WOMENS-HEALTH Messages for February, 1999: Re: Angela

Re: Angela - ovarian mass

From: Angela (anonymous@obgyn.net)
Wed, 17 Feb 1999 09:00:18 -0600 (CST)

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I left our previous exchange below for reference--just to review, I'm 46, organs probably "headed for the barn" as you said, irritable bowel, nodularity on rectovaginal exam, 10-week fibroid uterus, <3" ovarian cystic thing, dyspareunia (as of a while back), and I do also have sensations of pelvic pressure or heaviness that have got a little worse lately. (The only other symptoms that are worsening, though, are mostly mental things like fatigue, brain fog, memory failures.) Highly respected OB-GYN wants me to just get "cleaned out."

My main concerns/worries/objections are:

1) Isn't it true that TAH/BSO often is NOT a definitive cure for endo (though I realize the surgeon's skill is a big factor) and that even after TAH/BSO many women with endo can't take HRT because it aggravates the remaining implants? So why bother if it isn't killing me--especially since all this errant tissue is going to shrink in a year or a few years anyway?

2) Why is it that you guys always talk about TAH/BSO like it had no down side? If that's the case why is the Internet so full of horror stories about it? Not just serious physical problems (with bowels and bladder for example), but dreadful emotional crises described in terms like "loss of self"?

3) It really, really bothers me that if I have this operation I will be dependent on doctors and pharmacies to keep me biochemically functional for the rest of my life. (Even a mainstream source like the Harvard Women's Health Watch says that our organs continue producing significant hormones after menopause; I don't view HRT as an inevitable step.)

4) Finally, I can't help wondering if the pressure for TAH/BSO in a case of "messy pelvis" like mine is really on behalf of the practitioner and the payors--i.e., it is too (a) tedious (b) expensive to keep monitoring someone like me to make sure I don't have a malignancy anywhere.

Thanks again for your time and really would appreciate if you could reply once more. Think of it as an act of mercy toward your insanely busy fellow OB-GYN who won't have to listen to quite as much whining from me!

At Mon, 15 Feb 1999, anonymous@obgyn.net wrote: >
>>> no, no, it's not 6 in. now, it's just under 3 inches. when I had
>ultrasound in Feb. 98 the same ovary had a similar mass on it that was
>about half that size.
>
>****** Gotcha' -- but -- the fact that it is growing concerns me.
>
>>> My gynecologist is an extremely popular practitioner and highly
>respected surgeon/high-risk pregnancy and fertility specialist at a
>leading teaching hospital.
>******* I would stick with him! My wife goes here to my ex-partners but for
>major cancer things goes to The Ohio State University in Columbus, Ohio for a
>second opinion.

>
>>> He did a myomectomy on me about 6 years ago
>(went very well, but the damn things grew back, you know all about
>that). So now I'm 46, I have this 10-week uterus from recurrent
>fibroids,
>******* Get it OUT! Why suffer!
>
>>> I have intermittently nasty irritable bowel symptoms,

>
>****** Been there. Done that. 20 cm of colon removed. Funny when I retired the
>spastic colon and diverticulitis went away! Hmmm. Stress?
>>> dysprunia
>******* Not fun, but better than no pyrunia at all!
>
>>> bouts of back pain, and the impression of rectovaginal endo

>on exam (though I should mention that Endometriosis was NOT noted in my
>surgical report for the myomectomy). Used to have horrible menstrual
>pain, too, but that has been steadily receding.
>
>******* Your female organs are headed for the barn.
>
>>> For about two years since the fibroids grew back he has been trying to

>convince me that TAH/BSO is the way to go. I understand his reasoning
>but I think his bias against the organs of "postreproductive" (as
>opposed to postmenopausal) females is excessive so I've resisted it.
>******* No, I doubt any bias. He is in the business to help people (Women) and
>he is very busy.
>When he encounters someone who want a cure but doesn't take his advice,

>He is human and he becomes frustrated so he loses interest and feel that
>seeing
>you is a waste of time for him. (HE is not GOD!)
> I remember when my car developed a noise in the engine. I took it to
>the mechanic
>and told him that I wanted him to fix it. I also told him that I did not want
>him to open the hood
>because I only opened it once a month to prevent wear on the hinges. I told
>him if he could not
>solve the problem today, I would bring it back in two weeks.
>For some reason he laughed at me and said, "Are you nuts or sumpin'?
>
>******* I am not sure what to do with my car.
>
>>> Now, though, the ovarian mass gives me something more to contend with.

>******* Get it all out!
>
>>> Thanks for your thoughts, and obviously I'd appreciate knowing any
>further impressions you may have.
>
>******* Let your doctor open the hood and get you fixed so your stress will be
>less
>

>(probably helping your spastic colon) and sure as hell stopping your menstrual
>pain and cramps,
>And probably relieving the pain with intercourse and creating a situation
>(sans uterus)
>which can now be treated more easily with HRT. (The pros and cons of HRT
>is for another day. For now, "There are very few cons, and A LOT of PROS!"
>
>Agape,
>Dr. George

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