Ruth speaks with the quiet determination of a person who knows what it's like to stand alone against insurance companies. Against her boss, her friends.
      "I knew it wasn't all in my head ... but I had many people treat me as if it were," Ruth said of her six-year battle with endometriosis that has resulted in excruciating abdominal and pelvic pain, ultimately to two surgeries, countless doctor visits and severe drug interactions that threatened her life.
      Ruth's story starts in 1992 when she first began experiencing yeast infections and abdominal pain. She spent two years going to doctors and nurse practitioners, all of whom mistakenly diagnosed her as having one or more sexually transmitted diseases.
      "This was despite the fact that I hadn't had sex for two years before the pain began," she said. "I'd take the medicine they'd prescribe and, when it didn't work, I'd come back and we'd start the process over again. I went from one doctor to another, hoping the next one would be able to give me the answers I needed. No one could."
      "During that period, the pain progressed from a dull, constant ache to sharp jabs."
      "It felt like someone was sticking a knife in me and I'd double over in pain - no matter where I was." the 31-year-old Wisconsin woman said.
      Finally, in 1994, Ruth convinced a new doctor to send her to a specialist - something she says the others were reluctant to do because of managed care considerations.
      "The last doctor I saw before I was diagnosed admitted that she didn't know what was wrong with me. That was actually a relief because everyone before that just kept diagnosing and prescribing, even though nothing was working. I finally demanded that I be sent to an OB/GYN and that's who diagnosed me.
      "When he did the pelvic exam, I almost jumped off the table it hurt so much," Ruth said, noting that while the specialist believed she had endometriosis, he needed to run more tests to make sure.
      On April 1, 1994, Ruth underwent a laparoscopy - the only definitive way to diagnose the disease. Doctors found lesions throughout her uterus, ovaries and abdomen - a common manifestation of endometriosis.

      According to the National Endometriosis Association, the disease affects nearly 6 million women and girls in the U.S. and Canada, and millions more worldwide. Endometriosis occurs when the tissue that lines the uterus is found outside the uterus - usually in the abdomen on the ovaries and fallopian tubes, the area between the vagina and the rectum, the outer surface of the uterus and the lining of the pelvic cavity. Endometrial growths may also occur in the bladder, bowel, vagina and cervix.
      After the surgery, it took five months before her pain was gone. During that time, Ruth began taking birth control pills to help control the disease - which they did for about three years.
      Then, the pain returned.
      A computer technician by trade, Ruth was working for a school district, designing and maintaining its computer system. In August 1997, her department was involved in moving hundreds of computers and printers to and from five different school sites - a very physical job requiring continuous heavy lifting and crawling under and behind tables and desks.
      "The pain came on faster this time around," Ruth said. "My doctor agreed that it sounded as if the Endo had come back. He told me I'd have to go on short-term disability if I couldn't go on light duty, which was impossible because of our workload. By that time, there were days when just walking from the parking lot to the school would hurt. I was totally worn out."
      Taking her off birth control pills, which were no longer working, her doctor put her on Synarel - a nasal spray that cost $300 per month and is designed to shrink the lesions which were forming again outside her uterus. Ruth was told that it would take at least two months before the drug could build up in her system enough to start easing her pain.
      Just about the time she felt the shooting pains subside into a dull ache, Ruth had an allergic reaction to the drug.
      "I got hives the size of my hand on my body and my throat started tightening up. Had I not stopped taking it immediately, it would have killed me," she said.
Ruth was still working.
      "It was a very stressful time for me. I was afraid of losing my job, so I just kept working," she said. "But at the same time, I felt like my bones and joints were disintegrating from the inside out."
      "One of the rarer side effects of Synarel is that it shrinks your bone mass ... it puts you into a fake menopause, so you get all the effects of that, including what leads to osteoporosis."
      These weren't the only side effects Ruth had experienced in her early battle with the disease. Although birth control pills helped control the spread of the disease for some time, the "cure" didn't come without a price.
      "The depression I experienced was horrible ... it got so bad I began having suicidal thoughts. It took switching brands five times before I found one that didn't cause that reaction in me," she said.
      When the pain returned in 1997 and the drug Synarel was abandoned, another surgery was scheduled. This time, however, doctors were unsure when Ruth would be able to resume full-time work - if ever.
      "This whole thing was a roller coaster ride for my employer. They tried to be understanding, even though they didn't know much about the disease. But after seeing me go from one doctor to another, switching from one medication to another and then to find out that I'd have to have another surgery ... they finally had had enough."
      She was to be back to full-time work with her doctor's permission by Dec. 1, 1997 or she'd be terminated.
      Unemployed and facing another Christmas in pain, Ruth had other stressors to battle.
    "It was just everything ... you know? The depression that comes from chronic pain can be overwhelming at times. I had to fight with insurance companies who didn't want to believe that I was really disabled. One (claims adjuster) said to me, 'Honey, just take a Midol.' I felt worthless."
      "Sex was painful, so that put a lot of strain on the relationship I had at the time ... thank God my boyfriend was understanding. My (stomach) was bloated; I was reduced to wearing sweatpants. I couldn't fit into any of my old clothes. I looked pregnant and it totally impacted the way I looked at myself as a woman. My self-esteem took a dive."
      Then, on Christmas Eve, Ruth felt what she thought was a golf-ball sized mass in her vagina.

      "It was late at night and I was freaking out, thinking 'Oh God, what now?' I was four hours away from my doctor. I called and I couldn't get in to see him until the day after Christmas. It was very scary."
      Her doctor told her that what she felt was actually her cervix, which had been pulled down and to the side because her right ovary had adhered to her colon, causing her cervix and other organs to shift. Her scheduled surgery was moved up to Jan. 9 of this year.
      Granting an exclusive interview to The Press-Tribune in late April, Ruth said she still lives with pain on a daily basis, although it has been reduced from sharp stabbing pains to a dull ache. To reduce her need for the pain pills she had taken for years, she began going to a reflexologist, acupuncturist and massage therapist. Because her insurance doesn't cover alternative therapies, Ruth pays for these services out-of-pocket.
      "It's expensive, but it's really worth it," Ruth said. "It helps you deal with the pain - both mental and physical. I actually recuperated faster after the second surgery because I did these things."
      Because there is still no cure for endometriosis, Ruth holds no illusions that her ordeal is totally behind her.
      "This will be with me the rest of my life and it will probably come back sooner, now that I've had to get off all the drug therapies because of my allergic reactions. I suspect I'll have to have more surgeries and, ultimately, a hysterectomy - although there's no assurance that that will even stop the disease. Many women have done that and the Endo has still returned."
      "I don't live in a bubble. I have to admit that this will probably come back, so I am trying to find a job that allows me to work out of my home so I can take care of myself when I get sick again without losing my job."
      Despite her trials, Ruth is quick to point out that her story isn't "the worst one out there."
      "I've talked to women who have gone years without a proper diagnosis. Many have had doctors totally dismiss their concerns, going so far as to tell them that they're crazy and need to see a psychiatrist. Sadly, that's not an uncommon story."
      It is those stories, and her own experiences, that have led Ruth to join the small but highly-motivated group of women in the U.S. and Canada who are demanding that their governments look into the possible connection between the use of tampons, dioxin exposure and endometriosis.
      "Women have said to me, 'What can I do? I'm only one person'. If everyone has that attitude, then nothing will ever change. One person can make a difference. If people would start from wherever they think is important and go from there, we could make a difference," Ruth said.

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