Heather Guidone, Program Director, Center for Endometriosis Care is the first guest for the Chronic Illness Support Guest Blog! You can find information Heather has provided about endometriosis and adenomyosis as well as some of her journey below. We hope you find this information helpful in your journey with endometriosis and/or chronic illness.
Illness: former stage 4 endometriosis/adenomyosis
What is the difference between a gynecologist and an endometriosis specialist? A general gynecologist typically divides their time between OB and Gyn. They may also do some pelvic surgery and in-office procedures; rarely, however, do they perform advanced surgery (excision) for endometriosis. They do provide a wide range of important women’s health care services, but typically don’t offer subspecialty care for the disease.
Endometriosis specialists, by contrast, are dedicated to the diagnosis and expert treatment of the disease. In a Center of Expertise like ours, for example, we are exclusively focused on endometriosis and related pelvic pain gynepathologies. We’ve spent the past three decades providing diagnosis and highly skilled treatment of the disease, utilizing a multidisciplinary Laparoscopic Excision (LAPEX) / integrative care approach. We are also heavily involved in endometriosis surgery training and collaborative education, advocacy and policy efforts.
The caveat is, there is no formal accreditation for “endometriosis specialists” – therefore, any OBGyn can say they are a specialist. Peer recognition and patient referrals can play a large role in finding an actual specialist, and be sure to ask the right questions and look for red flags: http://centerforendo.com/drqanda
How can people become more educated about endometriosis and what resources do you recommend?
There is so much misinformation ‘out there’ about endometriosis. Sadly, even some of the most trusted medical sites we would typically turn to for accurate health education don’t have quality information about the disease, and the media largely gets it wrong quite often as well. Even some of the organizations founded to promote the disease have misinformation in their materials. It’s so important for people living with endometriosis - or who think they may have the disease - and their caregivers to seek out *quality* resources, as factual education, connecting with others who understand and finding the best care possible are the keys to coping better. A great place to learn about all things endo is our website, especially our educational article at http://centerforendo.com/endometriosis-understanding-a-complex-disease.
Check out moderated support communities as well – places like Nancy’s Nook for Endometriosis Education, Endometropolis and the ExtraPelvic Not Rare FB groups can help you find others who live with the disease, and those groups often feature input from endo specialists. There are lots of quality endometriosis organizations which can also help, that have the shared universal mission of raising awareness and connecting visitors to various resources. Some of them are listed here:
There are other key resources as well, such as -
Dr Sallie Sarrel and Dr Andrea Vidali’s EndoSummit, a fantastic educational event for professionals and patients alike: https://theendometriosissummit.com/
https://www.aagl.org/ - AAGL is a terrific professional organization for your doctors to be involved with. They also offer a patient-facing site for general gyn surg resources and information: http://www.misforwomen.com/
EndoWhat? and Endometriosis New Zealand have outstanding education programs in place:
https://www.endowhat.com/ - in addition to their School Nurse program, EndoWhat? is also home to the groundbreaking endometriosis documentaries of the same name.
Some great books to add to your endo library include (in no particular order):
“Doing Harm” by Maya Dusenbery
“My Femtruth” and “Femtruth: Endometriosis Edition” by Silvia Young
“Living with Endometriosis” by Samantha Bowick
“Endometriosis: Healing Through Nutrition” by Dian Shepperson Mills & Michael Vernon
“Googling Endometriosis”, “Surgical Management of Endometriosis” and “Endometriosis: 100 Q&A” by Dr David Redwine; you can also see his work at http://endopaedia.info
“Beating Endo” by Dr Iris Orbuch & Dr Amy Stein
“Endometriosis: the Makings of a Modern Epidemic” by Kate Seear
“Endometriosis and Pelvic Pain” by Dr Susan Evans & Deborah Bush
What is something you wish you would have known at the beginning of your diagnosis? So much! Most importantly, I would go back and tell my younger self that the pain and symptoms weren’t normal, they weren’t in my head, and I didn’t have to suffer in silence needlessly. I would tell myself that better care was possible, and that the disease is best treated through an integrative approach ranging from excision surgery to pelvic floor therapy.
How did you first get involved in endometriosis and patient advocacy? I was diagnosed decades ago in my late teens, so there was no social media, no publicity campaigns, no awareness walks, no websites, no talk shows featuring the disease, no celebrity PR efforts featuring their stories alongside their doctors. I had never heard the word prior to diagnosis. No one talked about endometriosis. I didn’t know anyone with it. I had no idea who might relate to my situation. So my determination to get answers about my own health brought out the citizen scientist in me and was really the early driving factor to what became a lifelong professional role in endometriosis. I spent a lot of time in libraries, poring over books and calling researchers out of the blue – no PubMed.gov in the late 1980s! - and eventually my efforts led me to a then-small community of others. We communicated by phone and actual letters (gasp!); those people were a lifesaver for me then. I was presented with some opportunities to do outreach and education, and ultimately an accidental activist was born. I then eventually connected with others professionally and started working in the endometriosis space exclusively and full time. Serving as Faculty at many events and being a part of so many boards, panels, coalitions and other endometriosis projects, I have had the absolute honor and privilege of collaborating with some of the best advocates in the global endometriosis community – standing on the shoulders of many giants - and they still continue to inspire me through their tireless efforts today. It is humbling to do the work we do, and I consider myself incredibly fortunate that I was able to take my experiences with the disease and turn them into something that might help others.
There is a lot of injustice surrounding endometriosis, make no mistake, and the disease space is rife with the agendas and biases of some. Patients don't always come first in this disease in some places, sadly, and many decisions are made about us without us. On many days it feels as though we are still pushing the same heavy boulder from 30 years ago uphill. Having the benefit of historical perspective, however, I do know that there are now many more people pushing the boulder with us, and we really have made tremendous strides over the years. There are a lot of good individuals working hard to find answers and make life better for all those affected by endometriosis. It’s a privilege to stand among them.
Tell us about yourself, what illness we are talking about today (definition, symptoms, etc.) and when you were diagnosed, how, what led to diagnosis, etc. Endometriosis is a disease characterized by the presence of endometrial-like tissue located in extra-uterine sites (“endometrial-like” is an important distinction, as the lesions are not comprised simply of normal endometrium that has gone rogue, as is often mistakenly claimed). The disease is a major cause of pain, subfertility, disability and significantly compromised quality of life. Impaired bowel, urinary, sexual and reproductive functions are common with endometriosis, and its systemic influences can significantly impact physical, mental, emotional and social well-being. Though often described as a ‘disease of menstruation’ and linked only to ‘painful periods’, endometriosis can in fact impact menstruators and non-menstruators alike, with symptoms routinely affecting sufferers far and apart from menses - including those who have undergone hysterectomy, do not menstruate (and in some cases, have never menstruated) and/or are post-menopausal. Teens and adolescents can also suffer from the disease, and we must also be inclusive of gender diverse people struggling to access endometriosis care and validation within a traditionally female-identified space.
The far-reaching impact of the disease on health-related quality of life cannot be undervalued – those living with endometriosis collectively report disruption (often chronic) to all domains of life, including work, education and social activities. The disease also takes a considerable financial toll on those affected, with personal costs estimated beyond $10,000 per patient, per year in the United States alone and beyond $15,000 per patient, per year in lost work productivity, according to recent data.
While endometriosis most commonly develops on pelvic structures, it is also found in distant locations like the lungs - yet is often ignored, misdiagnosed and/or improperly treated. For example, left incorrectly or inadequately treated, sciatic endometriosis can cause nerve damage; GI involvement can result in anatomic distortion, pain and alterations of bowel habits such as constipation, diarrhea, tenesmus, dyschezia and rectal bleeding; and bladder endometriosis may result in urinary frequency, tenesmus, burning pain, pain with micturition, dsyuria and suprapubic discomfort or pain. Without question, endometriosis is a systemic disease with body-wide impact; early diagnosis and proper intervention are critical. Unfortunately, despite affecting an estimated 176 million individuals, quality of care for endometriosis remains fragmented, with high treatment failures and consequent recurrence posing formidable challenges outside the subspecialty centers. Definitive causes remain elusive, as do universal cure or prevention, and much of the discourse surrounding etiology and treatments is ardently debated.
I've lectured and met patients and professionals from around the world, and our stories are always the same. Mine isn't different or noteworthy. My diagnosis came about just like anyone else’s...after being tired of suffering, I said ‘enough’ and demanded answers. I eventually was fortunate enough to find a caring physician who believed me, and immediately scheduled me for laparotomy, diagnosing me with stage 4 disease with deep bowel, bladder and extrapelvic involvement. Unfortunately, he retired soon after, leaving me in the hands of other doctors who didn’t understand endometriosis at all. That was the beginning of my long repeat surgical/medical suppression journey of failed treatments, infertility, crippling pain and a derailed life for years. My relief finally came through the hands of compassionate, skilled endo specialist – 2,000 miles away – who changed – and saved - my life.
What treatments have you tried? Did they help? Did you have side effects? Etc. Before my excision surgery – the only thing that ever helped my pain and infertility – I had multiple laparotomies, laparoscopies with superficial ablation of some lesions and a lot of lesions left behind, countless oral contraceptives, 4 rounds of Lupron injections (by the time I was 29 I had osteopenia, and by the time I was 39 I had osteoporosis – draw from that whatever conclusion you’d like), and various other fruitless attempts to treat my pain and crippling symptoms. I also had an emergency cholycystectomy, and later, a total hysterectomy (including cervix)/bilateral salpingoophorectomy following the birth of my child. Like many with endometriosis, I also had an incredibly complicated high risk pregnancy, after struggling with infertility for so long. Had I been able to access specialty care at the first signs of my disease, I would likely not have had to undergo poor surgeries - which made quality surgery that much more difficult - and medical therapies that were harmful to me, while continuing to suffer from a disease which just became progressively more painful and worse as time went on. I can’t change anything for myself, but I can continue my fight to make sure no one else has to be subjected to such abysmal care. Quality treatment and skilled, caring physicians do exist - no one needs to put up with subpar treatment or dismissal by any doctor.
Do you have other illnesses? Like many people with endometriosis, I also have other health challenges, among them being Hashimoto’s Disease, which can be a real struggle to manage; I have a wonderful doctor who has been with me for years trying to find the right ‘cocktail’ for that. I have some other things I deal with as well, like probably most of us in the community. We are all muddling through, doing the best we can.
How can someone show support (awareness colors/ribbons, etc.)? Yellow is the ribbon color for endometriosis (along with a couple other very important causes like support of our troops). The best way anyone can show support for someone with the disease, however, is by educating themselves and letting their loved one know they believe them when they say they are in pain. There are many other ways to help someone with endo as well, such as going to doctor visits with them or buying them an educational book on the disease. Reach out – ask your loved one with endo how to do the most good for them. Employers can also help support endometriosis by educating staff about the disease, making treatment resources available under any insurance plans, and accommodating their affected employees to the extent possible.
How can readers connect with you (Ex. Instagram, Twitter, Facebook, Website, etc.)?
We are also very pleased to offer free records reviews for anyone who may wish to determine if our Center can help them. Many of our patients have been told – as I was – that their case is hopeless or that removing their organs will “cure” them or that the only answer for the disease is found in an injection or pill. There is a better way, and there is always hope - so we encourage anyone struggling to reach out to us. Details can be found on our website at http://centerforendo.com, by calling our offices toll free at 866.733.5540 or emailing firstname.lastname@example.org.
Guest Chronic Illness Blog coming soon! Guests will be asked to provide information about their illness and must haves while experiencing pain and other symptoms.
Samantha Bowick, MPH is the author of "Living with Endometriosis: The Complete Guide to Risk Factors, Symptoms, and Treatment Options" and "Living with Alpha-1 Antitrypsin Deficiency" as well as a fellow sufferer of multiple chronic illnesses and patient advocate.Write something about yourself. No need to be fancy, just an overview.