Bed (AR)Rest

It was a Saturday and I started my day early, woke up at around 7 am and left home around 8:30.

1. met up with a client in MRT Ayala Station, Makati where I had to go up and down the stairs several times as I need to pee (restrooms were located at the basement)

2. waited for hubby to arrive and check out baby stuff in the nearby department store (walking the mall for about an hour or so)

3. went to Concepcion-Carrier in Sucat to check on their air conditioners in their bodega sale, realized their prices where quite steep (plus they don't offer warranty for service and parts, all items are working but have dents, discoloration, etc. pulled out from stores, they are either class A or B)

4. decided to go to Festival Mall in Alabang to check on the prices in the appliance store. walked some more and did some grocery shopping)

5. went home and arrived by 5:00 p.m.

I felt tired but nothing really unusual except for my achy feet from all the walking. I went to the living room and decided to watch TV. After a few minutes, I felt an urge to pee and realized that my crotch was a bit wet. I hurried to the bathroom and peed. As I wiped, I noticed the tissue became pinkish. I looked at the toilet to check for any unusual discharge but there was nothing. I was wearing dark panties so I couldn't decipher whether it was stained. I grabbed a tissue and wiped it on my undies and it caught a reddish spot. It was freaking me out so I called hubby and showed the tissues to him. I saw his face turned pale and asked me if I'm feeling ok. He told me to call my OB right away. Good thing my OB replied in a jiffy and advised me to relax, observe and take Duvadilan every 4 hours. My hubby rushed to the drugstore, he was really worried but I know he was trying to keep his calm to pacify me. 

That night I could hardly sleep. I was so anxious. We prayed. That was when I was able to get some sleep.

I woke up the next day to pee in the chamber pot (arinola). When I got up, I noticed a drop of blood with my urine. Again, I felt blood shooting up my head and I was nervous. I woke my husband up. I texted OB once again to report what happened. Told her my tummy felt cramped, occasionally bunched up and tightening. I have some pain in my pelvis. And mostly what made me really bothered was I haven't felt my baby move that day. She must be worried with my text message because she called me in an instant. She asked if I had taken my breakfast and that I should lie on my left side and try to feel the movement. While we were talking, I felt a kick! Thank, God! She told me to just relax and keep calm. She ordered a urinalysis and do some self check down there to test  for possible infections.  I should also take note of cheesy textured discharge, pain or itchiness. Lab results confirmed I had urinary tract infection and she prescribed Co-Amoxiclav 550mg to be taken 3x a day. Plus I need to finish a pack of 6 of Canesten suppository to clear the bacterial infection.

Because we only see my OB once a month, we were glad that she's amenable to answering questions over text messages and calls. I just text her my questions and she would most of the time readily reply to my queries. She would even give prescriptions thru text.

And because of all those things that's been happening to me lately not to mention I still have the endometriotic cyst and adenomyosis, eventually made my OB decided to put me on bed rest. I was on my 22nd-24th week then.  I've been experiencing intermittent contractions, which made walking difficult, I had to put a hand under my belly every time I stand  as if my pelvis would drop. The cramping was radiating from my belly to my hips down my thighs and legs. Though there was no unusual discharge aside from leukorrhea, my OB said it would be better if I take a leave from work and rest at home for at least 2 weeks. I should also continue with Duvadilan once every 4 hours. She issued a medical certificate that my hubby picked up from her UPMC clinic which says "pregnancy uterine, 22-23 weeks in pre-term labor, placenta previa", advised to take 2 weeks bed rest."

Being confined to your bed is not a nice feeling. I couldn't do anything but lie around the whole time. Good thing I was allowed to get up from time to time to use the bathroom and take a bath though I had a plastic stool with me so I can sit under the shower.  My hubby would bring me breakfast, lunch and sometimes dinner to bed.  On the contrary, it made me productive as it was during those times when I got to jump start this blog. I was able to feel more relaxed and composed as I kept account of this journey thus far. Though it was a challenge to type and surf the net lying down, I managed to finish a couple of post but delayed publishing them. 

Every day of those 2 weeks, I talked to my baby. I told her to be strong for mom and dad and hold on for a couple more weeks.  I played music for her and my husband would read her poems and stories. I told her it is indeed beautiful outside but she can mostly enjoy it when she's ready. We are eager to see her but we are willing to wait until it's time. We felt she's responding to each touch and caress with her constant movements. Her squirms and gentle kicks seemed to say, "Hey, mom and pop! Don't you worry. I'm A-OK. See you in a few weeks! I love you!"

Two weeks seemed so long without much to do.  But I realized how fast time flies that when I went back to work, I miss not having to do anything but lie around and talk to my babe.  Nevertheless, I was thankful I got to take that break from all the hustle and bustle and had a chance to bond with my sweet little one. I felt it brought us even closer.  It also made me realize how precious a gift was given to us.  I couldn't risk the dear life inside me. 

Thank, God! All Normal :-)

At 22 weeks (roughly 4 months), I was offered the Congenital Anomaly Scan (CAS) and Fetal Biometry as mid-pregnancy ultrasound scan. 

The CAS takes a close look at the baby and the uterus (womb).  The sonographer will check that the baby is developing normally and look at where the placenta is lying in the uterus. This is usually done in between 24 and 28 weeks, though I had mine at 22 weeks and 1 day. 
Seeing our baby on a screen was a wonderful event. We could see the baby is more like a human, with head, hands and feet. My husband was allowed to be with me during the scan to share the experience with me. He was quiet while the whole thing is happening (I can sense that he was nervous) lalo na when the sonographer asked me, "Bakit ka pinapa-CAS? Nagkasakit ka ba? Meron ka bang ininom na gamot?" (Why were you ordered a CAS? Did you get sick? Did you take any medications?) 

I couldn't recall an instance when I got really sick (though I have allergic rhinitis since I was little) nor remember having taken any medicine (I never took anything except for supplements since I knew I was pregnant). 

Although it was lovely to see our baby, the scan's main purpose is to confirm that baby's developing normally.  The scan took more than 20 minutes.  I kept my eyes on his face, carefully watching his reactions as he performed the scan.  My heart was beating fast. Silently, I was praying everything will turn out good and normal. It was quite difficult to read him because of his poker face reaction. Parang gusto kong itanong: "Doc, okay lang po ba ang baby namin? Wala po bang problema?" But I tried not to be atat. I just kept praying.  Then he said, "Malikot 'tong baby mo, ano?" then, "Baby, huwag masyado umikot...Ang hirap niyang hulihin, mommy!" 

I just smiled.

After a few more minutes, the sonographer turned the screen toward us and showed us the captured views and images. He showed us the shape and structure of baby's head including the brain; the face which showed no cleft lip/palates; spine (length and cross section); abdominal wall and internal organs; the heart (chambers and valves), lungs, kidneys and bladder; and of course the arms, legs, hands and feet. He even counted baby's fingers and toes- "1,2,3,4,5 - 1,2,3,4,5 COMPLETE!". He also measured baby's body to see how well our tiny tot is growing by head circumference (HC), abdominal  circumference (AC) and femur or thigh bone (FL). My baby is also in a transverse lie. The reason why we didn't get to know (yet) if we're having a boy or a girl. 

Is it a boy or a girl??? We can only guess :D

Thankfully, the measurements matched up to what's expected of our baby, given the anticipated due date (EDD: Sept 14, 2012).

BPD: measures the head; FL: bones/longitudinal growth
Heart Rate: 159bpm

However, the sonographer said he needed to perform a transvaginal ultrasound since he needed to check the placenta, the umbilical cord and the level of amniotic fluid (AF). The umbilical cord is fine and I have adequate AF for baby to move freely. But he suspected I have low lying placenta. 

True to his hunch, my placenta (inunan) lied low reaching down to partially cover the neck of my uterus (cervix) or what they called placenta previa. Asked what I must do to correct it, he said: "Nothing. Just observe. You'll have to have another scan in the 3rd trimester (8th month) to check its position. By then, it's likely the placenta will have moved away from your cervix. But definitely NO CONTACT."

Scan showed I have partial placenta previa 

After the scan, I texted my OB of the results of the CAS. She didn't seem alarmed. And just what the sonologist told me, it usually corrects itself as the pregnancy progresses as the uterus expands so does the placenta as it moves up. I shouldn't be alarmed with my baby's current position/presentation as babies move a lot and they tend to position head first (cephalic) at approximately 32-34 weeks of gestation to prepare for birth. She told me to avoid strenuous activities and be alert of any discharge or bleeding. 

Despite the placenta previa thing, we were very happy that baby is fine and growing normally. That's the thing to be thankful about! God is good! :-)

Thump! Thump! Thump!

Gestational Age: 8weeks 6days 

Just like our first consultation, our next check up was nerve-wracking (honestly, I felt more anxious).
Today, OB's going to check our baby's heartbeat. She gave me another request for a transvaginal ultrasound as suggested in the previous one. This will determine the fetal viability.

MSD: 3.7 cm. with crown rump length (CRL) of
2.1 cm equivalent to 9 weeks

Since the day we knew we were pregnant, we've been constantly praying for this pregnancy to prosper and reach full term. 




I know I have some condition which will make this pregnancy quite difficult and sensitive. My OB was even more "praning" than us, constantly reminding me to inform her of any pain, discharge or bleeding.


This picture to the left shows my baby @ 8w6d measuring 2.1cm or about the size of a kidney bean! (below) :)  

Finally, the ultrasound confirmed a single intrauterine pregnancy at 9 weeks by CRL with good cardiac activity. Yay! Thank, God! Happy thoughts! :'-)

My baby's heart beating at 160 beats per minute! That was fast! :)

We're pregnant! Now what?

"Congratulations, kudos, and woohoo – we're pregnant!"
  

In those rare moments when you're not dancing on air or completely freaking out, you may be wondering what you need to do next. That was what pretty much what we felt when we found out we're about to become parents in less than 40 weeks time. 

I was having mixed emotions. The moment that I saw those two purple lines, my heart skipped a beat. I was happy, excited, nervous and anxious all at the same time. Understandably, happy because finally after almost 2 years of TTC, fervently praying for a child-- this is it... I'm a step closer to my ultimate dream: becoming a mom!

On the day that we knew we were expecting, I immediately sent a text message to my OB. She was ecstatic! She recounted the period when we were just treating my endometriosis. It was quite an achievement on both sides. Primarily because we didn't need to go the usual tedious and draining route of work ups unlike most of her patients.  Thank, God!  She asked to me to see her soon. :) Read about our first consultation here.

Being first time parents, we were so very excited (!) to meet our little bundle of joy.  I thought it was a must to load up on good pregnancy (and parenting) knowledge. I registered with Baby Center so I can make use of their online tool: an estimate of my baby's development week by week. I also started compiling photos on the milestones page :)

But I find this site neater since it's in the Philippine context so expectant Filipino moms and dads like us can better relate to.  Plus it's got a simpler layout you can easily navigate among its pages making it an easier read.

Firstly, it's very important to prepare for an A+ Pregnancy.  Everyone benefits from a balanced diet, but pregnant women especially need extra nutrients because of the role these play in fetal development. For 9 months, our baby's nourishment will rely solely on what we eat. 

(For first time moms like me, you may also check out these interesting topics.)

Our journey has just begun and we hope and pray to make the best out of this wonderful path we have decided to take.

This is it!

Gestational Sac @ 4w6/7d

On our first pre-natal consultation, my OB had to check my baby's implantation- since in several cases, endometriosis results in ectopic pregnancies.

While performing the transvaginal ultrasound, I was quite nervous and praying everything will turn out okay. I was alone in the examination room while my husband waited outside. Though I could sense his nervousness, I kept on praying, whispering to God how we waited and wanted this precious gift.

The moment OB caught a glimpse of the GS (gestational sac), she exclaimed: "There's your baby" pointing to the monitor. "Everything looks good! It's not ectopic."

I was very happy with what she said and let out a loud sigh of relief. Thank God, it's intrauterine! meaning it implanted on the wall of my uterus.

Based on the TVS, my baby is about 5 weeks old and a teeny-tiny one: about the size of a pumpkin seed!

After seeing the result of the TVS, I was advised to take folic acid once a day and because I have adenomyosis and endometriosis, my OB prescribed Duphaston and Duvadilan tablets both to be taken 3x a day.

Duphaston (left) is a brand of synthetic hormone (dydrogesterone) that is similar to the naturally occurring female steroid hormone progesterone. Progesterone plays an important role in regular menstruation, the development of a healthy uterine lining and maintaining pregnancy.

Duvadilan (below) on the other hand, is a brand of Isoxsuprine (used as isoxsuprine hydrochloride) used as a vasodilator which causes direct relaxation of uterine and vascular smooth muscle. It is used in humans for treatment of premature labour, i.e. a tocolytic. 

Here's the result of the ultrasound:

Within the gravid uterus is a well-formed gestational sac measuring 1.45cm., equivalent to 4 6/7 weeks age of gestation. No fetal pole is noted in the present study. No retrochorionic hemorrhage is seen.
The previous noted adenomyosis is still noted, 2.5 cm thick. No adnexal masses seen.

Impression: Early intrauterine pregnancy 4 6/7 weeks by gestational sac.
Follow -up scan suggested to determine fetal viability.

EDC: 9/14/2012

This marked the beginning of our 9-month journey.

The Long Wait is Over!

I was beginning to put on some weight that I seemingly lost during my 6-month treatment with GnRH. I wasn't eating a lot but I noticed that my jeans were getting tighter (now I really have to get new ones), my tummy's bulging and my hips were getting fuller.  My officemates were quick to note that indeed I gained weight. At least they said I looked a lot healthier than the previous months, when my uniform seemed to be so loose and I looked like a zombie.


It was December... amid all the hustle and bustle and the rush of the holidays.  Everybody seemed so busy, I myself was busy with a lot of things. Literally, I got so preoccupied that I even forgot that I'm expecting my monthly visitor whose been absent for more than 8 months!


Parties were everywhere! Late night gimmicks and pigging out. Everything seemed to be "normal" for me. I went by my daily routine. Until one day, out of the blue, I just thought of texting my OB why hasn't my period arrived? She was quick to respond that it is actually ok not to have it soon so my endo won't recur just as fast. But she said I can do a pregnancy test just to be sure. A what?!  Yes. A PREGNANCY TEST.


I was nervous when she told me about doing a pregnancy test. First time jitters, i must say. Honestly, even if we've been married for quite sometime I never used a home pregnancy test (HPT)...ever... Simply because before I had this thinking that if I don't get my period in a month, that means I'm pregnant-- because my period was never late nor absent (not until I had the GnRH shots). So in short, the idea was kind of new to me. Funny, isn't it?


My hubby bought an HPT and I was reluctant to use it.  So many things were running in my head.  But I have to do this. I need to find out. And so I did. That was early morning of December 17, 2011. And the result:  NEGATIVE.


I didn't know what to feel then.  I immediately grabbed the HPT and threw it in the trash.  I was disappointed. And I didn't want anybody seeing it.


That afternoon, my husband asked me if I did my homework. I just answered with a nod with no reaction whatsoever. I just felt so insecure that moment more so when I saw the way he reacted to my reply. We were walking then, out in the busy street full of people but he couldn't hide his dismay. If he could only pound his fist over something, he would have done so.  He must have expected too much. I was just silent.


After that day, we didn't talk about it anymore. I guess it hurts to discuss things. We just let it be.


The next two weeks were busier.


We were supposed to welcome the new year with my family but then my husband asked if he could celebrate with his family this year since we spent last year with mine.  I obliged.  So we made the 5-6 hour trip to the province. We did the last minute grocery shopping. Very very stressful. 


They were also having their annual get together. We were hopping from one house to another, one village after the other trying our best to visit his relatives, getting to know each extended family member. It was fun and tiring all at the same time.


Since I could not absent from work because of the backlogs, we headed back to Manila. Even with a tired body, I dragged myself to the office.  I remember having sleepless nights. Oh... the drinking sprees? the motorbike rides? the clumsy parlor games? 


Aunt Flo hasn't arrived but I'm having occasional abdominal cramps and slight brownish discharge from time to time. My bosom were a bit sore as well. Just as when I'm about to have my period.  To me, everything was just NORMAL because I'm about to have my period except that my hips were getting wider and I found it even harder to fit in my working clothes.  


My officemates kept nagging me to do an HPT but for fear of disappointment, I won't budge. I was in denial.  And I don't want to see that look in my hubby's face again. It will definitely break my heart :(


My peers constant pressuring finally caused me to finally give in. I bought an HPT secretly. I did the test when everybody was asleep. I peed in a small container and used the pipette to put a few drops in the kit. It was kind of funny because I rushed downstairs as if I didn't want to see the result. After a few minutes, with a heart pounding so hard and fast, I went back to check on it. Guess what I saw?

10 January 2012 @ 05:24 :)

Our Support

With a number of doctors confirming I have endometriosis and adenomyosis, I began researching more about these conditions.


I downloaded bits and pieces of information: from diets, supplements, management, treatments etc. and even purchased related books that might be helpful.

BOOKS/E-BOOKS

I (hoped) to  also post here the many articles I downloaded from the Internet, which I compiled as guide specifically including diets, remedies and many other useful information about endometriosis and adenomyosis. You may send me an e-mail if you want copies of these readings.

Himalayan Goji Juice

VITAMINS AND SUPPLEMENTS
Aside from following the ENDO DIET, me and my husband took these two very special supplements which we believed helped us in prepping our bodies for healthy conception. For inquiries on these amazing products, you may send an SMS or call +639279213310.

Jule of the Orient

ACUPUNCTURE

Endometriosis is a gynecological condition that can cause severe pelvic and abdominal pain, excess menstrual bleeding and/or infertility. Western medicine often misses an endometriosis diagnosis until the woman has had symptoms for many years. Far less invasive, risky or costly than drugs or surgery, acupuncture is a natural approach, without side effects. It helps to relieve pain, regulate circulation and correct Qi energy imbalances.

SUPPORT GROUPS

I joined support groups and found comfort in the words of women who have the same condition as mine and hope from those who successfully conceived even with endo. I shared what I'm learning from the forums and blogs with my husband. He was reluctant at first but then seeing I am getting more and more optimistic each day somehow made him relieved.


Girl Talk in Female Network and EndoPhil in Yahoo Groups are just two of the many forums I visited which helped us in our journey and search for answers, treatments, and even alternatives. I felt I was stronger when I can identify with these women that though we don't see each other, there's this bond and compassion for everyone. I felt the 'virtual hugs' and the sincerity that comes with it.


I told myself, if these women and their partners were able to overcome the struggles, why can't we?

ULTIMATE SUPPORT

We couldn't discount the support we got from our family and friends who constantly provided us with encouraging and soothing words. And of course, to the Lord God Almighty thru Jesus Christ's intercession. Faith can move mountains and prayer is our best weapon. :)

The ENDO Diet

SO WHERE DO WE START?!

Let's start with pain and hormones in relation to diet …………

Endometriosis is an estrogen-sensitive condition, but the painful menstrual cramping that occurs is predominantly due to prostaglandin synthesis in the body. Prostaglandins are naturally occurring fatty acids, which are derived from dietary sources. The body can produce different types of prostaglandins through a complex series of pathways. 

There are the ‘good guys’ and the ‘bad guys’ of the prostaglandin group. The goal of a controlled diet is to block the ‘bad guys’ for their negative actions on the body, and increase the ‘good guys’ for their opposite and beneficial actions. The action of the bad guys is to increase uterine contractions, and the good guys have a soothing effect. By changing the types of oils that are taken into the diet, the production of the good guys can be stimulated, which helps with uterine relaxation. These oils are composed of omega-3 fatty acids, which lead to positive prostaglandin production. Excellent sources of the omega-3 fatty acid producing oils are:

• evening primrose
• Walnut oil
• flax seeds/oil

It is also important to decrease intake of those fatty acids that will stimulate the bad guys which are found in saturated fats, butter, animal and organ meat, lard.  In addition to decreasing bad fat intake, the diet should also consist of high fiber. Not only does this help with good digestion, but it is also thought that a diet high in fiber can decrease total circulating estrogens. It is recommended to incorporate 25 grams per day of fibre. Good sources are:

• whole grains excluding wheat and rye
• beans, peas and pulses
• brown rice
• vegetable and fruits
• oatmeal

The following foods are recommended to modulate estrogen levels by incorporating one or two servings a day:

• mustard greens
• broccoli
• cabbage
• turnips

FOODS TO AVOID

• wheat * - this includes breads, cakes and pasta products, all based on wheat
• red meats - promotes negative prostaglandins
• refined and concentrated carbohydrates - bread, flour, cakes made from refined flours
• refined sugars and honey - causes inflammatory reaction
• alcohol - consumes vit B stored in the liver
• caffeine which is found in tea, coffee, soft drinks -increases abdominal cramps and increases estrogen levels
• chocolate - as it contains sugars
• dairy produce including all milk and cheese - inflammatory
• fried food, margarine and hydrogenated fats - can stimulate negative prostaglandins
• soy products and soy protein products - tamari can be used in small amounts
• tinned and frozen packaged foods as little as possible
• additives and preservatives - increase chemical load on the system

Note: Meat, dairy and eggs, promote the pro-inflammatory prostaglandins.

FOODS BENEFICIAL FOR THE IMMUNE SYSTEM

• beans, peas, lentils
• onions
• garlic (raw or lightly cooked)
• carrots (contain beta-carotene)
• live yogurt (good for healthy intestinal flora)
• rhubarb
• seeds and sprouted seeds
• ginger
• green tea

HORMONE RE-BALANCING

Foods containing natural plant sterols (phytoestrogens) can be helpful. They are thought to block the estrogen receptors, so in turn excess estrogen in the body cannot ‘lock-in’ to these receptors. These include:

• peas, beans and pulses
• red and purple berries
• garlic
• apples
• parsley
• fennel
• brassicas: cabbage, cauliflower etc
• nuts and seeds
• celery, carrots
• rhubarb
• sage

VITAMIN AND MINERAL SUPPLEMENTS

Although the best source of vitamins and minerals is through a well balanced diet, many foods today are depleted in these vital trace elements. Today, most of us need to supplement our diet with some of the vitamins and minerals that our bodies need to function optimally.

The following is a list of supplements that will help women with Endometriosis:

• Magnesium - is a mineral and is believed to ease cramping with menstruation
• Zinc - is essential for enzyme activity, helping cells to reproduce which will help with healing. Zinc is also reported to boost the immune system and helping to create an emotional sense of well-being
• Calcium - levels of calcium in menstruating women decrease 10 to 14 days before the onset of menstruation. Deficiency may lead to muscle cramps, headache or pelvic pain.
• Iron - women with Endometriosis tend to have very heavy periods which can lead to an iron deficiency. This can lead to anemia which is characterized by extreme fatigue and weakness.
• B vitamins - these are important for the breakdown of proteins, carbohydrates and fats in the body. B vitamins are reported to improve the emotional symptoms of Endometriosis, and have proved helpful in dealing with PMT
• Vitamin C - is well known for helping to boost the immune system and help provide resistance to disease. It is also used in the body to build and maintain collagen within the body.
• Vitamin A - is another immune system booster
• Vitamin E - plays an important role by increasing oxygen carrying capacities and also strengthens the immune system
• Selenium - when taken together with vitamin E has been reported to decrease inflammation associated with Endometriosis, as well as immune system booster.

OTHER USEFUL SNIPPETS:

• Certain vegetables have substances that activate liver enzymes and help the liver to detoxify chemicals. This allows the liver to eliminate excess estrogen from the body more effectively. These vegetables include: broccoli, cauliflower and brussel sprouts.
• Auto immune diseases are thought to be triggered by free-radicals in the body, which could be an added factor in Endometriosis. Free radicals are destructive molecules and are found naturally in the body but can be made worse by pollution, stress, illness and smoking. There are minerals and vitamins that will help to fight off these free-radicals because of their antioxidant properties, including: vitamins A,C,E, CoQ10, selenium, vitamin B complex, as well as specific supplements being sold specifically as Antioxidants.
• It is very common for women with Endometriosis to suffer from Irritable Bowel Syndrome. I used to suffer from it myself, and it took quite a while to define which foods would trigger it off. These triggers can vary from one woman to another. Even simple things like drinking a hot drink when it was too hot would trigger it off in me. You need to really pay attention as to what your own subtle triggers are, as well as which foods will set it off.

TO SUM UP

• increase omega-3 fatty acids
• avoid meat, dairy products, wheat and sugar
• increase fiber
• modulate estrogen
• avoid caffeine and alcohol
• avoid refined foods, e-numbers, additives
• minimize or avoid soy products as they contain high levels of phytoestrogens, and soy contains a particular toxin which seems to be particularly detrimental for women with Endometriosis
• peel fruit and vegetables to remove toxic chemicals
• eat organic produce wherever possible
• drink lots of filtered or mineral water

By following the proper diet, complementing your diet with needed supplements and adopting a moderate exercise program, you should notice an improvement in your symptoms. If symptoms worsen, be sure to contact you doctor immediately.

That (Long and Gruesome) Six-Month Wait

It was around April last year (2011) after almost a year of unsuccessful TTC attempts when we finally decided to seek professional medical help.

Enlisting the help of a doctor friend who holds clinic at the UPMC-FMAB in PGH , she gave us recommendations of specialists in my case, which is an OB-Reproductive Endocrinologist, as endometriosis is believed to be caused by hormonal problems and disruptions in the woman's reproductive system.

Endometriosis

Adenomyosis

Aside from her recommendations, I also did my share of research and inquiry through friends, social networking sites and the Internet.  I found this forum particularly helpful as I became acquainted with the BEST and MOST TRUSTED OBs in the country. I was able to ask questions and learn from the experiences of other women, their successes and failures, giving me an idea what will it be like should I decide to undergo treatments or surgery.

My doctor friend gave us several names of specialists on reproductive endocrinology and infertility. I trust her inkling since a doctor most probably knows better than an ordinary individual without a medical background, not to mention doctors pretty much know WHO'S WHO in their profession.

Finally, we decided to see Dr. Gladys G. Tanangonan.

We scheduled our first consultation with her.  But firstly before that, I made a list of my symptoms (I ticked/checked which among these things I have). It helps to have your questions listed to make most out of the consultation.

TIP: Going to the doctor can be intimidating. One might feel rushed and forget to ask questions that are important. It's always a good idea to know what to ask beforehand and to take notes during the visit. Some of the questions here may be worth asking. Print out this page and take it with you to your next appointment. You may also want to look at this for more idea on finding a specialist for your case and several other things to consider when you make a consultation.

Our first meeting with Dr. Tanangonan was promising. Unlike my previous consultations with other OBs, we found much more hope and reassurance in her words.  She seems to know better about what I'm having and she answers questions straightforwardly but with compassion. She explained thoroughly without the feeling that she's in a hurry. Ours was an interactive conversation where me and my husband felt engaged and participative partners rather than mere recipients and followers of whatever treatment the doctor prescribes.

Obviously, we want to have a baby. So she thought of giving us a contact schedule: when and how often should we do the baby dance :D She said that sometimes, it's all about the proper timing and awareness of a woman's menstrual cycle and ovulation that determines her fertility and when she is most likely to conceive. So there goes the schedule which to me seemed mechanical.  Nevertheless, we should follow :-)

That first cycle was a failure, we didn't conceive despite strictly abiding by the schedule. Probably because me and my husband were just not so solved with the idea of having contact on schedule plus the pressure that goes with it: "This has to be!"

We were amenable to the idea of combination treatment, meaning not resorting to surgery immediately without trying other conservative options. First, our goal is to stop the menses so that the cyst won't grow to cause more problems. First she had me on Diane pills.  (My previous OB prescribed Althea which is relatively cheaper than Diane.  I think I was able to finish a few blister packs of Althea and just one pack of Diane because I didn't like it's effect on me.)

Diane 35

Althea 

After that, Dr. Tanangonan said she plans to give me GnRH agonist (Luprolex) once for 6 months.  A shot costs PhP9,000.00.

Luprolex Vial 1.88 mg. 

Our next option would be a laparoscopic procedure where she will probe inside my uterus using small incisions to make a proper diagnosis of my condition (to determine the stage of my endo) in addition to fulgurating the cyst/s and removing adhesions.

It was May of 2011 when I had my first shot of Luprolex. It was quite a good thing that I'm less than 50kg that a half dose will be just fine for me, so it saved us a lot. The doctor told me I shouldn't go over 50 or the drug might not be as effective.  Oh sure, with all the expenses I am compelled to defer my food trips and curb my cravings instantly.

I shouldn't be having my period the following month and that is June but to my surprise it came as usual though not as painful, with less blood clots and not heavier as it used to be. I was a bit alarmed coz after 2 weeks I still have spotting. I told my OB about it and she was quick to note that some experience flare ups with the initial dose and will subsequently subside after the next doses were given. She reminded me to take 2 caps of calcium everyday (1,000 mg) as the drug has an effect on bones (it can cause osteoporosis because it mimics menopause).

For couple of months, my moods were unpredictable. I had hot flushes then there were times I felt really cold. My joints were painful and I had numbing lower back pains. I felt my bones were getting weaker and brittle :( I lost weight unintentionally: from 50kg., I was 43kg after just a few months . I looked haggard and frail. My clothes didn't seem to fit my tiny physique I need an immediate wardrobe makeover.

My last shot was in October.  My period should resume by November (shivers...not again!) After that, I'm scheduled to have my trans-vaginal ultrasound on the 3rd-5th day of my menstruation to check the progress of my treatment. My doctor said that we can also have the HSG done to check if there are blockages in my fallopian tubes. She quoted me around PhP15K for the procedure. Geesh.

November came and still no signs of Aunt Flo visiting.  To me this is partly good.  No painful abdominal cramps, no sleepless nights, practically no limits to what I can do...at least for now.  But heck! This is also alarming.  What happened? Did the treatment ruin my cycle? Were my hormones disrupted and thwarted by my attempt to go into pseudo-menopause? Will I ever get my period back? Oh noes.

November flew just as fast and in came December (shivers....again and again).  I knew it was coming. I was preparing with the thought of reintroducing myself to the kind of pain and agony I once had (but never ever missed!). Six months seemed long but I'm prepared for this. I know its just around the corner so I said to myself, "Let's get it on!"

The Culprit: ESTROGEN DOMINANCE

Did you know that every three minutes a woman is diagnosed with breast cancer? Do you think estrogen dominance affects women only? Think again! Although there are numerous reasons why women predominantly experience estrogen dominance (use of birth control, menopause and pregnancy), both men and women are increasingly affected by estrogen dominance. 

Dr. Harry Eidenier, Jr., Ph.D., states, “We are swimming in a sea of environmental xenoestrogens.” Xenoestrogens are environmental, man-made chemicals that have a chemical structure similar to estrogen that accumulate in fatty human tissue.

Sources of Xenoestrogens

• Car pollution 
• Contaminated water
• Non-organic foods (particularly animal fats from dairy and meat)
• PCBs (polychlorinated biphenyls), Polycarbonate plastic bottles, food containers, baby bottles
• Pesticides, herbicides and fertilizers
• Some shampoos, lotions, toiletries and deodorants

The longer these foreign substances stay in your body the more opportunity they have to do damage. Your body has to detoxify these xenoestrogen chemicals every day, and over time this can become a burden.

The estrogen compound 2-hydroxyestrone is considered the ‘good’ estrogen, and 16-alpha-hydroxyestrone is considered the ‘bad’ estrogen. The importance is the ratio of these two estrogens. This can be determined through a simple urine test, 2/16 OH estrogen. Estrogen in general tends to promote cell division, particularly in hormone-sensitive tissue (breast and uterine lining). 


Excess estrogens in your body not only lead to aromatization, but estrogen dominant health issues including uterine fibroids, fibrocystic breast disease, ovarian cysts, menstrual irregularities such as heavy bleeding and cramps, endometriosis, menopausal symptoms, breast, uterine, cervical and prostate cancer, and reduced sperm counts in men.




Aromatase is an enzyme found in estrogen producing cells in the adrenal glands, ovaries, placenta, testicles, adipose or fat tissue and the brain.

Factors that Raise Estrogen and Cause Aromatization

• Age increases aromatase activity
• Carbohydrate intolerance and insulin resistance–this affects the adrenals and all other major hormone levels (the hormone you have the most control over is insulin–this is controlled through your diet. Hormones do not act independently). Insulin increases aromatase.
• Consuming a diet of processed soy and non-organic foods loaded with xenoestrogens, pesticides, antibiotics, etc.
• Food sensitivities
• Heavy metal toxicity (arsenic, barium, cadmium, lead, cobalt, aluminum, and mercury).
• Illegal drugs such as marijuana or prescription drug side effects–especially diuretics, anti-depressants, steroid, and liver activity drugs.
• Inflammation
• Liver congestion and function changes–Elevated AST and ALT values.
• Low protein intake
• Obesity–High estrogen is present in most obese people of all ages. Obesity in males = 25 percent body fat or greater. Obesity in females = 30 percent body fat of greater.
• Overuse of marijuana and alcohol–this equals higher blood sugar, triglycerides, and estrogens.
• Parasites
• Plastics, PCBs, pesticides, soaps, emulsifiers, skin care products, lotions, cosmetics and household cleaning products containing xenoestrogens, pesticides and other chemicals.
• Stress–if cortisol demand is too high, pregnenolone will be shunted to produce cortisol at the expense of other hormones.
• Zinc deficiency. Low levels of zinc have been linked to enlarged prostates and less than desirable levels of testosterone. Contact me for a zinc taste test to measure your zinc status.

Symptoms/Conditions Associated with Increased Estrogen

• Allergies and food sensitivities
• Breast, prostate and cervical cancers
• Decreased libido
• Depression and/or fatigue
• Early menstruation cycles for young girls
• Endometriosis, fibroids, hormone dominant cancers (breast, prostate)
• Fat gain around the hips, thighs and waist (men and women)
• Infertility and/or miscarriage
• Moobs (known as man boobs)–Excess fat or breast growth in men is a definitive indication of high estrogen in relation to their testosterone. This is often combined with insulin resistance.
• Estrogen dominance in men contributes to hair loss, atherosclerosis, prostrate problems, lowered libido and impotency.

For women battling fibrocystic breast disease it is important to eliminate any and all sources of caffeine from their diet. Some women can drink all the coffee they want and not have fibrocystic breast problems, but unfortunately, women with fibrocystic breast problems are always caffeine-sensitive. Women with fibrocystic breast disease and other estrogen dominant conditions are often deficient in iodine and often require more iodine than others do. Both the thyroid and breast have high concentrations of iodine.

The American Institute for Cancer Research says one-third of cancer could be prevented by healthy nutrition, consistent exercise and maintaining a healthy body weight. External estrogens can be eliminated through diet, supplements and lifestyle changes.

Reduce Cancer Risk and Estrogen Dominance with Nutrition, Lifestyle, Exercise and Supplements

Nutrition

• Alkalize your blood by eating approximately 80 percent of your diet from alkaline foods. Cancer thrives in an acidic environment. Consume organic foods versus conventional due to their abundance of synthetic pesticides, hormones, antibiotics, etc. Grass-fed, free-range, hormone-free, antibiotic-fee meats. Organic fruits and vegetables contain 50-80 percent more nutrients than conventionally raised produce. 

• Cruciferous vegetables–broccoli, cauliflower, kale, Brussels sprouts, cabbage. In an animal study at the University of Michigan, it was found that sulforaphane, a compound founding broccoli sprouts, eliminated breast cancer stem cells
• Fiber from vegetables and low-glycemic fruits. Fiber may help reduce the amount of circulating estrogen in your body.
• Drink only purified water and add unprocessed sea salt. Invest in a water filter.
• Green tea (at least three cups daily). The EGCG in green tea helps prevent breast cancer.
• Keep insulin levels low.
• Mushrooms–A study published in the International Journal of Cancer discovered that women who ate 10 grams of button mushrooms/day were 64 percent less likely to develop breast cancer.
• Organic, extra virgin olive oil.
• Read the entire list of ingredients on all products. You’ll be surprised at the number of chemicals, colorings and artificial ingredients.
• Walnuts–the omega-3 fatty acid, phytosterol and antioxidant combination found in walnuts have been shown to prevent cancer.

Avoid

• Alcohol in excess.
• Artificial sweeteners and food additives and chemicals.
• Caffeinated products in excess (coffee, tea, chocolate).
• Deli and luncheon meats, and anything else that contains sodium nitrates.
• Non-organic meats and dairy products.

• Excess iron, especially after age 50.
• Overcooked foods.

• Processed soy products.

• Storing your food and beverages in plastic containers; the estrogen-like compounds in the plastic can make their way into the foods and liquids. Instead use Pyrex glass containers.  

Refined carbohydrates, trans fats, sugars, HFCS and hydrogenated vegetable oils, Sugar is a food source for cancer. A study in the Journal Cancer Epidemiology, Mile Markers, and Prevention found that refined carbohydrates (white flour, sugar and high fructose corn syrup) are linked to cancer. The study of more than 1,800 women in Mexico found that those who got 57 percent or more of their total energy intake from refined carbohydrates had a 220 percent higher risk of breast cancer than women who ate more balanced diets.

Lifestyle

 • Breastfeeding versus formula feeding. According to a study in the Archives of Internal Medicine, women with a history of breast cancer are 59 percent less likely to reduce their risk of breast cancer simply by breastfeeding their child.
• Reduce your body fat.
• Determine your hormone levels.
• Suggested urine test: 2/16 OH estrogen (this inexpensive test measures estrogen metabolites). A low 2/16 indicates a high risk of estrogen sensitive cancers
• Go braless occasionally. Bras restrict the flow of lymph glands.
• Improve your mood naturally and get off antidepressants which raises aromatase.
• Campaign against pesticide use in schools and workplaces. Children are especially susceptible to the effects of xenoestrogens.
• Monthly breast self-exams and breast massage.
• Sleep between 10 p.m. and 6 a.m. for 7-8 hours of restful sleep.
• Sleep in complete darkness.
• Spend time in a sauna at least once a week.
• Spend time outdoors in sunlight without sunscreen 10-30 minutes daily.
• Work a first shift.
• Test for heavy metal toxicity.
• Store plastic water bottles in a cool dark place.
• Use natural pest control in your home and garden.
• Test iron and ferritin levels extra iron is toxic as we age, a potent oxidant, increasing free radicals and raises risk of cancer.
• Thermography uses an infrared camera, and is risk-free (no radiation) and painless. Thermograms can detect the possibility of breast cancer earlier, whereas mammograms cannot detect a tumor until it’s been growing for years.
• Use organic soaps and toothpastes (fluoride-free).
• Use only naturally based perfumes. Most perfumes are petrochemically based.
• Be aware of noxious gases from copiers and printers, carpets, fiberboards, etc. Computer monitors can emit a high level of electromagnetic force (EMF).

Suggested serum lab tests are Female Hormone Profile: Pregnenolone, Total Estrogens, DHEA-S, Progesterone, Testosterone (total); Male Hormone Profile: Pregnenolone, Total Estrogens, DHEA, Progesterone, Bioavailable Testosterone, Testosterone (total and free); Male: PSA (Test at age 50 for Caucasian; age 40 for African American); Both male and female: Thyroid panel: T3 Uptake, T4 and TSH; Vitamin D– 5 (OH)D

Avoid

• Avoid new carpet-it can give off noxious fumes.
• Avoid X-rays as much as possible. Opt for safer, more effective thermograms. 
• Smoking.

• Fabric softeners–they put petrochemicals directly on your skin.
• Synthetic flea shampoos, flea collars and flea pesticides for your pets and homes.
• Chemicals. There are at least 200 known chemicals that studies have shown are linked to breast cancer: View the list here.
• Avoid creams, lotions and cosmetics that have toxic chemicals and estrogenic ingredients such as parabens and stearal konium chloride. Cheap brands usually have more toxic ingredients.
• Avoid nail polish and nail polish removers.

Estrogen precursors such as plastic bottless. Bisphenol-A (BPA) is a widely used industrial chemical that has been directly linked to reproductive abnormalities and an increased risk of breast and prostate cancers, diabetes and heart disease.

Regarding pesticide exposure, the molecular structure of some pesticides closely resembles that of estrogen. This means they may attach to receptor sites in your body. It’s a known fact that women with elevated levels of pesticides in their breast tissue have a greater breast cancer risk.

Exercise

Cancer cells cannot thrive in an oxygenated environment. Daily, sensible exercise and deep breathing provide more oxygen down to the cellular level. Include walking, rebounder and strength training. Bouncing on a rebounder for two minutes every hour is good therapy for preventing or treating cancer. One hour after rebounding, white blood cells count normalizes.

Rebounding every hour boosts your immune system by flushing the lymphatic system. Exercise balances your insulin levels. Controlling insulin levels is one of the most powerful ways to reduce your cancer risks.

• Rebounding on a mini trampoline to increase lymphatic circulation and detox
• Exercise one hour daily. Consistent physical exercise reduces breast cancer risk according to numerous studies.
• Lift weights three times per week. Higher levels of strength are associated with a decreased risk of cancer.

Supplements

These supplements should be part of everyone’s supplement protocol to prevent disease and improve health.

• Omega-3 fish oils–make sure you supplement with a quality brand that is free of toxic heavy metals, PCBs and other chemicals. Research published in Cancer Epidemiology, Biomarkers and Prevention showed that postmenopausal women who take fish oil supplements may lower their rish of the most common type of breast cancer (invasive ductal breast cancer) by a whopping 32 percent.

• Vitamin D–prevents and reduces 78 percent of all cancers. Vitamin D suppresses growth of breast cancer by blocking and enhancing signals that inhibit cancer cell growth and by altering gene regulators of the cell cycle.

• Calcium d-glucarate supports liver detoxification of excess estrogen. The liver also needs B vitamins, particularly B6, to detoxify excess estrogen.
• Ensure healthy gut flora with probiotics.
• Evening Primrose or borage oil.
• Green tea.
• Increase progesterone levels with herbs such as Chaste tree berry. Bioidentical progesterone decreases the risk of breast cancer.
• Iodine/Iodide combination.
• Resveratrol–The Journal of Nutritional Biochemistry demonstrated high anti-tumor and estrogenic activity of resveratrol. Researchers compared resveratrol to other phytoestrogens and found that it increased cancer-cell death more than any of the others.
• Turmeric

Natural Aromatase Inhibitors (natural estrogen blockers)

Botanicals

• Calcium d-glucarate–helps liver detoxify excess estrogen out of the liver (500mg 3x/day)
• DIM–helps breakdown and metabolize estrogen (Women: 100-200 mg/day; Men: 200-400mg/day)
• Grapeseed extract (reduces up to 80 percent of aromatase)
• Green tea
• Indole-3 Carbinol
• Melatonin–anti-aromatase inhibitor (1mg) & potent antioxidant
• Myomin-an aromatase inhibitor that effectively reduces excess estradiol & reduces fibroid cysts.
• Nettle Root–blocks estrogen uptake in the prostate
• Passion Flower
• Quercetin
• Resveratrol–natural anti-aromatase inhibitor & block estrogen receptor sites

Avoid

• Synthetic supplements and prescription drugs.
• Excessive iron through supplements, diet and cast iron cookware. Iron is toxic as we age.

If you’re using birth control pills or synthetic estrogens such as Premarin educate yourself on what these drugs do to your body, particularly your hormonal system, your gut and your immune system. Provera has been linked to blood clots, fluid retention, acne, rashes, weight gain, depression, certain cancers and other disorders.

Anti-estrogen drugs such as Tamoxifen, a selective estrogen receptive modulator. This drug comes with a number of side effects including blood clots, strokes, dizziness, hot flashes, sexual problems, stroke, cataracts, leg swelling, mood swings and vision problems according to The National Cancer Institute. Tamoxifen has also been linked to endometrial and uterine cancer. Research shows tamoxifen increases the risk of the women developing a second and far more dangerous type of breast cancer by a stunning 440 percent published in the journal, Cancer Research.

Estrogen dominance is complex health condition, however by implementing and following the Winning Formulas above you can decrease estrogen dominance and reduce your risk of estrogen dominant cancers. Cancer may be caused from environmental factors, diet and genetics. Diet and nutrition, stress management, exercise, and sunlight are preventative measures for 90% of all health related diseases/conditions. Now is the time to take control and responsibility for your health with the four powers: Nutrition, Lifestyle, Exercise and Supplements.