Wednesday, November 26, 2014

Time has passed; has anything changed?

I just wanted to stop by to let you all know that although most of the posts here are a few years old, now, that doesn't mean they're outdated. I do review them from time to time to make sure the information contained in them hasn't been superseded by anything new and different.

Basically, the surgery remains the same and how we prepare and recover from it are still pretty much unchanged. If anything, there's more emphasis on the so-called minimally-invasive surgeries today, and while they can be good in some situations, we need to be careful to separate marketing-speak from what's in our own best interests.

If there's one thing that's changed in the past five years, it's been the number of surgery centers that have purchased robotic surgical equipment. But this carries an unfortunate cost for women. Although the robotic surgery is touted as being safer, less invasive, more precise and, especially, much faster to recover from, that's not actually been seen in use. In fact, according to a Reuter's news article that came out in 2013:
the tool didn't reduce complications linked to hysterectomy or otherwise improve women's outlook after surgery, researchers found. And it raised the cost of the procedure by almost one-third.
In fact, researchers who analyzed records of a large number of surgeries during the previous few years found that
The only advantage to robotic surgery was a drop in the proportion of women staying longer than two days in the hospital
Additionally, other studies have found that the surgery itself takes longer and in fact results in more pain than a conventional laparoscopic surgery. (source)

So why are these surgeries being promoted? This is an expensive piece of equipment and every moment when it's sitting unused, it's failing to return on that investment with profits for the medical center that purchased it. While robotic surgery does improve outcomes in some surgeries, a hyst is not one of those. That enticing advertising, then, is all about profits and not about your health.

Another interesting aspect to recent surgical techniques that reduce the size of abdominal or vaginal incisions is that the uterus has to be essentially ground into small particles before it can be removed via these tiny incisions and the tools that fit into them. Called "morcellation," this procedure is done via special tools called, not surprisingly, morcellator devices.

Since their introduction, there has been a worrisome trend of complications following on their use, especially when fibroids are present. In addition to damage to surrounding organs, the procedure appears to be quite effective at spreading previously-undetected malignant tissue to locations outside the uterus. This risk is now considered so well-demonstrated that hospitals are discontinuing the use of this tool in hysterectomies and other uterine surgeries and the major manufacturer of the devices has suspended their sale (source). Clearly, this is something to check with your surgeon about: unlike robots, this is not something that is advertised and you may not be routinely informed that your surgeon plans to employ this technique.

But basically, while modern surgeries may result in smaller incisions, the internal healing remains the same. In fact, we see more women mystified about how long it's taking to recover than we did when abdominal incisions were the major route. I think that there's a real push to be "back to normal" within days if not weeks of surgery, even when women have to exhaust themselves to do so (and reduce the quality of their healing besides).

Is there still a role for traditional abdominal incision hysts? Oh yes, and a woman shouldn't feel like a failure because she doesn't qualify for a minimally-invasive procedure. Any time there's risk of cancer or actual confirmed cancer, we face requiring a radical hysterectomy, a much more extensive procedure that in part relies upon our surgeon's clear view of the entire abdominal contents. And for fibroids, well, given the risks associated with breaking up a fibroid-filled uterus, I think I personally would still opt for an incision that allows a uterus to be removed essentially whole.

Other than this, the only other major trend has been the ongoing decrease of hospital stays after hysts. To some degree, this is a result of the more minimal procedures; it's certainly also due to insurance companies not wanting to cover the costs of an extra day or two of monitoring and drugs. Additionally, it can in fact be considered a reflection of the fact that it's to some extent more dangerous to be in a hospital, exposed to infections carried by others, than to be at home. So long as we are clear on what to report to our doctors and take care to get the necessary fluids and walking/repositioning exercise, there's rarely anything magical about being in hospital that we cannot do for ourselves. The most important aspect of safety in early recovery is recognizing complications, most typically those of bleeding or early infection, and reporting them promptly. Remember: if you're in doubt, it's always better to call than to wait and require emergency intervention.

And finally, the only other piece of news I can offer is that our old Yahoo message list is long gone. But that doesn't mean that women's need to discuss their surgeries and ask questions is over and done with. Nope: we all can use some company at a time like this. So Framboise, over at the Survivor's Guide to Surgical Menopause, has opened their discussions to those who are planning or who have had hysts of any kind. Feel free to join them and benefit from discussions with other women who have been where you are now.

Sunday, September 06, 2009

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Tuesday, July 21, 2009

Post-op: Getting back into shape

One of the things women in the later stages of postop recovery often ask on our message list is when and how they can resume or begin an exercise program to really get back into shape. That's a very good question because we definitely lose conditioning when we're inactive during early recovery and yet we need to return to physical activity in a manner that does not damage our healing.

Sadly, many surgeons, unless they have a personal interest in fitness, are not the best individuals to advise us. They will tell us to gradually increase our activity and avoid putting too much stress on our abdominals, but beyond that, unless they practice a sport themselves, they may not know what does or does not particularly require midbody strength.

Friday, May 01, 2009

For the guys and the women who live with them: hysterectomies, sexuality and old wives' tales

A hysterectomy is a daunting prospect for many men, and there are several concerns that men whose partners are facing a hyst typically have.

For some men, it's the helplessness in the face of a partner having such a severe health problem that she requires major surgery.  In American and much of other Western society, men are taught to be problem solvers, such that problems they cannot provide a solution to, situations where their encouragement and support are all they can bring to us, are very highly frustrating, and that frustration may be expressed as either unfocused anger or withdrawal of contact.

As women, we need to be aware that this response is normal and does not necessarily mean rejection of us as a partner. It means that where we can redirect the men in our lives as to how, specifically, they can help us with preparation and recovery, we may find they are more gracefully able to deal with their worries than if we silently wait for them to make a gesture of that help. And for men, it means that they need to reach for comfort with the idea that this isn't a problem they can solve, but a situation in which their support can ease that problem and truly provide what their women are needing.

 For other men, there is a concern over what a marriage may most mean to them: a ready, continuous supply of sex. Whether the relationship is a partnership or a religious one founded on the man owning the rights to the woman's body, many men are ill-equipped to deal with the notion that their spouses will be unavailable sexually to them for a period that the spouse, not they, will determine. For those whose religion only permits of procreative sex, there's that whole issue of what becomes of it when procreation is surgically eliminated. And when they tap into that delightful pool of Old Wives Tales that surround hysts and menopause, they can easily convince themselves that a hyst means the end of their (marital) sex life.

So there are some valid concerns here. Let's look at what is really involved.

Tuesday, June 05, 2007

How do they do that?

The Survivor's Guide to Surgical Menopause has tipped us to two interesting pages that give operative procedure details on:

DO NOT GO TO THERE IF YOU ARE SQUEAMISH. While there are no illustrations or photos, the terminology is medical and describes, layer by layer, each step involved.

It's also important that you understand that these are for "open" procedures. That means that they are the conventional, make-an-incision surgeries and that laparoscopic or vaginal procedures involve other steps. Other procedure variations don't seem to be posted to the site yet. And, of course, if you're having extra work done, like a recto/cystocele repair or endo removal, that will also change the exact method used.

Still, if you're wondering "how do they do that?" or why it takes some time to heal, this might help fill in those blanks.

The Survivor's Guide bookmark account has other useful and interesting stuff about surgeries, too--go check out tags like "surgery" and "hysterectomy."

Thursday, March 01, 2007

Transfusions as a potential blood clotting risk for women

We give a lot of attention to some forms of blood supply risk when we consent to a transfusion, but a newly-released study contains an additional factor we may want to discuss with our surgeons when we are talking about having a transfusion either before or after we have a hysterectomy.

In this study, researchers found that

Transfusion was associated with an increase in the odds of developing VTE in women (odds ratio, 1.8; 95% confidence interval, 1.2-2.6) but not in men (odds ratio, 0.9; 95% confidence interval, 0.5-1.9). In the absence of transfusion, female compared with male sex was not associated with an increased risk of VTE (odds ratio, 1.2; 95% confidence interval, 0.8-1.7).

What does this mean for us? We already know that a hyst (or any abdominal surgery) raises our risk of developing a postop blood clot, and that's why our doctors usually prescribe elastic stockings and/or pneumatic hose as well as anticoagulant therapy as a regular part of our immediate postop care.

But it could be that women who have a transfusion before surgery, perhaps to correct anemia from excessive bleeding, as well as those who require transfusion to compensate for blood lost during the operation, may be incurring an extra risk factor. And since blood clots are a very serious health threat as well as a reason why future HRT use may be forbidden, this is something to take into account when making the decision to permit a transfusion.

It's not necessarily a reason to turn one down, of course: sometimes blood loss can be life-threatening and there may be few other options for dealing with the situation. If a doctor knows that this elevated risk exists, there may well be specific measures to do with both detection and prevention that can be put in place that help reduce this added risk exposure. It's not a simple or straightforward decision, so it needs to result from a discussion with your own surgeon or doctor. But this new information is definitely something to be sure they've heard of and are taking into account in how they manage your overall treatment.

If you want to share the content of this study, it is:
Association Between Venous Thromboembolism and Perioperative Allogeneic Transfusion
Kent R. Nilsson, MD, MA; Sean M. Berenholtz, MD, MHS; Elizabeth Garrett-Mayer, PhD; Todd Dorman, MD; Michael J. Klag, MD, MPH; Peter J. Pronovost, MD, PhD
Arch Surg. 2007;142:126-132.

Thursday, September 21, 2006

Post-op: bowel activity

When bowels are handled and disturbed, as happens during a hysterectomy or any other abdominal surgery, they shut down activity for a period of time. This is why women are often surprised to find that they are limited to only liquids for the first day or so after their hyst: this gives the bowels a rest and doesn't overwhelm them before they are ready to resume activity. Eating too soon will only cause the undigestible food to back up, producing vomiting that is not a real appealing prospect for anyone who has just had abdominal surgery--not a pleasant thing to contemplate.

How do we know that our bowels are returning to function? Our caregivers can hear the sounds of sloshing when they listen with a stethescope, and before long, we can feel or hear the passage of gas. This is such an important recovery milestone that it is one of the criteria for discharge: we have to actually pass gas to demonstrate that our bowels are capable of taking up their digestive functions again.

For many women, this signals the most frustrating and uncomfortable part of recovery, however: dealing with gas and constipation. Narcotic drugs, low physical activity levels, a low-fiber diet, not drinking enough, and, for those who are users, lack of caffeine all contribute to impaired bowel motility and enhance these gas and constipation effects.

But those causes also provide us with a good set of things we can do to limit these unpleasant symptoms of our bowels recovering.