Adenomyosis 2

Let’s Talk About Adenomyosis

As a healthcare practitioner with a special interest in women’s health, more and more I am seeing women presenting with all the symptoms of Adenomyosis. This is why this post is called “Let’s Talk About Adenomyosis”.

Just like endometriosis, many women have had this condition missed and dismissed and then have to suffer the consequences and think that they just have to put up with it month after month.

Some women are completely unaware that they have adenomyosis. Those that have already been diagnosed with endometriosis often believe that all their symptoms are just related to this disease only, when it fact, they could have two diseases creating all their issues.

Many of the symptoms are the same as endometriosis, except that women will usually have heavier menstrual bleeding, or irregular bleeding issues.

Women can have both endometriosis and adenomyosis at the same time and now research is showing that they are basically one in the same disease, but just in different locations.

What is Adenomyosis?

Adenomyosis is defined as the presence of endometrial glandular tissue occurring deep in the endometrial lining (myometrium). The exact cause of adenomyosis is unknown, but current research is showing that it is a similar process to how endometriosis is caused.

Histologically both endometriosis and adenomyosis are one in the same disease state, but just occurring in different locations. We know that both diseases are driven by estrogen and that they have all the same signs and symptoms. Adenomyosis and endometriosis are not caused by estrogen dominance either. Even small amounts of estrogen will drive both diseases.

The only difference between the two disease states is that adenomyosis typically causes more heavy bleeding symptoms. The abnormal bleeding occurs when the ectopic endometrial tissue induces hyperplasia and hypertrophy of the surrounding myometrium. This causes uterine enlargement and subsequent changes in vascularisation (the new vessels may also be more fragile than usual) in addition to an increase in the surface area of the endometrium.

One of the key diagnostics for adenomyosis is the presence of an enlarged uterus on ultrasound, or via MRI. The enlarged uterus can also impact the surrounding structures and often impacts the bladder, leading to urinary frequency and other bladder issues.

Adenomyosis can also have the same bleeding symptoms as fibroids but correct diagnosis and investigations, will differentiate the two and ensure correct management moving forward.

What Are the Symptoms of Adenomyosis?

As mentioned previously, adenomyosis has all the same symptoms as endometriosis. Just like endometriosis, some women often have no symptoms (are asymptomatic), and are only diagnosed when they are having issues trying to conceive.

The main symptoms of Adenomyosis are:

  • Heavy, prolonged menstrual bleeding
  • Severe pain and menstrual cramps
  • Abdominal pressure and bloating
  • Bladder issues (frequency, urge frequency, incontinence)
  • Anaemia

Other associated symptoms such are:

  • Irregular bleeding
  • Pain with bowel movement
  • Irritable Bowel like symptoms
  • Urinary Tract Infection (UTI) like symptoms
  • Fatigue
  • Mental and emotional disturbances (depression, premenstrual dysphoric disorder)
  • Pain with intercourse
  • Infertility
  • Musculoskeletal pain
  • Lack of quality of life

Diagnosis of Adenomyosis.

Ultrasound is the most common (and indeed most useful) first-line imaging tool used to diagnose adenomyosis in a women presenting with any abnormal uterine bleeding. While ultrasound cannot definitively diagnose adenomyosis, it can help to differentiate and rule out other conditions with similar symptoms.

Sometimes saline solution is injected in the uterus at the same time as ultrasound is performed to give better imaging and to help evaluate the symptoms associated with adenomyosis. This is called sono-hysterography.

While trans-vaginal ultrasound (TVU) can be used, it can also miss the disease, especially if the user doesn’t have an expert eye, or extra training, or specialises in the diagnosis of adenomyosis.

MRI is considered a much better tool for the finding of adenomyosis, but it is a more expensive option. Even though ultrasound is a cheaper option, it can be inaccurate.

Blood tests cannot diagnose adenomyosis, or endometriosis.

The only proper way to definitely diagnose adenomyosis is via surgical intervention and a biopsy, but this is rarely done prior to a hysterectomy due to risk factors of damage to the uterine lining. Unlike endometriosis, the disease cannot be excised and the only cure for adenomyosis is hysterectomy.

Treatment and Management Options For Adenomyosis

The treatment and management of adenomyosis will depend in part on your presenting symptoms, their severity, and whether you have completed childbearing.

The medical management options for adenomyosis are usually in the form of hormonal therapy (the Oral Contraceptive Pill, Mirena IUS or other types of progestogen therapy) or surgical.

The surgical options are endometrial ablation, uterine artery embolism and hysterectomy. When considering surgical therapy it must be acknowledged that endometrial ablation and uterine artery embolism is less effective compared with the more definitive but more invasive option of hysterectomy.

Research does show that a significant portion of women, who choose to do endometrial ablation, or uterine artery embolism, will end up needing a hysterectomy. Hysterectomy is not the major procedure it was years ago and many are done laparoscopically and done intravaginally. This also helps with the recovery time. It all gets back to quality of life for many women with endometriosis. This is why hysterectomy is now a better option than other surgical interventions.

While hysterectomy is not something to be taken lightly, we do need to be real about quality of life and the ongoing pain, other associated symptoms, long term bleeding and the dangers of long term anaemia that adenomyosis can cause to a woman. Many women often quote getting their life back and wished that they had the hysterectomy sooner, rather than putting up with the lack of quality of life. Hysterectomy is a cure for adenomyosis, but it is not a cure for endometriosis.

Other Management Options For Women With Adenomyosis

  • Medical treatments(pain medications, iron infusions)
  • Complementary medicines (Acupuncture, Chinese herbal medicine, vitamins and nutrient support),
  • Nutrition and diet
  • Counselling & Psychology
  • Meditation and Mindfulness
  • Pain management clinics
  • Physiotherapy
  • Exercise therapy(weight baring exercise, resistance training)
  • Core strengthening(pilates, yoga)
  • Pelvic floor management(Pilates, Kegels Exercises/Kegels balls, Vaginal stone eggs),
  • Urodynamics

For women who do not want to consider surgical options, adenomyosis requires a multimodality/team approach for ongoing management, treatment and support. In most cases it will need a combination of the therapies above, or all of them, in conjunction with medical interventions and medicines.

In nearly all cases, treatment and management is the same as endometriosis, except there needs to be more focus on the heavy bleeding symptoms. I always apply a multi-modality approach to assist all my patients who have adenomyosis, or endometriosis, or both combined.

Mild symptoms may be treated with over-the-counter pain medications, complementary medicines and supplements and the use of heating pads to ease pain and cramps. It is important to talk to your healthcare practitioner about treatment options to suit your individual needs and individual symptoms.

Outlook For Women With Adenomyosis

Adenomyosis is not a life-threatening condition, although if some symptoms, such as anaemia and emotional disturbances, aren’t managed properly, or early on, it could potential be life threatening. Many of the symptoms such as heavy bleeding, pelvic pain, pain with intercourse, anaemia and bladder and bowel issues can, and do negatively impact a woman’s life.

Women with adenomyosis are often anaemic and long-term anaemia can have serious health consequences. See my post of serious consequences of iron deficiency. Click here

Many women with adenomyosis, if not all, will need an iron infusion if their iron levels are low. See my post “Could you need an Iron Infusion?”

While surgical options such as hysterectomy can cure adenomyosis, there are both medical and complementary medicines available that may help alleviate the symptoms of adenomyosis.

Adenomyosis and associated symptoms can resolve on their own after menopause. If women have endometriosis as well, they will often require ongoing treatment and management after hysterectomy, as hysterectomy does not cure endometriosis. As mentioned previously, hysterectomy will cure adenomyosis.

Anyone with symptoms of adenomyosis should consult a medical specialist, a healthcare practitioner that specialises in adenomyosis and endometriosis.

Final Word

If you do need help and assistance with the management of adenomyosis, the please call my friendly staff to find out how I may be able to assist you. My motto is ‘no stone left unturned’ and I apply this to every person I see and help. I also have a network of other healthcare professionals I work with as well.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Women’s Health Medicine and Master of Reproductive Medicine

-The Endometriosis Experts (incorporating adenomyosis as well)

 

10 Common Mistake seen with

10 Common Mistakes Seen With Endometriosis

1 in 10 women are diagnosed with endometriosis and it often takes up to 10 years to be diagnosed. The number 10 seems to be a recurring theme. So, for this post I am going to talk about the 10 common mistakes seen with endometriosis. Hopefully this helps to create some more awareness about this horrible disease and helps those who are suffering, or have not been diagnosed yet.

Below are the ten common mistakes I see with endometriosis.

1. Believing surgery has cured their disease

Many people with endometriosis are often led to believe, or have been told, that once they have surgery that their endometriosis is cured.

There is no cure for endometriosis, so surgery is not a cure. Hysterectomy is not a cure either.

All surgery does is deal with the expressed disease and that is it. It does not prevent further regrowth of the microscopic implants of endometriosis that are waiting to express and develop into lesions again. While surgery is a very valid medical option to address acute pain caused by the disease, it is not a cure. It only helps with symptomatic relief.

2. Not doing follow-up management of the disease after surgery

We know that despite the best medical interventions that women with endometriosis often will still be in pain, or have further expression and regrowth of the disease.

As mentioned previously, surgery is a valid treatment option for acute pain and for when hormones and medications are not working. But, from my experience I do see many have the surgery and then are not doing any ongoing management, except for pain medications. This isn’t necessarily the person’s own fault either. Many are also poorly managed post surgery and are not aware that they will need ongoing management of their disease state. As mentioned, many are literally just unaware that their disease can, and will grow back without ongoing support and healthcare management. It is crucial that all women with endometriosis receive ongoing care and management of their disease from an appropriately trained endometriosis expert.

3. Endometriosis care requires a multimodality/team approach

There is no one single medicine, or modality, that can effectively deal with endometriosis and this is why a multimodality/team approach is needed.

Surgery is just one treatment approach, which is also needed to definitively diagnose the disease, and then for when the disease is acute and nothing else is working. But surgery alone is not adequate to deal with the disease as a stand alone therapy.

Endometriosis is estrogen driven so there does need to be some form of progesterone support to help suppress further expression of the disease. This can be in varying forms and something I will discuss in another post.

There also need to be support of the microbiome and working on the microcirculation to the pelvic area and reproductive organs. There also need to be ongoing emotional support and care such as counselling, or psychology

There also needs to be dietary changes (low inflammatory based diet), physiotherapy, exercise, complementary medicines, acupuncture, nutritional medicine other modalities. All of this can be done alongside ongoing medications and medical support. Each individual with the disease has different symptoms and will require different multimodality care and support, based on their individual needs.

4. Not seeing the right surgeon

I know I always talk about it, but this is because many who are suffering from endometriosis and the associated symptoms, just have not seen the right person in the first place.

In every profession there is good and bad. There are those who specialise in a certain area, and there are those who don’t. The same goes for medicine and the same goes for surgeons too.

When needing a diagnosis, or surgical intervention for endometriosis, it is imperative to see an advanced trained laparoscopic surgeon who specialises in the excision of endometriosis. This way you also know that this surgeon is not only advanced trained and highly skilled, but also specialises in endometriosis and every aspect of it.

Not all gynaecologists and surgeons specialise in endometriosis and some dabble in it and are not highly skilled in the actual surgical requirements to effectively excise the disease properly. Some surgeons do not even do excision surgery and tend to just to ablation only. This is not how you surgical deal with endometriosis.

These advanced trained surgeons also have to do a certain number of surgeries per year to attain the status of being advanced trained. Someone who does a few surgeries here and there is definitely not advanced trained. These advanced trained surgeons also do extra years of surgical training and are the best of the best and why anyone who is suspected of having endometriosis, or has endometriosis need to see these surgeons only.

Too many women are under-serviced surgical, by poorly skilled surgeons, who are not specialised in endometriosis and who are not advanced trained and this is where all the problems start. It can also lead to making the patient worse and only leads to further suffering and years of pain as a result. It also means that the advanced trained surgeons then have to fix up the mess these other surgeons created.

The hard thing is some women are limited by demographic and location when it comes to being able to see an advanced trained surgeon. Unfortunately most of them do private work, and any in the public system have long waiting lists and may only do one day a week public surgical lists. You may not even get to see them unless you see them privately first and they put you on there public waiting list.

5. Not seeking help and intervention early enough

There is two parts to this that need attention and need discussion. We know that it often takes up to 10 years (or more) to be diagnosed with endometriosis. This means that a hell of a lot of women are being missed and dismissed by GP’s, allied healthcare practitioners, complementary medicine practitioners, specialists and so forth. This isn’t meant to be negative, or an attack on any one profession. These are the facts and something that cannot be ignored. It also needs to be discussed.

Then we also have parents waiting way too long to seek help for daughters, using the wait and see if it will go away approach. I see this often and I am often getting asked if a parent should just wait and see if their daughters pain will magically disappear. I often have to point out that if my daughter was passing out, or laying on a bathroom floor crying with pain, I would not be waiting to see if it was going to go away. Early intervention is the key to any disease. The wait and see approach is often the reason many women end up with years of fertility issues and years of pain, and other associated symptoms of endometriosis. The longer a disease is left to spread, the more damage it does, and the harder it is to treat.

Teenagers are not too young to have endometriosis and we are now seeing young girls as young as 5 years old having endometriosis found.

The other issue we see if women who know that they have the disease, putting off seeing someone for fear of more surgery, or fear of being dismissed. Again, this only leads to further complications and disease growth and thing being harder to treat.

Once a woman has endometriosis, the reality is that she may need further surgical intervention. But, it is needed to help with symptomatic relief and reduce inflammatory response in the body. The other thing is that by going and seeing someone who specialises in endometriosis, they are trained to help you manage your disease properly.

There may also be some non-surgical options that can be used and help with symptoms and disease management as well. But, you need to go in the first place, to get the help you need. Please do not put off getting your health and disease state managed properly. If you are in a bad place with your disease, make sure you get on that phone and book yourself in with someone who specialises in endometriosis.

6. Trying to manage the disease by yourself

I’ve covered this a bit in the last statement, but so often I see women trying to manage endometriosis themselves. This only leads to a vicious cycle that keeps going around and around and nothing good ever comes of it. The disease does not get managed properly, the symptoms get worse and then it all becomes way harder to effectively treat and manage.

Sometimes if things are left too long, there can be permanent damage that is not repairable. This is definitely why people should not try to manage their own disease and symptoms themselves.

If your disease state and associated symptoms are out of control and you aren’t being managed properly, please get on that phone and book in to see someone as soon as possible. Do not put it off any longer. Now is the time to do something about it, not tomorrow, or next year.

7. Getting medical advice from support groups

I am a big advocator of anyone with a long-term health issue receiving emotional and physical support. It is a must. But, it needs to be via trained professionals who are specialised to help you properly.

While I am also a big fan of support groups, I am not a fan of non-medically trained, non-healthcare people giving healthcare and medical advice to people within these groups. I love seeing the emotional support in these groups, but I don’t love it when I see people getting medical advice about medications, hormones and medical procedures. This is dangerous. I’ve even seen advice given on how to take ones own IUD out and this is when I have to speak out.

By getting medication advice, medical advice, surgical advice and any other healthcare advice from someone who is not appropriately trained, you are actually putting yourself in great danger. Please do not take the advice of anyone who is not a healthcare practitioner, or a specialist in endometriosis. Sure, get the emotional support from like minded people, and people who understand what you are going through, but leave it there.

The other thing is just being careful of not getting caught up in some of the negativity of some groups, where you also then start to focus and become your disease. You are not your disease and to move forward you need proper healthcare and lots of positivity.

8. Letting pain and associated symptoms get out of hand

Some of this I’ve also spoken about, but this is one thing I see often as well. Many people are at a point of self-managing with pain medications that are not working effectively any longer. This then leads to increased reliance and dependence of pain medications and it can also lead to increase pain and associated symptoms.

I have talked about pain medications and the withdrawal affects in previous posts. I have also talked about how increased pain medication use can actually cause pain and lead to further inflammation in the body. I have also talked about the addiction of pain medications too. It is a catch 22 situation. (Click here to see previous posts mentioned)

The point I am trying to make here is that if your pain levels and associated symptoms are getting out of hand, then you need to do something about it. Please do not try and manage your pain and symptoms on your own. Increasing your medications can have detrimental effects on your body and long term health consequences.

If you have to increase your pain medications, it means something is drastically wrong and that your pain levels need urgent professional attention. Your endometriosis expert/specialist is trained to help you get your pain levels and associated symptoms managed properly.

There may also be something else going on that could be sinister and require urgent medical attention. Never presume that all your symptoms are related to your disease. Seeking proper medical health and ongoing management, could just save your life.

9. Buying into the label and letting your disease own you

Having a chronic health condition myself, I know all too well how easy it is to fall it the trap of buying into the label of the disease. I also know all too well by doing this, you are letting the disease own you.

I also understand how hard it is on the bad days, not to get down about everything and think that there is no help, and how unfair things are. Yep, I truly get it. But, I also know that the more one focuses on the negative, and constantly lives in the disease state, the harder it is to truly move forward and get better.

Our thoughts and being negative can exacerbate pain pathways and they can also disrupt the healing pathways as well. If you listen to people that have overcome and illness, or a disease, they will always tell you it was by getting the right help and being positive. Positive mental outlook is very underrated in healthcare and its healing effects.

This is why I sometimes mention about being careful in certain support groups, where the focus is constantly on the disease, the label, and the negative. It isn’t good for anyone when that is all you hear. You need support, but you need to surround yourself with positive people, see the right healthcare team and also remember that you are not your disease, and it does not own you.

10. Believing that there is no help out there

I know many people have had a hard time and some have really had a terrible journey getting to where they are now. It is one of the reasons I am so big on giving people the facts about this horrible disease and trying to help women get the proper help they need. It is also the reason I do what I do now.

Having lived with a chronic disease and having dealt with my share of really bad experiences, I know all too well what many of you have been through. I thoroughly get it and I understand on all levels.

While many people have been missed and dismissed and many have seen their fair share of terrible healthcare practitioners, I do need to point out that there are some very good ones also. Never let your last experience by carried over with you. Not all healthcare practitioners are bad. There are actually some amazing practitioners out there who are experts in endometriosis.

Like I have said before, in every profession there is good and bad and this is why it is important to do your homework. Don’t just go off a friend’s recommendation, or some recommendation from your mother. Do your homework and make sure the person you are seeing actually specialises in your disease. You also need to be realistic that you need a multimodality team approach, and that you may need to see a few practitioners within a network of specialists.

When you do find someone you think may fit the profile of a true endometriosis specialist, make sure when you see them that they take a full history, listen to all your concerns, give you appropriate care and advice and are empathetic in helping you move forward with appropriate care and health management.

The one thing I tell people is to not go in with a negative attitude based on previous bad experience either. This can then lead to further angst and anxiety and could get a good practitioner offside too. At the same time, while you need to not take your last experience with you, you do need to make sure the person you are seeing is right for you. It is all about balance and not judging each person you see as being the same.

But, if the person you do see has no idea, then don’t be scared to say “Thanks, but not thanks” and be on your merry way. There is no harm in getting multiple opinions and the honest truth is that is what you need to do. Never just take ones person’s advice and be done with it. Get a second, or third, or tenth opinion if you have too.

Last, but not least, if you are struggling and are at a point you believe there is nobody to help you, please remember there is always someone out there. Never give up hope about that. There are some amazing people out there who will know how to help you properly and get you the help and care you need. You just need to find them. There are endometriosis experts out there and when you find them, they will help you.

Final word

If you do need help and assistance with endometriosis, or need help getting diagnosed properly, please give my staff a call, or send an email, and find out how I may be able to assist you. I do consultations in person and online as well. There are some conditions with online consultations, but my staff will explain all this too you. You may also need to come and see me in person, so I can make sure you get all the appropriate investigations and testing done too. I also have a team of experts I work and refer to as well. I do see people from all over Australia, far and wide, and some from overseas as well.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-The Endometriosis Experts

 

Microbiome

The Importance Of Properly Restoring The Microbiome For Optimum Health

One of the things I teach my patients is the importance of properly restoring the microbiome for optimum health and also reducing inflammation in the body.

Many people’s daily bloating, fluid retention, gastrointestinal symptoms, health issues, chronic disease states are being exacerbated by an unhealthy balance in this unique ecosystem we call the microbiome.

The problem is that many people do not really understand the importance of the microbiome, and even many healthcare professionals do not fully understand how to help with proper microbiome repair and restore.

Many people are also led to believe that by just taking probiotics, that this is enough to restore the healthy bacteria in the gut/microbiome.

I wish it was that easy, but it isn’t and this is why many people continue to have gastrointestinal issues, inflammation and chronic health issues, despite thinking that are doing the right thing for their gut health.

What is the Microbiome?

The human gastrointestinal tract (GIT) is host to an extraordinary amount of microorganisms composed of bacteria, viruses and microbes, collectively known as the microbiome. The microbiome is the name given to all of the genes inside these microbial cells.

Every human being has anywhere between 10 trillion and 100 trillion microbial cells all working together in a symbiotic relationship. This benefits both the microbes and their hosts, as long as the body is in a healthy state.

Recent scientific advances in genetics mean that humans know a lot more about the microbes in the body. There has been lot of time and money put into researching the interactions within the human body’s ecosystem and their relevance to health and disease.

The two terms ‘microbiota’ and ‘microbiome’ are often used to mean the same thing and are used interchangeably. I will explain the differences between them and how both are being used and researched in modern medicine.

You exist in a symbiotic relationship with your bacterial ecosystem, and there is a two-way relationship that makes your health inseparable from that of your microbiome and vice versa.

The benefits of a healthy microbiome/microbiota

The benefits of a healthy microbiome/microbiota, extend beyond the gut and digestive system and has a significant systemic impact on some the following:

  • Nutrient metabolism
  • Body composition (weight)
  • Cardiovascular health,
  • Chronic disease states
  • Inflammation in the body
  • Pain pathways
  • Immunity
  • Mental Health
  • Neuroendocrine function
  • Gene Expression

What is the Microbiota

The gut microbiota used to be called the microflora of the gut. The importance of the microbiota has been known for a long time, but now medical science is discovering just how important it is, and it is now becoming a cornerstone of preventive medicine.

The gut microbiota contains over 3 million genes, making it 150 times more genetically varied than the human body. The gut microbiota of each individual is very unique and it has a major contribution to how a person fights disease, digests food, and even his or her mood and psychological processes.

This symbiotic relationship greatly benefits humans. The presence of this normal flora includes microorganisms that are so present in the environment that they can be found in practically all animals from the same habitat.

However, while there are good bacteria found within these native microbes, some of these microbes also include harmful bacteria that can overcome the body’s defences that separate them from vital systems and organs. There are beneficial bacteria in the gut, and there are harmful bacteria that can cross into wider systems and can cause local infections of the GI tract. These infections can then cause infection and inflammation and can also worsen disease states in the body.

What is dybiosis?

The microbiome plays an important role in resisting intestinal overgrowth of externally introduced populations that would otherwise cause disease. In our microbiome, the “good” bacteria compete with the “bad,” with some even releasing anti-inflammatory compounds.

Bacterial dysbiosis produces an endotoxin called lipopolysaccharide (LPS). It is one of the most inflammatory substances known. LPS is also major contributor to the inflammation, which then drives many chronic health conditions and disease states.

These bad bacteria are called dysbiotic bacteria and cause a process called ‘dysbiosis’.

Broadly speaking, dysbiosis indicates the existence of either the wrong microbiota (e.g. overgrowth of bacteria, fungi and/or parasites) and/or the wrong numbers of the right microbiota (imbalances in composition), or either, in the wrong place.

Dysbiosis causes increased gut and intestinal permeability, which can lead to what we call leaky gut, or leaky gut syndrome. Dysbiosis can also consequent lead to up-regulation of inflammatory pathways and lead to increased inflammation in the body.

Dybiosis is implicated in many chronic diseases

Dysbiosis is very common it the western culture and bacterial dysbiosis is now being linked to causing, or exacerbating many health conditions and disease states. Research has found links between bacterial populations, whether normal or disturbed, and the following diseases:

  • Endometriosis
  • Adenomyosis
  • PCOS
  • Asthma
  • Autism
  • Auto-immune conditions
  • Cancer
  • Celiac disease
  • Colitis
  • Inflammatory Bowel Disease
  • IBS
  • Crohn’s Disease
  • Diabetes
  • Eczema
  • Heart disease
  • Malnutrition
  • Multiple sclerosis
  • Arthritis
  • Obesity
  • Metabolic Syndrome

What Causes Dysbiosis?

There are many things that lead to bacterial overgrowth, which then leads to dysbiosis. This is why many people suffer bloating, reflux, nausea, constipation, inflammatory bowel symptoms, and many other gastrointestinal symptoms daily.

Day-to-day risk factors include a western-based diet, overly hygienic living (being too sterile), alcohol, certain medications, hormones and the use of antibiotics.

Mood disorders, stress and being overly busy are also a big factors with creating dysbiosis and something that many overlook, or do not even realise. Yes, stress is a big factor in many gastrointestinal symptoms people experience daily.

With all these factors it means that almost everyone will have some degree of dysbiosis at some point in their life.

Many constantly have dysbiosis and why they often have long-standing digestive symptoms such persistent pain and bloating, constipation, alternating diarrhoea or other digestive imbalances. We also commonly see this with endometriosis and the dreaded “endo belly”

Medications Cause Dysbiosis and Significantly Affect The Microbiome

As mention already, many medications and hormones actually have a toxic affect on the microbiome and can cause dysbiosis. It is crucial to for all of us to understand the consequences of medication use in the gut microbiome. I’ll talk about this in my next post.

The good news, however, is although medications can cause a dysfunctional microbiome quite rapidly, you can begin to restore a healthy microbiome just as quickly through strategic microbiome restore.

Proper Microbiome Restore Protocols

When it comes to proper microbiome restore,  it isn’t just as easy as taking any old probiotic, or a combination of probiotics. Microbiome restore requires and individualised and strain specific approach and it needs to be done in stages with antimicrobials, gut repair and prebiotics as well. Dysbiotic microbes can be hard to treat effectively because they have evolved and adapted to life inside human beings. Consequently, elimination of these organisms requires a similarly evolved and adapted approach. This is all part of the microbiome restore protocol I use with my patients.

A New Understanding

When it comes to the perfect microbiome, researchers have discovered there is no ‘one size fits all’ across various populations. It is important to recognise that not all strains are created equal when it comes to their ability to rebuild a healthy microbiome.

What is now known is that there are only certain types of good probiotic bacteria that have benefit for our gut and microbiome, and that some strains of probiotic bacteria have no benefit. These new finding mean that we need to adopt a strain specific approach when repairing and restoring the microbiome.

From recent investigations and research, the best results are gained by introducing strain specific influential probiotic that have beneficial functions. These specifically influential strains are able to restore each patient’s unique microbiome by promoting the growth of key commensal (symbiotic) groups, but also by improving overall GIT function.

The Importance of Prebiotics

In addition to prescribing a specific probiotic formulation, prebiotic therapy is needed to help support and encourage the establishment of healthy microbiota by significantly increasing the numbers of beneficial bacteria. Without prebiotics, the probiotic bacteria do not grow and this is why they are essential for microbiome restore. Prebiotics are not talked about enough and many people do not realise their importance and often wonder why their probiotics are not working effectively enough.

Prebiotics are also needed to promote the growth of healthy microbiota, begin refurbishment of gut mucosa and improve gastrointestinal immunity. Prebiotics also help with inflammation and also support the integrity of the intestinal barrier, provide healthy immune responses and promote intestinal microbiome balance.

Microbiome Restore Protocols

With emerging research now highlighting the significance of developing and maintaining a healthy microbiome, it is important that everyone knows the importance of appropriate probiotic and prebiotic combinations. By supporting the restoration and repair of our micriobiome, we can all optimise our health, improve treatment outcomes and also help with reducing the risk of many chronic disease states.

If you would like to find out how to restore your microbiome properly, please give my friendly staff a call and find out how I may be able to assist you. Online and in person consultations are available. Some conditions apply.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

References
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  8. Hsieh H. Versalovic J. The human microbiome and probiotics: Implications for pediatrics. Curr Probl Pediatr Adolesc Health Care. 2008;38(10):309–327.
  9. Lam EK, et al. Enhancement of gastric mucosal integrity by Lactobacillus rhamnosus GG. Life Sci. 2007;80(23):2128-36.
  10. Seth A, et al. Probiotics ameliorate the hydrogen peroxide-induced epithelial barrier disruption by a PKC- and MAP kinase-dependent mechanism. Am J Physiol Gastrointest Liver Physiol. 2008;294(4):G1060-9.
  11. Gibson GR. Roberford M. Dietary modulation of the human colonic microbiota: introducing the concept of prebiotics. J Nutr. 1995;125:1401-1412.
  12. Fastinger ND, et al. A novel resistant maltodextrin alters gastrointestinal tolerance factors, fecal characteristics, and fecal microbiota in healthy adult humans. J Am Coll Nutr. 2008;27(2):356-66.
  13. Raninen K, et al. Dietary fiber type reflects physiological functionality: comparison of grain fiber, inulin, and polydextrose. Nutr Rev. 2011;69(1):9-21.
  14. Robison LE. Reeves S. EpiCor® and its immune effects on gut health. Embria Health Sciences, LLC. [Online]. No date. Available from: http://www.embriahealth.com/upload/pdf/EpiCor%20Science%20%20EpiCor%20and%20its%20Immune%20Effects%20on%20Gut%20Health_FINAL.pdf [Cited 16/02/13].
  15. Jensen GS, et al. Antioxidant bioavailability and rapid immune-modulating effects after consumption of a single acute dose of a high-metabolite yeast immunogen: results of a placebo-controlled double-blinded crossover pilot study. J Med Food. 2011 Sep;14(9):1002-10.
  1. Bartoli, C., Frachon, L., Barret, M., Huard-Chauveau, C., Mayjonade, B., Zanchetta, C., … & Roux, F. (2018, May 30). In situ relationships between microbiota and potential pathobiota in Arabidopsis thaliana. The ISME Journal. Retrieved from https://www.nature.com/articles/s41396-018-0152-7#article-info
  2. Berg, R. D. (1996). The indigenous gastrointestinal microflora. Trends in Microbiology, 4(11), 430-435. Retrieved from https://www.sciencedirect.com/science/article/pii/0966842X96100573
  3. Carpenter, S. (2012, September). That gut feeling. Monitor on Psychology, 43(8), 50. Retrieved from http://www.apa.org/monitor/2012/09/gut-feeling.aspx
  4. Clapp, M., Aurora, N., Herrera, L., Bhatia, M., Wilen, E., & Wakefield, S. (2017, September 15). Gut microbiota’s effect on mental health: The gut-brain axis. Clinics and Practice, 7(4), 987. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5641835/
  5. NIH Human Microbiome Project. (n.d.). Retrieved from https://hmpdacc.org/
  6. Shepherd, E. S., DeLoache, W. C., Pruss, K. M., Whitaker, W. R., & Sonnenburg, J. L. (2018, May 9). An exclusive metabolic niche enables strain engraftment in the gut microbiota [abstract]. Nature, 557, 434-438. Retrieved from https://www.nature.com/articles/s41586-018-0092-4
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Why you cannot manage your disease by yourself!

In this video post, I am going to talk about why you cannot manage your disease by yourself.

Many of us like to think we can treat ourselves, or manage our own disease, or even control every aspect of our lives, but the reality is.. .we can’t.

All to often I see many people trying to manage their own disease state and some of these people are actually healthcare practitioners themselves. The problem is that nobody can manage their own health issue and it is not safe to do so, because of being too close to it. Then the judgement becomes clouded and then this can lead to a vicious cycle of mismanagement and frustration too.

Have a listen to my latest video blog about this issue. I am also talking about this from personal experience and from someone who knows what many people go through too. Today was one of my bad day, so I have an open and honest talk about why you cannot manage your own disease yourself.

No matter who you are, everyone needs help from someone who specialises in the disease that they have. There is help out there. You just have to find the right people to help you.

If you do need help with managing a chronic disease, you can also give my friendly staff a call and find out how I may be able to assist you.

 

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

Don’t Wait Too Long To Get Help

In this post I am trying to highlight the importance of not waiting too long to get help, when it comes to pain, or any health condition.

Many people, myself included, with long term pain, chronic health conditions, often have higher than normal pain tolerance and can often leave things too long before seeking professional help. The problem is that the long a health condition is left, the longer pain is left, the harder it can be to treat, or manage on a clinical level.

I know I have spoken about this previously on many posts and why I am very passionate about early intervention for any health condition, especially pain.

During the last couple of weeks I have heard of people leaving things too long and actually ending up dead because of it. Just today, I have had two patients diagnosed with cancer, after leaving symptoms too long before seeking help. It just hits home the importance of seeking help early for any health issue we all face.

Have a listen to my latest post as to why we should not wait too long to get help.

Stress, Distress and De-Stress

Knowing the difference between stress, distress and de-stress.
Many people do not realise that being constantly busy and being stressed slowly creeps up on them and can one day cause major health issues for them. Being busy for for the sake of being busy is a very common issue these days. We actually refer to it as “The Disease of Being Busy”.

Too many people run their lives and their social status around this term. It is not a badge to be worn with pride at all. When people say that they don’t know how to slow down and relax, this isn’t good. They actually need to learn and retrain the body how to relax and what it feels like to relax.

Being too “Busy” causes stress on the body and can lead to disease, or exacerbate diseases that are already there. It also makes pain worse too.

Life is too short to be busy all the time and just being busy being busy. There is always time in a 24 hour day to take at least 1 hour for self. It is OK to leave emails, leave the washing etc and just be.

At my clinic I help people with learning how to relax and also giving ones body time out with many different forms of treatments. I also work in with counsellors, psychologists, and mindfulness practitioners,  who can teach people coping skills of how to slow down and enjoy life more.

Life is not a race and it is important that we teach children that being too busy is not OK either. It is OK to say “No” to everyone and just take time for self.

Stress and distress can not only cause physical symptoms, such as pain, but it can also cause emotional and psychological issues too. Stress can also kill you.

Symptoms of stress can accumulate over a long period of time and then present with acute symptoms, which can then become chronic. This is why I talk about learning to put yourself first and put your oxygen mask on before attending to others.

It is important to be aware of stress levels and also learning coping strategies and learning that being busy for the sake of being busy, may one day catch up with you and slow you down for good.

Have a listen to my latest video post about stress, distress and de-stress.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate.

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Anxiety and Chronic Pain and Chronic Conditions

Chronic pain and chronic illness can be debilitating. Both pain and chronic conditions can go hand in hand and both can interfere in the daily function in life.

While chronic disease state can cause pain, many do not realise that there are also other factors that exacerbate chronic disease and chronic pain.

Diet, alcohol, drugs, cigarettes, additives in food, chemicals, environment, and emotions can all exacerbate and flare chronic disease state and pain. But some of these things people do not correlate to being part of their daily struggles and increased levels of pain.

Anxiety and depression are two of the things that can exacerbate pain and also lead to chronic pain pathologies. For this post I am going to focus of anxiety because I see so many people who have it. Many people do not realise that they actually have anxiety.

Many people also ignore the signs of anxiety and fob it off as not being able to switch off, or they think too much, or they just do not know how to slow down and relax. Many just fob it off saying that they are busy and don’t have time to stop. They are basically busy being busy. But is it really all those things they think they are?

What is anxiety?

Anxiety is a normal emotion and almost everyone has experienced anxiety at some point.  It is the emotion that people have when something dangerous might happen. Anxiety is closely related to fear. Fear occurs when something dangerous is happening. Anxiety can also activate that fight or flight response and get one adrenalin activated and running through ones veins. Adrenalin is activated to help us get away from danger. The problem with anxiety, danger isn’t really happening. It is the perception of something that may happen. None the less, the body prepares for danger and the nervous system goes into hyperdrive and the fight or flight response is activated.

As mentioned before, anxiety can also be when something dangerous is seemed to be pending, or hasn’t happened yet, though we perceive it could.  This is why people with anxiety always tend to be nervous. They are nervous in their feelings, their body and their behaviours as well. These people are quite literally waiting for the possibility of something dangerous to happen, or needing to get up and get moving. They literally cannot sit still.

Anxiety can also be divided into different aspects: feelings, physical manifestations, thinking, and behaviours.

Feelings

A number of feelings are associated with anxiety. It can cause one to feel apprehensive, feel alarmed, feel tension, feel nervousness, feel doubtful and also make one feel out of control.

Physical manifestations

Anxiety can also lead to physical manifestation in the body as well. It can cause muscle tension, increased hear rate, palpitations, increased blood pressure, heaviness in the chest, gastrointestinal upset and urgency, cold hands and feet, increased sweating, dizziness and increased energy and even cause the body to shake.

Thinking

Anxiety can also influence the way we think. It can cause increased worry, increase focus on things that have not occurred, increased focus on possible danger and all of the consequences that could occur, increased thinking of the worst case scenarios of what could happen to one self and anxiety can also cause increased thinking and overthinking in general.

Behaviours

Anxiety can also influence the way be behave.  It can cause restlessness, avoidance of activities ( for fear of perceived danger), cause nervousness, inability to sit still, need to get up and move all the time, and cause difficulty in completing things.

Sometimes, anxiety becomes persistent and then can get in the way of day-to-day life. When anxiety is persistent and interfering in day-to-day life, it’s considered no longer normal. It is then considered a disorder.

Anxiety and pain

Everyone experiences pain at some point in their life, but for those with anxiety and depression, pain can become intense and very hard to treat.

Anxiety is now known to be one the most common conditions that accompanies chronic pain. Anxiety tends to go hand in hand with chronic pain, because pain is a danger signal.  When we get pain it is to signal danger that something is wrong in the body and requires attention.  Pain then sets of the warning system that then leads the nervous system to respond. This then often leads to that fight or flight response talked about previously.

The nervous system’s response to pain just in the same way it responds to danger. This can be in the following ways:

  • Feelings of alarm, apprehension and distress
  • Increased reactivity of the body, such as
  • Increased muscle tension,
  • Increased heart rate ad blood pressure,
  • Gastrointestinal reactivity and digestive pain and upset
  • Increased cognitive focus on the pain, and then a tendency to worry and catastrophize about it
  • Avoidance behaviours, such as guarding, resting, staying home and not engaging in activities that might bring about or increase pain

In acute pain, these responses might be quite helpful. These feelings of pain and fear allow someone to seek help in order to prevent further injury.

In chronic pain, these feelings become anxiety and avoidance behaviours. When someone has chronic pain for a long time, the anxiety and avoidance behaviours can become chronic. The chronic anxiety leads to a chronic sense of alarm or distress, which makes patients nervous and can’t sit still and finds it very hard to relax and recover.

Anxiety and chronic pain

Chronic pain also affects the brain and thought patterns and it can lead to a chronic focus on pain, which pre-occupies the attention of the pain sufferer. Everyday decisions seem to turn on how much pain the patient has at any given time. It also leads to then nervous system to become over reactive. This can then lead to chronic muscle tension, which can switch pain pathways on more and this then leads to more pain. Chronic avoidance behaviours can then lead to an increasing sense of social isolation, inactivity, muscles loss and then not being able to cope or function physically and mentally. Daily life literally can become an effort and the person actually become disabled.

When the body reaches this state the nervous system has become stuck in the vicious cycle of constant reactivity. Pain pathways become more reactive and harder to switch off and pain levels can become very hard to manage. This state of reactivity is associated with a condition called central sensitization. This is where acute pain has becomes chronic and then this goes hand in hand with anxiety and other mood disorders.

Anxiety can present differently in each person

Anxiety can present very differently in each person and chronic disease states can also trigger anxiety. Anxiety can also exacerbate a chronic health condition too. It can be a vicious cycle that keeps going around and around.

Everyone’s cause of anxiety is different and it’s often a combination of factors that leads someone to feel the way they do. Many do not even realise they are suffering anxiety as mentioned before.

It’s important to remember that you can’t always identify the cause of anxiety, or change difficult circumstances. You cannot always be in control of every situation either.

Recognise the signs and seek professional help

The most important thing is to recognise the signs and symptoms and seek advice and support.

There are people that specialise in managing chronic pain. Good pain management programs should use a multi-modality treatment and management approach consisting of the most effective treatments for anxiety, such as counselling and psychology, medications, diet and lifestyle changes, exercise and other therapies that can assist with pain and anxiety.

With the right help and seeing the right people, it is possible to get ones life back despite having chronic pain, and in the process overcome anxiety. The one thing I always explain to people it that you will not be able to do this on your own. You will need help from qualified professionals. No amount of Dr Google, or advice from friends and family is going to be able to help you get through this without the help of qualified professionals trained to help in this area of healthcare.

If you are experiencing long term pain and could also be suffering from chronic anxiety, please go and talk to your healthcare provider. Many people are unaware that they have anxiety and this is actually exacerbating their current pain. Your healthcare practitioner can also talk to you about effective pain management and also help you seeking help and getting coping skills for your anxiety as well.

Beyond Blue has a very simple Anxiety checker (click here) and I urge everyone to take the test, especially those with chronic long-term pain and health issues.

Please remember that there is help out there. Please do not suffer in silence thinking that there is no help, or no end in sight for your pain and your anxiety as well.

Take care

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

01 Dr Andrew Orr

 

 

Expectation versus reality with surgery and ongoing healthcare management

I have talked about expectation versus reality before but I wanted to go over this subject again. I think that many treatment plans and even surgical interventions and treatment outcomes are not explained very well.
This then leads to people not really knowing what realists health outcomes are and also what realists healing times are either.
In my latest video blog I talk about the expectation versus reality when it comes to surgery and recovery times. I also talks about being realist about time frames with treatment and results on ongoing healthcare.
I also talk about the realist time frames to help with certain conditions and also being real about healing times for pain.
Watch my latest video post to see what I am talking about and trying to explain
Regards
Dr Andrew Orr (DOAM, MRepMed, MWHM)
-No Stone Left Unturned
-Reproductive Medicines and Women’s Health Experts
-Women’s and Men’s Health Advocate

Let’s Talk About Iron

Let’s talk about iron. After my recent post about me having haemochromatosis and the importance of regular venesection and proper screening, I thought we should talk more about iron.

We need to not only talk about high iron and genetic disorders, such as haemochromatosis, but also talk about iron deficiency and proper screening and management of that as well.

In this video post I talk high iron, low iron and everything in between. I also talk about genetics and auto-recessive genetic pathways and the parental mode of inheritance.  This also goes for many other health conditions we see in people.

Please remember that early intervention, early screening, early treatments and early management is the key to any disease state.

Endometriosis Facts endometriosis can only be definitively diagnosed via surgical intervention 1

The Only Way To Definitively Diagnose Endometriosis Is Via Surgical Intervention–

The only way to definitively diagnose endometriosis and the causes of period pain is via surgical intervention. Scans, blood tests etc do not diagnose endometriosis. You cannot have a scan to diagnose endometriosis and you cannot have a blood test to diagnose endometriosis either.

The definitive diagnosis of endometriosis needs to be done via a laparoscopy

The definitive diagnose ‘is’ and ‘always will be’ via a laparoscopy/laparotomy, along with histology (biopsy) and tissue samples taken to examine. Most times a hysteroscopy is done at the same time and if there is an evaluation for fertility, dye studies for tubal patency will be done at the same time.

Women with endometriosis need to see an Advanced Trained Laparoscopic Surgeon

A laparoscopy is the goal standard investigation of examining the pelvis and for investigating gynaecological disorders such as endometriosis. The laparoscopy also needs to be done by what we call an Advanced Trained Laparoscopic Surgeon, who has extra years of surgical training, and who specialises in this disease and specialises in the excision of endometriosis.

It can’t just be done by a regular obstetrician/gynaecologist and this is where many go wrong. Many women just haven’t seen the right surgeon first up who has he proper skills to deal with endometriosis effectively. The first surgery should always be your best surgery and early intervention and management of this disease is crucial. The longer it is there, the worse it can become.

Ultrasounds and Bloods Tests etc Cannot Diagnose Endometriosis

All too often I get women telling me that they do not have endometriosis because their doctor has ruled it out via an ultrasound, or blood test. This is so distressing to hear and this is why so many women are missed and dismissed with this horrible disease that affects 1 in 10 women world wide.

Endometriosis Management Requires a Multi-modality Approach

But, please know that surgery does not cure endometriosis. It is just the first stage in the management of the disease and the active lesions that have been expressed and are present now. Endometriosis can, and will return for many suffers and this is why endometriosis needs ongoing care and a multimodality approach to treat it effectively. It needs a team to manage it properly. While surgery is an important part of evaluation, management and diagnosis of endometriosis, it is to help with symptomatic pain and then other treatments are needed to suppress the disease from further developing and also managing ongoing symptoms.

If you need help with period pain, or  assistance with endometriosis, please give my clinic staff a call and find out more about how I may be able to assist you.

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The Endometriosis Experts