Part OneBy: Jean Johnson for Fibroids1
Fibroids do more than cause heavy bleeding and feelings of fullness that can send a woman to the bathroom more frequently than she ever thought possible. These benign but potentially debilitating tumors can affect self-esteem as well.
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Considering Embolization?
To determine if you are a potential candidate for uterine fibroid embolization, consider the following list suggested by Dr. Kaufman:
1. Do you have fibroids diagnosed by physical examination, ultrasound, or another test?
2. Do the fibroids cause symptoms, such as heavy periods, pain, pelvic pressure, abdominal fullness?
3. Are you interested in exploring non-surgical treatments for your fibroids?
Getting an Appointment with an IR
Ask your gynecologist or primary care physician to refer you to an interventional radiologist for a consultation.
To find an interventional radiologist near you, you can also visit the Fibroids1 physician locator. Kaufman notes that “any woman with fibroids can make an appointment directly with an interventional radiologist for a consultation. A doctor-to-doctor referral is not always required.”
The Society of Interventional Radiology’s website, www.sirweb.org, also has a doctor finder for IRs who perform uterine artery embolization.
As Kaufman observed, “Interventional radiologists are the best physicians to discuss the procedure with a patient, as they have the most detailed knowledge about uterine fibroid embolization.”
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Over time, all the needed protection and not being able to go out as a person would like can take a toll. Indeed, if a woman didn’t start to feel at least a little insecure about her body and life under the full-court press of fibroids, something would probably be amiss.Consequently when we at Fibroids1 heard John A. Kaufman, M.D., professor and specialist in diagnostic radiology and vascular/interventional radiology at Oregon Health and Sciences Dotter Institute in Portland, say that his field owes much to women with fibroids, we sat up and listened carefully.
What a concept: The patient benefiting the physician. Life is a two-way street.
Women with Fibroids Help Interventional Radiology Come into Its Own
In the not too distant past, interventional radiologists like Kaufman were burrowed away in the basements of hospitals in radiology departments and saw patients only briefly when they performed a procedure ordered by the referring physician. In recent years, though, physicians like Kaufman who work in interventional radiology (IR) have emerged into the sunlight. They have opened offices of their own and now see their own patients just like other physicians. Kaufman, for one, is forever grateful and gives a powerful nod of thanks to the fibroid patients who played key roles in this shift.
“It’s a completely different paradigm today,” Kaufman said. “In the past we didn’t consult with the patient in advance or have significant contact after the procedure. But because women believed in fibroid embolization and were willing to come to us on their own, this specialty moved forward in the way that was necessary. What started with women seeking us out for treatment of their fibroids has changed all of IR [interventional radiology]. Now we provide what we call longitudinal care in which patients are seen in the office setting before and after procedures for a wide variety of conditions.
“The transition to having our own patients has made our work better. Now we’re not dependent on another clinician’s judgment,” Kaufman said. “When a fibroid patient is having her procedure, she’s my patient. It’s completely up to me and the patient, and no one else is involved. It’s personally empowering to have that degree of responsibility for what you are doing.
“We really owe a great debt to the women who believed in this procedure.”
Treating Fibroids Ranks High With Interventional Radiologists
“From a personal perspective, this is one of the most rewarding groups of patients that I work with. They are individuals with a serious health problem that degrade their life. Furthermore, in order to get treatment they have to make some pretty big decisions about major surgery,” Kaufman said. “These are individuals with long lives ahead of them as productive members of society. It feels very good to help women with fibroids because in many other situations in IR, patients are looking for shorter gains of one to two years of additional survival. With the fibroid patient you’re helping someone who has an expectation of about 40 or 50 years of life after the procedure.”
In other words, Kaufman said, “These women really feel lousy and their life is significantly impacted by their fibroids. We can make them better and provide long-term benefit.
“The published data strongly suggests that our approach [with uterine fibroid embolization] is very robust treatment,” he continued. “It’s nice to do a procedure that we feel has good durability. In some types of cases outcomes are not as well understood as we’d like. Treatments for blockages of small arteries in the calf, for example, have a high chance of closing down, but we do them anyway because there are frequently limited options. With uterine artery embolization for fibroids, though, we feel good about the procedure because there is enough data for a woman to make an informed choice.”
Uterine Fibroid Embolization Didn’t Come About Overnight
Kaufman reminiscences back to the early 1980s when he graduated from the Boston University School of Medicine. Clearly, his remarks point to the idea that in order to treat fibroids in minimally-invasive ways, interventional radiologists had to expand their knowledge of the body’s reproductive and pelvic circulatory systems to a precise understanding of the intricacy of the female reproductive system.
“I was almost going to be an Ob/Gyn before I began training in interventional radiology at Boston Medical Center [the former Boston University Medical Center and Boston City Hospitals], so the concept that you could embolize the uterus of a normal person was pretty scary. To do this, interventional radiologists first had to learn very detailed information about the arterial anatomy of the uterus – such as the size of the connecting arteries between the uterus and the other pelvic organs. We also needed to understand the biology and pathology of fibroids and other uterine diseases, and the details of other treatments that are available for fibroids,” he said. “All these things, prior to uterine artery embolization for fibroids, weren’t part of what we needed to know as interventional radiologists.”
In the second part of our interview with Kaufman, we’ll look more closely at how uterine fibroid embolization is helping women young and old, and paving the way for new techniques that can benefit a range of women’s health concerns.
