PART 3: How Do I Manage My Pain?

Updated: 6 days ago

*DISCLAIMER: This sharing is based on personal experience. There are no two bodies alike so what works for one doesn’t necessarily work for the other. Please seek professional advice before attempting any information obtained online.

*This post is a continuation of:

PART 1: Breakdown Before Breakthrough (endosupport.sg)

PART 2: My Journey To Getting A Proper Diagnosis (endosupport.sg)


Keypoints:

1) Get A Pain Management Doctor

2) Supplement Conventional Medicine With Holistic Approaches:

  • Nutrition & Exercise

  • Myofascial Release:

  1. Foam Roll, Lacrosse Ball, Massage Guns - Self Myofascial Release

  2. Spinal Manipulative Therapy - Chiropractic

  3. Active Release Techniques (ART), Instrument Assisted Soft Tissue Mobilization (IASTM) - Physiotherapy

  4. Deep Tissue/ Sports Massage/ Manual Lymphatic Drainage Massage

  5. Cupping (Bekam)/Acupuncture/ Gua Sha -Traditional

3) Knowledge is Power

4) Track Your Health:

  • Daily Food Log

  • Weekly Exercise

  • Period Log

  • Mental Health Log

  • Annual Health Screening



1) Get A Pain Management Doctor


It has been nearly 10 years since the first diagnosis. While there is still so much work that needs to be done before we could achieve integrated Endometriosis care here in Singapore, I am glad to see O&G specialists now send patients to other management avenues in retrospect to dismissing them just because Endometriosis is ‘common’. This is a huge improvement attained over the many years of advocating just so we could all be taken seriously. It is therefore very important for us to keep barging forward because it does make a difference.



From a medical approach, it makes sense to assign a Pain Management Specialist in finding the doses and types of pain relief medicine that work best for each patient depending on their goals and situations. Pain relief medicine, just like Endometriosis treatment, is enigmatic therefore requires expert handling and an individualistic approach where both patient and doctor should work together to attain optimal results. This too is a journey of trials and errors.



I am consulting with Doctor Christopher Liu Weiyang, who specializes in chronic pain management and liver transplant anesthesia. I see him every 6 months to review whether my current painkiller helps (or not). Over the years, I have tried a variety of concoctions; Tramadol, Diclofenac, Etoricoxib, Naproxen, Opioid to name a few. As my priorities change over time, so do my painkillers. For example, during the years when I was my own boss moving around and about as a fitness instructor, I had the luxury of time to rest and recover from the drowsiness that comes from taking Opioid. Now that I am working a 9 to 6 job, that option is not feasible. Instead, I am put on Etoricoxib (alongside Paracetamol) as it is a fast-relief painkiller minus the drowsiness. This way I can still function at work. However, because of prolonged dependency and incidents of misuse, this results in gastrointestinal & kidney issues. So, both I and Doctor Liu agreed on a strategy that should get me to gradually be less dependent on the painkiller.


“If you fail to plan, you are planning to fail” Benjamin Franklin

Having a Pain Management Specialist in this sense allows me to approach my pain strategically under the supervision of an expert. This is comforting; knowing that this path I walk is back by professional help.


2) Supplement Conventional Medicine With Holistic Approaches

  • Nutrition & Exercise

My priority now is to conceive naturally if my last Colposcopy result (in March 2022) turns out negative (I had Conization surgery to remove pre-cancer cells on my cervix earlier this year). By then, I would have completed all 3 doses of Gardasil-9 too (which is not recommended for pregnant women hence the plan had to be postponed until then).


I understand there are IVF & IUI options too, however, due to financial reasons (even after all the heavy subsidies available), these treatments are not viable for me. So, the only way I am left is to go by the natural route. Knowing this is my current goal, my pain management specialist; Doctor Liu, reminded me that, should I be in pain (notably from post surgeries adhesions) during pregnancy, it is not advisable to rely on any form of painkillers as this could affect the development of the baby. With this said, I should seek other alternatives to manage pain. Since I still have a couple of months left before trying again, this is the best time to experiment and build a solid foundation for my body to be in its best condition (physically, mentally & emotionally).


Strategically, pain management doesn't just go by popping pills. It has to be complemented with a healthy lifestyle. This way, dependency on the pills should reduce gradually too. We all know that the food we eat can either be the safest and most powerful form of medicine or the slowest form of poison. Especially for those suffering from Endometriosis since the wrong choice of food can trigger symptoms. So, it is important to be mindful of what we eat.


Exercise on the other hand is a natural painkiller and an endorphin booster. It should be tailored individually hence I won’t be listing down my regime as it is specific to my needs. However, I will share, besides targeting the major muscles, I do emphasize supplementary work to my lower body, hitting rudimentary areas like:


  • Adductors

  • Iliotibial Band (ITB)

  • Tensor Fascia Latae (TFL)

  • Sciatica & Piriformis

  • Soleus

  • Fibular/Peroneal muscles


Stage 4 Endometriosis messes up not just my pelvic cavity but also my large and small intestine. This results in neuropathic pain particularly in the lower back down to the sole of my feet. It is also due to adhesions developed post surgeries (I have had 5 surgeries in total since the first in 2013). I do notice that maintaining a conditioning routine on the muscles listed above, helps in making the pain tolerable.


“When Endometriosis related inflammation spreads to regions within the pelvic cavity, it increases the risk of causing nerve damage. Endometriosis scar tissue can pull nerves, or even attack nerves directly. Lesions building around these nerves will apply pressure on the nerves themselves, thus causing a constant, sharp pain. Patients have resorted to physical therapy and exercise in order to overcome their nerve pain due to Endometriosis. Acupuncture is also a highly popular option for patients suffering from neuropathy.” Endometriosis Symptoms: Neuropathy | EndoFound

  • Myofascial Release:

  1. Foam Roll, Lacrosse Ball, Massage Guns - Self Myofascial Release

  2. Spinal Manipulative Therapy - Chiropractic

  3. Active Release Techniques (ART), Instrument Assisted Soft Tissue Mobilization (IASTM) - Physiotherapy

  4. Deep Tissue/ Sports Massage/ Manual Lymphatic Drainage Massage

  5. Cupping (Bekam)/Acupuncture/ Gua Sha -Traditional


My training ground & Myofascial Release tools


Having Myofascial Release done professionally at least every quarter of the year is essential in one of my holistic approaches to pain management. The list above is some examples you can look into. While I have yet to come across therapists who are well-versed in dealing with Endometriosis pain specifically, having a background in fitness, nutrition, and health promotion enables me to pinpoint the affected areas clearly. This helps attain maximum relief from each session.




3) Knowledge is Power


Of all the knowledge that is most worth having is knowledge about health so I encourage you to take up courses on it. You could help yourself (your loved ones too) to understand and better manage your expectations (and theirs) on any medical-related issues as well as a clarity of mind in making sound judgments on lifelong treatments. You could also plan out nutrition, work out & recovery programs for yourself because you are aware of the factors you need to weigh in for the programs to be effective for you. Atop, you can easily point out fraudulent claims which are in abundance nowadays associated with health and beauty. Being one with chronic conditions, I encountered entrepreneurs claiming that their products can cure Endometriosis. We are susceptible to such false acts because we are desperate. However, with the knowledge, we could save ourselves from the agony. Plus, it is not easy to get professional help here in Singapore who is knowledgeable in dealing with Endometriosis symptoms. So, when you can’t find the solution, why not be one.


“A dream becomes a goal the moment you write it down. A goal becomes a plan the moment you break it down into doable steps. A plan becomes a reality only when you take action.” Marshall Sylver

4) Track Your Health:

  • Daily Food Log

  • Weekly Exercise

  • Period Log

  • Mental Health Log

  • Annual Health Screening

We live in an era where advanced technology is on our side. Keeping logs is so easy it can be done with an eye close. I find tracking all the above necessary. With this information, I could work around it, learn from it and make progress. Not having any data at all would result in a vicious cycle of uncertainty; not knowing where to begin let alone finding leads to the cause of triggers.


“Available evidence suggests that women with Endometriosis may be more susceptible to allergic manifestations (eg. eczema, hay fever, food sensitivities, allergies to medication) and to allergy-related conditions such as asthma.” Marina Kvaskoff PHD


  • Daily Food Log

I notice that I am prone to Urticaria and once had an Anaphylactic Shock. These incidents taught me the importance of having a daily food log besides balancing energy input (calories from food) with energy output (calories used for energy). I have been using MyFitnessPal app all these years and it is my handy dandy point of reference. It has also assisted me in identifying my Endo Bloat triggers.


“Some physical activity is better than none, and more is better than some.” Health Promotion Board

  • Weekly Exercise

Devices such as Fitbit, Garmin & Polar are trending and readily available. There are plenty of online apps too; MyFitnessPal being one, Strava, Apple Health, Map My Run etc. In fact, our Health Promotion Board came out with the National Steps Challenge where participants are given a free fitness tracker.


Jotting training program & clocking in mileage works as a motivating factor for me to keep going. Atop, it helps me to tweak the regime accordingly should the outcome, not to my satisfaction. This way, I am clear-headed in planning my next course of action instead of blindly following fads. Exercising is a coping mechanism that helps me stay optimistic on top of reaping other health benefits from working out consistently.


  • Period Log

Dealing with Stage 4 Endometriosis and Adenomyosis means dealing with pain that could occur during ovulation, pre-menstruation, and menstruation. Having a period log empowers me to prepare myself mentally for the possible episodes. It also allows me to make changes to my nutrition and workout plans. Besides, it is crucial to know the fertile period for conception to take place. Having a log also makes realization quicker of anything out of the ordinary and gets attended to immediately. You can look into online apps such as Endo Diary & Period Tracker: Monthly Cycles.


  • Mental Health Log

As shared in PART 1: Breakdown Before Breakthrough (endosupport.sg).



  • Annual Health Screening

Health screening result is like your body lamenting its problems to you. It is up to you to heed the warnings.


I know my body has gone through a lot, so it is only fair that I do my best to eradicate other potential harms. With a family health history of Diabetes, Hypertension, Heart Disease & High Cholesterol, I understand that I am also more likely to get them if I remain complacent about my health. Since the cause of Endometriosis & Adenomyosis is unknown, it is therefore not possible to take any preventive measures. However, I can still help my body reduce risk factors that could lead to other health complications such as the aforementioned conditions. Should life turn out differently despite putting in 100% effort, I know I would be able to stand tall knowing I have given my all. With no regrets, I could seek comfort in the long and hard-fought measures taken from listening to my body.



To sum up, creating positive momentum goes a long way. The key is to be patient yet stay consistent. There is no effort too small. When done repetitively, it could accumulate into a positive habit. You’ll get what you work for so keep working on it.


“Instead of feeling down about your situation, try to figure out what you can do to create positive momentum for yourself. Even at your lowest point, even at your lowest moment, there is something that you can do to create a small win. Now your small win might not be the same as my small win. Your small win might simply be getting out of the bed. Your small win might be going to the gym. Your small win might be making one more phone call or getting up an hour earlier to put in some extra work. You have to believe that you control your destiny. Don’t put that responsibility on anyone else but you.” Doctor Jessica Houston

I hope these three parts posts have helped you attain a light bulb moment in addressing your symptoms. I welcome your insights and stories of struggles and triumph over Endometriosis. Your stories can make a difference to someone who is suffering in silence. Let them know they are not alone.


Get your stories featured in endosupport.sg. Write in to:

iamnamira.e@gmail.com



Namira Mohamad Marsudi

Founder

E for Endometriosis