (valve between the small and large intestine)

There are several common symptoms of dysbiosis and SIBO. You may be experiencing several of them. They include :

Bloating, belching, burning, flatulence after eating
A sense of fullness after eating
Indigestion, diarrhea, constipation
Systemic reactions after eating (such as headaches and joint pain)
Nausea or diarrhea after taking supplements (especially multivitamins and B vitamins)
Weak or cracked finger nails
Dilated capillaries in the cheeks and nose (in a non-alcoholic)
Iron deficiency
Chronic intestinal infections, parasites, yeast, unfriendly bacteria
Undigested food in stools
Greasy stools
Skin that bruises easily
Fatigue
Amenorrhea (absence of menstruation)
Chronic vaginitis (vaginal irritation)
Pelvic pain

Dysbiosis is not uncommon in women with endo. Endometriosis-associated intestinal inflammation may alter the balance of gut microflora.[i] Balley and Coe investigated the intestinal microflora in female rhesu monkeys and found an increased amount of intestinal inflammation and fewer aerobic lactobacilli and gram negative bacteria in monkeys with endometriosis compared to those without the disease.52 A disruption in the gut microflora (dysbiosis) can have negative health consequences including poor digestion, malabsorption of nutrients, increased inflammation, and increased gastrointestinal infections.[ii] Intestinal microflora act as a barrier to gut pathogens by blocking attachment to the gut-binding site and produce antibacterial substances.

Problems with an overgrowth of bacteria in the small bowel can also result in the common gastrointestinal complaints among women with endometriosis. Recent studies have demonstrated the presence of Small Intestinal Bacterial Overgrowth (SIBO) in women with endometriosis.

In one study, 40 out of 50 women with laparoscopic confirmed endometriosis were found to have SIBO. [iii] SIBO needs to be considered as a contributing factor anytime a woman has severe bloating.

The gut also plays an important role in estrogen elimination. Phase II detoxification in the liver (medical term for the process of eliminating many hormones including estrogen) utilizes conjugation of estrogen to other compounds so they can be excreted in bile.[iv] If the gut flora is unbalanced, certain bacteria secrete an enzyme called beta-glucuronidase, which cleaves the glucuronide molecule from estrogen, allowing estrogen to be reabsorbed into circulation vs excreted in the stool. Lactobacillus, a healthy bacteria, decreases the activity of B-glucoronidase.[v] If the activity of B-glucoronidase is increased, more estrogen will be reabsorbed and potentially worsen the endometriosis.

Do you have any of these symptoms? If you do, they may be caused by more than your endo inflammation. If you have these symptoms after good quality endometriosis excisional surgery, your endometriosis is gone, but your symptoms may be a result of other conditions such as the ones discussed above. Some tests that may be performed include a hydrogen/methane breath test, a comprehensive stool study through a lab such as Genova Diagnostics, organic acid testing, and food sensitivity testing. There may also be therapeutic diets that can be helpful for symptom management such as the Specific Carbohydrate diet, the FODMAP diet, the Microbiome Diet, and the Autoimmune Paleo Diet. There is no one size fits all treatment for dysbiosis. Some diets that help with dysbiosis can make SIBO worse. A qualified practitioner can help to determine what studies and treatment may be helpful.  Some of the lab tests which may be relevant are included in our Specialized Lab Testing at Vital Health Institute.

You may be interested in this video : Enterome: the gut microbiome and it’s impact on our health:

Wishing you a happy and healthy day,

Danielle Cook, RD, MS

 

[i]. Balley M, Coe C. Endometriosis is associated with an altered profile of intestinal microflora in female rhesus monkeys. Human Reproduction. 2002;17(7):1704-1708.
[ii]. Miniello V, et al. Gut microbiota biomodulators, when the stork comes by the scalpel. Clin Chim Acta. 2015. Web. Accessed February 25, 2015.
[iii]. Mathias JR, Franklin R, Quast DC, et al. Relation of endometriosis and neuromuscular disease of gastrointestinal tract: new insights. Fertil Steril. 1998; 70:81-88.
[iv]. Evans, J. An integrative approach to fibroids, endometriosis, and breast cancer prevention. Integrative Medicine. 2008; 7(5):28-31.
[v]. Goldin BR, Gorbach SL. The effect of milk and lactobacillus feeding on human intestinal bacterial enzyme activity. Amer J Clin Nutr. 1984;39(5):756-61.

 

Vital Health Institute continues to provide the most comprehensive approach to the diagnosis and treatment of endometriosis.


Visit our website for more information.

 

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              Related StoriesTreating Pelvic Floor Dysfunction in Women with Endometriosis & Other Pelvic Pain ConditionsWhat Happens During a Diagnostic Laparoscopy?Management of Pelvic Pain in Women with Endometriosis 

New Procedure ~ Mona Lisa Touch now offered by Dr. Castillo

 

I am happy to announce this new procedure for total Treatment of: Vaginal Dryness, Itching, Burning, Painful Urination, Painful Intercourse, and Laxity. RSVP for our Open House, and learn how these symptoms can be easily eliminated in just 3 sessions in our office.Dr. Peter Castillo

Dr. Peter Castillo is happy to introduce Vital Health Institute’s latest and most advanced treatment option, the MonaLisa Touch™ laser. As providers of your care, we feel it is critical to provide leading edge, scientifically documented and proven technologies for our patients. This new procedure addresses and quickly treats a wide range of symptoms, including:

Vaginal Dryness
Itching and Burning
Laxity
Painful Urination
Painful Intercourse
Stress Urinary Incontinence

The groundbreaking use of a CO2 laser delivers controlled energy to the vaginal tissue to revitalize cells so that they make more collagen and enhance moisture levels, which is an essential component in vaginal cell health. Previously offered only in Europe, this FDA approved technology is now among the offerings of only a few specialist providers statewide. Think of it as a painless 5 minute miracle for your renewed comfort, sexual health, and vitality !

We are scheduling introductory appointments for two planned open house events, June 23rd and July 23rd, so please respond if you would like to be included in either of these specially discounted events !  You will meet Dr. Castillo and learn that there are other, less invasive, and overall less costly ways to treat these conditions, while reducing or eliminating your need for hormonal therapies.

Dr Peter Castillo offers a comprehensive range of leading edge in-office diagnostic, testing, and minimally invasive procedures for gynecological problems and pelvic floor conditions.   Find out more about his expertise in urogynecology by visiting his page :  Meet Dr. Castillo and also visit the Urogynecology Specialty Center on our home page.  Please feel free to call the office at 408-358-2511 for questions or scheduling.

 

Read this recommendation from Sarah, one of  Dr. Castillo’s many patients : “Dr. Castillo is a highly skilled, caring, thorough doctor.  I appreciated the extra effort and personalized attention he took in ensuring the best possible outcome. He is one of the best doctors in his area. He also followed up after the procedure to make sure everything went well. I highly recommend Dr. Castillo!”

 

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Kelly Heslin joins VHI for Public Health Masters Internship

This opportunity is exactly what I had hoped my public health education would offer: professional public health development in the field of endometriosis, working toward reducing the unnecessary suffering that so many women experience.Kelly Heslin

Kelly M. Heslin, of the Mel and Enid Zuckerman College of Public Health, University of Arizona, joins Vital Health Institute this summer to complete the Internship for her Masters in Public Health Degree.  Kelly’s Internship plan is focused on the development of an Endometriosis Education Plan that will serve as an outreach program in our community and elsewhere.

In Kelly’s words: “Endometriosis is a reproductive disease that affects at least 1 in 10 women worldwide, causing pain and infertility, as well as numerous other symptoms that interfere with a woman’s health and productivity. Vital Health Institute has invaluable connections to and direct involvement with the local community, as well as the endometriosis treatment and research community at large. I foresee this internship as merely a stepping off point, and I am optimistic that I will be able to continue working with this project specifically, or with one of the other major players in the endometriosis field to continue educating and advocating for women who are marginalized by the existing health system, both pre- and post-diagnosis”.

 

We warmly welcome Kelly to the Vital Health Team this summer,  for completion of this important work.

 

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Vital Health Launches Endo Survival Guide!

The Endo Survival Guide, co-authored by Dr. Cook, Libby Hopton and Danielle Cook, is the essential patient’s companion to living with and overcoming endometriosis and pelvic pain: from seeking help and getting an initial diagnosis to navigating treatment options and achieving optimal relief and wellness.

The guide will shortly be available in iBook format for download from iTunes.

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What it Really Means to Have Endometriosis

Endometriosis by definition is a disease process whereby tissue somewhat like the endometrium (the lining of the uterus) exists outside the uterus. This “rogue” endometrial-like tissue most commonly involves the peritoneum, a thin layer of tissue that lines the pelvic structures, the bowel, the bladder and the ovaries. Quite frankly a lot of this medical stuff can be quite dry and boring and does not convey what it is like for a woman to have this disease and how it truly impacts her life, her family, her career, her sex life, and her ability to live her life in very basic ways.

In reality, this disease can be like having tens or hundreds of excruciatingly painful blisters covering the inside of the pelvis. Infertility and pelvic pain are the two most common symptoms of endometriosis.

In reality, this disease can be like having tens or hundreds of excruciatingly painful blisters covering the inside of the pelvis.

Patients with endometriosis can experience horrific pain – for the lucky ones it lasts just a couple of days during their period, and in the worst cases the pain is 24/7. The dichotomy between the way women with endometriosis look well on the outside but are experiencing excruciating pain internally can cause even well-meaning people to doubt the severity of their pain.

Most women begin to have pain in their teenage years, sometimes even starting in junior high school. While similar in timing, this pain is completely different than normal menstrual cramps. It is not uncommon for these girls to miss a couple of days of school each month from cyclic pain that can exceed the level of pain patients experience after major surgery.

A lack of awareness of this disease can leave these girls without a correct diagnosis and support from their physicians. This can lead to a lack of appropriate treatment for the pain and invalidation of the patient’s situation. Her family is now led to believe that psychological issues drive the severity of her pain.

In this tragic situation, she is effectively held prisoner and tortured by her own body in broad daylight, with no one who fully understands her situation or who can effectively help her.

In this tragic situation, she is effectively held prisoner and tortured by her own body in broad daylight, with no one who fully understands her situation or who can effectively help her.

The symptoms usually progress as she matures into a young woman. Both the severity and duration of the pain typically increase. Initially most days each month are pain-free, but the number of these days slowly decreases until there are a greater number of non-functioning pain days. The unpredictability of the increasing number of pain days makes it challenging to maintain a functional life. It becomes increasingly difficult to make plans for a future date as it becomes more likely that it will be a pain day and she will not be able to follow through on her commitment for the activity.

As a disease, endometriosis can take away many additional aspects of a normal life. Mothers cannot reliably meet the needs of their children when the pain is too severe to function. Wives try to push through the pain to be intimate with their husbands, but eventually the pain becomes too intense to continue. Grinding fatigue as severe as that experienced with advanced cancer is present in most cases. Bloating, moodiness, and bladder and bowel issues are common as well.

Feeling like a vibrant desirable woman is long since gone. Acting like the loving compassionate woman, mother and partner that she truly is becomes more and more difficult. The stress on family relationships is common and real.

Even at this stage, most women fight the disease, refusing to let it completely take over their life. You would most likely pass right by them in public, having no idea of the devastation they are dealing with. Most of the time they get up, put on a brave face and do their best to live a normal life.

The medical definition of endometriosis does not even begin to describe the reality of what it means to have endometriosis. The next time you hear about endometriosis, please remember how devastating this disease can be to a person. While endometriosis can be frustrating, if you have a loved one, friend or co-worker who suffers from endometriosis, please remember to treat them with respect and compassion.

Further Reading
About Vital Health

What is endometriosis?

Is my pelvic pain due to endometriosis?

Does endometriosis have a cure?

What causes endometriosis?

What are the symptoms of endometriosis?

Treating endometriosis

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Dr. Cook Featured on CBS News

Endometriosis tortures people. It doesn’t kill them but there are times when you may wish it would kill you.Dr. Cook

CBS news LA covers the story of Leslie Valladares, a former patient of Dr. Cook who had her life transformed following his specialized endometriosis excision surgery. Leslie had suffered for years with the crippling symptoms of endometriosis and had been unable to find relief, despite enduring surgeries and rounds of hormone therapy with several doctors. After exhausting all her options locally, she decided to travel to Los Gatos to undergo surgery with Dr. Cook, world-renowned specialist in endometriosis, and went on to make a full recovery.

We hope that Leslie’s courage in sharing her story will bring hope to other women who are struggling to live with the same debilitating symptoms.

Read the whole story and watch the mini-documentary on CBS LA.

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