Dr. Richard Reed is an interventional radiologist currently working at the Huntington Memorial Hospital in Pasadena, California. Dr. Reed is also a Clinical Assistant Professor of Radiology at the University of Southern California, School of Medicine and is very active in the medical community, such as his participation in the National Uterine Fibroid Embolization Task Force. Dr. Reed advocates for the public awareness of interventional radiology, and he is working towards a future where women know all of their options in dealing with symptomatic fibroids. We are honored to present Fibroids1 readers with an interview from Dr. Reed.
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Fibroids1: How did you choose your specialty?
Dr. Reed: Currently, I specialize in interventional radiology. However, I actually started with a residency in internal medicine. During that time, interventional radiology was advancing as an innovative way to deliver treatment for a variety of conditions in a less invasive way. Interventional radiology allows me to use aspects of my internal medicine background for image-based therapy.
Fibroids1: What are the procedures that an interventional radiologist undertakes?
Dr. Reed: Interventional radiologists perform procedures that are performed under imaging guidance. Typically, interventional radiologists employ fluoroscopy, x-ray, ultrasound and computed tomography (CT) to perform less invasive procedures and treat a wide range of conditions.
Instead of performing open surgery on patients, interventional radiology allows treatment to be performed in a much less invasive way. Via a small incision, interventional radiologists can treat many diseases that would other require general anesthesia and open surgery. Embolization, the procedure of blocking the blood flow to various anatomical areas, the opposite of angioplasty, can be very beneficial in treating a variety of conditions. For example, embolization is used to treat trauma victims with life-threatening hemorrhage. Patients who sustain injuries from automobile accidents, gun shot or stab wounds can be treated in the angiography suite, where interventional radiology procedures are performed. Instead of using conventional surgery to stop the bleeding, an embolization procedure can be performed to find and stop the bleeding. Using interventional radiology techniques, a catheter or tube is directed into the blood vessel from the inside to control bleeding. Embolization can also be used to treat gastrointestinal bleeding and cancer. More recently, embolization has been used to treat symptomatic uterine fibroids.
Fibroids1: When did this less invasive treatment for uterine fibroids become available and mainstream?
Dr. Reed: Uterine fibroid embolization was first performed in the late 1980s in France. The procedure was initiated in an attempt to decrease bleeding in patients that were preparing for surgery to remove their fibroids (myomectomy). In patients that had a long time delay between the UFE and the myomectomy, patients would often find that their symptoms were dramatically improved after the embolization. These patients were followed and it was realized that embolization was very effective at relieving the symptoms of fibroids. Embolization was then offered as a primary therapy for the treatment of fibroids.
In 1995, the first publication on UFE was published, documenting the success of the procedure. At this time a gynecologist from UCLA traveled to France to learn more about the procedure and returned to refer the first two uterine embolizations in the United States. (These two procedures were performed by an interventional radiologist.) Since then more and more medical centers have begun offering the procedure. I have been fortunate to work with pioneers of the procedure in the early years of its development.
Fibroids1: Where do you see new trends, improvements and new possibilities in UFE?
Dr. Reed: The field is very exciting because fibroids are so common, occurring in up to 50 percent of all women. Being relatively new, it is still necessary to discover the optimal embolic material and particle size. Also, a better-working relationship between gynecology and radiology would be very beneficial in the future development of UFE.
Fibroids1: What do you feel is the most rewarding part of your work, in regards to the UFE procedure?
Dr. Reed: It is very rewarding to realize what UFE can offer women who suffer from symptomatic fibroids. So many women have hysterectomies for fibroids. A hysterectomy is a difficult operation to go through, requiring a long period in the hospital and six to 12 weeks of recovery time. The operation also has a large risk of complications. We can offer uterine fibroid embolization, a less invasive procedure that is done as an outpatient and diminishes recovery time to one week. It is very rewarding to treat women that have fibroids and offer them an alternative that is so much better than the surgical options.
Fibroids1: Are there women that uterine fibroid embolization is not an option for?
Dr. Reed: Patients are screened very carefully. If a woman has a condition other than fibroids causing her symptoms, she may require surgery. However, women that only have fibroids usually do very well with embolization. If very large fibroids are involved, larger than 10 centimeters, embolization may not be as effective. Also, women who desire future fertilty may opt for a myomectomy.
Fibroids1: What advice do you give women before deciding on surgery?
Dr. Reed: It is important that women understand fibroid treatment is only necessary if symptoms are present, which only occurs in a quarter of the women with fibroids. If there are symptoms that are attributed to fibroids, I advise women on what their options are.
Fibroids1: What are the options for women suffering symptoms from fibroids?
Dr. Reed: There are four options:
1. To do nothing.
2. Hormonal treatment. This treatment is temporary and can cause menopausal symptoms.
3. Surgical options: Myomectomy or hysterectomy. These treatments require general anesthesia, a four-night hospital stay, a long recovery (6 to 12 weeks), and are associated with a 20 – 25 percent incidence of complications.
4. Uterine Fibroid Embolization. This less invasive alternative does not need general anesthesia and can be done as an outpatient or with an overnight stay. Most patients are back to full activity in one week.
Fibroids1: Why are so many women not taking advantage of UFE as an option for uterine fibroids?
Dr. Reed: When women experience symptoms from fibroids they typically seek treatment from a gynecologist. They are often unaware of what an interventional radiologist is or how we can help with symptomatic fibroids. For example, if a woman has severe vaginal bleeding, she would typically call her gynecologist. It is unlikely that a gynecologist will refer a problem to an interventional radiologist if they know they can treat the problem with a surgical procedure.
In the future I hope that patients are referred to UFE specialists. Web sites like fibroids1.com are very beneficial to disseminate information and help women understand their options.
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