Lots and lots and lots and lots of GREAT stuff about hysterectomy and women’s health can be found at Hysterectomy.org
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books on hysterectomy
Should I have?
Today I just finished reading the book The Essential Guide to Hysterctomy. I come away with one question:
Should I have had my fallopian tubes removed during the hysterectomy?
I never thought to ask this question preoperatively. According to the author, Dr. Lauren F. Streicher, removing the fallopian tubes decreases the risk for ovarian cancer since this is where the cancer seems to originate. Who knew? However, I knew I wanted my ovaries and I have no history of either ovarian or breast cancer in my family … the purpose of my hysterectomy was for pain control … to say goodbye to dysmenorrhea forever!
Here’s a link (see below) to the list of ovarian cancer risk factors from the American Cancer Society (last revised Feb 2014):
LIST of OVARARIAN CANCER RISK FACTORS
This is going to be one of the questions I’ll be asking at my 6 week follow-up appointment … even though it’s a bit after the fact. I also read an article where one of the physicians mentioned likes to make decisions based on medical evidence rather than on emotions alone. This makes sense to me. And my surgeon / GYN doctor has always been up-to-date with his information; I’m pretty sure he would have suggested removing my fallopian tubes at the time of the hysterectomy if he thought it was a prudent idea.
Here’s what Dr. John Thiel has to say from the Feb 2013 Vancouver Sun article North American Experts on the Risks and Benefits of Fallopian Tube Removal for Ovarian Cancer Prevention:
Regina doctor John Thiel disagrees with B.C. ovarian cancer experts who recommend removing Fallopian tubes to reduce the risk of ovarian cancer. There just isn’t enough scientific evidence to justify such a procedure, he contends.
“I’m not an old crock. I love innovations. But I also believe in evidence-based medicine,” he says.
I wouldn’t think having the fallopian tubes removed to be a good idea if I wanted to preserve ovarian function as much as possible after the hysterectomy while not having any family history of cancer.
Here’s what the American Cancer Society has to say:
Tubal ligation (having your tubes tied) may reduce the chance of developing ovarian cancer by up to two-thirds. A hysterectomy (removing the uterus without removing the ovaries) also seems to reduce the risk of getting ovarian cancer by about one-third.
As for the harms, the surgery would take a little longer than tubal ligation or hysterectomy, and the risk of complications, including risks of bleeding, infection, and reactions to the anesthesia, would be slightly higher because, for one reason, the risks increase as the length of surgery increases. There’s a chance that, as with women who have a hysterectomy, removing the fallopian tubes would lead to women going through menopause earlier. One concern is that tube removal would interfere with the blood supply to the ovaries, which could prevent them from working as well, potentially leading to an increased risk of heart disease, stroke, and osteoporosis. But we don’t have any data to help establish just what the risks of tube removal might be.
To remove or not to remove .. the jury is still out on this one!
It’s all about educating yourself … here’s a pic that does a great job about education:
Spaghetti sans meatball with eggs …
I remember asking my doc before the hysterectomy, What happens when the uterus is gone … is there a big space? Apparently this analogy is quite common: the uterus is the meatball and the intestines are like spaghetti … once the meatball is gone the spaghetti fills in the space. Makes you hungry, doesn’t it? 😉
And according to The Essential Guide to Hysterectomy (2nd ed.) by Dr. Lauren F. Streicher:
One common question is, What happens to the eggs after hysterectomy when their is no … uterus to go to? Contrary to what you might be picturing, the eggs don’t pile up on the floor of your pelvis. The body simply absorbs them.
And with that thought I guess I’ll go eat breakfast now … but not eggs — I don’t like them.
UPDATE 11/29/2014:
After the effects of Effexor (venlaxine) on my taste buds in 2013, I started to have many food aversions — hating things I once liked. I am beginning to like eggs again! I’m so very happy about this! I also had a craving for popcorn last night!
I took Effexor (venlafaxine) for hot flashes — vasomotor symptoms — with the onset of perimenopause. Effexor (venlafaxine) is most commonly prescribed for depression.
You can read about my weird experience with Effexor (venlafaxine) below:
The TWO WEEK follow-up appointment
Today was my first follow-up appointment … it was supposed to be about a week ago but my doc had an emergent c-section to attend to.
Overall the appointment went well and all my questions were answered. I am surprised that he didn’t examine me physically; he said he will do that at my six week follow-up. I was hoping he’d look down there simply for reassurance that everything was healing well.
I told him about my TWO pain concerns:
- pain in the upper left side under my ribcage under the suture area and
- low back pain.
The upper left side pain is intermittent and worse with prolonged sitting — any sitting over an hour! He explained that the upper left side pain is due to a large internal suture he placed to reconnect a ligament and that this pain should definitely lessen. He assured me that this pain was quite normal in the healing process for the da Vinci hyst. He also explained that low back pain is common in hysterectomies of all kinds and this too should resolve in time. I let him know that I took only OTCs during the day but in the evening due to the back pain I am still taking one to two hydrocodone 5-325 mG tablets once daily; he assured me this is fine and quite normal as well. I read in the HysterSister booklet (see booklet link below) that the majority of women should not be taking opiates and / or narcotic pain medication after six weeks for their hysterectomy … I’m sure this is provided that the women is healing well and is not suffering complications.
Hystersister *FREE* Booklet:
My next question for him was about the Single Site Platform Laparoscopic da Vinci Hysterectomy. This single site surgery makes only one incision in the umbilicus. I asked my doctor (even though I’d already had surgery) why wasn’t this method / option available at the time of my surgery. I was feeling like I missed out on having only one incision — not that I’m some abdomen model. Obviously you can see from the previous photos I’ve posted I’m not any abdomen model. I’m not vain … it simply would have been nice to have a single incision in regard to healing. My doc explained that the maneuverability of the single site platform da Vinci with the existing instrumentation simply isn’t there yet … the technology is not quite perfected. He said he’s going to an upcoming seminar on the single site soon. He did mention there is one surgeon who has performed over 1000 of these surgeries to date … I don’t know if this is the surgeon (see below) he was talking about, but here’s the link: http://www.farnammd.com/blog/dr-farnam-leads-the-nation-with-single-incision-robotic-surgery
And … my doc didn’t seem to mind me asking him about this other surgery at all! I think he actually appreciated that I’m an informed patient. My doc is so great — he always has up-to-date information, not to mention he is both sincerely kind and caring.
I also asked about those stitches that might pass through my vagina. My doc said it was unlikely as they were quite internal and would dissolve on their own. I also informed him that I was spotting only requiring pantyliners.
As far as hormone replacement I thought he’d be starting me on some sort of topical patch. I need to take hormones despite still having my ovaries … I started menopausal symptoms (hot flashes, night sweats, insomnia and brain fog) last year … summer of 2013 to be exact at age 44. To my surprise my doc has given me ESTROGel 0.06% to be applied topically once daily. I don’t like the idea of doing this every day. He explained to me the patches can cause rashes and localized irritation. I trust my doc and will give the ESTROGel a try.
Here’s the site on ESTROGel: http://www.estrogel.com/what-is-estrogel
A concern I just thought of was in regard to flying with the gel as a carry-on. I get really paranoid about having my stuff taken away from me at the airport. I’d probably cry, yes, sometimes I am that sensitive and immature, if they took away my medication gel … my mind would go spinning thinking about all the hot flashes, night sweats and insomnia I’d have on my planned trip. I checked the bottle and the ESTROGel is only 1.75 oz. Whew! 🙂
The TSA (Transportation Sercurity Administration) states:
Liquids, gels, aerosols, creams and pastes must be 3.4 ounces (100ml) or less per container … [my emphasis]
Medications … are allowed in reasonable quantities exceeding three ounces, and they don’t have to be in the zip-top bag. [my emphasis] Declare these items for inspection at the checkpoint. TSA officers may need to open them for additional screening.
I told my doc about the insomnia I’ve been having and he had no real explanation basically chalking it up to post-anesthesia effects. I’m not so sure about that because I’ve read not only with hysterectomies, but also with other surgeries that people sometimes do have insomnia post-op. Of course, my immediate post-op period and the first few days that followed I slept incredibly well … almost too well! I told my doc about my sleeping regime and he didn’t bat an eye simply told me if it’s working to keep it up. When I do return to work, since I work closely with some very experienced anesthesiologists, I’m going to run the whole post-op, post-anesthesia insomnia issue by them and see what they have to say … I’m planning on asking more than one anesthesiologist too!
I brought up the HysterSister booklet (and website) to my doc —http://www.hystersisters.com/vb2/bookletorder.php … he hadn’t heard of the site or the booklet and said they might start telling their patients about it. I gave them my copy of the booklet since I’d already read it. I thought it was a great booklet and wished I had read it before my surgery, but the information was still incredibly helpful post-op.
And speaking of books I received my copy of The Essential Guide to Hysterectomy: Advice from a Gynecologist on Your Choices Before, During and After Surgery by Lauren F. Streicher, MD (2nd ed., copyright 2013). I ordered the book used for less than $9 online (see link below). I can’t offer any personal review of the book right now because I just got it today! 🙂 However, I did finish the chapter on Hysterectomy: Past & Present. All I can say is holy cow I’m glad I live in this day and age … very interesting historical information.
http://drstreicher.com/books/the-essential-guide-to-hysterectomy/
Personally I think I’m probably past most of the information in the book being a nurse and already having had my hysterectomy … but I think it will help me with any post-op information and also help me educate future patients with information undergoing a hysterectomy. I’ll be able to recommend the book too if it’s a good one!
da Vinci Total Hysterectomy 