Legacy in the News: Common medical practice stirs controversy

The Times

July 3, 2014

One day last winter, Michele Fisher started bleeding and didn’t stop. She could barely get out of bed. Her energy levels were dangerously low, as were her blood levels. In retrospect, there may have been signs for years, but at the time, all 42-year-old Fisher knew was that things were going downhill startlingly fast.

“I was pretty ill for two months. Actually, I would say very sick for two months,” the Clackamas resident said. “Most people said I looked like I was going to die. Basically, I mean really, because I was that pale, that anemic, that horrible.”

A referral from her nurse practitioner led Fisher to Melissa Pendergrass, a gynecologist who works at Legacy Meridian Park Hospital in Tualatin. Tests confirmed that Fisher had a fibroid — a large and intrusive mass of tissue on her uterus — and it had to go. After considering options, the doctor and patient decided that a hysterectomy through a process called power morcellation would be the safest and least intrusive route.

As Pendergrass explained, the process of morcellation has a long history. It’s primary purpose is to take a large specimen (like an obstructive fibroid) and to turn the tissue into smaller pieces, which are then taken out through several small incisions, replacing the need for major surgery in many cases. For about twenty years, power morcellation has been used to expedite the process, and since last fall the procedure has been under the light.

After some controversial cases were covered by The Wall Street Journal last fall, and then picked up by various other news outlets, laparoscopic power morcellation garnered negative attention from the federal Food and Drug Administration right around the time of Fisher’s surgery — she had her fibroid removed on April 15, just two days before the FDA released a statement strongly discouraging doctors from using the practice.

Through a fresh bout of research, the FDA found that 1 in 350 women who think they have a fibroid might actually have a sarcoma, which is a kind of cancer that can’t be officially diagnosed without surgery. By power morcellating, the cancerous tissue can be spread to other parts of the body, decreasing the patient’s chance for long-term survival. Later this summer, the FDA is meeting to discuss a possible power morcellation ban.

“For people to want to ban morcellation all together makes me concerned that we’re going to be harming a lot more women,” said Pendergrass. “Although the intention is admirable … I would hate for so many women to end up with big incisions again, bad recoveries, increased blood loss, complications, transfusions, when the risk is still low. You just try to individualize it for the patient.”

While Fisher and Pendergrass both acknowledge that complications do happen in some cases, they are relieved that Fisher was able to have her fibroid removed laparoscopically, something that wouldn’t have been possible without morcellation.

“As a patient, I would want those options. I would want to know what they are and be able to make that decision with my doctor myself, instead of not having those options available,” Fisher said. “Weighing everything, I felt personally that the risk of (sarcoma) was so minimal to the benefit that I was going to have.”

A couple months after her surgery, Fisher noted that “I actually feel better now than I have in years.” And when asked if she’d have the procedure done again, if necessary? “Absolutely,” she said. “Without a doubt.”

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For questions, contact Ashley Stanford Cone.