Revolutionizing Women's Health: Non-Surgical Alternatives
 Imagine working for a company that among its many operations, develops software and hardware for the Space Shuttle, prepares astronauts for space flights, and provides mission planning for the largest global exploration efforts in history. Georgia Dismukes doesn't have to call on her imagination: she's one of the aerospace workers at United Space Alliance, NASA's major partner in the Space Shuttle program and a critical contractor for International Space Station.
Ms. Dismukes knows well the results of exploration and research. After all, working in an environment of discovery and technological wizardry, she's a first-hand witness to scientific progress that benefits humankind. Last summer, the human resources professional became the beneficiary of medical innovation when her gynecologist diagnosed her fibroid tumors and referred her to John Fischer, M.D., interventional radiologist at CHI Baylor St. Luke's Medical Center, to see if she were a candidate for a new method of treatment.
Fibroid tumors, noncancerous (benign) growths in the muscular wall of the uterus, affect millions of women. Twenty to 40 percent of women age 35 and older has uterine fibroids of a significant size. While the tumors don't always present symptoms, their size and location can lead to problems, including heavy prolonged menstrual periods; cramping; pelvic, back or leg pain; or pressure on the urinary system and bowel. Ms. Dismukes' symptoms of heavy menstrual bleeding and pain became so severe that she lost days of work.
Fibroids are the number one reason for hysterectomy, the surgical removal of the uterus. They account for more then one-third of the 600,000 hysterectomies performed annually in the U.S. The procedure requires general anesthesia, last one to three hours and usually involves a hospital sty of two to five days. Full recovery can take four to eight weeks. Hysterectomies result in the inability to bear children and if the ovaries are removed, menopause sets in, accompanied by the ever-increasing dilemma of whether to take hormone-replacement therapy.
Some women with fibroids choose to have a myomectomy , the surgical removal of the fibroids. This procedure eliminates the symptoms and, like a hysterectomy, uses general anesthesia, requires up to five days in the hospital and four to eight weeks of recovery. It also leaves open the possibility that the tumors may reappear.
Dr. Fischer offered Ms. Dismukes another option. Uterine fibroid embolization (UFE) is a non-surgical, uterus-sparring, minimally invasive treatment lasting less then one hour and requiring only a small nick in the skin. On average, patients reutn to their normal activities within a week.
"I asked Dr. Fischer a ton of questions," said Ms. Dismukes. "He didn't mind at all. He took the time to explain the diagnostic tests, the ultrasounds and the MRI. Then he gave me details about the UFE procedure. I studied patient brochures and visited the Web sites so I could make the best decision for me. "She chose to have UFE because it was the least invasive option and would allow her to keep her uterus. The procedure would also allow her to return to work in a matter of days instead of weeks.
So what is this new treatment for fibroids?
"Fibroids thrive on a supply of nourishing blood delivered through tiny blood vessels," explained Dr. Fischer. "Uterine fibroid embolization blocks the vessels that lead to fibroids, causing them to shrink."
Rather than being placed under general anesthesia, patients are placed under mild sedation, which blocks any sensation yet allows them to breathe on their own and respond to questions from the physician.
"I insert a slender, flexible tube, a catheters, through a small nick in the skin into an artery at the top of the thigh, and inject a contrast fluid to make the artery visible on a monitor," Dr. Fischer continued. "With the help of x-rays and other imaging techniques, I guide the catheter into both uterine arteries and introduce tiny particles - EmbosphereTM microspheres - into the blood vessels leading to the fibroids. The microspheres block the blood flow feeding the tumors, a process called embolization. In a short time, the tumors shrink, alleviation a patient's symptoms. Most of my patients have returned to normal activities within five to seven days."
Since patients are under mild sedation, some, like Ms. Dismukes, choose to watch the procedure on the same monitor the physician uses to guide the catheter.
"It was cool watching what Dr. Fischer was doing, talking to him, listening to his calming voice. Of course, I was sort of loopy and kept dozing off. The whole thing was really a breeze," recalled Ms. Dismukes.
Most women stay overnight at the hospital and go home the next day. Ms. Dismukes had the procedure on a Friday, was home Saturday and back at work the following Wednesday.
"Women are busy, with jobs, with family, with life," she said. "I knew I didn't want to be out of commission for six weeks. To me, it was worth it - no significant pain and a quick recovery. DR. Fischer was great, the radiology staff was wonderful, and, believe me, CHI Baylor St. Lukes is the only place to go."
Best ness of all? Ms Dismukes is pain free, back at work in her office on the corner of Gemini and Apollo Avenues, thinking about satellites, flight crews and space stations. Things she'd much rather consider than a long recovery period.
This article was published in the Winter 2004 edition of Innovator, a season magazine published by CHI St. Lukes Episcopal Health System. Written by Melinda Muse
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