Sunday, December 17, 2023

ENDOMETRIOSIS 2023: FROM ESSENTIALS, ADVANCEMENTS TO FIELD REVIEWS

EDOMETRIOSIS RESOURCE GUIDE: GENE EXPRESSION 

To address endometriosis more effectively, we first need to understand what causes it. And it turns out it's not so simple. 

The Biology of Endometriosis
Endometriosis is a complex disease, which means that there is no single cause and no single answer. It is well known that endometriosis is very much linked to hormones, especially estrogen and progesterone. Gene expression research is providing many clues about other biological systems that contribute to endometriosis. These include inflammation and oxidative stress, processing of toxins – including chemicals called endocrine disruptors, blood vessels, and even repair of our DNA. While this can seem overwhelming  , it’s also opening up new opportunities for better diagnostics, earlier detection, and more effective treatments by addressing the root causes.

Gene Expression
Genes are sections of your DNA that carry the code for proteins that run everything that goes on in your body. On top of this, epigenetics is another layer that turns these genes on and off – like a light switch. Together, they support the proper functioning of our biology by ensuring that we are making the right proteins at the right time. 

While endometriosis has a clear inherited genetic component, it is equally influenced by the environment. This means that the choices you make, along with the experiences and exposures you have in your lifetime, can impact how your genes and body function. Though you can’t change your genes, you CAN influence how they get expressed and thus affect your health – and potentially the health of future generations.

In this Endometriosis Resource Guide, you’ll learn simple strategies to optimize your body’s own biology. It’s a powerful tool to help you regain some control back from a disease that all too often feels like it’s controlling you.

Simple Strategies to Transform Your Stress
Stress is everywhere, but what is it really?  In a nutshell, stress is any influence on your physical, mental, emotional, or energetic systems that creates an imbalance. A small amount of stress is actually healthy. 

Think about when you experience sore muscles in the early stages of a new exercise routine. The stress on your physical body gives a signal for the tissues to become stronger or more flexible.

Your body adapts and gets back into balance, better and healthier than it was before.

But feeling stressed over a long period of time is different. It depletes your body so that you don’t function at your best. You can’t think as well, your decision-making is off, your relationships suffer, and you feel too tired to do what you love.

Whether it’s a nutrient deficiency, exposure to toxins, overexercising, difficulties in relationships, insufficient sunlight, sleep deprivation, hormonal imbalances … ANY imbalance in the system creates stress. Stress then creates downstream imbalances in every system linked to health – including inflammation and oxidative stress.

Stress and Endometriosis
In this graphic, you can see how stress is linked to every aspect of endometriosis. It is a central component that influences both your biology and symptoms. Because of this, it is a key part of any strategy to address your disease.


Your Personal Stress Blueprint

What bothers me isn’t what bothers you. Why is that?  We are each unique in how we respond to stress. Uncovering your personal keys can transform how you approach stress - and your life.

Here are some simple strategies you can implement today. Each strategy can influence stress through gene expression and energetic balance. Together, they are much more powerful.


Your Guide to Healthy Gene Expression
Here are some simple strategies you can do to support and balance all of these biological systems, including stress, through healthy gene expression.

Eat Healthy Food
Food talks to our genes and provides critical support for biochemistry. The Mediterranean diet is the healthiest overall way to get what your body needs. Include more of the good stuff:

Vitamins and minerals

Phytonutrients

Fiber

Healthy fats and proteins

Minimize or eliminate the bad stuff:

Processed foods

Refined sugar

Alcohol

 

Move Your Body
QMovement is more than exercise for weight or appearance. It’s part of a body-wide communication system, so aim for at least 60 minutes daily. Vary it and make it fun! Ideas include:

Run, walk, hike

Workout at gym

Bike

Swim

Dance

Gardening

Play

 

Get a Good Night’s Sleep
Sleep is an active state of repair and regeneration, and is linked to every biological system through circadian rhythm. This means it’s not just about how much you sleep, but also when you sleep.

Aim for 6-8 hours a night between 9 pm and 7 am. 

Avoid night shifts and frequent travel across multiple time zones.

Address issues that interfere with sleep including snoring, sleep apnea, and restless legs.

 

Minimize Toxins
Toxins directly and indirectly damage DNA and alter biological processes. Minimize your exposure to endocrine disruptors and other toxins found in many places including:

Pesticides

Home cleaning products

Plastics

Personal care products

Air and water pollution

Smoking

Medications

 

Manage your Stress

Stress is a response to internal and external events, including thoughts, beliefs, and trauma.While you cannot avoid stress, there are many strategies for managing it so it doesn’t have a big impact. Here are some common ones; find what works for you. It’s good to practice several approaches so you always have the right tool at the right time:

Meditation

Massage

Energy work

Creative outlets

Nature, Pets

Connection & Hugs

JOY

 


Love yourself. Create your best life!

 


ULTRASOUND DIAGNOSTICS OF ENDOMETRIOMA

By: Dr. Robert L. Bard

According to the World Health Organization, Endometriosis affects roughly 10% (190 million) of reproductive age women and girls globally.  It is a chronic disorder that can result in life-disrupting pain during menstrual periods, sexual activity and urination.  Currently, there remains no known cure for endometriosis, whereby treatment is usually aimed at managing its known symptoms.  One objective of the medical community is to conduct early diagnosis and research continues to pursue effective treatments. [1]

Endometriosis starts in the endometrium with abnormal cellular proliferation.  Through the use of 3D Ultrasound, this disorder can be measured through the monitoring of the widening or the increased tissue in the endometrium.  Another form of quantitative measure is by the study of blood flow in the endometrium. Its ability to spread can be recognized by the number of vessels in the active tissue.  The big problem with staging endometriosis (or endometriomas) are the cysts that follow it.  Because of its capacity to spread in most areas of the body, a strategic protocol for clinical management is to conduct IMAGE GUIDED treatments, whereby use of real-time scanning of or during therapeutic process helps navigate the focus the treatment area.  Imaging solutions include CT (which has radiation), MRI, or the 3D Doppler ultrasound. 

CASE REVIEWS: We recently had a case where the endometriosis had metastasized under the arm. We've seen it metastasize in post-op scars. We can see the endometrial tissue block the ureters- hence, blocking the kidneys and destroying the kidney function.  Moreover, the scars can cause bowel obstruction.

While it's not categorized as malignant, it certainly can be deadly (as well as a seriously painful and debilitating disease). Women (especially those in advanced age groups) have expressed being completely incapacitated for three out of four days during their menstrual cycle.  A vast majority of them also claimed experiencing mental health issues because of the pain and discomfort. 

The following slides are from Dr. Robert Bard's lecture presented in 2016 for the obstetrics and gynecology department at Mount Sinai Medical Center in New York City (ref: prior lecture from Harvard Medical School/the American Institute of Ultrasound in Medicine).

click to enlarge
Use of the modern image guided treatment technologies offer non-invasive blood flow technology, which quantifies the aggression, either the aggressiveness of an inflammatory process like endometriosis or the invasive and metastatic potential of cancers such as endometrial cancer & cervical cancer.

FIG-1: Upon observation, this it is not a primary bladder cancer. This is an inflammatory mass because the vessels are smooth (cancer vessels are wrinkly)- and there is a visible difference between the two.  This is a three dimensional pelvic floor doppler study of the pelvis. If we start with scan A, we see the uterus on the bottom half and the bladder on the top, which is black, and within the black fluid is a mass. By looking below that, we see the (scan C and D) the abnormal blood vessels of the endometriosis. Hence, inflamed tissue is vascular and the same pattern of blood vessels from the abnormal endometrium is also in the bladder, indicating that the endometrial tissue has either invaded or metastasized into the base of the bladder. The two scans (B & D) show the bladder wall is intact. Hence, these are endometriosis that has metastasized or spread to the base of the bladder. 

click to enlarge
FIG-2:
 
In this image set, we have an endometrioma, which is (again) a large black area where the fluid is black, and within it, there's another nodule with the circle indicated by the red highlight.  We see that there's no blood flow in this- hence, it's not a primary cancer of the bladder.  In addition,  it is not particularly active inside the bladder, however, there is a stalk that is feeding blood vessels to the cystic area.  With the 3D Doppler, we can quantify the cyst in seconds, because 3D takes a dataset in 15, 20 seconds of a hundred, 150 pictures of the whole area, including the blood flow.  

Notice the 3D images on the left with the red circle (Scan A) is the endometrial cyst, which is black, and the circle shows a small nodule within the cyst. What's important with this as contrasted to the previous study is this is NOT VASCULAR, which means this is inactive or subclinical at this time. On the right (E,F,G,H), we see that the pedicle that's going to the cyst and feeding the cyst, the area has multiple blood vessels in it. Because we're using 3D volumetric technology, we are able to quantify the number of vessels in the pedicle. The more blood vessels in the pedicle, the more aggressive the disease is. So back to the cyst. The cyst, there were no vesicles, but the pedicle feeding the cyst had a 13% ratio of blood vessels to assisted tissue. 

EPILOGUE
Traditional medicine has not assisted with the mental depression, the anguish of the certainty that the pain will be monthly and the possible side effects including infertility. Since we've been using targeted therapies with lasers and focused ultrasound energies years ago, we are now globally using bioenergy treatments that is the near infrared laser and the pulse electromagnetic fields to calm down the process of this inflammatory disorder.



Introduction: by Roberta Kline, MD 

Under a joint report with the Women's Diagnostic Network and HealthTech Reporter, our editors met with Ms. MJ Smith, a clinical ambassador from Screen Point Medical (breast imaging AI) at the 2023 NYC Roentgen Society conference. At the height of the medical conference, we found MJ to be a uniquely profound and engaging speaker about women's health topics.  Exploring a private connection opened us into a collaborative and educational journey befitting our UNDERDIAGNOSED WOMEN series where MJ is truly a life-long supporter of diagnostic care, innovation and non-invasive options.

Endometriosis (sometimes called "endo" for short) is a common health problem in women that is reported to affect more than 11% of American women between 15 and 44. It gets its name from the word endometrium, the tissue that normally lines the uterus or womb. When this tissue is found in locations outside of the uterus, it is called endometriosis. Most often this involves the nearby organs and tissues – ovaries, fallopian tubes, outer surface of the uterus, bladder, bowel and rectum. It can also be found in other locations including the vagina, cervix, vulva, or even distant tissues such as the lungs, brain, eye, and skin. Just like the lining of the uterus, this tissue responds to cycling hormones to grow. But unlike normal endometrium, it is not limited to the surface and does not shed. Because of this, it builds up and creates inflammation, scarring, and other changes that contribute to the most common symptom: pain. 

While endometriosis is most often diagnosed in women in their 30s and 40s, it likely develops much earlier. Due to the wide range of symptoms that women can experience, and lack of effective and noninvasive diagnostic tools, women often suffer for years or even decades. Currently the only accepted way to diagnosis endometriosis is to directly visualize and biopsy the lesions with surgery. This is limiting for two reasons. First, endometriosis has to be considered as a possible explanation for symptoms that are often seen as “normal” for menstruating women. Second, the risk of not knowing has to outweigh the risk of potential complications of invasive surgery. 

Endometriosis can also make it harder to get pregnant, and it is not uncommon for a diagnosis to be made only as part of evaluation or treatment for infertility. Getting a diagnosis to explain symptoms is only the first step in addressing endometriosis, however. There is no cure, and most current treatments often come with significant risks or side effects but do not fully resolve a woman’s symptoms. While research progresses slowly, we still do not have a clear understanding of what causes endometriosis, how to diagnose it early without invasive procedures, how to ease symptoms, and ultimately treat and possibly cure the disease itself.

This special interview features great insight from a woman’s journey with endometriosis.  We explore her remarkable quest for answers from the range of pain relief to therapeutic treatments to risks of surgical solutions.


LIVING WITH ENDOMETRIOSIS:
From an interview with MJ Smith

My personal and professional missions are both in women's health. By day, I work for a breast AI company focused on helping radiologists find breast cancers on mammograms. I chose this path because I believe in advancing causes that support women's health simply because women are core members of our culture and our families. I have had two family members, both maternal aunts, who died of breast cancer, - one at the age of 36, and an the other at the age of 52.

Advocacy for Endometriosis is directly related to my personal journey. Growing up with endometriosis since puberty, I've been to the emergency department probably over 20 times for pain or pelvic pain related conditions. The pain had me flat on my back for days at a time or falling out of bed with pain.  I drove myself to a Planned Parenthood in Minnesota where I grew up and was prescribed birth control to manage it well into my twenties.  Despite the hormonal treatments, I still had a series of episodes. 

Endometriosis is the uterine tissue that grows and implants itself outside of the uterus. Going through that pain is the result of a complex process, resulting in swelling and bleeding inside the interstitial spaces of my body. Women who have endometriosis also often develop painful cysts on their ovaries. 

I think the biggest reason you see women in the ER is pelvic pain. Women with chronic pelvic pain (which is often what endometriosis causes) are underserved by the healthcare community because we're constantly complaining of pelvic pain.  The ER is not where you want treatment because you see a different doctor every time you get admitted. With emergency imaging, you usually get a pelvic ultrasound where cysts can show up and they're quick to assume that you have a cyst, or a cyst has burst and this is why you're uncomfortable.  I think now you can do a pelvic MRI with contrast media- but it's still not enough to offer a definitive diagnosis.  (To be continued below)



I found in the 20 years of suffering endometriosis that the only way to get a true diagnosis has remained to be a laparoscopic or an open pelvic surgery. It's incredibly difficult. 

I know another woman who struggled through over seven years of infertility and it was only after seven years, and by then she was well into her late thirties or early forties, that she had surgery to identify endometriosis. Only then was that woman able to get pregnant. I have had a similar experience. I wasn't suffering infertility, but I was in so much pain in my late twenties that my doctor recommended a laparoscopic exploratory surgery because the pain is was so severe. I remember I was prescribed a month's worth of Vicodin leading up to the surgery. I am not a person who developed an addiction to pain medicine- but in retrospect this was done in the time when the entire country fell into a pandemic of addiction to pain medicine. I wouldn't have gotten that prescription in this day and age in 2023 if I have pelvic pain.  Overall, there's no relief for me and over-the-counter meds that do not help. I just thank God I didn't develop an addiction after having taken Vicodin multiple times a day for a month leading up to that surgery... where, in fact, I was diagnosed with stage four endometriosis. 

One of my ovaries was almost lost due to endometriosis. My doctor was able to keep that ovary and as a result I was able to get pregnant with my first child. I had a second child years later but surgery comes with complications. To this day, at 44, I recently went to the emergency department because of pelvic pain and it's still something I live with. I do take hormones but I've given up on looking for answers from academic research because I think that, in my opinion, I don't think we've gotten very far. The choice of hormones have side effects like an increased risk of breast cancer or uterine cancer. I'm very interested in minimally invasive treatment procedures but I just think we've come to a standstill with the traditional medical community when it comes to endometriosis.





SEXISM IN THE WOMEN'S HEALTHCARE
by: Mary Nielsen

Many women suffer with undiagnosed endometriosis. The medical field has prided itself on providing objective observations because it claims to rely on science. However, sexism lurks in hospitals, clinics and other health care facilities and the gender gap in treating pain is real. Diane Hoffman and Anita Tarzian from the University of Maryland, Francis King Carey School of Law published, "The Girl Who Cried Pain, A Bias against Women in the Treatment of Pain." Although that study is 20+ years old, little has changed.

Sexist stereotypes that see women as 'emotional' and consequently medical staff doubt a physical basis for women's pain. Men are viewed as more 'rational' and when men say they are feeling acute pain, their symptoms are taken more seriously and considered to have a physical cause. This means women receive very different care for pain management and pain diagnosis. Researcher, Karen Calderone found that women are more likely given sedatives as an answer to complaints of pain and are perceived as being anxious.

Medical professionals focus on returning the woman to a state of being calm and not investigating the cause behind their pain. The sedatives can then make the women seem calmer from outside appearance, while their medical condition can continue to worsen as they remain undiagnosed. Undiagnosed endometriosis has enormous repercussions for a woman. Life altering heavy bleeding, cramping and pain can lead to infertility, anemia, and internal adhesions requiring surgery. 

Education toward gender bias and addressing women's pain is needed to allow earlier diagnosis with a non-invasive technology like ultrasound. 


CONTRIBUTORS

Robert L. Bard, MD, DABR, FAIUM, FASLMS is internationally recognized as a leader in the field of 21st Century 3-D ULTRASONOGRAPHIC VOLUMETRIC DOPPLER IMAGING. Dr. Bard specializes in advanced 3-D sonography to detect cancers in numerous organs including the breast, prostate, skin, thyroid, melanoma and other areas. Dr. Bard’s images are used to accurately guide biopsies, target therapy and provide focused follow-up after treatment. Dr. Bard’s medical career began as a diagnostic radiologist and evolved into the practice of non-invasive 3D imaging with ultrasound, MRI and laser technologies. He has served in the military, been the head Radiologist at several leading hospitals, and published a multitude of textbooks and scientific papers. He presents articles worldwide, teaches at International Conferences and is on the Editorial Review Board of National and International Medical Journals. Holding medical licenses in several states, he holds Board certification from the American Board of Radiology (1974) and Fellowship in the American Society of Lasers in Medicine and Surgery (2014)


BOBBI KLINE, MD (Educational Dir. /Women's Diagnostic Group)
Dr. Kline is a board-certified ObGyn physician, Integrative Personalized Medicine expert, consultant, author, and educator whose mission is to change how we approach health and deliver healthcare. She helped to create the Integrative & Functional Medicine program for a family practice residency, has consulted with Sodexo to implement the first personalized nutrition menu for healthcare facilities, and serves as Education Director for several organizations including the Women’s Diagnostic Health Network, Mommies on a Mission. Learn more at https://bobbiklinemd.com 


MARY NIELSEN (Founder/ Faculty Director - Spectrum Advanced Aesthetics)
Mary established and manages a certified aesthetics institution in Portland Oregon supporting the academic leadership and technical ability to grow a med spa profitably. Through collaborative relationships with evolving aesthetics business, her programs (Fearless Beauties and Cascade Aesthetic Alliance) functions to help the esthetician, whether newly licensed or a veteran with education and networking. She is also a published author of best selling textbooks in aesthetic wellness including ADVANCED AESETHETICS and FEARLESS BEAUTIES. Mary is dedicated to bringing change to the esthetics/beauty industry through comprehensive education and empowerment through knowledge.  https://www.fearlessbeauties.org/







2024 CLINICAL PROFILE OF THE DENSE BREAST PARADIGM - for the Obstetrics & Gynecology Society    Written by: Roberta Kline, MD   |   Published by ICRS Medical Press Ltd.


Breast cancer affects the lives of hundreds of thousands of women every year and is a leading cause of death.  While we have made great progress in advancing earlier diagnosis and more individualized treatments, we still need to improve our approach to achieve our ultimate goal - prevention. This requires a deeper understanding of the molecular mechanisms and the multitude of factors that contribute to the development of breast cancer.  

Dr. Roberta Kline, recognized speaker and publishing crusader for women's health brings you a comprehensive review and a deep-dive analysis of the current research  findings about breast density and its major risk factors for breast cancer.  Her reports uncover current imaging practices and clinical protocols updated in great support of breast density detection and the means of addressing this growing condition that affects over 45% of the female population. "Knowing a woman has greater breast density is a critical first step, but it doesn’t end there... we need to go further by understanding the causes of breast density, and how they relate to breast cancer-- we now have another avenue to proactively intervene to reduce risk or even prevent breast cancer in the first place."  This textbook is a champion in targeting the Dense Breast Paradigm as a blueprint and a clear course study for all clinical professionals who are dedicated to women's early detection and prevention programs. (More information)




2023 BOOK LAUNCH: "IMAGE GUIDED AESTHETIC PROCEDURES & TREATMENTS"
10/21/2023 - After two years in the making, we congratulate Dr. Robert Bard and his alliance of clinical experts for the launch of "IMAGE GUIDED AESTHETIC PROCEDURES & TREATMENTS".  Springer Medical Publishing proudly presents the first installment in clinical aesthetic procedures. This detailed and up-to-date overview of image-guided procedures focuses on the many aesthetic and reconstructive strategies delivered by some of today's renowned leaders in the clinical aesthetics community. They share their valuable expertise and field-based findings throughout this feature-rich textbook. The wide list of audiences for this text (ie. dermatologists, plastic surgeons, aestheticians, general surgeons) will enjoy an insider's look at each treatment program while providing remarkable field-based knowledge for the general non-medical audience seeking the latest information in non-invasive and minimally invasive aesthetic procedures.

Produced and edited by Dr. Robert L. Bard, (NYC based cancer diagnostic imaging specialist) this collective project showcases the most highly sought-after cosmetic treatments in each priceless chapter- through detailed breakdowns, experiential insights and a generous graphic tour of before and after progress visuals.  Thanks to the additional safety benefits of clinical imaging, our treatment professionals express added confidence in the pre-operative and post-op areas. In addition, many aesthetics procedures noted also brings significant advantages (of accuracy and efficiency) to the actual treatment process from real-time image guidance. 


WOMEN’S HEALTH DIGEST

From the publishers of THE WELLNESS JOURNAL and the WOMEN'S DIAGNOSTIC NETWORK NEWS comes a consortium of IPHA'S top professional contributors in women's health & wellness advocacy. Subscribe to our latest community E-news forum and get the insiders news on pain therapeutics, diagnostics and lifestyle upgrades. We welcome special guest contributors from all modalities of healing - from practitioners, product innovators and researchers. Also, gain valuable insight from success stories of real people and their experience with WHAT WORKED for them! Get front row access to our latest headlines. Visit: WomensHealthDigest.org









LAUNCHING IN 2024: NATIONAL COALITION OF WOMEN'S HEALTH SUPPORT
Professional health orgs, foundations and advocates of women's health disorders (primarily cancers) is uniting to form a national alliance of collaborators. This collective group is focused on "doing more together" as far as exploring new resources, sharing current ideas and addressing a wide range of topics about women's issues. Meetings like our latest Women's Powermeet series discussed the latest in diagnostic and therapeutic solutions while introducing who's who in national crusadership in the advocacy realm. Clinicians are also welcome to discuss patient-dedicated road maps and a more thoughtful health analysis and research-based evaluation. It is this level of commitment to women's health that provides a deeper sense of care for the patient that lends itself to a more holistic and integrative strategy to therapeutics. It is also this philosophy that draws more intuitive and insightful awareness on a global scale to offer collaboration platforms too better share insights on a patient's disorders to seek out better solutions. (See Women's Health Digest)


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ULTRASOUND DIAGNOSTICS OF ENDOMETRIOMA

  ENDOMETRIOSIS REVIEW 2023: FROM ESSENTIALS TO ADVANCEMENTS- By Dr. Robert L. Bard According to the World Health Organization, Endometriosi...