Treating endo pain without surgery and other NaPro updates

As I get ready to head to this year's Creighton Model and NaProTechnology conference, I was looking through my notes from last year's meeting.  I learned a lot of fascinating information and wanted to share it here before my brain is filled up with all kinds of new stuff from this year. 

1.  There is a possibility that charting CrMS and getting treatment from NaPro can be helpful in early detection of breast cancer.  This is a huge project for the future to understand this better, but Dr. H has done some preliminary work.  He found that infertile women with low progesterone were 5.4 times more likely to have breast cancer than infertile women whose infertility was due to non-hormonal causes.  In his study, breast cancer patients had statistically significant lower progesterone levels starting on P+5.  Their estradiol levels were normal.  Breast cancer patients also had statistically significant lower mucus cycle scores and higher variability in the length of their post-peak phase (about 5 days variation vs. 2 days variation for non-breast cancer patients).  A mucus cycle score is a way to numerically rate the quality of mucus in a given cycle; a higher score is better.

2.  Only 9% of cycles have ovulation occur on day 14.  Ovulation occurs slightly more often on day 15 or day 17 (11% of cycles).

3.  If you or anyone you know has been on progesterone support during pregnancy in an attempt to prevent miscarriage, you might know that most non-NaPro physicians think it's unnecessary, silly, etc., especially after the first trimester when the placenta is supposed to take over production.  Dr. H swears by it though and has a standardized progesterone curve that he uses to determine how good or bad a pregnant woman's progesterone levels are given how many weeks gestation she is, which guides the dosing of progesterone.  Previously there had been no study showing that progesterone was beneficial, especially after the first trimester.  Dr. H didn't think it was ethical to do such a study because half of the pregnant women would have received a placebo (no progesterone), and he didn't want to risk them losing their babies in order to publish a study to satisfy the skeptics demanding, "We want to see the evidence."  (evidence is good, of course, but at what cost?)  Now there is really good news: This study--a double-blind, randomized controlled trial (the best type of study)--is underway!   Well, it was underway as of last summer.  How is this possible, you ask?  What about the poor women at risk for miscarriage who get the placebo?

This is probably the only situation that I can think of which made it ethical to do the study:  A NaPro physician (Dr. V) in another country was following Dr. H's progesterone protocols on his pregnant patients.  Dr. V's boss found out and demanded that he show the boss the study supporting this practice or else stop prescribing progesterone to all pregnant women.  Dr. V was in a bind.  He also believed the progesterone was doing some good, and he could not bear the thought of withholding progesterone from his patients, especially the ones with a history of miscarriage.  So he said to his boss, "How about I conduct the study to come up with the evidence that progesterone is beneficial?"  His boss agreed.  Dr. V figured that this way half of his patients would get progesterone, which was much better than none of his patients.  He later got approval to do the study.

This is huge.  Huge.  I hope they'll give us an update at this year's conference how the study is going.

4.  Random fact of the day:  Endometriosis has been found in men.  In women, it has been found outside the pelvis--in the brain, eye, and lung--so the theory that endo is caused by backward flow of menstrual blood through the fallopian tubes doesn't explain everything.

5.  An audience member asked one of the physician presenters, "What anti-inflammatory diet should we recommend?"  The presenter said, "I would defer to the bloggers on the answer."  Love it!!  Probably 98% of the room had no clue what he was talking about, but I had a giant grin on my face.  How would this physician know about the IF blogs?  He's married to a blogger.  :)  The audience member waited for him to elaborate.  He then said the diet would include:  no gluten, dairy, sugar, caffeine, alcohol, or red meat.  It would also include supplemental omega 3.  He said his wife was on a "boatload of omega 3" when she conceived.  The audience member asked him to define "a boatload."  He said at least 2000 mg/day.  Another physician, an expert in omega 3, said that the EPA content of the fish oil supplement was the key ingredient and should be at least 700 mg daily.  They also mentioned that it's important to try to increase the ratio of omega 3 to omega 6 (so decrease omega 6 while increasing omega 3).  Red meat has omega 6 and is generally pro-inflammatory.  Omega 3 (in fish oil and flax seed) is generally anti-inflammatory.

6.  Two doctors had different answers for how to control endo pain without surgery.

The first said this combination of four items works for his patients:

• 5000 IU vitamin D daily
• at least 2000 mg of fish oil daily (EPA content at least 700 mg)
• low dose naltrexone
• diet with no gluten, dairy, or sugar

The second gave a long list of possible things to try, including:

• 100 mg of vitamin B1 daily
• 400 mg of magnesium twice a day beginning one week before CD1 and ending one week after the period
• 600-800 mg of Motrin every 6 hours beginning the day before CD1 and continuing through the painful days of the period (usually 2-3 days); the Motrin should be taken with food
• 60-100 mg of pycnogenol (this may also heal the endo)
• eliminate meat from the diet (works for some)

7.  Dr. H has often said that one of his big regrets is that he didn't insist that women chart during pregnancy from the beginning of his career.  He thinks there is so much more we could know about the signs of possible pre-term labor on the chart if he had many charts to study.  What he does know is that observing 2W (wet) in pregnancy usually means a cervical or vaginal infection.  Spotting in pregnancy also means infection most of the time.

8.  Sleep deprivation causes the same symptoms (low temperature, etc.) as thyroid system dysfunction.  Getting enough sleep is important!

9.  A good endometriosis surgeon needs to

• find all the endo
• remove all the endo
• prevent adhesions

Because a surgeon who doesn't do endometriosis removal regularly can actually do more harm than good (if his techniques aren't superior), it's best to go with a surgeon who specializes in endo.  I have heard NaPro surgeons (those trained by Dr. H for a year) say that they have done surgery on patients who had a previous endo surgery with a non-specialist and that the surgery could have been a lot shorter if the first non-specialist surgeon hadn't made things worse (e.g. adhesions everywhere caused by the first surgery).