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Physician heal thy profession: trailblazing fibroid docs shifting treatment paradigm

By Holly Bridges and Zal Press

In its 2014 roadmap for the future, the Canadian Medical Association declared “its readiness to take a leadership position in confronting the hard choices required to make health care work better for Canadians”.

Part of the solution, promised the CMA, was its framework for transformation that included:

  • Building a culture of patient-centred care
  • Enhancing patient access along the continuum of care
  • Recruiting more health care providers trained in high tech medicine

Things that are changing in caring for FibroidsWhile the CMA has a long way to go before all 72,000 of its members adopt patient-centred care to reduce wait times and fast-track better outcomes, there are pockets of practitioners who are demonstrating real leadership.

The recent Uterine Fibroid Collaborative Forum in Toronto, which saw both patients and physicians come together for the first time, offered a glimpse of this new patient-centred paradigm.

Some trailblazing Canadian gynaecologists who are on the front lines of treating women with fibroids surrendered a precious Saturday (from a workweek that is often 80 to 100 hours) to update patients on new treatment options.

Many of the gynaecologists who attended, such as Dr. Nicholas Leyland, Dr. Grace Liu, Dr. Ally Murji and even a young medical student, are true visionaries at the forefront of change. These surgeons are improving the lives of Canadian women yet often at their own financial peril (gynaecologists who practice minimally invasive gynaecology actually lose money because newer high tech alternatives pay half what a hysterectomy pays yet take twice or three times as long).

Dr. Nicholas Leyland, MD, Ob-Gyn, a long-time champion for women’s health and currently a Professor and Chair Department of Obstetrics and Gynaecology at the Michael G. DeGroote School of Medicine McMaster University, spoke of a politicized health care system.

“I can tell you that women’s’ health is just not on the radar,” said Dr. Leyland. “It’s not even part of the conversation and you can look at the quality of life data and the impact on the quality of women’s lives and it is at least as significant as the disorders that they have chosen to prioritize so ask yourself ‘Why is that?’”

A system, Dr. Leyland said, that has prioritized cancer, cardiac care, diagnostic imaging, joint replacement and sight replacement and neglected the needs of women with debilitating fibroids.

A study by the Johns Hopkins Bloomberg School of Public Health on the quality of life burden facing women afflicted with pelvic pain and Heavy Menstrual Bleeding (HMB) found that women who suffer from serious, sometimes life-threatening HMB have the same quality of life and level of function as heart attack and stroke victims entering rehabilitation.

We have to think of a different way to influence changeYet these women are not off work in treatment, or in hospital. They are working full-time, running kids to soccer, doing groceries, etc, all while struggling against the exhaustion and crippling pain that are the signposts of this condition.

Dr. Leyland and other gynaecologists who specialize in less invasive, less risky and less painful treatment options (everything from medication to keyhole surgery), are working hard to make these options the gold standard for women.

  • They have released new guidelines for the treatment of uterine fibroids which, for the first time, include non-surgical, medical management treatment options. The new guidelines can be found on the Society of Obstetricians and Gynaecologists website.
  • They are training new gynaecologists to perform less invasive surgeries.
  • They have developed an index called “technicity,” a system to monitor how many Canadian hospitals are performing less invasive hysterectomies (keyhole surgery versus open surgery).
  • And, they have formed a new society called the Society of Minimally Invasive Gynaecology.

So while their work is helping women with fibroids, there is still much work to do.

As Dr. Leyland suggested:

  • More gynaecologists need to adopt patient-centred care and follow these new fibroid treatment guidelines, which recommend hysterectomy as a last, not first, resort.
  • More patients need to understand the options contained in the guidelines.
  • Women need to pressure politicians to make women’s health a priority.

While the CMA has a big challenge ahead of it, dynamic leadership can be found in specialty practice that emulates the commitment to transformation the CMA roadmap heralds.

Raising awareness of uterine fibroids: a collective responsibility

By Zal Press and Holly Bridges

It is Not normal to have pain during sexEight thousand strong and counting. The voices of the women (and a few supportive men) of this organically driven nationwide collaborative are beginning to make inroads after a long two years. They are heard in traditional media, in online social media conversations, and in live events such as the second national forum in Toronto recently.

The biggest newspapers in the country have covered the issue. The late Barbara Turnbull, the Toronto Star feature health writer, brought attention to new treatments for fibroids.  Other Star writers highlighted the stories of personal suffering and courage of women who face limited choices in treatment and long, painful journeys to diagnosis. And The National Post ran a full-page feature on fibroids in a special supplement devoted to women’s health.

Starting up conversations

The strength of this collaborative, however, is its ability to turn online conversations into a support system that provides an easy way for sharing stories and information. Women suffer economic and social burdens, often hiding their condition from employers and families. In social media they have found solace in the experience of others, and gained knowledge of new treatment options that empowered them in their relationships with their physicians.

Despite these successes, the vast majority of women who suffer from fibroids, and that could be as many as 20% of the female population, are still unaware of all of the treatment options available, where to find support, and how to break out of the stigma associated with bleeding disorders.

Talk is cheap but not easy

For some women, talking about painful, heavy periods is still shrouded in shame and secrecy, which prevents the kind of awareness and societal conversation that is necessary to affect change.

“I’m one of those people that don’t necessarily like to talk about how I’m feeling,” said Carmen Wyton of the Alberta Women’s Health Coalition, who spoke at the forum. “I have had some significant health challenges in my life and chosen to keep them to myself so for me to talk about things like menstrual health and sexuality [is foreign] because I was brought up in a world where you kept that to yourself.

“It is important that we break that paradigm and get more comfortable with telling our stories.”

Professionally unaware

Women aren’t alone when it comes to lack of awareness of support groups, information and understanding the latest treatment options for fibroids.

“Even since our last meeting two years ago, many of the gynaecologists we invited to the forum were unaware of the fibroid group and the fact it has grown to over 8,000 members,” said Michael Houlahan of Sand Pile Inc. who organized the forum and specializes in healthcare stakeholder strategies.

And surprisingly, the path to greater awareness of treatment options remains elusive even for some gynaecologists. Physicians face obstacles to providing the best, and most appropriate care for a patient. The complexities of the healthcare system, time constraints, and reliance on the status quo continue to stand in the way of greater competency in the latest surgical techniques and medical management strategies.

“Getting the best evidence to busy clinicians is a difficult and challenging process because in talking to various doctors they may approach a problem based on how they were trained 20 years ago,” said Dr. Nicholas Leyland, Professor and Chair, Department of Obstetrics and Gynaecology at the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Ont.

So where does this leave women?

Be Very vocal with the medical communityIt’s not really a gloomy picture. On the contrary. The UF Collaborative Forum set new standards and opened a huge new door in the relationship between women and the professionals who treat them. As more gynaecologists become aware of these groups, the more they are directing patients for support.

New, allied initiatives have also emerged. In Alberta, Carmen Wyton’s (@cawyton) Women’s Health Coalition  is gathering steam and bringing attention to the entire issue of women’s health and the lack of focus by the healthcare system and society at large.

The evidence is clear that more informed and activated patients have better health outcomes. In the case of the treatment of fibroids, this applies equally to the more informed healthcare professionals. Awareness is a two-edged commitment and must keep growing if greater numbers of women beyond the 8,000 are to reap the benefits of making an informed choice in treating a condition that affects so many and has been cloaked in silence for too long.

Blood sisters:
fighting fibroids as one

By Holly Bridges and Zal Press

Why is it that suffering brings people together?

Is it a sense of duty, compassion or something more primal?

When someone close to us is critically ill, or passes away, our immediate instinct is to gather together. To connect. To share. To laugh and to cry.

First UF GatheringFibroid community is growing

The recent Uterine Fibroid Collaborative Forum held in Toronto (the second in two years), where women with fibroids and expert gynecologists gathered together for the first time, was a salve of sorts -a grassroots coming together of women whose lives are at the mercy of their own bodies, disabled by monthly bloodbaths that leave women feeling desperate, exhausted and alone.

In other words, the collective suffering of these women, and their growing frustration over a lack of access to timely and effective treatment options, has created a new and growing community of Canadian women who are desperate for change.

Their mantra is clear

Our suffering is real, we deserve better and we are stronger as a community.

We are tired of waiting years for proper diagnosis and treatment.https://youtu.be/

We are tired of a health care system that seems to put us last.

We are tired of being tired.

Whether through social media, word of mouth or a gentle nudge to join from a core group of women who are leading the charge, the size of the community of women with fibroids is growing, mostly organically, and remains mostly virtual.

Size of community

CANFib.ca website visualizationThe community is pushing 8,000 so far, with more than 5,200 members and growing of Canadian Women with Fibroids (CanFIB) on Facebook (founded by fibroid survivor Pat Lee), almost 1,500 on Hysterectomy Alternatives on Facebook (started by UnHysterectomy author and fibroid survivor Holly Bridges) and several more belonging to the new Alberta Women’s Health Coalition (co-founded by Carmen Wyton, who is also the chair of the Alberta Premier’s Council of the Status of Persons with Disabilities).

“If there’s one thing I find on the Facebook group, it’s women come for the first time and say ‘Thank God I found a place where somebody understands,” said Pat Lee.

Not formally organized

The fact that this fibroid fighters community remains largely informal, without any real structure, speaks to its very raison d’être.

For the most part, members are in the prime of their lives, in their 20s, 30s, 40s and 50s, when they need their energy the most. Their schedules are packed with responsibility, working, raising children, volunteering, coaching soccer, car-pooling, caring for aging parents or approaching menopause.

The last thing they want is more responsibility.

Bit by bit by bit

Yet the fibroid forum was a big step towards formalizing a Canadian fibroid community, one that continues to offer women a safe place to meet, share their common experiences, learn and vent.

“Communities help people evolve and gain new perceptions, empowerment and strength,” said Pat.

In fact, communities give us a sense of identity; they help us understand who we are and what we are experiencing so we can feel part of something larger than ourselves. And in doing so, we can build momentum towards achieving change.

“Lived experience is the most powerful place from which to speak,” said Mercy , a founding member of the forum.  “No one can deny your story, so understanding it and communicating as completely and effectively as you can, in the most compelling way possible, helps you and others to get to that big picture idea of creating a society that works for everyone in the best possible way.”

The trick lies in patients and physicians working together to build a better, more accessible health care system for all.

My uterus gets no respect: the UF movement gathers steam

UF-Collab-logoBy Holly Bridges and Zal Press

In the second gathering of Canadian women who suffer from uterine fibroid tumours, patients and physicians alike rolled up their sleeves to share and learn how this group is beginning to influence better health outcomes and improved quality of life for the one in four Canadian women suffering from this condition.

The day was recorded on video and graphic illustrations that captured the emotions and intensity of the day.

StoriesArePowerfulThe UF Collaborative Forum in Toronto was the first time that women and gynecologists came together to share their different perspectives on the gaps in health care that often leave women to bleed with limited choices of treatment. This groundbreaking event began the vital conversation between healthcare professionals and patients with the goal to establish a unique collaboration that tackles the critical issues affecting treatment and care.

The women who attended represented all stages of the uterine fibroid fight, including those facing surgery, those on the brink of emotional and physical collapse from years of suffering from painful and often uncontrollable bleeding, and those who have emerged victorious and symptom-free after hysterectomy or other treatments.

Val explained why she fought for five years to save her uterus, the organ that simply gets no respect.

Mercy, who also underwent fibroid surgery five years ago, described her journey to save her uterus as “traumatizing.”

In our original series of stories Patient Commando highlighted the many gaps in the treatment of fibroids, the inconsistency in treatment between physicians, the lack of awareness in our society about menstrual disorders and, most important, the burden of illness women live with every day.

Now almost a year and a half after our last series, a new set of stories has emerged as we continue to examine the issue and track the progress and achievements of this group.

HaveAVoiceWhile many of the women attending the UF Collaborative Forum expressed frustrations similar to the original group, the big difference this time was having physicians sitting at the table, sharing insights into the challenges they face treating patients. For most of these women, it was their first opportunity to talk with physicians about fibroids outside of the therapeutic relationship. And the same could be said for the physicians who listened attentively to the compelling and gripping personal stories.

Watch in the coming weeks as we pull back the curtain on this incredible day. You’ll hear more from Val and Mercy and other women such as Pat Lee from Canadian Women with Fibroids.

All in all, we’ll discuss six main themes:

Community – What is this uterine fibroid patient group and what do they want to say?

Medicine – The Society of Obstetricians and Gynecologists of Canada has released new treatment guidelines for fibroids. How will this affect physician practice?

Awareness – How will the uterine fibroid message be heard?

Advocacy – Fibroid women have self-organized and even made submissions to the federal government to approve certain drugs. What else can they do, how, when and where?

Collaboration – How do they continue partnering with physicians and other potential partners who may be interested in helping them grow?

The future – Where is this movement headed at this fork in the road? What can they learn from others like the budding Alberta Women’s Health Coalition?

The fight against uterine fibroids in Canada has taken a turn for the better and is picking up steam.


For more information about the UF movement:

Holly Bridges


Patricia Lee


Click on the graphics to understand why this movement got started…


…And why it’s gaining momentum today…


UF-Collab-Forum (1)