 |
What to do when the doctor says it's endometriosis
Paul Indman, MD and Tom Lyons, MD Paul
Indman, MD: I’m
Paul Indman and I’m at the national meeting of the American Association of
Gynaecological Laparoscopists, and I have with me Dr. Tom Lyons, who is the
author of the new book, What To Do When
the Doctor Says It’s Endometriosis. I’ve been watching Dr. Lyons’ work
for many years in surgery. I’ve watched him operate through videos and through
live surgery. Tom, it’s a pleasure to have you here. What caused you to write a book for women instead of
physicians? Tom
Lyons, MD: It
was to some degree a labour of love. I enjoy talking to my patients and this
subject of endometriosis is a topic that elicits a lot of discussion, and a lot
of questions that I think have remained shrouded in myths. I think a lot of
people make some assumptions about endometriosis that are not true, and for me
it was an attempt to tell patients with this disorder, or patients who think
they may have this disorder, how they can go about dealing with that, and how
they can go about helping themselves. There are a lot of ways they can help
themselves in addition to us helping them from a standpoint of a medical
intervention. I think there are a lot of things that patients can do for
themselves. Paul
Indman, MD: Such
as? Tom
Lyons, MD: There
are probably dietary alterations that are successful with some of these
disorders. There certainly are some remedies that are out there; vitamin
therapy, antioxidants, any number of things that I actually learned quite a bit
about while I was doing the book. I co-authored the book with a lady by the name of Cheryl
Kimball, who is very knowledgeable. She helped me wander through this area of
diet and holistic therapies, and really to find some reasonable answers for some
women. At the same time, the thing I know best is medicine. I
don’t pretend to know too much about anything else, but I think we are also
able to help people by allowing some of our patients to tell stories to other
individuals about their experience with this disorder, and maybe give some
recommendations about how to evaluate a physician when they go in to one who is
going to treat their endometriosis. Things of that nature. I really felt like I was sitting down in front of a
patient who had walked into my office and said, “You know, I think I have this
problem. What do you think?” It’s a process of education, and hopefully
communication and information that people can use to improve their lives. Paul
Indman, MD: Just
looking through this book I’m very impressed. It takes a lot to impress me
I’ll say, so I’m not just saying that. It looks well thought out, well
organised. It doesn’t look like it’s too technical but has enough details to
help women. Let me ask you one question. One of the common trends that
I am seeing in gynaecology is that instead of diagnosing endometriosis, which
often requires a laparoscopy, looking into the belly with a little telescope,
there’s a trend toward treating it with a medicine: Depot Lupron. This
certainly puts women into temporary menopause. It has side effects and it’s
very expensive. Do you think it makes sense to be treating women with medicine
rather than finding out why they have pain? Tom
Lyons, MD: My
personal opinion is no. If you look critically and scientifically at some of the
things that are being suggested, there may be a place for that type of an
approach. However, we really spend a lot of time discussing not only Depot
Lupron, but all the rest of the medications that are out there. And there are a
lot of medications that have been reported to be appropriate therapies for
endometriosis. There are a number of medicines that try to give the impression
that they cure the disease. One thing that we adamantly say, and I will adamantly say,
is that there is no medicine that I know of that’s ever been admitted to cure
endometriosis. That doesn’t happen. In fact, we don’t know if there’s
anything that can cure endometriosis. What we are after, and again,
endometriosis is a disease that we treat symptomatically, is a cessation of
symptoms and that’s our goal. However we go about that, and whatever is best
to do that, is the way I’m currently trying to practice. Right now we think
removal of the disease process by surgical excision of the endometriosis is the
best thing to treat those symptoms. The hardest thing for some people to understand about
endometriosis is that you can have fairly severe endometriosis and not have any
symptoms. That’s an interesting phenomena, but in truth, patients who don’t
have symptoms, who have endometriosis, probably don’t need to be treated at
all. It’s probably not going to do anything; it’s certainly not going to
kill them. I don’t know of anybody who’s died of endometriosis. I know a few
people who’ve died because they’ve had surgery for it, but that’s a whole
other story. I think to answer your questions specifically; I am not a
proponent of giving a patient Depot Lupron without a diagnosis. I think, and I
guess it makes me old-fashioned, but I like to have an idea and know what I’m
treating, particularly before I use a drug that has a high impact on the
patient’s psychological state. There are a lot of other symptoms and it’s a
very costly medicine. Paul
Indman, MD: I
also think there’s a psychological impact. Many women will find they have less
pain on a medicine that stops their menstrual periods. That doesn’t mean
it’s endometriosis and then they get labelled, “I have endometriosis”,
read about the worst cases on the internet, and forget about the millions of
women that have it and don’t know they have it. Tom
Lyons, MD: That’s
right. I think that’s very important, and we certainly see that patient, and I
think, that label. We try very hard not to label the patient until we have proof
that they have this disease that we call endometriosis, because that label
carries a lot of baggage, as I say, and it’s a big load for somebody to carry
who’s in their late teens or twenties. And now someone has tossed this label
on them of endometriosis, and they’re out there wondering whether or not
they’re going to have babies, do they have to have a hysterectomy next week;
all these terrible things that go with this “diagnosis” of endometriosis. Paul
Indman, MD: I
think for anyone who is hearing you say that, obviously they are interested in
endometriosis, and I think for a good, scientifically valid book, I really
recommend this. This is not a paid commercial, but I would like this available
for my patients, What To Do When The
Doctor Says It’s Endometriosis
by Dr. Tom Lyons. Thank you very much. Tom
Lyons, MD: Thank
you Paul, I appreciate that.
|
