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I am privileged to be a patient of Dr. Cook. His manner, and way of talking with his patients is the kindest, and gentlest I have ever encountered. He has never rushed me, but has listened to me, and most of all he has shown he cared about me, and my well-being. All the staff at his office (Vital Health Institute) are all very supportive, patient, and kind. The nurse practitioner, Linda, is also one of the kindest, most comforting ladies I have ever met. I was diagnosed with endometriosis in 2013 after years of horrendous periods, with pain and cramps that nothing would take away. I first... [More..] (Carri, Patient, 12-03-2017) If you have pelvic pain there is no other doctor that will treat you better than Dr Cook. I suffered from endo, adhesions, and uncaring medical professionals for 20 years. I found out about Dr C after a failed surgery that my doctor blamed on me and had a phone consult with Dr Cook and knew he was the answer but I couldn't afford it. I waited for 9 years for the right situation. In February of 2011 it was finally the right time. Besides just physically healing up I have been pain free since surgery. I mean I had killer cramps. The wake you up in the middle of the night so you can ... [More..] (Jennifer, Patient, 05-03-2012) All Suggestions For Andrew COOK MD

The real story about female cramps and pelvic pain. Endometriosis may be one of the reasons for severe pelvic pain

The Real Story about Killer Cramps and Pelvic Pain
Endometriosis may be one of the reasons for severe pelvic pain

Most of us have seen this patient. The office staff cringes at the sight of her name on the schedule, as they know you, the doctor will be behind the rest of the day after her visit.

Mrs. Smith is a 32-year-old who presents with killer menstrual cramps and states that she is unable to get out of bed a couple of days each month because of the pain. She claims that the pain she experiences every month is worse than childbirth. Initially, birth control pills helped, but her pain has returned. You have heard about the GnRH agonist, Lupron, and remember the studies provided by the pharmaceutical representative demonstrating its efficacy in pain relief. When offered Lupron she refuses, citing information on the Internet about severe side effects and long-term complications; and she wants Vicodan for the pain.

This woman is typical of a patient with chronic pelvic pain. These patients can be complex with multiple etiologies, which can transcend multiple medical subspecialties. This type of patient may have undergone multiple previous surgeries, perhaps even a hysterectomy. These patients have so many systemic complaints, have seen so many physicians, and all too often have not responded to so many treatments that the validity of their complaints may often be doubted.

This patient most likely is suffering from endometriosis, a horrible disease, which affects 5.5 million women in the United States. Unfortunately, most people have not even heard of endometriosis and many physicians do not understand the gravity of this disease and how it is best treated. The standard definition of endometriosis is a disease that occurs when the inside lining of the uterus, called the endometrium, flows back through the fallopian tubes and starts growing inside the body around the ovaries, bowel and bladder.

But, this only begins the description of the reality of endometriosis. The effects of endometriosis on a patient’s quality of life and chronic pain can be more devastating than cancer. Endometriosis can be thought of as a combination of tens or hundreds of painful bleeding blisters covering the inside of the pelvis mixed with chunks of scar tissue. Eighty-Five percent of women with endometriosis have pelvic pain, which includes pain with periods, pain with intercourse and pain with bowel movements. Physically and emotionally, the pain of endometriosis can cripple the ability of women to lead a normal life. The pain these patients experience is real. Patients commonly relate that their post-operative surgical pain is less than their pre-operative endometriosis pain. Other patients have infertility as a result of endometriosis.

There is no blood test to diagnose endometriosis. Laparoscopic surgery is needed to truly diagnose and remove endometriosis from the body, although a few select specialty endometriosis centers can sometimes diagnose advanced stages of endometriosis including bowel endometriosis with ultrasound.

Endometriosis can be treated medically or surgically. Medical treatment involves hormonal manipulation, most often with birth control pills (BCPs). If BCPs are not tolerated or are not effective then either Danazol or a GnRH agonist such as Lupron are options. The American College of Obstetrics and Gynecology (ACOG) Committee Opinion on the treatment of endometriosis feels it is OK to treat pelvic pain with Lupron prior to laparoscopy.

This past month, I attended both the American Association of Gynecologic Laparoscopists (AAGL) meeting in Washington DC and the International Pelvic Pain Society (IPPS) meeting in San Diego. The world’s experts in the treatment of endometriosis were in attendance. Most endometriosis experts advocate diagnosis and removal of endometriosis surgically with laparoscopic excision in women with significant pain. While many general OB/GYNs treat endometriosis surgically, studies have shown and the ACOG Committee Opinion agrees, that the more experienced the surgeon in treating endometriosis, the better the success rates with lower recurrence rates.

I believe the success rates correlate with how much of the disease is removed. If not all of the endometriosis is removed, then success rates are lower and the pain returns fairly quickly. Complete removal of endometriosis is nearly impossible with the most common technique using unipolar cautery to spot treat the endometriosis. Again, the more experienced endometriosis surgeons use wide excision to successfully remove all or nearly all of the endometriosis. This type of surgery can technically be extremely difficult.

Finally, pelvic pain is usually more than just endometriosis. Adhesions, painful bladder conditions (e.g. interstitial cystitis), bowel pain, pelvic muscle floor spasm, neuropathic pain are other contributory conditions. Pelvic pain is best treated at an endometriosis specialty center that utilizes a multi-disciplinary approach in order to treat all of the conditions contributing to the patient’s pain. While challenging and complex, the vast majority of patients with pelvic pain can regain their life with resolution or a significant reduction of pain with appropriate diagnosis and treatment of their condition(s).

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