Laparoscopic surgery for endometriosis is any surgery that attempts to remove or destroy endometrial implants, cysts and adhesions during a laparoscopy. For the purposes of this discussion it does not include laser surgery as this is covered separately later in this chapter.

Laparoscopy was originally only used as a means of diagnosing endometriosis but over the years it has been used increasingly as a way of surgically treating the condition. It is now common for some laparoscopic surgery to be performed at the time of a diagnostic laparoscopy — assuming the woman agrees and laparoscopic treatment is appropriate.

In the early days of laparoscopic surgery only simple procedures were performed but as experience with the technique has increased surgeons have treated increasingly severe cases and performed more complex procedures. The complexity of the procedures that your gynaecologist will attempt will depend on his or her level of training and experience.

Who is suitable for laparoscopic surgery

Laparoscopic surgery is generally only suitable for women with minimal or mild endometriosis, though in some cases it may also be appropriate for women with moderate disease.

Things to discuss before laparoscopic surgery

Before your operation you should discuss with your gynaecologist what he intends to do during the operation and what should be done if more extensive surgery is necessary.

What happens with laparoscopic surgery

The basic routine for laparoscopic surgery is the same as that described for a diagnostic laparoscopy (see Chapter 3) except that in addition to inspecting the pelvic organs, one or more of the treatment procedures outlined below will be performed.

Procedures that may be performed include the removal or destruction of superficial implants and small cysts, the removal of adhesions, the removal or destruction of endometriomas and the removal of an ovary. Few gynaecologists are able to perform the latter two procedures but it is possible that in the future more surgeons will be able to do so.

Any superficial implants and small cysts on the peritoneum and ovary will usually be destroyed by cauterisation. Cauterisation involves the use of a heat source or electrical current to destroy or ‘burn’ the implants or cysts. As the depth of the burn cannot be precisely controlled cauterisation is not used if there is any danger of damaging any important underlying organs, such as the fallopian tubes, bowel or bladder. It is not always possible to destroy all the implants and cysts present. Larger cysts may be removed by cutting them out.

Adhesions can be removed by cutting or cauterisation but again it may not be possible to remove all the adhesions present.

Effectiveness of laparoscopic surgery

Laparoscopic surgery has several advantages over conservative laparotomy because being minor surgery as opposed to major surgery it is associated with fewer risks and complications, causes less discomfort and has a shorter recovery period. It can also readily be done at the time of diagnosis which means that only one bout of surgery, one hospital stay and one recovery period are needed.

It is not possible to compare the results of laparoscopic surgery with other forms of treatment as there are no reliable figures available at present. The impression of many gynaecologists is that laparoscopic surgery relieves the symptoms in many cases and it restores fertility in some cases.

Risks and complications of laparoscopic surgery

The risks and complications of laparoscopic surgery are the same as those associated with a diagnostic laparoscopy except that there is the additional risk of damaging organs during cauterisation.

*63\83\2*

Gestrinone is a weak synthetic progesterone originally developed in the 1970s for use as a once-a-week contraceptive. First used as a treatment for endometriosis in the early 1980s, it has since been used in clinical trials in several European countries. It is not currently available in Australia.

How Gestrinone works

Gestrinone appears to work by suppressing the secretion of oestrogen by the ovaries, causing the endometrial implants to degenerate and waste away.

Dosages of Gestrinone generally used

At the moment clinical trials are still trying to identify the most effective dosage. It appears that dosages of 2.5 to 5.0 milligrams two or three times a week are likely to be effective.

Side effects of Gestrinone

The side effects are reported to be moderate and similar to those of Danazol, and include acne, increased appetite, vaginal discharge, irregular vaginal bleeding, headaches, decreased breast size, nausea, weight gain, excessive hair growth and depression.

How effective is Gestrinone

Early clinical trials have indicated that Gestrinone is an effective treatment for endometriosis and that overall it is as effective as Danazol. Its future role in the treatment of endometriosis is not known at this stage.

*61\83\2*

Hormones are chemicals — released by a number of glands in the body — which are responsible for the control of many of the body’s functions. The menstrual cycle is controlled by a number of hormones, the most important being the follicle stimulating hormone, the luteinising hormone, oestrogen and progesterone.

Follicle stimulating hormone-The follicle stimulating hormone (often abbreviated to FSH) is produced by the pituitary gland and stimulates the ovarian follicles to grow and develop.

Luteinising hormone-The luteinising hormone (often abbreviated to LH) is produced by the pituitary gland; it initiates ovulation and stimulates the corpus luteum to produce progesterone.

Oestrogen-Oestrogen is a hormone produced by the ovaries which stimulates the growth and thickening of the endometrium.

Progesterone-Progesterone is a hormone produced by the corpus luteum which prepares the endometrium for implantation of the fertilised ovum.

*4\83\2*

The female reproductive organs consist of the uterus, fallopian, tubes, ovaries, cervix, vagina, vulva, clitoris and labia.

Fallopian tubes-The fallopian tubes are two extremely fine tubes about 10 centimetres in length which extend from the upper part of each side of the uterus.

The ‘finger-like’ ends of the fallopian tubes, known as the fimbria, lie close to and curve around the ovaries. When ovulation occurs the fimbria draw the ovum (egg) into the fallopian tube, which then propels it to the uterus.

Ovaries-The two ovaries lie close to the ends of the fallopian tubes. They are about the size and shape of a brazil nut. They are 2.5 to 3.5 centimetres long and approximately 1.2 centimetres thick.

The ovaries contain thousands of tiny sacs called ovarian follicles. Each follicle contains an egg which is known as the ovum (plural ova). Once a month, under the influence of the menstrual hormones, one of these follicles grows and releases its ovum. After it has released the ovum, the remaining part of the follicle becomes the corpus luteum.

*2\83\2*

Think of where qualities like strength and flexibility are needed in the body, and you are probably thinking of tissue containing the mineral silica. It is found in the bones, cartilage, artery walls, hair, nails and skin.

Deficiencies will show in all of the above. Hair and nails may become brittle and the skin will lose some of its ability to heal, as well as its moisture and elasticity. Arterial walls will weaken and bone and cartilage development may be hindered. There is now some evidence to suggest that the silica may help shield the body against the harmful effects of aluminium and may provide some degree of protection against the development of Alzheimer’s disease.

Silica is available in most fibrous fruits and vegetables like celery, rhubarb, mango, asparagus and particularly lettuce. It is a major component of many of the vegetable skins and husks we often throw away. To take better advantage of the silica in our food, therefore, choose wholegrain foods and eat vegetables and fruit with their skins when possible.

Herbal sources include horsetail, which contains not only high levels of silica, but also the minerals necessary for its absorption by the body. Take it with care, in conjunction with herbs containing a mucilage such as slippery elm or marshmallow, as it can be harsh and scarring to the kidneys. A supplement of silica in tablet form is probably preferable for the treatment of deficiencies. Limit your daily intake to about 30-40mg/day.

*50\69\2*

This complaint is caused by a type of herpes virus (Herpes zoster) and is related to chickenpox — it is similar in appearance but more restricted in the areas of the body that are affected. Shingles can be particularly painful, accompanied by a fever of about three days duration. The pain and rash range along the intercostal nerves, under the ribs and running under the armpit to the back. It can also affect the face and shoulders. The rash or spots eventually form blisters and open weeping lesions. Even after these have begun to heal, the pain in the affected area may continue to be intense.

Like the rest of the diseases caused by the various herpes viruses, shingles is not curable. And there is only limited success in countering the symptoms. However, recent reports have suggested that such treatments as Vitamin E, taken orally and applied directly on the lesions, can reduce the pain. Vitamin C injections have also been found to be effective in both reducing pain and drying up lesions.

*48\69\2*

Sarah suffers from a typical case of seasonal affective disorder, or SAD. People with this condition are very sensitive to the amounts of environmental light and become depressed when these levels fall below a certain threshold, such as during the short dark days of winter. Although the problem probably has a genetic basis, the severity of winter depressions depends on the amount of light in a susceptible person’s environment. Often people with SAD who have lived in different locations report that their problem is worse the further away they live from the equator, with depressions lasting longer and being more severe than when they live in more tropical climes. For some reason not yet understood, women are more susceptible than men to SAD, especially when they are in their reproductive years.

When depressed, people with SAD tend to oversleep. Often they just feel like curling up in bed and being left alone. They empathize with hibernating bears who are free to laze away the winter without the responsibilities that beset us humans all year round. Such responsibilities often overwhelm the person with winter depression, who can barely rouse herself and get going, let alone tackle the chores, work and personal commitments that are part of ordinary living. Overwhelmed by these demands, the person with SAD feels like a failure and anxiety and depression are always close at hand. One source of comfort is often food, especially sweets and starches, which are consumed in great amounts, resulting in unwelcome weight gain.

Seasonal affective disorder is extremely common and has been estimated to affect about 5 per cent of adults. Another 15 per cent are estimated to suffer from a milder form of the condition, subsyndromal SAD or the winter blues. Although most people with the milder version of SAD do not seek out medical attention, the dark short winter days nevertheless interfere with their productivity and creativity and make life feel dreary and dull. It is estimated that approximately one in five people suffers from emotional or behavioural disturbances as a result of the winter.

Light deprivation for any reason will tend to depress these susceptible individuals. Two or three cloudy days in a row, a windowless office or the scarcity of light in their ground-floor flat are all quite likely to lead to a lack of energy and a slump in mood.

Once the connection is made between the amount of environmental light and the drops in mood, however, the condition feels immediately less burdensome. As Sarah put it, ‘understanding the problem is half the battle.’ The other half of the battle can be won with the help of light therapy, St John’s Wort and other antidepressant strategies.

*26\75\2*

Social phobia, one of the most common hidden causes of distress and anxiety in everyday life, is estimated to affect approximately one in eight adults. People with this problem have a persistent and powerful fear of being scrutinized, evaluated or being judged by others. As you can imagine, this condition results in considerable impairment of functioning as it prevents people from asserting themselves in work or social situations. Although people with this difficulty may simply appear shy to outsiders, actually they spend a great deal of time worrying about being embarrassed, and engaging in painful fantasies of being ridiculed or humiliated.

According to Dr Michael Liebowitz of Columbia University in New York, a pioneering researcher in the field of social phobia, there are several lines of evidence suggesting that brain pathways involving the neurotransmitter dopamine are disturbed in social phobia. To a somewhat lesser extent, pathways involving serotonin also seem to be involved in this condition. Studies indicate that anti-depressants may be of some value in the treatment of social phobia. As St John’s Wort has been shown to influence both dopamine and serotonin pathways, there is reason to consider that the herbal remedy might be of some benefit in social phobia. As several of the stories in this book have indicated, after starting the herbal remedy a number of people report becoming more outgoing and less shy, and more willing to take the initiative in a social or work situation.

Currently social phobia is a greatly undertreated problem, in part because it is not recognized by clinicians but perhaps also because the very symptoms of the condition – fear of being judged and humiliated – may prevent people from bringing their problem to the attention of a professional. For these people, an herbal remedy that can be purchased over the counter may be enormously appealing. Although formal studies of this use of the herb are needed, early evidence suggests that if you are painfully shy or afraid of making a social overture or asserting yourself, St John’s Wort may really be worth a try.

As we can see, there are many possible roles for St John’s Wort in everyday life – for stress, low energy, down feelings, insomnia, premenstrual symptoms and painful shyness. Small wonder that the ancients thought this herb capable of miracles, and attributed magical powers to it.

*24\75\2*

Charles Lakerman was a 78-year-old retired businessman who had had rhinitis for the past thirty years and mild intermittent arthritis of the hands for almost a decade. In the fall of 1967, he had developed acute arthritis of the hands, followed by involvement of the right elbow, shoulders, knees, and right hip. Aspirin was the only medication he had received.

At the time of his hospitalization for environmental testing, his hands were red, swollen, and inflamed, with very little motion in the joints. He was barely able to eat and refused to shake hands.

Under the program of comprehensive environmental control, Lakerman’s arthritis became progressively better, without his suffering any withdrawal effects. All of his joints were comfortable at the end of five days of fasting, although some residual swelling of the hands persisted.

Individual food ingestion tests resulted in the following reactions:

Corn: 3 hours, nausea and abdominal distress followed by spontaneous diarrhea; 6 hours, recurrence of arthritic pains of hands and left shoulder

Wheat: 31/2 hours, watery eyes and running nose; 12 hours, painful right knee upon awakening

Beets and beet sugar: 13 hours, slight aching of ankle upon awakening: a

new joint involvement

All other commonly eaten foods were test-negative, nor did he react to the commercial forms of such foods.

Mr. Lakerman remained symptom-free at the time of his hospital discharge and experienced no evidence of reaction upon returning home to follow his new diet. After eight months of freedom from arthritis, he tolerated wheat when it was returned to his diet once in five days for several months. However, he experienced a gradual recurrence of mild arthritis of the knees and hands as he increased his intake of wheat to twice daily, corn to three times per week, and began the regular use of beet sugar. All symptoms subsided when he returned to his former diet restrictions, and he has remained free of arthritic pains ever since then.

Many cases of rheumatoid arthritis also have a coexisting muscle involvement referred to as allergic myalgia. This may start either before or following the onset of joint involvement. Allergic myalgia may be acute or chronic, localized or generalized. It tends to be characterized by painful, tender muscles and sometimes presents as cramps or muscle spasms. I first described this condition in 1951.4 Myalgia of ecologic origin also occurs frequently in the absence of arthritis, in association with headache and fatigue. The postural muscles of the nape, back, chest, and legs are most commonly involved.

Although the causative roles of foods in individually studied cases of rheumatoid arthritis and myalgia have been documented for thirty years, there has been practically no recognition of these findings as taught by rheumatologists in most medical centers. The record shows clearly that of 1,000 cases of rheumatoid arthritis studied during the past three decades, specific foods have been demonstrated in most of them and environmental chemicals in many of them.

*77\110\2*

Kelly Johnson was a nine-year-old schoolgirl when she developed arthritis of the right ankle in the spring of 1970. This was followed by migration of the arthritis to both knees and ankles. Aspirin was the only treatment given until an operation (called a synovectomy) was performed on the right knee, in order to allow it to move more freely.

Four months later, the partially crippled child was hospitalized for food and chemical testing. Examination revealed swelling and limitation of motion in both knees, as well as a scar from the previous operation. Upon beginning the period of fasting, Kelly experienced nausea and headache as withdrawal effects. Progressive improvement occurred, however, so that after four days of fasting her joints were more mobile and less painful than they had been in many months.

Severe recurrences of arthritic pain, swelling, and other symptoms was associated with the ingestion of the following chemically less contaminated (organic) foods:

Rice: 2 hours, stomachache; 9 hours, itching

Chicken: 21/2 hours, pains in elbows and hands

Pork: 3 hours, stomachache; 14 hours, joint stiffness

Beef: 3 hours, chest pain and residual stiffness

Potato: 3 hours, right-shoulder pain

Wheat: 31/2 hours, itching

Corn: 5 hours, itching; 10 hours, swollen extremities

Milk: 91/2 hours, mild itching of skin only

Beet: 14 hours, swollen, stiff hands and feet

In contrast to some of the earlier cases, Kelly’s symptoms generally came on hours after the food ingestion test. Since another meal may have intervened between the ingestion of corn, milk, or beet and the development of symptoms, it was often necessary to repeat tests in order to make sure that a given food resulted in a given symptom. This is the kind of test which is extremely difficult to do outside a specialized hospital setting.

Other commonly eaten foods were all test-negative. Kelly went home in good condition and remained well on the diet we devised for her until the gas-fired furnace was turned on that fall. This was followed by a flare-up in her arthritis. She was therefore moved to an all-electric house. Since then, Kelly has remained symptom-free, adhering well to her dietary program. Other than some physiotherapy for pain in the operated knee, she needs no therapy— not even aspirin—at the present time.

*75\110\2*