Full Transcript Introduction and Guest Welcome 0:00 Welcome to The Coalition. 0:02 This is a talk show dedicated to discussing health, wellness, and inspiration. 0:07 I'm your host, Dr. 0:08 Shani Belgrade. 0:11 Hey, guys. 0:12 Due to a technical difficulty, the video freezes at times, but the audio is perfect and the conversation is too good to miss. 0:18 Let's get into it. 0:20 Hello, everybody. 0:21 Welcome to The Coalition. 0:23 I'm your host, Dr. 0:24 Shani Belgrave. 0:25 I am a bariatric and general surgeon in Atlanta, Georgia. 0:29 You can learn more about me and get connected at www.drshanibelgrave.com. 0:35 I am super excited to welcome to the show today, Dr. 0:39 John Lippman. 0:40 Dr. 0:41 Lippman is an interventional radiologist and the founder of Atlanta Fibroid Center. 0:46 He joins the show to share his expertise right on time for Fibroid Awareness Month. 0:52 Dr. 0:53 John Lipman, thank you so much for joining the coalition. 0:56 Oh, thanks for having me. 0:57 It's great. 0:59 Wonderful. 0:59 So can you please get us started by telling us a little bit about who you are and what you do? 1:05 I'm the founder and medical director of the Atlanta Fibroid Center. 1:09 Our center has been open for the past 20 years. 1:13 In fact, we're having a 20-year celebration at MCK September 18th at seven o'clock and all the proceeds of the event is gonna go to Hosea Helps Feed the Hungry. 1:27 So we're really excited about the event and we're excited about providing care for women suffering with fibroids completely without any surgery. 1:38 Well, congratulations on your 20 year milestone. 1:41 That's quite significant. 1:42 We've been very blessed and I have a tremendous staff, administrative staff, nurses, technologists, a whole team of great people to work with. 1:56 It's just fantastic to come to work every day.
What Fibroids Are and Common Symptoms 1:59 And it's truly a blessing. 2:02 I love going to work every day. 2:04 It's not cliche. 2:05 Because we have such a great team, it's really enjoyable. 2:10 And that passion and care really resonates throughout the organization. 2:14 And that's why people continue to come back to the Atlanta Fibroid Center. 2:18 In fact, patients will say, yeah, it's like going to the Four Seasons. 2:23 I haven't been treated like that in health care since I was on vacation. 2:26 So we're real proud of how we care for patients. 2:30 And we're real proud of our philanthropy and our commitment to the community. 2:35 Well, I agree. 2:37 Part of taking care of patients is providing a good experience in addition to the care and the procedures that are done. 2:44 So can you please kind of give a little bit of insight into what are fibroids? 2:49 Well, fibroids are the most common pelvic tumor seen in women. 2:54 And not only are they common in all women, but they are particularly common in African-American women. 2:59 In fact, it's stated that 80% of women of color have these benign tumors. 3:05 So they're not cancerous, fortunately, but they can cause a lot of women, a lot of misery. 3:12 What are some of the symptoms? 3:14 It's the number one reason why women have heavy periods. 3:18 So they often have heavy menstrual bleeding. 3:22 They'll often have pain because these tumors are rock hard, they're firm and they press on things. 3:28 So they can press on nerves to cause pain. 3:31 They can press on the bladder to cause increased urinary frequency and waking up at night. 3:36 They can press on the colon to cause constipation. 3:41 If they're near the cervix, they can cause painful intercourse. 3:44 So they will cause bleeding symptoms and they'll also cause bulk related symptoms. 3:51 So, you know, I was interested in talking to you because as you've just stated, fibroids are very common and you specialize in a treatment called uterine 4:03 fibroid embolization. 4:04 So can you kind of describe how that works and how is it determined whether or not a patient can benefit from that versus surgery? 4:14 Well, uterine fibroid embolization or UFE, some people call it uterine artery embolization or UAE, it's the same procedure. 4:24 And it was actually discovered by accident. 4:26 We'd been embolizing tumors, cancerous tumors for many years before UFE was discovered. 4:34 But somebody in France in the early 1990s got the bright idea, why don't we embolize fibroid tumors before they get a hysterectomy to make it an easier surgery,
How Uterine Fibroid Embolization Works 4:48 less anesthesia, quicker surgery time. 4:50 If you cut the blood flow off to tumors that are very vascular, it'll make it an easier operation. 4:57 It made sense. 4:58 No one had ever done it before because the focus had been on making very vascular cancerous tumors an easier operation. 5:08 But they started doing that in France. 5:10 And so these women would get embolization for their fibroids, meaning they were seen by an interventional radiologist who cut the blood supply off to these fibroids. 5:23 The fibroids then start to die. 5:27 And as they die, they soften and shrink. 5:29 And these women would then get discharged after their embolization procedure. 5:34 They would be sent home. 5:37 and to recover because, again, unlike in this country where we embolize a tumor, they're in the operating room that day or the next day. 5:46 In France, they had to wait. 5:48 And so they were waiting six weeks, seven weeks, eight weeks for their elective hysterectomy. 5:54 What happened? 5:55 Well, over that six, seven, eight weeks while they were waiting, the woman's symptoms went away. 6:00 And so they would call up the gynecologist and tell them, you know, I feel great. 6:04 Do I still need that second part? 6:06 Do I still need that hysterectomy? 6:08 And the answer was no. 6:10 All you needed was the embolization. 6:13 And so the gynecologist in France, who was leading the study with the interventional radiologist, called his friend at UCLA, 6:22 who was the chief of gynecology at UCLA and told him, you better get the interventional radiologist on this. 6:28 This is exciting. 6:29 And Scott Goodwin, who at the time was the chief of interventional radiology at UCLA, did the first 11 patients in the United States. 6:39 And he was presenting at a national meeting about that. 6:43 And I was presenting embolization on cancerous tumors. 6:46 And I'm listening to Scott talk about this. 6:49 And I'm like, wow, I'm in Atlanta. 6:51 I could help so many women. 6:53 And the light bulb went off. 6:55 It was kind of a seminal moment in my life. 6:58 And I came back to Atlanta and did the first UFE procedure here in the Southeast and have now amassed the largest experience. 7:08 So they tell me in the entire country, well over 10,000 women now have we've cared for and help them avoid surgery and literally get their life back. 7:20 I mean, it's transformational. 7:23 The difference between having these crime scene like periods and pain every month and the dread that goes with it to a normal life again. 7:32 And how it works is the access for us, we go at the very top of the right leg and what's the access point is the right common femoral artery, 7:42 right where the leg meets the torso. 7:45 If you push down in the crease, you can feel that artery and feel the pulse. 7:50 We enter there and then guide a little tiny catheter like a piece of spaghetti into each of the uterine arteries one at a time. 8:01 Each of them are like big trees and they branch getting smaller and smaller branches to get out to the leaves. 8:08 The fibroids are the leaves of the tree and I know what size those small peripheral branches are. 8:13 And I can plug up their blood supply. 8:15 So the big trunk and the main branches of the uterus stay open. 8:20 So the uterus is alive, but all the fibroids start to die. 8:25 And as they die, they soften and shrink. 8:27 And as the softening and shrinking go on, a woman's symptoms go away. 8:31 So it's a 30 minute procedure. 8:35 We take the catheter out, we put a little tiny dissolvable collagen on the way out to seal the little needle hole on the way in, 8:45 and it's covered by the pad of a regular Band-Aid. 8:48 They spend three, maybe four hours at our center recovering, and then they get discharged home. 8:55 as I say, literally with a bandaid at the top of their right leg, with a recovery at home that's pretty simple compared to surgery. 9:03 I mean, they're in bed or couch that day, but the next day they're up and walking around at the computer, back in the office within a matter of a few days,
Who Is a Candidate for UFE 9:14 four days, five days. 9:16 I tell patients plan on a week, but most of our patients are working well before a week, usually a matter of four or five days. 9:25 Wow, that was really interesting. 9:26 I didn't realize that initially it was used as a bridge to hysterectomy. 9:31 So that was really neat to learn that. 9:33 Yeah. 9:33 A lot of things in medicine are discovered by accident. 9:36 So you mentioned that it will shrink all of the fibroids. 9:41 Are there any patients based on the location of their fibroids or other factors that are not candidates for uterine fibroid embolization? 9:51 Almost every patient that's been told they need surgery for their fibroids is a candidate for UFE. 9:58 It's very rare that they're not a candidate. 10:01 There are some. 10:03 It's unusual. 10:04 Sometimes we need to do what's called a combined approach where we involve the gynecologist to help us. 10:11 They may have a lot of fibroids in the uterine muscle. 10:15 That's the most common location for fibroids. 10:17 But occasionally, in unusual circumstances, the patient will have a fibroid sitting in the cavity of her uterus. 10:26 And if we embolize a patient that has an intracavitary fibroid, that fibroid is going to come out. 10:34 Now, if it's small, like a centimeter or two centimeters, We won't worry about it because it'll break up and the woman probably won't even notice it coming out. 10:45 But if it's like three and a half centimeters and larger, that's something that we really don't want the woman to have to pass because if it does come 10:56 out whole, that would cause a significant amount of pain. 11:00 It's kind of like labor birthing a small you know, stone, if you will, through the cervix into the vagina. 11:07 So what we do under that circumstance is this combined approach where we embolize the patient, just like we do everybody else, 11:15 only in this particular woman. 11:18 In advance, we've already set up this removal of this one intracavitary fibroid. 11:24 And it's really easy to remove for the gynecologist because the fibroid is dead. 11:29 And it comes out very easily. 11:31 And we time it three weeks after the UFE, which is really the sweet spot, because you can't do it same day, next day. 11:40 The fibroid is still hard as a rock, and it's much harder to remove. 11:44 And you can't wait too long, you know, six weeks, seven weeks, eight weeks, because too many of those patients will, their bodies will try to, 11:51 you know, abort the fibroid. 11:53 It's what you're trying to avoid. 11:56 Three weeks after the UFE is a good spot for them to take it out. 12:00 And it comes out very easily. 12:03 Fascinating. 12:04 So can you please, Dr. 12:05 Lipman, take us through the process? 12:07 First of all, how are patients finding you? 12:10 And if someone, how does someone get in touch with you? 12:12 And then can you take us through the consultation?
Consultation, Imaging, and Treatment Options 12:15 And then what are the steps until they get to their procedure? 12:18 And then what's the follow-up care? 12:21 Well, patients will find us in a whole host of different ways. 12:27 We will get patients that are referred from gynecologists. 12:32 We will get patients that are referred from by primary care physicians. 12:37 Nurses are now starting their own practices and we'll get referrals from any number of healthcare providers. 12:44 That's one way we'll find patients. 12:47 Other patients will find us Because of our work in the community or our work, we took care of their mom or their sister or their aunt or a relative, 13:00 a family member, a friend, a coworker. 13:03 And people can come to us directly. 13:07 They don't need a gynecologist referral. 13:10 We'll get asked that all the time. 13:12 Now, if they have a certain insurance plan, an HMO plan requires a referral from a primary care physician or a gynecologist, 13:21 but a PPO plan or other plan like that, patients can just call the office and come in for a consultation to talk about the treatment options, 13:33 including UFE. 13:37 Once a patient is coming in for a consult, we usually also obtain an MRI examination of the pelvis. 13:45 A lot of these women, their fibroids have been confirmed or diagnosed based on pelvic ultrasound, but pelvic ultrasound is a very low resolution imaging tool. 13:56 It's great to confirm the fact that they have fibroids, but it doesn't show the fibroids in the uterus and the tissues around the uterus to really any 14:07 great detail. 14:08 The MRI is like high definition television. 14:11 You see everything to really superb detail. 14:15 And a lot of times we find things that they never saw on ultrasound. 14:20 And so it's really important to get the MRI and basically try to make that fit with what the symptoms of the patient are describing. 14:30 So For instance, a patient we saw not long ago had a big fibroid in the periphery of her uterus. 14:38 It's called a subcerosal fibroid. 14:40 Those are the fibroids that are on the outer part of the uterus, nowhere near the lining of the uterus. 14:47 They're out in the suburbs, if you will, where the lining is downtown. 14:51 And she was having horrible Menorrhagia, very heavy menstrual periods. 14:57 And as I mentioned, fibroids are the number one reason why women have heavy periods. 15:02 But she had this solitary fibroid that couldn't possibly be causing her heavy bleeding. 15:09 And she came in and wanted the UFE procedure because she heard how great it was. 15:15 and how minimally invasive it is. 15:17 But I had to tell her, you've got a fibroid, a big one. 15:20 You've got the most common symptom from fibroids, but it doesn't fit. 15:25 And so we got a special ultrasound study called a saline sonohistogram, which showed very small endometrial polyps, these little tiny growths along the 15:37 lining of her uterus. 15:38 And the gynecologist removed them a week later. 15:45 We have to put the puzzle together. 15:47 It's got to fit. 15:48 They have to have fibroids, they have to have symptoms, and they have to fit. 15:52 And if so, we go through the treatment options. 15:55 We'll talk about medical treatment options, whether it's hormonal therapies or whether it's a non-steroidal anti-inflammatory medicine. 16:04 We'll talk about the surgical options, whether it's a myomectomy, cutting a woman open surgically, removing some of the fibroid tumors, 16:13 or hysterectomy, removing the uterus, whether all but the cervix, the entire uterus, or even everything in the pelvis essentially. 16:23 So we'll go through the different treatment options from medical to UFE to surgery. 16:29 And then the woman will decide based on the risks and benefits of each of these procedures, which one she wants. 16:36 Well, thank you so much, Dr. 16:38 Lipman. 16:38 That was really thorough and a very clear description of how all this works and how it can be beneficial to patients. 16:46 For people watching that want to learn more, want to get connected, what is the best way for people to reach out to you? 16:54 Well, fortunately with the internet, it's a pretty easy task. 16:58 Our website is probably the easiest way. 17:01 Our website is atlii.com. 17:05 It stands for Atlanta Interventional Institute. 17:08 That's the parent company of Atlanta Fibroid Center. 17:11 So there's lots of information on fibroids and on the UFE procedure. 17:17 I have an Instagram page, which is dr underscore my last name. 17:22 So it's dr underscore L I P M A N. 17:26 And we're almost to that 10,000 followers. 17:29 So hopefully after this broadcast, a number of your viewership will put me over the top. 17:35 That would be great. 17:36 Um, we have a YouTube channel. 17:38 If, if somebody goes to YouTube and then the search bar types in Atlanta fibroid center, Atlanta fibroid center. 17:47 There are hundreds of videos on fibroids, on UFE, and they can even watch me do a UFE procedure. 17:53 It's one of the more common frequently watch videos and it's not gory because there's no surgery.
How to Reach Atlanta Fibroid Center 17:59 It's a very simple, easy 35 to 40 minute video. 18:06 I go step by step exactly what I'm doing each step of the way so that a patient can see the entire process of undergoing a UFE. 18:15 It's very simple. 18:16 As I say, it's a 30 minute procedure. 18:18 They sleep through it and then there's several hours of recovery afterwards and they go home with a band-aid. 18:26 and even have children after. 18:27 And this UFE procedure is covered by all insurance. 18:31 It's not an insurance issue. 18:33 And as I say, I've been doing this UFE procedure here almost 30 years now. 18:38 It's one of the biggest medical breakthroughs for women. 18:41 You just got to know about it, unfortunately, because a lot of women aren't hearing about it from their doctor. 18:46 And that's unfortunately sad. 18:51 Wow well thank you so much Dr. 18:53 Lipman for joining the coalition right on time for Fibroid Awareness Month. 18:58 I appreciate the opportunity to come on particularly during Fibroid Awareness Month and try to increase the conversation because sometimes and I know some 19:07 families feel that they can't talk about periods. 19:10 Men don't want to know about periods but Men usually have women in their lives and they need to know about periods and talk to each other about this. 19:20 And there needs to be more discussion, mother, daughter, sisters to each other, because this is important information. 19:26 And if you can avoid the second most common surgery done in the United States with a simple 30 minute procedure, why wouldn't you do it? 19:36 Wow. 19:37 Well, thank you so much, Dr. 19:38 Lipman. 19:39 You know, I agree that communication, conversations, dialogue around health are so important. 19:44 So you're a perfect guest to join The Coalition, because that's what the show is all about. 19:49 I want to thank you again. 19:50 And you have an open invitation to come back to The Coalition another time. 19:53 Thanks very much. 19:54 I appreciate you having me. 19:56 Sure thing. 19:58 Well, everybody, thank you so much for tuning in to another impactful episode of The Coalition. 20:05 Very special thank you to Dr. 20:07 John Lippman, founder of Atlanta Fibroid Center for joining the show right on time for Fibroid Awareness Month. 20:15 You can connect with Dr. 20:16 John Lippman and the Atlanta Fibroid Center on their website or on social media. 20:21 You can stay connected with me at www.drshonnybellrig.com. 20:27 Make sure you share this episode with friends and family to raise awareness for Fibroid Awareness Month. 20:32 I'll see y'all next time.
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