Two years ago, Yolanda Pesnell was diagnosed with uterine fibroids — benign tumours that originate in the uterus (womb). At the time of her diagnosis, Pesnell was presented with two options: to have a hysterectomy (to remove her entire uterus) or a myomectomy whereby only the fibroids would be surgically removed leaving the uterus intact and preserving fertility. However not all women are candidates for myomectomy. If the fibroids are numerous or large, myomectomy can become complicated, resulting in increased blood loss. If cancer is found, conversion to a full hysterectomy may be necessary. Pesnell said she was told this when diagnosed at the hospital and admitted that even the thought of going through with the myomectomy with the possibility of still having a hysterectomy and the chance of ever having children completely taken away from her was quite devastating.

For the 29-year-old, life would never be the same. Married for only three years at the time of her diagnosis, Pesnell and her husband had to face the possibility of never having children. Not willing to accept the options available to her spurred Pesnell on to seek other alternatives. Through her own research on the Internet and talking to friends, Pesnell found out about another procedure called embolisation. This is a minimally invasive means of blocking arteries that supply blood to fibroids. It is a procedure that uses angiographic techniques (similar to those used in heart catheterisation) to place a catheter into the uterine arteries. Small particles are injected into the arteries, which results in the blockage of the arteries feeding the fibroids. The blockage of blood supply caused degeneration of the fibroids which results in resolution of symptoms according to the Florida Medical Centre of Northern California.

According to the Centre for Disease Control (CDC) in the United States, gynaecological problems are common among women of reproductive age. In a report issued by the CDC in 2003, more than 4.5 million women aged 18 to 50 report at least one chronic gynaecological condition each year. Nearly half of all women who menstruate experience some pain during menstruation and ten per cent of them suffer from pain so severe that it interferes with their daily routine.

Most women can agree that having your monthly cycle is not something to look forward to but for Pesnell it was not the cramps, tiredness and moodiness she dreaded but the huge amount of blood loss. Once an active person who looked forward to her early morning workouts, she became someone who simply did not have the energy to get up and do much of anything anymore. Tiredness and dizziness often occurred to point where she felt like she would 'pass-out' due to blood loss. Socialising with friends, co-workers and acquaintances were very limited. According to Pesnell she was plagued with embarrassment and fear.

Through a health segment on television, Pesnell first heard the names Dr Nigel Hacking and Dr Omar Khan. Dr Hacking is a UK-based Interventional Radiologist and one of the World pioneers of embolisation.

He said, "There are 100 centres in the UK doing embolisation and I wanted to bring it to the Caribbean. I was invited by Dr Khan do my first case here (Trinidad) in 1999 and now Yolanda would be our 1,000th patient. Fibroid embolisation is not a new technique. It is fully recognised in the UK, Europe and the US. The procedure takes approximately 15 minutes and she would go home tomorrow with no scar and she would be back to normal in about a week or two. For a young lady like Yolanda there is still an opportunity for pregnancy. With fibroids there is a tendency to miscarry which she has experienced already. With embolisation we have reduced that a little. We can't abolish the chance of miscarriage completely but it gives a chance for a woman to become pregnant afterwards. I work very closely with the gynaecologists here who refer many of their patients with fibroids to us every year."

According to Dr Hacking, in Trinidad gynaecologists who don't do embolisation would offer myomectomy or a hysterectomy as options. Though embolisation is not a new procedure, Dr Hacking believes there is a need for more information and education to make doctors and patients aware that embolisation is also another option.

Pesnell said, "I was so relieved to know that Dr Hacking and Dr Khan were at St Clair Medical and I could have the procedure here in Trinidad and I would not have to go overseas."

Unfortunately Pesnell's relief quickly turned to one of desperation when she heard the cost of the procedure. Pesnell however did not let this deter her as she and her family tried to come up with the funds. After 12 months of saving, the figure was still beyond Pesnell.

She said, "I thought about putting off the procedure altogether. I just could not come up with all of the money. Thankfully the nurse on the other end of the phone line told me being the 1,000th patient to have this procedure meant I would have it at a reduced cost."

Just hours before she was due to go into surgery last Tuesday, the Express caught up with a brave Yolanda Pesnell. Wearing a simple blouse and jeans, anyone looking at Pesnell would believe her to be in good health. Unfortunately for the past year Pesnell's life has been in limbo due to this debilitating symptoms.

According to Dr Hacking, what causes fibroids is still unknown. Though not life threatening, there is the heavy bleeding that can be life-limiting to a point where you might need blood transfusions or iron pills. If you are a working woman or women with children it can disrupt your duties. If you are bleeding constantly for 30, 40 or 50 days it can also be embarrassing and limit a woman's life to such an extent that she can't go out to parties or socialise. It is not dangerous as such so it is not likely to kill you; just life-limiting, he said.

"What we are trying to do is get the information out there and Yolanda has been kind enough to want to share her story. I have waived my fee as well as the other doctors have waived their fee for her to have the opportunity to have the surgery," he said.

He said, "When it comes to fibroids, all we know is that it is very common in all women — about ¼ of all Caucasian women and ¾ of all African women get fibroids. So a lot of people think it is restricted to African women but it isn't. It is common across all ethnicities. It presumably has some genetic disposition because if your mother or sister used to have fibroids then you are likely to have it. It is important to note that embolisation is not a new procedure. This technique is essentially the same as that used to control bleeding that occurs after birth or pelvic fracture, or bleeding caused by malignant tumours."

The Express spoke with Pesnell on Friday and she was in good spirits a few days after her surgery.

She said, "Everything went well, the pain is minimal and I can't wait to get back to my regular routine. One of the first things I would like to do is to be able to exercise."

Dr Hacking said, "There are different types of fibroids; some women have solitary fibroids but most have multiple fibroids. It is very common for a woman to have ten or more fibroids. At the moment we are only offering this procedure at St Clair through Caribbean Heart Care."

For more information you can go to www.fibroidcaribbean.com

or e-mail Dr Nigel Hacking at:

nigel.hacking@ttinternet.com