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By Hope Waltman
Note: It is VERY RARE for a woman to experience sloughing of fibroid tissue Post UAE 23-24 months. However, my Post UAE recovery is still within the normal limits.
This situation did NOT cause any changes to my everyday activities and I continue to be very satisfied that I chose UAE.
My August 4, 2003, period started just like any other period. I had the occasional sloughing of fibroid tissue, but I noticed the tissue was a little bigger and I had some blood clots.
The occasional tissue discharge continued, and on Sunday, August 17, 2003, I experienced an increase of tissue discharge. I checked my temperature to see if I had a fever (infection) and watched for any foul odor from the discharge. The discharge slowed down after a few hours.
I kept Dr. Worthington-Kirsch, my Interventional Radiologist, posted about what I was experiencing and he suggested over-the-counter Iron supplements (27 mg). I was instructed to drink plenty of fluids so that I would not become dehydrated and to keep an eye on whether I was feeling weak or light-headed.
Dr. Kirsch contacted Dr. White, my Gynecologist, to update him about what I was experiencing. Dr. Kirsch felt the Gynecologist needed to be involved in case of possible impacted fibroid tissue or inflammation/infection.
On Tuesday, August 19, 2003, I experienced a second bout with tissue discharge. I called Dr. White and he wanted to see me in his office for a pelvic exam. He also wanted a CBC (Complete Blood Count) performed before the office consultation. I did not have an infection (during the pelvic exam if an infection was present the doctor would notice the uterus was hot inside). I did not have any fibroid tissue impacted in the uterus. Since I was sloughing so much tissue Dr. White ordered an abdominal and transvaginal (pelvic) ultrasound, and a sonohysterogram. Dr. Kirsch ordered a pelvic Magnetic Resonance Imaging (MRI) with contrast. Both doctors wanted to know how much the fibroids had shrunk.
Complete Blood Count (CBC):
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My Complete Blood Count showed the White Blood Cells (WBC) level to be 11.4, the flag reference for normal WBC is 3.5–9.5. Elevation can mean an inflammation or infection is present in the body (each laboratory has different flag reference numbers). A WBC of 11.5 is borderline, and probably represents nothing of any concern. WBC are produced by the immune system to help defend the body against infection.
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The Red Blood Cells (RBC) count was a little low. RBC are responsible for delivering oxygen throughout the body. A low RBC can indicate anemia, which can lead to fatigue.
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My Hemoglobin (HGB) and Hematocrit (HCT) were a little low. The Hemoglobin is a protein used by red blood cells to distribute oxygen to tissues and cells in the body. Hematocrit is the amount of blood that is occupied by red blood cells. Low Hemoglobin or Hematocrit numbers are good indicators of anemia. (It takes between 7-10 days for the body to rebuild new blood cells.)
Dr. White decided, from the Complete Blood Count test results, that I should continue to take the over-the-counter Iron supplement. Iron supplements can cause constipation. A diet rich in fiber or an occasional stool softener may be necessary. (Some doctors recommend Slo-Fe. Niferex-Forte may be less constipating.)
From the MRI, ultrasounds, and CBC test results a better decision could be made on whether a hysteroscopic resection would need to be performed to remove the infarcted (dead) fibroid that was causing the sloughing and bleeding.
Dr. Indman, a Gynecologist who performs the hysteroscopic resection procedure, briefly explains the procedure as follows, “A hysteroscopic resection is performed as an outpatient procedure. There is very little blood loss before or after a hysteroscopic resection of myomas when an expert surgeon performs it. Some women can return to work the next day, while some may decide to take several days off because of the anesthesia. The procedure takes approximately 5 minutes to over an hour, depending on the size and location of the fibroid and experience of the surgeon.” (For more information on Hysteroscopic Resection.)
September 4, 2003, I had the MRI performed in an ‘Open MRI’ facility. My new experience with this MRI was that the technician gave me a ‘ball’ device that I could squeeze if I needed her and when I received my films I also received a CD of my MRI images.
The MRI images showed the more inferior of the fibroids, located in the fundus (located at the top of the uterus) and anterior (front, on the left side) to the endometrium, was communicating with the endometrial cavity. What that means is the surface of the fibroid is touching the endometrial cavity. That allows tissue to pass directly from the fibroid into the endometrial cavity (and from there out to the vagina). The residual fibroid tissue is NOT a complication from the UAE, but the after effects from the uterine fibroid disease. I have two infarcted (dead) fibroids. Each is about the size of a small tangerine or plum.
As with any medical procedure, the way a woman’s body reacts to the procedure can be different from one woman to another.
The September 4, 2003, MRI images detected Nathobian cysts (they are natural structures that are filled with fluid and very rarely need medical intervention) in my cervix.
September 8, 2003, I had the abdominal and pelvic ultrasound performed. I was instructed to drink 32 ounces of water in a half hour period, 1½ hour before the procedure. I wasn’t allowed to empty my bladder until after the abdominal ultrasound was done. The test detected a simple right ovarian cyst approximately 3.1 cm in size (usually a cyst that is over 2.0cm (1 inch) is checked 6-weeks after the initial ultrasound to see if the cyst has decreased in size).
September 15, 2003, I had the sonohysterogram (i.e. hysterosonography) performed. I was instructed to take 3 Advil’s one-hour before the procedure because when the catheter is inserted into the cervix it can cause cramping.
Dr. Scott Wise performed the sonohysterogram. He was very patient and explained the whole procedure to me. The sonohysterogram procedure usually takes 20 minutes to perform. Dr. Wise explains the procedure as follows, “In hysterosonography, the perineum is prepped in a sterile fashion and a speculum examination is performed to localize the cervix (identical to a conventional internal examination by a gynecologist). A betadine prep is then used on the cervix. Thereafter, a thin relatively soft catheter is placed through the endocervical canal into the endometrial cavity. A small retention balloon is inflated at the end of the catheter to hold it in place and the speculum is removed. A transvaginal ultrasound is then performed while sterile saline is injected through the catheter.”
Dr. Wise said, “The most common technical problem is the inability to pass the catheter through the cervix. Some hysterosonography kits come with a dilator that helps but often does not solve the problem. The cervix in some women may function well to allow passage of blood and other materials from the uterus into the vagina. However, the cervix of these same women may be too narrow to pass the catheter in the opposite direction. Formal dilation of the cervix (such as performed by gynecologists for D & C's or hysteroscopy) may be necessary in some cases (which requires appropriate facilities in case of light anesthesia to be performed on an outpatient basis).”
My cervix was ‘too tight’ and the catheter could not be inserted into the cervix. Dr. Indman said, “This can happen to approximately 1 out of 1,000 women.”
October 20, 2003, I had my 6-week abdominal and pelvic ultrasound performed. The test result for the simple right ovarian cyst was the cyst was resolved. The left ovary was ok. The two fibroids had calcified rings around them, which confirmed the fibroids are dead on an ultrasound image.
Dr. Kirsch and Dr. White reviewed my test results and discussed my medical situation.
October 27, 2003, I went to Dr. White for my annual Pap test and examination. He teaches a lot of interns and I was asked if it was ok for the intern to be present at my examination. I said, “Yes” and the new intern performed a pelvic exam and felt the infarcted fibroids. Even though it may be emotionally uncomfortable for a patient to have two doctors perform a pelvic exam, I think it is VERY important for the future doctors to be exposed to the Uterine Artery Embolization procedure.
Dr. White explained the ultrasounds and CBC test results and Dr. Kirsch explained the MRI test result to me. We each received a copy of the test results for our files.
In conclusion - NO medical intervention needed to be performed, NO medication was prescribed except over-the-counter Iron supplements, my tests results were OK, I continue to keep my calendar diary, and I am scheduled to see Dr. White next year for my annual check-up!!!
I am VERY happy with my UAE!
Author’s Note: “I would like to acknowledge my thanks to the following people for helping me: My husband for being beside me with each uterine fibroid experience (doctor visits, ultrasound and/or MRI tests, and examinations). Dr. Robert Worthington-Kirsch (my Interventional Radiologist) for answering every email and phone call, and working with Dr. White on my medical situation. Dr. Wayne White (my Gynecologist) for being available when I had a medical concern. Dr. Paul Indman for explaining hysteroscopic resection and Dr. Scott Wise for his hysterosonography information. To Marie and Patty for sharing their thoughts about the article and proofreading the rough draft.”
E-mail question:
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If you have any questions after reading “My Journey” update, please feel free to contact me. – Hope
Refer to: My Journey Post UAE 25 Months to 3 Years
"My Journey" will be updated as needed.
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Hope Waltman |
| Founder of Hope For Fibroids, Inc. |
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My Journey: Post UAE 1 Year to 20 Months |
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Seen Through The Eyes Of A Fibroid Support Group (article) |
