It’s FRIDAY!

What a weird week I’ve had. How’s yours?

My husband has worked the 3pm-midnight shift every day since Sunday, so I’ve literally seen him for five minutes each day as we wake up to shuffle cars in the morning. My co-worker has this week off, so work has been a bit extra-busy. And I fell at work on Wednesday. I’m fine: just a few bruises and soreness, but my pride was hurt more than anything…

Then yesterday I started my period. It was a relatively calm and easy first day.

Last night I stubbed my toes into the corner edge of the bedframe (I know you know what that feels like). And today I’m sporting a very purple fourth toe on my right foot and can’t wear closed-toe shoes due to the pressure it causes on my digit.

And today’s period pain is a blend of low-level, “that-has-never-hurt-there-before” cramping, as well lower back pain (which may just be from the fall). So, I’ve popped some Ibuprofen, used my mum’s favorite Jeannie in a Bottle pain spray, and I’m just sitting back and listening to my body, trying to tune in and really ID where that abdominal pain is. Lots of heavy bleeding, but that’s probably because I didn’t have a period in January. WAIT: I’m gonna spray some of that stuff on my toe RIGHT NOW!

My period pain is on the lower left side of my pelvis, literally in the top of the hairline of my pubic hair, about an inch to the right of the edge of my mons. And, at it’s highest, it’s been about a 4 on the 1-10 pain scale. So, it’s manageable. But my uterus doesn’t live over there…and that’s where my pain’s been since I started my period (I actually had several seconds of severe stabbing pain there the day before my period). So what the heck? Something I’ll be monitoring. And I’m doing a lot of deep breathing this morning to calm myself down: “it isn’t Endo. It isn’t Endo. IT ISN’T ENDO”…And I don’t have a left ovary, so what the heck? Whatever. I’ll just watch, listen, wait, and see. It’s all I can do. I have my annual pap in May, soon to be followed by my annual transvaginal ultrasound. So, I’ll take notes and debrief my doctor when I see him in a few months.

Okay, enough rambling about my week…Onward to today’s quote!

“I am amongst a community of warriors.”

― Bethany Stahl, Endometriosis: It’s Not in Your Head, It’s in Your Pelvis

And THAT is the single-most thought that gets me through any of my Endo-terror moments: I am NOT alone. I am surrounded by Warriors and support. And so are you. And you. And you.

And, please, tell me about your week. How are yoU?

Much love, Lisa.

Blogs I updated this week:

C-Sections & Endometriosis – just one study was added:

• Cureus journal published a January 2021 study of a 45-year-old woman who had had a c-section two years prior to her doctor appointment. Eight months ago, she noticed a swelling mass on her right side. It had gotten progressively gotten larger as the eight months passed, most noticeably when she was on her period. The lump was mildly painful, but was controlled with NSAIDs. She had no other symptoms or concerns, other than the growing lump on her right side near her c-section scar. A hard mass could be felt during a physical examination and a CT scan showed a large 17x15x10cm (that’s nearly 7x6x4 inches!) mass. They guessed it was an abdominal wall Endometrioma, as it was seated in the abdominal muscles and had no other involvement with organs or structures. The mass was excised in surgery and three months later, she had no recurrence. Pathology confirmed their suspicions.

Endometriosis & the Bowel – I added the following studies:

• A 20-year-old woman was the focus of a March 2019 abstract published by an Italian journal. She complained of abdominal pain for the past 2 years and was referred to surgery by her psychiatrist. Endometriosis was found along her right pelvic area, her Pouch of Douglas, and her uterosacral ligaments. Nothing abnormal was found with her bowels. Eight days later, the cramps continued and she began to bleed from her butt. A second surgery was performed and they found evidence of a pelvic hematoma and rectosigmoiditis (ulcerative colitis). Three days later, they found fecal matter in her surgical drains. Another surgery was quickly scheduled and it was determined that her bowels had perforated and she received a bowel resection and ileostomy. Biopsy of the intestines found evidence of deep-infiltrating Endometriosis within the intestinal wall, and it’s surmised that caused the perforation. The study concludes, “The presented case confirms the importance of interdisciplinary cooperation between surgeons, gynaecologists, and pathologists. We also want to emphasize the need for extensive pathological examination of the resected specimens which is essential for a proper diagnosis.”
• The Turkish Society of Colon and Rectal Surgery published a 2020 article about a 28-year-old female went to the hospital due to abdominal pain, lack of appetite, nausea, and vomiting. The pain had been ongoing for about a day and worsened over a six-hour period. An ultrasound was attempted, but was inconclusive because she had too much gas. A CT scan found contracted bowels and they believed she suffered from a small bowel obstruction. A laparotomy was performed and defect which caused a bowel obstruction near her ileocecal valve. They resected the portion of blocked bowels and pathology found the blockage to be “fibrosis caused by Endometriosis.” The patient was released from the hospital after a four-day stay with no complications. The authors end their study with a powerful statement: “Mechanical small-bowel obstruction due to ileal endometriosis is a rare case…[i]t does not resolve spontaneously and surgery is the treatment of choice.”
• Another article published in June of 2020 followed the journey of a 32-year-old woman who complained of vomiting, diarrhea, and abdominal pain for two weeks. She was given pain killers, antibiotics, and a proton pump inhibitor, but did not improve. She’d never had these symptoms before. An ultrasound and CT scan revealed “intussusception”, which is when one portion of the intestine slips in and telescopes into another portion of intestine. An emergency laparotomy was ordered and she underwent a bowel resection. The intussusception was caused by adhesions and an Endometriosis lesion discovered in the colon. She was symptom-free three months after surgery.
• Case Reports in Medicine published an article in July of 2020 about a 51-year-old woman in Brazil who had been hospitalized due to a decrease in bowel movements (she was only poopin’ once every three days), and her bowel movements were “sharp and long”. These complaints had been getting worse over the past year, and about once a month would have blood in her stool. The physical examination and labwork were normal. And it may be important to point out that she had a hysterectomy in 2011 due to fibroids. A CT scan showed abnormal thickening of of her upper rectum and sigmoid colon. A rigid sigmoidoscopy was performed and they physicians were unable to proceed more than 30cm (almost 12 inches) into her colon due to a blockage and there was mucosa along the interior of her bowels. They suspected colon cancer and performed surgery to remove the diseased portions of her intestines. Pathology corrected the pre-op diagnosis with findings of intestinal wall Endometriosis. After healed from her surgery, the patient had no recurrent symptoms.
• In August 2020, Surgical Case Reports published an article of a 43-year-old woman who had been constipated for the past two years, but no abdominal pain. An x-ray revealed a lot of trapped gas (giggle), but a colonoscopy found a lesion in her upper rectum. On two separate occasions, samples of that lesion were taken and tested and came back as “nonspecific inflammation.” A CT scan showed wall thickening of that same section of her guts…and it also revealed a 4cm (a little bigger than 1.5 inches) cyst on her left ovary. An exploratory laparoscopy was performed: she had some fluid in her Pouch of Douglas an endometrioma on her left ovary, and some rectum adhesions. “No endometrium was found on the rectal surface or abdominal wall.” The upper rectum showed some signs of inflammation, which may have been a tumor. The patient opted for a bowel resection to remove that defect and lymph node surgery (her surgery was 7 hours long!)! The left wall of the rectum was stuck to her left ovary and large amount of stool was still stuck within her colon. She received a temporary ileostomy and was discharged home after nearly 40 days in the hospital. WHAT A TROOPER!!! A biopsy of the intestines came back as rectal endometriosis. But you want to get angry: they left the endometrioma there…inside…”and the patient was attending a gynecological department for hormone therapy at the time of this writing.” UGH! I’m so frustrated. I mean, maybe they had a good reason to leave it in, but UGH!
• Another study in August of 2020 was published in the Canadian Medical Association Journal. A 36-year-old woman went into the emergency room with a 9-month history of abdominal pain and rectal bleeding while she was on her period. A physical exam, labwork, and ultrasound were all normal. An MRI showed intestinal wall thickening of her sigmoid colon. And a colonoscopy showed a lesion with “red nodular surfaces” in her sigmoid colon. They suspected intestinal Endometriosis, as well as IBS or cancer. Although, pathology of the lesion from the colonoscopy came back as “nonspecific.” A second colonoscopy was conducted while the gal was on her period, and that pathology came back as intestinal endometriosis. The patient declined hormonal treatments and instead a bowel resection surgery occurred. They removed the section of her sigmoid colon and found no other evidence of any pelvic Endo.
• Diseases of the Colon & Rectum published a November 2020 study of a 31-year-old woman who complained of bleeding from her rectum. A colonoscopy revealed a polyp…which was biopsied and came back as bowel Endometriosis. She had already had a scheduled Endometriosis excision surgery on calendar so her surgeons tacked on a bowel resection as well. At the time of the publication of the study, she had no recurrent symptoms.
• In December 2020, The Japanese Society of Internal Medicine published an article about two cases of bowel Endometriosis. First, a 47-year-old woman had a colonoscopy due to a distended abdomen and complaints of diarrhea. She had a medical history of a hysterectomy, breast cancer, and thyroid cancer. Screening, labwork, and a physical examination came back with no abnormalities. However, the colonoscopy caught a small lesion on the wall of her cecum. Fifteen months later, she underwent another colonoscopy, which showed the lesion had grown substantially. A CT scan confirmed the presence of the suspected tumor and she underwent a partial resection of that side of her colon. A biopsy found it was an Endometriosis lesion, the same was visible on that last CT scan. The second case was of a 38-year-old woman who had a colonoscopy prior to a hysterectomy. The colonoscopy found a lesion inside her cecum, too; however nothing showed up on a CT scan so they decided to leave it be and she had her hysterectomy, which also included removing her tubes and ovaries. Fast forward three years later and she had another colonoscopy: the lesion was still there inside her cecum and the CT scan revealed nothing suspicious. Three years later (now 44 years old), a follow-up colonoscopy showed the cecum-lesion was still present. Labwork and a physical examination was normal (again). Another colonoscopy showed that the lesion was present and the mass had caused the ileocecal valve to deform. A CT scan (this time with contrast-enhancement and carbon dioxide insufflation into the rectum) did find presence of the tumor and a bowel resection occurred. During the surgery, her appendix was noted to be inverted and removed as well. Pathology confirmed she had cecal endometriosis and appendiceal endometriosis. The authors stress “these cases highlight the possibility of false-negative results with conventional CT in patients with cecal endometriosis. We consider CT colonography with air/carbon dioxide insufflation preferable to conventional CT for tumor detection in patients with cecal lesions identified during colonoscopy.” (emphasis added)