Q: I had a laparoscopic hysterectomy five years ago. No one ever mentioned that, if my fibroids contained cancer cells, the procedure could have spread cancer throughout my body. Why didn't they warn me? — Frieda R., St. Louis
A: That's true, and you and thousands of other women have dodged a bullet. That wasn't the case for 41-year-old Dr. Amy Reed. When she had a hysterectomy, she never suspected the minimally invasive procedure (power or electric laparoscopic hysterectomy morcellation) could make her far sicker than the discomfort she was experiencing from uterine fibroids.
But the power tool that minced up the fibroids — a morcellator — spewed cancer cells (hidden inside the fibroids) throughout her abdominal cavity. Less than a week after the procedure, she was diagnosed with stage IV leiomyosarcoma — a particularly difficult form of uterine cancer.
She and her husband started a campaign to let docs know that this was a dangerous technique and they should stop doing it. Her effort, along with several important studies, got the Food and Drug Administration's attention.
In April, the FDA issued an advisory: “Based on currently available information, the FDA discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy for uterine fibroids.”
How did they not know before? Surgical techniques, unlike medical devices and drugs, don't go through the FDA's approval process. So problems might not become widely recognized until thousands of procedures have been done.
And most medical professionals have been taught that cancer-containing fibroids are very rare, but researchers have recently found they're nine times more common than generally expected.
Doctors are working on ways to contain fibroid tissue as it is morcellated inside the body so that cancerous cells are not spread. But for now, it appears that laparoscopic or abdominal surgery that extracts the fibroids whole is the safe alternative.
Q: A friend of mine who used to be a bit heavy (he's 65) has lost a lot of weight, and he proudly told me he's finally eating the right amount of calories from very healthy foods. Well, he sure isn't eating very much food. Could he have an eating disorder at his age, and why haven't his doctors done anything about it? — Del R., Hypoluxo, Fla.
A: Eating disorders don't discriminate; they can afflict young or old, male or female. There's binging, bulimia, compulsive overeating, purging, night eating and what you seem to be talking about, anorexia — the inadequate intake of food.
Your friend could have developed the condition after a trauma, say, a health scare or the death of someone dear, but it's possible he's battled the problem for a while. If it is chronic, you or he may be seeing the results of the lack of vitamins and minerals: damage to the heart, digestive system, skin and brain.
Unfortunately, if he has an eating disorder, it's not surprising that his doctors haven't picked up on it. People expect the condition to affect young women, and some studies report only 10 percent of folks with an eating disorder are men. That's why your average guy is the last to be considered at risk. We believe it's a bigger problem and that about 25 percent of those affected are men.
When you see your friend again, the symptoms you might look for include making excuses for skipping meals or not eating in public and an obsession with calorie counts. Sometimes anorexia is associated with an obsessive-compulsive disorder, and checking and reducing calories becomes a ritual.