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Dr Fleming presents

Image supplied by Dr Fleming 2019: Word-cloud 'what support groups mean to us' - a collaboration with EPSS members

Earlier this year I had the great privilege of being invited to present at the Australasian Gynaecological Endoscopy and Surgery Society (AGES) Annual Scientific Meeting, held locally in Perth. Due to my experience with Endometriosis Perth Sisterhood of Support (EPSS), the topic I was to present on was “Patient Resources”. Due to my unusual combination of working in medicine, volunteering in support, and living with endometriosis myself, I have first-hand knowledge of the large range of resources available to patients. Grateful that this had been recognised, I quickly accepted the offer to participate in the conference and went back to my busy day to day life.

As the months went by and the conference drew closer, more information came trickling through. When I received a list of the people I would be presenting alongside, the gravity of what I had got myself into hit me! The list read like a “who’s who” of highly regarded health care professionals who treat endometriosis in Perth, from gynaecologists to pain specialists and pelvic floor physiotherapists. When I saw the chairs for the conference, I was even more intimidated, with two of the most popular gynaecologists among the members of my support group featured on the list. As a junior doctor, these people will one day be my bosses, and hopefully then my colleagues; I knew I had to work hard to make a good impression! 

Unfortunately, life and procrastination hit me hard. Before I knew it the first day of the conference had arrived and I only had two-thirds of a presentation! As I walked in I was hit hard with “imposter syndrome”. Due to the demands of working full time, studying a masters, helping the wonderful women of EPSS, and parenting two children, I had made it to my third year working in medicine without attending a single conference. The idea of presenting at my first conference was intimidating! As soon as the presentations started that was all forgotten.

The international keynote speakers were remarkable. The “Ferrari” of laparoscopic surgery from Italy introduced me to the concept of nerve-sparing pelvic surgery. This is vital when it comes to the excision of deep infiltrating endometriosis in order to preserve bladder, bowel, and sexual function. And as a few of my fellow endo warriors have unfortunately discovered, vital to prevent a worsening of chronic pain. The second speaker hailed from the United States, and over the three-day conference, she delivered three separate presentations on the tricky relationship between endometriosis and pain. She discussed the difficulties of identifying and treating central sensitisation, a condition that often develops alongside endometriosis. Central sensitisation is essentially when your chronic pain makes your nervous system misbehave causing a long list of symptoms including pain in the absence of any cause, bladder and bowel issues, and fatigue. My favourite analogy that describes it is a little bit nerdy; your brain and nerves are the computer, you and your personality are the person sitting at the keyboard, and the way your nervous system talks to itself is the software. Central sensitisation is when something goes wrong with the software. This is what many doctors actually mean when they tell you your problems are “in your head”. Unfortunately, treating it is still something we are working on but finding a gynaecologist you trust is a good first step!