WOMENS-HEALTH Messages for January, 1998: Re: More Endo Questions-Dr. Shanahan

Re: More Endo Questions-Dr. Shanahan

From: Kelly Shanahan, MD (anonymous@obgyn.net)
Fri, 30 Jan 1998 17:41:51 -0600 (CST)

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In reply to: Wendy: "More Endo Questions-Dr. Shanahan"

At Fri, 30 Jan 1998, Wendy wrote: >
>I really appreciate the fast responses I get on this forum. A lifesaver
>for me and my impatience to know!
>
>I decided to go ahead with the lap to diagnose the endo since I need to
>know if this is what I have before jumping into another pregnancy. As I
>have been reading and researching endo, I have a few more questions.
>
>1. Because of my bowel and bladder symptoms I am worried about my dr.'s
>competency in performing laser on these areas. Should they laser these
>areas?

First, ask your doctor about experience treating endo laparoscopically -- questions like how many cases, what is her/his preferred method for dealing with endo (lasar, excise, coagulate), what does she/he usually do about endo on the bowel, bladder or over the ureters. Lasar can be tricky in some areas, but sometimes injecting a bleb of saline under the area (like over teh ureter), can provide a margin of safety. Sometimes the better part of valor is to leave some spots of endo alone and use post-op medical therapy with Lupron. >
>2. I have also found research literature that states excision is
>superior to laser. I really don't want to be a repeat lap case if
>avoidable.

Because endo can penetrate more deeply than it appears on the surface (the "Titanic phenomenon", i.e., the tip of the iceberg), excison may be better at removing the entire lesion than lasar. I try to excise wherever I can >
>3. Have tricyclic antidepressants been used with any success in endo.
>My pain is of the burning nerve type and I wonder if this could help? (I
>am an RN specializing in cancer pain management).

I'm not aware of any specific studies on the use of tricyclics and endo pain, but chronic pain is chronic pain, and antidepressants certainly can be very effective in chronic pelvic pain. >
>Thanks again.

You're welcome again!

--
Kelly Shanahan, MD, FACOG
S. Lake Tahoe, CA

note: Opinions here are for educational purposes only. This information is not intended to supplant the need for you to consult with your own physician. It cannot take the place of a face to face consultation and examination.
Sorry, but private e-mails will not be answered.

Next message: Harvey S. Marchbein, M.D.: "Re: Low Libedo"
Previous message: Lucille: "Low Libedo"
In reply to: Wendy: "More Endo Questions-Dr. Shanahan"

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