Register for Dr. Mark Perloe presents "Endometriosis, PCOS,
and Recurrent Pregnancy Loss"
Sunday, January 3, 1999
Mperloe "Hi Terri.....do you have a question tonight?"
Terri62 "Am I in the right place?"
Mperloe "Depends on what you hoped to find. I am supposed to be available to answer medical questions on endometriosis, pcos and infertility tonight."
Terri62 "I was looking for the place were they were having a discussion on repeated loss of pregnancy."
Robinmk "Wanted to let you know that the estradiol levels and serum estrogen was normal...."
Mperloe "Well I would not say much of a discussion, but I sure would be willing to try and answer any ? you have on the subject."
Mperloe "Robin.....you will have to remind me of your situation."
Robinmk "They are saying it doesn't look like POF.....but I still have the hot flashes and the night sweats :o("
Mperloe "Robin.....are you on meds? What is your FSH level?"
Mperloe "Terri: Have you had repeated pregnancy loss?"
Terri62 "Well I wanted to look and see if my ? would be answered. It's embarrassing. Are you really a doctor? Are you male or female?"
Robinmk "I don't know, all I know is it is normal....no hormonal type meds....Zoloft Methadone for pain"
Terri62 "Yes, 9 times with 10 babies"
Mperloe "I am really an MD.....see www.ivf.com/mpmd.html to learn about me."
Mperloe "I am a male...."
Mperloe "WOWW."
Robinmk "Terri, Dr. P. is really a doctor right here in Atlanta, GA."
Mperloe "How old are you Terri?"
Terri62 "36"
Robinmk "Terri, I am very sorry for your losses."
Mperloe "OK, you may have an age-related issue, but I guess the losses occured when you were still younger and I doubt that is the issue."
Mperloe "Were chromosomes ok?"
Mperloe "Have they come up with any reasons yet?"
Mperloe "Robin...are you in Atlanta?"
Terri62 "No, it's not I was abused when I was young, really bad. Could there be damange there that causes that?"
Mperloe "Terri....no, that would not be a factor."
Robinmk "Yes, right down the street from N'side Hospital."
Mperloe "How did your MD evaluate the inside of the uterus?"
Mperloe "Did they look via hysteroscopy or do an HSG xray?"
Terri62 "The doctor said I was scarred really good. I never told him but I thought he may have known."
Robinmk "Terri, I'm very sorry."
Mperloe "I find that many MD's do not adequately evaluate the immune system."
Terri62 "I just had a hyst on the 18th of December."
Mperloe "They do not check a complete antiphospholipid panel."
Mperloe "Hysterectomy or hysterosalpingogram?"
Robinmk "Dr. P., my regular GYN is Arthur Gumer and Robert Albee did my last lapex"
Mperloe "Also, the immune system can interfere or not recognize the pregnancy."
Mperloe "NK cells are activated,"
Terri62 "The doctor in Tampa said they could do a surgery and have to stay in bed for awhile."
Mperloe "Terri....I am confused. What type of surgery did you have and what surgery will they do?"
Robinmk "Dr. P, what else could be going on to cause the hot flashes and night sweats if the hormones looked okay???"
Terri62 "No this was before I almost bled to death. I had to have an emergency hyst."
Mperloe "It could be infection, thyroid problems, low androgens, low progesterone other non-hormonal issues."
Robinmk "Terri, you have definitely been through it!!"
Terri62 "I had a total hyst, everything out even appendix."
Mperloe "Terri....OH, so the issue of recurrent preg loss is not an issue now."
Robinmk "I know I am borderline HYPERactive thyroid...could that do it??"
Terri62 "No, I was just wanting to let it go with knowing that the abuse was not a factor."
Mperloe "We have one IVF patient who we removed 18" of her rectum and colon, half the bladder, the appendix, both tubes and a complete side wall dissection. She is now painfree and we plan to start IVF this month."
Mperloe "OK"
Robinmk "It isn't enough that my internist at N'side wants to start medication yet...."
Mperloe "Robin...absolutely, it can."
Mperloe "If you are hyperactive because of thyroiditis....frequent in endo patients, then suppression and inderal if you have rapid heart rate are often a good idea."
Robinmk "I'm kind of between a rock and a hard place here....it is borderline and not enough to start thyroid meds, but yet I have symptoms......"
Robinmk "I do have a fast heart rate....usually around 98-110"
Mperloe "You might ask about low dose inderal 10mg LA."
Robinmk "When you say suppression, do you mean lupron?"
Robinmk "I will do that, thanks ;o)"
Terri62 smiles.
Mperloe "No, low dose synthroid if antibodies and thyroiditis or PTU or inderal if tachycardic."
Terri62 "Thanks for listening to me."
Mperloe "Who do you see at Nside?"
Robinmk "oh, okay......"
Robinmk "Diane Wisebram is my internist and Arthur Gumer is my GYN"
Mperloe "OK Terri.......I hope things have been going better since surgery. That is an awful lot to go through, but I hope knowing that the RSA was not related gives you some peace."
Robinmk "Are you familiar with either of them?"
Mperloe "I do not know Dr W. Are you happy? Always looking for more internists to refer to."
Terri62 "Yes it does, thanks."
Mperloe "I am impressed with, know and like Dr. Gumer."
Robinmk "She does mainly GI now, but yes, very happy...she can be very short with you, but she is always there when needed.....I love Dr. Gumer!!!"
Robinmk "My mother sees David Smith at St. Joes and likes him very much too."
Robinmk "Do you know David Taylor at Northside?"
Mperloe "I just had a brief visit to Nside GI lab. They do a fine job over there. I see a GI named Chris Sarzen....."
Mperloe "No to Smith or Taylor...don't know them."
Robinmk "Smith is in the 5671 Bldg at St. Joes and Taylor and Wisebram are together at Nside in the 980 Bldg"
Robinmk "What group is Chris Sarzen with?"
Mperloe "Himself"
Robinmk "Okay, there is also a group called Atlanta Gastroenterology Assoc, which is where I go since being diagnosed with pancreatitis."
Mperloe "Sounds like a good New Year's resolution would be to figure out a way to avoid physicians!"
Robinmk "I was sent to Scott Brooks at their Nside office since he specializes in ERCP's and ended up getting pacreatitis from the test....never realized how big a 2% risk is!!!"
Mperloe "It is 100% when you get it."
Robinmk "I agree with the New Years resolution!! I'm all for it!!!"
Robinmk "BTW Dr. P....David Taylor used to be with GA Baptist years ago...."
Mperloe "While my office is at GBMC, I now do most of my surgery at Nside."
Mperloe "It is just alot more attuned to doing the difficult surgeries and setup for bowel/bladder surgery when necessary."
Robinmk "I had my tonsils removed at GBMC when I was 18....14 yrs ago!!"
Mperloe "I am still waiting for some ultrasound relief."
Mperloe "I had hoped to buy a new doppler flow ultrasound to do some endometrial studies, but Shimadzu is just too slow."
Conn "I'd rather be in Atlanta vs here tomorrow-hopefully my 1st case won't be boy parts."
Mperloe "I am off for a meeting as editor of Endozone to Geneva next month. I believe that will also be cold and snowy in February."
Mperloe "Is that an US on you?"
Mperloe "It is an interesting meeting that will cover use of GnRH agonists...as well as the new class of antagonists."
Mperloe "Also, their use in IVF will be covered."
Mperloe "And, she can do US exams."
Mperloe "BTW, are you a member of the PCOSsupport organization."
Mperloe "It is a great group."
Jaffee "I think so, I dont know but I registered for the chats."
Mperloe "We are planning to have a meeting here in about a month. Members from all over the SE come."
Mperloe "Jaffee, they also have a website at www.pcossupport.org worth checking out."
Robinmk "That should count too :o)"
Mperloe "Maybe......but Dunwoody medical center?"
Mperloe "Have you read my articles on PCOS?"
Mperloe "www.ivf.com/pcostreat.html"
Robinmk "Dr. P...if I can get the levels of the hormones, can I email you with them to see what you think??"
Mperloe "We now have over 30 pregnancies attributable to use of metformin or troglitazone rather than ovulation medications."
Mperloe "Robin.....that is not really fair without arranging a consult to review everything.....I would not really want to guess with only part of your picture."
Schmoo34 "I need advice on endo pain."
Mperloe "How long have you been having pain?"
Robinmk "That is very impressive Dr. P."
Schmoo34 "Last 18 months actually. I'm seeing you on 18th but am losing my mind now."
Robinmk "Understand, might just do that."
Mperloe "Schmoo, do I need to see if I can get you in sooner than that?"
Mperloe "Is the 18th Monday or Tuesday?"
Conn "It's a Monday, isn't it?"
Mperloe "I dont think you have a new patient appt on the 18th as we are closed after morning clinic on the 18th for MLK. If somehow we screwed up, or you are in bad pain, maybe we need to get you in sooner."
Robinmk "18th is Monday"
Schmoo34 "I'm getting Emory records tomorrow"
Mperloe "OK, schmoo, can you drop them off for me and let me call you some time to see if we can arrange to get you seen sooner?"
Robinmk "Schmoo...are you the woman I spoke to today on the phone???"
Schmoo34 "Yes Robin"
Jennann "Dr. Perloe, I have a problem with irregular spotting that has been attributed to my endo can you tell me a little bit about this?"
Robinmk "When you said Emory schmoo, I knew it ;o)......good to see you in here"
Mperloe "Jennann, while spotting seems to be more commnon with endo, we really don't know why."
Mperloe "If you mean before the cycles that is."
Mperloe "Midcycle spotting or spotting throughout the cycle may indicate a polyp or fibroid and deserves closer followup."
Schmoo34 "Dr. P I would love to get in sooner, I'll bring records to you tomorrow."
Jennann "It used to only be days 21-28 but now it seems to be almost all month. I have no polyps or fibroids (numerous hysteroscopies to rule this out)."
Mperloe "It is thought that progesterone levels are lower, or that the increase number of white blood cells in the abdomen produce chemicals which interefere with the uterine lining and cause the spotting."
Mperloe "I would try adding a natural progesterone 50-100mg/day the last 14 days of your cycle to see if that helps."
Mperloe "You may also want to check a bleeding time and rule out von Willebrands disorder, a platlet problem if you also have heavy menses when they occur."
Mperloe "I would guess the low P is the issue with you though."
Mperloe "Treatment for endo, has not really been shown to change that picture unless the treatment is lupron...shutting everything off."
Jennann "I tried to start stimulation Dec. 3 for my first IVF cycle but had no response. I was told by RE that meds would "override it" it didn't. I continued to have spotting since and it has not stopped."
Jennann "My serum progest. was normal as well as e2 and FSH"
Mperloe "Jenn.....yes, they may be normal levels, but I believe that short of ablation, the extra P is worth a try."
Mperloe "I would guess you have had biopsy to rule out infections, and tried an antiboitic such as doxycycline to see if that can help."
Mperloe "If all checks out ok, I would not be concerned other than for nuisance stuff. If you are done childbearing, the ablation may be considered."
Mperloe "There is another condition called adenomyosis which is difficult to pick up unless you have a good US tech like Conn, or a nearsighted MD like me, who has looked over and over."
Mperloe "This condition is also called endometriosis interna.."
Mperloe "internal to the walls of the uterus."
Mperloe "It can be associated with pelvic heaviness and spotting."
Jaffee "Mperloe, I do have a question for you. I do have pcos, and it seems like alot of the gyns that I've been to, aren't all that knowledgable about pcos. One gyn says he will not treat me unless I go on bcp and I'm just so frustrated."
Mperloe "Treatment is zoladex or lupron and/or ablation or hysterectomy if you are done childbearing."
Jennann "If you are speaking to me - I am not done childbearing which is why I am trying IVF - I've been an infertility patient for 3 years. Tried Proges. My spotting continues after a "normal period" and stops on day 13 or so until day 21."
Conn "Jaffee- do not waste your time GO to a RE!"
Mperloe "Jaffee, where are you located?"
Robinmk "Yes, it is suspected that I have it but have been told that a hyst is the only way to really diagnose adeno.....with each exam it hurts terribly when my uterus is moved..is that the adeno??"
Jaffee "in Florida"
Mperloe "Most GYN's look at it like not infertility->bcp, infertility->clomiphene"
Mperloe "It is just not like that."
Mperloe "PCOS has soo soo many effects."
Mperloe "weight, irregular menses, pain, hair growth, hair loss, moodiness, depression"
Jaffee "What is a RE? I've tried and our family surgeon is the only one that helps me, but with the insurance today, there is only so much he can do for me."
Mperloe "I am amazed at how many women have borderline insulin resistance and state that use of metformin gives them their lives back."
Jaffee "I want to get into a medical study, but I don't know how and where to find them."
Mperloe "RE is a fellowship trained reproductive endocrinologist."
Mperloe "Most GYN have 3-4 weeks of training in dealing with infertility, PCOS and endometriosis during their training."
Robinmk "Dr. P....when the uterus is moved is that the adeno that they suspect I have??"
Mperloe "Not too much time to deal with such a wide range of issues."
Jaffee "Yes, I've been to an endocrinologist, but one says it's all in my mind, that I have this problem, the other says as long as I'm getting my periods, I dont need bcp."
Mperloe "Jenn...tell me about your IVF cycle...how is it going?"
Robinmk "I've been told by both my docs that a hyst is the only sure way to diagnose adeno...they are going by symptoms and exam when saying they suspect it."
Guest12 "Has spironolactone truly worked for anyone??"
Mperloe "Robin...that is because they are not really skilled in US hands on."
Jaffee "So I'm all confused because my insulin comes back high, the range is between something and 25 and mine comes back as being 95. I don't know what to do."
Mperloe "Spironolactone can work, but there are other ways to address the problems."
Jennann "Dr. Perloe, It was cancelled - nine days after stimulation. I only had 3 follicles (10-12-13) I'm 26 and was diagnosed with stage IV endo in 9/97."
Robinmk "That is a shame that one has to go through a hyst, but then again, if it helps the pain of adeno, then you do what you have to do......"
Mperloe "Jenn, the stage IV endo can often result in fewer follicles if there are alot of adhesions."
Guest12 "What other ways, my gyn won't give me anything else..I have been on spiro for 10 years."
Mperloe "If you are not likely to conceive (pregnant), then medications such as Finasteride, Proscar can be used. (The TV adds advise you not to use this.) It can cause abnormal male offspring if you conceive."
Jennann "Dr. Perloe, I had a laparatomy in 9/97 and subsequently had 7 months of lupron. Endo symptoms are worse than before. RE says that I don't need to have another lap. I am considering this..."
Mperloe "Guest we can now get at the root of the problem in many women by using metformin to lower androgens, if you have PCOS."
Mperloe "Often newer diagnostic tests can be helpful."
Mperloe "If the spironolactone is not working, and the risk of pregnancy is high, then I would consider using Zoladex 3m implant and addback therapy to avoid risks of low estrogen.....hot flashes."
Mperloe "This approach works well but really costs some $$$$."
Jaffee "Tell me what diagnostic tests are good, I have been fully diag with pcod, I had laparoscopy in 7/97 and it was confirmed for sure."
Mperloe "Jenn....did your MD do a bowel prep preop? And why laparotomy?"
Guest12 "Would a gyn give this metformin or do I have to go to an endo??"
Mperloe "Guest.....I dont know."
Mperloe "Some GYN's use it."
Mperloe "I would print the article I have www.ivf.com/pcostreat.html and mention it to your MD."
Jennann "Dr.P - I had the laparotomy because had an endometrioma in the incision scar from a previous surgery (dermoid cyst) I don't know about a "bowel prep""
Mperloe "I will speak to any MD about their concerns if they would like to call."
Mperloe "A bowel prep........is mag citrate, cleansing enemas....Sounds like fun...but it really isn't."
Mperloe "Anyway, if the MD does not suggest this before endo surgery, it means the MD is not prepared to deal with a full range of endo related problems and may mean that you're not getting the best possible care."
Guest12 "Wow you're pretty awsome..doc"
Mperloe "This is about the easiest way to check on the endo skills of your MD."
Mperloe "Thanks guest....I can type too."
Ladyzar "I recently had an abdominal hyst/bso, I am almost 6 weeks post-op. About 2 weeks ago I began having a pain while I tried to have a bowel movement. I realized I was tearing the skin around my anus. This caused considerable pain. Due to the Endo or the PCO, I have been a victim of chronic diarrhea. I believe this new pain is because for the first time in years my stool is solid. My question is, what can I do to stop it from tearing open and becoming re-injured? I re-injure it every time I have a bowel movement and it is especially painful. Occasionally I tear it sufficient enough for it to bleed. It is bad enough to make me dread and even cry about having to have a bowel movement."
Mperloe "Sounds like you have a fissure."
Mperloe "Did you have surgery here?"
Ladyzar "What is that?"
Mperloe "A fissure is a fancy word for tear in the rectal/anal mucosa."
Jennann "Dr. P - he didn't - it was emergency surgery done by my obgyn (I was in SEVERE pain) He then immediately after the surgery referred me to an RE. The RE does not believe that we need to deal with the endo and believes we need to go directly to IVF."
Ladyzar "I had it in TN"
Mperloe "It is not rare in endo women or after surgery."
Ladyzar "What can I do?"
Mperloe "The treatment involves using a steroid cream to the anus and stool softeners such as perdiem/metamucil."
Ladyzar "I need to get that from my doctor?"
Mperloe "If the steroid hydrocort or other type of steroid 3-5x/day does not heal things up, it may need to be surgically excised and fixed!!!"
Mperloe "Have you seen a GI physician?"
Ladyzar "No"
Mperloe "I would recommend that if you have seen a GI surgeon or GI MD, give them a call."
Mperloe "Maybe they will call things in."
Ladyzar "Ok"
Mperloe "You could try over the counter 1% hydrocortisone cream or epifoamHC, but if after a week, that does not help, please see someone about this."
Robinmk "It is suspected that I have adeno...when I have an exam done, it hurts when the uterus is moved...is that the adeno? What could cause pain on movement of the uterus?"
Mperloe "Robin...it could be adhesions from surgery, or fibrosis."
Mperloe "It could be adeno"
Mperloe "I think the best way to tell is by US."
Mperloe "I know that Conn and I can tell adeno on most patients."
Robinmk "They say I am forming them on the bowel now.......could that also cause pain on movement of the uterus?"
Conn "Even with our glasses off"
Mperloe "It is important to have a good quality US machine."
Mperloe "Robin...yes it can."
Mperloe "Endo on the bowel can be stimulated."
Robinmk ";o) Conn"
Mperloe "The rectum is often adherent to the back of the uterus or at least to the top of the vagina."
Mperloe "And the exam can stimulate things."
Robinmk "When does it end?"
Mperloe "However, the nerves in the pelvis are screwy."
Mperloe "In the rest of the body, one nerve innervates one area."
Mperloe "You can follow the nerve."
Mperloe "Cut the nerve, no feeling."
Mperloe "The nerves in the pelvis are more like a spider web."
Mperloe "They cover everything."
Mperloe "They also attach to the spinal cord at many levels."
Mperloe "So you can't cut a nerve and get all the pain."
Mperloe "In fact, you get very little by cutting nerve fibers."
Robinmk "Do you know of a great US Tech in Atlanta??"
Mperloe "BUT, the significance of this is that the nerve fibers get crossed so that a cyst in your right ovary can cause pain on the left."
Robinmk "I had a LUNA in June with the Lapex."
Mperloe "Uterine pain can be adhesions on the bowel or pelvic sidewall."
Mperloe "Endo in the sidewall, can cause knee pain.....go figure...it just makes our job tougher."
Mperloe "Please tell Dr. A that he did not cure you."
Robinmk "Pelvic side wall was smooth two weeks ago."
Mperloe "I think he is a wonderful surgeon, BUT"
Mperloe "Endo is not a curable condition."
Mperloe "It is genetic. 4X more likely if you have a relative with endo."
Mperloe "I don't think he can fix your chromosomes."
Robinmk "I will do that....he never did promise a cure though....My mother had endo and my cousin has endo."
Mperloe "Also, there are many different changes in the immune system, which cannot be fixed."
Jaffee "I have had adhesions on the bowl before and man did it hurt."
Robinmk "I wish he could, I really do!!!!"
Mperloe "It is only by combining excellent excisional surgery with suppression with Zoladex or other meds can we really get good control."
Conn "My friend, a tech as well, came off the pill for 1/12 she has endo. She has a simple cyst on the rt"
Conn "It went from 1.6 cm to 10 cm in 2 weeks."
Mperloe "Robin....I can do US in my office."
Mperloe "Conn, is it an endo cyst? or a CL?"
Robinmk "I threatened both Dr. Gumer and my pharmacist that if they didn't stop giving me the Lupron, I was moving in with one of them since no one would talk to me, so I won't do Zoladex either!!!"
Conn "She is now about day 6 or so in next cycle."
Robinmk "Thanks Dr. P!!!!"
Mperloe "If she is having alot of pain, Conn, then at that size she may need surgery."
Conn "What would you do?"
Mperloe "I would see about putting her back on the pill for now."
Mperloe "Is she off to conceive, or did she just forget?"
Conn "2 immaculate conceptions already- sick of pill."
Mperloe "I would tell her to grin and bear it, or to get back on a low dose pill."
Conn "She has endo ++ full metal jacket guys to do the job."
Mperloe "It prevents cancer of the endometrium and ovary and gives 4X cure rate if she ultimately gets breast CA."
Mperloe "Conn, she might consider a 3m zoladex and add back therapy."
Conn "thx"
Mperloe "Hi Ann.....How is that left side?"
Annmbarber "Just awful and the cold weather is not helping..by the way how are you?"
Conn "If you have a pt that is pcos and not trying to make babies, what do you put them on to decrease chance of breast/ov cancer, etc?"
Schmoo34 "What do you think the time might be to get in to see you? I'll have records there tomorrow."
Mperloe "For PCOS patients I am more concerned about uterine cancer and heart disease."
Mperloe "Anyway, is weight an issue?"
Conn "Debatable point"
Mperloe "Schmoo, I will review records and call you. Tell them to give them to me."
Jaffee "Well I have been fighting cervical cancer for 3 yrs, and just found a lump on my breast a couple of days ago."
Mperloe "I think that metformin can improve energy level and less food craving, hypoglycemia type stuff."
Schmoo34 "thank you!!!"
Conn "thx"
Mperloe "If they have none of this, then BCP is an ok choice or even natural progesterone 14/days/month."
Mperloe "Mary got your phone message, do you need to hear from her?"
Mperloe "Hope the perdiem is helping some."
Mperloe "I still think we need to give things some time, but if the pain becomes intolerable then an US to look at the L ovary seems like a good idea."
Jennann "For those of us with endo and want to get preg. and, as you say endo can't be cured, then what is best laps or IVF?"
Mperloe "Jenn....did they do an FSH level and estradiol day 3?"
Jennann "Yes -"
Mperloe "If you have undergone surgery once, and the tubes/ovaries are ok, then injections + IUI"
Mperloe "If you have done that, then IVF."
Mperloe "At your age, you should make more eggs"
Mperloe "How many ampules each day?"
Mperloe "Did you get lupron?"
Mperloe "Was the FSH ok?"
Mperloe "Sometimes after ovary surgery, the response can be diminished"
Jennann "They didn't want to waste time with IUI - said it wouldn't increase my chances - tubes are questionable. I did lupron 20 units for 8 days then 2 amps fertinex am 1 amp humegon for 3 days then 1 amp fet. and 1 amp hum. for 3 days."
Annmbarber "The perdiem is helping to clean out but I cannot get comfortable with that left side... I am at the moment trying the heating pad and laying down. It just doesnt feel right Dr.P..."
Mperloe "Conn, I am fine....I had undergone esophagoscopy to deal with a stricture. Better leave off the joke on my wife's cooking."
Mperloe "I asked them to probe every orifice they might ever want to probe if I was going to be drugged."
Mperloe "Anyway, they did."
Mperloe "I was in the Mexican restaurant, within an Hour from the start of the procedure."
Conn "Oh God"
Conn "Did they have big hands too?"
Mperloe "I got into an argument with the RN because they would not let me go to MD lounge for lunch."
Mperloe "Conn....no just cold instruments."
Robinmk "I hope all went well with your tests......."
Conn "Unlike yours"
Mperloe "Jenn,....I would use lower dose of lupron....10U then stop at start of meds in my patients."
Mperloe "I might also use 4 amps/day."
Conn "See, if you came for pie, you wouldn't have all these problems?"
Mperloe "I no longer will use fertinex."
Mperloe "Too many canceled cycles."
Mperloe "I like the mixture of FSH and humegon though."
Mperloe "I hope things go better next cycle for you."
Mperloe "If the tubes are questionable, then I agree that IVF is a better choice."
Jaffee "Myperloe, is there a way that I could mail my labs and tests to you, so you could review them for me and tell me what you think"
Mperloe "Barbara the RN did."
Jennann "I did 20 units then down to 10 at the start of stims. The meds seems to increase my endo pain. I am wondering if I need another lap to remove as much endo as possible before trying this again."
Mperloe "Jaffee. Yes, I can do a record review, or a record review + a phone consult. see www.ivf.com/mpmd.html to learn about how to do this."
Mperloe "Jenn....if there is an endometrioma, it should be removed."
Mperloe "If not, only if the pain is an issue."
Jaffee "Oh, this is great, thanks, I'll check it out!"
Mperloe "Removing the endo, otherwise, does not, in my opinon, improve the odds of success."
Mperloe "Barb........They always do....at least if you know what is good for you in the long run....and I do."
Mperloe "Jenn. I still believe that a lower lupron dose is useful."
Jennann "They didn't see any endometrioma with US but I thought you could only see endo with a lap?? And considering the spotting. . ."
Mperloe "Dr. Brindsen in Bourn Hall England, where first IVF baby was from uses 10U and stops all patients at start of injectables."
Mperloe "Jenn I am not worried about endo on surface, just a large 2+cm ovarian endometrioma cyst which can be seen."
Jennann "RE did say they would try a new protocol - I am trying a new RE that I hope I feel more comfortable with - Thank you very much Dr."
Mperloe "What about the 8 babies?"
Annmbarber "Any advice?"
Mperloe "Roberta...I sent you an infertility overview article by Dr. Sills and I and will send you an article on 8 is enough to post if you would like it."
Robinmk "I personally think having eight babies is taking such a health risk for mother and children....."
Mperloe "Ann.....I think we need to see you sometime soon and check the US."
Mperloe "I am not sure the cause of the pain, but lets check it out."
Robinmk "Dr. P, what are your thoughts on a woman having so many babies??"
Annmbarber "Should I call in the a.m.? I'm sorry about the frustration."
Mperloe "8 babies is a terrible risk and expense."
Mperloe "Unfortunately, all of us commentators......grabbed by the media to kibbitz on this did not really know what went on."
Mperloe "They are keeping things pretty well hushed up."
Jennann "Dr. P, aren't there ways to prevent that from happening?"
Robinmk "My thoughts exactly and I am not a doctor!"
Mperloe "So the gov may outlaw stuff, pass laws, when this is just the result of an MD who did not know how to manage this."
Mperloe "On the otherhand, it may have resulted even after excellent care."
Mperloe "So that is the dilemna."
Robinmk "Dr. P, Dr. Toledo was on the news when they were born, did you see him? He said that it is not good to go more than two babies really!"
Conn "I'm not a good enough mother to have 8 at once."
Jennann "The thought of governmental regulation makes me even more concerned."
Mperloe "As my wife says, the absence of information does not keep me from speaking."
Mperloe "Robin....I did CNN, BBC, Radio Dublin, ABC radio, CBS radio, front page of about 100 newspapers on this......AND"
Mperloe "It was all in the middle of clear liquids and a great prep for my procedures."
Conn "dedicated"
Mperloe "ie, it was DR PERLOE, live from his throne......and I wasn't wearing a crown."
Conn "Too much information"
Robinmk "Well, you were a very busy man that day!! LOL"
Mperloe "Anway, it is inappropriate to go for any specific number other than 1?"
Mperloe "Twins are also at risk."
Schmoo34 "Just wanted to know what long term things are women with endo to look forward to when there is no cure, my last surgery got me thru 10 yrs before this new pain started, I'd like to be "normal" again."
Mperloe "And, no one ever gave me a site nor did they tell me how to aim."
Mperloe "So, I think we need to be more careful and focus on the underlying causes and how we can generate two or three good follicles."
Robinmk "My cousin was on bedrest from the third month on with her twins...couldn't even get up to the bathroom!!! She was like that with the first one she had and that was a single birth...she had a catheter in her to keep her from going into labor with both."
Mperloe "Metformin/troglizone for managing PCOS, IMHO, is a good way of reducing the number of multiple births in a group with very high risk."
Mperloe "Schmoo: first not all endo recurrence is endo."
Mperloe "We now have close to a dozen patients with nerve entrapment as a result of the surgery."
Mperloe "In fact, on the endozone site (restricted to MD;s) there is a case review of a few of these patients to make MD's aware of this condition."
Jennann "Is the stimulation for IUI the same for IVF? For IUI I would think you'd need 2 or 3 good follicles but for IVF I thought you needed more than that?"
Mperloe "The results of treatment are dramatic and immediate and most MD's don't even know how to check."
Mperloe "Anyway, I think that endo is a progressive disease in up to 60% of women, so a combination of healthy diet and nutrition to build the immune system, and good skilled surgery and hormonal suppression....perhaps with addback therapy are best."
Mperloe "BTW, I have been taking stuff called Juice Plus. A nutritional supplement from fruit and veggies."
Mperloe "What is neat, is that an ID guy who gives it to his aids patients just ran a study."
Mperloe "They looked at NK cell activity."
Mperloe "AND, it was increased."
Conn "Do you feel better? I think since I have been dieting over the last yr I am lacking something!"
Lorim "Dr. P can you please exlain addback therapy? I'm a little new to endo"
Mperloe "NK cells are normally suppressed with endo, and some believe that it may be the cause of the problem....so who knows."
Barbaran "I took that when I had Chemo. I should get some more. I was told it is great stuff for the immune system."
Mperloe "Maybe we will learn more on how to supplement the immune system and what causes the immune problems associated with the condition."
Mperloe "I believe we are getting there though."
Robinmk "Where can we purchase Juice Plus???"
Mperloe "Addback therapy is the use of estrogen + progesterone in a constant dose very low to avoid some of the side effects."
Mperloe "of Zoladex or lupron."
Jennann "Can you stay on that indefinitely?"
Mperloe "these gnrhagonists lower estrogen levels"
Mperloe "they are approved for only 6 months......maybe due to side effects maybe due to $$$."
Mperloe "When you stop them, the stuff comes back."
Lorim "JP used to be available through networking."
Barbaran "Health Food Dept. It's a Pill. Take two and that's it."
Jennann "I took lupron for 7 months without addback - I only had hot flashes - I felt great while I was on it. Endo came right back after I came off of it"
Mperloe "SO, I would like to continue indefinitely, but am concerned about low E effects, hot flashes, bone, memory etc."
Lorim "JP is great...used to take it but couldn't stay on as it was too costly at the time."
Mperloe "The addback avoids all those symptoms but does not decrease effectiveness because the dose of E+P is low and constant, daily."
Mperloe "I have had some on it for over 3 years now and they are doing great. We check bones too make sure Ca is not being lost."
Jennann "Not an option for those who wish to get pregnant."
Mperloe "For more info on JPlus, please email me and I will send you a URL to listen to a lecture and can snail mail some info if you wish."
Mperloe "My email is mperloe@ivf.com"
Barbaran "Juice Plus costs about $30.00 a month But it is sure cheaper then being sick"
Lorim "Thanks for the expalnation Dr."
Mperloe "Jenn...so I would consider zoladex and addback rather than surgery. Alot cheaper. And with a shot every three months, it is not such a hassle."
Mperloe "Barbara...I have not had a cold now for 2.5 years! I think the stuff really works."
Mperloe "Many of my endo patients say they have more energy."
Conn "How about for children?"
Jennann "I did take the 3 month shot of lupron - it was convenient. What does this juice stuff have in it?"
Mperloe "They also have a weight loss program, set 4 life, which is high protein type diet, low fat. I think it is a great diet for PCOS patients because of the insulin lowering stuff."
Mperloe "They juice 7 pounds of fresh fruit and veggies."
Mperloe, "Take out all the salt, sugar and water,"
Barbaran "Why did I stop? I'm buying some more this week. Funny thing is as soon as we feel better we stop taking what made us feel good in the first place. Go figure!"
Conn "Talk about being on the throne"
Mperloe "And voila you have 2 fruit capsules in the Am and two veggies in the pm."
Conn "How many calories remain in the caps?"
Mperloe "Barbaran....that is true. While some really notice they feel better, many just feel good about the prevention benefits."
Mperloe "So how does prevention feel?"
Mperloe "Conn, the weight loss drink mix is 192 per serving. I believe the effect from the capsules is minimal."
Mperloe "Barb...are you a member/dealer?"
Conn "thx I'm having a hard time with my last 20 lbs"
Mperloe "If not, I should set you up."
Barbaran "Like many things in life (to me) a lot of it is in the mind.......But if it is in the mind then it is part of our body..........."
Conn "I agree"
Mperloe "Conn, email you snail mail address and I will try and send you an audio tape."
Mperloe "Their weight loss program is not fast..."
Mperloe "It is doable and sustainable."
Barbaran "No started it when I was on chemo for BC. It helped with exaustion........"
Mperloe "You should experience 5-10 pounds per months until you are where you want to be."
Robinmk "Dr. P, do you sell the Juice Plus also?"
Mperloe "I refer people to the company....you need to buy it or be referred, or be a dealer."
Conn "I'm doing WWatchers now-happily lost 50 lbs 20 to go- getting anxious"
Mperloe "I can help you order it if you like."
Lorim "congrats Conn"
Jennann "My dad just lost 80 lbs on WWatchers"
Mperloe "I can tell you more when you come in for the US Robin."
Conn "thx"
Robinmk "WOW...that is terrific Conn!! Congrats on the weight loss...WW is the way to go!!"
Mperloe "WWatchers is great.....albeit a bit $$$$."
Robinmk "Okay, thanks....Dr. P, do you really think you can diagnose the adeno by US??? That would be great...what do you do once it is diagnosed? A hyst??"
Mperloe "Robin...usually the hysterectomy is best if there is alot and you do not wish long term lupron/zoladex suppression."
Mperloe "Sometimes an endometrial ablation can help."
Guest16 "I am having laparoscopy and hysteroscopy to remove a polyp or fibroid in uterus on Friday"
Robinmk "Doesn't that mean I can't get pregnant? I am only 32 and would like to have a child at some point, although my chances are very slim."
Annmbarber "I will call tomorrow and speak to Mary. I am just too worried to wait 3 weeks and hurting too much."
Guest16 "How bad am I going to feel?"
Mperloe "Robin...then zoladex suppression is the only thing to do."
Mperloe "The after effects of the surgery can vary."
Guest16 "And for how long (I live in Vidalia...surgery in Savannah, btw)"
Jennann "Guest16 - I went to a bridal shower the same afternoon."
Mperloe "Depends on the amount of surgery and the skill of your physician and your reaction to anesthesia."
Robinmk "After what Lupron made me feel like, I'm up a creek without a paddle, so to speak ;o)"
Guest16 "Oh, wow, Jennann! that's good news! thanks."
Mperloe "Some have no problem......I was in a Mexican restaurant within an hour of anesthesia, but others may have nausea for the rest of the day."
Jennann "I'm sorry - not the lap but I did have the operative hysteroscopy. I went home and slept off the anesthesia and my husband drove me to the shower!"
Mperloe "WOW, Jenn...you must have an awful large house to need to be driven from bed to the shower!"
Jennann "he he he"
Guest16 "I had no problem with hysteroscopy, but he says this will be several hours of surgery."
Mperloe "Sorry, I could not let that pass....I am just that sort of sicko."
Pamela_h "Yes, I just stated taking metformin and wasn't sure how sucessful it has been. I seem to be adjusting to it fairly well."
Conn "not you!"
Mperloe "I would guess you will have more recovery."
Robinmk "Dr. P is on a roll tonight!! ;o)"
Mperloe "With that length of time, you can expect up to a week of recovery if all goes well."
Robinmk "Guest16, you will probably need more time to recover"
Mperloe "Remember the incisions may be small, but we can stilll do large operations through small incisions."
Jennann "Guest - I wish you good luck and a speedy recovery!"
Robinmk "Yes, I had to be reminded of that several times after both of my laps!!"
Mperloe "Next month you can tell us how well things went."
Robinmk "Hard to remember that one had major surgery when you look at the tiny incisions"
Mperloe "Pamela what dose are you taking?"
Mperloe "We have had over 30 pregnancies from metformin."
Pamela_h "1500mg a day and I started last Tuesday and have only had minor stomach problems."
Mperloe "I blieve it is important to monitor BBT charts to know when you are pregnant."
Robinmk "Yes Dr. P....I see them"
Mperloe "Did they start you on that dose right away?"
Guest16 "Thanks, Jennann...guess I'll plan on being out of commission for a week or so."
Pamela_h "Yes."
Mperloe "Pamela....That is not the way to start it."
Mperloe "It needs to be started gradually and built up to that dose."
Mperloe "Anyway, you also need to be off, the drug before surgery, or xray with a dye."
Pamela_h "I'm in the Air Force and I'm not really working with a fertility specialist."
Mperloe "If the temp stays up for 16 days check a home preg test and get off med if you are pregnant."
Mperloe "Please read my article at www.ivf.com/pcostreat.html and print it out and maybe discuss with your MD."
Mperloe "If you get diarrhea, talk to your MD about alternatives such as troglitazone."
Mperloe "Are you obese?"
Mperloe "We see about 30% ovulation at 3 months and 85% if you are able to stay on for at least 6 months."
Robinmk "Dr. P, do you have any articles on adeno too??"
Pamela_h "Not really I'm 64" and weigh 134"
Mperloe "No Robin."
Mperloe "OK, so troglitzaone can be an acceptable alternative if you cannot tolerate metformin."
Robinmk "Thx"
Mperloe "Good luck to all. I better get off and kiss/ or slug the kids good night."
Robinmk "Thanks so much Dr. P......you have been a big help"
Annmbarber "Bye Dr.P talk to you soon"
Guest16 "Thanks everyone! :0)"
Mperloe "Ann, call tomorrow....it will be a madhouse after getting back......."
Robinmk "Dr. P, I enjoyed the time prior to chat talking with you ;o)"
Robinmk "I'll tell Dr. Gumer we chatted too"
Mperloe "Thanks Robin...so did I but I got worried that I was in the wrong place, or that I was no longer loved/tolerated online with such a small turnout."
Mperloe "But things picked up at the appropriate time."
Robinmk "That could never happen Dr. P ;o)"
