Dr. Harjit Singh’s specialty is Women’s Health Intervention. He uses interventional radiology techniques to treat a variety of complaints including fibroids. Singh is associate professor of radiology, surgery and medicine, fellowship director, Cardiovascular and Interventional Radiology (CVIR), as well as Director of Education of the Penn State Heart & Vascular Institute. He also serves as associate program director of radiology residency in the Penn State College of Medicine.
Singh was born in Hartford, Connecticut and grew up on Long Island. He earned a Bachelor of Science in Biology in the accelerated biomedical program from 1983 to 1985 at Rensselaer Polytechnic Institute before taking his degree in medicine at Albany Medical College. From 1990 to 1997, Singh completed his internship and a residency in diagnostic radiology at the Albany Medical Center, and a two-year fellowship in cardiovascular and interventional radiology at The Johns Hopkins Medical Institutions. In 1997 he accepted a faculty position at the Penn State Medical Center where he established a clinical practice in Women’s Health Intervention in Hershey, Pennsylvania.
Fibroids1: Why did you decide to go into interventional radiology?
Dr. Singh: It was actually a choice between surgery and radiology since I felt I was good with my hands. But I loved the ability to see inside the body from the outside with imaging, so I pursued radiology. That took me down the path to interventional radiology, a field that I became truly enamored with during my two years at Hopkins – probably the most stimulating center on the East coast for medicine. It was at Hopkins that I fell in love with what I do.
Fibroids1: Your practice is within a larger OBGYN clinic. Can you explain how this unusual arrangement came about?
Dr. Singh: I have found a great deal of support here in Central Pennsylvania, and my specialization in women’s health Intervention has been well received. In the process since my arrival in 1997, I’ve developed a very cooperative and congenial relationship with OBGYNs in the area. Thus, this past summer I moved my clinic into the larger OBGYN clinic at the Hershey Medical Center.
It’s a very big deal around here. Patients are surprised because they think there’s a contentious relationship between the two groups – OBGYNs and interventional radiologists based on what they see in the pop media. They seem pleasantly relieved, and also reassured by the idea that we, as practitioners involved in women’s health, are collaborating.
Similarly, the OBGYNs in the clinic have realized that I don’t really take that much of their business. I feel the most appropriate way to handle uterine fibroid embolization (UFE) is to make it a small part of the treatment options. I’m very selective in who I treat, and not all women with fibroids are good candidates for embolization.
The arrangement really is a mutually beneficial one. A couple weeks ago I saw six patients in my new patient clinic for women’s health. Of those, I decided I could embolize three. In the remaining group of those I could not safely treat, two did not have OBGYNs they were satisfied with. So I was able to refer them to our OBGYNs. Thus the docs see me bringing new patients to our practice.
Fibroids1: What criteria do you use for selecting patients for UFE?
Dr. Singh: It’s not as much about the indications – we know that women come in with pelvic pain, bleeding and other symptoms commonly associated fibroids – as it is about making sure they don’t have contraindications for embolization. Typically, I screen out women who have pedunculated fibroids, are of childbearing years, and who have acute, severe symptoms.
Fibroids1: How do you determine the presence of fibroids?
Dr. Singh: We do pelvic MRIs on all patients. This enables us to make sure fibroids are the source of the symptoms. Large ovarian cysts, among other things, can cause a lot of pelvic pain, so it’s important to make sure that there are not other causes for the patient’s symptoms.
Fibroids1: How do patients find out that you use interventional radiology to treat women’s health problems including fibroids?
Dr. Singh: Word travels between family members and friends, and I probably have the longest running fibroid embolization practice in Central Pennsylvania with my first patient in mid-1999. Now, it’s nice when I hear referring physicians say, “This is the guy you need to go see on this.”
Also, in my specialty of Women’s Health Intervention, fibroid embolization is only part of what interventional radiology can do for women in terms of health issues. So I see women for various problems including pelvic congestion syndrome and fallopian tube blockages as well as fibroids, and they carry the news back to their circles as well.
What we do know is that the word is getting around. I’ve probably done close to 200 embolizations since I started with 50 or so of those in the last year alone. So the number is escalating as more women find out what we have to offer.
Fibroids1: How about the pain associated with the procedure?
Dr. Singh: All patients experience post-embolization pain. We admit the patients to the Interventional Radiology service and place them on either a morphine or dilaudid PCA pump for around 12 to 15 hours. The patients are watched overnight and discharged first thing in the morning. I have had to keep only one patient in six years for an extra 12 hours for pain control. The patient experienced lesser degrees of pain at home, culminating in a wave of cramps on day number three. I have not had any patients require narcotics at home, but I make it clear that is an option if they need it.