Director's Perspective

This past month was filled with a wide range of activities that had me running to and fro, popping on different hats for different roles nearly every hour of every day. On top of attending the annual conference for the American Association of Gynecological Laparoscopists in San Francisco, the NUFF phone was ringing constantly -- nearly 24/7 -- as women learned of our organization through reading the November issue of Ladies Home Journal. Special thanks to Amy Zintl for writing such an excellent piece on uterine fibroids.

In reviewing the past year's activities -- the first full year in existence for NUFF as a 501(c)3 -- I'm proud to list all of the following in our FY 2001 accomplishments:

- uterinefibroids online email group grew from ~600 members to over 1400 (with many, many women finding treatment resolution and returning to their lives, no longer in need of online support)

- nearly 10,000 email generated via the uterinefibroids online email group (compared to 3,591 in FY 2000)

- ~50 email inquiries made daily to NUFF; questions about fibroids, menorrhagia, adenomyosis, endometriosis, cervical, uterine & ovarian cancer, leiomyosarcoma, diagnostic tests, medical therapies, treatment options, brochure requests, Dear Doctor letter writing, physician finder assistance, etc. are all par for the course on any given day

- ~12,000 informational brochures distributed

- NUFF.org averaged 131 visitors/day for a total of 43,726 user sessions from 1/1/2001 thru 11/30/2001 -- not bad for the first year online and a website still under construction!

- Senate Report 107-84 of S1536 included report language directing additional research on uterine fibroids and treatment options BEYOND THE HYSTERECTOMY per the DEPARTMENTS OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND RELATED AGENCIES APPROPRIATION BILL, 2002 -- Thank you Senators (and special thanks to all of your aides who welcomed my "stranded" soul in your offices the week of 9/11/2001)!

- all of the following media ran stories on uterine fibroids with our assistance:

The Oregonian
Colorado Springs Gazette
San Francisco Chronicle
Lifetime TV for Women
Chicago Tribune
Washington Post
Discovery Health
SheTV
LA Times
Rodale Press
Ladies Home Journal
Woman's Day
FOX TV (wide range of regional stories done by affiliate stations)

And many, many more. In addition, these and other supportive media are currently in progress with stories to be seen in 2002. We just can't thank the media enough for every single story they ran -- as the impact of educating women about uterine fibroids via the media was truly life altering for literally thousands of women this year. Please accept our deepest gratitude and heartfelt thanks -- and keep up the excellent communication work in 2002!

- numerous websites have chosen to provide a link to NUFF, including the following sites which represent those with the greatest number of referred "hits" to NUFF.org to date:

nlm.nih.gov
fibroids.net
uterinefibroids.com
thefibroidplace.com
newshe.com
radweb.mc.duke.edu
medexplorer.com
ohsu.edu
drfibroid.com
ufecenter.com
salon.com
healthwindows.com
bestoftheweb.com
healthcyclopedia.com
discovery.com
wellnessweb.com
askphysicians.com
biomedgate.com
nci.nih.gov
fda.gov
hystersisters.com
mel.org
soundmedicine.iu.edu
massimini.com
allhealth.com
indiatimes.com

All of this and more, including the listing/linking of NUFF on a wide range of insurance provider's medical content portals for "members only." Indeed, the "Uterine Fibroids" and "Fibroid Treatments" web pages have even been mirrored into a few health provider's websites supplied to corporations offline and accessible to employees through their corporate intranet access. While some corporations may be cracking down on employee internet access, they are still providing key content on health issues via other means. Certainly, we applaud those companies for their dedication to supporting the health of their employees through this unique approach to providing access to critical health information.

Somewhat unbelievably, all of these accomplishments have been managed on a shoestring budget and a whole lot of hard work by volunteers all across this nation. We have a great deal to be proud of this year! Thank you to all who've pitched in and helped wherever needed or whenever requested.

NUFF is a growing entity, that's for certain. However, even with all of the successes highlighted above, I wish I could also say that we have the ongoing funding to truly pay even so much as our monthly phone and internet bills -- but, we don't. And, since September 11, donations have trickled to a halt. In seeking funding from several corporations for special projects (such as printing our Treatment Options brochure in Spanish), I rapidly learned that many business' grant giving divisions have been frozen, for now, as well. Recession often means less profit or no profit at all for a business to funnel to their corporate giving foundations. We'll keep looking for grant funds, of course. But, the process is time consuming and resources for doing so are limited. Sigh. If you can help in this regard, please let me know.

It's hard being a "startup" and the first few years of any business can be a financial struggle. Unlike the founder of CapCURE, I'm not related to anyone at the Milken Foundation and am at a loss in the creation of a "Presidential Board" to represent us and speak out about this disease. Actresses aren't exactly lining up to let the world know of just how bad the bleeding, bulk symptoms, or urinary incontinence can become and, basically, as long as uterine fibroids continues to be a "closet" disease, this organization will continue to struggle.

Even so, I believe strongly in the mission statement of this organization -- just as I know you do -- and will find a way to keep it afloat come hell or high water*. We need to bring it out of the closet and make information about uterine fibroids, treatment options, and the general lack of research publicly known. But, we can't do that without YOUR support. Won't you show your support of the mission statement and activities of the National Uterine Fibroids Foundation by becoming a member today? Becoming a member ensures your monthly receipt of this newsletter, but also keeps an extremely worthwhile and long overdo organization for women's reproductive healthcare afloat. We need your help. Desperately.

Carla Dionne

* Hell or high water: Persevere no matter what difficulties are encountered.

Footnote: Thanks to computer viruses being spread like wildfire right now, over 12,000 email disappeared off of my hard drive over night last week. Anybody else out there having a bad month for virus hits? ;) Luckily, only one file folder was targeted in this elimination of email. Even so, YOUR email may have been in that folder. If you've recently written to me and expected a response but didn't get one, well, please resend your email. Preferably without a virus attached! :)

Press Releases & the Media...

Ultrasound Surgery Shrinks Symptomatic Uterine Fibroids

CHICAGO (Reuters Health) Nov 26 - Results of a pilot study of MRI-guided focused ultrasound surgery (FUS) for leiomyoma of the uterus suggest that the investigational procedure is safe and effective, said Dr. Clare Tempany of Harvard Medical School.

Click here for the Full Story (you must have a Medscape account -- it's free -- for this link to work):
http://womenshealth.medscape.com/reuters/
prof/2001/11/11.27/20011126clin013.html

SheTV (Discovery Health Channel)
Episode 44
Dec 26 2001 6:30 AM EST
Dec 29 2001 9:00 AM EST

Discover a new treatment for fibroids that may reduce the need for hysterectomies; "heart math" for stress reduction and improved health in five minutes; the signs of hearing problems in infants and more accurate methods of checking for cervical cancer.

Click here to sign up for an email reminder notice on this show's broadcast:
http://health.discovery.com/schedule/episode.jsp?episode=2077345044

It Ain't Necessarily So: How Media Make and Unmake the Scientific Picture of Reality
By David Murray, Joel Schwartz, S. Robert Lichter
Released: April 2001, 249 pages

Reviewed by: Cathy Tokarski, MedGenMed, November 6, 2001.

This link will take you to Tokarski's review of this book (you must have a Medscape account -- it's free -- for this link to work):
http://womenshealth.medscape.com/Medscape/GeneralMedicine/
journal/2001/v03.n06/mgm1106.01.toka/mgm1106.01.toka-01.html

Personally, I find the finger pointing at the media and advocacy groups a tad bit amusing. Particularly since physicians have been "making and unmaking the scientific picture of reality" since the onset of medicine. Even so, this book is a good foundation for understanding not only the research itself, but also how interpretation and dissemination of information can have widespread impact on decision-making -- sometimes erroneously.

Click here for more info on this book at Amazon.com:
http://www.amazon.com/exec/obidos/ASIN/0742510956/
qid=1007838497/sr=1-1/ref=sr_1_10_1/103-3113232-4418224

New book from Malesky & Kittel along with the editors of Prevention Magazine.

Click here for more info on this book at Amazon.com:
http://www.amazon.com/exec/obidos/ASIN/1579544010/
s qid=1007838677/sr=1-1/ref=sr_1_2_1/103-3113232-4418224

---

What Did My Doctor Write?

Study: MD handwriting is often illegible
(HealthScoutNews) -- Confirming the long-held suspicion of patients everywhere, researchers at medical centers in Swansea, Wales, proved that doctors have terrible handwriting.

Click here for the Full Story:
http://www.healthscout.com/template.asp?ap=43&page=newsDetail&id=505033

This is an old story...but the punch line is worth the visit... ;)

Click here to read the study:
Legibility of doctors' handwriting: quantitative comparative study
Lyons R, Payne C, McCabe M, Fielder C.
BMJ 1998;317:863-864.
http://www.bmj.com/cgi/content/full/317/7162/863?maxtoshow=&HITS=
10&hits=10&RESULTFORMAT=&fulltext=handwriting&searchid=1007771071892
_4906&stored_search=&FIRSTINDEX=0

What's your health IQ?
Test yourself on these 10 questions about common health risks
Ladies Home Journal

How much do you know about the health risks you face? Ladies' Home Journal worked closely with top experts at the National Institutes of Health (NIH) to develop this test. For each question, choose the correct answer, then read on to find out how you fared -- as well as simple strategies to protect your health. -- Michael Castleman

Take the test here:
http://www.lhj.com/lhj/story.jhtml?storyid=%2Ftemplatedata%2Flhj
%2Fstory%2Fdata%2Fhealthquiz_09182001.xml&categoryid=%2F
templatedata%2Flhj%2Fcategory%2Fdata%2Fs_23.xml&catref=S23

Show & Tell...

American Association of Gynecological Laparascopists (AAGL)

Established in 1971, the AAGL recently celebrated its 30th year at their annual conference held in San Francisco, CA, November 16-19. As the first organization in the world dedicated to gynecologic endoscopic surgery, historical strides have been made by a multitude of gynecologists who are members of this organization. Working on technological advancements in women's healthcare that distinctly benefit women with endometriosis, menorrhagia, uterine fibroids, and pelvic floor disorders, endoscopists have often been the front-runners in researching and offering alternative treatment options beyond the hysterectomy. And, in terms of even the hysterectomy, advances that allow women alternative choices in the approach of surgical treatment and retention of the cervix and/or ovaries have been well received by a great many women in this nation.

Even so, I guess I really wasn't prepared for the onslaught of hysterectomy videos presented at this conference. As a patient advocate who has come to understand how little we really know about the far reaching impact of hysterectomy on a woman's long-term quality of life, this viewing of so many hysterectomies in the course of one weekend was emotionally draining, to say the least.

Because their technology includes the absolute capability to videotape all procedures, much of this conference consisted of video demonstration and discussion. Very cool and extremely interesting on one hand...but occasionally quite disgusting and downright discouraging on the other. Over the course of the weekend, I probably viewed over 30 hysterectomies. Some of which were extremely questionable--both in terms of necessity as well as technique. Specific patient information was scant, as most presentations were simply about the technology and technique at getting the job done. I guess you could say this added to my personal discomfort over watching and listening to many of the presentations. I truly wanted to know that these docs cared about the person they were shoving a laparoscope into and that the patient was more than just a piece of meat. Unfortunately, that rarely came through in any given presentation. Patient background details on the necessity of any given procedure was sparse.

Okay, now let's be realistic. Many of these docs like endoscopy because, well, it's sort of a grown-up version of playing videogames. When I first thought of this "gaming" perspective, I looked around and realized that much of this conference did indeed resemble some of the computer conferences that I've attended in the past. The field is dominated by men, new toys are cool (excitement was evident on a number of occasions), the "best players" are either grandiose showoffs or nerdy quiet, everyone else in attendance is just a wannabe with little hope of ever getting to the top -- but simply want to learn enough to be the "winner" in their own home town. "Boys and their toys..." as one person (who shall remain nameless!) commented to me. If patients are lucky, however, each doctor will walk away with their own sheet of codes* that enhance their ability to perform procedures.

Now, beyond the hysterectomy, there were also presentations on endometriosis, reconstructive surgery for pelvic floor disorders, hysteroscopic & laparoscopic myomectomy, treating vs. not treating fibroids when fertility is desired, uterine artery embolization (although most of what was presented on this topic was woefully incorrect --with the exception of a roundtable discussion led by Dr. William Parker and preliminary clinical trial data presented by Dr. Gaylene Pron). Manufacturers of endometrial ablation equipment* gave presentations nightly -- and had me wondering why more gynecologists aren't offering this as a possible solution to menorrhagia instead of hysterectomy. Menorrhagia (w/out fibroids), after all, accounts for a couple hundred thousand hysterectomies annually in this nation. After failed medical therapy, why aren't more docs offering ablation instead of hysterectomy?

On top of all of this, a live cadaver demo of pelvic anatomy was incredibly fascinating (remember, I'm no doctor and never attended medical school -- this was absolutely awesome to me!) along with live telesurgery of supracervical hysterectomy, hysteroscopic myomectomy, etc., on the closing morning of the conference were truly educational. My biggest complaint is simply that I'd honestly like to see this organization try to address long-term patient outcomes a little more vigorously through scientifically validated measures -- but do believe the AAGL to be an evolving organization open to ways in which they can improve not only technical specifics but also patient satisfaction.

To learn more about AAGL, click here:
http://www.aagl.com

*codes: term used by video gamers to represent "cheats" or "shortcuts" which help them beat the game and win.

*endometrial ablation equipment: FDA recently covered these approved devices quite nicely in the following article online: http://www.fda.gov/fdac/features/2001/601_tech.html

If you are a researcher, medical director, or study coordinator interested in sharing information about YOUR work in this newsletter, please contact me at: carla@NUFF.org.

What's New in Research...

Junctional Zone on Magnetic Resonance Imaging: Continuous Changes on Ultrafast Image
Nakai A, Togashi K, Ueda H, Yamaoka T, Fujii S, Konishi J.
Journal of Women's Imaging 3(3):89-93, 2001.

I enjoyed reading this paper. Has quite a few potential implications in terms of uterine contractions, fertility, etc. Although technical in detail, this paper is worth reading all the way through and definitely had my imagination spinning with additional questions...

Click here to read this paper on Medscape (you'll need a Medscape account--it's free--before this link will work):
http://womenshealth.medscape.com/LWW/JWI
/2001/v03.n03/jwi0303.01.naka/jwi0303.01.naka-01.html

Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology
Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, Uzan S.
Hum Reprod. 2001 Nov;16(11):2427-33.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11679533&dopt=Abstract

Imaging the endometrium: disease and normal variants
Nalaboff KM, Pellerito JS, Ben-Levi E.
Radiographics. 2001 Nov-Dec;21(6):1409-24.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11706213&dopt=Abstract

Comparative analysis of cyclin D1 and oestrogen receptor (alpha and beta) levels in human leiomyoma and adjacent myometrium
Kovacs KA, Oszter A, Gocze PM, Kornyei JL, Szabo I.
Mol Hum Reprod. 2001 Nov;7(11):1085-91.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11675476&dopt=Abstract

Inhibition of in situ expression of aromatase p450 in leiomyoma of the uterus by leuprorelin acetate
Shozu M, Sumitani H, Segawa T, Yang HJ, Murakami K, Inoue M.
J Clin Endocrinol Metab. 2001 Nov;86(11):5405-11.

Click here to order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11701714&dopt=Abstract

Up-regulation by igf-I of proliferating cell nuclear antigen and bcl-2 protein expression in human uterine leiomyoma cells
Gao Z, Matsuo H, Wang Y, Nakago S, Maruo T.
J Clin Endocrinol Metab. 2001 Nov;86(11):5593-9.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11701740&dopt=Abstract

Immunohistologic localization of estrone sulfatase in uterine endometrium and adenomyosis
Ezaki K, Motoyama H, Sasaki H.
Obstet Gynecol. 2001 Nov;98(5 Pt 1):815-9.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11704174&dopt=Abstract

Prevalence and risk factors of adenomyosis at hysterectomy
Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB.
Hum Reprod 2001 Nov;16(11):2418-21.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11679531&dopt=Abstract

Uterine necrosis after uterine artery embolization for leiomyoma
Godfrey CD, Zbella EA.
Obstet Gynecol. 2001 Nov;98(5 Pt 2):950-2.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11704217&dopt=Abstract

Ruptured degenerated uterine fibroid diagnosed by imaging
Kamat NV, Telkar HB, Ramani SK, Thakker AP.
Obstet Gynecol. 2001 Nov;98(5 Pt 2):961-3.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11704222&dopt=Abstract

Laparoscopic-assisted resection of bleeding jejunal leiomyoma
Abbas MA, Al-Kandari M, Dashti FM.
Surg Endosc. 2001 Nov;15(11):1359B-1359.

Just checking to see if anyone is really paying attention to these citations... ;)

Not a uterine fibroid at all...men get these lovely smooth muscle tumors as well...in less than ideal locations... (jejunal=portion of small intestine)...I particularly liked the characterization of surgical outcome in the abstract for this paper:

"...enjoyed an uneventful postoperative recovery..."

Enjoyed? Must be a difference in the cultural use of this word (this paper is from Kuwait)...because I can't honestly imagine any patient "enjoying" postoperative recovery from any procedure... ;)

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11727152&dopt=Abstract

Laparoscopic myomectomy after failure of uterine artery embolization
Stringer NH, DeWhite A, Park J, Ghodsizadeh A, Edwards M, Kumari NV, Stringer EA.
J Am Assoc Gynecol Laparosc. 2001 Nov;8(4):583-6.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677341&dopt=Abstract

Addition of laparoscopic uterine nerve ablation to laparoscopic bipolar coagulation of uterine vessels for women with uterine myomas and dysmenorrhea
Yen YK, Liu WM, Yuan CC, Ng HT.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):573-8.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677339&dopt=Abstract

Changes in myometrial thickness during hysteroscopic resection of deeply invasive submucous myomas
Yang JH, Lin BL.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):501-5.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677327&dopt=Abstract

Recurrence of leiomyomata after laparoscopic myomectomy
Doridot V, Dubuisson JB, Chapron C, Fauconnier A, Babaki-Fard K.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):495-500.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677326&dopt=Abstract

Acute uterine inversion due to a growing submucous myoma in an elderly woman: case report
Kopal S, Seckin NC, Turhan NO.
Eur J Obstet Gynecol Reprod Biol 2001 Nov;99(1):118-20.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11604199&dopt=Abstract

Expression of CD44 standard and isoforms V3 and V6 in uterine smooth muscle tumors: A possible diagnostic tool for the diagnosis of leiomyosarcoma
Poncelet C, Walker F, Madelenat P, Bringuier AF, Scoazec JY, Feldmann G, Darai E.
Hum Pathol 2001 Nov;32(11):1190-1196.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11727257&dopt=Abstract

Transient shrinkage of a uterine leiomyosarcoma treated with GnRH agonist for a presumed uterine leiomyoma: Comparison of magnetic resonance imaging finding before and during GnRH agonist treatment
Kawamura N, Iwanaga N, Hada S, Maeda K, Sumi T, Ishiko O, Ogita S.
Oncol Rep. 2001 Nov-Dec;8(6):1255-7.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11605044&dopt=Abstract

Cytologic features of a primary myxoid malignant fibrous histiocytoma arising in the uterus: a case report
Kiyozuka Y, Tsuta K, Akamatsu T, Matsuyama T, Mizuta H, Nakanishi K, Nakano S, Tsubura A.
Acta Cytol 2001 Nov-Dec;45(6):1060-8.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11726104&dopt=Abstract

Women's decision making regarding hysterectomy
Lindberg CE, Nolan LB.
J Obstet Gynecol Neonatal Nurs 2001 Nov-Dec;30(6):607-16.

Might I suggest that nurses can help these women improve their quality of life by also ensuring that the hysterectomy is not the ONLY treatment option information presented to them? Perhaps the focus should be shifted to assisting women find broader educational support in learning of ALL their options instead of supporting them through simply a "holding on" pattern until symptoms are no longer manageable and they come in begging for a hysterectomy...

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11724196&dopt=Abstract

Developing a Video Intervention to Model Effective Patient-Physician Communication and Health-Related Decision-Making Skills for a Multiethnic Audience
Richter DL, Greaney ML, McKeown RE, Cornell CE, Littleton MA; Pulley L, Groff J, Byrd TL, Herman CJ.
J Am Med Womens Assoc. 2001 Fall;56(4):174-7.

Hysterectomy decision-making, that is. I found this paper a bit curious as I honestly can't see how the hysterectomy can be objectively presented to a patient in isolation from other treatment options without an underlying objective to actually "influence" the patient's decision towards the physician's "reasonable" perspective of the hysterectomy as SOP. Regardless, this is an interesting paper that attempts to take a serious look at patient-physician communication and provide some tentative solutions for positive change.

On the related ENDOW (Ethnicity, Needs, Decisions of Women) website, there are two booklets: "The Wise Woman's Guide to Making Decisions" and "Talking to your Doctor." Both are extremely simple models which teach decision-making and communication behavior in a proactive manner. However, the first booklet, "Making a Treatment Decision," models the choice of treating fibroids -- and contains a woefully incomplete, over-simplistic, decision tree of options. If this is indeed representative of the video that was created on hysterectomy decision-making, then there are some serious flaws to this work.

Click here to read the paper from JAMWA:
http://jamwa.amwa-doc.org/vol56/pdf/56_4_9.pdf

For more information on the ENDOW project and to review/purchase materials developed as an outcome of this project, click here:
http://www.dopm.uab.edu/endow/

Hysterectomy: Beliefs and Attitudes Expressed by African-American Women
Shelton AJ, Lees E, Groff JV.
Ethnicity & Disease 2001:11(4)732-740.

Click here for ordering information on this paper:
http://www.ishib.org/main/ed_contents_v11_n4.htm

Pseudoaneurysm of the uterine artery after abdominal hysterectomy: Radiologic diagnosis and management
Lee WK, Roche CJ, Duddalwar VA, Buckley AR, Morris DC.
Am J Obstet Gynecol 2001 Nov;185(5):1269-72.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11717672&dopt=Abstract

437 Classic intrafascial supracervical hysterectomies in 8 years
Morrison JE Jr, Jacobs VR.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):558-67.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677337&dopt=Abstract

Hysteroscopic endomyometrial resection of three uterine sarcomas
Vilos GA, Harding PG, Sugimoto AK, Ettler HC, Bernier MJ.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):545-51.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677335&dopt=Abstract

Endometrial ablation using hysteroscopic instillation of hot saline solution into the uterus
Perlitz Y, Rahav D, Ben-Ami M.
Eur J Obstet Gynecol Reprod Biol 2001 Nov;99(1):90-2.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11604192&dopt=Abstract

A prospective controlled study of the effect of intramural uterine fibroids on the outcome of assisted conception
Hart R, Khalaf Y, Yeong CT, Seed P, Taylor A, Braude P.
Hum Reprod. 2001 Nov;16(11):2411-7.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11679530&dopt=Abstract

Spontaneous uterine rupture in pregnancy 8 years after laparoscopic myomectomy
Oktem O O, Gokaslan H, Durmusoglu F.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):616-8.

No abstract available -- click here to order from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677352&dopt=Abstract

Spontaneous uterine rupture in pregnancy 8 years after laparoscopic myomectomy
Seidman DS, Nezhat CH, Nezhat FR, Nezhat C.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):618-9.

No abstract available -- click here to order from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677353&dopt=Abstract

Ovarian function in late reproductive years in relation to lifetime experiences of abuse
Allsworth JE, Zierler S, Krieger N, Harlow BL.
Epidemiology 2001 Nov;12(6):676-81.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11679796&dopt=Abstract

Laparoscopic performance after one night on call in a surgical department: prospective study
Grantcharov TP, Bardram L, Funch-Jensen P, Rosenberg J.
BMJ 2001 Nov 24;323(7323):1222-3.

I really, really like the "Rapid Responses to this Article" section of the BMJ which appears below all papers published online there. I wish more medical journals would allow for this kind of input from readers.

Click here to read the full paper from BMJ:
http://bmj.com/cgi/content/full/323/7323/
1222?view=full&pmid=11719413

Low-dose dexamethasone effectively prevents postoperative nausea and vomiting after ambulatory laparoscopic surgery
Huang JC, Shieh JP, Tang CS, Tzeng JI, Chu KS, Wang JJ.
Can J Anaesth 2001 Nov;48(10):973-7.

...just gotta love the guys working on cutting down the nausea and "up-chuck" factor after a procedure... ;) every little bit counts in making any procedure more "comfortable"...

Click here to read the full paper:
http://www.cja-jca.org/cgi/content/full/48/10/973?view=full&pmid=11698315

Risk of Discovering Endometrial Carcinoma or Atypical Hyperplasia during Hysteroscopic Surgery in Postmenopausal Women
Agostini A, Cravello L, Bretelle F, Demaisonneuve AS, Roger V, Blanc B.
J Am Assoc Gynecol Laparosc 2001 Nov;8(4):533-5.

Click here to read the abstract or order the paper from PubMed:
http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?
cmd=Retrieve&db=PubMed&list_uids=11677332&dopt=Abstract

Intrauterine system preferred for treatment of menorrhagia
Nicholls H.
Trends Endocrinol Metab 2001 Nov 1;12(9):381.

Click here to read this trends review from BioMedNet (you must have an account -- it's free -- for this link to work):
http://journals.bmn.com/journals/list/browse?
uid=TEM.etd00932_10432760_v0012i09_00000509&rendertype=

Uterinefibroids Yahoo Email Group

Searching Archived Email

Have you recently joined the uterinefibroids email group and found the question on YOUR mind not the current topic under discussion? With over 3 years of historical email archived on this list group's database at Yahoo (~15,000 email!), it's a sure bet that the question may have been discussed in the past. Take the time to login online and check it out -- you may be pleasantly surprised at the vast quantity of information and links stored within archived email.

1. Login to your Yahoo account at: http://groups.yahoo.com.

2. Go to: http://groups.yahoo.com/group/uterinefibroids/messages

3. Type in your search terms and click the "Search Archive" button.

Relevant messages display in numerical sections of the archives. To review additional relevant messages, click on the "Next" link at the top of the Messages column and the search will continue through additional numerical sections.

For more instructions on a wide range of HELP topics for Yahoo Groups, click here:
http://help.yahoo.com/help/us/groups/

A few additional thoughts...

During the past month, there have been many days when my level of concentration was getting pulled in dozens of directions and focusing in on any single task to completion was difficult. Some of this is surely due to increased activity in supporting women turning to NUFF for assistance and patient education. But, a greater portion is no doubt due to the continued stresses of living in a new world of terrorism that our nation is actively engaged in battling right now.

News of the first U.S. deaths in Afghanistan quickly swept across the Internet, as it is not hard to know someone who knows someone who just had a son killed when one's community is truly the world, online. Our collective hearts sank, we shared a quiet prayer, and then we moved on to the next email. Some of us, however, turned to attempts at numbing our emotions through artificial means. Indeed, ABC News recently reported a nationwide increase in alcohol and drug abuse as many of us seek to self-medicate away our stresses and fears.

While I too indulge in alcoholic beverages upon occasion, familial heritage predisposes me to alcoholism and, well, I try to pay close attention to limiting my alcohol consumption as a result. From childhood experience, I can testify firsthand that it is no fun living with a parent who makes self-medicating via alcohol or drugs a way of life. Please, if you find yourself turning to alcohol or drugs during this stressful time period, don't be afraid to reach out for help and support from others instead.

Whenever stresses hit me hard, I've found that turning to the comfort of Native American music allows me to regain a sense of perspective and objectivity over the day's events. You see, my great-great-great-great grandmother was Choctaw. In 1832, she was forced to walk the Trail of Tears from Mississippi to Oklahoma.

The horrific injustice of having her well established and agriculturally productive farm land taken from her as she was forced to trek to untilled soil over 200 miles away, barefoot and wearing only a cotton dress during the dead months of winter, as well as the multitude of emotional stresses she must have endured as over 1/3 of her tribal nation was buried en route due to famine and disease, provides me a never-ending source of strength, courage, and inspiration to continue on through even the worst of situations.

I consider this woman, "Penny," my guiding spirit. She survived...and so can I. In the depths of sadness and despair, I've been awed by this woman's spiritual presence and always found hope for the future from remembrance of her own difficult journey and survival. Listening to Native American music reminds me of Penny, and allows me to refocus and get on with work. Perhaps this music will provide a sense of comfort and peace to you too.

Here are a couple of my favorite Native American CDs that I've found allowed me to find the space to breathe again during the past month. Yahoo has great sound files of all cuts of these albums which truly allows one to sample the flavor of the music.

Touching the Sweet Earth, Sharon Burch
http://album.yahoo.com/shop?d=ha&id=
1800746524&cf=10&intl=us&clink=dmmu-ks/sharon_burch

More on Sharon Burch:
http://www.canyonrecords.com/artburch.htm

Lifeblood, Joanne Shenandoah
http://album.yahoo.com/shop?d=ha&id=1801456158&cf=10&intl=us

More on Joanne Shenandoah:
http://www.joanneshenandoah.com

This music may not be everyone's cup of tea, but it has definitely helped to smooth out the rough spots for me on truly bad days.

Breathing with you and hoping your Trail of Tears with uterine fibroids is a short journey towards a safe and healthy haven,

Carla Dionne
Executive Director
National Uterine Fibroids Foundation
carla@NUFF.org
(805) 482-2698
1 (877) 553-NUFF
Author, Sex, Lies, and the Truth About Uterine Fibroids

"Never doubt that a small group of thoughtful committed citizens can change the world. Indeed it's the only thing that ever has." Margaret Mead

NUFF Mission Goals

The National Uterine Fibroids Foundation is a nonprofit public charity dedicated to the following five goals:

1. To provide information to the public about the diagnosis of, and treatment options for, uterine fibroids and related conditions;
2. To advocate for the rights of all women to maintain independent choice in the matter of deciding upon treatment options;
3. To facilitate research;
4. To promote alternatives to hysterectomy in an effort to reduce the number of unnecessary hysterectomies performed;
5. To provide support to internet-developed women's health groups.

To read more about our Mission Goals, visit the NUFF site at: http://www.nuff.org/about_mission.htm

Do not "Reply" to this email. Send suggestions and comments to: Newsletter@NUFF.org

The Fibroid Tidbits... is (c) 2000-2001 National Uterine Fibroids Foundation. All Rights Reserved. No part of this Newsletter may be reproduced in whole or in part without written permission.

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