Re: Vaginal Vs. Abdominal, Round 2
From: R. Daniel Braun, MD (anonymous@obgyn.net)
Sat, 30 Sep 2000 08:39:01 -0500 (CDT)
At Fri, 29 Sep 2000, Denise wrote:
>
>Thank you for the insight. I am seeking a second opinion to verify the
>need for abdominal hysterectomy. Especially since it was the only
>option offered to me. No other available treatments or methods of
>treatment were discussed with me or offered to me by the doctor. He is
>3 years out of his residency, and really seems to care, but I am
>unwilling to trust this major of a procedure to a relatively "young"
>doctor if there are viable alternatives that may speed my recovery time.
>I am also relatively new to this geographic area and this is the third
>OB/GYN I have seen since moving here five years ago....It is sometimes
>hard to find a good doctor in a new location. I had such a good doctor
>where I lived previously, if it were not 1500 miles away, I would go
>back there for the second opinion.
The youth of the physician is not necessarily bad at all. In fact at
the end of residency program is the time when we may have the best
eye-hand coordination and be the best surgeons we will ever be
technically speaking. As I indicated in my first response, not all
OBGYN's are trained well in all approaches to hysterectomy. There are
many reasons for this; A fair amount of time in residency is now spent
on other areas such as geriatrics and internal medicine so that we ar
qualified as Primary Care Physicians, We are now turning out many more
OBGYN's than we did before and there are the same number of surgical
cases available to train them. and so on. This particulr persons
training may not have offered much in the way of vaginal surgery or
Laparoscopy surgery,or it may be that your particular case is not suited
to either of those. Ask about them.
>
>Please understand, I am not questioning this doctor's professional
>opinion, I am trying to make the best decision for my health, and to
>minimize recovery time. Based on the information I've gathered, it
>appears that his diagnosis of a hysterectomy may be the best way to
>handle my case. I intend to follow up and find out the reasons for the
>method recommended, so I have also scheduled a follow-up appointment
>with him (after my second opinion) to ask more questions and clarify
>these issues. I have found this site to be balanced and helpful in
>helping me formulate those questions. Believe me, at times it is
>difficult to discern science from science fiction when access to juried,
>balanced, non-hampster research is not available to (or readable by)
>non-medical professionals. By the way, I found the UCLA medical center
>site informative. Any additional questions (or help in formulating
>those questions) would be greatly appreciated.
Usually, I have a discussion with my patients about ovarian function. I
usually recommend that ovaries be removed if the woman is 40 or over.
But I give her the choice. If on the other hand at the time of surgery,
I find pathology of the ovaries, they will be removed. This is all
thoroughly discussed.
After answering questions on this list, I wonder if my thorough
discussion is perceived as such by my patients.
RDB
>
>I am an engineer by training (BS, MS and PE), and am accustomed to
>assembling data into meaningful decisions that affect life safety. I
>realize that the doctor probably has 7 years of experience in his field
>counting his internship/residency program, but I am unfamiliar with
>training program and am a little apprehensive. Any comments you have on
>what the relative experience/training of a doctor at 3 years out of
>residency would be appreciated.
>
>My emotional state is also somewhat unstable and I seem to be in
>constant hot flash. A blood test has been done (results pending) to
>determine the state of the hormone levels. My doctor stated that within
>5 days of stopping the Aygestin, the bleeding would return. It has, and
>it just adds to the stress and pressure of the decision to be made. All
>this information will be available by the time my second opinion
>appointment is done and my follow-up appointment with the original
>doctor.
>
>My doctor also stated that there is a possiblity of removal of the
>ovaries during the procedure. His recommendation was that, if they are
>not functioning properly, they should be removed to avoid the risk of
>ovarian cancer. Is this done often?
>
>All this seems to be too much for me to sort out and handle at times.
>This whole situation has left me in sort of a state of shock, and
>frankly scares the hell out of me. I have never had any major surgery
>in my life to this point. Any help you can suggest or resources to
>research would be most appreciated.
>
>At Thu, 28 Sep 2000, R. Daniel Braun, MD wrote:
>>
>>The best route if possible is vaginal. There is less pain, less time
>>off, and less time in the hospital. The decision to do vagianl or
>>abdominal is based on many things. These include the size of hte bones
>>of your pelvis, the amount of mobility of the uterus, the size of the
>>uterus, the history of previous surgery, the training of the surgeon,
>>and the skill of the surgeon. A 3 cm fibroid by itself should not be a
>>contraindication to vaginal hysterectomy. The biggest uterus I ever
>>took out through the vagina was the same size as a 20 week pregnancy(The
>>top of the uterus was at the belly button). I know of some who have
>>taken out lots bigger ones than that.
>>In short there are many factors involved in deciding. If the procedure
>>can not be done vaginally, then the next best way is the
>>Laparoscopically assisted vaginal hysterectomy. The top part of the
>>procedure is done through the laparoscope and then the rest is removed
>>through teh vagina. Again the skill and training of the surgeon are of
>>paramount importance.
>>
>>RDB
>>
>>At Thu, 28 Sep 2000, Denise wrote:
>>>
>>>I'm 42 and have never had children, nor do I intend to. I have recently
>>>had abnormal menses - about 9 weeks of bleeding with lots of heavy clots
>>>and some cramping. Amazingly, I am not anemic, but the only way to stop
>>>the bleeding was chemical: Aygestin (spelling?) in 5 mg daily doses. It
>>>was also the first painful pelvic exam that I have ever had (always had
>>>normal paps, as well). The ultrasound indicated normal size ovaries and
>>>a peduncular fibroid of about 3 cm. The doctor's recommendation was for
>>>an abdominal hysterectomy. What are the indications for an abdominal
>>>versus vaginal hysterectomy? When is a fibroid "too large" for a vaginal
>>>hysterectomy?
>>
>>--
>>R. Daniel Braun, MD FACOG FOG
>>
>>This is for educational purposes only, and is not intended to be replacement or substitute for consultation and examination by an appropriate medical professional. Due to time constraints, private e-mails cannot be answered.
>>
--
R. Daniel Braun, MD FACOG FOG
This is for educational purposes only, and is not intended to be replacement or substitute for consultation and examination by an appropriate medical professional. Due to time constraints, private e-mails cannot be answered.
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