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just ahead at this week's addition of being well my guess is doctor greg
babcock
interventional radiologists from carl we'll learn more about the types of
procedures that are performed by interventional radiologists specifically
how do you terrain fibroid tumors can be treated that's next so stay right here
well doctor babcock thanks for coming and being welfare first-timer happy to
have you here don't thank you glad to hear
you arent interventional radiologist scientology all of that about what
what that means that what your job entails
uh... interventional radiology is otherwise known as uh... minimally
invasive surgery
or even energy tax
surgery what we do is we'd get access to places
but otherwise you'd have to have a full open surgery to to have the procedure
dot
generally we can do anything from
abscess drainage is where we can go in percutaneous with an incision about this
big
and we can put catheters and things and distal hollow tubes
and get the bad stuff out were person doesn't have to go back in the surgery
or going to surgery at all sometimes
this helps with people with like ruptured appendicitis and and other
things
we also duper fro bhaskar disease uh... we treat cancer
we'd also help people with liver failure and uh...
a lot of it is just
small incisions and then we go in with with our catheters
and we can perform everything kind of like mike research me
through these little access windows that we create
uh... a lot of it um... a lot of people know about like coronary artery and
requesting in stenting
at it was interventional radiology that actually first developed in that process
and since then we've given it over in cardiology is just run within their do
look over things that they're doing now
uh... we still pretty much tree everywhere else
except for the brain and heart with that type of arterial disease
and uh... we also hope with people with renal failure and getting dialysis and
access for them
and we do allot of uh...
cancer treatments for people that have uh... disease in the liver
disagreements were were focused right now im
but it they're trying to branch out in a place is really doing prostate or
people with pancreatic cancer
well one of the ways that interventional radiology is helpful is for women who
suffer from uterine fibroid tumors
turn let's talk a little bit about what what they are and how do women develop
them and why
going on on what you read at least fifty percent
of all women will generally get a fibroid of some size or shape
uh... the generally they goal mother lives not known uh... all it is is that
uh... benign
and uh... all takes is one cell
to be a little bit abnormal animates smooth muscle and fibrous connective
tissue
and it just
disloyal haywire and keeps growing and growing uh... the corp pseudo
encapsulated basically these things just
and they grow in a compressed the tissue around them
and if they grow big enough warfare in the wrong place
that's when they start creating problems
and um...
people can have multiple fibroids they could just have one
uh... generally you won't get a fire broke until sometime after
you start commercial cycle it's almost unheard of to have it before you are a
star p_m_s_
and generally most of the women that have 'em that are symptomatic
are usually in the thirties and forties www keisha lingers and some people that
are in their twenties but will stand in the thirties forties or even up in the
fifties
and um...
natural history is the continue to grow
and their blood supply is on the outside
so as they did
that kind of outgrow their blood supply so the in side portion a small portion
inside starts dying
because it can actually get the blood the nutrients it needs
and over time
a lot of them will just in the loop and
necrosis end and i a form their own
but sometimes patients can't wait that long because their symptoms were sort of
severe
uh... everybody can get a if you have a uterus an estrogen solely really don't
know why they grow
and
or they do know is that they grow with estrogen and then progressed and in some
of the other hormones and growth factors
but they just don't know why
are there some
the risk factors or
populations of women that depend more than others yes they're they're very
clearly are stephanie seymour often and african-americans in
there's been some suggestion that
it's also kind of related to uh... kilo it's which i have been americans it says
i would have a would accuse it's kind of an abnormal scar tissue growth okay
but african-americans definitely get the more often
there's different than a strong link with obesity
mhm diabetes switched current sometimes guidance of the state to an obc catagory
hand-in-hand
hypertension
and hereditary
uh... you have a mother and grandmother that have happened you definitely more
likely to get them
apartment colleges etc
and also no parity if you've never had any pregnancies uh... okay
then you're also going to be at an increased risk of getting
and if they only grow in the uterus or can they grow outside theater skinny
grow up in the floppy into user on them
they can grow anywhere
where there's uterus which is nonsense that's the muscle tissue it
abnormalities so they can grow and serve x
finger on the inside
there there's actually a couple of subtypes so there's some sure also
if you think of it uh...
uterus is either lekha
kevin inverted triangle or even a balloon shaky they can grow on the
outside right underneath the covering of the year so sir called substr russell
they can grow old
intramural or within the muscle itself
or they can grow some nicole soul which is actually just under
inside layer
of the universe and those of the ones that can be the most problematic
um... the fourth type is don't do it
mandy's actually grow out on a little stalled
and sometimes they can actually break off and those can be problematic no
matter where they're at if there are some sro soul
they can break off inside the problems and then they can actually win as
they're dying create a really bad infection okay
and if they're suddenly course along the inside they can cause problems with
attachment of the eg for pregnancy
or they can actually cause more problems with bleeding
now that can these kind
types of tumors ever turn cancers
there's some debate on and on the breakdown
what everyone says is yes they can turn into a stark homeless or
a malignant tumor and generally it's consider that they're doing in on the
inside okay
it's less than the one person i think the numbers somewhere between like point
one three and point to nine percent of mine
are thought to
become so common this but some people don't believe you think actually that
they're
when they find these it's actually a denovo it's was gonna be at the cancer
no matter what it was in what are some of the sentence thinking you haven't
fibroid tumors and not even know what bad salute lease co-counsel you depends
on where
if you have one that's intramural deftly just within the muscle in small
you control your whole life and never know it and they find a lot of these
uh... in in autopsies now have you know
she had
you know fibroid in
doesn't cause any consequence i say
and if you have them and they start getting smaller afternoon which cuz they
stop growing usually at menopause
um... again maybe you knew you had on when they stop
but if they did they don't know if you'll start on the ground in the wrong
place to start having symptoms
one of the uh... the biggest symptoms is not a roger or really heavy
menstrual bleeding ok and
people know
you know just all the sudden will be a change in its progressively usually
continue on
and be very very happy
bleeding in between periods by uh... longer periods
or even more severe periods are also uh... the big ones the ones that are
really noticeable
uh...
some people will think a long long enough and these three grown these
things can grown lot size of a softball
and if you have more than one
well then you can imagine that that's volume that's nice that they start
philippi people will get loaded
loaded uh... early ah...
say ciation in winter heating also and their you know they they don't use much
before
they'll circle pressing on the bladder so they're starr having increased
urinary frequency have to go
padi all the time and that's usually are a really big complaint and sometimes
it's just uh... war the clothing that they can wear grilling yeah hail just
rights also and i just feel very bloated all the time but vertically doing
during the periods
and their sizes of change addresses have gone out latest
noticed um...
big here yeah as those of you know you've just
and put out a bunch of weight it could actually be something absolutely no
usually by that time they've been followed sequentially with some type of
image and and and the usually that's with ultrasound it's contact
non-invasive
they can just follow up in the tractor growth
as soon as the symptoms and the fibroids a big nafta
we need to do something about it
we are determined to know what's happening
that was my next question is how do you diagnose them there's different imaging
techniques and how does if you go to your general practitioner worsen
symptoms
what are some of the ways that they can check to see what's going on
physical exam biz you know and generally uh... what they're going to start with
'cause it's the easiest you're in the office they can use it
sometimes they'll be
compression on the ***
or they can actually measure *** hike in hell
being the uterus is an
if you are someone comes in and you know they're not pregnant also the uterus
seems to be enlarged
usually mean something's going on so the next test will be some type of energy
okay
now as long as it related to the menstrual cycle more than likely i think
somebody would start with an altar sound
conditional radiation
it's one of cheaper exams
and it's fairly quick to get in and get out the most women you know are familiar
with having ultrasound exams before you know especially if they've ever been
pregnant
that gives us our
pretty good estimation although not the most active but pretty good estimation
of how many are there the sizes
and where they are and the types that they are ok we talk about uh...
treatment options in just a little bit thick
this definitely would have an impact on women's fertility
yes they're bad enough the court ok and why is that
well if you have a totally did or sub nicole so by the fibroids and they were
big enough
uh... it could block
*** from actually doing work needs to go
or could just created abnormal environment where the aid to no longer
attached to where it needs to attach
arm
it doesn't happen very often but yes it definitely can can have that problem
it can even cost spontaneous abortions if it's big enough in their specific
account related ones are where there are a stalker causing problems
if a woman has numerous spontaneous abortions uh... they're gonna start
investigating aware
wise is happening and then they would generally start with the uh... fiscal
examen waters tempat
solo woman is diagnosed with the she goes to her ovi gyi her general
practitioner and they determine that
something needs to be done so
they'll see someone like you
well let's talk about how
what are some of the methods for
getting rid of that
you can choose should be expected management where are you doing
insensitive
things that are doing the bloating the cramping it
that's your biggest problem
what really becomes problematic as if
they start having the real heavy natural cycles and then they're going to have to
figure out
well where are
and how many
and how big
sometimes what they can do is to and straw skippy where they can go in there
with the camera
and they can either cut arise
if it's a bit uncommitted one and remove some of that tissue display going into
the cervical canal
the least invasive cuz you don't have to actually make any holes are incisions
anymore
uh... affirm that you can do uh... i'm i'm back to me where they're actually
going in there and there
kind of removing some of the summit course although it was so basically
domenic reason nice thing where they came
keep the uterus
so in case you have a patient still wants to get pregnant
uh... but they can remove the fibroids they're causing the problem okay
and then that it gets more invasive as these things become larger and more
problematic and then it will either be a hysterectomy
there's a couple of different ways that they can get hysterectomies you can
either do a transnational or they can do
uh... surgery with usually allow crossed piece okay
it's minimally invasive in the sense that it's not uh... quite and open
surgery but it still
a false or very compact and there's a longer recovery time
or if they can come and get in a yeutter an artery embolization
what is the method that u
perform the molds that you've had the most successful at
what we use in its the only method that we actually used to these is the urine
artery implicit okay
and what we do is safe
little incision bleeding uh... access to
the arteries at the lag basically it's right that crease where you're like me
to money
how can we get into the federal artery
and because of the poll the sand
the symmetry of it
there's a vassal u_-turn artery on each side
and usually from that one access point we can access both sides all those
occasionally we do need to make
another small incision on the other side unit
and then what we do is we take pictures using video fluoroscopy
and contracts to re-enter contrast in that kind of goes with the blood does
and it gives us a roadmap of the abnormally large do an artery
okay and it shows us the fibroids
and then what we do is we go unless sequentially smaller catheters
and the kathy's we generally use are smaller than
became cartridge okay
and we go in there and if we inject some very very small particles these things
look like ah...
little bb sent out of
plastic exits aka t_v_a_ material employed vital alcohol
and we inject these
under fluoroscopy
and we do it on both sides and we do a journalist enough
to kind of for the call pruning the tree
if you can imagine on the artery start off a really big and then they just get
smaller and smaller and they branch mmm-hmm kind of like a tree
and what we do as we stopped the blood flow
by the sinks clumping up in the russell's
that a feeding five
roads that are allowing them to grow
okay and we stopped the blood cell
boats applied to the fibroids
and then they shrink and include over time takes a few months it's not
configs
flood the nice thing is you avoid surgery the recovery time is is much
much easier choosy for us it's about a week
two weeks you're only in the hospital usually overnight okay
compared surgery it could be
three-four weeks or maybe even longer oval
with some of the newer robotic techniques they've got it down to about
three weeks okay
so how does that process or how long is that
does that while one cult surgery that procedure take on the for woman comes in
how long is that usually take you to perform that generally fits
straightforward case toward our man about new which ok times two-and-a-half
hours
so it's it's relatively quick
uh... patient just lays on our table and uh...
they're awake i was gonna ask are you under full amnesties you're having a way
yet they're awake but what we do is we we couldn't we call kind of a twilight
and we have our combination medications that we do for for seven travel
and one takes away the pain
on the other one make sure that they really don't care so much
for the most part
access for nicholas is in the light a candle is quite a bit and for a few
seconds and then you know
after that most patients don't feel anything entail word nearly done with
the first side of the most asian and then they'll start filling some of that
cramping and it's very close to what it felt good
vengeful cycle
syrian that you stay open in the hospital that one night he got home the
next day absolutely
um... what are some of that
dina side effects are you know what kind of eg things can you experience now the
next day after you've been at home can you go back to work the next day or what
do you recommend generally we tell our patience you want to take about a week
off ok kind of a week where you're just not gonna feel lucky to it
the first day or two is usually the worse we keep people
in the hospital for uh... pain to trouble
that really is the big thing because what we're doing is were starving the
fibroids
huh and that can cause some some very severe cramping
so we use your card stu to pain control
and usually that's the first forty eight hours that that really is the worst
after that
most people do it what we call our posting box in from or kind of
flew like
you know you don't fill grade but you don't really feel completely
bad there's not really a lot of pain anymore just
a little cramping but you just have the blocks in mankind a flu like maybe even
some low-grade temperature and you just don't feel like doing much that lasts
about five days okay
and then after that most people after the first weaker or able to return to
work
uh... some people to my they need the two weeks but most people who would say
that they're ready to return to work within the first week
when you do that preceded you're cutting the blood supply off to the tumor yes
what what happened and mean what happens to that humor
it's a slow slowly dies
okay dis your body
the salt batter it just incorporates a over time
uh...
it's kind of it becomes internal scar tissue suvs socially but it just will
social
libby
so small that just no longer problematic in
or just completed
when you're in
the working on these tumors what's considered ballots in a year objects
what's considered a small tumor and what something that's
consider marks
i would say anything larger than
and orange health care
is marching
we've seen him we will we do get them were people will have one that's an
orange size one that's a softball size i mean we can the last one i did the woman
had one that was about the size of softball s and uh... she was actually
have a lot of lot of loading incise changes you know related to her fibroids
and she had more people she i think all told at about seven
uh... but mostly i think
people start feeling some kind of experience of
discomfort or where the symptoms of we talked about uh... more tickets about
the size of a golf ball okay
how long does it mean bad enough you know how long does it take for them to
grow
it depends on the personal k
uh... depends on how many there are depends on the personal out of that is
just very very individualistic
having them
and you know you have the most people get on the value weighted with alter
sound as follow ups about once a year ok so just they'll come in on the schedule
pointed to the altar sound anand ultrasound whoever's going to read that
you just wore the radiologist on some of the o began we do
ultrasounds
the compared to the motions of last time
while trying to do the same measurement so you know it this way in this way and
will compare and then to see if they are grown any in they can give them an idea
of the progress but generally speaking you don't need to do anything unless the
symptoms of severe ok so once that's been taking care of can they continue to
grow in other places in you can continue to get them up or you can then and
generally speaking once they've been gotten they've been guy ect
but until menopause
you would still be susceptible to to gross more i've never seen that
all right well
we have just a few minutes left let's talk about is there anything that we can
do to prevent them or
if you're gonna get them
he doesn't really matter what you do
mostly you're going to do them if you have a uterus and they have ethically we
talked wheaton
we really don't know why they grow and personal but they do
we know that they are responsive to estrogen
um...
what you can do is controller hypertension
control will be city those are deftly two things control diabetes that's you
know these adeptly things that are closely linked
but other than that there's not really a lot extra that you can do um... if you
have them and their symptomatic so there are a few other medications to birth
control pills
there is uh... g_ or h_
analogs that they can use there's a was that dan is all
there's a few medications but all those com with side-effects someone and
specialty smoke
whether or not you should be on birth control as his question what was really
more prone to getting blood clots in the legs
again as all causes uh... abnormal hello growth a deepening of the voice a second
exactly soldier there are but there are medications if you want ovoid procedures
altogether there did their deficit things that they can do
to prevent that
but alternately if you get a man they become symptomatic enough is just a
matter of
taking care of them and
no for some women getting hysterectomy
that's ok you know that that's okay there's some risks and competitions are
so shes but that they're a little bit higher than the u turmeric but they know
that the unisys com they don't have to do with that anymore when they're done
with my own other women
they want what would the surgery
or
because of work and money issues that they can take the time off
and this gives them an opportunity to
go another route that's very successful and very comfortable
within the n_ results and i think it's about eighty to ninety five percent of
all patients
have relief of symptoms within the first three months what sounds like there's
a lot of options out there for women to choose from absolute
i want to thank you for coming on the show and explain this topic to assign
i've learned a lot i'm hoping our viewers did to sell we look far to
having you back again though