>----- Original Message -----
From: "Helen Dynda" <olddad66@runestone.net>
To: "Multiple recipients of list ADHESIONS" <adhesions@forum.obgyn.net>
Sent: Monday, January 29, 2001 10:50 PM
Subject: Easing endometriosis...Is surgery the answer?
> Easing endometriosis: Is surgery the answer?
>
> May 30 - Not too long ago I read an Internet post from a woman who was
> looking forward to having her thirteenth surgery to remove endometriosis
> and, hopefully, to quiet her agonizing pelvic pain. Thirteen sounded like
a
> pretty big number to me. But experts on endometriosis say this isn't
> uncommon, even though no one has ever proven that surgery is the best way
to
> ease pelvic pain.
>
> WHILE STUDIES have linked endometriosis - a condition affecting women of
> reproductive age in which endometrial tissue migrates from the uterus to
> other parts of the body - with pelvic pain and infertility, plenty of
women
> with the condition experience neither of these symptoms.
>
> "We know endometriosis is associated with infertility and pelvic pain,"
says
> Dr. Barbara Levy, a clinical assistant professor of obstetrics and
> gynecology at the University of Washington in Seattle and at Yale
University
> in New Haven, Conn. "But that doesn't mean it's the cause of either of
these
> conditions."
>
> Still, for years surgery has been hailed as a permanent fix for women with
> both endometriosis and pelvic pain. Procedures to cut or laser off
> endometrial lesions are now common.
>
> Doctors see desperate women and want to help, explains Dr. Dan Martin, a
> reproductive surgeon and a clinical associate professor at the University
of
> Tennessee in Memphis. It's difficult to tell a woman that there is no
simple
> way to heal her pain, he adds.
>
> Another common endometriosis treatment, hormone therapy to shrink the
> tissue, must be taken indefinitely and it doesn't work for all women.
Plus,
> hormones, which are often given in the form of oral contraceptives, aren't
> an option for women trying to get pregnant. A hysterectomy also may help,
> but it too is not an option for a women wishing to conceive.
>
> Ibuprofen and other pain relievers can ease symptoms but don't treat the
> disease. Non-drug approaches such as biofeedback and physical therapy also
> may alleviate pain.
>
> MAKING MATTERS WORSE?
>
> But with many women undergoing so many repeat operations, some specialists
> are now questioning the value of surgery. Some, like Levy, wonder whether
> surgeons aren't just making matters worse in many cases.
>
> Every time a doctor operates - whether it's a big incision or a little
one -
> scar tissue forms inside the pelvis, Levy says. This scar tissue - known
as
> adhesions - can cause pain. And then there's the issue of nerve damage,
> Martin says. Multiple surgeries seem to be linked with pain from injured
> nerves.
>
> Many women undergo surgery over and over again. If you peruse the
> endometriosis discussion groups and bulletin boards on the Internet, it is
> not unusual to read accounts of women who've had multiple surgeries - 12,
> 13, 14, even more - and still suffer from pelvic pain.
>
> These women believe that they need more surgery because their trusted
> physicians have told them that the endometriosis has grown back and
another
> operation is the only solution.
>
> So why would women keep coming back for a treatment that seems so
> ineffective?
>
> Well, first and foremost, it's because their pain is so unbearable, Martin
> says.
>
> It's also because, for a short time, they feel better. And this may simply
> be the result of something called the placebo effect, Levy says.
Basically,
> when the doctor and patient both believe in a treatment, it can turn out
to
> be perplexingly potent.
>
> A particularly clear example of the power of the placebo effect came
several
> decades ago when researchers tested a popular surgery to correct angina -
> chest pain caused by an inadequate supply of oxygen to the heart muscle.
>
> The surgery, which involved tying off an artery in the chest, was
eventually
> tested by having one group of patients treated with the real operation,
> while another received only a chest incision. Ultimately, 76 percent of
the
> patients who received the real procedure improved. But 100 percent of
those
> who received the sham surgery got better.
>
> MANY OPERATIONS, NO RELIEF
>
> It was the failure of endometriosis surgery to provide long-term benefits
> that made Levy start to wonder.
>
> "My interest in this subject was tweaked by seeing patients with all these
> operations still in pain," Levy says. "This is not acceptable."
>
> Some women undergo surgery every two years, some as often as every six
> months, Levy says. "How many is enough?" she asks. "Do you wait till you
> have a major complication till you stop operating?"
>
> Levy isn't alone in concluding that an effective treatment should offer
> lasting relief.
>
> If the condition truly is the cause of the pain, "medical or surgical
> treatment of endometriosis should result in prolonged pain relief," Dr.
> William W. Hurd wrote in an article in the journal Obstetrics and
> Gynecology. Hurd is a researcher in the department of obstetrics and
> gynecology at the Indiana University School of Medicine in Indianapolis.
>
> Martin agrees that multiple surgeries are not the answer. If one surgery
> doesn't do the trick, then the doctor needs to try other, noninvasive
> approaches, he says.
>
> Levy wouldn't even do a first surgery on most women. But, she allows,
there
> is a small subset of women with endometriosis who can be helped with
> surgery. If the doctor prods a spot on the woman's abdomen during the
> physical examination and this causes pain each and every time the area is
> touched, then there is a good likelihood that surgery will help. Levy also
> will operate if a woman is trying to get pregnant and her reproductive
> organs are distorted by endometrial tissue growth, she says.
>
> It can be tough saying no to a desperate patient, Martin says. "But as
I've
> gotten older and seen how few times you help someone with surgery, I've
done
> less of it. I've learned to say no more often."
>
> http://www.msnbc.com/news/402412.asp#BODY
>