Let's talk about Endometriosis... On this week's episode of the Lunch and Learn with Dr. Berry we have Dr. Anila Ricks-Cord, a wife, mother of 3 hilarious children and a board-certified obstetrician-gynecologist. She is a motivational speaker, a 2-time bestselling author of The New Laws of Mommyhood & Marriage: From A New School Mom With An Old School Hustle and the co-author of The Making of a Medical Mogul. She is a media personality whose passion is to encourage women to address their health care concerns and fears, giving them a voice and empowering their best lives, mind, body, and spirit. This week she is on the show to talk about endometriosis, a disease that affects 11% of women, can responsible for painful menstrual cycles and even infertility. Listen to how Dr. Ricks-Cord has to deal with this problem in her current practice. Text LUNCHLEARNPOD to 44222 to join the mailing list. Remember to subscribe to the podcast and share the episode with a friend or family member. Listen on Apple Podcast, Google Play, Stitcher, Soundcloud, iHeartRadio, Spotify Sponsors: Lunch and Learn Community Online Store (code Empower10) Pierre Medical Consulting (If you are looking to expand your social reach and make your process automated then Pierre Medical Consulting is for you) Dr. Pierre's Resources – These are some of the tools I use to become successful using social media My Amazon Store – Check out all of the book recommendations you heard in the episode Links/Resources: Facebook Instagram Twitter Social Links: Join the lunch and learn community – https://www.drberrypierre.com/joinlunchlearnpod Follow the podcast on Facebook – http://www.facebook.com/lunchlearnpod Follow the podcast on twitter – http://www.twitter.com/lunchlearnpod – use the hashtag #LunchLearnPod if you have any questions, comments or requests for the podcast For More Episodes of the Lunch and Learn with Dr. Berry Podcasts https://www.drberrypierre.com/lunchlearnpodcast/ If you are looking to help the show out Leave a Five Star Review on Apple Podcast because your ratings and reviews are what is going to make this show so much better Share a screenshot of the podcast episode on all of your favorite social media outlets & tag me or add the hashtag.#lunchlearnpod Download Episode 132 Download the MP3 Audio file, listen to the episode however you like. Episode 132 Transcript... Episode 132 Transcript... Introduction Dr. Berry: Welcome to another episode of the Lunch and Learn with Dr. Berry. I’m your host, Dr. Berry Pierre, your favorite Board Certified Internist. Founder of DrBerrypierre.com as well as Pierre Medical Consulting. Helping you empower yourself with better health with the number one podcast, for patient advocacy. Today I get to bring you a special guest today Dr. Anila Ricks-Cord which is a good friend of mine and an expert in women's health and what she calls vagina land. She is hilarious, first of all. But she is really an expert because you guys know I'm not the biggest women's health discussion, right? Because there was a reason why I went into medicine but so I figured. Let's bring someone on who can kind of help me, kind of grasp what is knowledge and I really kind of avoid it when I was a medical student in medical resident. So today we're gonna be talking about endometriosis which depending on when you listen to gets its entire month of awareness March is Endometriosis Awareness Month. So I figured if a disease gets a whole entire month, it has to be important. And if it has to be important let's bring an important guest on. So I just want to talk. I'm just gonna give a little bit of a bio just so you can kind of understand exactly the person we gonna talking to. First of all she’s hilariously funny. You definitely gonna enjoy today's episode. Dr. Anila Ricks-Cord is a wife, mother three hilarious children. She's a board certified obstetrician gynecologist. She's a motivational speaker. She's a two time bestselling author. She's a media personality whose passion is to encourage women to address their health care concerns and fears giving them a voice in empowering their lives, mind, body and spirit. Can you know the theme: Empower yourself a Better Health. She currently resides in Texas where for loving spouse, three children and two lizards. She attended college at Indiana University. While there she performed research and published articles on rats in order to help curb alcohol behaviors in humans which is absolutely hilarious. She did move to Baltimore to perform research and publish articles at John Hopkins University. This time investigating acute respiratory distress random at the molecular level. She attended graduate school at Johns Hopkins and pursue a master's degree in biotechnology. She was accepted at the University of College Medicine. Experience significantly shaped how she practice medicine culminating her receipt of the Leroy Week's Award for Outstanding clinical skilled bedside manner and commitment to service. Again, she is absolutely amazing and I get again especially from my fellows who are probably not sure this is a podcast. I listen to this is a disease process that could affect your mom, could affect your sister, it could affect your cousins. So this is something you may well listen to just be able to kind of pass it on, right? Especially if you have a female friend or spouse or a wife or a sister who has these very vague complaints and no one seems to know what's wrong with her. And then you start kind of attributing it to maybe in her head. This is a disease process that may make you think different right. So sit back for another great episode again if you have not had a chance, make sure you subscribe to the podcast. Leave a five star review for the podcast. So we are on the radar of everybody so everyone can be empowered for better health. So again thank you. Let's listen to another amazing episode this week with Dr. Dr. Anila Ricks-Cord. Episode Dr. Berry: All right. Lunch and Learn community. So you heard that amazing intro with Dr. Anila and we're gonna, you know, really let her speak and introduce yourself to the community. And of course, you know guys, I've said this before, I am not no women's health expert. One of the reasons why I went and turned on medicine is because I kept getting kicked out of their rooms when I was a medical student, right? So I figured if we're going to be talking about women's health, especially disease course like endometriosis, right? I figure let's get the expert to talk and I'm just going to sit here and listen. So really, I'm actually going to be listening along with you guys and you know this, this expert kind of expand her knowledge on this and tell us what endometriosis in the show. But first and foremost, Dr. Anila, please again, thank you for coming to the Lunch and Learn with Dr. Berry. Dr. Anila Ricks-Cord Thank you Dr. Berry so much for allowing me to be able to be graced by your presence and share a little bit of knowledge. Dr. Berry: Just the feeling is, oh, a hundred percent mine. I've told Dr. Anila, a friend of mine and I told her, I said, I'm gonna get you on a podcast. Like you can't be given all that amazing information out to the community on Facebook and everywhere else and not give it to Lunch and Learn community. So I already, I had already pre-warn she would be on the show. Dr. Anila Ricks-Cord That’s you did, that’s you did. And I'm honored to be here. So. Dr. Berry: For those who may not know, you may not be following you, you give a little bit, you know, outside of the bio, little bit about yourself. Tell us why you do what you do and you know, kinda how you got to where you at now. Dr. Anila Ricks-Cord Sure. So I am a board certified obstetrician/gynecologist. I'm a wife of 22, going on 23 years. Praise God, Lord willing. I’m a mother of three awesome kids and I'm a two time best-selling author and a speaker. So through my books, my patient care, and my coaching programs, I encourage women to address their health care concerns and fears, giving them a voice and empowering them to live their best lives, mind, body, and spirit. So I'm originally east coast native. I'm the eldest of three children and a big science geek. I openly where their pin. I attended school in Indiana University, Purdue University at Indianapolis. And that was where I met my love and my biggest cheerleader perform research at Hopkins before having the privilege of attending Howard University College of Medicine and then completed my residency at WellSpan York, Pennsylvania. So I was inspired to practice medicine and led to become an obstetrician gynecologist secondary to the death of my mom. She was last 22 years old. She was misdiagnosed with the flu and subsequently died of Septicemia. For those who don't know what that is, it's essentially a bacterial infection in the blood, which basically causes massive organ failure and death. So this is why I do what it is I do. So. Dr. Berry: I love it. And you know, thank you for sharing that story with us because I think a lot of times people outside of in fact very, you know, full disclosure, we're actually recording this on like, you know, national doctor's Day, right? And I love this day. Because a lot of times physicians really aren't getting a lot of the fanfare and the good light that they should be getting. Right? You know, a lot of times there's a lot of misconceptions of why we became physicians. For some reason people think it's all about the money. I keep trying to tell you, trust me. (Most assuredly is not. Fannie Mae, Sallie Mae, she visits me on a regular). Can you chat and tell folks that, and it's really the love of wanting to see that next person get better. Right? And understanding that is, you know what, I wasn't there. I wasn't able to maybe make the steps I wanted to. It's like for my mom. Right? But maybe I can do for someone else. Right. And I, I'm, you know, I'm totally feeling that because I remember being a second year medical student and getting a phone call that my father was in the hospital and again, I'm a second year medical student. I didn't even know my dad had like medical problems. But you know, that's a whole another discussion. They don't, you know, patient guys don't like to talk about nothing. Right? And you know, subsequently from that he passed away and I said, you know what, there's no way that I'm not going to let people know, like, hey I only, I’m physician but I can't help you right from that day forth, I just kind of took that man once again, thank you for kind of taking your mantle and kind of really running with it. Dr. Anila Ricks-Cord It is what I was called to do. I feel like knowledge is power and my angelus says, when you know better, you do better. And my goal is to make it so that people know better so they can do better. Dr. Berry: I love it. So the topic at hand today is endometriosis. And I could tell you from a, I'll be honest, I'm an internist. I take care of patients than I used to take care of patients outpatient where I knew a little bit about it. But once I went inside the hospital, you know, my knowledge of it was very, very weak. Right? So I know that again in March where it's actually National Endometriosis Month, right? So any disease process that gets a whole month is one that I feel like the Lunch and Learn community needs to know. Dr. Anila Ricks-Cord So I happily, I will tell you about endometriosis. So before I can tell you what it is, allowing me to describe what's normal. First told you I'm a big fan of that Geek and women who become their menstrual cycles every month. The body attempts to get itself ready for the possibility of pregnancy. So I like to describe it as your brain calls her ovaries and says, hey girl, we're trying to get pregnant this month. Under the influence of your brain. Your ovaries make estrogen and progesterone, which causes the lining of your uterus to get nice and thick and fluffy, and it causes you to ovulate. The thickness of this lining. This thing happens every single month where every month we get nice and thick and fluffy, so we actually do get pregnant. There's a nice and nourishing space for a fertilized egg to implant and grow. If you don't get pregnant, that lining dies and peels off. And that peel, that lining is actually your menstrual blood, and so if you don't get pregnant, it starts all over again. Better luck next month. Maybe it'll work out next month. Exactly. Just like we bleed out of our uteruses and out of our vaginas and owns or whatever, you know, products you used. There's also something called the theory of retrograde flow where we actually need backwards too. So if you imagine that this uterus has like this cavity on the inside, and whenever I talked about my lives, whenever I do them, I use my face as the uterus and I take my laps and I separate and pull them up to the side and said this is the fallopian tubes. You bleed backwards into the uterus are actually from the uterus into the fallopian tubes and into the pelvis. You know, this is where it's an issue and some of us, that tissue, that lining, endometrial lining, the supposed to regenerate itself every month. Some of that tissue takes residents actually in your pelvis and your abdomen and so come next cycle, the tissue does what it does and it sickens to try and make a lining where it is, but it's in the wrong place. Yes, exactly right. Right. So you've got this out of bounds, bleeding going on, which triggers inflammation. Kind of like if you hit your elbow, you hit your knee and it swelled up. Right. Nice. And is sore. Your body responds to this perceived injury and your immune system kicks in and gets involved. And this is where scarring happens. So what is endometriosis is when you have your period in places other than in your uterus. And these endometrial cells, once they get access to your pelvis, they can then travel to other places and get access to your blood vessels and your root system and go outside your covas, to other places. So it is primarily a disease of your pelvis, but because they don't have any limitations and they don't know down, they can go other places too. Dr. Berry: So once that I retrograde bleeding happens. There's really like, oh all fair in love and war pretty much. Dr. Anila Ricks-Cord Yes. For some of us, we all do it. Not all of us, we all have this, this retrograde flow, but not all of us have tissue that are like boundaries. I don't know things like no boundaries. And so there's a, there's a thought that there's a genetic predisposition where there's a subset of people who have tissue that decides, Oh yeah, I'm going to be a topic, I'm going to grow wherever it is I wanted to go. Maybe, maybe it's like living in a large city, you need to get to some places not so highly populated. So you decide, a lot of people live like on the pelvic. The actual prevalence of endometriosis is not exactly known. So they say that you see it in between 25 to 38% of adolescents that have chronic pelvic pain and in 10 to 15% of women that are reproductive age. And so there's a substance and we talk about this theory of retrograde flow and then there's also a thought process to or told you big baggy claim. I apologize. I put disclaimer on it. Dr. Berry: We trust. We're just, we're all here for this. I'm sitting there, I'm listening. I'm like, okay. Okay. All right. All right. Dr. Anila Ricks-Cord Cool beans. So from an embryo logic perspective, I know you remember, you don't tucked it back in the rule that dig somewhere because it doesn't serve you anymore. But those of us who are women, when we actually go about being formed in our mother's womb, we have got a fallopian tube and a uterus and another fallopian tube and a uterus. And what happens is these two halves come together to make a hole. The center hollows out. And you've got, if you're lucky, you have one normal functional cavity. There's a subset of people who have what are called Mullerian anomalies where the two little pieces and uterus don't get together where they're supposed to. It doesn't hollow out the center and become one. And so these people are also a set up for endometriosis because they have topic endometrial tissue that ends up in other places. And so about 40% of these children that have these genital check defects will have issues with individuals. As they say, 50% of women that have infertility's had endometriosis and 70% of women and adolescents that have pelvic pain actually have endometriosis. Dr. Berry: And because we don't know the true figures, do you feel like the figures maybe higher than what we're even picking up? Dr. Anila Ricks-Cord I would say so because unfortunately it takes about nine years to diagnose endometriosis because it's a disease of exclusion. And so when people present, so you have a patient that will come and see you in and they've got these vague multitude of symptoms. So like in women in grownups, people who are not adolescents and adolescents have defined 10 to 19 years old. So reproductive age women, you can have a lady that comes to see you with a complaint of pelvic pain either with her periods or with sex. And so if it's pelvic pain with her periods and call a dysmenorrhea, which is this dull crampy pelvic pain, that might start about two days before your cycle starts last. The entire length of cycle might occur a couple of days afterwards. Or if it's chronic, we're, it's been present for more than six months. It can be dull or throbbing or sharp or even in one of my patients, she has a burning sensation every month on her cycle shows up. She's got a spot in her left lower quadrant or her anterior abdominal wall where it's like a hot poker. That's how hers that she has pain all the time, but when her period's shows up, it just burns in this one little spot. So that's what cycle you're paying with your period. If you have pain with sex, you will have patients that have complaints of pain with penetration, particularly deep penetration, and so when you go see your Ob-Gyn, one of the ways that you can kind of mimic this is the thought is when you get these endometrial implants in such a personal space, you can get these. It starts off as a microscopic disease and you can get nodules or uterus has got this support system inside our pelvis is kind of like the ladies who wear bras, kind of like a bra strap. So you've got the same call, uterine staples that supported on the inside of your pelvis. You can take your fingers in a lady who has endometriosis, put them in the back part of her vagina, separate them like a peace sign and stroke and practically make her leap off the table because she has nodular implants in the back. So you can simulate this, this pain with sex when you stroke on these easier to cycles on the back issues that nodules implanted inside. Ladies who present with infertility and so infertility technically is defined is a chick, is less than 35 years old, has been trying for a year to have, has been having regular sex for a year and trying to get pregnant and hasn't. If you're over 35 is six months essentially, but they say the 30 to 50% of women who have infertility had endometriosis. If you have a lady that presents and she has an incidental finding on ultrasound which has got some pain and you do an ultrasound, she's got a mass on her ovaries, there's a particular. Endometriosis implants can actually implant anywhere inside your pelvis, on your bow, on your bladder, inside the wall of the uterus to, and I'll come back to that one. And inside the ovary you can get what it called Endometrioma where when you look at them on an ultrasound where essentially the equivalent of blood clots inside the ovary, a lady that's got an ovarian mass and is an Endometrioma, if you have a high index of suspicion that she has endometriosis, you know, also present in ladies and have bladder issues. Like if you have a feeling like when you do not have a UTI but you feel like you go into the bathroom all the time or you feel like you've got to go right now or you have pain when you go to the bathroom. That could be a sign of endometrial implants in your bladder. If you have bowel issues where you have issues with diarrhea or waxing and waning diarrhea and constipation or pain when you desiccate or colicky bow, that can be a sign of endometrial implants in your bow. There is a version of endometriosis called adenomyosis. Which is what Actually Gabrielle Union had. Heavy menstrual bleeding is is a possible sign of endometriosis and by heavy menstrual bleeding. Allow me to clarify. A regular period is supposed to be no more than 80 cc's so in simple terms in an English Dr. Berry: Talk to the men. I hear. Dr. Anila Ricks-Cord Right. I'm about to say so. A normal period is for hotel bottles of lotion. That’s 2.7 fluid ounces or it's about a third cup. That Mixing Cup that you have in the kitchen when you make us up on one third cup size, that's ATC seats. Anybody who has more than that and some of the patients that don't have had that have had heavy menstrual bleeding, they making crosses and ease and the underpants they've got multiple two, three second. I'm like mattresses. Or they're use tampons. If you can use a super plus tampon and that thing falls out in an hour or two you have heavy menstrual bleeding. For Gabrielle Union. When she was talking about her fertility struggles, what she suggested was that she was in it to her doctor with heavy menstrual bleeding. Traditionally put her on OCP is birth control pills in order to be able to regulate her flow. She subsequently was found after having her struggles with fertility so she could, she had gone through some ivs cycles. She got pregnant a couple of, actually, she’s pregnant more than a couple of times. I think she suggested maybe nine times. She got pregnant, something along those lines, seven to nine times. But with her, she has endometriosis in the walls of her uterus. And so you've got this glandular tissue that's supposed to do right and be nice and fluffy like a comfort in the winter time for this egg that's on fertilizer on the wall. But it has a place where it's supposed to be. It's only supposed to be on the lining of the inside of the shoe is not deep with them. A muscle for people who have the endometriosis inside the wall of the uterus or the Adenomyosis. They actually have bleeding that occurs within the muscle itself. And this leads to inflammation and issues with fertilization and implantation and being able to carry a pregnancy. So again, heavy menstrual bleeding was also a sign as well as irregular menstrual bleeding. Endometriosis can also make itself manifest in the form of low back pain or chronic fatigue. This is why it's so nondescript and it takes forever to diagnose. Dr. Berry: That’s I think about. Nine years? Dr. Anila Ricks-Cord Nine years. Yeah. In adolescence, which is that group between ages 10 to 19 and there had been some documented cases of little girls who didn't have Mullerian anomalies I talked about what you just didn't come together. Right. They had the babies that have been documented to have endometriosis as young as eight and a half years old. Those little girls will have symptoms that are, that can be cyclic, like only a time with your pain and not having anything to do a period. But they can get pain that gives worsening and more severe when they actually start having periods and they can have rectal pain, they can have constipation, they can have pain with defecation when they go to the bathroom associated with their cycle. Rectal bleeding, pain with urination, and even blood in the urine or that need to go right now and so is so nondescript. You can see how a physician would run through a litany of tests before finally getting to the point where you even considered endometriosis at all. Dr. Berry: Nine year seems so long. (It is). Should it not be like more ahead of the line or do you really have to kind of rule out some big stuff first before you can say like, okay, let me let's think about endometriosis inside of them. No, cross my t's of everything else. Dr. Anila Ricks-Cord So I think that because it was a diagnosis of exclusion for the longest time to truly diagnose it, you need a tissue staff and so the thought process, (Tissue it's in the muscle. How do you get, wow, okay). Right and endometriosis, you only get, if you have a uterus of the path lab, that's how you diagnose that otherwise is I take you to the operating room. I do a diagnostic laparoscopy where I poke a hole inside your belly button, do you up the carbon dioxide, took another two holes inside your belly in order to be able to get camera inside there and some graspers to move around and look to see if I can see signs of disease. And it's not four stages to what you could have minimal disease, which is microscopic, and you don't see nothing to stage four disease where you have everything stuck like chuck on the inside. But ideally if you get to the point where you have to do laparoscopy, then you go inside and you biopsy this different parts of the pelvic sidewall underneath the uterus cycles. If it's on the ovary where ever you see there'll be, sometimes it looks chocolate, sometimes it looks white, and so any abnormalities you see you're biopsying them in order to be able to confirm the presence of disease and that's part of it. A lot of us who are conservative would want to try. I think old school thought was if you had endometriosis, let me try all these other things to make sure it's not that before I'd used last resort and take you to the operating room. (Which is operating room. When I talked to some people and say operating room, what? ). Exactly and yes, just when you think about that, if at any time you poke a hole inside anybody, anytime you performed surgery, there's a risk of it. It’s a disease thereafter and so it's a risk versus benefits kind of thing. But I think that the thought process, I think more people are becoming more aware about how much of a big deal this is. Because you think about how often do when you were seeing patients that were women, you joked that you got put out of the room all the time, that it's a comfort level that's got to exist between you and your physician and I'm sure you've seen the commercials talking about the meds and the chick the study have had endometriosis. When people don't feel comfortable talking about what's going on with their period, how much they bleed. Like you'd be surprised the number of women that have gotten Menorrhagia or heavy menstrual bleeding where they practically write their name on the floor in blood and cursing every time their period shows up and they think it's normal and they ask anybody about anything. Dr. Berry: Wow. Have you have trouble in the past and tried to even pull that type of information out of your patients? Dr. Anila Ricks-Cord You know, I think for me I'm fortunate in that I laugh and joke with my patients and then because I have also had issues with Menorrhagia like so black people are real good at making fibroids. Sidebar, I have a fibroid. Uterus is about the size of a 12 week pregnancy. And as a consequence, I think God has got a funny sense of humor cause at the Ob-Gyn, if somebody thinks that I have experienced it, I can relate to with my patients. And having been one of those chicks that has been a Menorrhagia without, not that people want to know what my contraceptive option is, but I use a Mirena IUD in order to control my Menorrhagia. Without my Mirena IUD, I can use a super plus tampon and it falls out every two hours. And I could write my name on the floor of blood curse using a regular tampon. Using a regular tampon, about Mirena. I don’t know what that was. And so I use humor in what are the bridge the gap in order to be able to ask those kinds of questions. So tell me about your menstrual cycle. How long does it last? What products do you use, how often do you change them? Because a large number of these people who have, who should have hemoglobin hematocrit of six. They eyeball rolling because they believe, they think that's absolutely normal. They think that's absolutely normal. And then because it's, it's your period and you're not comfortable talking about that stuff anyway. It's a don't ask, don't tell, unless you have the kind of relationship with your physician where you feel like you can talk about. Dr. Berry: Can you talk about it and if you can't, if I want to say you can't take their relationship isn't there to talk to it with your OB, you definitely not talking to the hospitalist. Dr. Anila Ricks-Cord Of course not. If the person see it on the bottom, you can to the physician. Why talk to people that you are not close? Exactly. Dr. Berry: Okay. All right. All right. So let's see. So you mentioned liking me and I told you I was going to get some learning today. I already let her know, oh we're going to do some learning today. Cause again this is, I'm taking those right along, which I'll be going again. I've experienced in taking care of patients with this disorder. But of course you know me, I'm referring out to the OB clinic when I, well I think is what you got. Go ahead. See my OB friends, see if that's the case. So definitely. Wow. Okay. So what about, so we talked about it. I, I hear somebody, you know, some of the signs and symptoms kind of really associated with it. Now, is there anything that these patients are doing that may have attributed to getting any endometriosis? I mean because I guess they have to have a menstrual cycle, right? So it's not all about the retrograde bleeding, but is there… Dr. Anila Ricks-Cord Well in theory, remember there are some babies eight and a half and haven't had periods that have issues with the document in endometriosis. Wow. The vast majority of us have this menstrual, heavy menstrual cycle related signs and symptoms. We were, we're cycling and we've got this retrograde flow, but you don't necessarily have to have a period. You can have these, these girls. So when you're talking about risk factors for it in the materials, as we talked again about the, the developmental conditions that predispose you to basically having your belly tampered with endometrial tissue. We talked also about the fact that there are some people who are believed to have the genetic predisposition. So if you have a first degree relative that has endometriosis and by first degree relative is either your mom or your sister or your children, if you have a first degree relative that has endometriosis, you have an increased likelihood of having it too. And there's a thought process that, and these people who have a genetic predisposition for endometriosis, there's something about the way their cells signal that they don't respect boundaries and go from one place to another. Like tutors, I'm going to the pelvic. And then there's also a thought to that if you started your period early, like 10 or less that you're an increased risk for endometriosis. And then it has unfortunately has awful side effects too. Awful side effects. Dr. Berry: Now are, those are the, especially because we would kind of lean on, they're kind of starting to period early. So of course, you know, we're talking about like kids and then obviously this is an issue that a dose deal with as well. But I'm always kind of fascinated, especially as I'm an internist, I really only see 18 and up, you know, as an OB, you know, you're seeing all kinds of ranges. Do the complications associated with it? Like are they much worse off in the child than adult or is it still kind of tight? I gets bad either way. Like we know the rectal bleeding, we know the urinated, we know all this. But like if you, if you had to I guess choose, right? Like when would you rather start dealing with these problems? Would you rather deal with it as you know, in, in the younger age or more of that old, they're 35 40? Dr. Anila Ricks-Cord Well, oh, sorry. That's interesting. Thank you for reminding me. I forgot about that. One might tell you a little sidebar about that one. So in theory with children, the thought process is again, 40 days, 40% of adolescents with general tract anomalies, 50% of them have issues with infertility and 70% of women and adolescents with pelvic pain, it's got it. But the thought is that you've got longer in, would it be repetitive or your belly with these things? And so as a child, outside of the symptoms that we discussed beforehand, okay, the issue is think about all the years particularly undiagnosed, that you've got your belly, your abdomen, and your pelvis, your bowel, your bladder being peppered by these implants inside your personal space that then may not reflect or respect boundaries. Hop a ride on your vasculature or in your lymph system and go to other places. You can actually have endometriosis implants in your chest. Dr. Berry: The chest wall? Dr. Anila Ricks-Cord Yes, you can actually, it's this thing with, with so you know, cells and how they're supposed to respect boundaries and go to confluence and owning by protein signaling. Endometriosis implants can end up inside your lungs. You can actually get a collapsed lung as a consequence of endometrial implants. You can actually have Hemolysis when you cough blood for people don't know where that is. Yes. Or you can actually have, what is the other one is there's the collapsed lung, this coughing up of blood. And there's one other, I'm gonna circle back. When you talked about the difference between adults and children from the standpoint of what it is they have, you think about you have longer to be able to develop the side effects which are infertility. And if he's a disease which distorts the tubes and the ovaries, you have inflammation which is going to cause scarring and you've got pain and so you've got a longer time in order to be able to do this. So yeah, it can give you chest pain, collapsed lung, a blood in the lungs and coughing up few months. And then also with endometriosis, which I'm a sidebar in people who don't have one, you talked about the difference between adult versus children. You can be a perfectly normal lady who went to go have a C section. And as a consequence of having a c section because the uterine lining was disrupted, you can get into endometriosis impulse anywhere along that incision line. So where when I do C section, so we, after the scan we cut that we cut through the Fascia, separate the muscles cut. So the organs are online with this peritoneum is what he's got his own thought casing. Your bladder sits on top of your uterus and there's this thing called the physical uterine peritoneum that you cut your, put some letter out of the way you cut inside the uterus, you deliver the humans, you close uterus one layer and then folded back on itself. You can get into the endometriosis implants from the opening of that uterus being out in the abdomen, in the Fascia, in the anterior abdominal wall, and in the incision site. In my residency program, we had a lady who had a complaints of pain every single time her periods showed up. And actually when we imaged her, you found what looked like a small little one meter hole and it was actually much larger when you got inside her and started dissecting out where it could be. Endometrial lining had implanted in her incision and every single time she had a period it would bleed in her anterior wall and that incision site. I had a lady who when she was a child she had, I can't remember what her particular condition was. She had some kind of condition where she ended up having anomalies with her legs. One was rotated backwards, the other was rotated in a strange way and so she ended up having to have one of an amputated and was a compromise. Actually had that, she had booked a mandated bilateral amputees and there was something going on with her belly when she had some kind of surgery or maybe there was a challenge or something that was playing. She presented with complaints of belly button pain at one point in time and on further inquiry when you talked to her, she said that she could milk her belly button around the time of her period, showed up and get a round discharge to come out. And sure enough she had endometrial implants in her belly wall were when she started cycling because she had surgery when she was a child. It was enough to disrupt stuff and literally she blown through her interior wall where there was a defect of a wall with the implants would bleed right inside there. She'd get a little know what’s inside. Another chick who came to office, same kind of thing, complaints of just barely walk. She had an endometrial coma in her anterior wall as well. And so you, you go to the treatment modalities for endometriosis cause she's got endometriosis. And then outside of what it does from a standpoint of being a child and you having all this time to pepper your belly and being able to get it being a normal chick who just had a c section or a disruption in the lining of the uterus. Now you have it causes all kinds of pregnancy complications. We causes miscarriage, increased restricts topic pregnancy. You can get bleeding during pregnancy and hemorrhage afterwards sets you up for Preeclampsia. You can have a Placenta Previa where ideally placement of the placenta is hanging from the top of the readers like a chandelier. It increases your risk for a preview where it covers the opening of your cervic for a c section, such your upper preterm labor and delivery, a c section and low birth weight babies. So it's just all unpleasant. (Oh Wow. Okay). And the thought is that because you have got these ectopic implants, this endometrial tissue inside your pelvis within triggers an inflammatory response. As women when we get pregnant. So we have relations, the sperm travels up of vagina for the rest of, it's through our uterus, Fallopian to define the egg, fertilizes the egg, and then the Fallopian tube pulls the egg, desperate lives towards itself. And then in the tube you got these hairs, these silly or that kind of push the egg through the tube and into the wall of the uterus. It is a thought process that with people who have endometriosis, that'd be inflammatory. Mediators are chemicals and their pelvis are so high that it's toxic to sperm. And that's part of the compromise with your fertility too, that this from getting sad then go. Dr. Berry: It's just not the place for me. Right? Dr. Anila Ricks-Cord No, I can't work on these conditions. I cannot be. So, no, it's crazy. Dr. Berry: That's and I guess the question is like, especially in your stance, like how, what's the likelihood that you're going to, you know, you see a young who is complaining of a lot of these issues and say, you know what, let me let, let's open you up and see. Right? Like let's do a laparotomy, right? Like is that, does that also ate into it as well that you know maybe the surgeons aren't likely to open them up to check because of like I don't want to put a surgeon. I don't want to put a kid through that. Dr. Anila Ricks-Cord And you think about the fact that if it's a child, some of us are comfortable with adolescents, some of us are not. There is a branch of gynecology that is specific to pediatrics and so you think about asking about whether or not people are even listening to what the complaints are. How many people with a child who complains of having constipation would ever think that has endometriosis and that you just eat too much junk or you need to drink some more water. I think that there's such a vague complaints that unless the child has been complaining about them the entire time and you've done a complete workup and I can't tell you the number of times where we'd endometriosis, it comes down to the gastroenterologist and the Ob-Gyn they've been sent and would it be able to get a colonoscopy in order to be able to be assessed to see what's going on with this presumed abdominal pain that once they ruled them not that is not GI in origin. Then it becomes, well the only other thing you got left down there is your reproductive organs. So it's either your guts or your uterus, which is where the attachments to it. Dr. Berry: I'm scared, scared for you. I don't have any of those issues with it being clearly, clearly this is why the disease process like this needs whole month. Right? Because it average nine years to like that, we got to move this out, right? We got to move this up quickly. That should not be the case. I'm sorry. I'm so sorry for you. Dr. Anila Ricks-Cord I think things are getting better. Again, we used to treat it like it was a zebra and you go through everything before you, and even from the same point of you ask about what's the like of somebody performing surgery. So ideally the founder to do laparoscopic surgery, but you think about people who manage conservatively, they would put you on everything first. Exactly. Birth control down to see what exactly you would. You would go through all the other conservative options before definitively going to surgery and, and the data suggests that even if you do surgery alone and that’s it, there are people who have defended over get relief with surgery, particularly if you have adhesions where you imagine that you've got with a good example of an adhesions? Where you have an abnormal connection of one thing to another. Maybe like imagine a ribbon and not inside your uterus but still if you had a connection between your uterus and your bowel or your uterus was stuck to your anterior abdominal wall because this inflammation causes this scarring and this is music disease that take place. If you want surgery, you just… Dr. Berry: Almost like a fly trap where like it's like it's stuck to that. Dr. Anila Ricks-Cord Yes. That’s a good analogy. Yes. Minus the dead flies. Exactly. Well you have things sticking from one point to another and it causes for the people who have chronic pelvic pain and have that disease, just going to the bathroom causes them problems. If they have issues with constipation and near bowel is stuck to the anterior abdominal wall or stuck to their uterus. A contorted in some way, shape or form. Can you think about how though the bow has got this motion where kind of squeezes fecal matter from one point to another? Just being constipated is enough to cause you wicked pain. And so people who have chronic pelvic pain secondary to disease, secondary to endometriosis, have to do things to alter their lifestyle to make it so the consistency of their stool is more like saucers. So the bowel doesn't get over distended and pissed off and cause pain. Dr. Berry: Wow. So we didn't scared Lunch and Learn community enough. They want to hear now. Like all right, you scared us. We believe you. We notice issue. Please tell me how to treat it or at least prevent it, right? Because I guess that's a two part question, right? Is this a way? Again, little kids is getting even before there, you know, they're menstruating, right? Is there an actual way that you could do anything about this? And if there is like how do I treat it? Like I, I know we've mentioned a little bit about the oral contraceptives, which again, I'm an internist. I don't know none of those things. Dr. Anila Ricks-Cord Oh that's hilarious. So I'm trying to be really, really good. But all I could hear you say…Nope, and I don't do that. So treatment options and prevention, unfortunately at this point, because we understand its mechanism of action, but we don't really understand what causes it. So because we don't really understand what causes it, we've seen the clusters of people that look like this and clusters of people that look like that, we don't know how to prevent it. And so the thought now is with treatment options, there are a couple. They thought ideally as you want to decrease your inflammation, and initially I didn't mean to scare anyone. Knowledge is power. I wouldn’t scaring anybody at all. Dr. Berry: Lunch and Learn community knows that you know, we're going to talk about a lot of disease courses. That you know what, if you're not, if it's not taken care of, it can cause a lot of problems. Yes, yes. Yeah. Take care of the problem. If you don't know that the problem is out there. Dr. Anila Ricks-Cord This is true. You're absolutely correct. And so with treatment, so ideally, first line is nonsteroidal anti-inflammatories, Ibuprofen and Naproxen. Back in the day we used to give people for chronic pelvic pain narcotics. And unfortunately we turned them into crack heads. So ideally the goal is to stay away from opioids. You want to do what you can do to increase, decrease, I'm sorry, inflammation. That's first one. Second is you use hormones. So you either have a couple of choices. You can either use birth control for non-birth control reasons. If you're not sexually active and you just have wicked pain or you get a two for trying to decrease your pain and make it said that you don't get any unplanned babies. The thought as you can use birth control pills, you can use injectable, which would be depot, you can use the implant, which is the next one on the ring. Do you either use them continuously when you get on a method and you stay on a method or use it cyclically in order to be able to make them. Dr. Berry: And from a, you know, from a non OB, I'll even talk about the guy on the guy's perspective, right? When y'all take birth control pills, so that it bleed less? So, yeah. Dr. Anila Ricks-Cord So yes. Ok I got you. Thank you for asking. In my case, I can write my name on the floor in blood and curse if mine is definitely about, not having or bleeding less. And so earlier when we talked before about how the brain calls the ovaries and tells the ovaries, we tried to have a baby and the ovaries go about thickening of the lining of the uterus and making it so you ovulate. Your body doesn't care how the hormones are made. You can either make them or take them. Your body just wants them to be present. And so the thought with the use of birth control pills or contraception, depending on which condom use is to thin the lining of the uterus. So you don't have a nice fluffy learning for an egg to implant. And some of them that modalities actually shut your ovaries down so you don't ovulate. In this case, the goal is to be able to thin the lining of the uterus and if you're using it continuously to shut down those ovaries so that that you don't have that tissue, that's another places. It's getting nice and thick and then after it gets nice and thick, it dies and you've got all this inflammation. You're trying to stop that process. Just shut it down. Thank you very much. Where you, you're in these other locations. Yes. Where you're living, where you've traveled abroad with this issue… Dr. Berry: We trying to starve those areas off. (That is exactly right). All right. All right guys, trust me guys. I got, y'all are here. I know. This is a woman's cell phone. Trust me. Dr. Anila Ricks-Cord Yes. From the standpoint of endometriosis, the goal is to starve that estrogen sensitive tissue that sitting out in the periphery. So you can either use hormones in the form of birth control or they're another batch of medicines you can use called GNRH agonist. I'm not going to have moment over this cause this term too much. But old school, there was a medicine called Lupron, which was a shot that you could get. New school, is this the one that you've seen on TV called Orilissa. They're both GRNH agonist and what they do is they cause the equivalent of a medical menopause. They shut you down, allow the implants to starve and die. But they can only be used short term, like the Orilissa. Depending on what your symptoms off, you can only use a six months to 24 months. And the same with Lupron because there's some side effects that go with it because it puts you into a medical menopause. It can actually decrease your bone mineral density and make it like a little old lady. The snap. Exactly. So those are treatments and if you do hormones that thought as if you do hormones, you do insets to so hormones and insets. And the goal was if you use the hormones when the same one of the contraception, the goal is to trick your body into this sort of false pregnancy state. Shut down your ovaries and make the implants die or go into a coma and decrease that inflammation. The next option would be surgery. Like we talked about laparoscopic. Laparoscopic surgery where you fill the belly up with carbon dioxide, drop the camera on the inside, put in some graspers in order to move things around. See if you can find some tissue to biopsy to confirm the diagnosis. If there adhesions, you disconnect those adhesions. And then if there are lesions that you can see, you do what's called ablation, you literally go and you burn these adhesions on the inside of the belly. Now, the lovely thing about surgery, but the bad thing about surgery is that anytime you have surgery, God makes all of our organs have their own organ case to them. Even your belly, it's got aligning cause like the inside of your mouth, anytime you pop inside somebody's belly, you risk the possibility of causing them adhesions as a consequence of the surgery. And if the surgery alone… Dr. Berry: With a c section? Dr. Anila Ricks-Cord Yes. Well, the endometriosis actually tracks. So all of these layers that you put together, it actually tracks into all of these. So imagine anywhere your nice touch, your skin fat Fascia, peritoneum, the endometrial cells can be in any of that line. From the inside of the uterus all the way out from the incision site in the uterus to the peritoneum, to the Fascia and the muscle wall in the back, all the way through in the skin itself, all the way through. And the lady I was talking about in residency, she had a tiny little lesion in her skin. But when you went to go dissect this thing out, it was huge. And it was in her Fascia. So it was like a mountain top. You just saw the top of the mountain. And when he got up on the news, right, you saw the rest of this mountain down inside, they were like icebergs. Now that…so. Dr. Berry: I'm not gonna lie, I might not wish endometriosis as my enemy. That's what I'm hearing. Dr. Anila Ricks-Cord It’s not a pretty thing to have at all. And the problem with surgery is that if you just do surgery here within a year, you've got symptoms that returned. Yeah, definitive treatment for endometriosis once you have done having your baby. So ideally for ladies who are reproductive age, the goal is to shut you down so you're ready to get pregnant, you get pregnant, then we shut it back down again. And then when you're done, depending on the severity of your disease process, some people respond well to hormones, some people don't. And definitive treatment for endometriosis is removing your uterus, tubes and ovaries being without hormone for a period of time to allow the implants to die off. And then restarting the hormones afterwards because you really need to be on hormones. Still menopause up in this country and average age is 52 otherwise you look like a man about to blood vessels and you snap crackle, pop in, all kinds of stuff. So outside of that, there's a thought process that there are some alternative medicine options that may or may not work. Now traditional data says it doesn't work. But you have to bear in mind that we are unique individuals. We have bio individuality. And so what works for one person may not work for somebody else but may work for the person that's using it. So this on is that acupuncture, herbal remedies and homeopathic May. I worked for some people outside of that. From the standpoint of you asked if there's anything you can do to prevent it. No. The thought process is to try and make yourself as healthy as you can be and to have coping mechanisms for the pain. So exercise. Dr. Berry: Health wise, you're talking about food or? Dr. Anila Ricks-Cord Right. We talking about food. We talking about balanced diet with very little processed food in it. We thought, I'm like getting enough sleep because you feel yourself when you sleep at night. We're talking about exercise and what it be able to decrease inflammation and meditation in order to be able to help cope with the pain. There's also in the DDA goes a suggestion to they're people who have endometriosis are deficient in vitamin D and so when we talk about how this tissue response and how we can say, Oh, you have to say the curb, but I'm going to go outside the boundaries and do other stuff. And these people who have endometriosis and are found to have vitamin D deficiencies. Folks believe this supplementation of vitamin D you might make a difference in any woman who is of reproductive age needs 800 international units of vitamin D a Day. Anyway, some of US Brown people don't spend a whole lot of time in the sun and don't generate the vitamin D and I'll give you an example. A lot of people who drink milk, they get milk and eat cheese. Drink milk and eat cheese. They get all the calcium and vitamins they need, I don't drink milk because I'm lactose intolerant. The last time I had my labs on, I'll tell you my vitamin D level with 17. I'm the surprised Dr. Berry laughing at me. Normal is considered to be normal to be 30 and in Vagina land as the OB Gyn. We lasted to be around 6. And so vitamin comes supplement outside of of finding that people who have endometriosis are deficient in vitamin D. There's also a thought process that vitamin D and depression have a role with deficiencies in vitamin D and colon cancer. There are deficiencies in vitamin D, so just bone up on your vitamin D. Dr. Berry: Get your Vitamin D. Right. Like I say that again. I kind of scoffed at first. I was like, what is this little thing had his own month? This ain't heart disease. This ain't, you know, verbally like, okay, all right. Dr. Anila Ricks-Cord It affects quality of life. Talked about seriousness of disease. The reality is the endometriosis isn't going to kill anybody at all. There's a thought process that when I talked earlier about the ovarian masses that you can get the Endometriomas. The endometrial tissue that invades into the ovary and obviously takes residents can actually give you so with ladies who held a Sidebar, I'm making a correlation. I apologize, I coming back. For the Ovarian Syndrome who don't have regular menstrual cycles are at increased risk range and mutual cancer because at lining become can become atypical and find it. That same kind of thing can happen in the ovary where the endometrial tissue that is implanted in the ovary this now cause this chocolate fiscal of blood, which is the endometriomas. He can take on abnormal qualities just like the lining of the uterus when it is a typical he ladies are at PCOS. They haven't found words actually become for lung cancer, but it has the capability to change cause it's inter-mutual tissue crazy stuff. Right. The bad thing about endometriosis is, like I said, if you, if you have it, it's everything. Unfortunately it can cause infertility. It can dictate whether or not you can move your house and function without pain. The patients that I have had that have had chronic pelvic pain secondary to endometriosis sometimes have to be selective about the kind of jobs that they take. Because if you have a pain syndrome that's present, say 21 days out of the month where you might have eight had a 10 pound most days. But maybe you get a break in on some other days, you've got five out of 10 pain interferes with your ability to be able to live. If you can’t get up to bed and get functioning because your belly is his feels like his demonically possessed and it's telling you all kinds of things from a pain standpoint and you can't function. Pain was, and how can you hold a decent job? There are people who, because they have issues with endometriosis and the pelvic pain is exacerbated when they have relations. If you are single and not all of you in an intimate relationship, you have a difficulty with engaging in relationships and if you're married, it can interfere with your ability to be able to have an intimate relationship with your spouse. And then that over time leads to depression because is a chronic pain syndrome. Intimacy is a huge part of having relations or we're having a relationship and imagine not being able to be intimately associated with the person that you've vowed to spend the rest of your life with because it hurts so bad you can't stand it, but it's like having a nails in the back of your personal space and so you'd much rather that than have an intimate relationship. Dr. Berry: Wow. Okay. All right. You and Endometriosis. Before we let you go. Right. I got a couple more questions are, you know, but more on a, on a lighter note, right. Because endometriosis is scary. Again, I might have to tell my residents like hey, that patient who comes in for this vague abdominal pain. We might've needed to move it up a couple notches on the differential. Now can you talk about how what you do can help women take just take better control? Not necessarily just for this show, but it's just in general. Right? And this is a question I like to ask. I just want to, and I want to kind of get my guesses thoughts on like what do they do to help people empower, especially in your world, women empower themselves for better health. Dr. Anila Ricks-Cord Sure. So what I like to do with all of my encounters be an individually as a patient, either in the hospital or in coaching or when I was in private practice in private practice is I encouraged them to be their own healthcare advocate. When you're looking for a physician, the purpose is to find somebody that you can partner with, with the ultimate goal of optimizing your health. Medicine is no different than customer service. It actually is like customer services for women. For those of us who like to drop some coins every now and then in places like say Nordstrom. Nordstrom is pricey as all get out, but the one thing that you can bank on with Nordstrom is they have customer service on luck. You know, they're rumored to have taken back a tire from somebody who said that they bought it there even though they don't feel tight. Medicine is no different than that. If you don't have a relationship with someone who listens to you and is genuinely vested in you being successful, you being healthy and your money someplace else, this also puts the onus of your health care on you. So I think when I think about my patients and they come and they talk to me, they say that nobody has listened to them and I think that's crucial. I think that you have to bear in mind that however old you are, you have had that body and know how that body works for however many years God has allowed you to live on the face of the earth. Dr. Berry: No one gonna knows better than you. Dr. Anila Ricks-Cord Right. You are your own healthcare advocate. You got this on lock. If you go see somebody and you were trying to talk to them about what you're experiencing and then listen to what it is you say, go ahead and pick up and walk right on out the door and take you off your money and your insurance card with you. Because you wouldn't take bad customer service at a restaurant. You wouldn't take bad customer service in a product that you purchased. (Nope). So why would you take it with your health care, which is more important and lasting than product you going to buy, meal that you eat and pass on through it. Dr. Berry: Please tell Lunch and Learn how can they find you? Right? Because I know some people are probably energized right now. You know, and I kind of alluded to your Facebook, like give them all the ditails because I need people to be able to kind of track you. Dr. Anila Ricks-Cord Sure. On the sly, I'm a firm believer that food is medicine that tells the body what to do. And so I have invested in becoming a health coach. So in addition to being an Ob-Gyn, I'm a health coach. And with that said, I love answering questions that Dr. Berry's alluded to. So on Wednesday evening, 7:00 PM CST cause I'm in Texas, I do Facebook live on women's health topics and you can find me across all social media At D R A N I L A O B Gyn, that’s Doctor Anila OB Gyn. You can also find more information on my website, which is also www.drnilaobgyn.com. That's D R A N I L A O B G Y N.com. And if you tune into any of my lodge will find that I love answering questions. I think that as I alluded to earlier, my mom died because there was nobody there to advocate for her. And at 22 years old I didn't know the questions to ask. My goal as a health provider is to make it so that you know what I know. So your arm to take better care of yourself. Dr. Berry: I love it. Absolutely love it. And of course Lunch and Learn community, like always, if you're running out, you're in the car, you're driving, wherever you doing, you don't have to worry. All the, all of her information will be in the show notes. So you we will make sure and, and you really just got to watch one of her Facebook lives because she gets very animated, right? Like she really make like, okay, yeah, this one was health really is, that's why I say that, you know, you're going to be on my show because I need someone animated to educate me. A women's health to really educate y'all. So again, she is always, which she seems to be when you listen to her and you could just tell the love that's there. I like that and have everything right. You could just tell the love that is there to educate, to help you. Right? Get to where you need to be. And that's what I love about her. Right. She's absolutely amazing. Again, we're going to make sure she will be a repeat regular on this show, especially again at ya'll. Y'all ask me a lot about women's health stuff and I'd be like, I'd be like, hey they, and this, I know what I know and I know that I don't know. Once I realized I know what I don't know. That's when I get the console. Dr. Anila Ricks-Cord It has been my privilege and it would most assuredly be my pleasure for wherever it is you'd like for me to talk about from vagina land cause I have it on low. Dr. Berry: All right. Again, I appreciate everything that you do for your community. Appreciate everything you do for just the world and allowing you to take your amazing talents outside of the clinic and outside of the one on one and being able to talk to the master. So again, thank you Dr. Anila for coming on the show this week. Dr. Anila Ricks-Cord Thank you so very much Dr. Berry. I appreciate it.