Right Questions for the Doctor?

Hi Sisters,
This is long. I'm been reading and researching and want to make sure I am asking the right questions of my doc on Tuesday when we discuss my last test, an MRI, in a series to determine which route I go. This website is wonderful and I hope those of you who have been on this path can double check my questions.

I'm 41, hormones normal, and I have 4 large fibroids internally and one very large posterior external fibroid. I'm anemic. Serious bleeding issues monthly and have back and abdominal pain in cycle. Uterus is 15 weeks. Emergency appointments in Jan and Sept due to excessive bleeding. Pap was clear, Endometrial biopsy came back clear. Ultrasound showed locations and sizes of my alien fibroids and took alabtion of the table for consideration. This is my second doc, loved my first one but switched insurance and lucked out with this one, not love but definitely like. With my first, 1.5 years ago we were in the watch and wait mode, but knowing we might have to proceed through options and I wasn't anemic but on the way and I acquired two more fibroids. My new doc started with about eight options and we're down to three as we've run through tests. I have the following options, UAE, Myoectomy, TAH (bikini incision). I'm not looking to preserve fertility so in reality I'm looking at the UAE or TAH. At this point I want to do something _now_ because I feel I'm placing my self at risk with the constant bleeding and my quality of life has been severly curtailed, but I want to make sure I'm getting my ducks in a row for MY decision.

Are these the right questions? (by the way I have read about the risks on all of the procedures even the ones off my "choice list" but want to see if what the doc says matches up with what I've read):

About the MRI
This was to rule out the posterior fibroid from being an adnexal mass and that I didn't have anything coming off of my ovary
- Did it rule out an adnexal mass?
- Did the MRI show anything that is cause for concern?
- Any signs of Adenomyosis?

Uterine Artery Embolization
Okay I'm not entirely clear I want this procedure, frankly the whole necrotic tissue thing icks me out.
- Are any of my fibroids considered too large for UAE?
- Will the location of the posterior fibroid affect this choice?
- Are there arteries the fibroids could reacquire?
- What are the risks of having this operation?
- What are the risks of Necrosis? Sepsis?
- Average reduction of Fibroids is 30% according to research will this make a difference in my case?
- What is the cost of this surgery?

About the Hysterectomy
- Would the Uterus and Cervix be taken?
- Will the ovaries be preserved? Unexpected consequences? Will there be an earlier menopause? What is to be expected?
- Would muscles be cut or retracted?
- What are the risks of having this operation?
- Would anything be done to my bladder or surrounding organs?
- Are there additional procedures that may have to occur?
- Mentioned Lupron to reduce the fibroids before this procedure - How much reduction is expected of the Lupron?
- Isn't Lupron an HRT? How long for the Lupron? Will there be any add back therapy? Progesterone to prevent bone density loss and joint issues? Should I be concerned about HBP or other risks?
- Everything I have read so far puts a Total Abdominal Hsyterectomy recovery from 6 - 8 weeks? You mentioned 4 weeks, what would make the recovery time less?
- Who would be handling the surgery? Are they board certified?
- What is the cost of this surgery?

Finally
- Do you have a reccommendation? Why?

I'm a fact nut and will pro and con almost anything to distraction to arrive at a decision. I'm sure I'm missing something any recommendations from my sisters would be greatly appreciated

Dear Dogger:

Your list of questions is excellent Here is a link to the fibroids section of our Resources Directory: https://www.hystersisters.com/vb2/lin...=browse&cid=26 and you should also check out www.thefibroidplace.com

Here's a recent headline regarding Condoleeza Rice having a UFE: http://www.cnn.com/2004/ALLPOLITICS/11/18/rice.health/

I hope you find the right answers soon. I am sending huge cyebrhugs

Hello,
I may have some answers for you from my doctor regarding the questions I asked when I was talking to him about a hysterectomy.
You can choose to take the uterus alone, or the cervix too. This type of surgery has a different name, one I cannot remember! But I do know that it was abbreviated LAVH?
I also asked about the ovaries. I am 35, have had no trouble with them other than an occasional functional cyst. He said he could look at them, see what they looked like and determine whether to take one, or take both, or even leave them. My choice is to leave them unless something is wrong.
There are risks will all surgeries, you should ask your doctor what your risks would be. Everyone is different.
I was concerned about the bladder. I have heard from so many that have had their bladders fall, or have had to have bladder reconstruction after having a hysterectomy. I told him I was concerned about this, and he mentioned something he could do where he would take ligaments and make a type of "shelf" to hold everything in place.
I asked about Lupron too. He told me he wouldn't request I have that with a hysterectomy, but if I wanted another ablation done, I would have to have the Lupron shot the day before surgery.
As for recovery, everyone is different, I have heard from 4 weeks up to 8 weeks. I guess it would depend on your age, your activity level, your job, etc. What would make it less? I am not sure, but if it were me, rest, rest, rest at first!
Insurance? My doc gave me the number of the person in charge of insurance at the clinic so I know what is and isn't covered before making my decision. Which I thought was great!

Hope this helps! It is all still very fresh in my mind right now!
Good luck!
Shermeg Attempted Ablation 6/05, D&C and Novasure Ablation 7/05

Thanks all. Had the appointment today and went through almost all of my questions. All clear on the big fibroid being a suspicious mass and ovary-eating-fibroid. whoo!

Turns out I have _two_ fibroids in the back on stalks not one big asymetric fibroid or an adnexal mass. I apparently am a very fertile fibroid farm up to six and growing. Because several are submucosal UAE is off the table, partially because of potential for prolapse due to size and location. So I have two options watch and wait or a hysterectomy. I've done my watch & wait, poke & prod and my homework and due diligence so I'm on my way over to pre-op boards once I get my date. I'm looking forward to eventually not camping in the restroom and living a new life.

Thank you all for your support in answering questions, this is a truely wonderful site.