Tag Archives: Nebraska Methodist Health System

Endometriosis

December 13, 2013 by

If you’ve experienced extended pelvic pain, you’re not alone. As many as 15 to 20 percent of women between the ages of 18 and 50 will experience chronic pelvic pain that lasts six months or more. Pelvic pain can have many causes and sometimes it’s difficult to find a specific cause.

It is estimated that approximately 70 percent of these women will have endometriosis, a painful disorder in which tissue that normally lines the inside of your uterus—the endometrium—grows outside the uterus, or anywhere else where it’s not supposed to grow. It usually grows on the ovaries, the fallopian tubes, the outer wall of the uterus, the intestines, or other organs in the abdomen or pelvis.

“The problem with endometriosis is that it can be difficult to diagnose.”
—Ginny Ripley, family practitioner at Nebraska Methodist Health System

The condition becomes troublesome when the displaced tissue continues to act as it normally would if it was inside the uterus and continues to thicken, break down, and bleed with each menstrual cycle. However, because the tissue is outside of the uterus, the blood cannot flow outside of the body. The displaced tissue can build up around the affected area and can become irritated, resulting in scar tissue, adhesions, or fluid-filled sacs called cysts. For women in their childbearing years, the adhesions may block the fallopian tubes and cause infertility.

“The problem with endometriosis is that it can be difficult to diagnose,” says Ginny Ripley, family practitioner at Nebraska Methodist Health System. “It doesn’t show up in ultrasounds or CAT scans, so the only definitive way to get a diagnosis is through surgery. Surprisingly, we’ve found that the severity of a woman’s symptoms do not correlate to the severity of the condition.”

So while some women with extensive endometriosis may have no symptoms at all, others may experience painful periods, heavy periods or bleeding, pelvic pain during ovulation, and pain during bowel movements or urination. The pain is usually located in the abdomen, lower back, or pelvic areas. Many women don’t realize they have endometriosis until they go to the doctor because they can’t get pregnant, or if they have a procedure for another problem. It is estimated that 20 to 40 percent of women who are infertile have endometriosis.

Because of the difficulty in diagnosing endometriosis, it is often a matter of ruling out other causes first before arriving at a diagnosis of endometriosis, notes Dr. Ripley. Other common causes of pelvic pain include fibroids, chronic pelvic inflammatory disease caused by long-term infection, pelvic congestion syndrome, an ovarian remnant, irritable bowel syndrome, interstitial cystitis, and musculoskeletal factors.

The type of treatment a woman receives will depend on the severity of symptoms and whether or not she is planning to become pregnant. Several treatments have to be tried before it is determined what works best. Many women can be treated successfully with anti-inflammatories or a combination of anti-inflammatories and oral  contraceptives and/or hormone therapy. Anti-inflammatories help reduce bleeding and pain. Birth control pills and hormone therapy help shrink the endometrial tissue by lowering hormone levels and help suppress the growth of additional endometrial implants—but they also prevent pregnancy.

“While the tissue growth may come back, it often cleans up the area long enough to allow a woman to conceive.”
—Katherine Finney, M.D., obstetrician/gynecologist University of Nebraska Medical Center

In more severe cases in which all other options have been exhausted, surgery may be recommended to remove the extra tissue growth, says Katherine Finney, M.D., obstetrician/gynecologist at the University of Nebraska Medical Center. Surgery is performed laparoscopically. This means that the doctor places a small, lighted tube through a small incision in your belly and looks for signs of displaced endometrial tissue. The tissue can then be removed or destroyed through heat or cauterization.

“While the tissue growth may come back, it often cleans up the area long enough to allow a woman to conceive,” says Dr. Finney. “Rates of conceiving are higher after surgery, but some women may still need fertility treatments to help as well.”

If pregnancy is not a goal, medications, such as hormone therapy, can be taken following surgery to prevent the growth of new or returning endometriosis, says Dr. Finney.

For women with severe pain due to endometriosis, a hysterectomy may be considered as a last option; however, this is rarely needed anymore. “We do far fewer hysterectomies today than we have in the past because we have so many other effective options,” says Dr. Ripley.

Some women may not require treatment, as they have no or only mild symptoms, while others can have notable symptoms due to pain and/or infertility issues. Treatment is typically based on symptoms. If you are near menopause, you may want to consider managing your symptoms with medications rather than surgically. Once you stop having periods, endometriosis will usually stop causing you problems, notes Dr. Finney. In rare cases, post-menopausal women will still experience continued pain, in which case their physician should evaluate them to determine if they are a candidate for surgery.

Smoking Cessation Aids

March 25, 2013 by
Photography by Bill Sitzmann

The old saying “third time’s the charm” didn’t work so well for Laura Adams when it came to quitting smoking.

“Every time I quit, I’d be good for about six months,” she says. “Then I’d get stressed about something and decide to have just one. Well, once you start up again, it’s all over. It’s an all-or-nothing thing.”

Adams is not in the minority. Most smokers will try quitting multiple times before they are successful. There’s a lot more to smoking than meets the eye, say local smoking cessation experts. “There’s an addiction to nicotine, the actual habit, and the emotional dependence that all need to be addressed,” says Laura Krajicek, a smoking cessation coordinator for Nebraska Methodist Health System.

A smoker for more than 20 years, smoking had become a crutch for Adams. “It helped me deal with daily stresses,” she explains. “When I had a cigarette, that was my relaxation time, my ‘me time.’ Coffee, cigarettes, and break time all went together. It was hard to have one without the other.”

Adams knew that it wasn’t a “pretty habit,” nor one she was proud of. With a campus-wide no smoking policy at her place of employment, Alegent Creighton Health Immanuel Medical Center, Adams would have to “sneak” to an off-site parking lot to smoke. To mask the nasty smoke odor, she would slip on a different coat, pull her hair back in a ponytail, wash her hands, and coat herself with body spray before returning to the office. “It was an embarrassing addiction,” she recalls.

“When I had a cigarette, that was my relaxation time, my ‘me time.’” – Laura Adams, former smoker

When Adams learned about Alegent Creighton Health’s smoking cessation program, Tobacco Free U, she decided this might be the extra push she needed to help her quit for good. The program focuses on the use of group or individual counseling in combination with a smoking cessation aid such as nicotine patches, nicotine gum, or medications.

According to the Cochrane Review, an internationally recognized reviewer of health care and research, combining counseling and medication improves quit rates by as much as 70 to 100 percent compared to minimal intervention or no treatment.

“Success rates rise drastically when you combine the two,” says Lisa Fuchs, a certified tobacco treatment specialist at Alegent Creighton Health. The counseling portion helps people tackle the behavioral addiction, and the smoking cessation aids help with the nicotine addiction.

Which smoking cessation aid is recommended depends on how heavy a smoker, health conditions, as well as what seems to be the best fit for that person’s lifestyle, notes Fuchs. These aids are most successful in individuals who have been counseled on how to use them appropriately. The most common aids include:

Nicotine patch – The patch is a long-acting therapy that delivers a steady dose of nicotine over a 24-hour period and is designed to curb a person’s cravings for nicotine. This may be appropriate for very heavy smokers. The dosage is gradually lowered to wean a person off the nicotine habit.

Nicotine gum or lozenges – Gum and lozenges are short-acting therapies that deliver smaller doses of nicotine and can be taken as needed to curb the nicotine urge. Tom Klingemann, certified tobacco treatment specialist at The Nebraska Medical Center, recommends that smokers schedule the doses so that they maintain a steady state of nicotine in the body to avoid the nicotine cravings and temptation to smoke. In general, he is opposed to short-acting nicotine replacement therapies because “they keep people looking for a chemical fix even though they may not be smoking anymore.” They are also very expensive, and most people trying to quit can’t afford the $40 a week price tag they would cost if used appropriately.

e-cigarettes – These work by heating up a liquid nicotine substance that is inhaled as vapor. The product is not regulated by the Food and Drug Administration (FDA) and many still have a lot of chemicals that may not be any healthier than actual smoking, notes Klingemann. “These are not intended to help people quit but keep them addicted to nicotine,” he says.

Medications – The two primary prescription medications used for smoking cessation include Zyban and Chantix, with Chantix being the preferred of the two, says Fuchs. “Zyban is an anti-depressant and may be recommended for a person with mild depression to help with moodiness as well as decreasing cravings and withdrawals,” notes Fuchs. It is believed to work by enhancing your mood and decreasing agitation related to trying to quit.

Chantix is a newer drug and works by binding to nicotine receptors in the brain and blocking them so that nicotine can no longer activate those receptors, causing a person to get less satisfaction from smoking. At the same time, it also triggers a small release of dopamine, the reward neurotransmitter in the brain. It appears to be safe and quite effective, notes Klingemann. Krijicek says that her clients have seen the most success with this aid.

“Success rates rise drastically when you combine [counseling and medication].” – Lisa Fuchs, certified tobacco treatment specialist at Alegent Creighton Health

Adams used Chantix, which she said helped curb her nicotine urges. But what helped the most, she says, was to change the habits that she associated with smoking. For instance, instead of coffee and cigarettes in the morning, she reached for coffee and orange juice. Because she normally smoked while driving, she changed the route she drove to work. She also replaced the time she would have spent smoking with more positive habits like walking her dogs, running, bicycling, and swimming.

“Once I quit, I started making healthier decisions in other parts of my life as well,” she says. “I started eating better, drinking less caffeine, and exercising more. I feel better now.”

“For 90 percent of smokers, the addiction is behavioral,” notes Klingemann. “It’s all of the other stuff that drives the smoking addiction. Until you start changing your behaviors and routines, it’s really hard to quit.”