By: Jean Johnson for Fibroids1
Pennsylvania might be behind California as far as trend setting goes. But when it comes to offering women with fibroids comprehensive care, the Hershey Medical Center is well ahead of the curve. By creating a Women’s Health Clinic with 19 obstetrics-gynecologists and one interventional radiologist who specializes in women’s health, this group of 20 physicians is able to offer women a full range of state-of-the-art treatments for uterine fibroids.
|Questions to ask your doctor:|
What options do I have for treating my fibroids?
Can you explain the risks and benefits of each option?
What is your recommendation?
What is the recovery period for the recommended option?
What about short term versus long term treatment options
Remember, you can always seek a second opinion if you feel your doctor did not answer your questions fully or appropriately.
“It’s all about feeling fully informed,” said Matt Davies, M.D. chief of the division of women’s health at Hershey and the Ob/Gyn residency program director. “Having the information readily at hand translates to our patients feeling fully empowered to make decisions.”
Hysterectomy was the gold standard for treating uterine fibroids for years. Major surgery that brings on early menopause, however, is a drastic step that many women with uterine fibroids who are waiting to have children until their thirties and forties are increasingly reluctant to take.
Myomectomy, in which fibroids are removed and the uterus left intact – and thus does not disrupt a woman’s natural cycle – is one option that Ob/Gyn surgeons offer women.
Another approach that has gained credence is embolization. In this procedure interventional radiologists work with real-time imaging via a catheter inserted in the groin, to cut off blood supply to fibroids.
In most cases, Ob/Gyn offices and those of interventional radiologists are miles apart. But, as uterine fibroid embolization has gained credibility, dialogue between practitioners in these various specialties has increased. So, the folks at the Hershey Medical Center took things to their logical conclusion and moved in together.
“We found that we were seeing the same patients in different places and having to discuss their cases by pager and e-mail,” said Davies. “Then Dr. Singh [Hershey’s interventional radiologist] said, ‘wouldn’t it be great if we could be in the same location so that if either of us had questions we could just walk down the hall.’”
Davies explains that he agreed as did his colleagues. The result was that in summer 2005 Harjit Singh, M.D. relocated his clinical practice to the Women’s Health Clinic and now sees patients right alongside the Ob/Gyns.
“Usually what happens is that patients are coming in to talk with Dr. Singh about uterine fibroid embolization [UFE], and a question will arise in which they want to hear more from a gynecologist,” Davies said. “When that happens, we’re happy to jump out of the office and talk to them on the spot. This flexibility works both ways, with Dr. Singh making him self available to visit with any of our patients who have questions about interventional radiology and embolization.”
Davies adds that by the time patients get to Singh, they have generally educated themselves through word-of-mouth from family and friends or by visiting web sites like Fibroid1.com on the Internet. “So often, patients just need to hear about the older options a last time before making their decision. That’s where we can come in and re-educate. It’s really a way of refreshing what they’ve already heard about.”
Singh points out that the mutually-beneficial relationship between himself as an interventional radiologist who treats fibroids with embolization and the gynecologists who use surgical techniques also helps generate patients for physicians on staff at the clinic. “If women who don’t have a gynecologist come to see me, and it turns out they are not good candidates for embolization, I can refer them to our Ob/Gyns here at the clinic.”
What’s taking place at Hershey really is a step forward, since only three years ago, associate professor of radiology and vice chairman of the department of radiology at Georgetown University Medical Center, James Spies, M.D. pointed to a serious communication gap between Ob/Gyn surgeons and interventional radiologists.
“Some Gyns and family practitioners are unfamiliar with UFE and with the medical specialty of interventional radiology. They may even be skeptical, which is somewhat understandable – it’s not a procedure they perform, and although the very same procedure has been safely used in women to stop bleeding after childbirth since the 1970s, it’s been used for fibroids less than 10 years,” said Spies before going on to refer to a 2002 study that he led. “Comparative studies such as ours hopefully will provide the needed information and help doctors become more comfortable with presenting UFE as an option to treat fibroids.”
What Spies and his colleagues found was that in 2002 most patients who saw interventional radiologists about the possibility of embolization were not referred by Ob/Gyns. Specifically, only one in 10 women who underwent UFE at Northwestern Memorial Hospital in Chicago were informed of option from their Ob/Gyns. The survey of 100 women produced the following results:
79 percent said Ob/Gyns did not mention embolization as an option
64 percent reported that their Ob/Gyns recommended hysterectomy
23 percent said they were steered to myomectomy by their Ob/Gyn
“There were 13 Gyns who did recommend UFE,” said Robert Vogelzang, M.D., chief of interventional radiology at Northwestern Memorial and professor of radiology at Northwestern University Medical School. “But of the rest of the women’s health physicians, at best they said they didn’t know anything about embolization – and at worst they said the procedure wasn’t effective. Several women were told in no uncertain terms that the procedure would result in severe pain for weeks. None of the women who had the procedure at our institution experienced that.”
Vogelzang’s study also determined that the majority (69 percent) of women found out about embolization through articles and advertisements on the Internet, television, newspaper and magazines, while 20 percent were referred by family and friends.
“More and more women are pursuing medical information on their own and are not necessarily content to follow the advice of their Gyns. In this day and age of modern medicine, women are asking if there are treatment options besides major surgery,” said Vogelzang.
Indeed, both Singh and Davies note that Hershey’s arrangement has been well received by patients. The pair of physicians says that women appreciate the idea that practitioners are collaborating, and that there is a single Women’s Health Clinic where they can get all the information they need.
As far as potential conflict of interests between the traditional surgical community and the newer interventional radiologists, Davies said, “I don’t see it as a conflict of interest as much as simply a newer technology that gynecologists initially didn’t understand. Other new treatments like freezing and heating came and went, but this one is staying. We’re all coming to realize that embolization is a viable treatment option for some women who are not good candidates for surgery.”
Conversely surgery is a good option for patients who are not good candidates for UFE, says Singh. So, at Hershey it’s all about professional practitioners cooperating in a single setting for the betterment of their patients. Clearly it’s a win-win for women with fibroids looking for the best in pre-treatment counseling as well as assurance that all options available will be on the table for their consideration. “This is global counseling at its best,” as Davies quipped. “One-stop shopping.”
To read an interview with Harjit Singh, M.D.
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