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Alarmed and Exhausted
Oct 26, 2000

Hi Dr. Luzuriaga; I thank you in advance for your response. This is a statement as well as an inquiry. I am HIV+ since 1991, and at that early stage of my life, I was sexually active and had acquired several STD's. Some, I remember being treated for. Others maybe not. The point now is that I have been abstinate for over a year now, but I stay on top of my GYN appts. Well, I've been diagnosed with multiple fibroids, and occasional pain in my right pelvic and ovarian area, with progressing lower back pain which at times is very severe to where I have to sit down. The first thing that was thrown my way was a complete hysterectomy. I would like to try to avoid this procedure if necessary. I also suffer from COPD, and I've been told by my pcp and other medical staff that I would be a high risk for surgery such as this (due to my lung condition). I've been treated pretty shabbily in the past concerning my women issues. Such as when I had a breast biopsy in 1996 and the doctors failed to advise me that while I was under anethesia in the O.R. that they had to do a more extensive procedure. The outcome being that afer I was sent home, in a few days I had to be rushed to the E.R. for a reopening and draining of the wound, and contracting a bacterial infection that I could have died from. I'm sorry that this may be a bit long, but I'd like for you to understand why some women are really frightful of having surgery done. I'm sure you probaly heard of other such cases. By the way, the lump was benigh (thank God). Well, back to the fibroids. Since I've told the GYN specialist that I'd like to try and avoid a hysterectomy, nothing else much has been said about other ways (if any), of them trying to evaluate my ovaries. I've had an ultrasound and internal ultrasound, which verified that the ovaries cannot be seen. Is there any other measures that can be taken to find out what's going on in that area. I was once given Lupron, which eliminated the discomfort in my pelvic area before, but I was told that they would not give it to me again. Why, I don't know. But I live in constant fear that I am going to get ovarian and or cervical cancer, and by the time they diagnose it, it will have spread to the point of non treatment. Once again, I thank you for you response.

Exhausted

Response from Dr. Luzuriaga

It sounds as if your main concerns are the pelvic pain that you have been having, what could be causing it, and what can be done to resolve it. It also sounds as if initial evaluation has identified uterine fibroids as the possible cause of this pain. Fibroids are benign (non-cancerous) growths in the uterus that can cause pain and abnormal bleeding. Hormonal treatments are sometimes used to try to manage fibroids; hysterectomy (removal of the uterus) is recommended in cases in which the fibroids continue to grow and cause problems.

You're right to question other possible causes for the pain and seem very concerned about a potential cancer (although it doesn't sound as if anything in the work-up thus far is suggestive of such). I would recommend that you discuss your concerns, need for any further work-up, and options with your GYN provider. If you remain uncomfortable with the recommended plan, you might seek an evaluation and second opinion from another GYN provider.

KL

Katherine Luzuriaga, M.D.


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