Tuesday, November 28, 2006

Uterine Fibroids and Treatment Options

We know that many women get fibroids growing in and around their uterus at some point in their lives and that some of us become very uncomfortable because of the symptoms the fibroids produce (these range from urinary frequency to painful and heavy bleeding). Research still has not shown why this happens and what predisposes us to it. I have a previous post in this blog about some of my experience so far and I will be writing more about it as I undergo treatment.

Considering that uterine fibriods have been a problem that has existed long before modern medicine came into being and given that they are the second most common reason for major surgery in women after child-birth (specifically c-section), it is a bit puzzling why we still don't know what causes fibroids. Not only this, what is even harder to understand is the lack of information women are given about the various options available for treatment. I am going to go over the options here in case someone who wants to know stumbles on them on this little outpost of the web.

Do nothing: Most women who have fibroids are aymptomatic and needn't take any course of action. These benign growths do not interfere with their lives. Other women turn symptomatic and still may choose to do nothing if the symptoms do not affect their quality of life. Even if the fibroids do affect the quality of their life, a woman may choose it as the lesser of two burdens given the treatment options. In addition, a woman who has not had children may, depending on location and the affects of the fibroid(s), choose to put off treatment till after childbirth in order to ensure that her fertility is not negatively affected.

Gonadotrophin therapy: Some women are given gonadotrophin drug (Lupron in USA or Prostap in UK) injections to chemically induce menopause. As the levels of estrogen and progesterone drop, reproductive organs (and the fibroids growing in and around them) shrivel. This therapy is associated with all the other wonderful symptoms of menopause such as hot flashes, bone loss (over time), vaginal dryness, etc. Soon as therapy is stopped, the reproductive organs AND the fibroids spring right back. This therapy is used pre-surgery (typically for 3 months) in women who are heavy bleeders and anemic to shore up their blood and help with recovery post-op. It is also supposed to reduce bleeding during surgery. However, this treatment is not indicated pre-surgery for non-anemic women. Surgery is easier on a non-shrunken uterus and fibroids. However, incision size may be larger if the fibroid is extremely large.

Hysterectomy: This has previously been the option of choice for many surgeons (and by extension their patients) as it was often the only option available. It remains a frequently used option and many women are expressing discomfort and displeasure with doctors who seem to present it as the only viable option. On the other hand, for many women who have severe symptoms, recurring fibroids and who are past child birth, this remains an acceptable option. Of course, a hysterectomy entails permanent menopause with its own issues. For women who are younger and who still want to keep their options for reproduction open, this is not an ideal option.

Myomectomy: This comes in two forms. Abdominal myomectomy and laparoscopic abdominal myomectomy. The first is when they manually make an abdominal incision and surgically remove the myoma(s) or fibroids. The second is when they use laparoscopes to do the surgery making small holes in the abdomen to thread in the laparoscope. Healing times and rates of infection differ. Typically the larger the fibroid or the more delicate its position, an abdominal myomectomy would be preferred over a laparoscopic myomectomy. The advantage of a myomectomy is that it is a more uterus conserving surgery and a woman may hope to maintain her reproductive abilities. Even if reproduction is not an important consideration, the avoidance of abrupt menopause alone would make this desirable in my opinion. [Menopaused women are not troubled with fibroids as the reproductive tissue has or is shrivelling.] However, myomectomies do not prevent the fibroids growing back.

Uterine Arterial (or Fibroid) Embolization: UAE involves threading catheters into the two uterine arteries. The catheters are used to deliver silting agents into the blood supply of the targeted fibroids. This results in the fibroid starving and shrivelling away and this relieves most symptoms. There are a couple of issues with this treatment beyond its indication for certain types of fibroids. Firstly, UAE is performed by radiological experts rather than gynecological surgeons. This may create a conflict of interest in that many gynys may not refer their patients away to another specialist for treatment even if they remain the doctor of record. Secondly, UAE is still doubtful for women looking to conceive as the blood supply to the uterus and ovaries should be as little compromised as possible.

Holistic options: There aint no herbs out there that I know of which can target a fibroid specifically and not affect anything else. I can imagine there are herbs that help relieve some symptoms (such as heavy bleeding). However, if a drug claims to shrink fibroids, it is probably functioning as a gonadotrophin. Now we know that menopausal women are outta the fibroid game, which leaves only those of us lucky enough to need these herbs to worry about the consequences of a potentially gonadotrophin herb. And if you are still considering giving birth at some point, you need to make the decision while weighing in your reproductive health and that of any baby that you will carry. In terms of other holistic options such as meditation and exercise, the way I see it, these can't harm us and if they help us- then great. Good food, healthy eating habits, relaxation and exercise are never wrong.

Friday, November 24, 2006

Toxic Wastes in Abidjan- Progress Report

So far Trafigura maintains that the wastes were not toxic and that it tried to dispose of them but due to its unfortunate selection of an Ivory Coast company called Tommy, many people were poisoned and about 10 lost their lives. Investigation has however revealed that Tommy is a shell company created while the Probo Koala was on its way to the Ivory Coast - talk about custom made. A report out this week suggests a chain of incompetence and negligence was to blame for the tragedy. So far those jailed include the manager of Tommy, two European Trafigura officials and a few Ivorian businessmen. Trafigura meantime has retained a high-flying British lawyer and is sticking by its story of compliance with national and international laws.

This is how globalism and international capitalism works. The tiny people get ground up and spat out by the cogs of big MNCs. All this delaying, legal mumbo-jumbo and obfuscation puts such heart-rending injustice out of mind over time. We feel less and less outraged as our lives are not affected and we can still get cheap oil. Hey, a few hundred unhealthy and 10 dead Ivorians versus the $300,000 to be paid for safe clean up. I mean, if Trafigura paid that sum, they would have to pass it on to their customer and we all know that cheap fuel keeps our world going around, right?

[Same picture, NYT- thanks.]

Monday, November 20, 2006

The Elusive Surgeon

Yuck! Well, I've been diagnosed with a uterine myoma and that has screwed with my head somewhat. Going from totally healthy and fit to being a patient is not easy because you are not mentally geared for it. I have also always taken good care of my health- good clean food, no bad habits, exercise... so of course, a small voice in your head goes- how'd this happen to me? Turns out, too many of us women suffer from this problem. It is the second most common reason for surgery in women after childbirth (why childbirth even needs surgery is another blog being written by April one of these days).

Depending on where you get your info from, fibroids occur in 40 to 70% of all women. A post-mortem study showed it in 70% (or was it 80%) of women autopsied. Most women, it seems, are asymptomatic and either never know they have fibroids or don't need to have them removed. Some of us turn symptomatic. I am one of them. Urinary frequency (my bladder is now reduced to the carrying capacity of peanut - ok not really, but close enough), a belly that is beginning to protrude (doc describes it as 16 weeks) are some of my symptoms.

I want to talk about how difficult it has been as a patient, specially when faced with a physician- oh wait! I have not been faced with him yet and am not likely to before I am rolled into surgery! I have had 2 appointments with my consultant (known as specialists in the US) in the UK under the NHS. And both times I met a fantastic research fellow working under him. She was thoroughly lovely, easy to talk with and extremely helpful but she ain't a surgeon (so she won't be cutting me open) and she is not the expert when it comes to answering my questions on treatment options. What information I have been gaining about what I have and what to do about it has come less from my consultant than from other sources due to active efforts on my part. The one letter I have from him addressing an issue I raised suggests that the guy is probably competent and means well, but boy oh boy, the fact that I will never even get to be more than a paper patient and then a sedated uterus to this guy bothers me no end.

Oh btw, the consent form I had to sign to get on the waiting list for surgery lists the "serious or frequently occuring risks" as:
1. Excessive bleeding during blood transfusion.
2. Excessive bleeding requiring hysterectomy (removal of the womb).
3. Incisional complications including hernia.
4. Infection which may require antibiotics.
5. Injury to adjacent organs requiring further surgery.
6. Venous thrombosis which may or may not result in pulmonary embolus.
7. Failure to achieve desired result.
8. Pain.

Would have been nice to observe a slightly greater investment or even interest in my care from the surgeon.