WOMENS-HEALTH Messages for August, 1999: Re: FIBROID TUMORS-Followup Question From Dr. Hill's Response

Re: FIBROID TUMORS-Followup Question From Dr. Hill's Response

From: D. Ashley Hill, M.D. (anonymous@obgyn.net)
Sun, 22 Aug 1999 10:09:33 -0500 (CDT)

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In reply to: anonymous@obgyn.net: "Re: FIBROID TUMORS-Followup Question From Dr. Hill's Response"

At Sat, 21 Aug 1999, anonymous@obgyn.net wrote:

>Oh brother! Okay, I simply cannot let this one go unchallenged. There
>isn't ANY reason that a gynecologist should be unfamiliar with uterine
>artery embolization. It is a procedure that has been around for over 20
>years

Actually, UAE has been around since the 1970s, but as a treatment for pelvic hemorrhage, for example after a cesarean delivery or gynecologic surgery. I have used it many times for this indication. However, it is a newer technique for the treatment of uterine fibroids. That's what we were discussing in the original series of posts.

>Vedantham, Goodwin, McLucas and Mohr covered this quite nicely in
>"Uterine artery embolization: An underused method of controlling pelvic
>hemorrhage", American J of Obstetrical Gynecology; April 1997 v176, n4 p
>938-948.

Again, your reference (which is a good paper), is for pelvic hemorrhage, not for the treatment of fibroids.

>Your scare tactic of referring to UAE/UFE as "horror stories of new
>procedures" is quite interesting in this regard.

This was certainly not intended to be a scare tactic, and in fact never stated anything negative about UAE as a specific therapy. I find UAE for fibroids to be very promising. Please re-read my original post. I was speaking generally of newer medical techniques and the reason why a number of doctors are reluctant to advocate these as treatment options. The person originally posting the question appeared angry that her doctor did not consider this as a valid treatment option. I stand by my statement: there are many horror stories about doctors and patients getting on the bandwagon of newer medical treatments, only to find out, after extensive research, that these treatments were unsuccessful or even dangerous. I actually think that UAE will become another viable treatment option for fibroids, but wanted to point out that her doctor should not be faulted if he or she is not (yet) willing to pursue this newer therapy.

Please see my post from yesterday on this subject thread. I will look for my reference, which I believe was of a single case or two cases of post-UAE complications in term pregnant patients. I read about 10 medical journals a month, attend many conferences, and confer verbally and via e-mail with gynecologists and family physicians from all over, but I really think I kept a printed copy of this. It may be an unpublished report, which is very common (although it should be submitted for review). I'll be in the office late next week and will hunt around for it.

Please do not misinterpret the goal of my first post. My partners and I are academic physicians and often evaluate newer medical treatments. We utilize the ones we feel have enough evidence to support, and hold off on the others. I do offer referral for UAE to my patients with fibroids, and discuss it as a viable option, but none have ever accepted this. Perhaps this is regional, but the overwhelming majority of our patients prefer either myomectomy of hysterectomy for symptomatic fibroids. Most patients we see are uncomfortable "leaving them in" and would prefer removal of the fibroids or the uterus. However, it would be unethical of me to make assumptions that every patient shares this view, so I offer UAE as a reasonable approach. The radiologists at our institution are quite capable of doing this procedure. My original post was really in response to a very negative attitude about gynecologists, including suggestions that my colleagues and I routinely consider economics before patient care. This may be true in some cases, but there are plenty of examples, including some I gave in the original response, that clearly show that doctors usually take the high road with regard to economics. True, some gynecologists are just plain bad doctors, but usually this is a skill issue, and not because they are greedy.

Best wishes,

-- Ashley Hill David Ashley Hill, M.D. Associate Director Department of Obstetrics and Gynecology Florida Hospital Family Practice Residency Orlando, FL http://home.mpinet.net/dahmd

The above is intended for general medical education, and is not for specific medical advice. I apologize, but I am unable to answer personal e-mail due to time constraints.

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