KAY: Question to Ask One's Doctor

[Guest guest]

In a message dated 4/23/2004 8:31:10 AM Eastern Daylight Time,

cactuskat2@... writes:

I do feel so much better after learning from my OB that it is not a

leiomyosarcoma, even though he said that I need to have a hyst. Every OB that

I've

seen, 5 so far, recommend a hyst as the normal thing to do.

Dear Kay:

Your post reminded me how important it is for us to ask a very critical

question of our doctors, once we've been told of the doctor's treatment

recommendation for us.

Whether it's our second, third, or UMPTEENTH opinion, we really need to

follow-up by asking:

" Doctor, on WHAT are you basing your OPINION --to do X? "

So often we patients KNOW--but tend to forget-- that when a physician makes a

recommendation for surgery, his or her recommendation is just an OPINION--not

a pronouncement of MEDICAL CERTAINTY. No matter how emphatically the message

is delivered to us. No matter how many media " best doc " distinctions he has

received. It's an opinion.

A good doctor will have valid, well-thought out medical reasons on which to

base his opinion.

A less competent doctor who dictates a given treatment for us may simply be

saying what HIS/HER comfort level/experience leads him to advise, with respect

to a given procedure. Similarly, there could be financial incentives

influencing his recommendations. And/or his information may be outdated, his

experience may be inadequate.

So, Kay, maybe hysterectomy IS " normal. " Normal for him and his practice.

But-always remember- " normal. " does NOT mean it's necessarily THE BEST thing for

you, the patient.

Of course, NO gyno I have ever known would have readily admitted to a

patient-- " Doris, when it comes to myomectomies, gosh, I'm " all thumbs " --so....

whaddya say we go the with hysterectomy, 'cause it's less challenging for

me--Ok? "

No, you don't hear those kind of admissions too often-- any more than you see

framed subpoenas the doctors has received for malpractice suits, hanging

neatly on his wall!!!:-)

Or, how 'bout hearing this: " ly, Joan, the reimbursement for

hysterectomies is sooooooo much better than what your insurance gives me for

MYOS. So,

have a heart--and have a hysterectomy! And help my bottom line!!! "

Lest anyone here forget, hysterectomy is easy surgery. Myomectomy requires

much more skill, and much more technical competence.

Another important question to ask is the risks/benefits to each procedure.

As we all know by now, everything in life has risks and benefits. If your

doctor says there are " no " risks to hysterectomy or myomectomy, or

tonsillectomy,

fire the liar.

Of course, there is no guarantee that you will get a thoughtful, informed

answer even when you DO ask certain probing questions of your trusted

gynecologist. I should know.

Of the MANY gynecologists I asked --regarding changes in sexual response

post-hysterectomy (because, naturally, all of them recommended hysterectomy for

me). . .

Every single one of these doctors--male and female gynecologists alike-- said

" there IS no change in sexual response after hysterectomy. " Actually, one or

two conceded that, there would be NO change in sexual response, PROVIDED my

cervix " is left in. "

When I challenged this blanket assertion, and then brought up my concern

about losing MY pleasurable uterine contractions after hysterectomy, a funny

thing

happened.

Without exception, I got the same no-verbal response from ALL those docs:

They all stared at me, as if.......well, as if I had monkeys on my face!

(I'm sure You ALL know " that look " )

Ultimately, I suppose it's how WE, and not our DOCTORS, view the risks and

benefits.

But, a good doctor will provide a COMPLETE review of treatment options, and

outline the pluses and minuses.

No one disputes malignancy as being a valid reason for hysterectomy. And

there are other cases in which hysterectomy is kinda a no-brainer: cases that

are complicated by extensive endometriosis, adenomyosis, and unusual scenarios

such as the one described by listmember Michele who had a very rare monster of

a fibroid, a parasitic fibroid.

But barring any of those above-mentioned conditions, in this day and age for

us, (unlike our mothers) most of us on this list could probably avoid having a

hysterectomy---if that's what we desire.

Roma,

who has chosen to retain her uterus,

even with a gynecological history that once included 46 uterine fibroids (of

all types--excluding pedunculated!) endometriosis, adenomyosis, and ovarian

cysts too numerous to remember or count!

[Guest guest]

Hi Roma! My diagnosis is adenomyosis only, so far. Just had a D&C

yesterday to further check endometrial hyperplasia for atypia. Office

endo biopsy showed " without atypia " . My understanding is that if " with

atypia " cells are found, the hyperplasia is " pre-cancerous " and if that's

true, I would probably opt for a hyst.

In the meantime, however, I am frantically searching for an alternative

to hyst. I noticed you listed adenomyosis as one of your conditions. I

have not come across any information that has encouraged me about myos

being an alternative surgery for this condition and for someone my age -

54. (It seems like nearly everything I've read stipulates myos are " for

those who want to preserve their fertility " .) Can you tell me more about

your surgery and your doctor? I do not want to lose my uterus unless it

is my best option. With only adenomyosis (no symptoms except enlarged

uterus)and hyperplasia that can be treated effectively if not pre-cancer

kind, I am hoping to circumvent hyst. Would appreciate any info you can

provide from your own experience.

Kathy

[Guest guest]

Drs at Albany Medical Ctr in NY have been looking at UAE as

treatment for adenomyosis--may be something you'd want to check into.

With only adenomyosis (no symptoms except

enlarged uterus)and hyperplasia that can be treated effectively if not pre-

cancer kind, I am hoping to circumvent hyst.