Is it rare or medium rare?

Back in 2012 when I had my first surgery to diagnose and treat endometriosis, my surgeon was able to ablate the lesions from my Fallopian tubes, but he was not comfortable working with the lesions on my bladder. For five years these implants continued to grow and spread, until my recent surgery in 2018 where endometriosis was excised from my bladder, colon, and ribs. Sadly, there were implants on my diaphragm that my surgeon did not feel comfortable removing as she was not trained in working with the thoracic cavity. In these cases of thoracic endometriosis, only a handful of doctors in the world are skilled enough to work side by side with a thoracic surgeon to carefully ablate the implants using a technique called VATS (video assisted thoracoscopic surgery). Thus, after waiting and suffering 5 years between surgeries to remove the endometriosis (for a total of 20 years) there were still residual implants left inside my body that I knew was going to spread eventually.

A few months after my surgery I went into the hospital with excruciating abdominal pain. Upon admitting me into the ER my blood work revealed elevated lipases at 2000. A repeat blood work showed the same spike and so I was admitted as an in patient to continue doing more tests. That story ended quite quickly as is the beast of the medical system: two doctors claimed I had pancreatitis but the more senior doctor disagreed and sent me home. I suffered – and continue to suffer – 2 whole months with this chronic debilitating pain. It so turned out that after around 7 weeks I started to exhibit symptoms of a colitis flare and was going to pull through at home until I had these weird heart pains which were new for me and fairly frightening to say the least. Skipping ahead to when I got to the ER, my lipases were at 4000 and this alarming number enticed the doctors to admit me once again, even though this wasn’t what I came into the hospital for. Back on the pancreatitis train we went, proceeding with blood work, a chest X-ray, fecal testing, two endoscopes and the list goes on. While my lipases continued to bob all over the place during my 7 day stay at the hospital, my colitis symptoms subsided and the mystery continued. This visit brought on the interest of the general medicine doctors and the gastroenterologists who ruled out acute pancreatitis (I don’t drink and I don’t have a gallbladder to form gallstones: the two main causes of acute pancreatitis). They failed to fully rule out autoimmune pancreatitis as my IGg4 levels were normal (as is the case with type 2, not type 1). They also failed to rule out EPI – exocrine pancreatic insufficiency – a disease in which your pancreas lacks the fundamental enzymes to break down foods into basic nutrients and thus your body does not absorb nutrients from foods you eat.

Along the way I had suggested that since none of the scans showed any abnormalities in the pancreas, any blocks or any stones, that perhaps this could be endometriosis on the pancreas, making it angry, and causing it to spike in lipases. The theory was not thrown out. In fact, the two teams of doctors thought it best to bring in the Gynaecological team for a consult to see how plausible this could be. First came the residents who stated this was an interesting theory although the endometriosis on organs such as the pancreas and liver were too rare. I begged the question “is it more rare to have it on my organs or on my diaphragm?” – needless to say the answer was not provided. The second step was to ask the attending doctor what he thought about this theory. Instead of having a voice he played the politically correct card and deferred to my endometriosis specialist who unbeknownst to me is the head of gynaecology at the hospital. Here is what she said:

I have never seen endometriosis on the pancreas in all my years of practice and I strongly believe this cannot be the case. She would be written up in a case study. I have told the patient that she should be on Lupron to use as a diagnostic tool to determine whether the pain she is having is in fact associated with endometriosis. I now, however, think that we should hold off on lupron as it could confound any other finding for this cause of pain, and so we will back out of this case until the other departments have run up against a wall,… and then we can bring lupron back on the table.

That, my friends, was the last time I heard from my endometriosis specialist aka my quarterback. I was livid. I was exhausted. I felt denied and betrayed all at once. The other piece of this story is that she refused to refer me to THE ONE AND ONLY doctor in Canada who is qualified to remove endo using VATS until I performed the lupron diagnostic. She never came back onto the case, and I fired her. Because, I can!

Today I continue to suffer from the abdominal pain, in the comfort of my own home, and have a few extra tests booked as the doctors are curious and excited to determine what is going on with my body. I cannot say I was denied proper care because the doctors at the Vancouver General Hospital have always gone above and beyond. What I can say is that while endometriosis on my pancreas may sound like a hilarious and rare probability, I have since been in touch with a handful of endo sisters who have either suspected or confirmed endometriosis on their pancreas and/or liver. So again, I ask you, is it really that rare, or is it medium rare?

Endometriosis is a disease that effects 1 in every 10 women. Some say it is genetic; others attribute the disease to early life trauma, and in some cases we hear cockamamie theories such as “women bring this upon themselves by having sex too early”. Women at the age of 14+ begin seeing a gynaecologist for yearly Pap smears. These doctors are specialized in the reproductive system but so few of them understand endometriosis. There are highly specialized endometriosis surgeons who have spent a great deal of time understanding how this disease spreads and furthermore how to eradicate the endometriomas from organs and spaces outside the womb. These surgeons, albeit experts in the field, may or may not be able to work with certain organs such as the bladder, the colon and in some cases even the diaphragm. Even worse, a very small number of endometriosis surgeons are trained in excision surgery; they continue to perform ablation surgeries that simply cauterize the lesions. The point is there are very few resources dedicated to better understanding this disease, and very few professionals who are specialized in the field of treating endometriosis.

If you are looking for proper care for your endometriosis please ask the questions you need to, to determine which piece of the puzzle your doctor is able to take care of. If your gynaecologist does not know how to treat endometriosis make sure they refer you to an endometriosis specialist. If a surgeon wants to perform surgery to treat the endometriosis make sure they are conducting an excision surgery – this is the only type of surgery that will remove the lesions and give your body a fighting chance.

Dont tell me what to do

Working on you, when you are ready

I refuse to be called a millennial and in the grand scheme of things I dont think Im that stubborn. But I have noticed a trend in my life: that I can only do things when I am ready. For instance, when I was 12 years old my father brought home a copy of The Wealthy Barber. To this day this book continues to be recognized for its illustrated wisdom of teaching thousands of people how to save and invest their money. Dad had just started to learn about this at a greater scale and thought it would be fun to teach me how to grow my money at a young age. Surely if I had listened and followed back then I would be fairly wealthy. But it was the LAST thing on earth I wanted to be learning or practicing. We continue to laugh about this today as Dad makes every attempt to teach my younger cousins and now my nephew – any last ditched effort to get the young ones to invest. At the age of 35 I would commend myself for how money smart I am, but only because NOW I have an interest.

Over the last month I have been in a dark place. My diaphragmatic endo took over my life, putting me into the hospital three times in one month. I have been nothing shy of spoiled with love by my social media family as well as my real family and friends. Each one has taken a vested interest in finding me comfort but up til now, I wasnt really ready to think about how to reset my life. I was more focused on being angry. I have slept more in the last month than I did in my teenage years. My boyfriend and my mother have taken turns flying across the country to take care of me. And while little victories (healthy blood work, no diagnosis of something fatal, etc) make them exceedingly happy all I can think about is the pain and how angry it is making me. One afternoon mom suggested – after reading some rather basic endometriosis blog articles – that I should incorporate deep breathing exercises into my daily routine. What did I do? I tore her a new one. “I dont need you to read blogs I already read 20 years ago, telling me to do things I already know. I need you to find me a specialist”. She knew I was angry. She rested my head in her lap and let me cry and cry and cry. I knew yelling at her wasnt fair. And while everything she said was correct, I wasnt ready.

The remedy for my sanity was to fly back home for a while. I live in Vancouver but Ottawa is where my soul is. I had a flight booked already, so nothing in the world was going to stop me from getting on that plane. For two weeks, while I was at home I took some much needed time to listen to my body, listen to my surroundings, and start to take in cues. The first thing I did was breathe. Yes, exactly what mom had told me to do, but this time I was ready. Lets be honest, breathing doesnt really help when you have diaphragmatic endo because it hurts like hell. So instead, I do breathing exercises  1) to understand my limitations and 2) to build the muscles around my diaphragm SO THAT if and when I get a collapsed lung I will be in the best shape that I can be. Its not much, and again, it doesnt create miracles, but its something. On the daily I try to do 5 long, deep breathes, roughly twice a day.

In addition to my deep breathing, I am also finally ready to make some other positive changes.

  1. Eating greener – Note that with my Ulcerative Colitis I started out on a low residue diet for nearly 4 months and then started to bring in root veggies which are healthy and low in fiber. I maintained this diet for another 4 months which has brought me to a very stable state (ie no sign of inflammation or irritation in my colon alongside Entyvio infusions). My body is finally ready to take the next step. On the advice of a social media friend I am slowly starting to bring healthier food back into my diet. She provided me with a suggestion to start with a handful of leafy greens per day, and wait a full 24 hours to see if it sits well. Mission accomplished! Now I am incorporating a handful of leafy greens into every meal. Once I am confident that this will not cause I flare, I am going to start replacing some rice with Bulgar, and then start to slowing bring in new veggies; keeping a diary along the way.
  2. Being liable (Myfitnesspal) – Ok so I am horrible for apps. I utterly detest the apps that require me to input my meals simply because they need the data, and I get nothing in return other than some simple graphs. But I also admit I have never understood calories except for the brief year in highschool when I was gaining weight from the pill and decided to starve myself. That was a good lesson on how not to obtain calories. But in all seriousness while I am trying to reduce pain, stay healthy and be whoever it is I am supposed to be, I am basing it on no metrics whatsoever. I decided to download myfitness pal. Yup, I definitely have to input my meals but it tells me when I am eating something good or bad, it gives me goals to achieve and shows me how much impact a little walk can make. If nothing else, it is making me very aware.
  3. Forgiving –  I am learning to forgive people for telling me how they think I should live my life. I am forgiving people for not taking me seriously before. I am forgiving the world for giving me two autoimmune diseases. I am forgiving my body for being flawed. I am forgiving my soul for taking times to cry. I am forgiving my dog for passing away when I needed her the most. I am forgiving my colon for being sensitive. I am forgiving my body for being too strong; and at times for being too weak. I am forgiving people who love me the wrong way. I am forgiving the medical industry for not pouring more money into endometriosis research. I am forgiving healthier people for thinking there is a diet that will cure ulcerative colitis. I am forgiving.

The Tango Between Two Diseases

Symptoms from Endometriosis and Ulcerative Colitis

I feel like my endo and my UC have been doing the tango, competing for first prize. On days when my UC  tends to be on the quiet side, my endo craves to steal the scene and do a few painful twirls on my diaphragm. Then they swap back and forth – never a dull moment! For those of you who have both diseases and potentially have diaphramatic or thoracic endo pain, you know that the localized pain is very similar in location and intensity to your UC pain. Lets see if I can explain with an image…

female pain points v2

The image above is a great depiction of the internal female body, and the areas that are most affected by the two diseases. I have tried to do a mock up of where my pain areas are (pink = endometriosis; orange = ulcerative colitis). As you can see the areas that I feel endo pain are very similar to the areas I feel UC pain. For instance, I have endometriosis on my ovaries (not shown here) and adhesions on my left ovary which impacts my left sciatic nerve. However, after my entyvio infusions or during extreme UC flare up, I feel intense joint pain in both my left and right hips. While my diaphragmatic endo pain appears to be quite higher up than the upper colon pain these areas truly are close together when you are trying to discern one from the other.  And lastly, pain in abdomen and areas neighboring the abdomen caused referred pain up to the right shoulder.

Note: I also dont have a gallbladder so this is why there are complications between my liver and my colon, and why I take bile salts when I remember to.

Some good news though!

  1. Today I had my very first firm, intact, pain free poop in 3 months!A shout out to the ‘Ulcerative Colitis’ facebook group who confirmed that it IS possible to start feeling and seeing results after only two loading doses of Entyvio. I was worried at first because after both first and second loading doses I was feeling abdominal pain that eventually subsides; with the last loading dose causing extreme joint pain. When my UC joint pain subsided I was unfortunately left with sciatic pain from my endo,… but whose counting really?!? *insert eye roll here*.
  2. I am on schedule for my excision surgery on March 12th with one of the best doctors in the industry. It will be a long and drastic procedure that will aim to remove endo from the typical places as well as up near my diaphragm. The only thing that could stop the surgery from happening is if I have a flare up but Im doing everything in my power to prevent that from happening! I am so excited!
  3. I need a third positive thing…oh.. i know! I just added eggplant in my diet!

 

The Endometriosis Coalition

I finally saw a specialist this week who was able to semi-confirm I have endo on my diaphragm, hip, and deep within my abdomen. They kept using the term ‘rare’. “your pain path is very rare”, “the location of your endo is very rare”…. and I just started to feel a little bit… helpless. When I was recapping my prognosis to my boyfriend he told me, “you’re not rare, you’re unique”. And all of a sudden I remembered something beautiful I read on an IG post from the Endometriosis Coalition a few months ago.

The Endo Co bracelet’s knot design is made individually by hand, making each one slightly unique, just as each woman’s body is unique.

The Endometriosis Coalition is a foundation that creates a safe community for endo patients, and raises money to support endo research – something there is truly not enough of. I reached out to the founders to find out a bit more around their fundraising initiatives and they informed me that this year the funds will help support research within the World Endometriosis Foundation, with next year’s goal to be able to fund internal research, and each new year providing bigger and profound goals.

One way they raise money is to provide women with a beautiful bracelet – as per the quote above. 30% of the proceeds will be donated to the Endometriosis Coalition to help raise awareness and research around endometriosis, a disease that affects 1 in 10 women, and yet is frequently undiagnosed, with many of its sufferers unaware that they have the disease.

*18K Gold/Silver/Rose Gold Plated/Copper
*2.29”/5.82cm Inner Diameter
*Adjustable

I was worried I had missed a deadline to order my bracelet, and with the events that occured last week at the clinic, I thought today was the perfect day to buy my symbol of being unique. Please check out their website, their story, and their bracelets.

To find out more please visit: https://theendo.co/