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Saturday, August 23rd, 2014
1:49 am - UofM Endo Consult Transcript
<lj-cut>
[Both]: Hi.
[Dr.]: We met two times ago, when you were here.
[Me]: Yeah.
[Dr.]: I'm Dr. Brown. It's nice to meet you. . .
[Me]: Hi.
[Dr.]: . . . and then you saw Dr. Wahl, and she gave you Lupron-
[Me]: No. She didn't, she . . .
[Dr.]: Oh. I thought you'd . . . [SS] . . .
[Me]: . . . suggested for the second time that I take it and I refused it for the second time.
[Dr.]: OK. How are things going?
[Me]: Really bad. Worst ever. Um . . . nine hours after my ultrasound that had normal results, I had
the worst pain of my entire life . . . I would've probably gone to the E.R., if I hadn't already had a
traumatic experience going to the E.R. . . .
[Dr.]: Yeah.
[Me]: . . . with that kinda pain . . .
[Dr.]: Yeah.
[Me]: . . . and every single day since then, including today, I have had pain that shoots up to what
used to be a 10, and, only because of . . . the night of the 17th, the pain I've been in now probably
only rates . . .
[Dr.]: . . . [SS] . . . (*sounds like, "...so more normal...")
[Me]: . . . at like an 8 or a 9.
[Dr.]: Are you still having urination problems?
[Me]: I . . . am not sure, I think maybe the oxybutynin has . . . maybe made, slightly a difference?
[Dr.]: Ok.
[Me]: Like . . .
[Dr.]: How much, and how often do you take it?
[Me]: I take it every night at bedtime, one 5mg tablet.
[Dr.]: Mm-hmm . . .
[Me]: Um . . .
[Dr.]: . . . 'cause after you've been taking it for a while, you can go up on that too.
[Me]: . . . one thing I've noticed, it seems to have maybe possibly made- I mean I still have great
frequency, it's . . . still abnormal. Um, and bothersome. But, um, I have been making it through more
nights without having to use the little, thing under my bed . . .
[Dr.]: Yeah. OK.
[Me]: . . . but I've noticed that I've had like, just, re- in recent weeks I've had like, hesitency, where I
have the sensation of needing to go, and the discomfort of needing to go, and then when I start to go
it's like . . . [pauses] . . . and I have to like, focus my mind on letting everything relax . . .
[Dr.]: Is that usually in the morning? 'Cause that can happen sometimes with the oxybutynin too, do
you feel like you're emptying your bladder though, once it does get started?
[Me]: Once it gets started, most of the time I feel like I'm emptying it, but I do notice . . . that.
[Dr.]: OK, and um, how often are you going during the day?
[Me]: I mean, I wo- only actually counted, once, when I did a Pee-Log and it was like, 14-20 times . . .
[Dr.]: OK. That's . . .
[Me]: . . . but, um, I would . . .
[Dr.]: . . . still quite a lot.
[Me]: . . . I would say now I'm probably going about . . . 10-14, 15 times.
[Dr.]: OK. Um, and have you been able to make an appointment to see Urology? They're hard to get
into I know sometimes . . .
[Me]: Yeah, it was like really far off, and, I just, I didn't- I didn't make an appointment yet. I can, I can
make that appointment . . .
[Dr.]: OK.
[Me]: . . . but, I mean, I'm not even that concerned about my urination at this- right now. I mean . . .
[Dr.]: Right. A lot of pelvic pain . . .
[Me]: . . . I'm not . . . [SS] . . .
[Dr.]: . . . so, what do you want to do? I know you were here last time when we talked a lot about
different treatment options, um, two of the things we talked about trying are the Mirena or the
Lupron, have you thought more about those two options at all?
[Me]: Yeah, I've thought them both, to death, and I'm not doing either one, at this juncture, that's my
decision, I'm not doing it, I'm n- Mirena is . . . [SS] . . .
[Dr.]: No! Of course- I- no, that's, totally fine. I just, was curious if you'd thought more about themand
we haven't talked . . . [SS] . . .
[Me]: I have. I hav- It's, it's all I've, thought about is, is, what am I gonna do about this problem, and
that's obviously in the- among the things I've thought about, and I'm . . .
[Dr.]: Mm-hmm.
[Me]: . . . not doing either one right now, and I'm not, opposed, to doing either one in the future
but . . . I'm not taking Lupron, empirically. I'm not . . .
[Dr.]: OK.
[Me]: . . . and I'm not op- posed t- I'm opposed to taking it until I have a diagnosis, unless I'm- I have a
surgical diagnosis I'm, I'm opposed to taking it- Mirena I'm not opposed to, except for the fact that it
would delay, three-to-(preferrably)-six-months, at least, any further action, while we see if it's doing
anything, and if it's having, 1/7th the side-effects? A hu- the same amount of side-effects? Magically
no side-effects? You know, it'll be a while before we even know, so, I'm opposed to the delay
associated with the Mirena.
[Dr.]: Yeah.
[Me]: My life- I'm, tryin' to get married. I, I'm plan- I'm, I'm, telling people that I'm, 'planning a
wedding' . . .
[Dr.]: Mm-hmm.
[Me]: . . . I took classes, for the first time in five years, over the winter . . .
[Dr.]: Mm-hmm.
[Me]: . . . I only took two, and a lab . . .
[Dr]: Mm-hmm.
[Me]: . . . I got A's in them but it just about killed me.
[Dr]: Mm-hmm. [more of a protracted sympathetic vocalisation, N.O.S.]
[Me]: [pause] . . . I, I lost my job more than a year ago. [verge of tears]
[Dr]: Yeah.
[Me]: I'm not trying Mirena and hoping for the best, at this point.
[Dr]: Yeah.
[Me]: Once I know, for, actual real, what's going on with my body, then I'll consider, whatever can, you
know, Mirena might be able to offer, but . . .
[Dr.]: Well, as a standard of care . . .
[Me]: . . . there are things about it that I like.
[Dr.]: . . . as a standard of care at our institution we, try one of these treatments to make a diagnosis,
before we do surgery . . . and the reason is because, um, there's, more risk to you with the surgery,
than doing either of those two things.
[Me]: [nearly inaudible] Yeah.
[Dr.]: Um, if you really strongly feel like you want a surgury for a diagnosis, there are, other places that
do that, but we don't do that here.
[Me]: Yeah . . . that's what I figured . . . I have, an appointment in Atlanta, next Thursday.
[Dr.]: Georgia?
[Me]: Atlanta, Georgia.
[Dr.]: Are you moving there?
[Me]: No, I'm seeking care for my d- disease, down there.
[Dr.]: OK. Well, when you, see someone down there you know you're more than welcome to kinda
send us their records, and y'know you don't always have to go down there, you can come back here,
um, we- we can . . . [SS] . . .
[Me]: I mean, I, I am gonna probably- I mean, I'm gonna get their opinion, send my records to them . .
.
[Dr.]: Mm-hmm.
[Me]: . . . I wrote a 16-pg. narrative of my . . . menstrual life and history . . .
[Dr.]: Mm-hmm.
[Me]: . . . and they're gonna read it, and . . .
[Dr.]: . . . and your welcome to a- to have us send our records to them too, about the things that
we've talked about.
[Me]: I've, I've- I'm probably going to need- I mean, I'm not leaving Michigan any time soon, I'm
gonna need follow-up care.
[Dr.]: Mm-hmm. And you're totally welcome to come back here, people get second opinions all the
time.
[Me]: OK.
[Dr.]: Um, who were you gonna see down there?
[Me]: Um, it's c- it's a- called the Center for Endometriosis Care, Dr. Ken Sinervo, and Dr. . . .
something Albee. Um, they've been . . .
[Dr.]: Have you tried to get in with our endometriosis-people here? Dr. Skinner, and her group?
[Me]: . . . I . . . thought that's what I was, he- here . . . through- I called the number on the
'Endometriosis Center' webpage of the U of M Health System.
[Dr.]: Um, this's just the general like, resident clinic.
[Me]: . . . [lengthy pause] . . . Oh. Really?
[Dr.]: Mm-hmm.
[Me]: I thought I was, here . . . at the . . . [SS] . . .
[Dr.]: But the pelvic pain specialists, have another clinic in this building. That's not this clinic . . . but,
generally they have us try a couple of treatments before they'll see patients . . .
[Me]: Yeah, I . . .
[Dr.]: . . . but we have some specialists here, Dr. Skinner and Dr. Asani [SP] . . .
[Me]: . . . I wo- I would love to see Dr. S- Dr. Super-Specialist if, if, if they would see me but, I'm- I
mean I'm not gonna, do, a Lupron-shot just to get in the door.
[Dr.]: OK. Well I'm- I know Dr. Skinner really well, and she's, one of the the two doctors who leads
that clinic, and I can kinda let her know about you- your case , but, usually what they'll do is they'll
review people's records, before they can get into the clinic because so many people want to get into
that clinic . . .
[Me]: OK. [or possibly, ". . . great . . ."]
[Dr.]: . . . and if you haven't tried either of those treatments before, they probably won't see you.
[Me]: Yeah.
[Dr.]: Um, but, um, I . . . [SS] . . .
[Me]: Will they see me if I've had a . . . surgery . . . [laughs] . . . that shows in like, pictures and video,
what's goin' on?
[Dr.]: It's possible. I can talk to Dr. Skinner about it, and see what she thinks.
[Me]: 'Cause I mean, I do- I d- I mean I don't know what kinda follow-up care I'll need. It . . .
[Dr.]: Yeah.
[Me]: . . . I assume I probably will. I- in fact I assume I'll probably wanna go on Mirena as soon as I'm .
. .
[Dr.]: Done.
[Me]: . . . done.
[Dr.]: Yeah, and you're welcome to get that here, um, but, why don't you just follow-up, after you
come back, or, you know, when we can kinda touch base, y'know . . .
[Me]: OK . . .
[Dr.]: . . . and go from there.
[Me]: . . . [becoming tearful] . . . It's just that it's really . . . bad . . . [crying] . . . It's like . . . [pause] . . . I
can't ev- I'm, bed-ridden, for the last, since the 17th, this is like the farthest I've traveled outside my
house . . .
[Dr.]: Mm-hmm. Oh, I know . . .
[Me]: . . . [sobbing] . . .
[Dr.]: . . . but the reason . . .
[Me]: . . . I can barely get up- I'm, keeping my husband up, in the middle of the night, and he's the
only one able to work. I can't . . .
[Dr.]: . . . but the reason we recommend trying those treatments is because more people benefit from
them than benefit from surgery, and there's a lotta side-effects from having a, a surgery.
[Me]: I know.
[Dr.]: And surgery is riskier, people die having surgery . . .
[Me]: I know.
[Dr.]: . . . from unexpected complications . . .
[Me]: I know.
[Dr.]: . . . and more people get benefit- what is it about the Lupron and the Mirena that worries you?
[Me]: Well, I'm a severe migraine sufferer . . .
[Dr.]: Mm-hmm.
[Me]: . . . I can't have a shot that, could, potentially set off, a multi-week long migraine.
[Dr.]: Being under general anesthesia could do that too.
[Me]: . . . [lengthy pause] . . . They're- they- . . . [laughs] . . . there would be more- I think there would
be more benefit though, for that kind of a complication, the- the, trade-off would be different. I
mean, I don't- I'm at my highest weight ever, I don't . . . I don't wanna put on, 20 pounds, I don't want,
to get migraines . . . I, am already experiencing bizarre hot-flashes, I already have severe insomniasevere,
I've already sought treatment at the U of M sleep disorders clinic because of how life-long and
severe my insomnia is and that's a major Lupron side-effect. I already- it's all I can do to sleep at
night . . . [pause] . . . I'm, not, gonna put 20 pounds on, before m- I get married, and, and, have my,
already profoundly disrupted sleep disrupted, potentially further . . .
[Dr.]: Mm-hmm.
[Me]: . . . and, and risk, triggering migraines, that, already disrupt my life, as it is- I'm already
extremely migrainous lately, and, I can't handle going through life, with a continual pain in my
head . . .
[Dr.]: Yeah, have you seen a doct- . . . [SS] . . .
[Me]: . . . on the hope that it'll relieve the continual pain in my . . .
[Dr.]: Yeah, do you see a doctor for your migraines?
[Me]: . . . When I was a teenager, and young adolescent I took Midrin but it's off the market now. I . . .
[Dr.]: Mm-hmm.
[Me]: . . . [thinking of name] . . . Imitrex helps. My mother-in-law-to-be takes, Imitrex and she . . .
[Dr.]: Mm-hmm.
[Me]: . . . sometimes if I have a bad headache, so far, has just- I've . . . [SS] . . .
[Dr.]: Do you have a regular, like, primary care doctor that you see?
[Me]: Yeah, I have to- I have actually not, been back in to see her since I got insured. The reason I
haven't done anything is becuase migraine medicine's extremely expensive . . .
[Dr.]: Yeah.
[Me]: . . . so, I've . . . now I could probably . . .
[Dr.]: Yeah, why don't you go back in . . .
[Me]: . . . mention it . . .
[Dr.]: . . . to see her. And then please do send us the records from, the discussion you have in Atlanta,
or, we- you know, whatever happens there we're happy to provide your follow-up care, and then, I
think you should try to get in, to, the chronic pelvic pain clinic here, 'cause that's not what this clinic is,
this is a general, clinic.
[Me]: OK . . .
[Dr.]: So I think that that would be, good too.
[Me]: . . . OK. Ehh-
[Dr.]: OK?
[Me]: Can the webmaster . . . I'm serious, can the webmaster make sure the phone numbers on the
webpage for U of M's pelvic pain clinic . . .
[Dr.]: Yeah, but if you haven't . . .
[Me]: . . . are correct?
[Dr.]: . . . but if you haven't seen anybody in our system, they'd put you in a general clinic first . . .
[Me]: Oh, OK.
[Dr.]: . . . you know, to, kinda get evaluated, but, I can talk to Dr. Skinner and see if she'd see you, or if
she'd want more, information, or . . .
[Me]: OK.
[Dr.]: . . . or one more treatment trials [sic] first, OK?
[Me]: OK. . . . [sniffs, tearfully] . . . Alright. Um . . . [pause] . . . and then I was just kinda curious as far
as the ultrasound went, it seemed like it was a very basic ultrasound. It looked, I- I mean, they, they,
looked at what, my 'adnexa'?
[Dr.]: Mm-hmm.
[Me]: And, and, determined that, it was present, and, more or less normal appearing, but I don't
know what, 'softer signs' they . . . might've looked for, with the protocol the sonographer used. I don't
know . . .
[Dr.]: In general they just look at your uterus, and you ovaries . . .
[Me]: So they don't, check, for 'soft-', 'soft signs' like, mobility of the, organs, or any of the
gastrointestinal tract, or . . .
[Dr.]: No.
[Me]: . . . the urinary bladder.
[Dr.]: No.
[Me]: So, OK. So, that wasn't the kind of ultrasound I was getting when I . . .
[Dr.]: That's actually not something we offer here . . .
[Me]: OK.
[Dr.]: Um, 'cause there's not a lotta evidence behind that, but . . .
[Me]: OK.
[Dr.]: . . . we can tell the mobility of those organs with your pelvic exam.
[Me]: Oh, you can, OK.
[Dr.]: Yeah. And everything felt pretty freely movable . . .
[Me]: Pretty freely movable.
[Dr.]: . . . on your exam.
[Me]: OK. . . . [long pause] . . . OK. . . . [pause] . . . I mean, I'm not get- . . . when it was just, really bad
dysmenorrhea, I was like, 'Well, if it's adenomyosis, I'm not, getting it taken out-' . . . [laughs] . . . '-until
I've had kids.'
[Dr.]: Mm-hmm.
[Me]: 'So, I'll suck it up, and, see what I can work out.' But, then, in the last, year and a half it's been,
insideously and then, rapidly, worsening to like, you know, constant, constant- My life, I'm . . .
[becoming tearful] . . . I can't even move around my own apartment, like, walk around . . . [begins to
cry] . . . so now, I guess I'll go, see what they say, and I'll probably definately be back to, follow-up . . . If
you could, m-m- mention me, to Dr. Skinner . . .
[Dr.]: I will, I will. But, I want you to know that we're not like, closing the door on you, it's just that as
our standard of care . . .
[Me]: . . . [sniffs] . . . I understand.
[Dr.]: . . . we offer treatment before we offer, doing a surgery. And, the treatment, especially the
Lupron . . .
[Me]: . . . medical treatment . . .
[Dr.]: Right.
[Me]: . . . versus, surgical . . . treatment.
[Dr.]: Right.
[Me]: OK.
[Dr.]: Because the medical treatment can give us a diagnosis, especially the Lupron, because, if your
symptoms are fixed then we know it's endometriosis that you have.
[Me]: I wanted to actually- on that point particularly, and I know this seems- this is about- this
conversation should probably be wrapping up, but, I wanted on that particular point . . .
[Dr.]: Mm-hmm.
[Me]: . . . about the Lupron . . . empiric Lupron . . . [pauses while pulling up document on ipad] . . .
This is from, the, Practice Commitee, of the American S- Society for Reproductive Medicine, and under
'Diagnosis' . . . [sniffs] . . . it says . . . [pauses] . . . 'Once endometriosis has been diagnosed, progression
of the disease is not reliably assessed by pain symptoms or radiologic tests. Gonadotropin-releasing
agonists (GnRH-a) have been advocated, to diagnose and treat endometriosis without performing
laparoscopy, based primarily on the results of one study involving 95 women with moderate-to-severe
chronic pelvic pain unrelated to menstruation who were randomized, to either receive. . . Lupron, or a
placebo . . . The underlying premise was that improved pain symptoms during the hypoestrogenic
state induced by, the Lupron treatment, might reliably indicate that endometriosis was the cause.
Citation, citation.' . . . [sniffs] . . . 'However, pain relief in response to LA for depot suspension was not
significantly different for those who did, or did not, have detectable endometriosis at laproscopy;
81.8% versus 72.7%, respectively. Therefore the resonse of LA, for de- depot suspension did not
acurately diagnosis endometriosis.' . . . [sniffs] . . .
[Dr.]: Yeah, I don't know the details of the studies, for which we, we set our guidelines . . .
[Me]: . . . [sighs] . . . I actually know, quite a lot about the details, for a lot of the studies, that a lot of
the guidelines get written on, and, I . . . that's why I'm goin' to Atlanta.
[Dr.]: Yeah, and I think you should have a conversation with our specialists here, and I'll get in-touch
with them and see if they can see you- did we get a referral in at your last visit? Have you gotten any
information about filling out information for their clinic?
[Me]: I've gotten the, the, two questionaires, and I've got them filled out, I just haven't- I mean I
didn't make the appointment so I didn't bring 'em back.
[Dr.]: OK . . . OK.
[Me]: . . . [sniffs] . . .
[Dr.]: Well I'm glad you have that stuff though and I'll let Dr. Skinner know about your case too, OK?
[Me]: OK. That'd be great.
[Dr.]: And good luck OK?
[Me]: Thanks.
[Dr.]: Yeah, you're welcome, I'll give you this 'cause they like to get that with the check-out, OK?
[Me]: OK. . . . [sniffs, clears throat].
</lj-cut>
...So yeah, she was a dumb bitch.

(comment on this)

1:47 am - Partial Symptom Log (Winter/Spring '14)
[03/19/14 - 8pm - 3am (03/20)]
Possibly worst cramps ever experienced. Pain-scale=11/10
Also, diarrhea, lower back pain, abdominal pain, fatigue.

[03/21/14 - 3:45pm] - Temp._99.7-99.8. (While studying french grammar online, sitting in armchair.)
(NSAIDS? - ?)
Lower back pain, abdominal pain, fatigue.

[03/22/14 - 3:32am] - Temp._99.3-99.4. (While watching TV, sitting in armchair.)
(NSAIDS? - ?)
Constipation, lower back pain, abdominal pain, fatigue.

[03/23/14 - 1:32am] - Temp._99.2. (While watching TV, sitting in armchair.)
(NSAIDS? - Yes.)
Constipation, lower back pain, abdominal pain, fatigue.

[03/23/14 - 5:32pm] - Temp._99.9-100. (While sitting on floor, studying.)
(NSAIDS? - Yes; 1000mg acetaminophen approx. 2hrs. prior to measuring.)
Constipation, lower back pain, abdominal pain, fatigue.

[03/25/14 - 5:45am] - Temp._98.5.<---but, shivering?
Constipation, lower back pain, abdominal pain, fatigue.

[03/27/14 - 1:42am] = Temp. 98.8
Diarrhea, lower back pain, abdominal pain, fatigue.

[03-27-14 - 11:49pm]
New, sharp/twinging pain in lower back on left side by tailbone. Duller/deeper lower backache
over the last 2mo. has become pretty bad (worse) in the past week, bi-laterally painful w/ certain
movements and worse on the left side while at rest.
Diarrhea, abdominal pain, fatigue.

[03/29/14 - 4:51pm] - Temp._99.4-99.5.
Diarrhea, lower back pain, abdominal pain, fatigue.

[03/31/14 - 4:00pm] - Temp._99.8
(NSAIDS? Yes.)
Diarrhea, lower back pain, abdominal pain, fatigue.

[04/01/14 - 2pm] - Temp._99.8-99.9.
(NSAIDS? Not in last 10 hrs..)
Diarrhea, lower back pain, abdominal pain, fatigue.

[04/01/14 - 7:50pm] - Temp._99.7.
(NSAIDS? Yes.)
(Quite severe back-pain, greatly diminishing range of movement and activity level. Abdominal
cramping as the day progressed which started with a temporary subsiding of the recurrent bouts of
diarrhea, and seemed more diffuse/possibly-GI-related at first, but then felt progressively more
'reproductive' in quality, and began to involve the pelvic and then groin/leg area as the diarrhea
returned. Lack of appetite. Tylenol @ 2,000mg seems worthless today, concerned to take more on a
less-than-full stomach. [...] ...Okay, in all honesty, it's like 2am in the morning and the pain I'm in right
now is almost indistinguishable qualitatively from the pain of my last period (not including that one,
worst bout of 10+/10 cramps that tore through 10hrs of my evening like an F5 tornado on 03/19; that
pain was qualitatively similar, but of such greater intensity as to be categorically unique)... since the
end of that bout of cramps my abdo./pelvic pain has seemed more diffuse, and possibly GI-related w/
lots of diarrhea that came back after a 4-day pause following my period and until today and yesterday it
seemed like it was, I don't know, maybe more gastro than gyno... ...I have since sort of reinterpreted my
lower-back/sacral pain (initially in my mind strongly associated w/ period pain due to its initial
emergence within a 6hr span of severe period/period-pain symptoms onset) as possibly being GIrelated
due to its having stayed around between menstrual periods for going on 3 cycles. So I've been
wearing the GI-centric glasses in looking at and thinking about my symptoms recently since my period
ended (having been so @#$@# intense this month, but so relatively short-lived) and it took me a
minute to tune-in to what I'd been trying to tune-the-fuck-out all day and actually realize that this pain
was, with the passage of the day, becoming increasingly period-cramp-like, rather than tenderness/-
inflammation/-backache/-diarrhea-cramp-like. But at this point in the night there is no denying the
menstrual /reproductive quality of this pain, it is in addition to the layers of other kinds of pain, that all
seem for that matter to be quite a bit worse in the last 48 or so odd hrs.. Can pain behave synergisticly?
It's very hard to untangle!! It's like these different pains are all competing with each other for my
attention and my back pains are like shooting throbs that pierce the diffuse but strong ache in the wider
area; they're really bad!

[04/05/14 - 2:30am] - Temp._99.1-99.2.
(NSAIDS? Yes.)
Diarrhea, lower back pain, abdominal pain, fatigue.

[04/06/14 - 7:36am] - Temp_98.9.
(NSAIDS? Yes.)
(Felt *somewhat* better last night & yesterday. Walked on treadmill briskly for 20-30min.,
started getting crampy pain in all the usual places about 15-20min. AFTER stopping (*not* during or
immediately after, so it was *not* exertional "runner's cramp") but they were mild-to-moderate and
somewhat short-lived (less than an hour). Muscles soreness over the last 3-or-so days kinda worse than
the already painful norm, esp. in legs and arms, but less fatigue and nausea also, so it's been easier to
deal with than it otherwise wouldda been. Breaking out in bad acne though, which sux. :( Back still
hurts but I suppose less than it has at its worst. Diarrhea still, but not esp. painful (just annoying,
inconvenient, and abnormal). Abdominal tenderness and bloating overlaid with transient mild twinging
crampiness in pelvic/abdominal region sending sharp throbbing twinges to lower-mid back. Have the
symptoms been debilitating today/yesterday? No. Does feeling this way (or worse) practically every
single day of my fucking life seriously negatively impact my QoL? Absolutely!! Are my symptoms
*often* truly debilitating? Lately yes, at least a couple days a week (these are the days for which I've
made no entry in this log, or minimally descriptive (sometimes post-hoc) entries, when there was too
much to have to describe & include, & I was too jacked up to face or bother even attempting to
describe it)).

[04/06/14 - 7:50pm] - Temp._99.7
(NSAIDS? Not in the last 12 hrs..]

[04/07/14 - 3:00am] - Temp._99.6
(NSAIDS? Yes; 1000mg. @ 1:00am, and 1000mg 7hrs. prior.)
(Ok, so apparently I forgot to knock on wood when I wrote yesterday about feeling 'somewhat'
better because I went to sleep around 8:30am, and was awakened around 11:45am in a profuse sweat(*)
with gnawing crampy colicky pains along with vague hunger (which is not to say appetite) so I made
myself eat 2 pkts. of granola bars and tried to go back to sleep, which took quite a while as it was hard
to get comfortable. I woke up later between 4:30-5:00 and felt like total shit. Back pain, body aches,
lack-of-appetite-bordering-on-nausea, diarrhea, crampy gnawing colicky abdominal pains, and my
temp. back up above 99.5 (symptoms seem to go from bad to worse when my temp. elevates above this
reading, or at least that seems to be the vague pattern that's emerging). Very little energy. Next to
impossible to concentrate on anything remotely requiring concentration. [...] ...It's a quarter to 4am
right now and my abdomen has been hurting since I woke up, and it's been worsening for the last
several hrs. so right now it's to the point where I'm having a really hard time concentrating on finishing
my french assignment! :(
(* - I've been forgetting to include the "sweats" in what I write down. They are more often
(though not always) at night, and they are just totally ridiculous. I had to get up and put a folded sheet
down where I'd utterly saturated the one on the bed, and when I flipped my pillow over it was damp on
the other side. I get the sweats a lot now, they seem to vaguely correspond to my level of active
symptoms, and so when my symptoms are active like they've been for days and weeks on end, I get
them nearly every night, for days and weeks on end. I assume it's probably relevant to include this.)

[04/07/14 - 10:45am] - Temp._99.4

[04/12/14 - 12:00pm] - Temp._99.2

[04/12/14 - 6:30pm] - Temp._100 (<---no surprise; I felt inexplicably and uncomfortably warm
@ the time, which is why I re-checked it.)
(NSAIDS? Yes.)
Horrible, awful liquid diarrhea (multiple 'sessions' over 3-4hrs., forming in my mind a single
'episode') w/ *extremely* painful cramping for hours upon waking (& not in the least little bit 'relieved'
by BM), continued diffuse pain and tenderness of abdomen throughout day (though slightly less
severely than in first several hours). Sacral back pain, fatigue, poor concentration. Hunger without
appetite, frequent urination. I took two of the 'antispasmodic' capsules from Dr. Bortman while the
diarrhea was at its worst, and although the diarrhea did resolve w/in about an hr. of taking them, I don't
know if this is attributable to the meds or if I was simply just 'done' w/ my 'business'... also, what did
*not* resolve along w/ the diarrhea was the great deal of pain I was in... 'twas somewhat lessened after
the active diarrhea ended but honestly not really all that much. Also: twinging/throbbing sharp pains
circumferentially around the torso (@ the level of the navel) throughout the day, mostly in the front of
the body and occasionally sending throbs and twinges downward to the pelvis and upward to the
bottom of the ribs. (* - Also, my symptoms were about the same yesterday, though I don't know what
my temp. was then as I didn't measure it.)
(...Now, I'm quite familiar w/ all of my personal signs & sensations, & honestly I'd say that this
is my period-pain starting to "ramp-up" (Ryan mentioned he took note the other day of the fact that I'd
gotten out the electrically heated 'period pad' which reminded me of the cramp-like throbbing twinge
on my left side that was keeping me awake one night, which I was trying to either relax or 'burn' out the
sensation of w/ the heat of the period-pad.); the twinging pain is in large part occurring geographically
as described above, but is composed also of a migratory aspect which seems to be jumping around at
sadistically-arbitrary-will from one place to the next with the one thing shared in common by all these
locations being that they are all precisely places that start twinging w/ usually sharper pain during and
immediately prior to my period. Being that my last period started on 3/19, that puts my next 'expected'
period onset just about exactly one week out. This upcoming week is the last week before Finals Week,
& in each of my three classes this week there will be a last, non-Final unit exam given, followed by 3
cumulative Finals scheduled for the immediately following Finals Week. So while I'm trying to
complete my remaining assignments this week, and having to decide how much time to spend
preparing for this week's exams vs next week's exams, I'll also be dealing with a full week of totally
disruptive, utterly defeating pre-menstrual symptoms that are now about as bad as many people's fullon
periods are at their worst, and when the week is out and I am overcome with the urge to sleep
continuously through the next one, in lieu of restorative downtime I will instead get to 'level up' my
character and (without the time even to do an 'equipment check') face the two-headed boss monster
born of the co-occurrence of Finals Week & My Period, where the stakes are even higher, handicaps are
increased, and things start to get really fun...
"Will there be blood?"
"Oh yes, yes, there will be blood..."
...After all the hard work I've put into this semester, despite all the pain & disruption of the ongoing
prison riot that has been taking place inside my body, I feel like the coincidental timing of my worst 2
menstrual weeks with the hardest most trying and stressful 2 weeks of the semester is so unfair since it
can quite literally take me out of the game for what adds up to days at a time (hours and days are the
absolute last thing I have to spare between now and the end of the term), and in a wholly unpredictable
manner... The variable, difficult-to-predict nature of the never-the-less inevitable disruption can take on
many forms, all equally potential; will it come in the form of a 3-day migraine? Or will you instead be
forced to the floor to writhe in pain two nights in a row. Or might it be a seemingly menstrually related
freak injury that forces you to contemplate purchasing crutches or bringing an awkward 'back pillow"
to class? Might it simply come in the form of 'only' moderate dysmennorheal uterine cramping that,
instead of being shock-inducingly painful, comes accompanied by utterly freakish and horrendously
painful cramping diarrhea that adds hours to your morning routine which of necessity must come from
time otherwise used for sleep, lowering your concentration and then turning right around and lowering
it further by causing continuous (presumably digestive) pain and discomfort? ("But hey at least the
uterine cramps were only a 7-8 and only lasted one night... oh yeah, and at least it's not Cancer.").
(And hey! Why not?) What about combinations of any or all of the above? How many of these
disruptive symptoms MIGHT there be *this* month? And *when* MIGHT they decide, lol, like Putin,
to "rear [their] head[s]"? How much advance notice will your body give you that "shit's aboutta get
real", and how are you to plan around it, once you feel it start to come on, when the unpredictability of
your symptoms casts an even pall of uncertainty across your entire upcoming schedule? Even as you
experience it beginning to happen, you know that these symptoms will continue to eat through & leave
you with vastly less time to accomplish things than you would otherwise have had in their absence (the
same can be said for energy), but *how* much less time will that actually be? And *which* slots of
time will be affected, & *what* had you originally planned on putting that time towards? The fact that
even low levels of risk and uncertainty require contingencies, and higher levels may require
contingencies within contingencies within contingencies, is exhausting to think about, let alone put into
constant action while enduring the bodily burden of active symptoms, and when the reason for the
uncertainty in the first place involves the nature and timing of highly variable intervals of great bodily
distress.)
I mean, either one of the two regrettably coinciding things (finals week, reproductive pain) is more
than enough of a challenge on its own. I just feel like fate and luck are totally fucking with me at the
moment; the cost of this disease just in terms of pain-already-endured and its attendant past opportunity
costs is already so high that having to watch its effects so very seriously threaten the outcomes of my
efforts and goals is just absolutely terrifying and enraging. If I had a definitive diagnosis, or at the very
least a concrete specific solid plan in place to *effectively* manage/control the unpredictable-butultimately-
expected pain IN THE SHORT-TERM, then maybe it wouldn't be freaking me out so badly
that the requirement to give hormonal treatment (ie, the IUD; I will not be taking Danzol or Lupron at
any time in the foreseeable future, t.y.v.m.) a 'final try' means that, unless the IUD is some incredible
side-effect free miracle pain cure (& honestly given it's mode of action, I'd think the pain-control from
hormonal manipulation would have to be BETTER than that likely obtainable with surgery in order to
justify it's continued use in lieu of surgery), it will likely be another 6mo. before surgical treatment is
commenced; (2wks. sexual abstention, +3mo. trial of IUD, +a recommended minimum of 1 mo. postdiscontinuation
interval prior to surgery, +however long it takes to schedule and prep. for surgery... )
...It's like a minimum of 5mo. total, and probably closer to 6mo., but in the meantime, like I said, if the
IUD is ultimately not able to provide *desperately* needed symptom relief, or provides an
unsatisfactory level of relief, or an unsatisfactory level of side-effects, then I'm left where I started,
which is an unacceptable position to be in for even 6 more months, because in the meantime I still have
shit in my life like Finals, and job-hunting, & planning a wedding, and planning my academic schedule
for the summer, and the lack of diagnosis is significant, and this significance should not be minimized
by looking at it from a strictly medical standpoint; if treatment is 'very effective' in the absence of
diagnosis, and major differential diagnoses have been ruled out, then I 'get' that the clinical utility of
definitive diagnosis may be relatively low and a moot point, as the general diagnosis is confidently
suspected and symptoms are being controlled... which might be all fine and well and true, but in the
broader social context diagnosis carries potentially broader social meaning. People want their
diagnoses!! Furthermore, the patient has (and I, as a patient, have) a legitimate desire to know with
robust detail what, *exactly*, is going on within their own body, to know that whatever it is, it is being
assessed w/ that same level of detail by those Drs. whom they have chosen to trust enough to allow to
make treatment decisions; They want to know how their disease would be judged during surgical
staging, if possible they want the disease taken out, not suppressed indefinitely into dormancy (or
partial dormancy); women w/ symptoms throughout their cycle would probably want (I would, and do)
to know if menstrual suppression will eliminate pain that is peri-menstrual or continuous...
...and so here I am, and as I contemplate the "medical treatment options", they all still feel (to me) like
little more than temporal barriers to surgery, given their generally temporary effect on symptoms rather
than underlying disease, their potentially side-effects laden profile, and ongoing monetary cost, and the
feeling that I will have to wait this long to see if I am satisfactorily relieved of pain (if not disease
itself), or to even just determine definitively whether endometriosis is indeed what ails me, it just feels
unbearably like an unnecessary delay & time-barrier to not just potentially more effective, but
potentially curative surgical resection of disease, and determination of extent of involvement of
surrounding organs. And I have no plan (other than copious administration of *utterly useless*
stomach-burning NSAIDS) in place to deal with the pain this 'suspected' disease can and does throw @
me, both in moments of acute super-intensity and on the more chronic level 2-4wks/mo.. I have no
good way of confidently indicating what's wrong with me to anyone or explaining the nature of its
debilitating effects on my functioning & productivity, or handling the pain of each day on my own
without falling ever increasingly behind in my life (lol, I thought people w/ "IBS" were s'posed to
*eliminate* sources of stress in their lives!!?))
I mean if, like I said, I knew what the plan was to control and minimize the crazy effects on my life that
my crazy symptoms are currently having and can be expected to continue to have at least until my body
adjusts and the levonorgestrel starts taking away the pain, then that would one thing. But I don't feel
like anyone has really communicated about this to me & so I don't really feel like there's much of a
plan except 'expectant waiting' & re-evaluation in 3.5 months, and herein to my mind lies the problem;
not only will I still be vulnerable to the continued effects of the disease in the absence of an adequate
therapeutic effect of the hormone, there are apparently no contingencies in place for instances over that
3-4 mo. period of failure (in terms of pain) of that treatment, taking into consideration the costs to me
of such failures when & if they occur. And related to this for me is the issue of judging the
effectiveness of the hormonal treatment, when I don't know exactly what is even causing my pain and
discomfort and various other symptoms like fatigue and diarrhea and urinary frequency and lowerback/
upper-leg pain and generalized abdominal bloating and tenderness. At what point can the
suppressive hormonal therapy be said to be "effective"? How are we to define this word for our
purposes? I know what 'effective' generally means in the scientific medico-legal sense, which is
"producing an effect of sufficiently robust magnitude as to not be statistically ascribable to chance".
This may be adequate for FDA regulatory purposes, or for reporting the results of your study in the
journals, but it is not a useful definition for guiding treatment decisions that involve making
discriminating choices among very different treatment options, especially when they are presented to
you in triggered-series ("Attempt treatment A, if A is not effective initiate treatment B, and failing that
move on to options C, D, & E, in that order." <---this kind of formula is very often the only rational
way to practice medicine, and really is best practice, but, its appropriate application requires a clear
definition of the standards by which each treatment and its outcome will be judged and this is
especially important when the available treatments are incomparable in terms of their manner of effect
and the first and second-line treatments must be tried in the clinical setting of no confirmed diagnosis,
making their 'effect' difficult to judge and necessary to qualify.

[04/13/14 - 11:30am] - Temp._98.7 (<---Holy shit this is like my first nearly normal reading in over a
month! However...)
Diarrhea (
[04/13/14 - 3:21pm] - Temp._99.8

(NSAIDS? Not in last 10hrs.)
Diarrhea, backache, crampy abdominal tenderness, low-energy and concentration. Sweaty
armpits. Took two 'antispasmodic' capsules after first diarrheal BM, and it might be the reason I haven't
been continually running to the bathroom for more diarrhea, so that's encouraging. If calming the
diarrhea means calming some of the pain often associated with it, then that will be a great help in
recognizing other kinds of pain as it occurs and distinguishing which pain is gastrointestinal (/diarrheal)
in nature, and which is directly reproductive. Not that it'll ever be clear cut and straightforward, but
quieting the diarrhea and the pain it seems to directly cause should help at least somewhat to clarify
what's what.

[04/14/14 - 12:00pm] - Temp._99.7
Diarrhea, cramps, abdominal pain, back pain.

[04/15/14 - 5:00pm] - Temp._99.5-99.6
Diarrhea (very liquid), abdominal/pelvic pain, sharp cramps, back pain, messed up appetite.

4/17/14 - bad cramps all day, diarrhea, started very lightly spotting (pussy blood), backache really bad
too, same as yesterday (except yesterday had a bad nearly migrainous headache), and day before...
monday was bad but ever so slightly less so.
Using heating pad, taking round-the-clock NSAIDs, dicyclomine capsules as needed; level of
functionality=very poor.

4/19/14 = bad cramps all day, liquid diarrhea, (bleeding started on the 18th, hormonal headache from
4/17-19/14), bad lower backache, tenderness and intermittant pain in upper/inner thigh/groin area,
cramps and backpain seemed to be referring pain upwards to right shoulder/shoulder-blade/armpit area,
increased urinary frequency.
Using heating pad, taking round-the-clock NSAIDs, dicyclomine capsules as needed; level of
functionality=very poor. (missed Friday's exam on the 18th, and had little to give to studying on the
afternoon & evening of Sat. the 19th.)

4/20/14 - cramps. diarrhea, backache, urinary freq., generalized myalgic soreness,
Using heating pad, taking round-the-clock NSAIDs, dicyclomine capsules as needed; level of
functionality=poor.

[05/03/14 - 3:15am] -
Bad constant pelvic/abdominal/lower-back pain all day today (and yesterday, but especially
today). Pretty debillitating, actually. Moved UofM appt. up (or is it 'back'?) to this upcoming Tues.
(5/6), and hopefully I'll get through the weekend and have the appt., and have the appt. go well and
maybe start to see some desperately-needed progress on that front. Have been having lots of what
seem to be hormonally-triggered migraines lately too. Diarhhea. Urinary frequency. Fatigue (but much
of this is related to resuming my downward titration of my Adderall dosage). Mood overall pretty good
this week, all things considered.

[05/03/14 - 4:00om] - Temp._99.1-99.2

(comment on this)

1:44 am - Misinformed Like a Boss...
More-or-less verifiably untrue statements made to me by the generalizing OBGYN 'specialists' @ UofM:
1.)
 That the elevation of circulating serum levels of progesterone associated with use of the Mirina
coil, because it is "miniscule" and "negligible" (14.28%, to be exact) compared to that observed
with oral BCP, is too low to cause side-effects, even in demonstrably sensitive individuals (ie:
"The Mirina coil has zero side-effects profile").
2.)
 That endometriosis (because of its nature as a "recurrent", "progressive" disease), "always,
always" comes back, even after the most meticulous and thorough conservative surgery.
3.)
 That the reason for this 100% post-surgical recurrence rate is the medically relevant existence
of "invisible, microscopic" endometriosis, which is "impossible to [see/find]" laparoscopically,
and is thus "always missed".
4.)
 That the ubiquitous existence of this "missed, invisible endometriosis" (which is the major
cause of the 100% post-surgical recurrence rate) provides a valid rationale for routinely putting
nearly all diagnosed endo. patients on post-surgical suppressive medical therapy (typically with
DepoLupron).
5.)
 That Sampson's theory of retrograde menstruation (in the pathogenesis of endometriosis) means
that even if total surgical removal of endometriosis *were* possible (which is not the case, as
per above), that the recurrence rate after conservative surgery would *still* approach 100%
unless menses are medically suppressed after conservative surgical treatment (by whatever
hormonal means necessary).
6.)
 That in endometriosis, "severe disease" (presumably stage III-IV?) is generally "inoperable".
7.)
 That in endometriosis, very widespread superficial disease is effectively "inoperable".
8.)
 That diagnostic laparoscopy can / should / must not be performed, even for strongly suspected
endo., until after a full and exhaustive diagnostic work-up has been completed for every
individual endo.-associated symptom the patient reports (by referrals to specialists in every
body system involved in the symptomatic picture.). That the decision to operate should be
treated like a diagnosis of absolute exclusion, to be arrived at only *after* every alternate nonendo.
explanation for every endo.-like symptom has been exhaustively pursued. That to
proceed in any other way would be to proceed in error. .
9.)
 That in the endometriosis population, pain-symptom response to Lupron, even at only 30 days
into treatment, is "universal" (ie: 100%).
10.)
 That because of this universiality, therefore, "empiric therapy" with Lupron can be used
reliably enough as a diagnostic tool, in suspected but unconfirmed patients, *in lieu of*
diagnostic laparoscopy as to obviate the need to perform one.
11.)
 That response (of pain) to Lupron, reliably indicates and thus allows for a confident diagnosis
of endometriosis (ie: "non-surgical diagnosis via response to empiric therapy with Lupron
produces few-to-no false-positives").
12.)
 That non-response (of pain) to Lupron allows for a confident ruling out of an endometriosis dx
(ie: "non-surgical diagnosis via response to empiric therapy with Lupron produces few-to-no
false-negatives").
13.)
 That Lupron therapy (despite its fundementally supressive main effect) immediately prior to
surgery has no potential whatsoever to supress the recognisable visual appearence of atypical or
subtle endo. lesions/implants/foci at the time of surgery, even to the inexperienced surgeon.
14.)
 That no endometriotic implant which could have been identified at surgery in a Lupron-naieve
patient (for instance one with subtle or atypical lesions), has ever, (at any time, in any place, by
anyone, in any way) been missed by visual inspection at surgery in such a patient as the result
of receiving pre-surgical treatment with Lupron.
15.)
 That the reported side-effects of Lupron therapy (when experienced in that minority of
subjects/patients that experience them), do not (ever) persist (at all) (in any way) (for any
individual) beyond the cessation of therapy.
16.)
 That establishing a solid diagnosis or non-diagnosis of IC (in a patient with a lifelong history
and current presentation strongly suggestive of endometriosis, including, among many other
suggestive signs and symptoms, the symptom of urinary frequency of 15mo. duration) is
relevant to the future diagnosis or non-diagnosis of endometriosis (ie: it is relevant enough that
further delaying the diagnosis of the endo. until the conclusive diagnosis (or ruling-out) of IC is
achieved through complete urological work-up is an appropriate requirement for pursueing
laparoscopic diagnosis and treatment of endo.).
17.)
 That the above rationale is equally applicable to functional or inflammatory disorders of the GI
tract. (ie: "
18.)
 That in a patient with clinically suspected endometriosis who in the past has tried and
discontinued 4-5 different types of combined HBC (due to total lack of sought benefit(s) and
several *bad* side-effects), it is a reasonable clinical assumption to make that 100% of the sideeffects
previously experienced (of which all are among the main common side-effects of
* progesterone * ) were actually caused *entirely* by the estrogen in the HBC (*not* the
progestins), and that to the extent that there was no beneficial effect, 100% of that lack-ofbenefit
can be blamed on the interference of the estrogen preventing the potentiallymiraculously-
effective progetins from effecting their obvious benefit.
19.)
 That a tentative diagnosis of endometriosis reached via response (of pain) to an empiric trial of
Lupron is *necessary* *prior* to obtaining a confirmative diagnosis via laparoscopy, and that
to proceed to laparoscopy without first testing response to Lupron is somehow dangerous or
irresponsible (except in the few cases where obvious endo. can be unambiguously visualized on
scan or directly palpated on exam...or, perhaps, where *fertility*, rather than pain-relief, is the
goal of surgery).
20.)
 A person with my symptoms/history is "more likely to benefit from [medical therapy] than from
surgery".
21.)
 General anesthesia can cause a migraine that lasts continuously for multiple weeks on end
without resolution (sim. to those that can be triggered by multi-month DepoLupron injections
in sensative individuals).
22.)
 There is little-to-no evidence for the utility of an advanced/expanded TVUS protocol (when
performed by an experienced & specially trained sonographer) for the indication of
endometriosis, which looks for both "hard" and "soft" signs of endometriosis-associated
pathology and includes (beyond vis. of just the adnexa) examination of visible portions of GI
track and urinary bladder. That there is no such thing as a specialized protocol specific to this
indication in existence, or that there is no evidence for its superior sensativity when performed
skillfully.

(comment on this)

1:36 am - Endometriosis: full narrative
   I have recently had to confront the fact that I no longer clearly remember what it
really, truly feels like to have an experience, a single waking moment, that is not in some
way colored by the experience of pain. About a year ago, the same statement wasn't
true; the truth of that statement has been an actively developing fact over about the last
year of my life. In the last year, I've experienced a major and even rapid personal
decline in my ability to function, and major escalations in terms of increased pain and
new symptoms of relatively recent onset. I am writing the following narrative in order to
tell a personal story, in my own words, which I have never truly told before. Much of
what I have to tell has taken place over roughly the last 14 months. But the current state
affairs (medically speaking), such as I find it today, is something which has in reality
been more than 15 years in the making. In order to put the last year in its full and proper
context, I feel the history should begin at its most truly relevant beginning.

   My first period, which occurred a few months after my 13th birthday, was, for a long
time, one of my worst. It hit me like a swinging steel column, and brought on what at the
time was undoubtedly the worst, most intense pain I had ever up to that point
experienced (and I was at the time already a migraine sufferer of many years, no
stranger to high level pain). It started out with intensely cramping diarrhea. I had never
been one to get randomly loose bowels outside of the occasional 48hr stomach bug, and
even then, I had never experienced such terrible cramping along with a bout of diarrhea.
I was expecting that during the half hour I spent sitting on the toilet moving my bowels I
would begin to experience some relief in the unusually intense cramping pain, but to my
surprise, even as the diarrhea stopped, the painful cramping which preceded it only
continued to intensify. Menses were the last thing on my youthful, premenarchal radar &
so I remained on the toilet for a long time as the cramping mounted, expecting more
diarrhea to follow... None did, and after a certain point the cramps became so intense
that I started breaking out into a cold sweat, and had to crawl from the toilet on the floor
into my parents bedroom and onto their bed where I spent the next two hrs writhing and
sweating and breathing in ragged gasps until I passed into a delirious sleep. The next
day after school I began to bleed and everything, I guess, made more sense.

   This has always been what my periods were like. Early on in my adolescence, when
trying to develop my yardstick for comparison of my menstrual pain with what one might
call 'normal', I would be told that 'normal' was a range, and that some women just tend to
fall at one end of that range in terms of their menstrual experience, and that since
periods can be worse (more painful, more severe) during adolescence anyway, I would
have to just deal with it every month until it 'settled down' (hopefully) at some far-flung
future date...

   ...And so I dealt with it. Since I was a severe migraine sufferer for most of the school
years leading up to my first period, I had already been dealing with a chronic pain
condition that would cause me to miss school with some frequency. Luckily, by the time I
was 13 and starting my period, my headaches had started to improve in terms of their
severity and frequency and from that point on seemed to hit me more in conjunction with
my period pain, rather than at other times. Now when I missed school because of a
migraine, it was usually a migraine of menstrual origin and accompanied by bad cramps.
Even when I didn't have a migraine with a period (I always had insanely horrible
cramps), that's what I would say was wrong with me when my cramps hit. People were
always more sympathetic to my migraine pain than to my menstrual abdominal pain. So
that's what I usually said was wrong.

   Never the less, at this point my periods were still, despite being incapacitatingly
painful, usually of a mercifully short duration (1-3 days of intense-but-intermittent
cramps, 2-5 days of normal bleeding). The interference in my life that the severity of my
dysmenorrhea had was limited to my time of active bleeding, with usually no more than a
couple days affected.

   My periods and dysmenorrhea continued from age 13-15 mostly unchanged through
the end of 9th grade.

   At around age 16 I developed anorexia nervosa, and was hospitalized with a BMI of
14.4. I spent 2 weeks on the children's floor of Beaumont Hospital in Royal Oak (MI),
followed immediately by 6-8wks spent in-patient at River Centre eating disorders clinic in
Sylvania, OH.. I was released to my parents and began receiving intensive
multidisciplinary outpatient treatment including 2x/wk counseling with a psychotherapist
(Dr. Ann Weeks Moye, PhD) whom I currently still meet with on a weekly basis. I did not
get my period back until a few months after my 17th birthday. *********************

   Over the next three years (age 17-20) my periods became increasingly painful and
severe. I would be essentially bed-ridden every cycle for as long as the cramps lasted,
only now when they hit, I would be in writhing agony for 48hrs straight and would find
myself taking high doses (esp. for my body weight at the time) of OTC painkillers and
living plugged into a heating pad. Sometimes, a given cycle (as bad as they normally
were) would surprise even me with its intensity, & more than a few times did I wake up
on the floor of my bedroom or bathroom after having apparently passed out from pain. I
would wake up shivering as if from a nightmare when the clammy perspiration began to
dry on my skin. It was traumatic for my partner at the time to have to sit with me while I
would be going through this, knowing there was nothing he could do to make it stop
even a little bit.

   My first and only period-related ER visit took place when I was 19 (and living in
Dayton, OH), and to this day remains one of my most painful and terrifying menstrual
experiences ever... I had been sitting with my heating pad trying to focus my breathing
and relax my muscles as the invisible monthly torturer gleefully went to work on my
every last nerve ending, when suddenly (impossibly! inconceivably!) the pain I'd been
feeling began to intensify further. It was so much worse than anything I had ever
experienced up 'til that point that I began to doubt that anything as 'normal' as a period
could possibly bring on such a response in my body. My heating pad seemed smaller
than a postage stamp; the pain was spreading down my legs, and up my back and
sides. It seemed like there was such an overflow of pain from my abdomen and pelvis
that it was referring itself to my ribs and shoulders and armpits and groin and thighs
and... I needed to apply heat to all these places, so I hobbled into the bathroom to fill a
bath.

   With the water running, I sat down on the toilet and, as if by the mere act of sitting,
had a sudden unexpected bowel movement (highly unusual for me at the time, as I was
at baseline typically more constipated than anything else, esp. after the recent toll of
anorexia on my body). The water continued to run, filling the tub at an excruciatingly
slow pace. I could no longer sit on the toilet, so I slid down to the floor and draped my
arms over the side of the tub waiting to get in. By the time the tub was somewhat full I
could barely think straight with all the pain, and could do little else to get in the water
than to roll myself over the edge of the tub with a great, floor-drenching splash.
("Mission accomplished.") It was within less than a minute of being in the water, though,
that 'all hell broke loose'...

   ...I felt instantly nauseous and dizzy. It seemed like whole sets of unknown muscle
groups were clenching and spasming without any control. After what was somewhere
between a few seconds and an eternity, I realized that I could not voluntarily control or
move my legs. I felt the need to get out of the water and sit on the toilet again but I
could not command my body to stand. I felt through the cramps my bowels starting to
move again and tried to gather all the mental control I could summon to hold my
continence until I could drag my self onto the toilet, but I could barely think or breath, and
I was delirious and nauseated and - before I could flop back over the side of the tub, I
felt a wave of stabbing involuntary abdominal contractions and realized that despite my
best efforts, I had accidentally shit in the tub.

   Horrified, I finally lifted myself over the side of the the tub, and once more I was on
the bathroom floor. The most stabbing of my pain seemed to be directly over the
location of the appendix and I was worried that the timing of the pain with my expected
period onset was possibly a mere coincidence, and I wanted to call my romantic partner
(who was working from his home office down the street) and tell him to come get me,
that I needed to go to the ER. My phone, however, was at the other end of my
apartment, and so I began the world's longest, slowest crawl across the floor toward it.

   When I finally reached my phone and got through to Mark (my S.O.), I was nearly
incoherent and barely able to gasp out the words to convey what I needed. He
immediately dropped his two young children off with a neighbor and came to get me.
When he got there, my condition was unchanged, and he had to carry me out to the car.
As we rushed to the ER I tried to tell him more about what was happening, but all I could
manage was, "Something's wrong. Something's... wrong." and, "It's probably my...
period... but... something... I don't know...". When we arrived, I tried getting out and
walking in myself, but after a few steps, Mark just picked me up and carried me into the
ER.************************

   After that frightening experience, I started reading up on "severe dysmenorrhea",
hoping to discover the possible cause(s) of my freakishly painful symptoms, and learn
what might possibly be done to MAKE IT STOP. It was at this point that the word
'endometriosis' first entered my vocabulary, and the more I read, the more convinced I
became that it represented the single most likely diagnosis, given my symptoms
(should they ever be investigated). I explored and entertained the possibility of other
diagnoses and, allowing for the chance that my symptoms were indeed merely outliers
within that nebulous range of 'normal', I entertained the possibility of no diagnosis. I
needed, like the ads on TV say, to 'talk to [my] doctor' about this. I would need them to
help me confirm or lay-to-rest my suspicions, or at any rate get to the bottom of it all, or
(barring that) at the very least offer me treatment to help manage my symptoms.. As
someone who'd relied for nearly the last 2 years on local urgent care clinics for the one
or two minor acute needs I'd had while living in Dayton, 'talking to [my] doctor' would
necessarily, for me, entail finding a doctor.

   At some point while I'd been living in OH (prior to the ER trip), the MI doctor who'd
handled/provided my general medical care since the time of my adolescent
hospitalization informed me she was leaving professional practice indefinitely to start her
family. Unsure of how much longer I would even be living in OH, I decided after the ER
trip to see a female GP back in MI from the general practice I'd gone to when still living
at home with my parents.

   In the exam room during that appointment, I told the doctor of
my menstrual worries and woes. I told her of my ER 'experience', describing it as the
major precipitating event that had led me to her office for the consult. I explained that
the problem had been been getting worse in recent months, that my periods were
becoming alarmingly more severe in terms of pain, bowel symptoms & blood-loss.
Sometimes, though infrequently, sex was painful (during or after), if I was on or near my
period. Sometimes having sex seemed to 'stimulate' the onset of my period, causing
immediate post-coital cramping and bleeding, even if I wasn't really 'expecting' one to
start just yet. It wasn't like this all the time, but when it happened it was bad.

   I told her that these extra-especially-intense 'super periods', like the one that sent
me to the ER, were becoming an increasingly frequent occurrence, and that the
crippling, mind-numbing pain they brought along with them was coming to define a new
norm for me, whereas once upon a time they were occurring only a few times a year. I
told her that in the past, even my most intense cramps still only usually occurred in a
single 1-5hr episode just prior to bleeding, and were usually followed by an otherwise
uneventful & unremarkable rest-of-the-period. I described my growing alarm, though, at
the fact that over the previous 6-12mo., the super-crazy pain of initial-onset cramping
(while always eventually receding somewhat from its peak intensity), was more and
more often coming to be followed by 36-72(+)hrs. of continuous, cramp-like pain. Like,
bad pain; take-the-day-off-work-or-school-pain, even if not rush-to-the-ER-with-apresumably-
exploding-appendix-pain. The 'new norm' now was generally 1-3 days of
the former type of pain following an initial 1-8hr. episode of the latter type. Also, I was
often cramping (often badly) in the 1-2 days leading up to my period as well...

   ...And this is what it had come to be like, basically every month, while I was
seemingly experiencing more pain and heavier bleeding with each passing cycle. I told
her that as a typically chronically-constipated person, I thought it odd and found it
interesting that my periods had started making me intermittently-diarrheal for the extent
of their duration, & that my now-monthly super-cramps had themselves become a major
trigger for either diarrhea, or the additionally painful passage of hard-formed stools
(Bristol Type I&II). I told her that as a new college student with academic disabilities, I
was struggling with the unpredictable loss of time otherwise budgeted to scholastic
productivity. I broke down and confessed that it had finally progressed to a point of
actually, truly, interfering with my life.

    I told her that the experience of going to the ER, especially with the 'type' of pain that
brought me in, was frankly traumatic. I explained that I had since made it a top-priority
Goal-In-Life never to have to go through that nightmare again, but that I needed her
help to get this thing under control... At the outset of our conversation I had hoped that
she would at some point bring it up herself, but, when she didn't, I waited for a good
opportunity, and hesitantly asked if maybe, possibly, it sounded like it might be
endometriosis.

   Upon hearing my question, she smiled at me and asked if I thought that's what I had.
I said I honestly didn't know, but I thought it a strong possibility that bordered-on-likely,
and she asked what made me think that. I replied (somewhat perplexed), that
everything I'd just been telling her abou t constituted my 'reason' for thinking so, and that
I was telling her because I wanted her to tell me, in her expert medical opinion, if she
thought so too, or at least felt it likely enough to actively investigate further. I was
vaguely aware, from what I had read, that real definitive diagnosis of endometriosis
could only truly be made surgically, and with this in the back of my mind I was hesitant to
even bring up the general subject of diagnostic investigation(s) knowing that surgery
potentially lay somewhere at the end of that path. I wished, of course, to avoid the
prospect of surgery if at all possible, and I was also worried that I would sound, by
simply broaching the subject of diagnosing endometriosis, like I was somehow asking for
surgery... I would have considered it "bad form", at best, to request surgery or referralfor-
surgery from a PCP on the first consult and so I posed my question hesitantly and left
it open-ended...

   ...and I was genuinely interested in her thoughts on the matter and was curious as to
what suggestions she might make. What she told me was essentially this :

   She thought some aspects of what I described sounded like it could be
endometriosis, but that given my age (19) she thought it unlikely. As to the issue of
making a confirmative diagnosis though, this was, fortunately, something of a moot
point, as the treatment would be the same for me in either case; I didn't have to "have
endometriosis", diagnosed or otherwise, to get the benefits of her recommended
treatment plan. What I did need was a PAP and a pelvic exam, both long overdue. I was
to be put on an extended-cycle, combined oral contraceptive pill right away, and for this I
needed to promise to try to quit smoking. Given that what I basically was reporting was
problematic periods, the goal of the extended-BCP was to limit the number of periodsper-
year I'd need to put up with. Plus with any luck, she said, in time I might find that
even those periods I was still having, had nevertheless become lighter and less painful.
I could also look forward to potential improvement in my probably-hormonal acne (which
I'd mentioned earlier and was apparent on my face). I would be able to know in 3-
preferably-6mo whether the BCP was working/helping/whatever. If by then I was still
having "problems", or if somehow (god forbid) things had managed to get worse, I
should see her to follow-up.

   Frankly, it all sounded very reasonable, and I was eager to begin taking my
prescribed medication as instructed; cost, inconvenience and ADD be damned. The
birth control prescribed was Seasonale (levonorgestrel .15mg/ ethinyl estradiol .03mg, 84ct.
active), and since the Sunday on which I had planned to start the pack coincided with the
onset of my next period, I started taking the pills the same day (Sun.) that I started fullout
bleeding (I had already been cramping and migrainous for more than a day). The
pills did not seem to affect this period, which wasn't really a surprise. It was a bad one
though, nearly as bad as the month before. If perhaps not necessitating further ER
visits, this was only because I had come to view my last ER trip as a "fool me once..."-
experience; nothing short of a gunshot wound to the face would get me to return to an
emergency room willingly and no amount of pain, on its own, would ever again be
sufficient.
   At one month into the pack I was doing fine, the biggest challenge being simply
forming the habit of taking every pill at the same time each day. At around the time
when I would otherwise have been expecting my next period, I did notice that there was
some minor-to-moderate twinging and cramping, although I didn't bleed. But within days
it passed, and was significantly more manageable than my last two cycles had been; I
considered it an improvement.

   By two months in, though, the acne-improvement part of the hormonal experiment
was a decided failure. If anything it seemed to be aggravating my acne, to new neverbefore-
seen levels of severity.... Which would have actually been fine, but for the fact
that I was also noticing an increasingly-ever-present feeling of being painfully
premenstrual; like, despite the absence of menstrual flow, I was still getting
premenstrual(oid) cramps (as to be distinguished from primary menstrual cramps). This
cramp-like pain did not rise to the intensity level of menstrual cramps, and I considered
that a major plus. On the other hand, those had long-ago ceased being the only type of
cramps that plagued me, and I'd hoped that "saving [me] from having to go through a
period" would've meant more than just saving me from this one symptom. A month
earlier, the twingey bloated crampiness that I got around the would-be time of my period,
had passed and resolved in about as many days. At two months in, these symptoms
had begun like before but they quickly became a good deal worse... and this time they
kind of just kept on hanging around, like a period badly wanting to happen, for the entire
last month of the active pill pack. By the last month of the pack, I was getting IBS(oid)
symptoms, and I didn't know whether to look forward to or fear the white tablets at the
end of the pill sheet.

   Well, the correct answer turned out to be fear. I was visiting home when it set in.
 
   When I first arrived, I was breaking out so badly on my face that my mom started talking
(somewhere between insultingly and adorably) about scheduling me for an "emergency
dermatologist appointment" on her dime. I did not end up going on such a consult
during my visit home but I did have to post-pone making the return drive to Dayton due
to how bad the pain was and how long it lasted.
 
   At this point my sense of the time-line of events gets a little bit fuzzy. I did eventually
get that PAP and pelvic exam, the results of both of which were unremarkable. I know I
went back into the doctor's to follow-up roughly around this time and I don't remember if I
saw the same or a different doctor. Whomever I did see though, I remember telling them
about my poor response to the HBC treatment, and I know I was counseled to try giving
the Seasonale another 3-month-try, "just to be really sure". I'm pretty sure it was at this
point that I was counseled that if I wanted to "give up" on the birth-control treatment
entirely, as in, categorically, there were other, *stronger* medications to be tried, ones
that "turn off your ovaries", & "produce a chemical menopause". I do not remember if
the doctor prescribed me another course of Seasonale or not. If they did, I probably
filled it, but I don't recall how far into the pack I made it before ultimately discontinuing. I
did ultimately discontinue it though, for I was, even with consciously managed
expectations, worse than unimpressed with the results.

Blah, blah, blah, BCP, acne, BCP, pain, suffering, ultram, percocet, BCP, blah, blah,
blah...******************

   ...Over roughly the next 4-8 years, I continued to make the occasional half-hearted
attempt to re-open the topic for discussion with my various health care providers, but the
extent of my treatment (of any aspect of the problem) was very limited over that timeframe.

   During this time, especially in the beginning, the nature of the problem was such
that I was much more able (relative to now) to go on basically managing the symptoms
on my own, by whatever means available to me. The quality and contents of my limited
# of medical encounters (those that even touched on this subject) mostly served to do
little more than affirm this fact in my mind. I variously tried this or that BCP, in a dabbling
expectant fashion, on and off, here and there. My experience each time would be more
or less a reprise of the first, with only minor differences. None of the various BCPs I've
tried have ever really given me any of the hoped-for benefits I'd been looking for over the
years, and all of them eventually presented me with a fundamentally similar set of sideeffects
(differing somewhat only in emphasis). As a result, many of the details of my
"treatment" over those years, particularly in terms of chronology, are a bit jumbled in my
mind, but can be easily summarized so Here goes nothin'...

   After the failed-try with Seasonale, I know I was at some point also tried on
Seasonique (identical to Seasonale except that in Seasonique the last 7 pills contain .
01mg estradiol), with possibly even poorer outcome. I know I was prescribed Loestrin24
Fe (norethindrone acetate 1mg , ethinyl estradiol .02mg), but as I recall this was just for
emergency contraception; I may have stayed on it though for while after that, but I don't
clearly recall. ...After hearing a friend sing its praises (at length), I did at some point go
into the doctors office asking for Ortho Evra (norelgestromin 6mg /ethinyl estradiol .75mg
weekly patch), primarily for its BC properties and the added convenience of its novel route
of administration. Around age 20-21, I stayed on the patch for a number of cycles,
3wks. on, 1wk. off, using the patch as directed. I sometimes noticed a slight decrease in
the heaviness and duration of my m. flow during the patchless 4th week of each month,
but heavy/prolonged bleeding (by itself) had never been a primary or major problem of
mine, and while the effect was obviously welcomed, I was chagrined to admit that during
that 4th week off, my pain each time was much unchanged.

   It was still so bad, in fact, that I eventually became tempted to try experimenting with
using the patch in a continuous, extended fashion. I decided to see what would happen
if I started skipping periods. My friend, I came to learn, had been doing so for the last
6mo.; I decided to give it a try. By the third or fourth month of continuous-use, I was
feeling about the same as I had on the extended levonorgestrel/ee regimen, but with
considerably more bowel urgency, bloating, and nausea. A doctor I saw about my
digestive symptoms around this time said, "IBS" and "avoid stress". I didn't mention
OrthoEvra as a factor since I wasn't taking it as prescribed, but I suspected a causalconnection.
Why would I suddenly have IBS? Yeah, I was nervous and stressed, but to
no greater extent than usual and in many ways much less so. I decided I'd finish
wearing the patch I had on for the week, and allow a natural (or at least withdrawal)
period to follow that.

   Within 24hrs. of that decision though I changed my mind and just took it off. The
extreme pain continued like always, but the "IBS" stuff cleared up after cessation of use
of the patch. That was the last attempt at HBC treatment I would try for the next several
years. My own personal "index of suspicion" was still highly raised when it came to
endometriosis, but I had been made well aware of what I could expect in terms of "next
steps" in the treatment of my symptoms, had been told diagnosis was a low-priority, and
had been made to feel like my pain was an even lower priority still. I was also, on some
level, vaguely afraid to escalate my requests for medical help since somewhere in the
back of my mind sat the one or two hysterectomy-related comments I'd gotten from
doctors (whenever I pressed them with questions), flashing on and off in neon colors.

   I don't really know if any one doctor ever actually sat me down and explicitly told me
that Lupron™ and Hysterectomy were my only options (after HBC), and I actually doubt
that they did since I don't recall any conversation at all in which options were ever
actually clearly laid out and openly discussed. But Lupron™ and Hysterectomy were,
nevertheless, the only 'options' that I believed would be initiated by any of the providers
I'd seen. Because of this, I kind of shelved the idea/question of endometriosis
indefinitely. *************************

   At some point toward the end of my time living in Ohio, while staying at my parents on a visit
home, I came across what appeared to be the remaining half of a >10yrs-expired bottle of percocet,
prescribed to my grandmother in 1991, the year she stayed with me and my parents in our duplex,
dying of cancer. I remembered that year clearly. I was in first grade, and my parents had just bought
a 2-family house down the block so they could move my mother's parents into the home and care
for my severely demented grandfather while my grandmother slowly died of colon cancer in the
bedroom upstairs. The bottle was dated to just a few months before she passed. It was a sad
reminder, but I was glad to have made the find. It was a relief to have something to keep in the
cabinet, like a fall-back, for those moments every so often when the pain would become more than I
could stand. Despite their fairly limited supply, I was able (through a system of strict rationing which
sought to balance the urgency of the present need against the fact of their dwindling number and
potential future need) to make that 1/3 bottle of percocets last well over 5 years, which turned out
to be right around the time I turned 25 and lost coverage under my mother's employee health-plan.
Losing my health coverage really, um... sucked. I had been continuing to see my therapist, selfpay,
on a twice-monthly basis, and I had exhausted the lifetime maximum for such care years prior to
losing coverage entirely (I was still active recovery from anorexia when that particular maximum was
reached, and had been self-pay ever since). It was at about the same time I was losing my coverage
that I started experiencing a severe worsening in my perennial respiratory allergies, as well as
recurring episodes of anaphylaxis, which were deemed officially to be idiopathic, but which I suspect
(on at least 3 occasions) were triggered by mold exposure.

   Previously in this narrative, I mentioned that no amount of pain would ever again by itself be
enough to get me to willingly return to an ER. The statement remains true, even to this day, but it
was not too long after I turned 26 that the anaphylaxis started happening at random. In a span of
less than 2 years I'd been back to the ER (covered head-to-toe in confluent urticaria, near-syncope,
face like a blow-fish) more times than I care to recall. I had to stop seeing my therapist in order to
pay for the rising cost of my allergy care, at first as emergency care in times of anaphylactic crisis,
then later in the form of immunotherapy treatment (which was desperately needed and has given
me my life back since commencing it).

   So while it's true that over the last 4 years there's been a continued decline in my
menstrual health, during the first 3 of those 4 years, the decline was more insidious than
rapid. It's really only been in the last year, though, that the decline has been precipitous.
A little over a year ago, with my allergies more or less under control, I decided it
was probably time, insurance or no, to establish an ongoing relationship with a single
doctor, so they could get to know me and maybe help me start getting a better handle on
my health in general. I started seeing Kendra Schwartz, MD, (WSU Physicians Group,
Family Medicine) as my regular PCP. She has been my regular doctor for about the last
year...

   ...Fast-forward to the present day. Its hard to even describe the present state of my physical
health because its gotten to a point where many of the words that I'd have to use to truly,
accurately describe the quality and magnitude of my symptoms, are words which (at least until
very recently) I would have never imagined myself using in self-description. It's hard for me to
admit what describing my recent history and present state forces me to admit. For example, I
would not describe myself as bed-ridden, but only because I prefer the hair-splitting accuracy of
"comfy-chair-ridden".

   For the last many months, I've had chronic but intermittently-worsening pelvic/abdmn/back
pain that intensifies greatly on a cyclic monthly basis. I have only been keeping track of the
timing of my period-onset since the beginning of this year, but my sense of my cycle prior to this
is that it has always been somewhat irregular, but generally only mildly so. The dates of my
cycles since the beginning of the year are as follows:
Jan. - ?? (toward the end of the 1st wk. of Jan.)
Feb. - 4th
March - 19th
April - 18th (light spotting on 17th)
May - 17th (*)
(*... Worst pain ever experienced, ever. More on this later.)
 
   I've lived with my fiance, Ryan, in our current apartment for about the last year (15 months).
It was during the 6mo. prior to that, while we were living with his parents during our apartment
search, that I first noticed myself getting bowel urgency in a bothersome way. It was the first
time in quite a while that I'd needed to share a bathroom with anyone other than Ryan, and living
in a 1-toilet house with 3 other people (incld. another woman) was a surprisingly difficult
challenge. I'd never really needed to wait my turn like this (true), but then again, there really did
seem to be a marked uptick in the level of intestinal urgency I was feeling (sharing one household
bathroom with Ryan and his parents just served to make it more noticeable).

   It was also while living with his parents that I began noticing increased urinary frequency,
the abnormality of which eventually became undeniable. With our sleeping quarters located in
the basement, and on a different level from the home's only bathroom (ground floor), I found my
already chronically disturbed sleep interrupted further by the incessantly recurring need to make
bathroom trips upstairs. I have had severe difficulties falling asleep for most of my life, at least
as long as I can remember. I am usually very, very slow to fall asleep. It became frustrating to
have to schlep up and down the stairs, all through the house and back just to empty my bladder
before bed, only to find myself unable to fall asleep before the sensation of fullness and urgency
to void again returned to distracting enough levels as to prevent sleep. It started seriously
disrupting my sleep.

   I was working, at the time, in a quasi-supervisory capacity/position at an extremely
physically/mentally demanding job wherein I'd become the de-facto trainer of nearly all newhires.
I could not afford the further loss of sleep I was experiencing from all this increasing
bladder frequency, and so I improvised a temporary solution in the form of a nighttime chamber
pot (a sacrificed kool-aid pitcher, actually), kept under the bed and emptied/rinsed daily. I used
this nighttime system for most of the 6mo. we lived there, and as solutions go, it seemed fairly
adequate. By the time we were moving into our new apartment though, at the end of those 6mo.,
my urinary frequency had gotten steadily worse, and so I've never stopped keeping a nighttime
pee-container under/beside my bed. Screening/blood-work (fasting glucose) was negative for
signs of (pre-)diabetes.

   At some point, after mentioning my substantially increased bladder frequency (and now,
urgency) to my Dr. (and getting mostly blank stares in response, along with a change-in-subject
when I couldn't confidently calculate a daily pee-avg. from my variable daily experience), I
decided to keep a meticulous 24hr. Pee-Diary. I measured the volume of liquids I drank, the
foods I ate, and marked the times I ate and drank them. I noted the time of each void and
measured the volume of each output. My feeling was basically, the more data generated, the
better. When I was done, I brought it back in to the doctor and gave it to her. I gave it to her, not
just to read, but also so it could be put in my chart and made a part of my med. record. I was
disappointed not to find it in the records from her office that were sent me per my recent request
(I didn't retain a personal copy; who knows what she did with it?). Basically what I learned from
keeping the pee-log was that in the 24hrs. recorded, I urinated 14 times, and that'd been with me
trying to hold it for much of the day; had I actually peed whenever I first felt the need, the
number would have probably been closer to 20. The diary confirmed that I was not taking in
excessive fluids, not excreting volumes excessive for the amount taken in. In fact, the volume of
my individual voids was (unless I'd been painfully holding it for hours) actually quite low. The
daily volume overall was normal. The situation was diagnosed by my doctor as, "Probably a bit
of interstitial inflammation", and left at that. I told her about the sometimes marked worsening of
this symptom during, and in the lead-up to, my period, but she did not seem to find this very
relevant.

   About a year ago, during a particularly nasty episode of cramps, I started feeling a throbbing
ache in my right upper (inner) leg. Sitting in my chair, it was most acute in the inner-groin area
where the leg attaches to the body, but when I stood up and tried to take a step I felt a searing
pain shoot down the inside of my right leg, and upwards along the front of my hip to the right,
along my bikini-line. I could barely take more than a few steps at a time before the pain
collapsed me to the ground.  At work, I was allowed (begrudgingly, by my boss) to be put on
"light-duty" for a week, which still required that I spent nearly all of my shift on my feet, even
though just making the walk in from the parking garage was causing me to limp and bringing me
to tears. Beyond that week, though, I was made to understand, the sympathy would stop and full
duties would resume, whether I was fully ambulatory or not. And so I went back in to the doctor
to report/complain of the problem, which had emerged so obviously (to me) in conjunction with
my bad period pain. I had done absolutely, literally, nothing whatsoever to injure myself, in fact,
I had been seated when the leg-pain first started, clutching my heating pad, "handling" my
dysmenorrhea. What could I have possibly done, between sitting and standing, to have caused
myself an injury that would render me unable to lift or put weight on my leg on the first
attempted step? Well, I thought I should be scanned for cysts, and asked my doctor to order a
TVUS, which she did.

   A couple weeks later the doctor called to tell me the TVUS results were back and everything
looked normal; no cysts (nor anything else that might cause weird, sudden leg-pain) were
detected. She told me to call in a few weeks if the pain wasn't getting better. When I saw her a
month later (6wks. after the onset of the leg pain) I told her that I was shockingly still
experiencing significant pain in my right leg with lifting and weight-bearing, but that it was also
significantly lessened from before, currently manageable, and slowly getting better. She told me
that this sounded "very consistent" with a musculo-skeletal injury of some type, but declined to
speculate on how I might have sustained such an injury without managing to notice it. It took
upwards of 8wks before the pain from the (sustained-while-seated) leg injury receded enough not
to affect my gate. It took fully 10wks, truth be told, before it was finally gone (worsening briefly
during each of my two periods over that time). I had to take percocets (as much as I dared, on the
days I needed to drive and be mentally present at work) given to me by my soon-to-be mother-inlaw
(left-over in the cabinet from an old hernia op.) just to make it through the physical demands
of my day, on a number of occasions.

   The eventual resolution in the acute (suspiciously reproductive) leg pain did not mean, of
course, an end to my problems. My once-occasional intestinal urgency had progressed into what
at times was nearly daily diarrhea. Loose BMs multiple times a day. The altered bowel habits
during my periods had turned into altered bowel habits before/during/&-after my period, and the
symptomatic, "peri-menstrual" portion of my monthly cycle was expanding in both calendar
directions, seemingly taking over the entire month. It was getting bad enough, and a-cyclic
enough, that I started wondering if perhaps it didn't represent an independently occurring
problem on top of the menstrual issues. I had reasons to doubt the "IBS" explanation, but I did
feel it would be prudent to rule-out IBD, since my paternal aunt (dad's only sib.) is a lifelong
sufferer of UC. I thought it might be time to see a GI-doc, but at the time my GP seemed pretty
"meh" about my reported GI symptoms, so I resolved to try a gluten-free diet first before asking
for a referral.

   At some point in the last year, at one of our consults, I decided to go along with my GPs
recommendation to give HBC a 5th & final try before calling it quits. She wrote me a 3mo.
prescription for Ortho Tri-Cyclen (Norgestimate - .180mg [x7], .215mg [x7], .250mg [x7], .000mg [x7],
Ethinyl Estradiol - .035mg [x21], .000mg [x7]), which I took regularly but was forced to discontinue
after 10wks due to severe GI-related side-effects, severe worsening of acne (deep and painfully
cystic like never before), and a general lack of any benefit at all whatsoever. My periods stayed
painful. My periods kept worsening. I felt cramping, colicky nausea 24/7. My then-daily
diarrhea, believe it or not, managed to significantly worsen. I hadn't been on any form of HBC
for a number of years, but this experience differed from those of previous years only in the fact
that it was probably worse. So much for last-ditch efforts. I don't know why I expected anything
different.

   A few months later, I'd become symptomatic to the point that it forced me to leave my job .
 
   Eventually I went back in to the doctor; I'd been on the strict-gluten free (low-dairy) diet for
nearly 4 months and hadn't noticed any improvements. My menstrual & peri-menstrual pain was
still becoming an ever-increasingly heavy burden. The number of days before and after my
period on which I was having clearly menstrual pain was increasing at an alarming rate. I wanted
referrals to the relevant specialists, which I felt should include an OBGYN and a GI specialist.
She obliged me by giving me the card for her OBGYN colleague in an affiliated office down the
hall, and said she had no one in particular to recommend, GI-wise (I was uninsured at the time,
so a 'referral' was really little more than a professional recommendation, and apparently she knew
of no one to recommend.) I didn't bother regaling her with the details of all the other recent-orrecently-
worsening symptoms I was experiencing. I'd been seeing this doctor regularly for just
under a year and had already learned how largely pointless it was to bring stuff up to her.

   When I "injured" my leg, and was disabled by acute pain, she was unable to determine a
cause, reluctant to investigate, and unwilling to offer me anything whatsoever beyond "Wait and
See" (Read: "Tough It Out") to help me deal with the extremely severe and disabling pain. What
point would there be in now mentioning the fact that again, during my period, while sitting down,
I appeared to have somehow "injured" my lower-back? Or that the pain from this lower-back
"injury" which I apparently "sustained" while seated with a heating pad during the worst of my
monthly cramps, had improved slightly from its worst but still continued to bother me more than
a month later? To my ever-vigilant doctor, my severe and worsening bladder symptoms were,
"A little interstitial inflammation". My GI symptoms were, "...::crickets::...". My
"dysmenorrhea" was still an isolated problem that could be fixed with the right HBC, even
though I was now experiencing "dysmenorrhea" (despite normal bleeding) at least 3wks out of
each month.

   I didn't need to pay someone $140 (out of pocket) over and over just to shrug their shoulders
at me after 30-seconds no matter what I told them. To tell this woman I was experiencing
something as non-specific as "crushing fatigue" or "constant painful bloating" would have served
only to further solidify her impression of me as "that kind of (female) patient", and make her eyes
glaze over. I was also reluctant to mention that my pelvic pain had reached the point of being
chronic, because then I'd just be another female "chronic pelvic pain" patient, and from what I
could tell, from all that I'd read, these patients did not seem to be particularly well-treated. I
would just as soon have saved these observations for a specialist who might actually know what
the hell to do. When it came to my case, my GP was clearly not "on the caper" like I needed her
to be. I didn't hold it against her (not really), but instead took it as a sign to look elsewhere for
help.

   I decided to look for that help first in the form of an OBGYN that had come recommended to
me by my therapist (due to a conveniently located office down the hall in the same bldg.).
Dr. Cara Smith practiced at the Women Caring For Women clinic, (which might have more
accurately been called the Women Helping Other Women Be Pregnant & Have Babies clinic
because honestly that seemed to be it's whole focus; I was the only non-pregnant patient that I
saw the two times I was there). That was the clinic's focus, though as board-certified OBGYNs,
it's doctors were obviously willing and legally free to treat/manage the occasional endo. case that
might find its way through their doors. I met with Dr. Smith on Wed., 2/26/14. We went first to
her office for a lengthy and somewhat tense discussion of the problem (*this conversation is a
whole story unto itself but I'm already pages past reasonable for the length of this narrative), then
over to the exam room where she performed a rather painless internal exam. She didn't feel
anything 'weird'.

     Over the course of our first (and I think only) consult, on the basis of things she said (about
endometriosis, its diagnosis and its treatment) she managed to help me realize that I probably
really should be seeking advice and care from a serious, legit, sub-specializing expert. Even
though by the end of our first consult I had decided that I did not desire any of the medical or
surgical services offered by this doctor, I had no idea where to find a more confidence-inspiring
provider. Until I found somewhere better to transfer my treatment, she was the only provider I
had, and so I let her schedule me for a 2nd TVUS and and 2nd PAP (I'd had both in the last year).
I told her I was in a monogamous, hygienic, 8-year relationship, and the results of my last PAP
were clear for whatever was tested, but she seemed to want to re-test and I was like, "whatev".
The TVUS I wanted to repeat anyway, as I was unsure as to the quality of the last one. I
scheduled them for the same day the following week, and had the TVUS done in the AM, with
the PAP scheduled at their 2nd location 25min. away. The sonographer commented that my
uterus appeared "premenstrual" (as expected given the date of my last cycle), but mentioned not
seeing any "prominent follicle" on either ovary... Both scans (TV & abd.) were done with
bladder full. I headed out for the other location. ...Just before arriving for the debatably-needed-
PAP, I got a call that Dr. Smith had been called into delivery and was very sorry so when could
we reschedule?

   I never went back in to discuss the TVUS results. I figured, if my next (better) doctor is
interested in the results they can have them sent. If they just want to redo it with their own
sonographer and protocol, then so much the better. Within a week or two I had gotten myself an
appt. at the University of Michigan Endometriosis Center (in Ann Arbor, MI) with Dr. Lindsay
Brown.

   ...My therapist has a lot of respect for the University of Michigan & generally holds the institution
in great esteem. I, in turn, have a lot of respect for the knowledge and opinions of my therapist, so
upon her suggestion I started looking into the various services offered through the UofM Health
System. I was excited and relieved to find the web-page describing what UofM calls its
"Endometriosis Center". [http://www.uofmhealth.org / medical-services/obgyn-endometriosis ].

U of M Endo Center - 1st visit , w/ Dr. Lindsay Brown :
● I met with Dr. Brown on: 4/8/14

● Told her the recent history of the problem and what had been done to investigate and treat it
so far. I was fairly impressed by the way the conversation went, particularly because she
correctly read early on that I had a relatively sophisticated understanding of the topics under
discussion and seemed willing to have a substantive conversation with me on that level; Dr.
Smith had not.

● She was the first doctor to show any real concern regarding my urologic symptoms (a 'plus'),
and had treatment ideas to help control them ('plus'). She felt the symptoms warranted further
investigation and referral to a urologist for diagnostic work-up, but was willing to prescribe
Oxybutynin (5mg/bedtime) in the interim. Her index of suspicion seemed raised for co-morbid
IC (or possibly for IC as alt. dx) but wanted Urology to confirm this. I felt this was reasonable
and prudent and so the referral was also a 'plus' in my mind. However, she also made it sound
as though the outcome of these urologic investigations (for IC) were somehow a controlling
factor in how far she could proceed down the path of diagnosing and treating my suspected
endo.. Like, as if the suspicion of endo. might go up or down depending on the outcome of the
IC work-up. As though she was unwilling to surgically investigate(/treat) my fairly probable
endometriosis until the urologist finished looking into it and... ...and what? Told her I had IC?
Told her I didn't? Even with a dx of primary uropathology to explain 100% of my urinary
symptoms, would the remainder of my symptoms/history not still warrant timely gynecological
investigation? I didn't like this "wait 'till literally all the results are in" approach to dealing
with the endo. question.

She performed a pelvic exam. She said she was going to internally press on 3 dif. muscle
groups and to say each time when it hurt. The 3rd place she pressed caused a significant jolt of
pain in the right side of the front pelvis and right leg. The rest of the exam was physically
uncomfortable but only minorly painful. But I was impressed by the fact that she was able to
palpate purposefully and elicit pain. Previous exams had only been incidentally painful and
never sharply so. Another 'plus'.

● I told her that I'd been to a first consult with a GI (Dr. Bortman) and was waiting on results
of prelim. lab-work, but that he hadn't decided to do a colonoscopy yet. She thought it was
good I was getting evaluated and expressed interested in the results of a colonoscopy. She bid
me follow-up w/ Dr. Bortman to schedule the procedure.

● Because I was so symptomatic, she wanted to initiate medical therapy, ASAP. I told her I
was not willing to go on Lupron at that time, especially not without a reliable (surgical)
diagnosis. She responded to this with visible disappointment, accepting my position while
urging me to at least go home and "think about it" (I guess one last time, or, more than I already
had). With Lupron momentarily off the table, her proposed treatment was a 3-6mo. trial on the
Mirena Coil. I told her of my negative past experiences with the 5 other HBC formulas I'd tried
and expressed reticence at the fact that even under ideal circumstances, with perfect symptom
control and no side-effects, I would still be no closer to having my pathology diagnosed or it's
areas of involvement characterized. I didn't feel comfortable agreeing to a 3-6mo. diagnostic
delay just to see if a hormonal treatment might effect an unknown level of symptom relief
without any of the previously encountered side-effects. I understood that Mirena was a
progesterone-only implant, with local>systemic effect, but this did not to my mind add up to a
persuasive argument to spend another 6mo. ultimately undiagnosed, risking side-effects while
hoping for 'adequate'(?) palliation. I remained unconvinced, but since I felt like I'd used up my
veto-power on the Lupron issue (and since Mirena did present somewhat novel aspects distinct
from my 5 previous HBC treatments) I agreed to go home and deeply consider the IUD 'option'.

Before the 2nd consult:
● A few weeks later, I had the colonoscopy. My bowel-prep. was "excellent" and my colon
was pristine. The lab-work was also back and unremarkable except for mild anemia.

● After my best effort at thoughtful reconsideration of hormonal Rx (Mirena), I decided that it
was more likely to delay, rather than prevent, the ultimately needed surgery. I felt my need for
answers should not have to be subordinated to my need for treatment, when the two could be
provided at the same time at surgery (at least to a greater degree). Mirena was an inferior
alternative, as far as I was concerned, at least at this juncture. In the meantime, the variablebut-
chronic lower back pain was insidiously worsening, with several alarmingly acute
exacerbations. I could no longer fit into or comfortably wear 98% of my clothes. The backpain
was becoming disabling, especially in conjunction with the incessant abdomino-pelvic pain
I was getting for at least a week before and after my periods, which themselves had taken on an
"out of this world" quality in terms of how intense the pain was. Even mid-cycle, I could no
longer find any comfortable positions in which to sit for any length of time without feeling
painful pulling/pressing throbbing aches that would grow into sharper twinging stabbing throbs
if I didn't shift my body almost constantly. Laying in bed I could still not escape it, though
laying in bed (with the heating pad) was sometimes the least aggravating. I developed a
nagging bi-lateral ache in the groin/inner-leg area that was worse on the right during my period.
My periods were again setting new all-time records for worst-pain-ever, and the pain brought
on with each period was continuing significantly beyond the end of my bleeding, sometimes
continuing into and beyond the following cycle. I was taking so much Tylenol (on a daily basis,
for months) it was seriously starting to mess with my stomach. I needed them to do better than
"Mirena".

● ...I'd made my decision, and called for a follow-up with Dr. Brown. Dr. Brown had nothing
available for well over a month, but "another doctor in the center" was available much sooner
and so I arranged to be seen by that doctor.

U of M Endo Center - 2nd visit , (w/ Heather Wahl, MD) :
● I saw Dr. Wahl on [5/6/14].

● Dr. Wahl was a doctor in the sense that she was a (presumably well-trained) resident with
absolutely no ability to independently make important treatment decisions. Nevertheless, I
explained my situation, filling her in on my symptoms. I informed her of my decision to
decline the IUD for the time-being and, when I attempted to explain my reasons, it led to a nice
little back & forth (between her, myself, & my fiance). After re-stating my position more
forcefully, she eventually interjected with, "So, to cut right to the chase, what you're saying is
you want to talk about surgery; you feel it's time, and you want it done. Right?" and I was like,
"Well, yeah." At that point she started talking about what I could expect in terms of next steps,
if we were to in fact go forward with surgery. She explained that I'd still need to come in for
another TVUS, but that pending that, so long as Dr. Brown (who would perform the surgery)
was willing, I'd be put on her surgery schedule (with a pre-surgical consult prior to that). Of
course, Dr. Wahl had to leave and go run all this by whomever it was in whose hands the
decision actually lay (her attending? Dr. Brown?). She excused herself and left.

● When she returned, I could see on her face that she knew I wasn't going to like what she had
to tell me. She had spoken with whomever (I think it must have been Dr. Brown), discussed it
with them, and had the following to report: On my prior visit with Dr. Brown, I had said I was
unwilling to agree to a 3-month shot of DepoLupron, and she'd then offered the Mirena Coil as
an alternative. I was now also declining the coil, and this decision apparently forced them to
put Lupron "back on the table". They were benevolently willing, though, to let me "opt" for the
1-month only injection, since I was "so concerned" about side-effects with the 3-mo. shot.

● Wow, what a pointless and stupid proposal! Give me something that could give me at least a
month of side effects, any one of which would be unacceptable, to give me equally temporary
pain-relief from my cycles but... they were only proposing to give it for a single month, and
specifically the month before they might potentially operate? Ummmmmm.... No. I didn't think
so; they were clearly either hoping to minimize/de-emphasize whatever side-effects I might
report while planning to try aggressively, after a month, to get me to submit to another-month-of-
Lupron-instead-of-surgery... That, or they wanted to use it "empirically" (which I would
never consider a valid or adequate reason to take a 1-3mo. shot of Lupron, for so many
reasons). I asked point blank if the 1-mo. Lupron shot being proposed was for
empiric/diagnostic purposes, and that's exactly what the intention was. I was like, "Uhhh, I'll
need to think about it, again.", and Dr. Wahl encouraged me to just go ahead and schedule it
when I schedule the TVUS, since I could always cancel the shot-appt. if I changed my mind.

● That was exactly what I did; I scheduled them both on the same day, canceled the Lupron
shot pretty soon after, and showed up for the TVUS on 5/16/14.

● The results of this ultrasound are included in my records. The results were more or less
normal (sm. amt. free fluid, "probably physiologic").

● Early in the a.m. on the 17th, about 9hrs. after doing the scan, I began my period with the
sudden onset of what I consider to be the absolute worst, truly most intense pain I have ever
experienced, by far, in my entire life... for sure. I have never been affected by pain in the way
this pain affected me. More than any other event in this narrative, my experience on that night
deserves its own re-telling. It was an experience like no other, involving pain like truly no other
I've ever endured. But at 16pgs. already, I'll leave the description at that, because what I've
been experiencing in the 2wks. since that night is equally significant...

● ...In the past 2wks., since the onset and conclusion of my #1 most-painful period ever, I have
been dealing with near-continuous pain that has been just totally debilitating, taking from me
what little strength I still had left to keep functioning even at the already low-level of recent
months. A few months ago, I was a part-time student (returning for the first time in 5 years!)
managing to still achieve A's in my relatively few courses. Sure, it seemed like it nearly killed
me trying to stay academically afloat despite my health problems, especially toward the end of
the term, when my menstrual symptoms conspired to occur/worsen during the most challenging
part of the semester. But even then, less than 2mo. ago, I was still able to push through finals
and finish with the 2 A's I deserved... whereas now I've reached a point where I'm barely able to
hobble around my own apartment, have nearly constant abdomino-pelvic pain with chronically intermittent leg/pubic/lower-back pain. I hardly have enough energy to do basic things for
myself. The pain wakes me up from sleep. It keeps me up at night. It even keeps my spouseto-
be awake at night (which to me is a *major* issue because he's already the only one able to
work at the moment). It shoots up to a 7-9/10 for extended periods on a daily/nightly basis. It
is more bi-lateral lower down in the pelvic region, but occurs intermittently higher up
abdominally and when it does it is worse (sharper, more frequent) on the left side.

● Hopefully when we meet I can better describe the relevant features of the pain as I currently
experience it. But there's a lot to it, it's actually quite complex in presentation, so I'm going to
stop the narrative here.

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Monday, June 4th, 2012
6:00 pm

Does the fact that I had to write the following, and that no one seemed interested in, or even to understand it, constitute demonstrative proof that hippies are bad at math?


No. Just another drop in the overwhelmingly large bucket of evidence...Collapse )



current mood: irritated

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Monday, June 28th, 2010
2:51 pm - I'll get you "Jill M.", if it's the last thing I doooooooo!!!!
http://www.minesweeper.info/countryranking.html

(*scroll to "USA, MI")

current mood: nerdy

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2:42 pm - New MSClone NF time record!!


current mood: hot

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Monday, April 26th, 2010
12:50 am - Well there goes the neighborhood... (& by "neighborhood", I mean, of course, "my face").
Just took another Keflex®. I have to take one every 6hrs. for the remainder of the week, provided the plastic surgeon who stitched me up Saturday finds the sutures to be healing normally when I go in for a follow-up tomarrow. I'm actually somewhat more concerned about my broken teeth, and the extent of the work they'll likely require... and the cost of that work, given my current uninsured status. I'm beginning to tire of my inability to chew anything remotely solid; it's getting very, very old.

I'm also worried about eventual scarring; I scar very easily. Minor scrapes linger visibly for months after they've healed. The guy who sewed my chin back together was highly competent, seemed very good at what he does, but... without the aid of collagen injections somewhere down the road, the shape and symmetry of my chin will likely have been permanently changed. I was not pleased to receive this news. Receiving this news filled me immediately with the strong urge to smoke, something highly detrimental to the final cosmetic outcome of the wound healing process. Not surprisingly, just about every effect that smoking cigarettes has at the cellular level leads to darker, thicker, & more extensive scarring. ...Knowing this, of course, makes me really crave a cigarette.

Incidentally, and somewhat ironically, I was totally stone-cold sober when I flew off Rian's bike. Had I attempted to make my way home that night at a more "responsible" hour this would not have been the case.

A veritable symphony of tiny violins...Collapse )

*[4/27/10] ...So after following up w/ the plastic surgeon, Dr. "Frighteningly Steady Hands" Khan, and seeing my dentist (3 temporary crowns for the next 2wks while the real ones are getting made), I feel a lot better about how things look. My jaw (miraculously) did not fracture, and so far at least I seem to have (also quite miraculously) escaped any obvious nerve damage. So "Go Me!".

...Kind of totally fucked up my semester though, which was riding heavily on a perfectly executed finals week performance. That situation is, however, ultimately remediable, whereas a complication-ridden healing process would not have been.

So. Given the host of alternatives, I'm actually relatively pleased with the situation at present. I do still wanna write about all the totally awesome, bone-scrapping, tooth-shattering, muscle-shearing, gland-ripping gorey details though, while thinking about it still has me feeling like a total badass. I will when I'm less sore and tired, cause seriously it was pretty fucking intense.

img265.imageshack.us/slideshow/webplayer.php

current mood: sore

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Sunday, April 25th, 2010
5:54 pm - Spitting blood & teeth...
Goddamnit.

I'm actually kind of really pissed about my face, of which I shall write more soon.




...Definately not what I wanted to spend my last weekend before finals dealing with.

current mood: lacerated

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Tuesday, April 20th, 2010
5:58 pm - Damn you Livejournal & your 150 Interests limit(!)...
frustration, impulses, no man's land, new friends, surgical precision, precise meaning, shame, sound logical arguments, maturation, getting lost, lanterns, steampunk, systemic risk, auditing the Federal Reserve, tiny boxes, pattern drafting, law, lawyers, conspiring, 115mph, a treehouse in ohio, adderall, agoraphobia, allan schaerges, ambiguity, ambivalence, anthropology, archetypes, autumn, behavioral family systems analysis, big black boots, bombay sapphire, brain damage, broderick tower, cognitive neuroscience, collaborations, collars, contexts, curiosity, dawn, domination, dr. moye, driving, dropouts, earl grey, egyptian rat screw, ellery avenue, emotional intelligence, empty spaces, enough to eat, experts, exploring, faded, forgetting, feline cerebellar hypoplasia, forget-me-nots, frost, geniuses, getting dirty, greek mythology, guilt, hard work, neural plasticity, spinning bookshelves, denver international airport, articulation, learning french, abandoned skelletal structures, high V/P splits, hebbian learning, human motivation, impostor syndrome, insight, intrigue, intuition, k-selection, kittens, learning disabilities, leonard cohen, like minded people, linguistics, lonesome dove, lovely, making lists, manowar, mastery, melting, merrill stulberg, mirroring, my bed, my own bustline, neurolinguistics, nick cave, nicodemus, nonverbal, npd, nvld, object relations, ocd, old flames, old mansions, one step ahead, open 24 hrs., owboo, plans within plans, potential, practicing piano, pretexts, promiscuity, pride, privacy settings, progression, projective identification, proxemics, psychoanalysis, psychology, psychometrics, rain, refinement, regression, remembering, rest areas, risk, robert hare, barbaric!, rooftops, roommates, rust, sabotage, satire, scowling waitresses, secrets, self-actualization, self-efficacy, sewing, sexual deviance, skin, smirking, smoking, stimulants, storming the gates, story time, stranger music, submission, subtexts, subtlety, the autistic spectrum, this time next year, uncertainty, undercurrents, vindication, wabi sabi, wanderlust, westlaw.com, white peonies, wind, your anima




...I guess I just keep adding'em here.

current mood: aggravated

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12:20 pm
History repeats itself...












...& the beat goes on.

current mood: morose

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Friday, April 3rd, 2009
6:53 am - People got no skill...
http://www.detnews.com/article/20090402/METRO08/904020395/To+urban+hunter++next+meal+is+scampering+by




Now I *really* wanna trap and raise pheasants (phezzies!!).

current mood: impressed

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Friday, January 16th, 2009
4:31 pm - The art of making people uncomfortable... Brilliant.


current mood: rushed

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Wednesday, December 17th, 2008
11:01 pm - Bonnie Tyler is my new hero...




current mood: sore

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Monday, December 8th, 2008
6:33 pm - Chasing Dion Tiu
Dion Tiu is the name of the guy who holds the current long standing world record for best time on minesweeper expert and intermediate. This video gets a little epileptastic toward the end, but is still kinda cool 'n worth watching.



This is the video of Dion Tiu's record setting game, in which he beat his previous best time (the former world record of 38 seconds) by like 2/10s of a second or something.


::sigh:: I've recently been honing my ability to play without flagging, a challenge I long took to be hopelessly unrealistic and inarguably beyond my reach. I've since come close to beating my flagging record in non-flag mode (and in a few cases, had I not died toward the very end of the game, come close to beating it by 10 seconds or more). When I get some time and inclination, I'll upload and post a couple'a choice clips of my best recent attempts and most crushing defeats. The idea, once I've perfected my non-flagging game, is to work on reincorporating use of flagging back into the game but to a limited purposeful degree, where strategic placement of specific flags would allow me to open multiple squares simultaneously in one click which would otherwise need to be uncovered individually.

current mood: dorky

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Monday, July 28th, 2008
2:02 pm - Kind of obscenely impressive...

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Saturday, July 26th, 2008
11:36 pm





(I think not speaking Portuguese greatly increases the entertainment value of this narrative montage, like the "Explain what's going on in this picture" questions on psych tests.)












...and Rian closed on his house today.

current mood: lethargic

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Sunday, May 4th, 2008
5:29 am - Postmodernism Generator...
http://www.elsewhere.org/pomo/

Every time you refresh the page it generates a new, highly literary, sociopoliticocultural essay. It was a link at the bottom of a page (http://www.physics.nyu.edu/faculty/sokal/#papers) chronicling the academic & media response to Alan Sokal's "Transgressing the Boundaries: Toward a Transformative Hermeneutics of Quantum Gravity".


...This is exactly the kind of thing I wanted to do when I wanted to create a Manowar lyrics generator. It's pretty fucking sweet.

current mood: amused

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Sunday, April 6th, 2008
5:45 am - Pushing Sub-80...


...I plan on actually writing something of substance and sticking it in here eventually, but the sun's almost up, and I really should try and sleep...

current mood: impressed

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Monday, March 10th, 2008
10:10 pm - Yeowsah!






current mood: tired

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