ENDOMARCH 2019 DATE

ENDOMARCH 2019: SATURDAY, MARCH 30, 2019

Thank you again to all of the Endo Activists & Endo Supporters from around the world, who helped make 2018 another successful year for endometriosis awareness on a global scale.

Although endometriosis awareness month may have come to an end, for millions around the world, the suffering continues 24/7, as endometriosis has no off button and too many are still being severely harmed due to unacceptable diagnostic delays and inadequate or inappropriate medical care.

This is why we will continue marching and have set the date for next year’s Worldwide EndoMarch as:

SATURDAY, MARCH 30, 2019.

HEALTH RIGHTS ARE HUMAN RIGHTS.
Join the Global EndoMarch Fight For Justice
Of course, you don’t have to wait until 2019 to join the fight for change. There are other EndoMarch programs that occur year-round, so be sure to sign up here to become an EndoMarch member, in order to receive updates, automatic entry in our annual raffles, other special offers, and most importantly, to help us fight for the human rights of millions of endometriosis sufferers, who demand and deserve endometriosis health care reforms now.

endomarch 2019 logo save the date Time-to-end-the-silence PNG

 

ENDO ACTIVISTS OF THE WORLD, UNITE!

MESSAGE FROM THE FOUNDER
THANK YOU TO ALL ENDO ACTIVISTS OF THE WORLD

Dear Patients, Country Captains, Chapter Presidents, Precinct Managers, Ambassadors, EndoMarch Volunteers, Family members, and all Endo Activists & Supporters,

First and foremost, we would like to thank you for your selfless dedication, hard work, and advocacy to make this grassroots movement a success. You have answered the call to arms to help advance medicine and advocate for endometriosis patients the world over, so that the millions suffering from this devastating disease can receive urgently-needed improved treatment options, timely diagnoses at the onset of symptoms, a non-invasive diagnostic test, and a fast-track toward a cure.

Indeed, thanks to the efforts and initiatives of so many EndoMarch supporters & volunteers, we are pleased to report that this grassroots movement has gone viral internationally. Many governmental agencies, like the United Nations, have gotten involved to help young girls, women, and transgender individuals with endometriosis.

CNN & SENATOR HATCH ON ENDO:
“NOTHING SHORT OF A PUBLIC HEALTH EMERGENCY”

You also now see news coverage about endometriosis in the mainstream media much more often. For example, today, CNN published an op-ed about endometriosis written by Senator Orrin Hatch (Utah), who declared what we’ve been saying all along, that the lack of adequate research funding and awareness about endometriosis constitutes “nothing short of a public health emergency.”

MEDICAL SOCIETIES JOIN THE FIGHT FOR CHANGE
The most respected medical societies around the world also continue to support this noble cause, including the American Medical Association, the Society of Laparoendoscopic Surgeons, and the Royal College of Obstetrics and Gynaecology, just to name a few. Collaboration with these and other medical societies is currently underway, so that, for example, standards of care protocols can be updated to address the urgent, unmet needs of endometriosis patients, while other collaborative efforts continue to focus on providing advanced training to the next generation of endometriosis excision surgeons.


GENOMICS-BASED 21st CENTURY MEDICINE
Greater awareness about the urgent issues facing the endometriosis community will also eventually lead to increased investments into 21st century precision medicine, which is key to achieving improved health outcomes based on the principles of individualized, genomics-based medicine.


NON-UTERINE ORIGINS OF ENDOMETRIOSIS: A RESEARCH PRIORITY
With more research funding, researchers can also continue investigating what the latest endometriosis studies support: that the pathogenesis of endometriosis is multi-factorial and includes causes that are non-uterine in origin, such as the metaplastic transformation theory, which was actually first postulated in the 19th century.


HYSTERIA: GOODBYE & GOOD RIDDANCE
And, finally, all of your Herculean efforts to set the world free from centuries of medical mythologies, like hysteria or Eve’s Curse, are also paying off and will usher in a shining new era, when patients no longer know more about endometriosis than their own health care providers, which is the current 21st Century reality that so many face today.

PROUD SUPPORTER OF THIS ENDO UNITED WORLD
These achievements would never have been possible without everyone’s united efforts, creative awareness campaign initiatives, and unwavering commitment to the cause. For this, we thank you all immensely again for your ongoing support and generous contributions.

Forward we go!

Camran Nezhat, MD, FACOG, FACS

Founder, Worldwide EndoMarch & World Endometriosis Day

Today is the day we march!

TODAY IS THE DAY WE MARCH!
Today is the day we march en masse, to fast-track toward a cure and better care for #endometriosis sufferers the world over. Best wishes for everyone’s EndoMarch events today! Our Team USA staff will be super busy managing the events today, but you can see all information for the USA Events on the blog page below.
 
TRAVEL ADVISORIES FOR DC ENDOMARCH & SF ENDOMARCH:
Please see the travel advisories on the DC EndoMarch & SF EndoMarch dedicated blog pages listed below.
 
We will be marching with everyone either in person or in spirit!!
 
CLICK HERE FOR OVERVIEW OF USA EVENTS
 
CLICK HERE FOR DC ENDOMARCH DETAILS – START TIME 12 NOON
CLICK HERE FOR SF ENDOMARCH DETAILS – START TIME 2 PM

7-DAY COUNTDOWN IS ON!

COUNTDOWN IS ON!
Just one week to go until the global Endometriosis March uprising. Let’s do this. Let’s show the world that we are #176MillionStrong rising up as one!

ONLY IN UNITY will we be able to tear down those walls of shame and stigma that have silenced endometriosis sufferers for far too long.

ONLY IN UNITY will we be able to put an end to centuries of sociocultural institutional inertia that has allowed this sick, scandalous status quo to stand unchallenged.

ONLY IN UNITY will we be able to send the message loud & clear that we will not allow another generation have their lives devastated unnecessarily because society still refuses to take endometriosis seriously, still refuses to fully believe the testimonies of those who are suffering.

GENDER INEQUALITY IN MEDICINE
If young boys have their acute abdominal pain taken seriously in the ER in cases such as acute appendicitis, what else but gendered medicine explains the disparate treatment of young girls with endometriosis who have similar acute symptoms, yet are practically condemned from the start as liars and fakers?

“BELIEFS CAN BE A FORM OF BLINDNESS”
“Beliefs can be a form of blindness.” The catalyst for the global EndoMarch uprising was the 2012 history of endometriosis article titled, ‘Endometriosis: ancient disease, ancient treatments’ (Nezhat et al), which opened our eyes to the fact that women and girls, with what may have been endometriosis-like symptoms, have suffered thousands of years of historic injustices, in which they were blamed for their illness or otherwise accused of madness, immorality, or imaging it all.

Sound familiar?

4,000-YEAR HISTORIC INJUSTICE
Today’s inadequate treatment of endometriosis sufferers is a legacy and direct descendant of these ancient beliefs and prejudices. The United States of America is currently the wealthiest, most powerful nation in the world. Surely we can do better than the ancients did from 4,000 years ago. And surely we owe it to our mothers, daughters, sisters, wives, aunties, and friends, to fight for their rights to prejudice-free medical care.

Let’s be the generation that finally puts an end to 4,000 years of senseless suffering.
Time is up. Something must change.

REGISTER FOR AN ENDOMARCH NEAR YOU
http://www.endomarch.org/event-info/

#Endometriosis #EndoMarch2018 #176MillionUprising #WeNeedaCure #WeNeedBetterCare #EndoHealthCareReformsNow #EndGenderedMedicineNow #RacialEqualityinMedicineNow

 

#LivingwithEndometriosis

WALL OF ENDO WARRIORS – LIVING WITH ENDOMETRIOSIS 
Thank you to everyone who sent in their pictures, including to Team USA endo activists, Kellye, Nicole, Riana, and to everyone on the international EndoMarch teams, especially Teams Finland, Italy, Spain, and Zimbabwe, for their contributions from previous years. And, special shout out also to Ashley – @ashleykaiser_endoadvocate – for compiling several of the following picture-quotes from her Instagram followers.

endomarch 2018 flyer NEW PICS ashley cawood heart

endomarch 2018 post it note team usa kellye palmer

endomarch 2018 quotes living with endo badass women uk lady ashley friend

endomarch 2018 pics to share trish wells

 

endomarch 2018 quotes living with endo most misunderstood ashley friend

endomarch 2018 flyer new VALENTINES riana fonseca picendomarch 2018 post it note new york nicole deoliveira

 

endomarch 2018 post it note team zimbabwe

endomarch 2018 quotes living with endo what happens when ashley friend

ENDO QUILT NEW 4 TOP CHOICE a

endomarch 2018 quotes living with endo spreading love n hope ashley friend

endo quilt spain feb 14 a

 

 

 

 

endomarch 2018 post it note team finland blonde galendomarch 2018 post it note team italy

5TH ANNUAL WORLDWIDE ENDOMARCH

5TH ANNUAL WORLDWIDE ENDOMARCH
Please join us for the 5th Annual Worldwide Endometriosis March (EndoMarch), taking place in dozens of cities around the world, on Saturday, March 24, 2018(*).  In the U.S., the events are free and open to all. (* Some international EndoMarch may take place on a different date).

WHY WE MARCH
Despite the millions of women, girls, and transgender individuals, around the world who live in unbearable anguish, endometriosis continues to be one of the most urgent yet ignored public health issues of our time. This is why we march, to get the word out that endometriosis is not just a ‘bad period’, but one of the most serious, potentially incapacitating chronic diseases people can face in their lifetimes.

The estimated 200 hundred million women, girls, and transgender individuals (1 in 10) around the world who suffer from endometriosis deserve better. Let’s be the generation that ends this nightmare once and for all.

JOIN THE GLOBAL ENDOMARCH MOVEMENT
Click here for a list of all USA EndoMarch events.
Click here for a list of all International EndoMarch events.
Click here for information about how you can get involved.
Click here for information on how to join the Virtual EndoMarch.

endomarch 2018 flyer NEW FLYER FINAL JPEG

endomarch 2018 fact sheet NEW BEAUT JPG STEPH

4th Worldwide Endometriosis Day; A Message From our Founders

Dear EndoMarch Supporters, Volunteers, Ambassadors, and Team and Country Captains:

On behalf of all of us at Worldwide Endometriosis March and Endometriosis Day Headquarters, I would like to sincerely thank you all for your continued support of the Worldwide Endometriosis March (EndoMarch) and its mission to bring awareness to endometriosis all around the world. We have only a days until the Endometriosis Day and the 4th Worldwide EndoMarch, the leading movement in the US and around the world, to March and end the silence for endometriosis.

In the United States, we will host our national event in San Francisco. We would like to express our gratitude to Dr. Robert Wah (Past-President, American Medical Association), Dr. Linda Giudice (President, World Endometriosis Society), and Dr. Paul Wetter (Chair, Society of Laparoendoscopic Surgeons) who will join us once again, and who have all attended our Marches for the past three years. In Washington DC, Howard University will host our event and our appreciation goes especially to Dr. Hal Lawrence (Chief Executive Officer, American Congress of Obstetricians and Gynecologists) Dr. Alan DeCherney (NIH: Child Health and Human Development) Dr. James Robinson (MedStar Washington Hospital Center) Mr. Sean Tipton (Chief Advocacy, Policy and Development Officer, American Society for Reproductive Medicine), Dr. Kevin Smith (Kaiser Permanente Mid-Atlantic Group), who will join us again in our Educational Symposium.

Only three years have passed since our first Annual Worldwide EndoMarch in Washington DC, and the grassroots movement is taking off by leaps and bounds. This year for our 4th Annual Worldwide EndoMarch, cities in the United States will be holding marches from coast to coast, from San Francisco and Los Angeles to Washington DC, and everywhere in between, from Kentucky to Minnesota. We are hardly alone, though, in our growth within the US and we are pleased to announce that we have more countries, states and cities joining us for our global movement, including Switzerland, Barbados,Canada South Alberta, Stockholm-Sweden, Germany-Schweinfurt, Hong Kong, along withWorldwide EndoMarch Team Argentina, Worldwide EndoMarch Team Australia Adelaide High Tea, Worldwide EndoMarch Team Australia Brisbane High Tea, Worldwide EndoMarch Team Australia Canberra High Tea, Worldwide EndoMarch Team Australia Gold Coast High Tea, Worldwide EndoMarch Team Australia Hobart High Tea, Worldwide EndoMarch Team Australia Melbourne High Tea, Worldwide EndoMarch Team Australia Newcastle High Tea, Worldwide EndoMarch Team Australia Perth High Tea, Worldwide EndoMarch Team Australia Sydney High Tea, Worldwide EndoMarch Team Australia Wollongong High Tea, Worldwide EndoMarch Team Austria, Worldwide EndoMarch Team Barbados Bridgetwon, Worldwide EndoMarch Team Barbados St.Michael, Worldwide EndoMarch Team Belgium,Worldwide EndoMarch Team Brazil in 13 cities in 12 different states in Brazil: Sao Paulo, Rio de Janeiro, Belo Horizonte, Florianópolis, Porto Alegre, Campo Grande, Brasília, Boa Vista, Fortaleza, Salvador, Londrina, Maringá, Curitiba, Worldwide EndoMarch Team Canada Alberta, Worldwide Endomarch China, Worldwide EndoMarch Team Cyprus, Worldwide EndoMarch Team Finland, Worldwide EndoMarch Team France, Worldwide EndoMarch Team Greece, Worldwide EndoMarch Team Hong Kong, Worldwide EndoMarch Team Hungary, WorldWide EndoMarch Team Ireland, Worldwide EndoMarch Team Italy, WorldWide EndoMarch Team Jamaica, Worldwide EndoMarch Kuwait, Endometriosis New Zealand, Worldwide EndoMarch Team Nigeria, Worldwide EndoMarch Team Panama, ,Worldwide EndoMarch Team Portugal, Worldwide EndoMarch Team Saudi Arabia,Worldwide EndoMarch Team Spain, Worldwide EndoMarch Team South Africa, Worldwide EndoMarch Team Switzerland, Worldwide EndoMarch Team Uganda, Worldwide EndoMarch Team UK London, Worldwide EndoMarch Team UK Glasgow, Worldwide EndoMarch Team UK Manchester, Worldwide EndoMarch Team UK Cardiff Wales,Worldwide EndoMarch Team Zimbabwe.

Last but not least, each year, Worldwide EndoMarch selects one person who has contributed significantly to those affected by endometriosis, and names him or her the “Endo Hero of the Year.” We would like to Congratulations to Dr. Hal Lawrence, Executive Vice President and Chief Executive Officer of American Congress of Obstetricians and Gynecologists, who will be awarded by the Worldwide EndoMarch as the 2017 recipient of the Endo Hero of the Year award, for his outstanding contributions in the field of endometriosis research and advocacy. Dr. Lawrence joins the previously accomplished honorees, Dr. Linda Guidice, past president of the American Society of Reproductive Medicine, and Dr. Robert Wah, past president of the American Medical Association. Our Hero award to him cannot do justice to how grateful we are for Dr. Lawrence’s contributions to improving patient care. As the leader of the top organization of gynecologists, Dr. Lawrence is committed to implementing healthcare reform so that all women in this country can have access to the care that they need and deserve.

Our leading nominee for the Hero of 2018 is Dr. Paul Wetter, Chairman of the prestigious Society of Laparoendoscopic Surgeons, the largest multidisciplinary minimally invasive surgical society in the world. Among his initiatives, Society of Laparoendoscopic Surgeons has started a subspecialty surgical fellowship for endometriosis, the first ever in any academic setting. He is the pioneer and champion of Open Access collaboration in medical education around the world, he brought together top innovators in minimally invasive surgery to form the influential and highly read journal, JSLS, and is improving the health of millions through his OR Ready global initiative.

Once again, I thank all of you for your selfless dedication to this important cause over the past three years. Please join me to end the silence for Endometriosis.

Forward we go,

Camran Nezhat, MD FACOG, FACS
Farr Nezhat, MD FACOG, FACS
Ceana Nezhat, MD FACOG, FACS
Azadeh Nezhat, MD FACOG, FACS
Founders of Worldwide Endometriosis March and Endometriosis Day

Endometriosis of the Diaphragm

Protocols and Best Practices for Treating Diaphragmatic Endometriosis
Keywords: Endometriosis of the lungs, chest, diaphragm, upper abdomen

 By Camran Nezhat, M.D., Farr Nezhat, M.D., Ceana Nezhat, M.D.

Lately there have been many discussions reminding us of just how crucial it is to eradicate endometriosis as completely as possible. As a surgical imperative, this is actually a time-honored principle, one that has been observed since at least the late 19th and early 20th centuries, when progenitor pioneers like Marion Sims, Cullen, and Sampson found that patients were more likely to experience relief from symptoms when as much disease as possible was removed. Sims was so committed to this principle that he even used his own fingernails to “excise” endometriosis that was otherwise difficult to remove with the standard instruments of his day! (1 , 2 )

However, implicit in some of these narratives is the flawed assumption that endometriosis returns as a result of an incomplete and/or inadequate method of treatment (ie, ablation/excision) from a previous surgery,. While it’s certainly true that inexperienced surgeons might treat endometriosis inadequately, what’s equally true, if not more so, is the fact that endometriosis can recur despite the most thorough treatment possible.

In other words, all the medical interventions in the world, by all the world’s greatest practitioners, cannot prevent endometriosis from returning in certain cases. Since these and other similar misconceptions about endometriosis have become rather prevalent lately, we thought it was a good time to bring these issues into the conversations.

And, since we are on the topic of thoroughly treating endometriosis, we would like to add to the discussion the issue of diaphragmatic endometriosis, an extragenital form that actually is sometimes overlooked and left behind due to its propensity for hiding behind the liver and other structures of the upper abdomen. (3 )

Quick overview of the diaphragm’s anatomical features
For those who might want a quick anatomy refresher course, we thought the following review of the thoracic diaphragm’s anatomical features would be a good place to start. The most important muscle for human respiration, the diaphragm is a long and thin, convex organ located below the heart and lungs, attaching to the lower ribs, sternum and lumbar spine and forming the base of the thoracic cavity. Positioned as it is, it conveniently separates the chest cavity from the abdominal cavity. Lengthwise it ranges from 6 to 12 inches, while its thickness usually measures somewhere between one-quarter to one-eighth of an inch. With its symmetrical, lobe-like formation, the diaphragm’s right and left sides are distinctly demarcated (though still contiguous). For this reason, many physicians refer to the two lobes as the right and left hemidiaphragms. The diaphragm’s main innervating source is the phrenic nerve, which in turn is fed by the cervical nerves C3, C4, and C5. (Many of our physician friends will probably remember the mnemonic, “C-3, 4, 5, keep the diaphragm alive.”). However, there are also two peripheral innervating sources called the intercostal and subcostal nerves, located at T5-T11 and T12, respectively.

Highly flexible, the diaphragm contracts and relaxes as breathing takes place. Specifically, when a person inhales the diaphragm and its intercostal muscles contract downward, thereby widening the thoracic cavity in which the lungs are contained. As a result, air fills the lungs through the mechanical process of suction. When a person exhales, the diaphragm and intercostal muscles relax, thereby mechanically forcing air out of the lungs.

Most Common Symptoms of Diaphragmatic Endometriosis
Symptomatic diaphragmatic endometriosis can manifest as shortness of breath (dyspnea), epigastric pain (upper GI), and pain in the chest (pleuritic), shoulder, and right or left upper quadrant (upper abdomen), all of which may or may not be cyclic. The rarer but more serious and potentially life-threatening conditions of catamenial pneumothorax, hemopneumothorax, chest wall lesions, and lung parenchyma can also cause similar symptoms and sometimes occur concomitantly with diaphragmatic endometriosis as a result of diaphragmatic defects caused by the necrotizing effects of endometriotic lesions. (4 , 5 )

Congenital defects or fenestration of the right hemidiaphragm can also contribute to the development of diaphragmatic endometriosis, as well as in surrounding areas of the chest, lung, and pleural cavity. For these reasons, these conditions should be ruled out during any diagnostic investigations. Although rarer still, with fewer than 20 cases reported in the literature, liver endometriosis should also be a part of differential diagnoses, as it too can cause cyclic upper abdominal pain. ( 6 , 7 )

The good news about diaphragmatic endometriosis is that after thorough surgical treatment, studies have found that it is far less likely to recur than other forms of the disease. (4 ) While most implants are superficial and cause no discomfort, others can be deeply infiltrating, including cases of full thickness infiltration. In one of our studies, 29% of our patients had deeply infiltrating implants. (8 ) In more serious cases like these, the lesions can cause multiple small perforations which need to be surgically repaired.

Although lesions can present with varying colors and morphologies, the most common form appear to be those which have a bluish cast to them, as demonstrated by Figure 1 below. However, others have reported purplish-red lesions.

Other common features
As you’ve probably heard by now, most lesions occur on the right side, a propensity which many cite as the central supporting evidence for Sampson’s retrograde menstruation theory of pathogenesis. However, lesions have been found on all parts of the diaphragm, such as its phrenic nerve, as well as adjacent structures. Sometimes lesions are bilateral, while others form on just one side. And, sometimes the majority of lesions present anteriorally, where they lie hidden behind the liver. Given such a wide variation in locations, the entire diaphragm and adjacent areas must therefore be thoroughly investigated.

Preliminary steps for determining a treatment plan
For those who are not symptomatic but who have been diagnosed with any of these extragenital forms of endometriosis incidentally, some recommend to take an expectant approach with no further intervention, unless symptoms later occur. (9 ) However, for those patients who are symptomatic, surgery has proven beneficial when other medical interventions have otherwise failed. (7 , 10 , 11) If proceeding with surgery, however, one must take care to counsel patients well about their other options because injury can occur to the diaphragm, phrenic nerve, lungs, vessels, or heart. And, as with any other procedure, care should be individualized, taking into consideration the patient’s goals, age, medical condition, etc, as well the practitioner’s experience and availability of appropriate inter-disciplinary consultants.

A few key protocols in surgical management
While diaphragmatic endometriosis presents many unique challenges, we thought we would focus on just a few key protocols that we’ve relied on over the years to help us navigate through these especially tricky anatomical landscapes.

The first issues to address are concerns about access and visualization of the upper abdomen and the diaphragm’s entire surface. We would like to urge our community to not let these particular concerns be reasons to resort to laparotomy, which is known to most likely cause the painful and potentially intestinal-obstructing thick vascular sorts of adhesions in more than 93% of cases. (12 , 13) By resorting to laparotomy, one treatable problem would be exchanged with another potentially disabling one.

To avoid all the headaches that laparotomies can come with, the first step is to consult with an endoscopic surgeon experienced in upper abdomen procedures. Surgeons with sufficient experience will be able to utilize several different techniques and devises to help obtain a clear view of the diaphragm and adjacent areas. For example, the patient’s position can be changed during surgery, so that the diaphragm’s surrounding organs fall away from it enough so that one can see parts that would be otherwise obscured. As well, surgeons can add more port holes (the tiny incisions in which the laparoscopes are inserted) in the upper abdomen so that better visualization can be obtained. More advanced surgeons can even rely on highly specialized techniques, such as resecting the falciform ligament or using the laparoscopes to gently move the liver and stomach away from the diaphragm so that it can be better visualized. In fact, we routinely deploy these and other minimally invasive strategies in oncological gynecology, when it’s often necessary to debulk diaphragmatic metastatic disease which sometimes requires partial resections of the diaphragm and mesh placements. (14)

As for excisional techniques, it depends on many factors, including the nature of the lesion itself. However, the most essential consideration is complete removal of endometriosis. Randomized controlled studies have shown that thorough eradication of the disease is the only variable consistently associated with any measureable reductions in pain and recurrence rates. (15 , 16) And, contrary to common misconceptions, it makes no difference which technique is utilized; vaporization, ablation, hydrodissection, and scissors excisions have all proven to be effective methods. There are also many devises that can be used for complete excision, all of which have their own advantages and disadvantages. For example, compared to monopolar instruments, the laser has proven especially safe and useful for excising or otherwise eradicating both superficial and deeply infiltrating endometriosis, since it poses no danger of having its energy heat arc out in erratic ways. As a result, laser surgeries are associated with substantially fewer incidence of inadvertent injury to surrounding healthy tissue or organs. (17 , 18 , 19)

The following video of laparoscopic diaphragmatic stripping for ovarian cancer demonstrates several techniques which, even though they’re applied here in an oncological setting, nevertheless can be used for treating diaphragmatic endometriosis as well:

http://www.youtube.com/watch?v=jMXfRW-Whfc .

Of course, surgical outcomes ultimately depend entirely on the skill and experience of the surgeon. This is especially true for those who specialize in treating endometriosis, a field of such complexity and ever-changing paradigms that the only hope we have for staying ahead of such a fast-moving curve is to continuously advance our knowledge in the latest surgical tools and techniques. The availability of proper instrumentation has also proven to be critical, for no matter how great of a pianist you are or want to be, you can’t play if you don’t have a piano or if the one you’ve got is utterly out of tune.

Postoperative medical care depends on whether patients are planning to conceive. For those wishing to become pregnant, there are no further postoperative medical interventions, other than the routine postoperative care and perhaps ART treatments or the like. For patients who are not planning to conceive, they may continue with some sort of hormonal suppressive treatment.

Collaboration with other sub-specialists is crucial
All of these protocols will prove nearly meaningless, however, without the element of multi-discipline collaboration, especially critical for treating such a multi-organ, systemic disorder as endometriosis. For example, even though we were the first to report on the laparoscopic treatment of liver endometriosis and have to our knowledge performed more of these surgeries than any other surgeon or institute, after over 3 decades of experience we have had only 3 such cases. For this reason, we’ve always advocated seeking out collaboration with experts from other fields. The same goes for endometriosis of the lungs, chest wall, and diaphragm, which collectively have accounted for no more than 40 of our cases over the years. Again, even though these 40 cases represent the first and largest number ever treated laparoscopically, it’s still a comparatively small volume relative to the other types of surgeries we routinely perform. Given the rarity of such cases, collaboration with other sub-specialists is therefore an absolute imperative for the safety and well-being of patients. We hope we’ve been able to provide some helpful perspectives on some of surgery’s most complex and contested issues. For further reading on these subjects, please see our list of references below. And, stay tuned for an upcoming white paper on lung endometriosis, which can have similar symptoms as endometriosis of the diaphragm, but which poses even greater potential for dire, life-threatening consequences if not treated correctly.

REFERENCES
1) Nezhat C. Nezhat’s History of Endoscopy: A Historical Analysis of Endoscopy’s Ascension since Antiquity. Tuttlingen, Germany: Endo-Press; 2011.

2) Nezhat C. Pelvic pain, infertility, endometriosis: Old diseases, old treatments. Fertil Steril. In press.

3) Nezhat, Camran; Nicoll, Linda M; Bhagan, Lisa; Huang, Jian Qun; Bosev, Dorian; Hajhosseini, Babak; Beygui, Ramin E. Endometriosis of the diaphragm: four cases treated with a combination of laparoscopy and thoracoscopy. Journal of Minimally Invasive Gynecology. 2009; 16(5):573-80.

4) Nezhat C, et al. Bilateral Thoracic Endometriosis Affecting the Lung and Diaphragm – Case Report. In press. JSLS.

5) Endometriosis: Science and Practice. Linda C. Giudice, MD, Johannes L. H. Evers, David L. Healy.

6) Nezhat, C. et al. Laparoscopic management of hepatic endometriosis: report of two cases and review of the literature. Journal of Minimally Invasive Gynecology 12, 196-200 (2005).

7) Nezhat F, Nezhat C, Levy JS. Laparoscopic Treatment of Symptomatic Diaphragmatic Endometriosis: A Case Report. Fertil Steril, Vol. 58, No. 3, Pp: 614-616, 1992.

8) Nezhat’s Operative Laparoscopy, 3rd ed. Cambridge Press. 2005. p 289-291.

9) Falcone T, Lebovic DL. Clinical Management of Endometriosis. Obstet Gynecol. 2011;118(3):691- 705.

10) Nezhat, C. C., Seidman, D. D. S., Nezhat, F. F. & Nezhat, C. C. Laparoscopic surgical management of diaphragmatic endometriosis. Fertility and Sterility 69, 1048-1055 (1998).

11) Mangal, R. R., Taskin, O. O., Nezhat, C. C. & Franklin, R. R. Laparoscopic vaporization of diaphragmatic endometriosis in a woman with epigastric pain: a case report. Journal of reproductive medicine 41, 64-66 (1996).

12) Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJS, O’Brien F, et al. Postoperative adhesions: Ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Diseases of the Colon & Rectum. 2001; 44(6):822-9.

13) Redwine DB. Diaphragmatic endometriosis: diagnosis, surgical management, and long-term results of treatment. Fertil Steril. 2002; 77(2):288-96.

14) Nezhat FR, DeNoble SM, Liu CS, Cho JE, Brown DN, Chuang L, Gretz H, Saharia P. The safety and efficacy of laparoscopic surgical staging and debulking of apparent advanced stage ovarian, fallopian tube, and primary peritoneal cancers. JSLS. 2010 Apr-Jun;14(2):155-68.

15) Healey M, Ang C, Cheng C. Surgical treatment of endometriosis: a prospective randomized doubleblinded trial comparing excision and ablation. Fertil Steril 2010; 94:2536-40.

16) Wright J, Lotfallah H, Jones K, Lovell D. A randomized trial of excision versus ablation for mild endometriosis. Fertil Steril. 2005; 83(6):1830-6.

17) Sutton CJ, Pooley AS, Ewen SP, Haines P. Follow-up report on a randomised controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal to moderate endometriosis. Fertil Steril 1997; 68: 1070–4.

18) Luciano AA, Whitman GF, Maier DB, Randolph JF, Maenza RM: A comparison of thermal injury, healing patterns and postoperative adhesion formation following CO2 laser and electromicrosurgery. Fertil Steril.1987;48:1025-1029.

19) T, Vilos GA: A comparison between laser surgery and electrosurgery for bilateral hydrosalpinx. Fertil Steril. 1985; 44: 846.

Pain, Redefined

quotes CORRECT Pain-with-menstruation

“Pain with menstruation is not normal.
Pain with bladder function is not normal.
Pain with bowel function is not normal.
Pain with sexual relations is not normal.
Pain with sitting-standing-moving-breathing is not normal.

Pain with basic biological functions is not normal and deserves to be investigated by a caring physician who believes you.”

– Dr. Camran Nezhat
#EndometriosisAwareness #EndoMarch