Re: Mary, could this doctor in the UK know someone in Ireland?
From: summer (anonymous@obgyn.net)
Sun Jun 29 19:05:35 2008
OK, I know I've given you a lot of reading to do :)
Not to be indelicate, but what are your bowel movements like? i realized
when I was in college or so, that the more constipated I was, the more
pain I had...I didn't know what was going on, but if I took a little
magnesium, it helped me a lot
I had to be careful, though, because if I had too much, I'd get spasms
and diarrhea
But if I was constipated, BOY WAS THE PAIN BAD!!! The more ''fluid''
things were, the better
At Sun, 29 Jun 2008, summer wrote:
>
>http://www.endometriosistreatment.org/html/reprint14.html
>
>''The Management of Endometriosis in the United Kingdom''
>
>''Dr. Jeremy Wright is an English physician that visited and trained
>with Dr. David Redwine in the spring of 1999 as part of a Royal College
>of Obstetricians and Gynaecologists Bernard Barhon Travelling
>Fellowship. The Fellowship is awarded every two years. He has been
>practicing in OBGYN since 1973 and as a specialist for the last 13 years
>working in both the National Health Service and in private practice.
>
>He has a special interest in the surgical management of endometriosis
>and spent a month with Dr. Redwine to learn some of his specialized
>surgical techniques and to undertake some areas of audit and research
>using his unique database of patients. In the United Kingdom Dr. Wright
>is a director of The Centre for Endometriosis and Pelvic Pain offering a
>specialized service for patients with this disease. The Centre’s web
>site can be visited at http://www.psiesys.com.
>
>By Jeremy Wright, MD
>
>Endometriosis is truly an international disease as can be seen by the
>amount of time given at international conferences to the consideration
>of its treatment. That, too, is a sign that there is no agreement on
>the appropriate management of the disease in its different stages.
>
>As in America there is in England no consensus. The incidence of the
>disease too is difficult to assess. However, in England, because
>national data is collected on diagnosis, it is possible to assess the
>prevalence of the condition.
>
>There has been an ongoing survey of women born in 1946 who have been
>asked to fill in a questionnaire every year. Six percent of these women
>report having been treated for endometriosis at some time. We would
>seem to be dealing then with a condition that is as common as asthma,
>but equally one in which the optimum treatment is a matter of some
>dispute — medical vs. surgical or even the appropriate surgical
>modality. However like Dr. Redwine I believe the optimum treatment is
>surgical and the appropriate surgery is excision.
>
>In order to understand how treatment is undertaken in England it is
>necessary to understand a little about how the English National Health
>Service works. In England there is a principle that medical care is
>free at the point at which it is given although it is paid for out of
>taxes and consumes 6.5% of the gross domestic product (GDP). In
>monetary terms that amounts to millions of dollars, but it is only a
>small percentage compared to most western countries.. Only a tiny
>percentage of the population have private insurance.
>
>All patients are registered with a Family or General Practitioner and
>this is the first person to whom they would go with any problem.
>Referral to a specialist is only through this family doctor who will
>usually choose the specialist for you.
>
>The General Practitioners buy hospital care for you from local District
>General or Teaching Hospitals with whom they will have a contract.
>Typically the time from having a referral made to having an appointment
>with the specialist is in the order of 4-6 weeks or more. Waiting times
>for surgery following this appointment are in the order of a year.
>
>A further complicating factor is that all the District Hospitals will
>have doctors on Residency programs so that your consultation, and indeed
>any surgery that you have, may be undertaken by a doctor in training.
>There are very few physicians who have a special interest in
>endometriosis, so your chance of seeing a true specialist in the disease
>is slight (although all gynaecologists will be aware of the disease).
>
>Referral for a third specialist opinion is very rare. Thus it can be
>seen that although the cost of medical care can be kept to only 6.5% of
>the GDP, rationing of medical care both in terms of choice and waiting
>time becomes implicit within the system.
>
>Following a consultation with a member of the specialist team it is
>likely that a diagnostic laparoscopy will be advised. If you have
>endometriosis this will hopefully be diagnosed by visual inspection of
>the pelvis, although it is very unlikely that a tissue diagnosis will be
>made by biopsy.
>
>On many occasions, sadly the diagnosis may be missed either because of
>inexperience or a less than thorough inspection. Often patients in whom
>the real diagnosis is endometriosis will be labelled as having
>unexplained pelvic pain. This may lead to a round of further
>laparoscopies and further inaccurate diagnoses. Pelvic inflammatory
>disease is frequently misdiagnosed at this time leading to repeated
>courses of antibiotic therapy and concomitant yeast infections.
>
>There are very few physicians who undertake operative laparoscopy. If
>you are lucky enough to be referred to one of these, you may have a
>limited amount of electrocoagulation to the visible endometriotic
>lesions. Otherwise you will usually be offered medical therapy which
>closely mirrors that in the USA. Although offering some symptom control
>while it is taken, it does not offer the prospect of a cure.
>
>As in America, side effects of some of the treatments outweigh the
>symptoms of the disease. Many patients prefer to put up with the
>disease rather than the treatment and may turn to fringe medicine.
>Patients with intractable symptoms will eventually be offered major
>surgery, typically a hysterectomy with or without removal of the
>ovaries, but often with retention of the disease. Conservative excision
>is rarely performed.
>
>In the United Kingdom there is an active Endometriosis Society and many
>self-help groups that offer helpful advice to women with this disease
>and teach them coping strategies. The Endometriosis Society, however,
>never recommends particular physicians or treatments. Its main purpose
>seems to be as a coordinating facility for local groups. Strong local
>groups can, however, work together to improve the facilities for the
>women in their area.
>
>Family Practitioners are on the whole sympathetic to the women’s needs
>and will help in any way they can, but this is perforce largely medical
>therapy. Many of the physicians with an interest in the condition are
>primarily interested in aspects of fertility rather than pain and this
>tends to allow medical therapy to dominate the therapeutic picture.
>
>Although the picture would initially seem bleak, there is some light at
>the end of the tunnel. All hospitals are now caught up with the concept
>of clinical governance and the principle of “Evidence-Based Medicine”
>and audit of one’s results. This means that treatments should not be
>offered unless they are shown to be effective by means of thorough
>audit. In matters of audit, Dr. Redwine, with his detailed database,
>leads the way and is a good example of “best practice.”
>
>Increasingly there will be a requirement for us all to audit our
>practice in such detail and it is only in this way that we can truly
>assess the results of our therapeutic interventions.
>
>There is now a growing group of physicians throughout the United Kingdom
>beginning to take a special interest in the surgical management of
>endometriosis especially using laparoscopic techniques. They are
>developing the specialist skills needed to undertake this sort of
>surgery although there remains much controversy about the appropriate
>surgery, whether it should be concentrated on ablating the disease
>either by burning it or by vaporization either using a laser or some
>other technology.
>
>There are two centers in the United Kingdom which offer excisional
>therapy as practiced by Dr. Redwine; mine in the south and Professor
>Ray Garry’s in the north. Others offer ablative therapy, and specialist
>endocrine clinics offer medical therapy. There is even one unit that
>offers open surgery for the condition when gynaecologists and surgeons
>work together to tackle the disease.
>
>Because of the nature of English practice, however, none of these
>centers offer a service devoted to the management of endometriosis where
>ever in the body it is found. There are only two where there is the
>expertise to offer the appropriate excisional therapy for infiltrating
>disease, a much more common situation than most people, even authorities
>on the condition, realise.
>
>One of our governing and credentialling bodies however, The Royal
>College of Obstetricians and Gynaecologists, is recognising this gap in
>provision. It is through their generosity that I was awarded a
>travelling fellowship to come and study with Dr. Redwine so that I may
>bring some of his skills back with me to the United Kingdom to help
>patients there and to help train the next generation of physicians in
>how to deal with the condition effectively and safely. Looking ahead, I
>think that there is real chance that proper and effective endometriosis
>treatment centers will be set up where patients can come to get the
>expert and effective treatment they need.
>
>These centers will be required to present transparent audits of their
>work to show that it is truly effective and offer thorough supervised
>training to residents in training programs so that the skills can be
>safely passed on.
>
>The medical systems in the two countries are very different. There is
>good and bad in both of them. Neither system, however, offers
>consistent and rational treatment, although there is probably more
>choice available in the USA. As you move more closely to managed health
>care and we try to move further away from its obvious inadequacies,
>there will, somewhere in the middle, be a situation where people
>suffering with the chronic pain of endometriosis can get the considered
>and appropriate treatment they deserve. It is my hope that my recent
>stay with Dr. Redwine will help speed that process in the United
>Kingdom.''
>
>At Sun, 29 Jun 2008, Marydoll wrote:
>>
>>Hi Summer,
>>
>>One of my ovaries burst and some of the small parts imbedded themselves
>>into my bowel and now the bowel is septic, my other ovary has a very
>>lager cyst (15cm x 30cm) growing off it. So both ovaries will be
>>removed. I had my 2nd MRI done this week and it does not look good!
>>
>>Thank you for you prayers i pray for you all
>>
>>Mary
>>
>>At Sat, 28 Jun 2008, summer wrote:
>>>
>>>Hi again, why are they removing the ovary? It shouldn't need to be
>>>removed, unless there's cancer - as I understand things! I do pray for
>>>you! :)
>>>
>>>At Sat, 28 Jun 2008, Christina wrote:
>>>>
>>>>Hi Mary
>>>>Don't ever apologize! That is what we are here for.....there are a
>>>>select number of people that we can talk to face to face in our daily
>>>>lives and that is why we have this forum.
>>>>
>>>>I am so sorry to hear about the severity of the disease with you. Keep
>>>>us posted after your surgery. I will be thinking about you within the
>>>>next month. I am sure that you will have a successful surgery and I
>>>>hope that you find relief afterwards.
>>>>
>>>>Take care.
>>>>Christina
>>>>
>>>>At Thu, 26 Jun 2008, Marydoll wrote:
>>>>>
>>>>>Hi Ladies,
>>>>>
>>>>>This is my first message on this support group.... although I read all
>>>>>your comments daily and take to heart all your problems and advice.
>>>>>
>>>>>I am going into hospital next month to have my 4th surgery. This time
>>>>>the surgery is different, I am having part of my bowel, rectum, ovary
>>>>>and one of my tubes taken out. I will end up with a colostomy bag and I
>>>>>am very scared.
>>>>>
>>>>>At 26 this is all very hard to take in... I have not worked since July
>>>>>last year and lost that job due to the usual problems to many days off
>>>>>and being to sick when I was there to concentrate....
>>>>>
>>>>>I just wanted to know has anyone had surgery like this and how was it
>>>>>afterwards, with yourself, with your relationship, with your job....
>>>>>
>>>>>I feel like this is it, if I don’t get through this I will just give up,
>>>>>I have had enough....
>>>>>
>>>>>Mary (sorry about the moan)
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