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.

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.]

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.

Toxic Wastes? Dump on the Poor!

I am convinced that Africa is the world's dumpster. None of us really care about this continent, except in terms of what resources it can provide to the rest of the world. Europe is up in arms about how many immigrants land on its shores from Africa- many dying on the beaches after a perilous journey. No regard whatsoever for the tourism of the affected countries and all those folks who have come to the beaches to enjoy the sun, sand and surf. America couldn't give a damn about the continent- when it came to Iraq they dreamt up weapons of mass destruction and went in to save the day; Charles Taylor was gutting Liberia at the same time but the US decided when it came to Africa the very organization they label as incompetent and irrelevant (yea, we are talking about the UN) was good enough to handle Liberia using its peace keeping force. Let's not forget history here folks- Liberia is the nation created by those former slaves who chose to return to Africa from America. IMO, there should have been a greater desire to help those whose pasts were shackled to yours. But of course, Liberia's black gold isn't in liquid form.

Here is a recent example of the mistreatment of Africa and Africans that makes my blood boil.

The Probo Koala- a Greek oil tanker, flying a panamanian flag, leased by the London branch of a Swiss firm whose headquarters are in the Netherlands- docked into Amsterdam to get its holds cleaned of what it claimed were marslops, before heading out again. Amsterdam Port Services contracted to do the cleaning for $15,000 but as they started the cleaning, they found that what they were pulling wasn't just marslops and not of a volume they assumed it would be. The mixture they were withdrawing was toxic, the fumes were making the workers sick and the residue cleaning estimate was changed to $300,000 for full and safe clean-up. Trafigura, the lease-holding company, decided this was way too much to pay for clean up and processing, and sought a short-cut. [ FYI, Trafigura posted revenues in 2005 of $28 billion, in case anyone is keeping a tab.]

Trafigura contracted with a company called Tommy in the Ivory Coast and all that toxic sludge (500 tons worth) was dumped around the capital city of Abidjan on the 19th of August. Oil traders and toxic waste experts say that it is clear to see that a country like Ivory Coast has no facilities capable of handling toxic wastes of this kind or proportion. Yet, Trafigura claims that the responsibility lies with the company they contracted to carry out the removal and disposal. Meantime, 8 people are dead and 77,000 sickened by the sludge. If what is happening in the Ivory Coast today were to have happened in any country in the Western World, if even one life had been lost in the West, if even a tenth of the numbers of people were sickened in the West, do you think this story would have faded away this easily? Oh wait a minute- what am I thinking, one life in the West is so much more valuable than one life in Africa. It is only Africa and the lives of Africans- who cares!
This picture shows 6 month-old Salam Oudrawogol of Abidjan, Ivory Coast, who developed these sores since he was exposed to toxic waste in August.
The picture at the top of this page shows another resident of Abidjan near a dump in Akouedo where much of the toxic material was dumped.
[Both pictures taken from NYT (thanks). My Probo-Koala story draws on BBC and NYT reporting; angry editorialising- all moi.]

Revisiting a Thin Issue

So after Madrid fashion week brought the focus on models and image issues, it seems they opened a breach in the dyke that had kept at bay viewpoints that expressed reservations about female image and health issues. London fashion week followed up by stating that they were not going to tell designers who to choose as models and how to run their shows. The culture secretary for the UK, Tessa Jowell, joined the debate with a call to follow the Spanish example. Well, anyway, all to no avail.

But. Surprise! Milan fasion week has stated that it won't participate in the exploitation of young women and has announced a new code that models need to adhere to in order to participate. In order to participate, models will have to carry a medical certificate showing they are healthy. Young school-age girls need a guardian accompanying them. The code also combats the exploitation of vulnerable women who fall prey to unlicensed operators who talk them into having sex in the hopes of attaining their dreams.

Ok, before anyone goes around thinking, I have something against skinny women, let me say that I acknowledge that some women can be naturally thin. The issue with me is not the thinness- it is the imposition of an ideal. It is the restriction of a natural range. That is why I think Milan's actions go further than Spain's. I think Spain's heart was in the right place when they tried to curb an epidemic of body-image illnesses. By asking models to show a medical guarantee of health, Milan says whatever size you are- you gotta be healthy.

I love to see policy being formulated by the users. Let's see how this keeps developing.

[interesting link: http://news.bbc.co.uk/1/hi/help/3681938.stm]
[pics were either NYT or BBC- I forget which- so thanks to both I guess]

And what gives me the right to Nation-bash?

So... a friend read my Orient Express post and told me that it made him very uncomfortable to read it. I seemed to be so anti-China in it. Do I hate China and the Chinese?

Well, let me ask you if the Chinese dissident who is thrown into jail for protesting things he sees wrong with the Chinese political ideology hates China? Maybe s/he does, maybe not. To answer that question straight up- No, I do not hate China as a country or the Chinese as a people. Historically, this is a culture that is a sister to my own (Indian). I do however have a strong aversion to China as an ideology- that which seems to avert attention from individual rights by making them secondary to a nationalistic philosophy which is dictated by the few to the many.

Many Chinese have given voice to how much better their lives are getting. And yet, the few dissidents whose voices are raised against some injustice are being silenced underfoot. Why? If everything is so good, why be scared of a peaceful movement like Falun Gong? Why kidnap the Panchen Lama and replace him with a State-sanctioned Panchen? Why not let Taiwan exist independently? Why...

In short, no I don't hate the country of China anymore than I hate the US or India. But I am as much against its ideology and philosophy as the nearest Chinese dissident.

Role Models

So... New development.
Madrid Fashion Week has decided that this year they will not be allowing any models with a BMI lower than 18 to participate in the show(between 18.5 and 25 is considered the normal range). While this is not a premier fashion show- hey, its a start! Every year they were facing protests from doctors and women's rights groups and this year they decided to ban underage and underweight models. Go Spain!!

About 30% of the models have flunked the BMI test. I am glad we are beginning to pay some attention to the role models put out there for younger women. Male models don't look half as unhealthy as some of the thinnest female models. Umm..no I am not recommending or even condoning male modelling- just saying body image issues-wise, they are nowhere near as unhealthy.

We need healthier role-MODELS.

[Color pic from BBC news site and B&W pic from a French website on Anorexia and Kate Moss/Amber Valleta as far as I can tell. Thanks guys.]