Re: Hysterectomy or not?
From: R. Daniel Braun, MD (anonymous@obgyn.net)
Thu, 31 Aug 2000 06:27:43 -0500 (CDT)
The original poster was 49 and had hyperplasia and a 9cm cystic ovarian
structure. That doesn't mention the rectovaginal fistula and urine
leakage that was also dropped in as an afterthought.
I would caution that the urine leakage be evaluated pior to the surgery
to make sure it is correctable by surgery and to find out which
procedure has the best chance of correcting it.
Also the not every Gynecologist has much experience repairing R-V
fistulas. They can be very tricky to repair well, much of that depends
on the reason for having the fistula to begin with. If due to Crohn's
disease or previous radiation, very unlikely to heal postop.
In general, this lady has many reasons to have a hysterectomy and
removal of both ovaries.
All the literature about there being too many hysterectomies done, has,
IMHO, caused many women who really need the procedure to delay having it
done and to suffer needlessly for years longer than necessary.
RDB
At Thu, 31 Aug 2000, Claudia Twisdale RN wrote:
>
>I agree 100%! I was in same boat last fall, and finally got through the
>insurance red tape and had a TAH and BURCH repair in November. Regrets?
>Not peeing every 30 minutes, not leaking all the time, not bleeding all
>the time, not cramping all the time....Regrets?? NO! Howevere, yes it is
>major surgery and a big choice, but you must weigh everything and make
>choice yourself. Oh, and I am 32, was 31 at surgery time.
>
>At Wed, 30 Aug 2000, Debbie wrote:
>>
>>{{{Mary}}}
>>
>>I can certainly relate! I am 32 and about to have a hysterectomy for
>>excessive uterine bleeding with an undiagnosed cause thus far, although
>>my gut tells me I have adenomyosis and my doctor said no way because I
>>don't have much pain, the path report will tell for sure.
>>
>>I have has this problem for two and a half years.
>>
>>I used to work. I used to go out with my family. I used to be happy. I
>>used to love life and couldn't wait to jump out of bed and take on a
>>brand new day;)
>>
>>One month I had a "period from hell" and my life has never been the same
>>since that first month. In the course of two years, I became depressed.
>>I didn't want to get out of bed anymore. I cried everyday. I wanted my
>>life back!
>>
>>I tried alternatives: Wait and See Approach: I waited, and saw myself
>>just losing more and more blood! Pills: Developed a blood clot in my
>>leg. D&C: Hemorrhaged more after it. Endometrial Ablation: I still
>>bleed and I want a guaranteed cure I will never again in my entire
>>lifetime see another drop of blood from my uterus! I have bled enough
>>for the lifetime of three woman in the course of two years and I am
>>done!
>>
>>It came down to a quality of life issue for me. I am not anemic, I
>>don't hemorrhage anymore since the ablation, but after the trauma of
>>hemorrhaging each and every month for two plus years, I was at the end
>>of my rope and made the decision to schedule a hysterectomy and get my
>>life back.
>>
>>I am scared. I know this is major surgery and I know there are risks. I
>>also know there are benefits to this surgery, and I am confident I will
>>survive and be glad I made this choice;)
>>
>>Because I am 32...I had to fight for this surgery. My doctor said I was
>>too young. Everyone told me not to do it as I might regret it. My head
>>was spinning from everyone's opinion and it blocked out what "I" wanted.
>>Be careful when asking for advice on hysterectomy, as I learned the hard
>>way that it just confused me and made me more scared. I knew in my
>>heart, for me to be free, to be really free and have a full, happy life
>>again, I would ultimately have to have this surgery.
>>
>>I would recommend getting a second opinion. I too think some doctors
>>are a bit "knife happy", and that is not good either. I have researched
>>hysterectomy too much and know too much for my own good...but again, I
>>am extremely confident that I will do just fine with this surgery as it
>>is the second most common performed OP on woman, that is sad, but it
>>also makes me feel more calm as I am about to have it performed, if that
>>makes sense...
>>
>>If I were in your shoes I wouldn't hesitate for a second to have the
>>hysterectomy, but I am not and this is a very personal decision a woman
>>has to make w/her doctor.
>>
>>I wish you the very best in this decision, I know how hard it is to
>>make.
>>
>>Listen to your heart, and do what YOU feel is best, as you are the one
>>that will have to live with this decison for the rest of your life.
>>
>>Blessings,
>>
>>Deb
>>
>>At Tue, 29 Aug 2000, Mary wrote:
>>>
>>>I would appreciate any advice....I'm feeling fairly confused about what
>>>is the best way to proceed.
>>>
>>>I'm 49 and somewhat overweight. I have hyperplasia and have been on
>>>10mg progesterone/day for the last 75 days. I've had my period straight
>>>since 6/8/00. The flow cycles between fairly light and very heavy
>>>(about 3-4 days every 2 weeks)with large clots and lots of heavy
>>>cramping. Some days the cramps are so bad that if I was pregnant I'd
>>>know I was in labor. I can't seem to get much relief via Ibuprofen or
>>>Aleve for the cramps. The cramps are with me every day, just some days
>>>are a lot worse than others.
>>>
>>>I had an ultrasound in July...the lining was 12cm then, and reduced to
>>>8cm at the August ultrasound.
>>>
>>>To complicate matters, I also have several fibroids.
>>>
>>>To further make a mess of things, I have a follicular cyst on the left
>>>ovary which was 4x6cm on the first ultrasound, and was 7x9cm on the
>>>second ultrasound. There is some pain involved with this all the time,
>>>although it's not severe.
>>>
>>>My doctor says the cyst is too big to remove laparoscopically and will
>>>require an abdominal incision. He feels that instead of fighting with
>>>the hyperplasia off and on for several years and risking it becoming
>>>pre-cancerous, I should also have my uterus removed as long as I'm
>>>having that big an incision anyway and I'm so close to menopause. He
>>>further recommended removing the healthy right ovary as a preventive
>>>measure.
>>>
>>>His colleague also recommended removing everything, and asked if I
>>>wanted my appendix out at the same time. He also felt he could fix my
>>>recto-vaginal fistula and do something about the urine leakage...Yahoo!!
>>>
>>>I was feeling that they were both a little knife happy, and yet the one
>>>dr. said that no good gyn. would recommend leaving the uterus with the
>>>hyperplasia since they were removing the left ovary anyway.
>>>
>>>I'm feeling pretty miserable most of the time so some days all that
>>>removal sounds great, but I don't want to do anything stupid either. I
>>>don't have any issues about removing body parts, but I'm concerned about
>>>long-term effects of 100% removal, HRT effects, etc.
>>>I wasn't expecting that kind of solution to my problem (I thought they'd
>>>just remove the cyst) so wasn't prepared to ask intelligent questions of
>>>the dr. I'm just starting my research as to the best way to proceed and
>>>then will go back to the dr. Recommendations, anyone?
>>>
>>>--
>>>Mary
>>>
--
R.Daniel Braun, MD FACOG FOG
**Note: Opinions expressed here are for educational purposes only
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