A man in Oregon wrote to Dr Obama after Elizabeth, hit wife, asked him to read about endometriosis. Jonathan, a twenty-seven-year-old administrator at a large company in Texas, was searching for an answer that made sense, Elizabeth seemed to be suffering terribly, and it was getting worse. What he read about endometriosis seemed to correlate with Elizabeth’s symptoms and life-style. He hoped Dr Obama might assist him further.
His letter is a touching one. It is a love note for Elizabeth as well as a sad tale of all-too-common experiences with misdiagnosis and improper treatment of the “career woman’s disease.” It goes, in part, this way:
“I’m writing at a point of desperation in my wife’s life. She has learned after five years of pain that she has endometriosis. Elizabeth has seen twenty doctors since 1982, when they began having chronic pain in her vulva following an abortion. Doctors couldn’t find any condition that corresponded to her pain and either dismissed her as neurotic or prescribed creams that irritated the area.
“Then, a few months ago, a general practitioner diagnosed endometriosis based on her symptoms: painful urination, history of bad menstrual cramps, and abdominal pain. We heard that Danocrine would help over other treatments, but he insisted she take Norlutin. A synthetic progesterone, which created terrible side effects. Elizabeth then went to a top gynecologist on whom she’d pinned all her hopes. He told her that she had problems ‘accepting a normal sex life’ (we’ve been unable to make love for months because intercourse was so painful for Elizabeth) and that nothing else was wrong with her!
“I’m not a doctor, but I think I’ve unearthed every available medical journal on endometriosis. I feel pretty confident that Elizabeth has this disease and no other.
“I never would have believed how a woman can suffer and still be ignored by those with the power to heal if 1 had not seen it myself. This is why I’m writing a letter like this. Please give our problem your attention. We trust your opinion and hope you can answer us, no matter how briefly. What should we do next?”
Endometriosis can dramatically alter the daily rhythms of a woman’s life, and Elizabeth is a good example of this. Often, intimate relationships change when pain becomes a demanding third party. In these cases, coping with the disease not only requires fortitude of spirit but needs the understanding of others.
Of the many points Jonathan raised in Elizabeth’s case, the most significant was his description of two of the three symptoms (the “triad”) that most typify endometriosis: a history of bad menstrual cramps and dyspareunia (or painful intercourse). The third, infertility! is, in my opinion, a good probability for Elizabeth, although getting pregnant is not relevant to her now. Although a laparoscopy; or “Band-Aid procedure,” performed by a good diagnostician can help reveal the truth about Elizabeth’s condition, it’s a fairly good bet based on her symptoms that she has endometriosis and that a laparoscopy is not necessary in her case. As mentioned earlier, a standard suction abortion is rarely responsible for the onset of the disease. A badly performed abortion, however, may have caused some damage to the uterus. The doctor might have accidentally wrenched it in some way, tearing it slightly so that endometriotic tissue spread to the cervix and vagina. It is worth noting that the disease very rarely implants itself and grows in the vagina. However, during an internal examination a doctor can see very small brown-black (“powder burn”) spots of endometriosis on the cervix.
Unless there were actual lesions or indication of infection, we would say that the pain an Elizabeth’s vulva was not due to a localized problem, but radiated down from another source. Most likely, the pain originated in pelvic organs inflamed with actively growing endometriotic tissue. Such growths would alto account for frequent urination, since the bladder is commonly involved in this “glue-stick” disease.
Partnership of any kind, but especially partnership in health care, requires harmonious goals. You and your doctor must be able to exchange information freely and decide on the wisest course of action.
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