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Revolutionizing Women's Health: Non-Surgical Alternatives


Mrs DismukesImagine working for a company that among its many operations, develops software and hardware for the Space Shuttle, prepares astronauts for space flights, and provides mission planning for the largest global exploration efforts in history. Georgia Dismukes doesn't have to call on her imagination: she's one of the aerospace workers at United Space Alliance, NASA's major partner in the Space Shuttle program and a critical contractor for International Space Station.

Ms. Dismukes knows well the results of exploration and research. After all, working in an environment of discovery and technological wizardry, she's a first-hand witness to scientific progress that benefits humankind. Last summer, the human resources professional became the beneficiary of medical innovation when her gynecologist diagnosed her fibroid tumors and referred her to John Fischer, M.D., interventional radiologist at CHI Baylor St. Luke's Medical Center, to see if she were a candidate for a new method of treatment.

Fibroid tumors, noncancerous (benign) growths in the muscular wall of the uterus, affect millions of women. Twenty to 40 percent of women age 35 and older has uterine fibroids of a significant size. While the tumors don't always present symptoms, their size and location can lead to problems, including heavy prolonged menstrual periods; cramping; pelvic, back or leg pain; or pressure on the urinary system and bowel. Ms. Dismukes' symptoms of heavy menstrual bleeding and pain became so severe that she lost days of work.

Fibroids are the number one reason for hysterectomy, the surgical removal of the uterus. They account for more then one-third of the 600,000 hysterectomies performed annually in the U.S. The procedure requires general anesthesia, last one to three hours and usually involves a hospital sty of two to five days. Full recovery can take four to eight weeks. Hysterectomies result in the inability to bear children and if the ovaries are removed, menopause sets in, accompanied by the ever-increasing dilemma of whether to take hormone-replacement therapy.

Some women with fibroids choose to have a myomectomy , the surgical removal of the fibroids. This procedure eliminates the symptoms and, like a hysterectomy, uses general anesthesia, requires up to five days in the hospital and four to eight weeks of recovery. It also leaves open the possibility that the tumors may reappear.

Dr. Fischer offered Ms. Dismukes another option. Uterine fibroid embolization (UFE) is a non-surgical, uterus-sparring, minimally invasive treatment lasting less then one hour and requiring only a small nick in the skin. On average, patients reutn to their normal activities within a week.

"I asked Dr. Fischer a ton of questions," said Ms. Dismukes. "He didn't mind at all. He took the time to explain the diagnostic tests, the ultrasounds and the MRI. Then he gave me details about the UFE procedure. I studied patient brochures and visited the Web sites so I could make the best decision for me. "She chose to have UFE because it was the least invasive option and would allow her to keep her uterus. The procedure would also allow her to return to work in a matter of days instead of weeks.

So what is this new treatment for fibroids?

"Fibroids thrive on a supply of nourishing blood delivered through tiny blood vessels," explained Dr. Fischer. "Uterine fibroid embolization blocks the vessels that lead to fibroids, causing them to shrink."

Rather than being placed under general anesthesia, patients are placed under mild sedation, which blocks any sensation yet allows them to breathe on their own and respond to questions from the physician.

"I insert a slender, flexible tube, a catheters, through a small nick in the skin into an artery at the top of the thigh, and inject a contrast fluid to make the artery visible on a monitor," Dr. Fischer continued. "With the help of x-rays and other imaging techniques, I guide the catheter into both uterine arteries and introduce tiny particles - EmbosphereTM microspheres - into the blood vessels leading to the fibroids. The microspheres block the blood flow feeding the tumors, a process called embolization. In a short time, the tumors shrink, alleviation a patient's symptoms. Most of my patients have returned to normal activities within five to seven days."

Since patients are under mild sedation, some, like Ms. Dismukes, choose to watch the procedure on the same monitor the physician uses to guide the catheter.

"It was cool watching what Dr. Fischer was doing, talking to him, listening to his calming voice. Of course, I was sort of loopy and kept dozing off. The whole thing was really a breeze," recalled Ms. Dismukes.

Most women stay overnight at the hospital and go home the next day. Ms. Dismukes had the procedure on a Friday, was home Saturday and back at work the following Wednesday.

"Women are busy, with jobs, with family, with life," she said. "I knew I didn't want to be out of commission for six weeks. To me, it was worth it - no significant pain and a quick recovery. DR. Fischer was great, the radiology staff was wonderful, and, believe me, CHI Baylor St. Lukes is the only place to go."

Best ness of all? Ms Dismukes is pain free, back at work in her office on the corner of Gemini and Apollo Avenues, thinking about satellites, flight crews and space stations. Things she'd much rather consider than a long recovery period.

This article was published in the Winter 2004 edition of Innovator, a season magazine published by CHI St. Lukes Episcopal Health System. Written by Melinda Muse

 

Uterine fibroid embolization offers alternative to hysterectomy


Gayle Waden, now 46, lived with uterine fibroids for 20 years before achieving a solution to her condition. And much of the credit goes straight to her for conducting diligent research on the Web.
 
"For years, I postponed taking action because a hysterectomy seemed to be the only answer for my constant back pain and heavy menstrual discharge." Said Ms. Waden. "My doctor told me that she had seen many Black women with such fibroids, and they would probably shrink after menopause with estrogen reduction. Still, when a friend told me she had read about something new, I decided not to wait any longer. I looked into it on the Internet."

What Ms. Waden learned was that a relatively new non-surgical treatment was very effective at elimination painful and distressing uterine fibroids. So she explored further and located Dr. Fischer, M.D., interventional radiologists at CHI Baylor St. Luke's Medical Center. He had a strong record of successfully performing uterine fibroid embolization - and she appreciated how clearly he explained what would be involved.

Fibroid embolization offers an alternative to hysterectomy and to myomectomy. Hysterectomy consists of removing the uterus, while myomectomy involves cutting out the fibroids while leaving the uterus intact. Embolization, on the other hand, "starves" the fibroids of their blood supply, thereby making them shrink and die.

During the embolization procedure, which takes just over an hour with the patient under conscious sedation, the interventional radiologists inserts a catheter in the groin area, guides it to the uterus, and through it delivers sand like plastic particles that clog the uterine arteries. Recovery time is minimal; the patient may spend several hours in bed and stay overnight at the hospital for observation.

" I stayed at CHI Baylor St. Luke's Medical Center for 24 hours and left the hospital as if I had nothing done. Soon after, the nurse called me at home to see if my pain was under control" Once big positive for Ms. Waden was that her time off work was much shorter than if she'd had a hysterectomy. Typically, the time off is 20-40% of what would be required for a hysterectomy. Most patients return to work or to her daily activities within a week.

"That and avoiding major surgery made me very happy," she noted.

Although embolization has been employed for decades to treat tumors in other areas of the body and to stop internal bleeding, its use on uterine fibroids began in early to mid-1990's. Dr. Fischer, who has performed the procedure for three years, reports that the success rate is high - over 90% - the risk level is low, and there is no evidence of fibroids returning after the procedure.

"Of course not everyone is a good candidate for the procedure," he acknowledged. "The effects on fertility are unknown, although there are anecdotal reports of normal pregnancies after the procedure.

" Dr. Fischer performs the procedure in the Radiology Department of CHI Baylor St. Luke's Medical Center and can be reached at (832) 355-4110 or by email at jfischer@stlukeshealth.org.

Published in the July 20 - 26, 2003 Edition of the Houston Defender, Houston's Leading Black Newspaper. Written by Diane Callen