Endometriosis and Miscarriage

October 15th is a yearly date in which those who have experienced pregnancy loss are remembered. There is still so much taboo and silence regarding these losses. The American Pregnancy Association states that miscarriage "is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage."  Many endometriosis patients are often at a greater risk for miscarriages, preterm labor and ectopic pregnancies due to the effects of this disease and have experienced great loss.

There are many reasons that a woman with endometriosis can have a miscarriage and luckily, through medical intervention, some of the reasons can be helped.

Egg Quality

At the Endometriosis Foundation of America’s last Medical Conference, there was a lot of talk about infertility and early pregnancy loss in endometriosis patients.  Endometriosis affects everything from the quality of the eggs, to their maturation to embryo implantation.  Doctors have always suspected that endometriosis can affect the uterine lining, often interfering with embryo implantation. But now doctors are realizing endometriosis can even affect the egg quality itself.  A recent study found that women who did not have endometriosis, who used donor eggs from women with endometriosis, had a much lower rate of achieving a healthy pregnancy. This study suggests that women with endometriosis have a lower egg quality. One reason for this lower egg quality may be that women with endometriosis have cytokines in their peritoneal fluid, which is caused by inflammation. This fluid is part of the follicular fluid which encases the eggs and can affect them adversely.  Doctors at the conference suggested that egg freezing is an option for young patients worried about their future family building. It is also recommended for endometriosis patients, especially those with recurrent pregnancy loss, to use in-vitro fertilization and preimplantation genetic diagnosis to help achieve a healthy pregnancy. These techniques will allow doctors to see the genetic makeup of an embryo to see whether it is genetically sounds. Only transferring healthy embryos will allow patients to have a better chance at avoiding pregnancy loss.  Studies have also shown that women with endometriosis have a higher success rate using frozen embryo transfer as opposed to doing a fresh IVF cycle.

Immunological Component

It is the belief of Dr. Seckin, along with other authorities in the field, that endometriosis has been found to have an immunological component that can lead to miscarriages.  This immunological component is again due to excessive inflammation caused by endometriosis. The body's own impaired immune system can result in rejection of the early implanted embryo.  He believes any patients who have gone on to become pregnant and miscarry after surgical intervention should arrange for a reproductive immunological profile.  An expert reproductive immunologist can help correct or strengthen a women’s immune system leading to a better chance for a healthy pregnancy.

Anatomical Reasons

Unfortunately, endometriosis can leave a destructive path in a patient’s pelvis. Scar tissue and adhesions can form on the fallopian tubes which can lead to an ectopic pregnancy. This loss is not only devastating, but dangerous because it is very important to terminate the pregnancy before the tube ruptures. Also some women with endometriosis often have a uterine defects such as an abnormally shaped uterus (heart shaped, or with a septum [wall] dividing it). This abnormality may interfere with maintaining a pregnancy. Dr. Seckin asks many of his new patients who have had children if they have had atypical births. Many have experienced pre-term delivery and emergency C-section. 

 

After complete excision of endometriosis in the pelvis all inflammation sources are eliminated. Dr. Seckin has seen a great number of his patients go on to have healthy pregnancies. He takes great care in carefully removing endometriosis on the uterus and the ovaries to help patients with their family building. He often can surgically correct uterine defects and also free up the fallopian tubes to help patients get pregnant. For those still have issues, he works with some of the best Reproductive Endocrinologists and Immunologists to help patients have the best chance at achieving a healthy pregnancy. 

Endometriosis is a disease that forces patients to live with chronic pain. It is cruel that is also can lead to the devastating experience of pregnancy loss.  Please know that you are not alone. October 15^th is a day to remember these losses and reach out to other women who may be suffering these losses in silence.

Radio Interview With Victoria Hopewell on Miscarriages

I recently spoke with therapist, author and infertility advocate Victoria Hopewell about my experiences with miscarriage. The American Pregnancy Association states that miscarriage "is the most common type of pregnancy loss, according to the American College of Obstetricians and Gynecologists (ACOG). Studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage." A miscarriage can happen for many different reasons. RESOLVE has a great information regarding why a woman may miscarry:  http://www.resolve.org/diagnosis-management/infertility-diagnosis/common-causes-of-miscarriage.html  Unfortunately, some women may never know exactly whey she miscarried. Miscarriage for anyone is devastating, but when a woman is also struggling with infertility and then miscarriages after finally becoming pregnant, it seems especially cruel.

In the following radio interview I talk to Victoria about my experience having 4 miscarriages and the road to diagnose my balanced translocation, a genetic mutation affecting the majority of my eggs that causes recurrent pregnancy loss.

http://webtalkradio.net/internet-talk-radio/2013/09/16/in-search-of-fertility-miscarriages/

Endometriosis and the 5 Stages of Grief

Endometriosis is a chronic, painful disease that has a profound impact on every aspect of a woman’s life. Sometimes a woman can suffer with symptoms for more than half her life, depending on when she starts to menstruate and when she goes into menopause. That is a long time to be in pain and ultimately it can alter a patient’s emotional well-being. Adding a mental health provider who understands the disease can have a positive impact on your overall care. When your life revolves around a chronic illness such as endometriosis, there exists a loss of health and quality of life that you have to cope with.  Endometriosis patients deal with grief on a daily basis.

Dr. Elisabeth Kübler-Ross (July 8, 1926 – August 24, 2004) was a Swiss-born psychiatrist who first discussed the Stages of Grief as a pattern of adjustment that is now known as the Kübler-Ross model. In her book, On Death and Dying, she proposed that the five Stages of Grief are denial, anger, bargaining, depression, and acceptance.  As an endometriosis patient myself, who has often turned to a mental health professional for support, I find that these stages of grief can also be applied to endometriosis patients. What Dr. Elisabeth Kübler-Ross states for dying patients is also true for those of us facing endometriosis; “individuals experience most of these stages, though in no defined sequence, after being faced with the(ir) reality.”  Below I explore how the Stages of Grief can be applied to endometriosis patients in order to illuminate the complexities of how an endometriosis patient can be feeling on any given day.

Denial

Merriam-Webster defines denial as a “psychological condition in which someone will not admit that something sad, painful, etc., is true or real.” For a patient, denying that endometriosis is a serious disease that can impact a person’s daily life is sometimes easy to do when our society as a whole is completely in denial regarding the gravity of endometriosis.  Sometimes our families, co-workers and friends belittle endometriosis due to their own ignorance about the disease.  Our own gynecologists and other doctors are also in denial as to the gravity of the disease or sometimes even the existence of the disease! As patients we want to believe them. We wish that our pain was manageable and that our bodies were not failing us. As our symptoms get worse, we take more pain medications and keep going, not wanting to face the reality of yet another surgery.  We try to ignore the disease. We don’t want to believe that this disease can have lasting impact on not only our fertility, but our urinary, digestive and sometimes even our respiratory symptoms.  We deny until our symptoms finally make us feel scared or completely broken.

Anger

Endometriosis is one of THE most frustrating diseases out there, and there are many legitimate reasons for patients to be angry.  For myself, I know anger comes and goes.  It takes a lot of energy to be angry, and energy is not something many endometriosis patients have a lot of. There are systemic reasons to be angry:  “Why aren’t there any excision specialists in my area? Why won’t anyone take my disease seriously? How come no one has heard of my disease? Why isn’t there a cure? Why is no one talking about this disease?” There are also very personal reasons to be angry, ranging from the frustrating to the profound: “Why didn’t my first gynecologist properly treat and diagnose me a decade ago? Why can’t I JUST have sex with my partner without negative repercussions? Why can’t I go out when I want/eat what I want/exercise like I want?  Why can’t I take care of my kids like they need?  Why can’t I keep a job? Why do I need to have surgery all the time? Why can’t I leave my bed?” And for many women with endometriosis, one of the greatest losses to be angry about, “Why can’t I ever get pregnant or carry a baby to term?”

Bargaining

When trying to bargain with a disease like endometriosis, I feel like we are trying to bargain with the devil. Patients are constantly trying to bargain with this disease to no avail. We bargain for health, energy, and the ability to go places and do things. We bargain for fertility and the chance to have babies. If I eat right, exercise, try herbs, get rest, drink water, cut out caffeine,  go to acupuncture, yoga, or physical therapy, stop drinking alcohol, take all of my vitamins, and take awful prescribed drugs, maybe I will be okay? If I do all of these things, maybe the disease won’t spread and maybe I won’t have to have another surgery? We bend ourselves backwards and alter our lifestyles for the small hope that we can control the endometriosis, keep it at bay, beat it into submission. Although all of these tips may help daily symptoms and improve a patient’s quality of life, endometriosis is an insidious disease that for the most part cannot be bargained with.

Depression

Many women battling endometriosis are also battling clinical depression.  Many of the symptoms of endometriosis are eerily similar to symptoms of depression.  The Mayo Clinic states the following symptoms as warning signs for clinical depression: Irritability or frustration, even over small matters. Loss of interest or pleasure in normal activities. Reduced sex drive. Insomnia or excessive sleeping. Changes in appetite.  Slowed thinking, speaking or body movements. Indecisiveness, distractibility and decreased concentration. Fatigue, tiredness and loss of energy — even small tasks may seem to require a lot of effort. Feelings of worthlessness or guilt. Trouble thinking, concentrating, making decisions and remembering things. Frequent thoughts of death, dying or suicide. Crying spells for no apparent reason. There are physical limitations and exasperations that come with being in chronic pain and living with endometriosis, like slowed thinking, irritability and fatigue, which also mimic clinical depression.  There is also a natural sadness, fear and uncertainty when coming to terms with having an incurable, chronic disease and all of the lifestyle implications that follow. Feeling all of these emotions and more are so important.  It is vital for endometriosis patients to seek out support through mental health counseling, especially if there are thoughts about suicide or overwhelming hopelessness. 

Acceptance

Acceptance is a general feeling that although things are bad they are going to be okay. Acceptance is also the idea of embracing the disease instead of resisting it. This idea seemed foreign to me at first. We are always talking about how we are Endwarriors and how we will fight the disease with everything we have.  The problem with fighting or resisting the disease is that it is exhausting.  My own therapist recently said to me, “Surgery is like food and water to you. You need it to not only survive but thrive, so why not embrace it instead of fighting the need for it.” I am learning I have to choose my battles.

When I have the energy I will fight for endometriosis awareness. I will fight to educate those around me, my family, doctors, and others in the general community about endometriosis. I will fight for women who do not have access to good, quality care. I will fight for a cure. These are all positive outlets for my anger and helplessness. But I am through fighting with my endometriosis because I will not win. It exists in my body and I will accept that I cannot change it. The harsh reality is that with the exception of having an excellent and knowledgeable excision specialist, there is little more I can do.  I will embrace my next surgery with because as hard as surgery is, it will help me. I will embrace my endodiet when I can because I know it will help to ease my symptoms. I will try and face this disease with courage, dignity and grace and survive it to thrive.

 

Many people feel that endometriosis is only a physical illness and they don’t recognize the emotional toll that a disease like this takes on a patient.   Mental health is just as important as physical health, and patients are encouraged to seek the support of a mental health counselor to help cope with this disease. Dr. Elisabeth Kübler-Ross documented the Five Stages of Grief many years ago when having conversations with patients who were dying. As endometriosis patients, although we are not dying, we have many limitations to our quality of life. It is no wonder that we too feel grief when facing the daily challenges endometriosis poses.  These Stages of Grief can help us all understand our emotions as we strive to accept our disease and seek out the proper surgical treatment that will help us.

EndoDiet Cook Book Review: Gluten Free Mediterranean Gourmet Cuisine: Invaluable Recommendations for a Healthy Immune System.

Following a gluten and dairy free, organic diet can help endometriosis patients manage their symptoms. I recently had the chance to chat with Aslihan Sabanci, an author and entrepenuer, who has written an excellent cookbook and gluten free guide that is great for endometriosis patients. Her book is called, “Gluten Free Mediterranean Gourmet Cuisine: Invaluable Recommendations for a Healthy Immune System.”

 

Mrs. Sabanci was delighted to answer questions and give tips on how to start eating gluten free. She started eating gluten free many years ago for her the benefit of her own health and wrote this cookbook out of her need to find tasty and practical recipes.  Here is what Mrs. Sabanci had to say:

 

Q: I read that from the time you were a little girl you were experimenting in the kitchen and using your friends and family as taste testers! You take pride in your recipes. How important is it for you that your food not only be gluten free, but taste good?

 

A: I think it is very important that my recipes taste great. Great tasting food is the key to eating a well balanced diet. Don't forget, if your healthy food does not taste great, you will always prefer the fried, super fattening and super tasty unhealthy food over the healthy food.

 

Q: You stress how important it is for your recipe ingredients to be practical and expressed your frustration in many gluten free recipes having bizarre, hard to find ingredients. 

 

A: Today, especially in big cities like New York and Los Angeles, there are more gluten free options to choose from. However, many gluten free ingredients are still hard to find when you are traveling or when you are not living in the cosmopolitan cities. That's why for my book,  I wanted to use easy to find ingredients, from any regular grocery store or supermarket.

 

Q: Dr. Seckin believes there is an immunological component to endometriosis. Some women who are diagnosed with endometriosis also suffer from other autoimmune inflammatory diseases. Women with endometriosis also suffer from chronic fatigue.   In your book, you talk about ways to boost your immune system through diet.  What is an easy way an endometriosis patient can boost their immune system on a daily basis?

 

A: To boost the immune system, it is very important to eat a well balanced diet full of whole foods and plenty of antioxidants. I mention all of these valuable antioxidants, their resources and how much they are found in which nutrients in my book, and I worked with an award winning doctor and a dietitian, and a nutritionist to figure out the antioxidant values of each and every recipe in my book. These doctors then formed charts to graphically present these calculated antioxidant values. This way my readers can be informed about the health benefits of my recipes.  To help boost the immune system, the most valuable antioxidants to consume are: Fiber, Vitamin A, Vitamin E, Vitamin B1, Vitamin B2, Niacin, Folic Acid, Vitamin C, Calcium, Magnesium, Iron, Zinc. The most efficient way to increase antioxidant intake is to increase the daily  consumption of fruits, vegetables and legumes. I also dedicated a chapter in my book on these nutrients and their natural resources.

 

Q: Many women reach for gluten/dairy/sugar filled foods when they are stressed or when they have their period, which can only inflame their endometriosis. It can be a physiological response, just as much as an emotional one. What is your “go to” recipe in your book that can replace any chocolate/salty/fried comfort foods?

 

A: When I am craving chocolate, it usually works for me to eat a handful of pistacchios to harness the craving. In addition, fruity deserts are an excellent way to stop cravings for the high calorie deserts and in addition, by consuming fruity desserts you will also get plenty of antioxidants as a bonus! For example, Kabak Tatlisi, a savory and sweet pumpkin dessert, has plenty of vitamin C, A,B1, B2 and magnesium in it.

 

Q: For the woman just diagnosed with endometriosis, what would be staple items from the supermarket you would pick up right away to get started on a gluten free diet?

 

A: Quinoa flour (to make bread or any other pastries), quinoa pasta or

the actual quinoa, all kinds of rice to make variety of rice dishes, so you do not get bored with cooking only one type of rice (wild rice, basmati rice, risotto rice....) and plenty of fruits and vegetables.

 

               

Q: When you first started eating gluten free, what was the hardest to give up?

 

A: Pastries....

 

Q: How did eating gluten free change how you feel?

 

A: I felt less swollen and bloated. I started fitting into my jeans again.

 

 

Q: Gluten free eating is hard, although your wonderful book makes it easier! What words of encouragement do you have for people taking on gluten free eating?

 

A: Do not be scared! Go beyond the books and experiment for yourself. Do not forget to exercise and to get enough good night sleep. Try to make best out of it, and have fun!

 

 

   Mrs. Sabanci’s cookbook is excellent. You can find simple and delicious recipes that are great for the Endodiet. Within the pages, one can find a multitude of easy, fresh recipes from Guacamole to Sesame Chicken, to delicious desserts and smoothies. Although some of the recipes contain dairy, many of the dairy ingredients are optional or can easily be substituted with almond milk or Earth Balance.  You can find Mrs. Sabanci’s cookbook on Amazon: http://www.amazon.com/Gluten-Free-Mediterranean-Gourmet-Cuisine-Aslihan/dp/6058882613

My Truth about the Endodiet

                I can remember my first appointment with Dr. Seckin like it was yesterday. For the first time, I was meeting with a doctor who completely understood the ins and outs of a disease that had always been misunderstood and misdiagnosed by all of my doctors for most of my life. Dr. Seckin not only understood endometriosis and how to treat it, but he also had extra information about the disease that I had never been exposed to before. As I was leaving my initial appointment I remember him saying to me, “Remember, no gluten or dairy, eat organic and try to stay away from sugar, caffeine and red meat.”  In that moment, my whole world changed.

                I love to eat. Maybe it is the Italian ancestry pumping through my veins or maybe it is because for a lot of my life I have used eating as a coping mechanism to deal with stress. Having a bad day? A milkshake will surely make me feel better. Ice cream, pizza, Frappucinos, mozzarella sticks, chicken parmigiana are just some of the foods I loved to eat. Yet, I would always notice these foods did not love me. Bloating, cramps, immediate diarrhea and sometimes even vomiting would often come after I ate these foods. In high school, my friends and I would always go to a pizzeria and Starbucks before going to a Wednesday night meeting for an after school activity. I would almost always spend the first 20 minutes of the meeting in the bathroom because I would feel so sick, suffering from what I thought was irritable bowel syndrome. My husband always thought I was lactose intolerant. We knew that if I ate certain foods I would have a certain amount of time to get home to use the bathroom. But it wasn’t just dairy products that made me sick. Eating bagels or too much Italian bread would also make me feel ill.

                When Dr. Seckin told me about the Endodiet years of feeling ill after eating certain foods finally made sense to me. Endometriosis is such a pervasive disease that affects all aspects of my life. I shouldn’t have been too surprised that endometriosis and diet were also connected, but I was. It never crossed my mind. Furthermore, after talking to many women in the endometriosis community, they verified that they too felt better after staying away from certain foods.  Many women through the process of trial and elimination had figured out just what Dr. Seckin had told me and were already doing the Endodiet. I am continuously amazed and impressed by the ingenuity and wisdom of patients and their drive to improve their daily lives as they cope with this chronic mysterious disease.

                It is really hard eating gluten free, dairy free, organic and staying away from caffeine, alcohol and most sugar. There are times I do really well with the Endodiet. There are other times where I do not do as well and then pay the price for eating as I wish. Can eating right cure my endometriosis? I don’t think so. But, I do feel that when I eat right my quality of life improves dramatically. Unfortunately, endometriosis in of itself causes a lot of stress, which then tempts me to eat things that are unhealthy! It takes a lot of discipline for me to cope with my stress in a healthier manner and I fear it is something I will probably be working on for the rest of my life.

Three Questions to Ask Your Surgeon Before Being Operated On

Three Questions to Ask Your Surgeon Before Your Operation

Most endometriosis patients have similar experiences when it comes to finally being diagnosed with the disease. It starts with the appearance of a host of inexplicable unpleasant symptoms that show up a few years after menstruation begins. Many women go from doctor to doctor, trying to figure out what exactly is wrong with them. Some women will come across a knowledgeable gynecologist and figure out early on that it is endometriosis. Some women will not be diagnosed with endometriosis until they are having fertility issues. 

For most women, their first surgery to treat endometriosis is not performed by an expert endometriosis surgeon. For most women, their first surgery is performed by a well-meaning gynecologist or reproductive endocrinologist.  These doctors go in and ultimately do more harm than good.  They use surgical techniques that actually cause the endometriosis to spread in the future.  They will prematurely do hysterectomies on patients because they feel it is the only solution. They can damage vital organs in the body while trying to remove the endometriosis due to their inexperience. Or they simply leave endometriosis in places they do not feel comfortable operating on.  Some doctors open a patient up and quickly close them up after seeing how bad the disease is. They realize immediately that they are over their heads. Patients may get temporary relief from these surgeries but often, within months, they feel worse than they did before the surgery.

Here are three important questions to ask your surgeon before agreeing to be operated on:

Do you use the excision method to remove endometriosis?

Dr. Seckin, expert endometriosis surgeon and co-founder of the Endometriosis Foundation of America, uses the excision method to remove the endometriosis. This is the best way of removing endometrial implants. Endometriosis is like an iceberg. Doctors can only see the tip of the disease when looking at it, but the majority of the disease lies deep below the surface. Most gynecologists and reproductive endocrinologists use laser ablation and vaporization to remove the endometriosis. Not only can heat damage the ovary, but when a doctor burns away the endometriosis it turns the tissue black, making it very hard to see if there is endometriosis that needs to be removed from the surrounding tissue. More importantly, this method does not remove the deep infiltrating endometriosis that lies beneath the surface. Only excision can address that. Some experts believe that vaporizing the endometriosis can actually spread it to more places in the abdominal cavity. This method also does not remove the majority of the disease.

If I have endometriosis on my bowels, ureters, nerves or any other places that is not related to my reproductive system, will you remove it? Will you have other experts involved in my surgery who know how to treat endometriosis?

Most doctors are not endometriosis experts. Most often, gynecologists and reproductive endocrinologists will ablate endometriosis off reproductive organs in hopes of giving their patients temporary relief or helping them achieve pregnancy. When they go in and see that a patients’ bowel is connected to her uterus or her ureters are attached to her pelvic wall, they don’t know how to handle it. Doctors will do what they can, but will leave the bulk of the disease. Ultimately this just creates more scar tissue and more pain for the patient.  Dr. Seckin will gather a team of professionals that are adept at treating endometriosis. He will have an urologist, a gastroenterologist, or a neurologist involved with the surgery if a patient needs extra care. It often takes a team of experts to combat this disease.  It is important that your doctor has a plan for treating ALL of your endometriosis.

Can you make preserving my reproductive organs a priority?

The old school way of treating endometriosis was to offer patients two options, Lupron or a hysterectomy. It is extremely surprising to hear that so many doctors still only offer these solutions, whether a patient is 19 or 46. Expert endometriosis surgeons will try their best to free and preserve the fallopian tubes, ovaries and the uterus of their patients. Dr. Seckin has not only helped many patients live a life that is more pain free, but has helped them achieve pregnancy after surgery. Sometimes the endometriosis is so wide spread or adenomyosis is so severe that even the best expert will have to perform a partial hysterectomy or a full hysterectomy on a patient.  It is one of the many devastating, lifelong impacts of this horrible disease.

Search for the Best Care

For many patients, when their doctor finally puts a name to their lifelong symptoms, there is an immediate sense of both gratitude and fear.  There is the attitude that since this is the one doctor that could finally put a name to my misery, than he/she must be able to fix it. In this time of crisis and acceptance, endometriosis patients must behave like patients being diagnosed with cancer. They must seek out the best, most knowledgeable endometriosis surgeons to ensure quality care and treatment of this debilitating disease. Hopefully one day, expert care will be available in every city, covered by every insurance plan, to lessen the already heavy burden of the patient.

 

EndoWarrior The Song!

Some of you may be surprised by this, but I like to write music! I know, I know, crazy right? I am a social worker!! But sometimes I am lucky enough to be on the side of inspiration. Sometimes the angels whisper in my ear, sometimes they hit me over the head with a frying pan. This is one of the frying pan situations. As many of you know, the Million Women March for Endometriosis is happening this March in DC and in cities all over the world. I feel like there needs to be a rally song, a song to unite us all, to make our voices heard, to explain to the world what we feel on a daily basis. I titled the song after one of my favorite Endometriosis Support Groups and a popular hashtag on twitter that explains how fierce and brave us endometriosis patients are. Below is a link to the song.  A fellow Endowarrior, Rachel Cohen, is performing it with her beautiful voice. She is not only a singer, but an author and is compiling a book of stories from endometriosis patients from around the world. Check out her blog at http://endofromtheheart.blogspot.com/

EndoWarrior Working Lyrics

People say I’m crazy,

That I’m just not strong enough.

People say I’m lazy,

That it’s time that I get tough.

They don’t understand,

This pain I can’t ignore.

It hurts with every breathe,

I can’t take it anymore.

Chorus:

I may not be strong enough or tough enough for you.

You may not choose to see my reality as truth.

But, I’ll no longer listen to your words that are only hurting me.

I am a warrior you will see.

 

Surgery after surgery

The many scars run so deep.

And yet it always seems,

Nothing brings relief.

Hard to keep my head up,

Feel so all alone.

Countless hours spent,

With my heating pad at home.

Chorus
I may not be strong enough or tough enough for you.

You may not choose to see my reality as truth.

But, I’ll no longer listen to your words that are only hurting me.

I am a warrior you will see.

Bridge

It’s time we come together and stand as one in pain.

It’s time for once our cries aren’t heard in vain.

If we lean on each other our power will not wane.

 

The mountains I have climbed,

One day you will understand

Then you’ll finally know

How strong I really am.

Chorus:

I may not be strong enough or tough enough for you.

You may not choose to see my reality as truth.

And I’ll keep fighting this disease that has completely ravaged me.

I am a warrior you will see.

Endowarrior you will see.