Question: Hello, I have stage IV endometriosis and have have multiple laparoscopies/cystectomies to remove extensive adhesions & endometriomas. I'm 36 years old and was first diagnosed at 24. I have no other health issues. I've been working with my current doctor for almost 5 years now. He's an OB/GYN and is a specialist in dealing with Endo and other Gynecologic oddities. He's absolutely wonderful, extremely caring and is very good at what he does. I've have had NO issues with any of my previous surgeries and have had relief of symptoms right after. But after this last round with my endo, there have been many issues and we're completely stumped on what this is.

My endo has been growing back very aggressively lately and at the beginning of September, I came to him with my usual endo pain and also a strong right sided pain. Appendicitis was ruled out and another Endometrioma was found on my left ovary. We decided to do another scope (9/10/14) to remove the cyst and also clean out any endo found. He found extensive adhesions basically connecting uterus, bowels, ovaries, tubes, everything together. It took him a while to unwind it (he uses DaVinci) . Everything was successful, however, after I awoke from anesthesia, i had a numb patch on the top of my left thigh and I couldn't urinate. I wore a Foley XXXXXXX for a couple weeks, during which we would remove the foley every few days or so to see if I could urinate, but with no success and the foley being replaced. After a couple or so weeks, I learned how to self-cath. Still today, I have the numb patch on the top of my thigh and I'm still self-cathing. He believes there might have been a nerved stretched during that procedure and it's just a matter of time for the nerve to heal itself, which makes sense to me with the numb spot. At this point too, the right sided pain started coming back. This is a sharp pain in a specific location that I can point to. Furthermore, I started getting a new pain which was strong general dull ache across my whole lower abdominal area, plus I started getting excessive discharge vaginally. It was runnier in texture and not strong odored. More CTs/Ultrasounds were run and it was found I had another cyst on my right ovary and again, appendicitis was ruled out. Multiple antibiotics were started and eventually, in the 3rd week in October, I was admitted to the hospital to get IV antibiotics. We ended up doing another scope (10/23/14) and he found that my Cervix had separated from my vaginal wall, on one side, which is where all this discharge was draining from. Also, there were adhesions and endo spots growing already (which were removed). A drain was put in as he said the whole area in my cavity just looked wet. Woke up just fine from that surgery. After a few days, the drain was removed and I was sent home. I should mention, I only had a fever and slightly elevated WBC at the first onset of the drainage. After that, I have not had a fever and CBCs are normal. During this whole time, I have been seeing my dr 1-2 or more times per week. He's done multiple CTs with XXXXXXX to find leaks in my ureters and anywhere else. At one point, we saw a small abscess near my left ovary, but that shrunk and the radiologist didn't feel it needed to be drained. He's run basically every test he can think of and has consulted with multiple dr's, but nothing ever showed up as unusual, except for my cysts (which are all endometriomas).

Nothing has really changed with the way I feel. I still have the same strong right-sided pain and the same strong general pain across that area (just feels like inflammation/infection). But I also now have left sided pain. They found 3 complex cysts on my right side and 5 on my left ovary. ALSO, i still have this drainage! It's less now, but that tear it was draining from is closed up mostly. We were thinking this drainage has to be from irritation/inflammation from urine leaking somewhere. He's never seen a leak in my previous CTs, but maybe something was missed. He consulted with a urologist who quickly agreed to see me. I saw him on Thursday (12/18/14) and he did a cystoscopy to see if he could find any leaks. He didn't see anything.

The odd thing is, when I was being admitted for this procedure, they told me I had a fever. My average temp is 97.6 and I believe I was over 99. It kept going up (eventually close to 102) and they gave me tylenol and went on the with test. They did have me stay in the hospital and gave me fluids and a bag of cipro. My fever eventually broke this morning (Saturday 12/20/14). During my stay, my dr requested an Infectious disease dr consult with me. He ran some more tests. My dr had to leave for out of town, so at this point I was going to be seen by his colleague and the ID dr. The urologist cleared me as he didn't see anything wrong, from a urology stand-point. The ID dr was great and seemed to have a good plan for what we were going to test and look at, but unfortunately, he also had to leave town, so I was going to get the results from his colleague. Today, his colleague (the ID dr's) stopped by to let me know he didn't see anything wrong either. My WBC was elevated, but it was going down. Then my dr's colleague stopped by to let me know she didn't see anything really wrong and that it was probably inflammation from ovulation (????) and it would clear up. Both cleared me and I was discharged.

I'm home now and I have my results. I'm still in significant pain. This pain from the inflammation/infection is really strong (i'm on pain meds for it). PLUS, I still have the strong sharp pains in both my ovaries from the cysts that are there. I got to look at my blood work results when I got home and I was surprised. I think there are things that show an infection or lots of inflammation and I'm not sure what to do. My dr doesn't return from out of town for over a week. I'm hoping someone might just have an idea of what could be causing all of this!!! If my temp climbs up again, I'll go back to the ER.

Blood - (showing only the ones that are flagged as out of range)
WBC - 12/18 - 13.6, 12/19 - 18.9, 12/20 - 10.2
Absolute Neutrophil - 12/18 - 11.1, 12/19 & 12/20 - not tested
RBC - 12/18 - 4.07, 12/19 - 3.76, 12/20 - 3.81
Hemoglobin - 12/18 - 11.8, 12/19 - 10.9, 12/20 - 11.0
Hematocrit - 12/18 - 35.3, 12/19 - 32.8, 12/20 - 33.5
CRP - 12/18 - not tested, 12/19 - 171.0, 12/20 - 167.0
ESR (sed rate) - 12/18 - not tested, 12/19 - 23, 12/20 - 32
Calcium - only tested on 12/18 - 8.1

Urine - tested 12/19 only
Ketones - 40 (A)
Mucous Urine - Present (A)

I'm hoping seeing all of this info sparks an idea in your head that might point us in the right direction. This has been going on for a while now, so I tried to capture as much detail as I could, but I could be missing some things. If you want any more info, just let me know.

Thank you :)
XXXX

Thank you for your response! Could the elevated CRP and ESR showing inflammation be the result of the cysts too? Could the cysts be causing inflammation in surrounding tissues possibly?