The Hemp Connection:
surgery

If you have PCOS, it's likely you've been told that your risk of diabetes is increased. And that means it's likely this news headline caught your eye.

Here is the reference to the article that the story was based on, if you want to track it down online or in your local library.

Dixon JB, O'Brien PE, Playfair J, Chapman L, Schachter LM, Skinner S, Proietto J, Bailey M, Anderson M. Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial.
JAMA. 2008 Jan 23;299(3):316-23. Comment in: JAMA. 2008 Jan 23;299(3):341-3.

Wouldn't it be great if this claim were true? There are some important caveats to consider before getting in line at your nearest bariatric clinic.

1. The authors of the original study used the word"remission", not"cure", to describe what they observed. Even in cancer treatment, there is a 5 year waiting period a patient must pass before being told they are free and clear of the disease. Somewhere in the trip from the research lab to the news desk a huge leap in logic occurred. Of course,"cure" attracts more viewers--and advertising dollars--than"remission"--but just beware that just as reporters can change their own appearance to look better on camera, so can tweaking a few words increase the potential attractiveness of a story, even one with some originally valid scientific basis.

2. Diabetes can often take years to develop. If there was indeed a high incidence of remission, it is possible that it might take longer than 2 years for patients to start to have signs and symptoms of the disease again.

3. Patients who underwent surgery also lost weight. So who's to say which was the bigger influence? And it took two years for remission to develop. If surgery really was the only influence, not the dietary change or change in body composition, it would likely have occurred much more rapidly.

4. Having surgery is not a license to eat what you want. Especially with bariatric surgery. I participate in a discussion group with dietitians who specialize in bariatric surgery treatment and it is clear, this is a serious, drastic move, requiring serious commitment to change. It is absolutely not risk free.

Your choice is your choice. But just be absolutely sure, before you opt for this solution, that you get all of the facts. And that when you have the facts you understand what they are really saying, not hearing what you'd like them to mean.

Due to some unusual cramping and bleeding, I went in to see my reproductive endocrinologist (RE), who is dually board certified as a gynecologist and an endocrinologist. If you have PCOS, and especially if you’ve ever tried to get pregnant and had a problem doing so, you have probably been referred to a RE. REs have a specialized understanding of the way our hormones affect our fertility, blood sugars, insulin resistance, and other PCOS-related conditions. They treat many PCOS patients, because PCOS is a primary cause of infertility.

One vaginal ultrasound and one pregnancy test later (the doctor and I duly noting that I am well over 40, infertile by all medical definitions, and just about as likely to be pregnant as Mother Teresa), it was determined that there’s a UFO in my uterus! Well, not really, but that’s what it looks like on the ultrasound screen. So, if it’s not a polyp, a cyst, a fibroid, or a baby, what is it?

Cancer comes to mind, and the possibility of cancer necessitated an endometrial biopsy, which is a very uncomfortable procedure in which the tissue in your uterus (the endometrium) is sampled (that’s medical-speak for pulled out in tiny chunks) and sent to the laboratory to be tested. Fortunately, no cancer was found. However, given that PCOS patients are much more prone than average to conditions such as hyperplasia (a proliferation of sometimes questionable looking cells) and endometrial cancers, the recommendation is almost always surgery to remove the tissue, be it a polyp, a cyst, or in this case, something unidentified. I am fortunate to have a highly skilled, aggressive doctor, who knows me and my condition very well, and I agree with this recommendation.

That was the good news, but then I learned the bad news – that my eggs had officially expired. While some doctors question the accuracy of the anti-mullerian hormone assessor, it’s a pretty accurate way to determine whether your eggs are still of use (and to what degree), or if you are pre-menopausal or post-menopausal. No longer having viable eggs was not unexpected, given my age. Nonetheless, there’s an emotional hit to all of this. There is a sense of loss, of unrealized potential, and a need to acknowledge that the door on having a biologically related child, created with my own eggs, has officially closed. At the same time, there is a surprising sense of freedom and relief accompanying this news. Given my personal and family medical history, I no longer have to make an active choice about passing on my genes. With assisted reproductive technology, the doors are open to carrying a pregnancy anytime up to age 53. I just know now for certain that, for me, a pregnancy would mean using donor eggs.

A visit to the RE can be painful or uncomfortable, confusing, enthralling, educational, inspiring, or worrisome – all at the same time. Surgical procedures and testing add to the complex mix of emotions aroused by having a condition or conditions you don’t entirely understand, an equally confusing array of treatment options, time pressures, and a host of medical practitioners, all with their own particular slant on what constitutes your best treatment plan, and why.

For me, that means surgery next month to remove the UFO, continued monitoring of my endometrial condition, and of course, more visits to the RE, especially should I decide to pursue a pregnancy with donor eggs in the future. I like the idea that I still have options, the immediately pressing medical concern is being addressed appropriately, and some aspects of my fertility still offer possibilities. PCOS has a rhythm and a flow of its own, shifting in prominence at various stages in your life and reproductive cycle, and contributes to a mix of emotional experiences. In choosing how to manage your care, your fertility, and your emotions, I hope you too are able to focus on the positive.

If you have not had the opportunity to hear Gretchen's interviews with pcoschallenge.com, please take the time to do so! Gretchen will also be hosting a PCOS expert webinar next Tuesday…to attend please contact www.pcoschallenge.net for more details on how to do so.

As you’re reading this blog post, I’ll be heading off to my long-time gynecologist/surgeon for a pre-surgery briefing, signing of consent forms, and preparation instructions for an outpatient surgery to remove a cyst from my left ovary the following week. For some of us, it’s regrettably routine, and for others, the idea of having surgery is very frightening. The fear may be constant or fleeting, depending upon your history.

In my case, I would ordinarily not be afraid, but I had surgery two years ago and ended up with a deep and painful pelvic infection that took months to truly resolve. To say that I was terrified of returning to the same hospital would be putting it mildly – I think I had a near-hysterical reaction initially. Here’s what I did to calm myself, which I hope will be useful to you as you face your medical fears.

Identified alternatives – I considered another hospital (but my doctor is only on staff at this one), another surgeon (no, thanks, I need someone who knows me well and whom I trust implicitly), delaying the surgery (again, no thanks, as this has become a chronic pain situation over the last few months), or not having the surgery at all (this didn’t seem viable either, for the aforementioned reasons).

Researched/gathered information – in addition to talking extensively with my physician, I spent a fair amount of time with my nose in some books, and talking to my medical practitioner friends, as well as reading research and opinions on the internet. I always say, knowledge is power. But in this case, I may have scared myself unnecessarily by being a little too well-informed.

Consulted with other experts – I consulted with a physician/friend who knows the surgeon, an infectious diseases expert about how to ensure that I don’t get another infection, and people who have been through scary medical procedures themselves.

Took my time – I took my time, partly because of my schedule, partly because of my doctor’s schedule, and partly because I really don’t want to have surgery, and I was hoping the matter would resolve on its own. I tried a lot of alternative approaches, which helped, but I’m now confident that surgery is the right choice.

Considered risks, benefits, and outcomes – the risks include loss of the ovary, potential infection, or of course death (they put that on all the consent forms). Benefits include relief from pain, restoration of normal and comfortable functioning, and relieving my body of some diseased and dysfunctional tissue. Given the precautions I’m taking, along with my choice of highly esteemed surgeons, I expect the best possible outcome.

Came to peace with an imperfect decision – I really, really, really don’t want to have surgery! And I don’t want to go back to that hospital, and I don’t want to lose my ovary. But I also know that I can’t reasonably continue dealing with the level and frequency of pain I’ve endured for the last few months, the surgeon is excellent, the hospital’s outpatient department is better than its inpatient services, pharmaceutical treatments aren’t containing it or remedying it, and alternatives work well for a bit, but aren’t a permanent solution. I’m okay with my decision, regardless of the outcome. I’ve done the best for my body and my peace of mind, and that’s all I can do.

Gretchen Kubacky, Psy.D. is a Health Psychologist in private practice in West Los Angeles, California. She specializes in counseling women and couples who are coping with infertility, PCOS, and related endocrine disorders and chronic illnesses.

If you would like to learn more about Dr. HOUSE or her practice, or obtain referrals in the Los Angeles area, please visit her website at www.drhousemd.com, or e-mail her at Gretchen@drhousemd.com. You can also follow her on Twitter @askdrhousemd.