Sunday, February 19, 2012

Endometriosis and Depression (Part 2)

The Science of Endometriosis and Depression


Today I will be going over some of the more researched and scientifically backed purposed relationships between Endometriosis and Depression. Now, let me put a warning in now. I am majoring in Neuropsychology. I have worked in a medical research microbiology lab and under three different professors for research assistance. I am what you could call a full fledged nerd. A little hazard of this is that I have become very comfortable with the language and formats of scientific research. So today, although I will be citing resources and discussing papers, I will be trying my absolute best to remain as plain language as possible. If there is anything you do not understand, PLEASE email me or leave a comment. That way, I can fix it for everyone. My goal is to write this for other people--not myself!


First off, there are many confounding factors that make it difficult to ascertain exactly why there are such high rates of depression in women with endometriosis. I am still looking for the exact number (if you know the study, please email me the reference!) but it has been found that women with endometriosis DO report much higher rates of depression. That much is clear. It's the why that has everyone so boggled.


The main problem is that without advances in endometriosis (good animal models, more funds, etc.), the exact nature of the relationship between depression and endometriosis is a mystery. In fact, some have even proposed that it may even be possible that women that are not vulnerable to depression experience less pain than women who are. Meaning the pain you feel with endometriosis could have more to do with anxiety/depression and less to do with endometriosis. This does not mean that it is a 'fake' disease; that is not what I am saying. But the experience of pain ('how bad it feels') may differ depending on one's mental state. Anyone with endometriosis can tell you that the amount of physical pain felt often has little correlation with the progress of the disease. Meaning a women with little endometriosis could be experiencing much more pain than a women with highly advanced endometriosis. Part of it has to do with where the endometriosis is. But another part may have to do with your personality type(1). Past research suggested that personality type could lead to endometriosis, but more recent research is suggesting that depression/anxiety is more likely a consequence of endometriosis.


Personally, for me, from what I can discern from more modern research, is that endometriosis-depression is a dangerous cycle. Persistent pain from illness increases the likelihood of developing secondary disorders--such as mental conditions like depression and anxiety. Meaning hurting all the time takes a toll on your mental state. These mental dysfunctions (such as mild depression) increase the severity of pain sensation (i.e., it hurts more than it used to). Then this pain furthers the risks for mental conditions. Which then increase the subjective sensations of pain(2). To put it simply, you could be caught in a dangerous downward spiral of pain and depression. To me, this is the biggest reason for why it is important to address both when trying to deal with the complications/difficulties/tragedies of endometriosis.


Other aspects of endometriosis also increase the risks of depression. Such as the restrictions that the pain causes on one's life. One primary reason is the social dysfunction(3). When a patient is experiencing chronic pain, it prevents them from being able to socialize normally. Meaning the pain keeps them from making and keeping connections with friends and loved ones. Without that support net, you are more susceptible to depression. Not to mention to other immunological hiccups. Meaning, people who frequently socialize or maintain strong friendships are not only more protected against depression, but also infections. The link is still being studied, but for whatever reason, people who socialize more recover/heal/defend better than those who socialize less. The exact reasons for the relationship is not clear, but that the relationship exists is a fact. Try not to let the pain keep you from loved ones.


Speaking of pain, aside from social dysfunction, pain alone can lead to higher rates of depression. As I said earlier, depression can increase the severity of how pain 'feels'.  Studies have found, in comparing endometriosis women with and without pelvic pain, the rates of depression are over twice as high in women with pelvic pain(4). This relationship between chronic pain and depression has been repeatedly researched; however, there is no agreement on whether the disease/disorder causes the depression or depression causes the disease/disorder. For our purposes, it is simply beneficial to keep this relationship in mind and be cautious of the risks of depression when dealing with a chronically painful illness. Like I said earlier, you want to avoid the cycle. Also, as I hinted earlier, it has been suggested that the degree of pain can be an indication of the severity of depression; however, this relationship has not been explored fully. Additionally, keep in mind that the stage of endometriosis is not linked to the risks of depression(5). Meaning that pain is a greater implication for depression than the stage of the disease.


Research will continue to explore the medical links between endometriosis and depression. Current research is attempting to discern the relationship between endometriosis and unbalanced  chemicals/hormones. As one endometriosis fighter once said, there is a horrible imbalance of hormones in an endo-sufferers body. That alone can trigger mood swings and social difficulties. However, these imbalances are often different between woman and it is difficult to see if it is a cause or reaction. As I said, there are too many variables--too many things to get in the way of what is being studied. What really needs to happen for endometriosis, what could really lead to substantial break throughs, is a suitable animal model. That is the only way to control the environment and explore all the many factors of endometriosis. They have rat models for ADHD even (and I have ADHD--I'm not saying it's not important. But I wish endometriosis got the same research funds that ADHD does). There needs to be an endometriosis model. I found a study with an experimental endometriosis model, but I have yet to find research announcing a ready-for-testing model(6). For now, the chemical perpetrators of endometriosis are elusive.  


That is majority of current research I found. I am sure there are more. But I have responsibilities to attend to. Please read this over. This is an uphill battle that women with endometriosis are fighting--every single one in pain is at risk for depression. Know that risk. And know how to fight it. And if you are in the place of a supporter, know these risks too. It helps to have a support team that knows little things to help.


For Part 3, later this week, I will cover ways to deal with pain related depression. Keep on fighting.




References (Sorry, I haven't converted these all into APA yet--ran out of time!)
  1. BULLETIN OF EXPERIMENTAL BIOLOGY AND MEDICINE Volume 152, Number 1, 93-97, DOI: 10.1007/s10517-011-1463-0 
  2.  Psychoimmune Interactions in Women of Reproductive Age with EndometriosisGomibuchi H, Taketani Y, Doi M, Yoshida K, Mizukawa H, Kaneko M, et al. Is personality involved in the expression of dysmenorrhea in patients with endometriosis? Am J Obstet Gynecol. 1993;169: / 723 / /
  3. Peveler R, Edwards J, Daddow J, Thomas E. Psychosocial
    factors and chronic pelvic pain: a comparison of women with
    endometriosis and with unexplained pain. J Psychosom Res.
    1995;40: / 305 / /15
  4. Lorençatto, C., Petta, C., Navarro, M., Bahamondes, L., & Matos, A. (2006). Depression in women with endometriosis with and without chronic pelvic pain. Acta Obstetricia Et Gynecologica Scandinavica, 85(1), 88-92. 
  5. Depressive symptoms, anxiety, and quality of life in women with pelvic endometriosis Rodrigo de P. Sepulcri, Vivian F. do Amaral European journal of obstetrics, gynecology, and reproductive biology 1 January 2009 (volume 142 issue 1 Pages 53-56 DOI: 10.1016/j.ejogrb.2008.09.003
    • Francisco Delgado-Rosas
    • Raúl Gómez
    • Hortensia Ferrero
    • Francisco Gaytan,
    • Juan Garcia-Velasco
    • Carlos Simón
    • and Antonio Pellicer 
    • The effects of ergot and non-ergot-derived dopamine agonists in an experimental mouse model of endometriosis Reproduction 2011 142 745-755





Tuesday, February 7, 2012

Endometriosis and Depression (Part 1)

So this is a difficult post to do. It goes against human nature to admit serious weakness, but from what I've read/seen, this really needs to be talked about. Many women with endometriosis (and friends and loved ones who support this women) are unaware of the connection between endometriosis and depression.

Why am I bringing this up? I have heard too many stories lately about women with endometriosis and both attempted/successful suicides. Women that are in so much emotional and physical pain that they give up. They feel alone, defeated, and out of options. I cannot help but feel that some education, prevention, and support may have helped them. So here is my attempt.

My first serious scare with endometriosis and depression came at the hand of a chemo-type drug called Lupron. Many women with more aggressive forms of endometriosis are prescribed this drug. It involves a series of 2-3 shots and it chemically shuts down ovary production, essentially forcing a woman into menopause. It's also used to treat fibroid tumors and males with prostate cancer. Now, if menopause isn't enough of an emotional rollercoaster for most women, then you should really try out Lupron--on top of the standard up's and down's, you get the fun added factor of severe avalanches of hormones and chemicals.

My experience with Lupron was horrible. It did not work at all; I still grew endometrium and another fibroid tumor. On top of that, I had horrible mood swings and severe depression. It was some of the most awful feelings I've had in my life. I was really lucky to have a supportive family, boyfriend, and doctor. They all encouraged me to seek proper medical treatment to reclaim a balance and I avoided a complete and total meltdown. But I came scarily close. I was luckier than some. And my experience prompted me to be more open about the ups and downs of endometriosis. I think being honest about this, something some may find embarrassing could really help some women. So I'll take the risk.

So why is proclivity for depression higher in women with endometriosis? There are a few theories. First of all, having any chronic, painful illness is likely to make you more likely to downward spiral. A constant battle against pain and feeling crumby can weigh anyone down. It's easy to get discouraged and be upset with your situation. Not all treatments are effective and you are constantly left with a feeling of defeat. And when you are tired all of the time, it is harder to collect the necessary 'starter energy' to feel happy on bad days.

Part of that feeling crumby all the time also messes with one's social support system. Women with endometriosis are all too familiar with the constant disruption of plans. Canceled plans seem to be a constant song with these women. Not because we don't want to go out--I am constantly starved for social interaction. But we're always stuck home, curled up with a heating pad, pain killers, and sickly hope that we'll feel better in the morning. And missing that pivotal social activity really compromises the friend network of people like me. Some people get sick and tired of the neediness and canceled plans. I can see why they get frustrated. I just wish this wasn't a reality face more often than I would ever envision for myself or anyone else. I want to be social! I want a great support system! I NEED a great support system... but that is often lost in jumble of this miserable illness. 

I'm sure this entry sounds overall really depressing. Honestly that's not my intention. I'm just trying to illuminate a lot of pent up feelings that I see in a lot of these really wonderful women. They are strong, compassionate, and caring women. And that too often gets eclipsed by these negative feelings they must constantly battle. They aren't self wallowing and I'm sure some of us come off a little whiny. I actually had to make a jar for myself where I put a dollar in every time I whine. And It really blew me away how negative I could be sometimes. And it put me on a mission to overcome my negative feelings that come from endometriosis and all its added fun.

[Stick around for part 2 and part 3 soon--I'll explore some of the chemical causes of depression in endometriosis women and ways to over come it]

Monday, February 6, 2012

Apple Cider Chicken!

    This is my personal apple cider chicken recipe--just made it tonight, wish I could have taken pictures, but I'll make it again soon and bring my own to the table. It's a very easy dish to make healthy and gluten free. Perfect for someone with endometriosis and anyone with taste buds ;) 
    Prep/Cook Time: About 45 minutes
    Ingredients:
    1. 3 organic granny smith apples, sliced thinly
    2. 1/2 teaspoon of cinnamon
    3. 1/2 tablespoon of brown sugar
    4. 1/2 teaspoon lime juice
    5. 1 yellow onion, sliced into thin rings
    1. 1 1/2 cups apple cider
    1. 2-4 tablespoons of apple cider vinegar
    2. 1-2 tablespoons of white wine (not necessary)
    3. 8-16 oz's chicken fillets (depending on preference) 
    4. 1 teaspoon basil
    5. 1 teaspoon rosemary
    6. 1 teaspoon thyme
    1. 1/4-1/2 teaspoon of black pepper
    1. 3 tablespoons of olive oil
    2. 1 tablespoon minced garlic
    3. (if desired) Cooked rice, to place cider chicken over
    Directions
    1. Mix the apple cider, apple cider vinegar, and white wine
    1. Slice the apples (leaving out the core) and place into a mixing bowl. Add the cinnamon and brown sugar, mix well, and sprinkle with the lime juice. Mix again.
    1. Heat a skillet to medium with a  tablespoon of olive oil, and then add the apples. It will take 5-10 minutes for them to brown.
    1. While the apples brown, place another skillet on the stove on medium with a tablespoon of oil and 1 1/2 tablespoons minced garlic. Let warm.
    1. Slice the onion into thin rings. Add to skillet, and begin to brown. Will take about 6-8 minutes. Periodically stir onions up--let them brown but not burn. If they finish browning before step 8, simply follow step 8's directions.
    1. While onions and apples brown, begin to prepare the chicken. Place the chicken on wax paper and sprinkle a half a teaspoon each of the basil, rosemary, and thyme. Sprinkle with some pepper. (reserve second half of your spices).
    1. When apples finish browning, scrape them back into the large mixing bowl. Keep skillet on the stove (on medium-low heat) and add 1 tablespoon olive oil and 1 1/2 tablespoons minced garlic.
    2. Place the chicken into the heated, empty skillet. Place them seasoned side down. Season the exposed raw side facing up with the remaining spices. Each side will require about 3 minutes. Make sure that the chicken is cooked tender, but not raw.
    1. By now the onions should be well browned; add the liquid mixture (apple cider, cider vinegar, and (if desired) white wine) to the skillet. Let simmer to start boiling down.
    2. When the chicken is cooked through, add the chicken to the onion/liquid mixture skillet. Add the browned apples.
    1. Cook the skillet on medium, let the liquid simmer down somewhat, for just a couple more minutes.
    1. The food is ready! Scoop the chicken, onions, and apples, lay them over a bed of rice (or whatever else is preferred) and enjoy!
  

Friday, February 3, 2012

Costco Sure Seems to Know How to Keep Customers (/sarcasm) [edit: well apparently they do! :) ]

Note: This post was imported from the original blog this site is based on. It is a personal account of my experience and is not very relevant to the current website. I have kept it out of respect to the journey that led me here. 
[EDIT] So today I just got a call from the manager of that specific Costco. He apologized to me for what happened and assured me that he would be going over with his employees what happened. He said that the problem in question was definitely unacceptable and assured me that he did not condone the behavior of judging who or who not needs assistance when shopping. He asked me to identify the employee in question and I told him that I wasn't trying to get anyone in trouble, it was an issue of the employee not having training for how to handle the situation. I said I didn't blame him for not knowing what to do, and felt it could be to everyone's benefit to include training on disability variances. The manager was very nice and pleasant. I accepted his apology and thanked him for taking time to call me. A great reminder of what a fantastic company Costco is. 
Surgery Again 
As I wrote last week, I had a pretty 'awesome' abdominal surgery. I got four incisions and my surgeon scraped off layers of tissue from my abdominal cavity. My lung diaphragm, my intestines, my bladder, my uterus and ovaries, all needed diseased tissue scraped away. Oh, and BONUS, I had another tumor cut out! I was supposed to stay in the hospital overnight, because the pain was not under control, but I knew I couldn't afford that. I was hooked up to some mobile tubes, went home the night after my surgery, and returned to have them removed the next afternoon. Real fun couple of days. Thankfully, Dr. Arrington is a fantastic surgeon, and even with all that work, my incisions came out neat and tidy (see picture below).  


Luckily my mother flew out to help me manage everything. I am so grateful to have been helped out so much. My boyfriend wanted to come, but could not get off enough work, though he was there in spirit and by phone. Friends were also supportive and helpful, as they knew this was a rough surgery. It was my fifth one and ranked high for pain and disruption.

Story of this Post
After a couple days of rest, we tried to go on my first store outing. I was pretty dizzy and weak, and on morphine, so I had to lean on my mother from the and wobble into the store. We moved slowly. She had me hold onto the cart for support. Unfortunately, it was a little too much, and I fainted and fell on my face... and my sutures started bleeding. It hurt horribly, and my mother had to basically carry me out to the car. That was our last outing for the day.

Several days later, we try again. Moving is important for healing, so we try another store outing. Still weak and sore, we decided to try costco, which has an ample supply of motorized carts.
My mother pulled up to the front, as the handicap spots were not close enough, and left to park the car while I limped into an available cart. While trying to start it, a visibly angry woman in a walking cast walked over with an employee. The employee looked uncomfortable, and he told me that I needed to get out of the cart. The woman seems agitated and mutters about how she 'actually needs it'. I would have asked why that cart, but an elderly fellow then dropped off another cart, so I just hobbled into the one he vacated. My mother and I do my shopping, and no fainting occurred. Success!

My mother loaded the groceries into the car (I could not even lift a grape), and I tell her I'll drive the cart back; she can pick me up at the store front. She argued that she should do it, to just sit down in the car, but I felt it was the least I could do. I felt rather useless. So I putt-putted back to the store, parked the scooter, and hobbled over to the 'exit employee'. I tell him it's parked, but not plugged in, because I could not bend over after internal surgery. I asked him if he minded plugging it in for me.

Lo and behold, cue the 'walking-cast-lady'. Where did she come from? She spotted me, sprouted a furious look, and began to shout at me. She barked that I should stop taking motorized carts from 'people who actually need them'. I looked at the store employee, who looked at both of us, and then pretended not to hear. (I am sure it was awkward for them, but I could not help but feel abandoned after he helped her earlier). I was too confused/woozy to know what to do. I briefly considered lifting up my shirt and showing her my bloody sutures, but I ultimately decided it was not worth it. I let her bluster and rage and moved on. 

My mother pulled up in the car and I wobbled in, a dazed look on my face. I told my mother what happened. Anyone who knows Jackie, she is a crazy woman when angry. She stopped the car, threw on the break, and started unbuckling her seat belt. I'm begging her to stop, it's not worth it, etc., when finally I said this, "Mom, yes, she's a crazy dramatic person, who seems to think she's the only one who's ever had a foot injury. She's probably cranky and her foot hurts. But you know what? I am going to recover from this surgery. I will be able to walk again and not need a motorized cart for my shopping. But her? She will always be a mean, crotchety, bitch!" And that's pretty much all that needed to be said. No murders took place and we quickly left.

As for now, I'm not really concerned about the rude lady. I'm glad I kept my cool, though I wish I had pointed out how awful she was being. Such a striking reminder that people do not realize that not all maladies are visible. What really disturbs me, is that employees helped her harass me, and did not respond when she escalated.

Overall, I would much rather have broken my foot than be dealing with this crap, I can tell you that!

Wednesday, February 1, 2012

Nacho Recipe

Here is my first posted endometriosis-safe food recipe. It's mind numbingly simple, but it's perfect for those days where you feel too weak/ill/in pain to make a complicated healthy dish. I won't include many units, because it is honestly completely up to preference.

Ingredients:

  1. One can of Rosarita Fat Free Refried Beans (good fiber and protein source!)
  2. Enough Chips to fill the bottom of a 9 x 13 pan ( I prefer blue corn!) 
  3. One cup of grated cheddar cheese (or another of your preference. you can raise and lower this amount by preference)
  4. Two green onions sliced
  5. 1/4 cup slice olives (if desired)
  6. 1/4 cup of chopped cilantro 

Directions
  1. Preheat the oven to 400* F
  2. Cut, grate, and prepare your toppings
  3. Lay the chips out on a 9 x 13 pan (it is optional to grease it, though spraying it first will help with clean up)
  4. In a bowl, mix up the refried beans, chopped toppings, and most of the cilantro (save a little for garnish). Stir until ingredients are well mixed. This will also help with the malleability of the beans. 
  5. Spread the refried bean mixture over the chips. This is done easily with two spoons. Once spread well, top with the grated cheese, evenly. 
  6. Stick the pan in the oven for about 8-10 minutes (until cheese is well melted--you don't want cold beans) 
  7. Now, before you take it out, switch the oven to Broil. Only for a minute. Any longer and the chips will burn. This step is optional--it will give the nachos a crispier feel. 
  8. Enjoy! (also optional--eat nachos over a salad. Add a little salsa and ranch dressing--very good!) 

Hope you enjoy this recipe as much as I do--it's wonderful to have a quick, easy, healthy option for dinner sometimes. Endometriosis can shut you off from quick food options, so recipes like these can come in handy. And whether or not you have endometriosis, I'm sure you'll find your nachos delicious!


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Contact me at bedhead@bedriddenhead.com

About The BedRiddenHead

I want to be happy. And this site is about that chance. How to strive to thrive in the body I've got and maybe turn my experiences into something worthwhile.

This site aims to help educate and reach out to people all over that struggle with pain or illness. To try and make something helpful. I work as a medical research writer, my background is in neuropsychology and biology, and I want to share what I learn in a way that is easy to understand. I am not a doctor. I'm definitely not your doctor. I am just some lady who wants to make someone's (anyone's) life a little bit better. Whether you have endometriosis, a chronic injury, a struggling friend, or just want to learn something new, I hope to make a place that has what you are looking for.

Thank you for stopping by, I wish you strength in your health and happiness.