question

December 31, 2000

Hey all:

I only ate 11 GM of Carbs today...is this OK?? I ate a lot, drank a ton, but

stayed away from " high carb " options. Let me know, OK???

Thanks

August

December 31, 2000

Hey all:

I only ate 11 GM of Carbs today...is this OK?? I ate a lot, drank a ton, but

stayed away from " high carb " options. Let me know, OK???

Thanks

August

January 1, 2001

August You done us all proud Girl!!

January 10, 2002

I have been developing a list of questions I have been gleaning from all the

posts I've been reading as I have an appointment at the end of the month for

a consultation as well. Here they are for anyone that may find them useful.

You will also notice that there is info in some of the questions in

parenthesis. I included info that was provided by some of the Doc's on these

boards so I would have the info handy when I asked the question.

Hope this helps! I apologize for any spelling errors. Not sure how the

listserv will handle the formatting of this list. If it gets " messed up " I

can e-mail it as a word document to anyone who wants it.

Ann

General Questions

· How do I know that I don't have further issues such as adenomyosis, polyps,

hypoplasia, cancer or growths outside the uterus in the abdominal cavity?

· Will a MRI be done pre-procedure? Why or why not? What is the resolution

on a MRI compared with the tests I have had?

· What are all the options for my condition whether or not you can perform

all of them?

· If the fibroids grow suddenly, will these treatment options still be viable?

· What do you usually suggest for women with symptoms like mine? How many

patients have you referred out for procedures you can't do?(Gynes to

interventional radiologists or IR to gyn's-since there is no one procedure

that fits all patients).

General Procedure Issues

· I want the IV into my forearm for ease of use of arm.

· Will a foley catheter be used? Will it be inserted post anesthesia?

· What is your approach to pain management post-op? Who provides it and are

they experienced in dealing with patients that have had this procedure? If I

have negative/allergic reactions to the drug, what are the other options? Do

you make use of patient-controlled pain medication in the hospital?

· How long of a hospital stay is involved (minimum and maximum)?

· What are the chances the procedure will relieve my symptoms (Heavy

bleeding, large clots, gush bleeding, painful cramps, bulk symptoms, weight

gain, large abdomen, reduced bladder capacity)?

· What are the possible side effects and complications of the procedure and

how often do they occur?

· How many of these procedures have you done? How many in the last year? In

the last month?

· How many cases resulted in an open laparotomy and how many resulted in

hysterectomy?

· What is the possibility of forming adhesions and how can they be dealt with

later?

· What medications/drugs will be used during the procedure? Please include

all anesthesia, pain medication, solutions used in relation to endoscopic

equipment etc.

· Can you speak to some of the patients who have had the procedure, if the

doctor gets the permission from them in advance before giving their number to

you? Include patients who've recently been operated on as well as those who

are six months to a year or two in recovery.

· How many people will be involved in the procedure? Are they all certified

in their role, or are there students, residents and other people " in

training " who will be involved in the procedure?

· Are there other medications/vitamins/herbs that would conflict with the

procedure?

· Can you please provide a signed document indicating what type of procedure

we have agreed on (Documentation regarding hysterectomy?).

· Can the procedure be documented on videotape?

Myomectomy

· Have you ever performed a hysterectomy on a woman when the intent was to

perform a myomectomy?

· Who is doing the anesthesia and how often have they done anesthesia for

this procedure and how often worked with you? What type of anesthesia do

you recommend in this situation? If for some reason there is a problem with

the initial anesthesia, what is the back-up plan?

· Can the fibroids be removed with a mini-lap or a full laproscopic procedure?

· Do you make use of an Interventional Radiologist during surgery to control

bleeding?

· Should excessive blood-loss occur, would you resort to a laparotomy or

hysterectomy?

· How will my fertility be preserved during surgery (attention to protecting

the uterine cavity and tubes, use of adhesion barriers, etc)?

· What would happen if anything suspicious is found during surgery? How

would frozen section's be handled? Do you perform a biopsy on the fibroid to

determine if it is cancerous? What routes would you take if it was

determined to be cancerous?

UAE

· What method do you use to close the incision? Manual Pressure? Perclose?

What about problems with the Perclose causing problems for further caths or

uae's. What about narrowing of the vessel? (Perclose adds complexity. For a

routine procedure that uses a small catheter, I think that it is not

necessary. The advantage (ability to get the patient up and about more

rapidly) is often not realized because of cramping or nausea after the UAE.)

· Is there a difference in outcome based on device (product size, primary and

secondary embolic material) used?

· What type of material is used to plug the arteries? (PVA, BTW,

Embospheres)

(PVA is a plastic. It is NOT silicon or silicone. (BTW - Silicone is one of a

class of plastics, PVA is in a different class, silicon is an element - one

of the most common elements in the world. Silicon Dioxide is simple sand or

glass). PVA has been used as an implanted biomaterial since the mid-1940s.

It is one of the best known and safest biomaterials known to science. There

are NO reports of adverse reactions (short or long term) to PVA. Embospheres

are made of yet another plastic (tris-acryl), which also has a documented

history of biocpmpatability spanning over 20 years.

· What is the size of the particles? (Embolized with particles <355 microns

in size which led to increased uterine ischemia and more uterine necrosis

than with larger embolic particles).

· What about UAE syndrome? (Roughly 15% of UAE patients experience this

syndrome, that there is no known way to prevent it or cure it, and that the

doctors are really not even sure what exactly is causing it.

Post-Embolization Syndrome (PES), characterized by acute and/or chronic pain,

temperatures of up to 102º, malaise, nausea, vomiting and severe night

sweats).

· How will we know if I have on Uterine artery or more than one on each side?

If there are variations in the pattern how much experience do you have in

dealing with this situation. How do you manage it? (about 1 woman in 50-100).

· What is the exposure to radiation during this procedure? What are the

risks from that? (There is an exposure of approximately 20 rads (radiation

absorbed dose) or more depending on the length of time the procedure takes.

The absorbed ovarian dose is significantly higher than from standard

fluoroscopic diagnostic procedures).

· Occurrence of side effects:

· infection from tissue death of fibroids, which can lead to endometritis

(infection of the uterus) which may result in lengthy hospitalization with

intravenous antibiotics

· foul vaginal odor, coming from the uterus

· misembolization: polyvinyl alcohol (PVA) particles may inadvertently flow

into organs or tissues where they should not be, causing damage to other

organs or other parts of the body

· damage to the ovaries (resulting from particles migrating to the ovaries)

· vaginal expulsion of fibroid

· failure to shrink fibroids or resolve symptoms

· regrowth of fibroids

increased uterine and fibroid volume

January 10, 2002