By: Jean Johnson for Fibroids1It was six years ago in June of 1999 that Heidi Hormel put her trust in Harjit Singh, M.D., fellowship director of Cardiovascular and Interventional Radiology (CVIR) at the Penn State Medical Center in Hershey, and became the interventional radiologist’s first uterine fibroid embolization patient. Hormel had suffered almost a year by the time she found Singh and decided to have the embolization. Indeed, it was back in May of 1998 when she was 36 that Hormel had her first attack of severe abdominal cramps – cramps that went way beyond anything she’d ever experienced.
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Severe Cramping“They hurt,” Hormel said. “Usually with previous more normal menstrual cramping it was more like aching, but this was – I could actually feel my abdomen moving.” She paused to think and then added, “It was like a charley horse – the worst charley horse you can imagine. The cramps would wake me up out of sound sleep, or if they came while I was at work, they were so bad that I’d have to come home. Usually they came around the time of my period, but like with the bleeding, I never knew if they were going to be really bad or mild enough to manage.”
That was in May, and Hormel’s gynecologist diagnosed endometriosis. “If the fibroids were there when the cramping first took me in to see her, my gynecologist couldn’t feel them. So she diagnosed endometriosis and put me on the pill. The theory is that the pill often solves the problem for women because it regulates cycles and hormones.”
Heavy bleeding
For awhile, Hormel seemed to get some relief, but then not only did the cramps return but she also started experiencing severe heavy bleeding.
“That was my biggest concern – the breakthrough bleeding. It came just the one time in December, and it was very, very bad.” She half-chuckled with a sigh, remembering. “It was a bad, bad thing, and even after the one time it was getting intolerable, in part because I never knew what to expect. After December I probably bled almost all the time, and you never knew when it would be just spotty or when you would just flood when you stood up. By the spring I’d sometimes go through a pad in 20 minutes.”
Prognosis: Hysterectomy
Hormel was concerned enough about the breakthrough bleeding that she called her gynecologist.
“She said just to double up on the pills, but I said ‘no, something’s not right.’ I was pretty insistent, and at that point in December when I went back in she found the fibroid. Her first comment was ‘you’re going to have to have a hysterectomy. This thing is so huge.’”
Hormel’s gynecologist also told her a myomectomy wouldn’t work in her case. “The fibroid was the size of the grapefruit and had so much blood supply that my doctor thought I might bleed to death or at the very least need a very large transfusion if she didn’t take the uterus along with the fibroid.”
“‘Only a hysterectomy.’ That’s what I heard. I was 36 at the time and had no children so I didn’t particularly want to lose my uterus,” said Hormel. “I just didn’t think it was a good idea to get rid of a body part that wasn’t diseased. Also I didn’t want to go into premature menopause – or have major surgery. That was the question: was there some way to get rid of the fibroid without major surgery.”
Internet: Source for Information on UFE
Hormel has an undergraduate degree in English and History, and a master’s degree in Journalism. She was working as a reporter for her local newspaper back in 1998 when all this happened.
“So, yeah, I knew there was information out there, and I just couldn’t’ believe there wasn’t another possibility – that there wasn’t some other way to deal with this. The web was pretty new then, but we had it available at work, and I was able to go in and surf around. I just wanted all the information I could get about this, and it wasn’t long before I found out about embolization,” she said. “But it was new then. Only about 200 women worldwide had had it. My gynecologist said she would look into for me, but she still wanted me to prepare for the hysterectomy by taking Lupron and building up my blood count.”
That’s when Hormel’s physician located Harjit Singh, M.D. at the Penn State Medical Center in Hershey. “I went up, and Dr. Singh seemed excited and felt he could do the procedure. I felt comfortable with him and so I said ‘yes, this is what I want to do.’”
Hormel First UFE Patient at Hershey
“I had no qualms about being Dr. Singh’s first patient. He was very cautious and warned me about all the things that could go wrong – the artery that he had to puncture for the catheter might bleed, the little plastic beads they embolize with might go the ovaries or elsewhere, infection, the procedure might not work, or it might only embolize the big fibroid and leave others behind to continue causing symptoms. All those things.
“But Dr. Singh had done similar procedures for other problems, and I felt confident that he was experienced with the basic technology. Also, he made me very comfortable,” Hormel said, stopping to chuckle. “I remember there was another doctor with him that was learning, and they were both so excited about doing it. They were confident and excited, so that helped too.”
The Embolization Procedure
“I was awake and aware – like in a twilight sleep. They have to have you awake because you have to hold your breath periodically when they shoot the dye in. I have really bad eyesight and wish I would have worn my glasses so I could have seen the x-ray.”
The procedure took quite a bit of time – 45 minutes to an hour, and although Hormel expected pain related to the embolization, she had next to none.
“I didn’t really have pain associated with the procedure, but I have lower back problems and lying like you have to, completely flat with your legs straight out and not bent, my back really started hurting. Even once the procedure was over, you had to lay completely flat for four hours on the gurney and then another four hours of sitting up a little bit. They gave me a morphine drip, though – a little pumpy thing. So I used it for my back pain.”
Recovery
“They gave me Percocet to bring home in anticipation of a lot of cramping, but what cramps I had weren’t as bad as what I’d been going through all year. I was really very lucky because I know it can be painful, but I didn’t experience that during or after the embolization. I probably could have got by on Advil – it just was not bad.”
Hormel says that she did take a week off work.
“During that week felt like I got tired a little faster that usual, so I didn’t push myself. But I didn’t really feel all that bad and by the end of the week felt like I was just fine and ready to return to work.”
Complications Easily Resolved
“I did have one complication after the embolization,” Hormel said. “What they hope happens is after they embolize the fibroid dies and shrivels up. But mine was so large that when it died it pulled away from the wall of the uterus, and my body tried to pass it. It got stuck, though, so my gynecologist had to do a D&C. The doctors were upset about that, but not me. I was glad to get it out of my body and rid of what they call the bulk symptoms – things like abdominal swelling so much that your pants don’t fit right, and pressure on the bowel or bladder.”
“As far as I was concerned, I got what I wanted all along. Relief from symptoms without losing my uterus,” Hormel said. “If I had it to do over again – even back in 1999 when embolization wasn’t done nearly as widely as it is now – I’d definitely go with Dr. Singh and have the procedure. No doubt in my mind at all. I’ve had a great outcome. No return of symptoms. No problems. So I’m quite pleased with the choice I made.”
