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The Ovarian Cyst Syndrome Pelvic Pain
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The Ovarian Cyst Syndrome & Related IssuesThe young woman had had surgery twice for "pain ascribed to "ovarian cysts" at a Modesto private hospital, and she was ("dumped") referred to me at Scenic General County Hospital, for continued care. She had lost her private insurance. The gynecologist was the same surgeon that had once performed a hysterectomy on a patient with Alzheimer's for "pelvic pain." The young woman, a mother of two, was crying as she described her pelvic pain. I asked her if the pain was causing her to feel depressed. Crying, she said YES. (This is an important step in medicine. Had I said to her, "You're just depressed and there's nothing wrong with you," it would have been a disastrous clinical encounter and the patient would not have been served well.) In clinical psychiatry, I first focus on the physical pain, as I develop a rapport with the patient (the pain is often not where it seems to be).I reviewed her medical data, and I noted, as it often happens, that she had been operated for benign, physiologic ovarian cysts that measured less than 4 cm (1 inch = 2.54 cm). My examination revealed tenderness over her back, left chest wall, neck, and over the sides of the stomach (colon areas). As I examined her tender epigastric area, I asked her if she had been experiencing pain as she ate (early satiety). She said, "Yes, I do. Do you know why?" My reply was simple: "Your 'ovary pain' must be getting you to feel depressed. If you eat, when anxious, you may be swallowing air (nitrogen) which is not absorbed by the stomach and makes you feel bloated."I asked her: "What else is going on in you life that may be compounding your unbearable pain?" I discovered that her once functioning husband had become a paranoid schizophrenic. Her life had become a nightmare. Slowly, I nurtured her back to health without subjecting her to more unnecessary procedures or surgeries. (Hospitals have a moral and fiduciary duty to protect our patients and carefully monitor procedural doctors, especially when patients fail to recover or die.)Over 25,000 new cases of ovarian cancer are diagnosed in the United States. A pelvic sonogram should be inexpensive ($125, total cost) and readily available to all patients. Since about 5% of all ovarian cancer is familial (positive family history), women with hereditary breast/ovarian cancer should be checked for specific genetic markers that include BRCA1 and BRCA2. If we do away with the medical profiteers and unnecessary medical procedures, a universal health care plan is a reality that will cost our nation no more than 15% of our gross domestic product.When Senator Hillary Clinton or Governor Schwarzenegger talk about healthcare for all, do they know what they're talking about? If Senator Clinton were to say that she is going to pilot a 747 next week, would you get in the plane? No way! After all, she did vote for the war in Iraq and it took her a long time to acknowledge that she had made a grave error. To impose on our industry a 4% of payroll as proposed by some politicians is untenable and unnecessary. We just need to change the status quo and accept that we have over 2,000 insurance companies that want to be in the healthcare business. It cannot be sustained. Some politicians think that small American businesses can just be made to pay more into a system that is highly immoral, corrupt and inefficient. Sadly, we are becoming a service economy-not the industrial giant we once were.Luis Lomeli MD
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