Tests, Risks and Confusion Prior to Oophorectomy

Once again I'm in the planning stages for another surgery, the oophorectomy, for this coming December.  I'll be staying local this time, having the surgery here in Singapore.  Little did I know that there would be so many medical tests needed prior to surgery, nor did I fully understand the implications this surgery would have on my body.

Pre-Surgery Baseline Testing

On June 21st, I was happy to receive an email notifying me that all of my tests have been arranged for November, thanks to the help of my local doctor, Dr. Tucker.  These pre-surgery baseline tests will include:

• blood panels (including the CA-125 ovarian cancer marker)
• bone mineral density test
• pelvic ultrasound
• appt. with Dr. Dharshini to discuss results and formalize the oophorectomy surgery details
• appt. with Dr. Tucker to discuss results of double mastectomy, results of recent lab work and preparation for the oophorectomy

Bone Density, Osteoarthritis and Cardiac Disease

I think the test I really didn't expect to see was the bone density test.  Apparently, premenopausal women, like myself, who choose to remove their ovaries for cancer risk reduction, are then put at a higher risk for low bone density.  As discussed earlier, this surgery will put me into immediate menopause, meaning I'll begin experiencing side-effects such as hot flashes, night sweats and mood swings (oh how I feel for my lucky ducky husband.)  

A side-effect of the surgery is lower levels of estrogen, which is directly related to bone strength.  Low levels of estrogen=lower bone density.  This isn't great news for someone only 38 years old.  To help combat this loss, I'll be prescribed Fosamax, should I actually need it, but more importantly, weight bearing exercises and calcium.  Another shocker, I'll be at a higher risk for osteoarthritis.  Something to do with estrogen and cartilage.  I feel like having this surgery is going to make me old overnight.  It's scary, the unknown.  

Cardiac disease is another concern as a result of this surgery.  I'll be asked to take a daily low dose aspirin after I have the surgery.

"Conclusions: Bilateral oophorectomy performed before age 45 years is associated with increased cardiovascular mortality, especially with cardiac mortality. However, estrogen treatment may reduce this risk." Credit: http://www.medscape.com/viewarticle/586638

By Ruby Wang (Own work) [CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

Risks

I research too much some say.  All this reading and research sometimes freaks me out.  I think to myself, what in the hell am I doing?  Here's an example of one such research article I came across that was enough to send me in a panic. 

"In particular, studies have revealed an increased risk of premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, osteoporosis and bone fractures, decline in psychological well-being, and decline in sexual function. The effects involve different organs (e.g., heart, bone, or brain), and different functions within organs (e.g., cognitive, motor, or emotional brain functions). Estrogen treatment may prevent some of these negative outcomes, but not all.

Conclusion:
The potential adverse effects of prophylactic bilateral oophorectomy on heart health, neurologic health, bone health, and quality of life should be carefully weighed against its potential benefits for cancer risk reduction in women at average risk of ovarian cancer."                                      Credit: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585770/ 

Am I making the right decision with this next surgery?  Am I taking it too far?  Are the risks of the oophorectomy more than my actual risk of getting ovarian cancer?  Making the decision to have my mastectomy was a no brainer.  I knew in 2005 I wanted it and I waited anxiously to have it.  Having this oophorectomy is scaring the crap out of me.  I'm not coming to this decision lightly.  I still have cold feet.  Maybe I won't go through with it the more I research, maybe I will.  I'm still five months out...that's plenty of time to swayed one way or the other.

The surgery risks don't end there.  As of now, I have no cancer.  However, there's always that small chance that something changes between now and when I'm in surgery.  There is a small chance that ovarian cancer cells could be found during the surgery, in which case, they would then have to perform a full hysterectomy in addition to the oophorectomy.  I don't want any part of that scenario as there is a much higher risk of complications during the surgery with less than favorable outcomes.

Insurance

I was happy to hear that the office received a verbal 100% guarantee of payment, but we are waiting for it in writing, which should be another five or so days.  Once I have the guarantee, I can move forward knowing this surgery can happen.  Waiting the five and a half weeks for my mastectomy surgery was really difficult on me as I wondered if they'd say not, and then what.  

If you have any words of wisdom, thoughts or advice, I'd love to hear from you.  Please leave a comment below or catch me on Twitter.  I'm looking for something, anything, that will help me make the right decision for myself.