Emily (paintedglass) wrote,
Emily
paintedglass

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.
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