Ms. L wrote me:

Hello Dr. Kavokin,

I was reading some of your literature and found it to be quite informative. I have a question that perhaps you may be able to answer: If a woman’s ovarian cyst ruptures, (especially multiple cysts from PCOS) can these ruptured cysts become an infection?

Hi, MS. L

Short answer: anything can become infected. Though I do no think ruptured ovarian cyst becomes infected very often, did not hear about that. I will look more literature and probably place the answer on my website.

Sincerely,
Alex

OK. I looked the literature.

I didn’t do very extensive literature search. Should admit. Anyway, some available books mention that ovarian cyst may become infected. However the infection is not described as the main complication in ovarian cyst rupture.

Also, I don’t remember that anybody told me otherwise. Maybe there is some specialized article that says: the condition happens in one point three percent of cases with Standard Deviation of half percent. I don’t know exact percentage. Need to look more. PubMed service did not give many abstracts on PCOS + infection.

Anyway.

So how would it look alike?

A young woman comes to ER. She is premenopausal. She complains on mild (or maybe severe) pain in her belly. ER Doctor takes history. The woman also mentions changes in her menstrual interval. Let’s say regular is 28 days. Last one was delayed.

Physician puts gloves, puts jelly on gloves. Then he puts his two fingers into the female vagina. The other hand is on belly. Then he starts to palpate.

It is named pelvic exam. Modest name. Though in Russia it is named vaginal exam, which it is.

Is it a common type of exam? Depends. They usually send you to CT (computer tomography) scan if there is severe abdominal pain. Charge 1000. Boom. Done.

Exclude the price. Exclude delay in reading (somebody should look and interpret what is going on). Exclude radiation. CT scan gives better picture than just poking your belly.

CT scan helps to diagnose abdominal pain of uncertain origin. You can really image what is going on. Though, there are cases when physical exam gives more clues. Physical exam must be performed always. Pelvic exam is somewhat a special one.

I remember how I performed a pelvic exam in medical school. It is actually difficult even just to insert two fingers into vagina first time. Female Gynecologist asks me: "So, what do you feel?" Patient goes the same, encourages me: "What do you feel, what do you feel, do you feel it?"

I guess she felt a sort of museum artifact. Heck, I did not feel anything.

Well. Actually I felt something - aside from uterus - something round. I would say 5 cm in diameter (would it be less I probably would not feel it at all) and semi-solid on touch. Also I saw that the patient grimaces. It is tender when I push hard.

It’s it. How to say that it was tuboovarian abscess (that it was) for sure, I don’t know. You really need experience to perform this type of exam. Experienced gynecologist can tell almost precisely what is going on.

Let’s discuss that woman in ER. She will have tenderness on one side. Physician should be able to feel a mobile cystic mass. (Cyst or rather cystis is Latin for bubble. Palpate is Latin for touch. It means you touch something and feel what it is). What if the pain is severe? It often means that the cyst ruptured. My impression is that modern ER orders CT scan right away. If you are not very sure what is going on, you will go from less expensive methods to more expensive and end up with CT anyway. Ruptured cyst causes significant pain. Here CT is indicated.

Alternatively they may order Ultrasound Exam. Transvaginal ultrasound uses the probe inserted into vagina. Ultrasound is cheaper than CT. Ultrasound visualizes cysts clearly. Though, ultrasound gives less information for excluding other pathology. Ultrasound is also safe from the radiation point of view.

In PCOS ultrasound shows increased number of small cysts in both ovaries. Usually more than five confirms the diagnosis.

Culdocentesis may give some useful information too. The name came from cul-de-sac. It’s French I guess. Cul-de-sac is one of the pouches in the pelvis. Centesis means: stick a needle and draw. These days it is considered an outdated method. But if you do not have other machines, it is very useful.

If the content is blood, the ruptured cyst was probably Corpus luteum cyst. If the content is purulent the ruptured thing was probably a tubo-ovarian abscess or other pelvic inflammatory disease (PID). Other abnormal masses can rupture as well. Teratoma gives oily fluid, endometrioma gives "chocolate" old blood.

What is a follicle?

Female body is created for reproduction and childbearing. Oocyte is the start for a new human being in the ovaries. Several layers of specialized membranes surround an oocyte.

The membranes protect the oocyte, help in feeding and nurturing of this small cell. One of layers has a beautiful name Zona pellucida. Pellucida means shiny in Latin.

When the oocyte matures, a small bubble (follicle) filled with special fluid is formed around. In mid-cycle the follicle bursts and the oocyte goes first into peritoneal cavity, next into ovarian tubes (fallopian tubes). The tubes lead into uterus. Tubes, by the way, have special small hair-like things inside - fimbria. They beat in one direction. They propel the oocyte into uterus.

I remember I read somewhere that there are 11000 follicles. When a girl is born, there is no more multiplication of oocytes. After the birth the follicles sit dormant. When the female goes into her reproductive age, the follicles start to grow and mature (one by one).

Only 400 of them mature.

Yeah, it should be like this. Calculate. Average cycle is 28 days. So there are around 12 cycles a year. Women start to menstruate at 13-15 years old. The menopause is around 45-55 years. Total is 30-40 years

Multiply everything together. It should be around 400.

By the way, an interesting thought.

All those discussion about abortion and Stem Cell research. Somewhere in nineteen century the baby was considered the baby when it was born. The church even struggled to admit anything like existence of cells etc. Rare baby actually survived beyond first year. Heck, the hypothesis that human been consists of small cells was actually admitted widely not so long ago. Maybe hundred years ago. Then, all that research happened. People learned how the fetus is created and how it grows. Now the public idea is that fertilized oocyte is already the baby.

Have you seen any oocyte under microscope? Even a human hair near an oocyte looks like a skyscraper near a real human.

Now, if the public perception had shifted this way in several decades, shouldn’t we punish all women for that they recklessly loose 400 potential babies during lifetime. Isn’t it a crime?

Then, maybe we should punish every man for losing millions of sperms - also potential babies. Where did this idea come from that fertilized oocyte is the baby and non-fertilized oocyte is not? Shouldn’t we move the boundary a little bit earlier? Need to think about that.

Anyway.

Ovarian follicle (follicle means small bubble in Latin) usually mature, rupture and release the oocyte that was in this follicle. Sometime the rupture delays. Then ovulation delayes. (Ovulation is rupture and release of the oocyte. Oocyte is the cell that eventually becomes the fetus after sperm gives the genetic material).

Normal cycle is divided into follicular phase (when the follicle grows) and luteal phase. Luteum means yellow in Latin.

When the follicle ruptures (by the way rupture means burst or tearing), the oocyte goes out.

The cavity that left behind (remember it was small bubble) is filled with blood and special cells, producing hormones. These special cells grow in quantity and fill that cavity. These cells produce hormones that help the fertilized oocyte to attach and to grow in the uterus. Because they grow in quantity, they create a yellowish body in the ovary. It is literally yellowish. The name is Corpus Luteum (corpus=body, luteum = yellow).

This is normal cycle.

As we said, the follicle sometime doesn’t rupture (there is a bunch of reasons). A physician should sort out several different conditions. This is an abnormal cycle. If follicle does not rupture it becomes the follicular cyst. Cyst also means bubble in Latin. There are actually plenty of different kinds of bubbles in medical Latin. Big ones and small ones. Normal and abnormal.

OK, the cyst did not rupture. Then what happens?

Well. If cyst doesn’t rupture, it usually resolves. That fluid inside the cyst is reabsorbed and the cyst collapses.

However, if the cyst ruptures, it causes acute pain. The pain comes from irritation of peritoneum (lining of peritoneal cavity) with blood and cyst content.

Why it is not painful when a regular follicle ruptures and releases the oocyte? Probably, a regular follicle is too small. In addition it doesn’t cause much bleeding.

In contrast the cyst is a really big bubble (sometime 5-10 cm in diameter). If it ruptures, it instantaneously release bunch of special fluid. Plus, there is significant bleeding because there are a lot of blood vessels around to feed.

Significant is of course relative.

For example, take 5-10-20 ml of blood from a patient vein in a hospital daily. He complains about the pain from the needle mostly.

But if you get the same 10 ml of blood into peritoneum… Wow. You will cry. There are plenty of nerve endings. Peritoneum is too touchy-feely. Tender.

Besides, the cyst has high concentration of prostaglandins. Prostaglandins, in their turn, are mediators of inflammation. They should cause significant pain directly and indirectly.

From the other hand bleeding could be really significant. Then it becomes really dangerous.

A physician also should not miss an ectopic pregnancy. Doctor will order a pregnancy test for that. If an ectopic pregnancy starts to bleed, this is really really worrisome. It seems like your blood did not left your body. However the blood is in the abdominal cavity. It left the blood vessels. It is internal bleeding. You die quickly.

Polycystic ovarian syndrome is a little bit different animal actually. Here is some genetic predisposition.

Classically: an overweight young female presents with oligomenorrhea or amenorrhea, anovulation, acne, hirsutism, and or infertility.

What is what? Poly = many. Many, many, many men. So PCOS means bunch of those bubbles in the ovaries. The follicles did not rupture on time, as they should. Oligo means a little. Meno is derived from menses. Rrhea means flow in Latin

So olygomenorrhea = flowing a little bit (less than it should). A- is a prefix that means "No". So, amenorrhea = no flow at all. Hirsutism. I don’t remember where it came from, but means hairy or hairiness. Actually excessive hairiness.

Causes of PCOD or PCOS (disease or syndrome) are obesity, genetic predisposition and some other causes of Luteinizing hormone (LH) excess.

There is a self-amplifying cycle:

LH stimulates theca lutein cells. Theca means sort of capsule. Doesn’t really matter, just an anatomical term. Those cells are special. They produce androstendione and testosterone. Androstendione and testosterone are actually male hormones. You know, bodybuilders use these hormones to get muscle bulk. You probably heard about those hormones. Sport doping uses testosterone. So, athletes build their muscles and trash their liver.

Rumors say that a famous Hollywood actor used the hormones. Later he got liver transplant. Though he always denied the use.

Anyway, female body converts androstendione into estrone (a weak estrogen). Fat cells do this. Estrone is a female hormone already.

Basically any body produces androgens (andros = man) and estrogens (female hormones). Just the proportion of those hormones makes us male or female.

The cycle happens in normal person as well.

The estrone stimulates pituitary secretion of LH. Pituitary is a small gland in you brain. Pea Size. It’s small, but it sooooo powerful.

Pituitary has another name - hypophysis. Hypo means down, phys means growth, so this gland is growing from below the rest of the brain. Pituitary gets bunch of connections from hypothalamus. Hypothalamus means “below thalamus”. These two areas of brain regulate almost all the hormone production in organism.

Higher levels in brain hierarchy regulate them.

Hypophysis gets a command. Then it produces some intermediate messengers and hormones. The hormones go into blood and control whole body.

Hormones are like orders, like messages to the rest of the body.

Brain may give quick orders: Signals go through the nerves. It is like a phone order or cablegram.

Brain also regulates organism through the hormones. This is like a mail order. Sort of if the brain sends letters by regular mail. The hypophysis is the Post Office in this case.

PCOS kicks in when a woman is obese. There are more fat cells to convert androstendione to estrone. Estrone has such effect that it stimulates pituitary secretion of LH. LH in its turn goes back to those theca lutein cells we discussed and turns them on again, to produce more androstendione, which is again converted into estrone.

Self-amplifying cycle

In addition, that increased level of testosterone causes the hirsutism (she becomes hairy like a male) and acne in female. In a normal person this cycle is probably designed to support the development of fetus. Estrogen helps placenta to grow. Placenta supports fetal growth.

However, in a person with PCOD the cycle is going out of normal control. In this case LH causes growth of the cysts in the ovaries.

Why?

Because the corpus luteum cyst is partially made by overgrowth of those theca lutein cells. LH stimulates theca lutein cells.

Also, women with PCOS have intolerance to glucose (sugar) and resistance to insulin. It means there is a lot of insulin (hormone that helps to utilize glucose mainly).

However excessive insulin does not work. Either receptors to insulin do not work or something else, but the glucose is not utilized. Hence, energy inside the cells drops. Hence, a big pile of other problems mounts. As if it is Diabetes Mellitus. Diabetes is a different topic of discussion. For us, it is worthwhile to mention that people with diabetes are very much prone to any infection.

PCOS causes acanthosis nigricans also. Acantocytes are special skin cells. Nigricans means black in Latin. That thing looks like thickened pigmented skin. When you touch it, it feels like velvet. Usually it happens in axilla, neck, below breast, in inner thigh and vulva. So, mostly all those places where skin folds.

The treatment for PCOS includes different medications: oral contraceptives, progesterone, glucocorticoids, ketoconazole, spironolactone, cyproterone, flutamide, cimetidine, finasteride, ovarian wedge resection, laparascopic electoracutery, mechanical hair removal, etc.

All methods break the cycle of overproduction. The medications are either hormones themself or hormone-like substances that occupy receptor site and prevent regular hormone to work.

The medications act on different levels. Normal hormones have very complicated regulation. There are loops and feedbacks in the pathways.

To suppress a hormone production or action, you give similar hormone or another hormone or non-hormone at all, that goes to the feedback loop and breaks it and so on. It’s really long separate discussion.

Basically, you either decrease hormone production or shift ratio toward female hormones.

Another way, the best probably, is weight loss. No fat cells - no conversion of andrgoens etc… You can make conclusions yourself. It’s the first line of treatment.

For a simple follicular ovarian cyst (not PCOS) doctor rules out ectopic pregnancy. Then he may send patient home and repeat pelvic exam in 6-8 weeks. Especially, if the cyst was small, less than five cm in diameter.

For larger cysts, doctor would order pelvic ultrasound.

Most follicular cyst will resolve on their own in six to eight weeks. Though, a physician may give oral contraceptives. Again, this suppresses stimulation of cyst by hormones from the hypophysis. The hormones are named gonadotropins.

If the cyst is still there after 6-8 weeks, a suspicion arises that the cyst maybe malignant. Then doctor orders other studies. CT scan. Physician may perform surgical procedures also. He looks what is this cyst really.

Corpus luteum cyst is usually not treated. However, oral contraceptives may be used.

Rupture of any kind of those cysts leads to another story. Acute pain, bleeding into peritoneum. Sometime bleeding is very severe and is true emergency. You need also to distinguish other process in the abdomen. For example, appendicitis looks similar. You can treat mild case of non-complicated cyst rupture with just observation. Appendicitis almost always requires surgery.

There are many other problems arise. Surgeon scratches his head: what’s going on? Is this this or is this that? Here is the CT scan gives big advantage.

Now, going back to the question of Ms. L.

If the cyst was infected, I don’t’ see a reason why a ruptured cyst wouldn’t become infected. Cyst content is very nutrient-rich. Remember? All those cells and their products are dedicated to feeding the oocyte (future baby). Should be very tasty for any bacteria.

Rupture may cause significant bleeding as well. This blood is also different from the blood in your vessels.

This blood is sitting in the pelvis, not moving, quickly clotting. Clotting prevents entry of white blood cells. "No flow" prevents entry of antibodies. Absence of flow prevents entry of other protective chemicals (complement etc).

So, it is very nutrient-rich media for bacteria growth.

They can go wild. Why not? If a female had another pelvic infection before, that infection can flare up. In a normal person peritoneal cavity should be sterile. However, any gynecological or gastrointestinal infection may supply bacteria. Now, mix these bacteria with the content of the leaking cyst. It just destined to become infected.

Actually Ms. L later answered her own question in another e-mail. She had cysts multiple times and they became infected several times.

So, to answer the question: Will the ruptured cyst become infected? Not necessarily. Rather not. Can it become infected? Yes.

Aleksandr Kavokin MD/PhD, Phila appendicitis_disease@yahoo.com http://www.appendicitis.uni.cc/ Aleksandr Kavokin, MD1994 Russia,PhD1997 Russia - Immunology and Allergy, postdoc at Cancer Center at Med U of South Carolina, postdoc at Yale - Cardiology, Molecular Medicine. http://kavokin.com http://www.geocities.com/aging_rejuvenation/ http://www.geocities.com/appendicitis_disease/

Cervical cancer is the second most common cancer in women worldwide. And in the United States, an estimated 13,000 cases of invasive cervical cancer are expected to be diagnosed each year.

Cervical cancer is usually caused by a sexually transmitted virus called the human papilloma virus or ‘HPV’. Most HPV infections will not lead to cervical cancer. However, infection with these viral types can lead to abnormal changes in the cells of the cervix. Certain changes called ‘high-grade lesions’ may progress to cervical cancer and cervical cancer signs if not treated.

Common cervical cancer signs include these symptoms:

• Vaginal bleeding after sexual intercourse

• Pelvic pain

• Pain during sexual intercourse

• Unusual vaginal discharge

• Abnormal bleeding between menstrual periods

• Heavy bleeding during your menstrual period

• Increased urinary frequency

Pap smears are the best screening technique currently available to evaluate the cells on the face of the cervix. The Pap smear is defined as a test for the signs of cervical cancer such as cancerous or pre-cancerous cells of the cervix. Most Pap smear test results come rated from Class I through Class V.

• Class I is normal,

• Class II means an irritation or inflammation,

• Class III means it is a true cervical dysplasia that can range from mild to serious,

• Class IV may be one of a variety of pre-cancers or cancers,

• Class V is one of the serious invasive cervical cancer signs.

Pap smear tests are necessary, but they are not always accurate. And their results sometimes appear normal even when a woman has the abnormal cells of cancer. If cervical cancer is suspected and the pap smear test comes back either as normal or as positive, consider getting another pap smear from a different laboratory and a second opinion from another doctor. If your Pap smear shows dysplasia, a biopsy can rule out cervical cancer.

Another testing method is being developed that uses a small fiber optic probe that may replace pap smears. This method is still being tested. Hopefully, it should give women more accurate screenings, eliminate unnecessary biopsies and help diagnose cervical cancer in its early stages.

Early stages of cervical cancer often go on without any noticeable symptoms! Cervical cancer is usually a very slow growing cancer. Cervical cancer is often diagnosed and treated in an advanced stage when the success rate is much lower. Most women that have invasive cervical cancer will be treated with surgery, chemotherapy and radiation or some combination of these. There are women that will have a hysterectomy as a consequence of cervical cancer that has spread within the cervix.

There are two types of hysterectomy — the partial and the complete. In a partial hysterectomy, only the uterus is removed. In a complete hysterectomy, the uterus, fallopian tubes and ovaries are removed (the medical term for removal of the ovaries is oophorectomy).

A complete hysterectomy will have a significant impact on a woman’s hormonal balance and health since the ovaries are such an important source of hormone production. Even a partial hysterectomy can have a significant effect, first because the uterus plays a role in hormonal balance, and second because in most cases the circulation to the ovaries is impaired enough by the surgery to seriously affect their function.

There are conditions for which hysterectomy is advisable or medically necessary. These include ovarian, uterine or cervical cancer, uncontrollable bleeding, severe endometriosis (adenomyosis) and complex hyperplasia, to name a few.

Women should know what the cervical cancer symptoms are so that proper medical help can be obtained when needed. To learn more about cervical cancer signs, causes and natural treatments, visit Cervical Cancer Signs and Treatments to read more.

Copyright 2005 Olinda Rola.

Olinda Rola is the webmaster of http://www.safemenopausesolutions.com, a website of natural solutions for a variety of health problems. Visit her website and learn more about ways for improving your health. She is the editor of the free newsletter ‘Women’s Health Newsletter’. Go to http://www.safemenopausesolutions.com/womenshealthnewsletter.html to subscribe.

Nano Technology may in fact hold the keys to fighting many different types of cancer in the human bio-system. The technologies are so promising we may see survival rates skyrocket, thus everyone can live strong in the upcoming decade. Nano Tubes use in fighting cancer is indeed, a unique process; it works by inserting tiny microscopic carbon synthetic rods into the body to deliver the cancer treatment to the exact spot needed. By directly aiming the rods into the cancer cells, the healthy tissue is saved.

This research is quite promising and is being researched by Stanford University. Chemotherapy seems to becoming a thing of the past. That is the theory that nuking the body and seeing which dies first; the cancer or the person. Even when the human survives it is left with huge amounts of destroyed tissue, which was not cancerous. When you see a person who is using chemotherapy to treat the cancer you see their hair fallout, but that is only one of many dire and serious side effects.

These nanotubes are so small they are the width of a DNA strand. The nano tubes will be heated up using near infrared light in a laser beam, which takes about two-minutes. The cancerous cells are quickly destroyed. This research is only in the preliminary stages but should be solved within the coming decade.

The nano tubes will be coated with a vitamin called folate, which is found in cancerous cells, but does not normally bind with healthy cells. Once these tubes touch the cancerous area they quickly bind and then are electrified with near infrared laser light, killing the cells. Nano Tube technologies are quickly coming of age and once they are available this process should be relatively easy to use. One cancer already targeted is Lymphoma and tests of the process are being done on mice with good results. There are other cancers it might work on well to and have been suggested. For instance Ovarian Cancers, Cervical Cancer and others; Nano Technology and biomedical processes are coming of age as we speak.

"Lance Winslow" - Online Think Tank forum board. If you have innovative thoughts and unique perspectives, come think with Lance; www.WorldThinkTank.net/wttbbs/

Serious cases of cervical cancer can be successfully treated, although it is best to catch cervical cancer early. The best way to do this is with regular, routine and periodic paps tests. In the invasive stage more drastic measures need to be taken to stop the spread of cancer and even in this case if the cancer has not moved beyond the cervics there is nearly a 90% rate of survival. Forty years ago we couldn’t say that, so things have come along way. By getting paps tests abnormal cells are found early and removed or treated very easily.

There are many ways used to treat later stage cervical cancer. Hysterectomy surgery in the invasive stages is one of the more popular ways to treat cervical cancer and is used often inn younger women, because it preserve the ovaries. Hysterectomy removes the uterus and cervix thus removing the cancer in the process. Hysterectomies in more serious cases include removing part of the vagina, cervix, uterus as well as any lumph nodes in the region.

Radical trachelectomy can be another method used to preserve fertility, this would remove the cervix and lower part of the uterus, but the rest of the uterus is left for bearing the fetus. Lymph nodes are also removed in the pelvis and there is further surveillance to see if cancer has spread. Chemotherapy anti cancer drugs can also be used to enter the patients bloodstream which can increase the effects of radiation to treat cervical cancer. Radiation treatment is also possible to shrink the tumors killing the cancer cells. This prevents the cancer cells from reproducing.

The less serious cases are treated with a simple hysterectomy or radical trachelectomy, which would first choice in invasive stages. Sometimes in later stages a combination of any of these will be used. If you have periodic paps tests you can prevent this level of treatment and even if you have to go through any of these levels of treatment you most likely will end up a cancer survivor like Lance Armstrong. So talk with your doctor, stay informed, do your own research and think on this.

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How serious is it to get paps test screening to reduce your chances of cervical cancer? One of the best ways to prevent cervical cancer is to watch for the HPV virus. There are a couple ways that pap tests are done. The most common way is for the doctor to brush cells off for a sample from you cervix. Then those cells are put on a glass slide and sent to a lab, where they are put under a microscope to look for abnormal cells. Those abnormal cells are reviewed. The other type of test is to use a fluid type test or liquid test, however the cell samples are collected the same way.

It is important to catch the abnormal cells in a pre-cancerous state and prevent a life threatening cancerous event. Many doctors will also look for the HPV virus by additionally ordering a DNA test, this is a good idea for those in the risk ages which are generally between 35 to 55 years of age. Those women under 30 years old usually are taken care of by their bodies eventually and the HPV infections would not be associated with cervical cancer.

Learn more about this, talk to your doctor, ask questions and do you own research. It is important to get pap test screening periodically and you would be wise to do so. Think on this.

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Of all the common cancer that affect woman, cervical cancer is among the top list. Sexually transmitted HPV (human papillomavirus) is the culprit in most cases of cervical cancers. Over half of the cervical cancer reported cases occur in women between 40 and 55 although it is not uncommon for women of 35 to be amongst the risk group. The body’s immune system works to keep the HPV from doing damage, yet the HPV virus can last for years and over time it takes some cells on the surface and turns them to cervix cancer cells. Routine and periodic screening from paps tests can help you catch this early and thus this has helped reduce the number of deaths in women in the United States, but still we lose 4,000 to 5,000 women a year to cervical cancers.

In research the things, which increase risk of cervical cancer may include large numbers of sexual partners, which increase risk of HPV. Having other sexually transmitted diseases also increase you chances of cervical cancer. Weak immune system periods can increase your bodies ability to keep the HPV at bay. Early sexual activity can also cause a problem, due to non-mature cells being more apt to take on the cancer cell growth. Even smoking although research is not conclusive may in fact inhibit your bodies defenses against HPV.

Your strategy for reduction of risk of the HPV and cervical cancer damage should include routine and periodic paps tests. Ask your doctor for additional information and do your own research on this. It is smart to pay attention and early screening is the key to saving lives. Think on this.

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Ovarian cancer risks can be reduced. It might be wise to look into some of the research to develop the strategy, which is right for you. Here are a few ideas and thoughts on some of the things you might wish to add to your lifestyle or subtract in order to reduce your risks of ovarian cancer.

One way to reduce your risk of ovarian cancer is the use of oral contraceptives or birth control pills. This has been found to reduce the risks of ovarian cancer by up to 50% by those women who use them for up to three or more years. For those women who have had genetic screening and have been found to have mutations of certain genes may also get significant benefit although more study will be needed to confirm this.

Tying of the fallopian tubes can also significantly reduce risks of ovarian cancer by two-thirds or 66%. It might be an option for you if you are sure you are done with having your last child. There is also many studies suggesting that hysterectomies decrease the risks of ovarian cancer. Of course such operations probably are not a good idea unless there is another good medical reason. It is recommended for those women who have already been thru menopause or near menopause that ovaries should be removed with a hysterectomy operation.

Those women who have more than one child and breast feed for more than one year seem to have also reduced their risks of ovarian cancer. Those women who have children after age thirty-five also appear to reduce the risk of ovarian cancer.

Of course it is best to discuss these issues with your doctor, get screening and have a strategy on reducing your risks of ovarian cancer. Do your own research and think on this.

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Many have speculated that high diets of fat and/or meat might increase the risks of getting ovarian cancer for women. Yet most dairy and meat associations defend their products and say that there is not comprehensive studies or research that can confirm this, in fact they say that the industries are unnecessarily being condemned for something that is most likely completely false and conjecture at best. Of course they have financial motivation for saying that and so one has to question their sincerity.

When reviewing these claims further we see that they may actually have a point. The World Cancer Research Fund have studied the results of the tests and research and they too have concluded that high intakes of dairy, fats and meat products may not be a risk of ovarian cancer. There have not been enough in depth studies to prove anything either way. More studies are needed to determine if these claims are correct or not.

Milk consumption may not have any increase in the risk of ovarian cancer at all. The studies seem to be too limited and those research papers suggesting such may not be viable. Although others say that commercial interests are clouding the issue and claiming that more data is needed when plenty of data and proof already exists. Yet we know that milk products are important to our diets and help in many nutritional aspects. If nutrition is neglected due to perceived risks in ovarian cancer in women, then such advice can cause other health issues.

It is imperative that all women get periodic pap tests to catch any possible ovarian cancer early; that is the best advice. If you are a woman it would behoove you to do your own research and learn more about ovarian cancer. Think on this and stay informed.

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Is it true a vaccine to end the threat of cervical cancer? Chock one up for modern science, maybe it is good that the Drug Companies are making such high profits after all and have so many lobbyists in Washington D.C. if they can keep solving these problems that plague mankind or in this case Womankind. And this is just the kind of thing woman can be happy for as it nixes one more type of cancer that could potentially take one’s life.

The vaccine is comes in three shots taken in series and is said to be 100% effective in preventing cervical cancer. The vaccine’s maker is Merch and Company and the vaccine protects against four viral strains. HPV or Human Papilloma Virus is the cause of cervical cancer and genital warts. Over two million Americans are carriers of some form of HPV, meaning it would not take very many partners to hurt the law of averages and put one at risk.

Cervical Cancer kills about 300,000 worldwide and about 4,000 each year in the United States. The vaccine is best taken before girls become sexually active, which ensures 100% protection. Modern medicine is making headway on many types of cancer and this latest breakthrough is an awesome thing. Some day human beings will not have to worry about cancer, until that day, each new cure, treatment or vaccine is one step closer to that goal. Think on it.

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Part II Conquering the Fear, Fighting the Cancer

Ovarian Cancer: Process and Survival

Post Surgery

Read Part I for information regarding diagnosis and surgery…

The next few weeks after my discharge from the hospital, were very busy. My sister, Nance, and my mom decorated the house and Christmas tree. My sister Lauren visited from Washington and cleaned, cooked and lent invaluable support to all of us. There were visits to the surgeon for follow-up and the oncologist for the initial visit. John and my sisters accompanied me. It was so very helpful to have someone else ask questions and write down information. It can be an overwhelming experience, especially when you’re a little "spaced out" on vicodin for pain management, as I was. I signed on to be part of a clinical study using different combinations of medications for eight instead of the normal six cycles. Laurie had brought a book with her that offered a lot of information on how to deal with an ovarian cancer diagnosis and subsequent treatments. One suggestion was to research clinical studies. There is a great deal of "cutting edge" research out there but you may have to hunt for it, do your homework, and bring the information to your doctor. My oncologist’s office was conducting a trial, I was accepted, and I was scheduled to begin treatment on December 21.

Even though I was dreading the whole process, I knew I had to approach it in much the same way I did the surgery, almost like an athletic event or a race. I wanted to go in as strong and as prepared as possible and with a better "attitude."

Attitude is defined as a manner of acting, feeling or thinking that shows one’s disposition, opinion and mental set. We may not be able to control a situation, but we can choose our attitude about that situation- victim or fighter; passive or aggressive; depressed or striving toward joy and happiness; caught in the "why me’s" or searching for the "what can I learn from this." With the help of many people and through much reading and research, my "attitude-adjustment" process unfolded.

A booklet entitled "Preparing for Chemo" suggests several things that I immediately put into action.

1) Get your hair cut short so that when your hair starts falling out, it’s less traumatic and won’t clog the shower’s drain. (This worked for the drains but I was still traumatized.)

2) If you plan to wear a wig, shop for it before starting chemo. My sisters and my dear friend and hairdresser Patty, helped with both of these steps. Watching my long hair fall to the floor was very hard and yet made me feel the tiniest bit more in control of what was happening to me. To my surprise, everyone loved my new hairdo. The compliments boosted my ego when I really needed it. Nance and Laurie accompanied me to the wig shop. Laughter is very good medicine-and we laughed a lot as we all played with the wigs before settling on two very nice ones. Four hundred dollars later I was armed with my hair prosthetics and a sore belly from laughing. At this writing, I’m sporting my own very short hair after nine months of wigs and hats.

3) The booklet suggests having a dental check up and cleaning before starting chemo. Also important is giving your home a thorough cleaning and perhaps scheduling someone to come in once a week thereafter- a clean house can minimize exposure to infectious agents.

4) Building up strength through exercise and a good diet can help minimize some of the side effects of chemo. This booklet and other helpful literature, is available through oncology offices and offers good practical information. I also found the library and the internet to be good resources.

Shortly after my homecoming, from the hospital, I received a telephone call from Lindy, a volunteer with the Cancer Society (set up by my husband and the cancer support staff at the hospital.) She had been diagnosed and treated for Stage IIIc ovarian cancer seven years ago. Hearing from her gave me a real boost and some good tips for dealing with the upcoming chemo. She shared her experiences with surgery, hair loss and complete recovery! She is still cancer free! In addition to advice on make-up to camouflage the fact that one has no eyebrows or eyelashes, she told me how helpful acupuncture was for her. She felt that it really minimized some of the chemo side-effects and "rebalanced" her body’s energy. I had had a few sessions of acupuncture many years ago, and I immediately knew that this would be right for me. I believe in its efficacy and definitely feel the sessions have been very beneficial.

My first acupuncture session was four days after the first chemo treatment. The meds they gave me to prevent nausea worked very well. I didn’t have much of an appetite and felt a little achy and tired but the only real side effect I experienced was a terrible, hand-wringing itching and tingling in my hands and feet. Amy, my acupuncturist, has worked with several people undergoing chemo, is very knowledgeable, and had a good treatment plan in place for me. I scheduled to see her 2 days before and 4 days after every chemo session. After my first visit with her, I did feel better, more energized and the itching had definitely dissipated a good deal. She gave me some suggestions on supplements and some Chinese herbs to use.

The side effect of itching, burning and tingling is called neuropathy and is fairly common with the types of chemo protocol I was on. After my second and third sessions, the symptoms worsened! I turned to the internet to learn more about neuropathy and what, if anything, I could do about it. I found an article by Cindy H. Makencon, website: www.ovarian-news.org, entitled "coping-Tips for dealing with neuropathy." She offered a great deal of helpful information including reports of studies on the benefits of taking fairly large doses of L-Glutamine Sulfate and Chondroitin. I forwarded this information onto Carolyn, the research nurse in charge of my clinical study, and she shared the information with the oncologist. I had already started taking L-Glutamine when I met with him. He had further researched and developed a new treatment plan for me which included large doses of L-Glutamine, a change in one of the chemo meds, and the addition of a medication called neurontin. The combination of all these things worked! The neuropathy gradually subsided and I’ve had no further problems.

I believe a few other factors contributed to my being able to handle the chemo pretty well. I continued to increase my exercise regimen, progressing to walking everyday and then back to the gym for step-classes, albeit modified, and lifting light weights. Exercise builds muscle strength, increases oxygen and blood flow and for me, was and is a real physical and mental energy boost.

I came across a book entitled: "Herbal Therapy & Supplements- a Scientific and Traditional Approach" written by Merrily A. Kuhn, RN, Ph.D. and David Winston, a herbalist and ethnobiologist. The book was part of an at-home study course that I needed to complete for my RN Continuing Education Credits. The book offers a comprehensive guide to many common and some less common herbs and supplements, their uses, adverse effects, contraindications, and drug-herb interactions. After careful research, I started using several herbs and supplements designed to minimize chemo side effects and boost my immune system. I was careful to use things that do not stimulate estrogen in the body as my cancer was estrogen-receptor positive. I started taking these supplements one or two things at a time in smaller doses in order to monitor any unfavorable reactions, before adding more. Most importantly, I notified my doctor that I was taking supplements and having acupuncture.

At the end of this article, I will offer a complete list of the supplements and herbs that I have been using and some information regarding the rationale for each of these additions.

For several months, our kitchen counter resembled a drug and supplement store. I had to write up a daily schedule of what to take when. It was worth it! Once the neuropathy was under control, I tolerated the remainder of the chemo treatments pretty well. I was able to work full time and exercise, and my appetite and energy levels were good. Physically, acupuncture, exercise, diet, and supplements were, and still are, valuable tools which helped me deal with the chemo and recover from its serious effects.

On another level, the emotional and spiritual aids were an even more powerful part of the healing process. Previously, I mentioned my visualizations regarding pre and post operative healing and seeing myself healthy and cancer free. Now, it was time to take it a step further and include it as a powerful adjunct to the chemo medications. Rather than seeing the meds as a poison, I started to visualize it as "nectar from the gods," washing through me and being taken up by my immune cells as a potion to destroy cancer cells. A few weeks before my first treatment, I read an article about a young local girl who had battled cancer at age 16. She wrote a book about her experience and included her thoughts on seeing her chemo as "nectar from the gods." I admired her outlook and incorporated it into my work. My husband, John, created a special tape for me to listen to while receiving the infusion of chemo. This guided exercise included relaxation, healing messages, and suggestions for picturing my immune cells taking care of things and using the chemo effectively. Before each chemo session, even before they started the IV, he would do a relaxation exercise with me. This ritual became a very important part of the process. By working on my "attitude" towards the chemo and by connecting with these parts of myself that can be powerful self-healers, I felt I was taking back control of what was happening. Feeling that you are part of the healing process instead of a passive receiver of medications etc., is very empowering.

Rituals and routines are very comforting, especially when you’re experiencing stressful times. My "chemo ritual" evolved from the very first session. The night before, I meditated and did my healing visualizations at bedtime. John drove me to the oncology center. I selected my chair and we settled in with his relaxation exercise. My sister, Nance, arrived bearing muffins and silly magazines. After visiting and chatting, John left for work and Nance and I munched muffins and laughed at the National Enquirer stories. About an hour before the infusion was completed, my brother, Tom, would arrive for a visit and to take me home. Somewhere in the session, my sister, Laurie, would call from Washington to check in and often John would "pop in" in his travels. I always had company and felt lovingly supported. Sabrina included me in her meditation every morning and my mom would stop by the day after the session for tea and a chat. Every three weeks from December 21 through May 27, we followed this routine. The nurses and my family got to know one another and we became a real team!

Returning to work seven weeks after surgery was another normalizing routine that made me feel like I was taking back my life. Except for the day of chemo and the following day, I’ve worked full time, feeling productive, healthy and normal. My co-workers have been very supportive and caring. They even threw me a graduation party to celebrate the completion of chemo.

Even before my last chemo, I was researching what to do to prevent a recurrence of the disease. I found information on a clinical study for Ovarex, a vaccine designed to prevent a recurrence of ovarian cancer. After many phone calls, letters and haggling with my insurance company, I was accepted into a study being conducted at Stanford’s Cancer Center in Palo Alto. It involved monthly infusions for the first three months and then every twelve weeks for the rest of the year, with routine labs and CT scans. I’ve experienced only mild side effects and feel fortunate to have access to one more tool.

This past year has been one of lessons for me. I would have preferred the "universe" had given me a gentle tape on the shoulder instead of this Giant Thump on the head to let me know I had things to learn about myself and how "I am" in the world. Here are some of the things I have learned from this experience:

1. Pay attention - perhaps if I had agitated more forcefully with my doctor that something was NOT right, she would have responded with more attention. LISTEN to your body and trust your intuition.

2. Don’t take anything for granted - people, job, health, hair. When you face the loss of these things, you realize how special people are, how the day-to-day routine of a job is a gift, how precious good health is and even how much better a "bad hair" day is than NO HAIR!

3. There are a great many sources of invaluable information out there through people, libraries and the internet. Taking advantage of these resources allowed me to create a comprehensive plan to restore my health and fight the disease using a combination of Western and alternative therapies.

4. We do have choices in how we deal with a crisis - probably the best choice for me was to reach out and ask for help. The more people I told about my health issues, the more positive energy came my way. I felt empowered rather than vulnerable and armed with my helmet (a wig, which, by the way, I got complements on) and my armor (acupuncture, supplements, chemo, prayers and visualization) I was ready to do battle. I was "Warrior Princess" instead of cancer patient.

5. Laughter is GOOD MEDICINE!
At this writing, my labs and CT scans are completely normal. I’m back to my normal routines of work and exercise. I’m sporting a "Jamie Lee Curtis" hairdo. I am excited about decorating and shopping for Thanksgiving and when we all come together, we’ll have a lot to be thankful for! Before we dig into our feast, I’ll be asking each person to write on a piece of paper, one thing that they are grateful for. Each of us will then withdraw one of these papers from the basket and try to guess who wrote the message. It will be easy to guess mine. I’m grateful for all the love and support from my family and friends (with a special thanks to my son, Matt, and my husband for shaving their heads to support me and to my son, Mike, and his band for dedicating songs to me at concerts and their fund raising for the Cancer Society.) I’m grateful for the prayers and best wishes that came my way from people I don’t even know. I thank you!!! Well, of course, that’s more than one thing on my piece of paper but so what! It’s time to celebrate!

Happy Thanksgiving 2004 and celebrate every day of your life.

Barbara’s Complete Ovarian Cancer Fighting Supplement List:

Three Imperial Mushroom Capsules - available through acupuncture office

A) Reishi- Immuno stimulant: enhances immune system; use is sanctioned by the Japanese Health Ministry as an adjunct treatment for cancer; Increases activity of chemotheraputic agents and reduces adverse effects such as nausea, decreased white blood cell counts; helps protect the liver against damage caused by viral, drug and environmental toxins.

B) Shitaki- strengthens immune system response; improves survival times of cancer patients when used concurrently with chemo.

C) Maitake- best known for cancer fighting properties; many doctors in Japan use it to lower blood pressure and blood lipids; effective as an anti-tumor agent and immune system modulator.

Echinacia- used in Germany along with chemo in the treatment of cancer. May enhance white blood cell counts in persons undergoing chemo.

Cat’s Claw- reduces side effects of chemo; used in clinical practice in Europe for cancer & HIV; has important immune enhancing properties; helps increase the number of T-cells, the true soldiers of the immune system. In Austria, it is used together with conventional treatment (chemo, radiation &/or surgery) to treat hundreds of cancer patients per year.

Graviola- scientists have been studying this herb since the 1940’s - four studies were published in 1998 re: significant anti-tumor properties and selective toxicity against various types of cancer cells (without harming healthy cells; Purdue University has conducted a great deal of research on the Annonaceous acetogenins family to which graviola belongs) much of which has been funded by the National Cancer Institute or the National Institute of Health.

Acidophyllis- rebalances intestinal flora (especially important when you’re taking a lot of medications.)

Multivitamins with Vitamin E

Calcium Supplement

IP-6 with Insositol- has been studied extensively for over 20 years; has powerful effects on the immune system.

Wheat Grass Juice- increases hemoglobin; rebuilds the blood; improves body’s ability to heal wounds; washes drug deposits from the body; neutralizes toxins and carcinogens in the body.

Green and White Tea- Chinese believe green tea is a cure for cancer and a longevity tonic; boosts immune system function; research being done all over the world and in the US by the National Cancer Institute re: anti-tumor activity. Both green and white tea are excellent antioxidants.

Website for researching herbs- Plant Database Raintree Nutrition

I used the guided relaxations/visualizations CD’s from the Stress Education Center-Dstress.com 1. #209 Stress Management for Pre and Post-op Survival 2. #208 Stress Management for Healing

Reference: Health Update from SELF Magazine by Jennifer Nelson November, 2004 Ovarian cancer: a not-so-silent killer

"Early diagnosis is crucial. When disease is caught before it spreads, 80 percent of women will survive."

by Barbara Ehlers-Mason, RN and L. John Mason, Ph.D.

Written in November, 2004, one year after the Surgery for Ovarian Cancer, in November, 2003

Stress Education Center (707) 795-2228 website: http://www.dstress.com

L. John Mason, Ph.D. is the author of the best selling "Guide to Stress Reduction." Since 1977, he has offered Executive Coaching and Training. His wife, Barbara Ehlers-Mason, RN, was diagnosed in October, 2003 with Stage III Ovarian Cancer.

Learn everything that you can if you think you or someone you know has Ovarian Cancer. Be prepared to fight.

Please visit the Stress Education Center’s website at http://www.dstress.com for articles, free ezine signup, and learn about the new telecourses that are available.

Please take good care of yourself!