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Re: Mary, could this doctor in the UK know someone in Ireland?
From: anonymous@obgyn.net
Mon Jun 30 15:04:30 2008
There are several different forms of magnesium available in supplement
form, i.e., oxide, gluconate, citrate, sulfate, etc. Some are much more
likely to cause diarrhea than others. I take magnesium gluconate for
prevention of migraines and have no problems with it affecting my
bowels. Magnesium
citrate is actually used as a laxative, so, obviously, this wouldn't be
a good choice!
At Mon, 30 Jun 2008, Christina wrote:
>
>It's best to take a magnesium/calcium supplement. Calcium will help
>balance the magnesium so that your bowel movements aren't too frequent
>or too loose. Magnesium helps to relax the muscles and will definitely
>help with cramping. I take magnesium/calcium on a daily basis with the
>rest of my vitamins and supplements.
>
>At Sun, 29 Jun 2008, summer wrote:
>>
>>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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