By John Armentrout
I have had the pleasure of working with Dr. Newsome for several years now. I remember a particular patient I was allowed to observe during a consultation sessions. Mrs. Abernathy was a young lady who was here to discuss her and possible treatment options with Dr. Newsome.
“What if I don’t want to undergo surgery?” These were the first words spoken to me by Mrs. Abernathy – who was here for an Interventional Radiology (IR) consult with Dr. Newsome. She was here to discuss her uterine fibroids – a cyst like growth in her uterus. She had seen her OB/GYN about a month earlier for painful cramping, heavy bleeding during her menstruation, and a general “full” feeling a few days prior to menstruating until it was over. She said these feelings had been going on for some time, but over the last few months she decided to see if anything could be done. A MRI scan was preformed, and that is how her gynecologist discovered the fibroids. The treatment he recommended was to have a radical hysterectomy – removal of her uterus and the fibroid tissues. Mrs. Abernathy was here to discuss the possibility of another treatment option she had read about, called Uterine Fibroid Embolization (or UFE).
Dr. Newsome is one of our Interventional Radiologists. She specializes in less invasive treatments for many issues. In Mrs. Abernathy’s case a UFE, a minimally invasive procedure where we use special long thin tubes called catheters to direct material that will cut off blood flow to the cyst tissues (the fibroids). This can in many cases be done without surgery. Dr. Newsome reviewed the MRI scans to determine the size of the fibroids. For the best outcomes there are a few guidelines our doctors must follow with regard to size, location (in the cavity or space of the uterus, in the muscle or the wall that forms it, or if it is located outside – basically in the abdominal cavity), and density – how “thick” the cyst tissue itself is.
Dr. Newsome and Mrs. Abernathy then proceeded to discuss the procedure itself. In most cases it requires an overnight visit. The procedure takes anywhere from 1 to 3 hours, usually about 1.5 hours. Mrs. Abernathy would come in to the main hospital and be admitted for the UFE. Dr. Newsome took about 45 minutes to explain the entire process that Mrs. Abernathy would undergo in the hospital if she chose to have the uterine fibroid embolization procedure preformed.
If she chose to proceed then Dr. Newsome explained how her visit would go. On the day of the procedure, Mrs. Abernathy would come into the front of the main hospital. The admitting staff would take her to an outpatient unit where they would complete all her paperwork, start an IV (for fluids and relaxing medication in the procedure room), and have her change into a hospital gown. The Interventional Radiology (IR) department staff would bring Mrs. Abernathy to their pre procedure area and review all her paperwork, double check her medications, review the procedure with her and answer any questions. Once everything was ready, they would go in the procedure room.
Once in the procedure room the IR staff will connect various monitoring equipment – blood pressure, oxygen (how well she is breathing), and EKG (or heart rhythm). One of the groin areas will be shaved and washed with a surgical soap. Then Mrs. Abernathy will be covered with a large blue “blanket” (sterile surgical drape). Then Dr. Newsome and the IR staff will then put on their protective equipment (hats, masks, and sterile gowns) to reduce the likelihood of any infections occurring.
Dr. Newsome explained how the staff will administer “conscious sedation” – or relaxing medication that will make Mrs. Abernathy sleepy. While not like the operating room – where the anesthesia doctors would put her to sleep, this medication is similar to what is given for a colonoscopy – a “twilight” medicine that makes you sleepy and forgetful for about an hour or two. Once the medication has taken effect, Dr. Newsome will then proceed to numb the groin area she plans to insert a small IV tube (called a sheath) – like the IV for fluids in the hand. Once this sheath is in place, there is very little additional discomfort in the groin area. Using X-ray (similar to a chest X-ray) Dr. Newsome will advance a long thin straw-like tube called a catheter to the blood vessel that feeds the uterus. Using special x-ray dye, Dr. Newsome images the blood flow to the fibroid tissue.
Once the blood vessel that feeds the fibroid is discovered, Dr. Newsome is able to utilize special materials that allow her to specifically target and prevent blood flow to this area. The idea is not to remove the fibroid tissue, but to cut off the blood supply to it. This in turn will cause the tissue to starve and shrink in size. This in many cases reduces and sometimes completely reverses the symptoms like the ones Mrs. Abernathy was experiencing. The cramping and full sensations, and heavy flow she was experiencing, in many cases, is due to the fibroid tissue ‘pushing’ on the walls of the uterus – filling the space it occupies, like taking a rubber balloon and blowing it up. It is still the same rubber glove, there is just more ‘inside’ of it causing it to expand. When the cyst tissues shrink down, it is like letting the air out of the balloon — allowing it to return to its normal shape and size.
Mrs. Abernathy was quite excited by what she had heard and the less invasive approach. Dr. Newsome did caution her that many times patients experienced pain and discomfort the same day of the procedure. That is why an overnight stay is required. Having experience in performing many hundreds of these, Dr. Newsome found keeping her patients on pain medication overnight reduced the likelihood of extreme discomfort and resulted in better outcomes for her patients. Mrs. Abernathy thanked Dr. Newsome for all the information and said she would talk with her gynecologist about this exciting alternative procedure. But, as she said when she came in “I don’t want to undergo surgery!”