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9cm fibroid, possible second.  Biopsy tomorrow.  Pre op questions 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

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Unread 10-02-2011, 06:55 PM
9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

I was diagnosed on 9/30 by in office ultrasound. I have an approximately 9cm intercavitary fibroid and possibly one more causing very heavy periods, cramping, discharge between periods and pre menstrual headaches. I am 40 years old. My doctor discussed TVH, LAVH, DH and TAH. He feels my fibroid is too big for TVH or LAVH and prefers to have the whole uterus for the pathology report. I was initially excited thinking "woo hoo, no more pain, no more periods" then reality and too much internet set in. On Friday I expressed that I preferred to wait until some out of town guests came and went so the Dr. wants to do a biopsy tomorrow just to make sure the growth isn't something other than a fibroid. I am on his schedule for the TAH on October 27th.

This is what I have prepared to take back to my GYN tomorrow based on the initial diagnosis. Your input is welcome.

I do trust my doctor's opinion and I am open to having a hysterectomy. If biopsy comes back normal, I owe it to myself to make sure I explore my options. I may prefer to delay the surgery 2-3 months.

I have privacy issues with having procedures done at the local hospital because I work there and yes, it's the only one within 30 miles.

Because we are military and newer to the area we don’t have the family and friend resources we need during initial recovery from a full TAH. We live in a two-story house and have two large dogs, very active dogs. My husband rotates between day and night shift. All his work requires him to be gone 14 hours a day so after he takes off for my initial recovery I will need some assistance from the 10 day to 3 or 4 week recovery period from full TAH.

1) How long until the biopsy comes back?
2) How many fibroids do I have?
3) What type?
4) Where are they?
5) Can we attempt to shrink them in order to perform a laparoscopic or vaginal hysterectomy?
6) How small do they have to be for you to be comfortable with a less invasive surgery?
7) What methods of shrinking them are you comfortable with?
8) Will you order additional imaging like an MRI or lab tests for progesterone and estrogen?
9) Will it affect our relationship if I ask for a second opinion?
10) How do you feel about uterine artery/fibroid embolization? And whom would you refer me to?

If I proceed with the TAH
1) Should I shave, wax, trim?
2) What is the pre-op prep?
3) How long will surgery take?
4) What determines my ability to be discharged after surgery?
5) How long until I can go up and down stairs?
6) What is the follow up care?
7) How long on the pathology report?
8) Will an abdominal binder be provided?
9) What medications will I be discharged on?
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Unread 10-02-2011, 07:42 PM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

I think you have a good list of questions.

UFE was my first choice too, but my fibroids were to big. As I was told by the IR, I could be treated but wouldn't see much shrinkage, in fact maybe 30% if that. Honestly, I did consider just going with it, to avoid a hysterectomy. However, I came to my senses, realizing, the UFE would only buy me time.

I admonish you to choose a date the works best for you. To me prep work is important. Speak with your husband, is it possible for him to use vacation time? In addition, discuss with your Dr how your privacy at the hospital will be handled.
Unread 10-02-2011, 08:52 PM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

Your questions are good. I also agree that you might need more help, depending on your recovery and your general household. I had a TAH BSO, and my DH went back to work about 6 days post op, BUT he was home in the evenings, and we have three cats - not active dogs. There were other chores - such as shopping, cooking, dishes, etc. - I needed him to do for the first few weeks.

Good luck to you.

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Unread 10-03-2011, 09:00 AM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

i have a 10cm fibroid, along with several others. i am going in tomorrow for my LAVH. 5 yrs overdue. i've had 2 biopsies. both came back good. no cancer cells or anything. i haven't had one for 2 yrs now, though. there just wasn't any reason to get one this last month, as we already knew i was getting the surgery - finally - now that i have insurance once again.

you have great questions. make sure you get answers to all of them. and lots of luck to you! just do what you're told to do for recovery, etc. everything will work out just fine. hopefully you'll have all the at-home help you need. i don't have any. just be careful doing the stairs, too!

best of luck to you!!!!
Unread 10-03-2011, 02:05 PM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions


Great list of questions.
If your main concern is the recovery without as much help as you would like, you should look for a doc who will do a less invasive surgery for the quicker recovery. Do you have a reason to be concerned about cancer or does it look like fibroids? I had fibroids. Two normal endometrial biopsies gave me confidence to wait and wait I did--for five years. I was able to have a LSH after Lupron worked well to shrink my huge fibroids. My uterus was still very large but a good surgeon can do a minimally invasive procedure, size isn't the determining factor.

If your problem is fibroids, there shouldn't be a big rush. You should have time for research, second opinions and to get your life in order before surgery.

Let us know what your doc says.

Unread 10-03-2011, 02:17 PM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

I got all but two questions answered today. UAE wasn't even mentioned on Friday's visit. Today I am told I'm an excellent candidate for the procedure pending biopsy results. Hmmm. It's not worth the discussion but it comes to mind that if the GYN keeps referring to the size of the large fibroid in comparison to the size of a baby's head, why wasn't it found at my annual in March and why wasn't UAE mentioned on Friday. Certainly not worth the effort because it doesn't change where I am today, but good to get off my chest.

I have no family history of pelvic cancers - all the women live to late 80's and mid 90's so I don't anticipate poor results, yet the decision in on hold until then. Thank you all so much for the support!
Unread 10-03-2011, 02:38 PM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

Your questions are great!! I had a 20 week size uterus and a 12 cm fibroid along with other fibroids not as big. My belly looked 4 months prego. I took a series of 3 Lupron shots 3 months before surgery which shrink my fibroids and I lost 11 pounds before surgery. I was able to have a LAVH and I am so glad. I did not want a TAH. My recovery has been really good.

I did have to look for a doctor that specialized in large fibroids. 2nd opinion if your not sure.

Good luck to you. Sending Hugs your way!!
Unread 10-03-2011, 06:40 PM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

Hi navy wife, I'm glad you got your questions answered by your GYN. With your history of pain, heavy bleeding and migraines, I believe you shouldn't delay. Sounds like the type of hysterectomy is your major concern and recovery times.

I had a uterus the size of 14 week pregnancy with a large fibroid and adenomyosis (growth of the lining of the uterus into the uterus wall, enlarging the size of the uterus and causing heavier periods). I also had a rear facing uterus, therefore My GYN prefered TAH to ensure she had space to complete the procedure with care and within less time. This reduced the time under anaesthetic.

I've read other responses and know that others have had success with different approaches. I would go with your surgeons advice as long as the reasoning behind it makes sense.

Recovery from TAH. The post op checklists are great and remind us of expectations/limitations during recovery.
I think you could cope alone post day 10, if you had meals/snacks prepared, a clean house, laundry up to date, things to occupy your mind, etc. But considering your hubby works 14 hour days, I would get someone to do the heavy cleaning for you 1 x week. You would need to get the dogs walked too. I found walking exhausting (not overweight), and could only make it to the third house down our street and back in week two, very slow pace. Coping with your stairs may be all the exercise you need at this stage.

At 4 weeks post op, I do say "yay" and see a wonderful active, unworried, life ahead without my cranky uterus.
Bes wishes in your decision making
Unread 11-14-2011, 05:35 AM
Re: 9cm fibroid, possible second. Biopsy tomorrow. Pre op questions

I am one week post op from my UAE for treatment of my 8.3 x 7.5 x 8.3 centimeter intramural fibroid. I have been searching this site for more conversation on the recovery of UAE because of the belief that I'd be expected to be back to normal within a week.

My procedure went well according to the radiologist (whom I work for). I had no issues with the urinary catheter or the IV sedation. I remember attempting to view the images on the screen and the doctor ordering more sedation. My husband states the procedure took about two hours. I knew going in that I do not handle narcotic pain medications without nausea and vomiting. For better or worse the RN's could not get my Dilaudid pain pump working and finally he suggested they administer IV medication by hand. I did get one by hand dose and was finally set up on the pump. I never pushed the button for the supplementary doses. I began vomiting and threw up every 30-60 minutes until they removed the pump about 6 hours later. I was also receiving Zofran for nausea and Torodol for pain and swelling, both IV. I woke up to a more alert state at 8:30PM and managed to go a few hours with out pain meds. I then tried an oral Percoset, which came up about an hour later. To end the pain med story, I was not able to use narcotic medication for my pain.

My worst cramps were just after the procedure, 24 hours after for a few hours then 72 hours after for most of the day. I was on Torodol for 4 days. Day 3 was the worst. I have nothing to compare it to and was ready for my husband to take me back to the hospital. He contacted the radiologist who did some research and prescribed Tramadol. I'm not sure if the worst was over by the time my prescription arrived at the house or if it helped, but I used it for another 2 days.

I felt nearly normal on the 5th night, but the last two days I have a constant feeling that I just stood up too quickly. Dizzy and tunnel vision. Not severe, but enough to be cautious and concerned that I can't over do it. I continue to have mild cramping, sometimes in front, sometimes across the entire posterior pelvis. My UAE was performed on the last day of my menstrual cycle so there was already spotting. I continue to spot but am able to use nothing more than a panty liner. Some of the spotting is a clear slimy substance (like snot).

I do not feel capable of working an 8 hour shift at the hospital and know I'm not a whimp. But am concerned that others will think I'm milking it. I have a follow up appointment with my GYN next week and the radiologist plans an MRI at six months post op. I'm frustrated with the dizziness and lack of energy. How long did it take you other UAE gal's to feel normal?

***Recovery update:
Maybe someone like me (looking for feedback) will eventually stumble across this.

The 8th and 9th days were much better. The dizziness gradually subsided and energy got better. If I had a flexible job that didn't require pushing gurneys and portable x-ray equipment I could have been back to work for 6-8 hours by the 10th day. I still have occasional cramps, mostly across the posterior pelvis. Sometimes I have twinges of pain on the right or left side of my uterus and sometimes my lower abdomen feels tight or firm. The spotting continues to be light in color (darker than honey, lighter than pancake syrup) and I have a follow up appointment with the GYN this week. I continue to hope this full TAH alternative works to shrink my fibroid to either avoid the TAH or hysterectomy all together.

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