Uterine Artery Embolization/post-hyst. menopause/regrowth after FAS

hi
I am 41, had a myomectomy 6 years ago for multiple fiborids which returned within 2 years. Now i have a 16 week size uterus, with 20+tumors up to 5cm in size. I have wanted to avoid surgery altogether again, but now tired of dealing with symptoms: bladder pressure, bloating, 8 day menses, pain with pressure, abdominal bulk.
I thought UAE would be the answer, but seems like it only reduces size up to 50%. DO you know much about this procedure.
I met with a new surgeon recently who specializes in myomectomies> He recommended hyst..( keeping cervix, and ovaries) because of the numbers of tumors, likelihood of regrowth, and family history of tumors.
What percentage of women experience early menopause with hyst. when ovaries are intact?
What percentage of women DO have regrowth after FAS????
WHY does FAS cost twice as much as a myomectomy?
I am interested , but concerned about insurance coverage. (Fortis Insurance)
Thanks
leslie

Dear Leslie-
Unfortunately, you learned first hand the problems with myomectomy surgery. Your tumors did not return, they were never completely removed during your first surgery. This is a major difference between myomectomy and FAS, and one of the reasons for the cost factor.
FAS is much more thorough-we usually remove, on the average, about 20 tumors per patient; and have removed up to 65 from one patient. The uterus needs to be thoroughly examined, not just superficially. Small tumors can be found deeply imbedded in the muscle wall, which get left behind in a regular myomectomy. Many physicians also do not remove multiple, meaning many, tumors due to the blood loss problem. With the use of 2 lasers (also a cost factor) we have no blood loss concerns, and have never transfused a patient, not even the woman with 65 tumors.
This procedure has been performed for over 10 years and I have only seen one patient with a recurrence; she was in her late 20’s with already moderate disease. This is not the norm.
We never recommend hysterectomies unless there is a malignancy involved. If there is no cancer, why remove the organ? The nature of this disease is that it is genetic so family history is not a reason for hysterectomy, nor is the number of tumors. As you have seen, LARGE numbers can be removed (65) and the uterus saved for hormone balance and regulation. UAE is limited to few number of tumors and the entire uterus cannot be treated, as with FAS.
Early menopause can occur with a hysterectomy, but more prevalent is the incidence of hormone imbalance and difficulty with hormone regulation post surgery. It is always better if the body can do it naturally than to rely on chemical intervention.
If you would like your insurance checked out, or would like to speak to our nurse, please call the office.
Dr. DJ

Dear Dr. del Junco,

Several days ago my wife was told she had a 3 1/2 x 1 cm solid mass on one ovary, and a 5 1/2 x 1 1/2 cm solid mass on the other. She is 49, peri- or recently post-menopausal.

The masses were discovered as a result of symptoms that developed a few days after they began her on estrogen replacement therapy. They told her, in order of seriousness, that the transvaginal ultrasound indicated she had a 1) fluid filled cyst that would drain, 2) a “chocolate” cyst that would need to be helped to drain, a 3) dermis (sp?) growth that would have to be removed, or 4) a benign tumor. Because of the clear, smooth, and definite boundaries of the masses, she was told that it was unlikely that they were malignant growths, although always a possibility.

She was told to wait 3 weeks to see if the masses subside. If not, they will put her under general anesthesia the day after her followup visit and do a laparoscopy. What they find will determine what they will do while she is still under the anesthesia.

She is quite concerned about the possibility of removal of her ovaries, and possibly her uterus as well. It was not clear if they will remove the masses from the overies if they can’t be drained, or will just remove the ovaries. She will have decide whether to grant permission for her ovaries and uterus to be removed before she goes under general anesthesia, thus directing the surgeon how proceed if this level of surgery is indicated.

What are our options? We live in the Midwest–are their others who follow similar procedures as yours closer to us than California? Also, it sounds as though your procedure (which she discovered on the Net) is very effective, but perhaps indicated for far more serious conditions than hers. Any help you can provide will be deeply appreciated.

We are about 2 hours from the University of Iowa Hospitals, and 3 1/2 hours from the Mayo clinic. We are within a day’s drive from Chicago, Kansas City, Omaha, and St. Louis.

Concerned husband

Dear Concerned Husband-
This is the only place in the United States performing FAS. You would need to come to California for the procedure.
Your wife was diagnosed appropriately however I do not agreed with the intended surgery. The ovarian cysts can be safely removed with a laser and the organs reconstructed. There is NO need to remove her ovaries or uterus. I do not consent my patients for organ removal; we have legislation in California that requires all women be consented for sterilization 24 hours prior to surgery, if this is a consideration. In my practice, this is NOT a concern or an option.
If we can be of assistance, please call my office nurse.

I am 36 years old. I recently had my third Blighted Ovum within 7 years (9-14 week pregnancies). I also had a miscarriage at 6 weeks, about 5 months ago. It wasn’t until after the first 2 Blighted Ovums that I was diagnosed with 3 fibroids (2 being submucosal and 1 Intramural measuring approx. 3cm each). I have constant lower back pain and horrible cramping with my peroids. I don’t have extremely heavy peroids compaired to some I have heard of, but heavy enough. I am appealing my insurance for the third time to consider UAE as an alternative to a hysterectomy. The OBGYN’s that I have seen within my insurance group give me no other options but to have a hysterectomy and make me feel ignorant when I bring up any alternative procedure. What is the wrong with the system? Would FAS possibly be a better alternative since I do want to continue trying to have a baby.

Dear Tammy-
You are definitely a candidate for FAS, with classic fibroid symptoms. Our procedure would allow you to preserve your organs, and the possibility of getting pregnant. We do NOT recommend UAE because they have no long term reports on the effect of their procedure. By cutting off the blood supply to the fibroid, surrounding areas of the uterine muscle are also effected. There is not way to determine how much of the uterus will be directly effected and potentially destroyed. With FAS you do not have this problem. We remove the fibroids using a laser that reduces the damage done to the surrounding tissues without destroying viable uterine muscle. We have had great success, and our patients are very happy. Please call the office if we can help you.

Dear Tammy –

Just to let you know, UAE is already documented to have caused the death of a 51-yr old woman from a massive blood infection due to the dying fibroid tissue. Emergency hysterectomy was performed, but other complications occurred and she died. See article in the July 24 issue of LANCET, a highly prestigious medical journal. Make no mistake about removing blood supply from tissues (good or bad) – it’s not as simplistic as it sounds. I am familiar with blood/tissue biochemistry from my professional background and I happen to be one of the many successful recipients of FAS. My body is just where it should be after almost 8 months post-op – perfectly normal. And I mean from ALL aspects, organ size, function, emotionally and physically. With UAE you may or may not get major improvement, and that’s because you are altering circulatory pathways in your body, plus try to UNDO whatever your body’s dysfunction created, without really resetting its balance. I am even “over 40”, so you would think I should be a hormonal mess – BUT I am not! So be careful about UAE – at least study this website and talk to other FAS patients. If you have specific questions, I am always available by email or phone. Think of hysterectomy as the result of very limited surgical skills – and don’t give up! Good Luck!

Mica

Hi,

I am 48 years old. My periods have been irregular and body changing so I know I am heading for Menopause. Due, to thin stools which I felt were not right I had the test done where they scope the lower colon. They found a rectoseal and hemmroids. A week aFter this test I felt like all my organs were going to fall out of my body. There was so much pressure on my bladder I was afraid to go to the bathroom. The rectoseal which had never bothered me pain wise, activated and seemed to get bigger and more painful, I had pain in the right side going to the navel, to pubic bone and a sore bladder. I felt like I had to hold my adomen to stand up and keep everything from falling out. The onset was so sudden, I called my General Doctor over the weekend wondering if I should go to emergency. After a week or so the feeling that everything was going to fall out faded away.

After many painful tests they found the rectoseal moderate and it took a catscan to show that I have 6cm Fibroid tumer. I have been working with my general Doctor and Colon Doctor and no OBGYN yet (next step in the system). All other organs looked fine (no prolapse).

Now have: soreness and pain in rectoseal area. sore bladder and sore right side like a borderline burning sensations. Some days are worse than others. I still have periods (always bad cramps)and they are irregular. In the last three years I have developed ankles that swell up off and on (never had this problem and worked on my feet for years) and feel up and down tired.

It seemed to me like I was attacked from the inside all of a sudden. I may have had many of these things for a time and not known it but to me it seems everything is happening at once. I went from on and off swollen ankles and tireness with no other pains to painfull hemmroids, rectoseal and fibroid tumer (within 1 or two months timeframe).

I will be seeing an OBGYN in this area but this is a small town area and I want to know my options. It is also very hard to get into a OBGYN here. Two that were highly reccomended and known to be progressive are not taking any new paitents or referrals. In any case I will get a second opinion and would consider coming to your clinic.

Questions:
Do you have any thoughts as to why it seemed like I got the big hit? (like maybe my body chemistry is spiking)

Can any of this be resolved without surgery?

If surgery for all is recommended, can all of these things be taken care of at one time at a clinc like yours including the rectoseal?

IF surgery is needed for rectoseal, from your perspective, is it better for the rectoseal to be fixed through the vagina or the rectum?

Does your clinic assist women with a natural program to get through menopause? It is obvious to me I need help!

I live in Battle Creek which is 1.5 to 3 hours from Chicago, Ann Arbor, and Detorit Michigan. Do you know of any clinics that have procedures like yours these areas?

I know you can’t diagnose an e-mail but I would appreciate a response to my questions and any information you can give me as to what may be going on and possible options.

Thank You,
Deborah

Dear Deborah-
Thank you for your email….you do have a lot of questions!!!
First, let me say, our location in California is the only place currently offering FAS. We are unaware of any other physicians performing this exact type of laser reconstructive procedure.
There is no way to know why you are suddenly having increased symptoms……both your fibroid and rectocele are surgical conditions -they will not go away without surgery.
Rectoceles are always repaired vaginally, and are not something we do here at our office. This is very simple traditional gynecology that is done on an outpatient basis and can be performed by any gyn. Our procedure is much more specialized….and requires reconstruction within the pelvis.
Since we are a surgical office…we do not follow patient for hormonal regulation…this we refer to either gyns or endocrinologists.
I would recommend you have your fibroid removed….is should alleviate some of your symptoms.
Good Luck

Dear Doctor,

Thank you for responding to my message (Deborah S). Since I have written you I have seen an OBGYN Nurse. Upon examination she feels that the fibroid tumer began to press down into my colon. I have a serious spine curvature so my tailbone is off to one side. The colon, rectoseal, tumer and tailbone meet together causing pain. She is setting me up to see the Doctor in one month. hysterectomy was encouraged (as I don’t need these organs at 48 anymore)but other options were made available.

Now we get to my question. Since your office does not do the rectoseal surgery would it make sense to have you take care of the tumer (also have overian systs) and whatever else you may find and go through another surgery for the rectoseal?

Thanks for your help!
Deborah

Dear Deborah-
No matter where you elect to have surgery….both procedures should not be performed at the same time.
I would recommend the abdominal procedure first and a repair of the rectocele at a later date.
Give my office a call if we can help you.

Hi doctor,
I want to know the total cost associated with FAS.
I can not understand it from the website, which says $4,000.00 at one place and $22,500 at the other place.Please tell me in words instead.
I appreciate you for this website, as it can help many..
Thanks,
a person in need..

Dear Person-
The total out of pocket for patients with no insurance (ie: HMOs that dont cover,or out of country patients) is $22,500-this pays for everything: 4 nights in private hospital room, all services, laser company with technician, and 7 doctors.
The $4000 is the “average out of pocket” most patients have in total for everything when they have insurance coverage..
Hope this clarifies.