Thursday, April 26, 2018
Health

Hysterectomy rates drop because of nonsurgical options

Not until after the surgery did Sandra Nauer realize how sick she'd been.

"Oh, my gosh, I had no idea I was in such bad shape," said the 44-year-old California woman.

After years of excruciating back pain, fatigue and other symptoms, she had an outpatient hysterectomy on May 22 — and on June 7, she returned to work running her catering business.

"I'm a new woman," she said. "Holy smokes, I feel like a million bucks."

For earlier generations of women, hysterectomy was all but a rite of passage before age 50, albeit a difficult one. Even now, it remains the second-most-performed surgical procedure for American women still of reproductive age. By age 60, one in three women has had the surgery, according to the Centers for Disease Control and Prevention.

Still, hysterectomy rates in the past three decades have dropped from almost 56 per 10,000 women to 33 per 10,000, American Congress of Obstetricians and Gynecologists statistics show, and the surgery itself has been streamlined into minimally invasive procedures with shorter recovery times.

Some experts say that up to two-thirds of the 600,000 hysterectomies performed each year in this country could be avoided.

"The rate has come down a little but not enough," said Dr. William Parker, UCLA School of Medicine clinical professor and author of A Gynecologist's Second Opinion. "In the old days, hysterectomy was all we had to offer for patients. We were taught that it was the solution for almost every complaint."

Today, alternative treatments often replace surgery, particularly for women below age 50.

"One of the problems is that the information on alternatives hasn't seeped out as widely as it should into the medical world," said Parker. "A lot of the newer surgeries now are minimally invasive, but many doctors haven't been trained to do them."

For younger women, 90 percent of hysterectomies are done to address benign tumors, pelvic pain, excessive bleeding and endometriosis. For older women, the most common underlying diagnosis is cancer.

Side effects of the surgery — which involves the removal of the ovaries in almost three-fourths of patients — can include the early onset of menopause, bladder and bowel problems and loss of sex drive.

Research also shows that hysterectomy can increase a woman's risk of heart disease and lung cancer.

"It's important that women understand, even if they're not having children anymore, they might like to have sex, and they might like not having a heart attack," said Nora Coffey, founder of the Pennsylvania-based Hysterectomy Education Resources and Services Foundation.

Hormone treatments can help relieve abnormal uterine bleeding and other menstrual cycle disorders, for example, as can endometrial ablation. Similarly, medications can help shrink uterine fibroids.

"There are certainly nonsurgical ways to deal with female problems besides removing the uterus," said Dr. Wesley Hilger, medical director of Sutter Medical Center's minimally invasive gynecology program. "It's a conversation you have with the patient."

Like other experts, he sees a significant generational change in attitudes, with younger patients demanding answers from their doctors.

"Many older patients who've had hysterectomy years ago don't know why," he said. "They'll say, 'My doctor said I needed it.'

"Now patients have access to information on the Internet. We have a real discussion."

Of the 1,500 hysterectomies he estimates that he's performed in the past six years, he said, only a handful have involved the traditional abdominal incision stretching from hip to hip. Most are vaginal, laporoscopic or robotic surgeries, and increasingly no overnight hospital stay is involved.

"You have to overcome historical bias," he said. "Patients have the idea that because their mother was in the hospital five days after her hysterectomy, they should be, too."

Comments
Four new ways you can avoid fines for not having health insurance

Four new ways you can avoid fines for not having health insurance

There are already more than a dozen reasons people can use to avoid paying the penalty for not having health insurance. Now the federal government has added four more "hardship exemptions" that let people off the hook if they can’t find a marketplac...
Published: 04/26/18
‘Pretty scary’: Study found 71 percent of commonly used medical scopes tainted by bacteria

‘Pretty scary’: Study found 71 percent of commonly used medical scopes tainted by bacteria

In an ominous sign for patient safety, 71 percent of reusable medical scopes deemed ready for use on patients tested positive for bacteria at three major U.S. hospitals, according to a new study.The paper, published last month in the American Journal...
Published: 04/25/18
Residents went three days without running water at unlicensed ALFs

Residents went three days without running water at unlicensed ALFs

ST. PETERSBURG — Three days.That’s how long residents of two unlicensed assisted living facilities went without running water before the authorities shut the facilities down last week.The Public Works Department said it turned off the water at 3418 a...
Published: 04/24/18
Exercise myths persist, so let’s fight them

Exercise myths persist, so let’s fight them

When it comes to fitness, can you tell the difference between fact and fiction? Misinformation abounds, and research is continually disproving it. Some myths, like "no pain, no gain," are fading away, but there are plenty more that persist. It’s impo...
Published: 04/24/18

Veteran who survived blast receives unusual penis transplant

WASHINGTON — A veteran who lost his genitals from a blast in Afghanistan has received the world’s most extensive penis transplant, and doctors said Monday he’s recovering well and expected to leave the hospital this week. Saying they wanted to addres...
Published: 04/23/18
Do not eat any romaine lettuce, the CDC warns

Do not eat any romaine lettuce, the CDC warns

Public health officials are now telling consumers to avoid all types of romaine lettuce because of an E. coli outbreak linked to the vegetable that has spread to at least 16 states and sickened at least 60 people, including eight inmates at an Alask...
Published: 04/20/18
Florida hits a milestone: More than 100,000 people are registered to use medical marijuana here

Florida hits a milestone: More than 100,000 people are registered to use medical marijuana here

Florida has hit a milestone of sorts as it slowly moves toward wider availability of medical marijuana.The number of patients in the state who are registered to use the substance has surpassed 100,000 for the first time, according to Florida Departme...
Published: 04/20/18
Florida Hospital Carrollwood spending $17.5 million to expand emergency department

Florida Hospital Carrollwood spending $17.5 million to expand emergency department

Florida Hospital Carrollwood is expanding its emergency department. The hospital, 7171 North Dale Mabry Highway in Tampa, is spending $17.5 million to add 15 new private treatment rooms, new pediatric rooms and waiting areas, and new technology, acco...
Published: 04/18/18
Barbara Bush’s end-of-life decision stirs debate over ‘comfort care’

Barbara Bush’s end-of-life decision stirs debate over ‘comfort care’

As she nears death at age 92, former first lady Barbara Bush’s announcement that she is seeking "comfort care" is shining a light — and stirring debate — on what it means to stop trying to fight terminal illness.Bush, the wife of former President Geo...
Published: 04/17/18
Preparing for the worst, staffers at Johns Hopkins All Children’s learn through simulation

Preparing for the worst, staffers at Johns Hopkins All Children’s learn through simulation

When the patient got violent, Dr. Michelle Hidalgo didn’t have time to think. She had to react. The woman was moving strangely and seemed erratic. Hidalgo had to make a tough call — it was time to physically restrain her for everyone’s safety.Then th...
Published: 04/16/18
Updated: 04/17/18