WOMENS-HEALTH Messages for March, 1998: Re: Hysterectomy Upcoming -- Questions

Re: Hysterectomy Upcoming -- Questions

From: Angela (anonymous@obgyn.net)
Sun, 29 Mar 1998 01:58:28 -0600 (CST)

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In reply to: anonymous: "Hysterectomy Upcoming -- Questions"

At Sat, 28 Mar 1998, EMM. wrote: >
>TAH scheduled for 4/9.
>
>I've had a fibroid for 12 yrs. During this time I had the same ob/gyn.
>Last year he became disabled and no longer practices. The fibroid gives
>me NO trouble, I have light regular periods as I have all my life and
>had no problem getting pregnant and carrying 2 children. It recently
>grew from the 9wk size it was right after pregnancy/ birth #2 in 1990 to
>12 wk size last year and now around 16-18 wk. The 3 physicians I have
>seen (trying to find a replacement for my long-time doctor) all
>immediately said TAH, abdominal incision and take cervix out too. I am
>40.
>
>Tests done are: IVP (normal bladder function, no ureter problems),
>transvaginal U/S and regular U/S. This showed also 2 tiny fibroids next
>to the "mother ship " fibroid :) The 3rd doctor I went to, who I
>selected for my surgery,
>which was supposed to be a myo, did a CA-125 which was 80. She says
>because it was 80 that now there's got to be a vertical incision, take
>everything out in one piece. A friend who is breast cancer rad.
>oncologist at Mass. Gen. said this number is normal for a large
>fibroid and since I was on last day of my period when test taken, that
>was another reason for the elevation. My new doctor also took an
>endometrial biopsy, but I haven't heard any result from that yet.
>Ovaries looked perfect on the U/S and transvaginal u/s, and the tech did
>make a concerted effort to find them because of the fibroid.
>
>So now I wonder if I am taking the correct course. The fibroid must
>come out, that's for sure. I sent my new gyn a list of these questions
>but she hasn't gotten back to me yet. To complicate, I live in Phoenix
>which apparently is somewhat of a hysterectomy oriented medical
>community. The various groups I have talked with for referrals
>basically said there's no real good, newer tech, options here.
>
>I have also read about the many benefits of leaving the cervix in. Have
>had 1 abnormal pap, 7 years ago, followed up by cone biopsy. Diagnosis
>was mild dysplasia. No problems since, and I adhere to all my checkup
>schedules. All the doctors I have met here want to take the cervix,
>with vague "prevent cancer" reasons.
>
>All this leaves me feeling very uncomfortable about taking
>an irreversible step. Yet I really don't see what else I can do except
>go down the list of every gyn in my health plan, which seems like a
>waste. Since it takes 6-8 weeks to get appts... well that doesn't help
>me.
>
>Am I being unreasonable in questioning this? If the doctor truly
>suspects cancer (ovarian) wouldn't they do say a lap and take a peek
>first? Also none of the prior doctors
>worried about this, is the current doctor just being extra careful?
>
>--
>--confused in Phoenix
>

If I were you, and assuming there are no medically significant details you've neglected to mention, I would cancel that TAH and not reschedule it until you get a clear and complete rationale that satisfies you. It sounds like the search for a new doctor is getting you overwhelmed, and you must step back and clear your head before you make such a major and irrevocable decision about your body. In a situation like yours, it can be very difficult to maintain your grip on the fact that the doctors are consultants to you, and you are in charge.

Part of what makes me say these things is that you don't mention anything about symptoms--in fact, you seem to be saying that your body is functioning rather well--yet you say, "The fibroid has to come out, that's for sure." Why, if it's not bothering you and your urinary tract is not obstructed? From what I've read (having had fibroids for a long time, like you), I gather that gynecologists used to automatically recommend some sort of surgery whenever a fibroid uterus reached 12 weeks' size. But that's not true anymore.

About CA-125 specifically, I'm not an expert but I believe this marker can be elevated in the presence of endometriosis, FYI.

As for the things you have been told about your community, I wouldn't buy into that yet. I can't really imagine what "newer tech" treatments/options you require that aren't available somewhere in or near Phoenix. Frankly, I think the real problem is that EVERY community is a hysterectomy-oriented one if the patient has passed her 40th birthday. You may have to do some work to get around that bias. It's tedious and expensive, but I think you probably should talk to another doctor or two.

Good luck.

Angela

Next message: Elizabeth: "Timing of Fertinex, HcG and Progesterone"
Previous message: Veronica: "Cushing's, PCOS or something else?"
In reply to: anonymous: "Hysterectomy Upcoming -- Questions"

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