Tammy: Chronic pain after surgery

Tammy is a 50 year old aesthetician who first consulted me for hormone imbalance issues 2 years ago, at the age of 48. Her medical history, unfortunately, was quite long and complicated, stemming from a complication of urethral tear from a foley catheter inserted for a hysterectomy that she underwent at the age of 36. Tammy was previously an extremely healthy woman, who hardly ever visited a doctor. She first began experiencing heavy, irregular menstrual bleeds, which led to an endometrial ablation at the age of 36. Her symptoms progressed despite the ablation, and this was followed by a hysterectomy. She began experiencing chronic bladder symptoms after the urethral tear, which led to the diagnosis of interstitial cystitis. She was treated with numerous hydro-distentions and bladder instillations. She also developed cecal volvulus at the age of 37, which led to a right hemi-colectomy (partial colon removal). Her multiple surgeries (also included gall bladder removal, right ovary/fallopian tube removal, and finally, left ovary removal) created scar tissue adhesions throughout her abdominal cavity. This also led to nerve entrapment in her groin, which caused chronic pain. She was labeled with "fibromyalgia" thereafter, and placed on methadone narcotic for chronic pain, which she felt inadequately addressed her chronic pain.

Tammy not only lived with chronic pain after her surgeries, but she experienced severe hot flashes, night sweats, insomnia, headaches, chronic persistent fatigue, 60-lbs. weight gain over 6 years, memory loss, dry eyes, dry skin, and her marriage was suffering because she had "no sex drive"! She was given various medications in an effort at HRT, which included premarin for 3-4 years, followed by estratest, and then Fem ring, all of which caused side effects, and helped only minimally with her symptoms. Tammy was so distraught that she literally stated to me: "If I have to live like this for the rest of my life, I'd rather be dead!"

After some initial laboratory evaluation, I determined that Tammy had borderline low-functioning thyroid, low B12, very high cholesterol, high CRP (indicating inflammation), increased rate of bone loss, and an estrogen level so low that it was undetectable! I placed her on low dose thyroid hormone, vitamin B12 supplementation, and a rhythmic cycling regimen of bio-identical hormones, which required a few months of adjusting with follow-up labs. Tammy began to experience improvement in all of her symptoms, and began to taper off her methadone, as she felt her pain was improving. I also suspected that she had insulin resistance, and placed her on appropriate treatment, which also helped with Tammy's weight, carbohydrate cravings, as well as mood.

At her most recently follow-up appointment in August of 2008, Tammy told me she was feeling great, and that she "hadn't felt this good in 20 years"! She was completely off medications for pain and for insulin resistance by this time, and was able to maintain her weight. Her husband was so impressed with her improvement, that he also wanted to have his hormones evaluated. She felt that the hormone balancing treatments "gave me my life back", and planned on continuing them indefinitely at this time. Best of all, her "fibromyalgia" completely resolved!

Tammy's situation, unfortunately, shows how her life was severely negatively impacted by complications of surgery. Had she had her hormonal status thoroughly evaluated before the endometrial ablation, her symptoms may have responded to hormone balancing treatments, which might have spared her from the hysterectomy and subsequent complication of urethral tear that led her to so many other problems thereafter. She was being condemned to a life of narcotic use for the label of "fibromyaliga", neither of which addressed her underlying problems and symptoms of hormone deficiency, vitamin B12 deficiency, hypothyroidism, and insulin resistance.