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Re: Vaginal Vs. Abdominal, Round 2From: D. Ashley Hill, MD (anonymous@obgyn.net)Sat, 30 Sep 2000 13:51:55 -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. Your questions/concerns are very appropriate. The problem we have on this forum is that we don't have the benefit of either face-to-face contact, or the all-important physical examination. In general, it sounds like your uterus is not all that enlarged. A peduncluated fibroid should not cause abnormal bleeding, but it can cause pelvic pressure and pain. Has you doctor looked at the uterine lining with a saline ultrasound, hysterosalpingogram, or hysteroscopy? It is usually the uterine lining that causes bleeding, so I would focus on the endometrium as the potential cause of your heavy bleeding. Certainly, an endometrial biopsy, to rule out hyperplasia or even cancer, is warranted. If your doctor has not done a workup to image the endometrium, then I would strongly encourage a second opinion. There are great young doctors and bad old ones, and vice versa. I recently recruited two younger doctors to join my practice. To use an olympic sport analogy, these ob/gyns are the "Marion Jones'" of gynecology. In fact, one of them, less than a year out of practice, delivered my wife's baby. I have seen gyn's in their 40s and 50s who are horrible, and those just out of practice who are great, and, again, I have seen the opposite. Please don't let age impact your decision. As with all other human endeavors, there are great doctors and there are horrible doctors. It does depend on where someone trained, but a bad doctor will not necessarily get good training at a good program. This is why picking a doctor out of an HMO book, or choosing a doctor because of ethnicity, gender, or location, are bad ideas. Finally, as Dr. Braun stated, a vaginal approach is usually best. A 3cm pedunculated fibroid should not prevent a vaginal approach in most patients. Another option is a total laparoscopic hysterectomy, where the uterus is "morcellated" using what amounts to an internal blender, to cut the uterus into pieces and remove it through small abdominal incisions. However, if it's possible to remove it through the vagina, then that's the way to go. The decision to remove ovaries is very personal. Forty-two is not old, but if you have a family history of ovarian, breast, or colon cancer, or you are very overweight, which makes pelvic exams difficult, then it *might* be prudent to remove the ovaries. Further, if you are already in menopause, there is probably not much value in leaving the ovaries in place. However, if you have a personal or family history of osteoporosis or cardiac disease, it might be prudent to leave them in. When in doubt, I usually advocate leaving them in place. Good luck to you with your decisions.
-- D. Ashley Hill, MD Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, Florida
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