Appeal to Intergroup for
Uterine Artery Embolization
What they dont say
Foundation Health Systems, Inc.
Position Statement: Uterine Artery Embolization for Treatment of Fibroids
Dated 10/08/98, with lines for approval signatures from Dr. Dale Berkbigler and Jacqueline Sandvik. My copy is not signed.
Comparative risks of abdominal hysterectomy vs. UAE
Uterine artery embolization is a simpler, safer choice than abdominal hysterectomy.
Risks during and after hysterectomy are appreciable. Here are some gentle warnings from The Hysterectomy Associations Website (http://www.hysterectomy-association.org.uk/info/hyster/affect.htm):
Physically ... Immediately following the operation you will spend some time in hospital recovering, the length of time will depend on the type of operation you have had. You will be encouraged to get out of bed as soon as possible, this helps your recovery and will improve your circulation to avoid the danger of blood clots forming...Among my personal acquaintances and family who have had hysterectomies, I am aware of subsequent problems with urinary incontinence, bowel misfunction, chronic pain and significantly diminished sexual response. This is not to say that hysterectomy is always followed by such problems, but in a significant number of cases, it is, and I am unwilling to risk it given a reasonable alternative. UAE is a more than reasonable alternative.
Once at home you will be advised not to be too active for at least six weeks, this is to give time for the muscles and tissues in the abodomen to heal. There may be gentle exercises that your GP or surgeon may suggest ... but don't push yourself too hard. You should be aware that it can take a long time to recover from this type of surgery, even up to twelve months, but generally after six - eight weeks you should be able to return to work part-time and take on some lighter household tasks.
Sexually, you may resume intercourse after about six weeks, however you may find that it is different in some ways, this will depend again on why you had your hysterectomy and the type of operation you have had. The best thing to do is to take it slowly as you will need time to recover.
Although some women report that their sex life improves following a hysterectomy, as they are not experiencing great pain any longer, others report that they have different types or intensity of orgasm, this is because it is not just the clitoris that is involved in creating an orgasm , but the womb and cervix also are as they are contractual muscles. Therefore, orgasm may be less intense when they have been removed.
Emotionally you may find that you are depressed following your operation, this may be due to having gone through major surgery which is traumatic in itself ... some women report a feeling of loss as they are aware that they can no longer have children or that they feel they are no longer "womanly"...
It often helps to talk about your experiences with other people in the same position as yourself. There may be a menopause clinic or well woman clinic at your hospital, surgery or nearest large town or you could try contacting one of the many support organisations that are available for information and support.
Risks during UAE are minimal to negligible. At The Society for CV and Interventional Radiology Website (http://www.scvir.org/fibroid/index.htm), we find:
Complications occur in fewer than 3 percent of patients. Serious possible complications include injury to the uterus from decreased blood supply or infection. This is uncommon and hysterectomy to treat either of these complications occurs in less than 1 percent of patients. Injury to other pelvic organs is possible but has not yet been reported and the chance of other significant complication is less than 1 percent.
I am acquainted with a number of women who have had UAEs via a discussion list on the Internet, and none of them report subsequent depression and a need for support and counseling, and nearly all of them report being up and about in a week, and even going to the gym - something they had felt like doing, due to fibroid-fatigue, in years.
Abdominal hysterectomy is a far costlier procedure than uterine artery embolization in terms of patient recovery time and impact on the workplace.
Patients recovering from abdominal hysterectomy typically remain in the hospital from 2 - 4 days. Patients recovering from UAE typically remain in the hospital 1 day at most.
It typically takes 4 - 6 weeks to recover from an abdominal hysterectomy before returning to work. It typically takes 1 week to recover from UAE before returning to work.
The patient is not told all the terms of the contract before signing, including which procedures are not covered.
I knew prior to October 1998 that I wanted to have a uterine artery embolization rather than a hysterectomy. I had no way to determine that Intergroup would not cover this procedure. Representatives of the insurance company are free to interpret terms like experimental in a manner that benefits the company and not the patient. The patient has no such freedom.
When I asked an Intergroup phone clerk for a list of covered and not-covered procedures, she said There is no such list.
I believe that I have a right to retain a bodily organ where that option is practical. To minimize the importance of the uterus as a disposable baby carriage is to seriously undermine the concept of womens rights in favor of a patriarchal notion that women are no more than breeders to be tossed aside when too old or otherwise unable to bear children.
One must consider who benefits from FHSs policy on UAE. If this procedure has been proven successful an average 90% of the time, FHS may fear that they may be called upon to pay for another procedure, such as hysteroscopic resection or even hysterectomy, the remaining 10% of the time. To that end, they are willing to ignore the 40% post-operative complication rate of hysterectomy, because it is the patient who suffers in that case - not profits.
For the last two hundred years, civilized people have trusted trained physicians to help them with medical care decisions.And finally...
My gynecologist, who I trust and who Ive found to be exemplary in ability, training and compassion, referred me to a trained medical specialist for a procedure that would eliminate the need for me to undergo major surgery and recovery after removal of a major organ. Now Im finding that this relationship of trust is being replaced by the prerogative of people Ive never met, ex-doctors, ex-nurses and business people of questionable ethics, to determine my medical care. These people are making decisions that have caused me to endure hours, days, weeks and months of pain subsequent to my initial referral for uterine artery embolization in February 1999.
I was initially referred for UAE in February. It is now mid-August. I hold the administrators and owners of Intergroup and its parent company, Foundation Health Systems, Inc. directly accountable for six months of physical misery and lost productive time.