Well aloha once again,
Last week I took a vacation and went back to my old stomping grounds in Hawaii. (don't tell anybody or they'll think I'm slacking!) It was great to see my house there, and my old friends. The highlight of the trip was seeing all the whales! It was truly whale season, and we must have seen 100 whales, more than I've ever seen. We were fishing one day on a boat, and this huge humpback breached right in front of the boat, then rested at the surface just off the bow for several minutes before diving back into the deep. That was cool.
So what's new in the realm of Endo???
Well, there was a new paper published this month that identified genes in the peritoneum of women with endometriosis that are not active in women without endometriosis. These genes are thought to promote the development of endometriosis lesions via the same pathways that were used during embryogenesis (the formation of organ systems in the first 10 weeks after conception). The genes were found in highest concentration within endometriosis lesions, then slightly less in normal appearing peritoneal cells of women with endometriosis, and almost none in the peritoneal cells of women without endometriosis. These same genes are important in the formation of a normal uterus and normal endometrial tissue. Their conclusion was the same as Dr. Redwine has spent his life trying to prove: that endometriosis forms by a metaplastic (change) process where normal peritoneal cells (cells lining the abdominal cavity) change tissue types such that they become cells that resemble the endometrium (endometriosis). This means that it is NOT formed by retrograde menstruation (Sampson's theory) and does NOT continue to repopulate the pelvis and regrow after excision, therefore it is NOT futile to remove endometriosis instead of giving Lupron. Gee, sounds familiar, eh????
When I was in Hawaii last week I told my old neighbors about what I was doing here in Bend, and about what endometriosis surgery was like. I told him that endo was like a weed that had really deep roots that wrapped around all the important structures in the pelvis like the ureters, bowel, blood vessels, etc. He said, "why not use Roundup?" I just laughed, because the analogy of Roundup to Lupron was so obvious. The endo weeds are resistant to Lupron roundup, so we have to be able to get in there and dig it out. I think it's a great analogy, so I thought I'd share it with you all.
So, I'm still taking suggestions for topics to write on. Let me know what you're interested in, if I'm answering your questions, if you think I should take a different tack, or whatever. I'm like the genie in the bottle - your wish is my command.
A Hui Ho (Hawaiian for "Until next time"),
Dr. Mos