Beating Endo. Dr Iris Kerin Orbuch

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СКАЧАТЬ years of pain in six weeks, but the fact that you’re noticing a difference in only six weeks is promising: It means that your central nervous system is responding, and that this multimodal treatment plan is working. It won’t happen overnight, but you can see that change is coming.” Exactly so, and the glimmer seemed electric.

      One part of the plan Elena had not yet had time to follow up on was to consult a specialist who could help her deal with her upregulated central nervous system. So Iris now referred her to a physiatrist who combined Eastern practices of mindfulness and meditation and Western advances in medical treatment to calm the central nervous system. Both approaches are needed, Iris argued. Learning how to meditate was powerful, but often not enough to cool the system on its own. Ditto for taking a pill: Pharmacology can be powerful but far less so when it acts single-handedly. Both together—meditation and the drug, Eastern and Western wisdom—are what cool the central nervous system and help restore the body to balance and efficiency.

      The specialist alerted Elena that he would be starting her on a low dose of the medication he prescribed and would then increase the dosage incrementally. It meant she would not feel the drug’s effects for at least a month, maybe longer, as she worked her way up to that “therapeutic” level of intake. Too much of this medication too soon, the specialist warned Elena, could cause unpleasant and serious side effects. He also advised her to download a mindfulness app and spend ten minutes in mindfulness-based stress reduction each morning. She would at least start her day in a downregulated frame of mind and body—“Almost as good as an island vacation,” she told herself. But the specialist also recommended she start a serious meditation practice and/or begin seeing a talk therapist or pain psychologist.

      Having experienced the benefits of her efforts so far, Elena embraced these ideas. She also felt she had gained a clearer picture of the multiple different causes of her pain. What she had thought was her “stage one endo” she now recognized as multiple coexisting conditions. She was beginning to understand in the most immediate terms how different actions raised the heat of her central nervous system. But she also wanted to know when she could have surgery.

      “I could operate on you tomorrow,” Iris replied, “but I would be a really bad doctor if I did that. I would be doing you a disservice. Let’s cool your body down a bit more and wait about six to twelve weeks before we schedule your surgery. Continue the PT regularly, stay true to the diet, take the meds and do the mindfulness practices the physiatrist prescribed, and you will be well primed for surgery.”

      An administrative assistant working for a high-profile senior vice president at a high-profile investment firm doesn’t get that much time off. Iris said Elena would need a week away from the office for surgery and rest at home (not to mention real healing, which can take as much as three months)—so Elena and her boss had to do some fancy stepping to get her the stretch of healthcare leave she needed for her excision surgery. It took another four months. The time was not wasted. Elena kept at the treatment plans for all of the coexisting conditions she and Iris had identified, and she saw dramatic progress in all of them except one: Her painful periods persisted—further indication that her endometriosis needed to be addressed by surgery. But she could sit comfortably now, only had her sleep interrupted “once a night at most” to urinate, and no longer strained as she once had to move her bowels.

      She was also far less anxious, and each diminution of her pain, each easing of her body’s tightness reinforced that equanimity and strengthened her commitment to the changes she was undertaking. By the time she finally had her surgery, the nutritional principles and the exercise regimen, the mindfulness and movement practices that had once been lessons to learn had become second nature—automatic behaviors intrinsic to her lifestyle.

      In a way, Elena was lucky to feel improvements right from the get-go—as soon as she undertook those first changes in diet and began PT with Amy. The belief that the program worked, as sweeping and constant as were its requirements, was the impetus to keep going. The woman who had walked into Iris’s office in utter despair had achieved a state of well-being that had previously seemed beyond reach.

      TAYLOR

      Taylor is twenty-eight, with a razor-sharp mind and a fit body, both of which she exercises regularly and intensively. A committed professional, clearly on the partner track in the law firm that snapped her up right out of law school, she works long hours and, given that her specialty is tax law, often deals with stressed-out clients. It suits her. She supplements—or perhaps counters—her work life with a highly active social life and frequent dating. She hopes to marry and have children one day.

      But Taylor has persistent aches and pains. Once a month, she deals with fairly severe menstrual pain by loading up on Advil, which helps. But it isn’t just menstrual cramps; she feels pain in her very bones. One is a frequent ache in her left hip. Another is an almost constant pain in her tailbone. In fact, she felt so uncomfortable sitting at a desk or at the conference table all day that she had a stand-up desk installed in her office; now her tailbone hurts only during meetings around the conference table. She finds that she must frequently bolt out of those meetings and head to the ladies’ room to deal with an increasingly urgent need to move her bowels, and at the same time, oddly enough, she is beginning to realize that her “system” seems to alternate between constipation and diarrhea. Worst of all, however, is that she is finding sex painful. It started out as superficial pain, but the pain deepened and persisted; it has now reached the point where she finds the pain—both during and after sex—hard to bear.

      She had been to see her gynecologist about much of this. His recommendation was that she have a glass of wine and maybe do some gentle yoga. Taylor already drinks wine and does yoga, although not the gentle kind, so she didn’t find this advice terribly useful.

      She decided to see an orthopedist about her hip pain and the pain she felt while seated. He ordered a diagnostic imaging test, and sure enough, it showed a labral tear in Taylor’s left hip. What a relief it was actually to stare at the image of what was causing her pain! Despite the surgeon’s warning that it would take six months to heal completely, she went ahead with the labral tear surgery and then began six months of hip PT geared specifically toward full recovery.

      The operation was deemed a success by her orthopedic surgeon. That is, the labral tear was successfully repaired, and Taylor enjoyed slight relief from her hip pain. But the relief was minimal in comparison to all the other discomforts that remained with her—the menstrual cramps, her problems with her bowels, the tailbone pain that she felt sure would recede along with the hip pain but that did not. Above all, she was still having pain during sex. In fact, it was getting worse, and it was making her anxious and depressed.

      Taylor tried another gynecologist. Sitting in his office, watching him take copious notes as she answered his questions, she noticed a book on the shelf behind him: Heal Pelvic Pain, it was called, by Amy Stein. She got her hands on a copy and began doing the exercises it offered.

      She started to feel better, and Taylor expected that, along with the running and CrossFit that were her normal fitness routine, the pain would recede.

      It did, and the bowel urgency also improved, but not enough. And the pain during sex persisted, which was extremely discouraging. Taylor wanted a cure; she also wanted a real diagnosis. She worked so hard at becoming fit and strong and healthy. Being a “healthy person” was a big part of her identity, and the inability to heal her symptoms was emotionally as well as physically painful. There had to be something wrong.

      So Taylor made an appointment with the author of Heal Pelvic Pain and proceeded to Amy’s midtown office. She narrated her story, answered Amy’s many questions, and told her what the gynecologist had “prescribed.” Amy was pretty convinced she was hearing the classic symptoms of probable endometriosis—and, in the gynecologist’s “prescription” for a glass of wine and gentle yoga, an unfortunate bit of medical ignorance. After an extensive, СКАЧАТЬ