Endometriosis Getting More Attention

Endometriosis Getting More Attention

By Ed Coghlan

The pain of Endometriosis is well known to women who suffer from it.

It affects 10% women of reproductive age globally and has prompted the collaboration between two leading non­profit organizations dedicated to the improvement of women’s health; the Endometriosis Foundation of America (EFA) and the American College of Obstetricians and Gynecologists (ACOG).

The issues they want to explore?

  • Collaborating for the full-scale expansion across all states of the EFA’s adolescent education program, The Endometriosis: Promoting Outreach and Wide Recognition (ENPOWR™) Project.
  • Implementing more robust efforts to improve the standards of diagnosis and care associated with endometriosis, particularly among young adults so as to reduce the current delay to diagnosis in the field of Adolescent Gynecology.
  • Improving training standards for surgeons on the techniques specific to endometriosis, such as proper recognition and excisional removal of the lesions.
  • Producing updated practice guidelines for the diagnosis and treatment of endometriosis.

Tamer Seckin, MD, FACOG, and Founder of Endometriosis Foundation of America (EFA), EFA Medical Director, Dr. Harry Reich, a pioneer in minimally invasive surgery for treating endometriosis; Dr. Ray Wertheim, endometriosis specialist; and Theresa Davidson, EFA Managing Director, met with ACOG’s Vice President for Practice, Dr. Christopher Zahn, and Director of Federal Affairs, Rachel Gandell Tetlow are all part of this awareness push.

“I am thrilled about collaborating with ACOG, as it is one of the most influential women’s reproductive health organizations in the nation, with the ability to make a tremendous impact on practice as a whole,” said Seckin. “Early diagnosis is crucial to detecting endometriosis and awareness is key to timely treatment. Working with ACOG, the EFA can expand its awareness campaign nationwide to reach so many more medical professionals and women.”

According to the Journal of Human Reproduction, women who suffer from endometriosis have to wait an average of 12 years before getting a proper diagnosis. “This is unacceptable, and it has to change,” said Seckin.  He added, “Misdiagnosis, dump diagnosis and ignoring or dismissing the symptoms of endometriosis, and incomplete and improper surgeries are the main reasons for the long delay in diagnosing, and treating the disease.”

Seckin talked about the pain associated with endometriosis.

“Endometriosis lesions can grow deep and wide, spreading and clinging to a woman’s uterus, appendix, rectum, ovaries, intestines, leg nerves and other parts of the pelvic region. These lesions are like leeches that attach to, reproduce on, and grow on whatever internal organs they find. They are similar to a slow-growing cancer that invades the organs in the pelvis, and in rare cases they can spread to the diaphragm, lungs, kidneys, or brain.”

“Endometriosis causes excruciating pain. This disease always causes inflammation, which can lead to adhesions, scarring, internal bleeding, bowel  or urinary dysfunction, constipation, painful intercourse, and infertility.  The physical pain can be so unbearable that it leads to psychological pain.  A woman’s career may suffer.  Relationships with loved ones may become strained.  She may have to miss a lot of school, or even drop out.  This disease threatens to become a woman’s identity, ruling every phase of her life.”

In March, EFA co­founder Padma Lakshmi met with congressional leaders on Capitol Hill to initiate discussions about more collaborative efforts to facilitate endometriosis awareness. “The collaboration between the EFA and ACOG is the first of what I hope will be many partnerships with the EFA,” said Seckin. “The EFA looks forward to creative partnerships both in the public and private sectors that will help spread the word out about this debilitating disease.”

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Authored by: Ed Coghlan

There are 14 comments for this article
  1. Carol Drury at 10:11 am

    The Endometriosis Association’s Teen Outreach Program has been offered in more than 33 states across the U.S.–currently in Texas. The program is designed to be presented by the school’s nurse or health educator, and includes a presentation of the Association’s award-winning film, Teens Speak Out, as well as a copy of the Association’s fourth book, Endometriosis: The Complete Reference for Taking Charge of Your Health. Contact the Association at support@EndometriosisAssn.org or visit the website at http://endometriosisassn.org/family.html for more information or call 800-992-3636. Free brochures in 30+ languages, and brochures for teens in English, Spanish, Portuguese, and Lithuanian are also available.

  2. Carol Drury at 8:35 am

    A free information packet and brochures on endometriosis in 30+ languages are available from the Endometriosis Association by calling 800-992-3636 or sending an email to support@EndometriosisAssn.or or going to http://www.EndometriosisAssn.org and clicking on the “Free Info Packet” icon at the top of the screen. The Association has been providing and supporting education and research about this chronic, painful hormonal and immune-system disease since 1980. Girls as young as eight have been diagnosed with the disease. The Association also has a free brochure for girls, and one for teens.

  3. connie at 6:39 am

    I suffered from endometriosis from Pre- puberty until my early thirties when I had a total hysterectomy including myb cervix. I have suffered from chronic debilitating pain for probably 20 years. I have been diagnosed with fibromyalgia among other things. With what I am reading now I wonder if I am still suffering from endometriosis? Because of the cdc guidelines I am currently being weaned off the opiate pain meds that I have used without a dosage increase or any other issue for 10 years. Soon I will be unable to get out of bed alone as I was prior to being put on fairly high doses of opiates. I am a pain patient not and addict and I am tired of being treated as one! I have tried most things recommended for treatment of this pain with no positive results. Someone needs to use the brain God gave and realize that for some of us the only relief comes from opiates!

  4. Stephen Rodrigues, MD at 4:00 pm

    @Anita
    “as a sufferer of a complex of dysfunctions such as Endo, Chronic Myofascial Pain, TMJ, Trigeminal Neuralgia, … pelvic floor dysfunction, cervical arthritis and Coccydnia.”

    I must apologize for your predicament. I’m discovering that many of my most elite colleagues have no clue because they are all lockstep in Allopathic narrowed mindsets. They have not had a chance to test the standards they pass down the line to me. The treatment standards just do not work when translated into actions. On paper, it is written to look reasonable, but it is far from reality. The American Physician educational systems have let us all down.

    Your diagnosis cannot be all of those arbitrary descriptive names. But you do have total body intramuscular micro-scar pain, dysfunctions and malfunction seeding thus you are suffering from end-stage muscle atrophy, dystrophy, and metabolic failure. You muscle cellular environment is in a total corrupted state. Your body is now alien to the normal human form = a zombified body.

    Today I am working with evidence that is broader, deeper, vetted, correct, complete, and all inclusive.

    Please Note;
    Most Allopaths and laypersons only see the skeleton, blood or descriptive terms as the cause of pain. This altered and tainted view started in the 1960s when the integrity of evidence died; for-profits.

    Most all the evidence you’all have at your disposal is incorrect, incomplete and invalid. Using narrowed and tainted Allopathic evidence does not fit into the laws of human biology – this is very profitable.

    Once I discovered this breach in integrity was a startling realization that I WAS miseducated, misdirected and deceived by my formal AMA approved medical training. You all and many of your providers are misdirected too. The FRIGHTENING part is many do not even know, and many do not even care to know. Ouch! I can prove it.

    This statement is 100% false: The treatment of pain is by medications and or surgery, fixing or removing the broke parts of the skeletal joints, tendons, nerves or the spine.

    This statement is 100% correct: The aches, pains, stiffness, malfunctions, dysfunctions – experiences we feel within our bodies are located and sourced in the muscular system which will only benefit from physical therapy.

    The exact pathology is intramuscular micro-scars. Intramuscular micro scars will only fully and completely take advantage of the entire wellness and therapeutic recipe.

    Any treatments that are offered which are not full and complete will probably not restore the patient back to a normal state of well-being. This is because the pathology of this disease is microscopic, infinite, involves all 700 muscles of the body; this means thousands of muscle bundles, tens of thousands of muscle cells and even into the molecular and chromosomal structures of muscle cells.

    Muscular pain and dysfunctions will cause secondary and tertiary pathologies which will show up on x-rays and in the blood tests. Treating secondary and tertiary pathologies will not touch the primary pathology, and thus this delay will further increase the secondary and tertiary pathologies plus add in more pain, misery, confusion, bewilderment and betray the patient of the PT treatments that are curative and restorative.

    All long-term pain problems or syndromes will affect the mind, body, and spirit. This disease is a set up for mental trauma.
    We call this post-traumatic stress disorder. But in long-term pain, the trauma is not over. The patient is living with this incarceration with no rest is a recipe for anxiety, depression, aggravating prior mental illness and ultimately suicide. These mental and spiritual parts of chronic pain have to be included in the treatments – or treatment failure rates will increase.

    Using a knife to treat this type of pain may help, temporarily, but a knife is not the corrective or complete treatment. Any benefits from a knife will only be luck. A knife is cheating the patient out of the proper care. A knife is a man’s attempt to defraud nature and the pathology of muscle-derived pain and dysfunction.

    Cheating is the reason why you all are still in pain.

    Betray this evidence and the people who you say you are supporting and need help out of pain are also betrayed.

    Godspeed.

  5. Michele at 10:11 pm

    Dear C.M,
    Thank you for your heartfelt reply and well wishes for my granddaughter. I appreciate everything you wrote..but, I am saddened for all of the pain that you have endured and continue to bravely live with. I guess that I am one of the lucky ones in that the removal of the final ovary seemed to stop THAT pain. I have gone on to being diagnosed with so many other conditions that it is hard to even remember them all.
    I am right there with you fighting this new Federal legislation on reducing opioid use. As a chronic pain sufferer, I have been treated at times, worse than the heroin junkie shooting up in a flophouse.. All from “educated” Doctors. The more I complained about the treatment, the more urinalysis tests that I was made to give at paying the $20 copay every time. It was if the male Dr thought there was no way that this woman has never called in early for refills or asked for more drugs or made up a lame excuse to get more medication. 10 years after the Hysterectomy, I was almost fatally injured in a botched surgery. I have been on every narcotic there is without any problem of addiction. In fact, I purposely have kept my usage at the lowest level possible from knowing this is a lifelong condition I am living with and I fear of getting to a point where nothing works. This is kind of a funny, yet sad story that happened recently. Part of getting a pain pump implant is that you have to get a psychiatrist review. Lame, is the nicest word I can say here! I answered honestly and to my surprise was shown a report that he had denied me because he though I over dramaticized my level of pain! I was labled a “possible” drug seeker. Mad is not even the word for it. Though my pain management Dr told me to not let it worry me..it is a permanent piece of my file. I feel like saying to him, buddy let’s trade lives for a week and see what he says. He would not make it 2 days before begging for relief. Soon, I may try again with a different psychiatrist..but there are also the other fears that come with getting the pump. How can one man’s portrayal over ride the opinion of a Dr and many other Drs who actually know me and think his opinion is rubbish? I get the feeling that I have to fib about my pain levels in order to be a normal candidate? Like, wth??? I’m not lying nor will I? I have never been addicted to drugs nor have I ever run out early or taken them any differently than prescribed.in fact, at the end of the month, I always have at least 2 days worth of pills left over. Funny thing is that after this chat with the shrink and playing on the computer which asked me the same question over and over in every different way imaginable, I was finally able to get an MRI done which showed 5 bulging discs and then went on to slip on my dad’s wet stairs and now have blown out those discs, I believe, because I am now in daily pain in my lower pain and spine. Degenerative Disc Disease.. I am tired of being treated like I am a second class citizen and hearing reports that say that I must be addicted by now. Yes, there is a huge difference between the word addicted and dependent. Yes, I am dependent, no doubt..but addicted, no way we all have to join together in this fight. It is not right that any living thing exist in pain. It is not acceptable to be labeled a drug seeker by a man who obviously knows not one thing about pain. It is your mother, grandparent, elderly neighbor and many more who are dependent on taking medication in order to have some resemblance of a life. Why is our lives being controlled by those who do not even understand what we live with?,please join the fight to take back some control over our lives. God knows how much has been robbed from us already. What’s even more crazy about my case is that my 4 life threatening injuries were caused by a General Surgeon that I had stupidly believed in and picked him myself. I worked in the Operating Room and was friends with him. To this day, almost 16 years later, I still do not know what went wrong. I have absolutely no faith in our medical system anymore. I lost my career in the blink of an eye, almost lost my life and would have had I not been so determined to live and most of all that bothers me still.. I was never told by him that he was sorry. Now, I have heard that he has stomach cancer and has a colostomy bag. Do i feel any empathy for him? Not one shred. I am but one of his victims. Many other are buried with his secrets. I tell everyone I know now to interview a Dr prior to surgery. Don’t just ask him ot her if they have ever had any medical malpractice suits..most importantly, ask if they have ever settled out of court. You see, this is what they do to hide their failures..they settle out of court. That way it does not go on their record. I won my malpractice suit, but all the money in the world will never give me back my health and now I so understand what my grandparents said when they told me that good health means everything as you age. I wish that I did not have to learn the hard way that it is so true. Be good to yourselves and teach your children that they are not invincible and each injury or damage to their bodies will come back to haunt them later! Thanks for listening to me ramble on.I hope my story may help at least one person make a better informed decision about who they allow to cut into them. Do your research!! Please….
    Thinking of you, C.M. and wishing you all the best.. Take care….

  6. Anita at 8:46 pm

    Dr. Stephen Rodrigues, I must note that many of the points you wrote are incredibly validating to me, as a sufferer of a complex of dysfunctions such as Endo, Chronic Myofascial Pain, TMJ, Trigeminal Neuralgia, and musculoskeletal dysfunction, adhesions from peritonitis, pelvic floor dysfunction, cervical arthritis and Coccydnia. I recently had Endo surgery at age 50 by an excision specialist (7 years post total hysterectomy.) I had to dispel a few myths about Endo treatments to some medically trained personnel during my hospital stay, who didn’t yet have the in depth knowledge of Endometresis treatments. Suffice it to say getting myself diagnosed and treated over the years in a timely and effective manner is best summed up as a “very hellish ongoing journey.” I recently started dry needling therapy as part of my multi disciplinary approach to pain management. I truly appreciate your advice stressing the importance of utilizing those various self care routines and modalities to aid in healing and dealing with the pain. I’m so glad that the seeds of awareness are growing for Endometriosis to help alleviate suffering for all affected by this hidden disease.

  7. C. M. at 5:36 pm

    Michelle,
    First I would like to say how sorry I am that your granddaughter is going through this horrible disease. It does tend to run in families which is dreadful.
    Please know that just because all (both ovaries & uterus) are removed it does NOT mean that there will be NOT be anymore pain.
    I too had three surgeries with the third being 8 months after the second & yes, the ovary that was left & healthy was destroyed in those 8 months. Guess what? I knew right away that there was still Endometriosis. After a full hysterectomy I had *worse* pain than I had had before. It was horrifying. I had to crawl around the house on all fours.
    Also know that I was on pain medications, Oxycontin when it first came out, for 6 years. After having a *fourth surgery, with Dr Harry Reich (mentioned in article) I knew he had gotten all the endo but I still had one more hurdle to jump. While I was healing not only did I pop internal stitches which required silver nitrate treatments for weeks, I also contracted Lyme disease. It was an over a year recovery because of that, with a lot of pain still because I was healing so slowly. After getting better I weaned off all pain medications & didn’t take any until needing them ten years later for RSD/CRPS. So please, know the difference between abusing/addiction & dependance on pain medications.
    Pain patients that get addicted is extremely low. According to studies (below) the highest number of people/patients that get addicted are people that already tend to abuse illicit drugs &/or alcohol.
    Here is the important part of the studies, based on 67 studies, with the link below – All the best wishes for your granddaughter.
    Results-
    All 67 reports had quality scores greater than 65%. For the abuse/addiction grouping there were 24 studies with 2,507 CPPs exposed for a calculated abuse/addiction rate of 3.27%. Within this grouping for those studies that had preselected CPPs for COAT exposure for no previous or current history of abuse/addiction, the percentage of abuse/addiction was calculated at 0.19%. For the ADRB grouping, there were 17 studies with 2,466 CPPs exposed and a calculated ADRB rate of 11.5%. Within this grouping for preselected CPPs (as above), the percentage of ADRBs was calculated at 0.59%. In the urine toxicology grouping, there were five studies (15,442 CPPs exposed). Here, 20.4% of the CPPs had no prescribed opioid in urine and/or a nonprescribed opioid in urine. For five studies (1,965 CPPs exposed), illicit drugs were found in 14.5%.
    CONCLUSION:
    The results of this evidence-based structured review indicate that COAT exposure will lead to abuse/addiction in a small percentage of CPPs, but a larger percentage will demonstrate ADRBs and illicit drug use. These percentages appear to be much less if CPPs are preselected for the absence of a current or past history of alcohol/illicit drug use or abuse/addiction.

    http://www.ncbi.nlm.nih.gov/pubmed/18489635

  8. Stephen Rodrigues, MD at 4:57 pm

    Joan Hamm, you are correct with a few bits more data –

    All chronic pain problems must have a valid location!!

    Think muscular and think MFP&D, the greatest pain masquerade of all times.

    Forget this evidence and you or your patients will want to die from abject pain and misery.

    YES, MFP&D will alter the DNA and Chromosomal structure, i.e., shaggy or ragged telomeres which make the cells act like cancer cells.

    I call these cases Hellfire and Brimstone Pain Cancers. aka, TN, ON, TOS, RSD, CRPS, and PN.

    This type of pain will spread, metastasis to infect all of your 700 muscles, crushing and punishing the life out you. Then you or your patient will want to die or commit suicide from no treatments.

    This awareness is serious business and nothing to ignore if you have a compassionate bone in your body.

    See my prior post for the only treatment options for muscles.
    Godspeed.

  9. Stephen Rodrigues, MD at 4:43 pm

    ““Endometriosis causes excruciating pain. This disease always causes inflammation, which can lead to adhesions, scarring, internal bleeding, bowel or urinary dysfunction, constipation, painful intercourse, and infertility. ”

    There are perfect cases which match the dx criteria and there are not so perfect cases.

    Beware of the greatest pain masquerader: Myofascial Pain and Dysfunctions MPF&D as per Travell.Simons.Rachlin.Baldry.Gunn.

    There are cases who have significant scarring and no pain.
    Lots of pain and no scarring.
    If there are additional signs and symptoms that are not within the Endo diagnosis list, this may be a valuable clue that MFP&D is an overwhelming possibility.

    If you or your provider do not treat the muscular system directly with corrective options, you or your patients may suffer unnecessarily.

    I alway recommend this a foundation to all pain or stressful problem:
    Mindfulness, stress management, heat, soaking, massage, stretching 4-6 x per day, range-of-motion movements, yoga, inversion, traction and spinal adjustments.
    Profession a massage 2-3 x per week.
    Spinal adjustment 1-2 x per week.
    Acupuncture and GunIMS
    Plus the use of various “needling” options.

    Godspeed

  10. Michele at 2:28 pm

    Endometriosis is a horrendous thief of One’s life and sanity. I dealt with it for years and underwent 3 Laproscopys before having a Hysterectomy with the Dr leaving the least damaged Ovary against his better judgement. I was only 29 years old at this time and he worried about me getting enough estrogen.
    One year later, I was at the end of my rope with constant pain, a diagnoses of Interstial Cystitis which showed the Endometriosis had attacked the outer wall of my bladder. I returned to the operating room in disbelief that I was back to the beginning. Years of pain with no relief. I could not take pain pills due to chronic constipation… He removed the Ovary and did what he could to remove the lesions from the bladder and which now had covered my entire abdominal region and organs with Endometriosis. I was angry that a well known and respected Gyn would leave a damaged Ovary in me knowing he was taking a big chance..with my life! Dammit, I’m not a guinea pig, which is how I felt.
    What I learned later was that Endometriosis is a blood borne disease. It can burrow into your tissues and remain unseen.. It then tries to make it into your blood stream. If successful, you are in big trouble because it can travel to your brain, as it did a woman in England years ago. Imagine that?!! It has been found in lungs and all other Organs. A friend of mine is fighting this disease right now. Her Gyn wants to do ANOTHER Laproscopy to cauterize her lesions. Why? Why, I ask? This is also her third Laproscopy. Obviously, it is not helping and a waste of her energy, time and health,,as far as I am concerned.
    I have pleaded with her to have a Hysterectomy with removal of both Ovaries.
    She is 46 years old and has no plans for children, so why keep these damaged Organs. I guess in Nova Scotia, the Gyn does not like removing both Ovaries.
    Hello? Why is this choice left up to him? A man who will NEVER feel this kind of pain? I’m so dismayed, angry and fearful as she prepares to go through this again. I know the likely outcome.
    I would like to see there be a limit to the number of Laproscopys before a full Hysterectomy is done. Then have a useful and accurate way of delivering the Estrogen that every woman needs.
    I have been through so much because of this disease that I believe I probably contracted in my teen years. I’m just going to say this although it is a bit embarrassing! I always had huge clots when I had my period. So, I decided to try to flush them out with a douche bottle. It did help to remove the clots, but I believe that I flushed the Endometrial tissue through my Fallopian tubes and that is how I began my journey with Endometriosis. My Gyn says it is not possible, but I have spoken to many women who have Endometriosis and they also tried flushing. There has to be a correlation.
    Mothers of young girls, please warn them not to try flushing the clots out. Instead research, talk to other women and go to as many Doctors as you have too before letting the disease progress to the point of causing so much damage that it leads to infertility. I have a young granddaughter who has the same terrible painful periods with clots as I did. I found out that she has also tried flushing the clots out. I was horrified. I took her to our Gyn only to find that their solution is to hand out pain pills and anti inflammatory meds. She was 15 at that time, now 18 years old. Thank God that she refuses to take the pain meds and uses Tylenol instead because of the recent over-news about the correlation between using pain meds which then leads to drug abuse.
    Thank you for bringing this to my attention because I had forgotten about it until this reminder. I hope my lack of being attentive has not led her to more harm. Teenagers think nothing bad will happen to them, so for all the mother’s who have been down this journey, please inform your daughters and stay vigilant. I certainly will be from now on.

  11. Joan Hamm at 8:39 am

    From a teenager on I had severe pains near womb. No Dr knew what it was. Told me normal cramps. Every year at least twice the pain so bad I was hunched over. They did X-ray’s and said normal period pain. This went on until I was 36 years old. I went to the emergency room doubled up in severe pain. The nurse there said to me a Doctor told her if a woman came into emergency room in severe pain in the area to call him. I was lucky his office was near hopspital. He took one look at me examined me.. Took tests to see my inside womb area and told me the mass was so large it might burst. The next morning I had to have an emergency complete hysterectomy. He saved my life and I always went to the best obgyn’s!! I went through he–all my life with this!! A miracle happened I was saved at age 36. One more thing RSD! CRPS needs to be written alongside Cancer as having Daily Severe Horrible pain suffering!! Nothing helps the patient survive but pain meds. ! Eases the pain to be able to function.. To live and do good for others. Without meds I would have died long ago. RSD spreads at times too.

  12. Tamara Johnson-Scott at 5:47 am

    Is that suppose to read every 10 out of 100 women have endometriosis? ☺ I know I suffered horribly with cramps and low back pain for years before being diagnosed in the early 90’s. When I was told that I’d never be able to have children I changed my diet cut out sodas,red meat, pork, chicken and breads/chips and only ate seafood, veggies and fruit. I’m happy/proud to say that I’m a mom of not one, two or three children but five!👍😉
    Whatever I did worked and it was soooo easy. Fourteen months after our 5th and final child was born I had to have a hysterectomy. Holy cow that was hands down the BEST surgery I’ve ever EVER had!! Good bye and good riddance endometriosis!

  13. C. M. at 5:22 am

    Meant to say; this is fantastic news. So glad it Endometriosis is going to get more attention. Hopefully it will be common knowledge soon. I also hope more doctors learn from Dr. Harry Reich the proper ways to get get rid of endometriosis.

  14. C. M. at 5:19 am

    I had to wait longer than 12 years for a proper diagnoses. My records read like a novel for a doctor.
    I had had three surgeries in an 8 month period, the 3rd was complete removal of everything, a hysterectomy.
    Supposedly I should not have had any pain because of the complete hysterectomy. Wrong. Try to get a doctor to believe you still have pain, & much worse pain, after having a complete hysterectomy. I went to so many doctors I lost count (the two previous had retired).
    One thing I always said was that I could tell the difference between adhesion pain & endometriosis pain. Well, most doctors scoffed at this statement or said I just wanted pain medications, or both. Finally I was lucky enough to speak to Dr. Harry Reich. When I said that sentence to him, he stated “Well of course you can”. I felt such a sense of relief that someone believed me.
    I was/am so lucky to have landed in his care for the fourth & final surgery. I thank my lucky stars for his wonderful expertise & caring for women. He found so much endometriosis that had been missed, some he said must have been there since I was in high school (I was 35 at the time). I often wonder if he uses the recording of my surgery for teaching because it was after a full hysterectomy.
    I had Andenomyosis & Endometriosis. It took many, many years from me. Now I have RSD/CRPS & have heard of others too that have had both & wonder if there is some weird connection.
    If Dr. Harry Reich happens to read this, my hat is off to you. Many heartfelt thanks for your caring & expertise. You gave me my life back, at least until getting RSD/CRPS. Thankfully I don’t have to live with both at the same time though.