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7: Dr. Brooke Winner, Medical Director Minimally Invasive Gynecologic Surgery
249 Plays4 years ago
Grit and Grind podcast is brought to you by Grit City Women - A female forward organization that nurtures a creative approach to empowering female entrepreneurs, small business owners, and leaders in Tacoma. Join host Krystle Edwards and special guest Dr. Brooke Winner, Medical Director Minimally Invasive Gynecologic Surgery at Swedish Medical Center. July is Fibriod awareness month. In this episode, host Krystle Edwards shares her recent experience with fibriods and an uncertain diagnosis.
1. July is Fibriod Awareness Month
2. My Story and why I choose Dr. Winner
3. Fibroids and treatment options currently available
4. Dr. Winners work to educate women about minimally invasive treatments
5. Surgery during a pandemic
Learn more about Dr. Winner:
1. July is Fibriod Awareness Month
2. My Story and why I choose Dr. Winner
3. Fibroids and treatment options currently available
4. Dr. Winners work to educate women about minimally invasive treatments
5. Surgery during a pandemic
Learn more about Dr. Winner:
- Website : https://www.swedish.org
- Insta : @dr.brookewinner
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Transcript
Introduction to Grit and Grind Podcast
00:00:10
Speaker
Welcome to Grit and Grind, a podcast by Grit City Women, where gritty is the new pretty. This is Grit City Women founder and host, Crystal Edwards. In today's podcast, episode seven, we have special guest, Dr. Brooke Winner, medical director of gynecologic surgery at Swedish. Welcome, Dr. Winner. Thank you so much for having me. Thank you for being here.
Empowering Women in Medicine
00:00:34
Speaker
This is a little bit off topic from what we normally do, but I never miss an opportunity to empower women with knowledge, especially in areas where we don't necessarily have all the support we need. So I will go into a little bit more of why Dr. Winter's here. But first, Dr. Winter, why don't you tell us a little bit about yourself? Sure. So I am a minimally invasive gynecologic surgeon at Swedish Hospital Fertile Campus in Seattle.
00:01:01
Speaker
And what that means is that I am an OBGYN by training, but then I did a couple of years of extra training just dedicated to surgical training. And then ever since I've been in practice, I've never delivered babies. I don't do a lot of routine care. I specialize in minimally invasive surgery for non-cancerous conditions for women. So that's what I'm doing here in Seattle. And I'm originally from Alaska, and then I went to medical school here at the University of Washington.
00:01:29
Speaker
I moved out to St. Louis where I did most of my training and I was on faculty at the university there for a couple of years. And then I moved back to Seattle about almost two years ago now. Wow. So you, you came back to Seattle. Why did you come back to Seattle?
Dr. Winner's Career Journey
00:01:42
Speaker
I, my family's still in Alaska and St. Louis was just so far away from home. Um, so Seattle is nice. It's a big enough city that I can sub specialize in, um, you know, focus my area of practice, but, um, quick enough to get home.
00:01:59
Speaker
Why fibroids? Why did you choose this particular field? You know, it's interesting. When I was in medical school, I knew I was interested in women's health. And so I was thinking about OB-GYN, but I actually didn't think I would like the surgery part. I was a little bit squeamish. I was scared of blood, which is funny now.
00:02:23
Speaker
Um, so I wasn't sure if I could be an OBGYN and then in my, uh, surgical rotations as a medical student, I actually realized that surgery when it's done properly is actually very neat and tidy and well controlled. Um, and I liked that. And so I thought OBGYN would be perfect. I can.
00:02:42
Speaker
deliver babies, do routine care, get to know my patients over a long period of time, and also do a little bit of surgery, which sounds great in theory. But as I went through my training, what I realized was that surgery is pretty complicated. And if I'm going to do something like that, I want to do it really well. I was seeing a lot of the surgeons that I trained with have to call another surgeons to help them quite a bit. And I didn't like the way that felt. So I decided that if I was going to be a surgeon, I wanted to sort of go all in.
00:03:12
Speaker
And I like delivering babies, but I realized that that is a hard lifestyle. I mean, babies are born in the middle of the night and I don't do very many hysterectomies or myomectomies in the middle of the night. So that's how I kind of picked this path.
Crystal's Personal Journey with Fibroids
00:03:27
Speaker
So the reason that you and I connected was because I recently was diagnosed with a fibroid. And so I'm just going to share this story and it kind of leads into why you're here is also July is fibroid awareness month, correct? Correct.
00:03:46
Speaker
Correct. So we're right on track. So back, I guess in December, I was diagnosed with the fibroid, very large fibroid. I think it was about 13 centimeters, if I'm correct.
00:04:02
Speaker
And I really didn't know what to do. I went and saw a surgeon that really, I kind of felt like it was out of her league a little bit because I still wanted the opportunity to have children. So I went and I looked up surgeons and I was like, if I want to preserve my ability to have children, I need to find the best surgeon there is. And that's kind of how I came across your profile.
00:04:27
Speaker
And you had like 45 something, five star reviews. And it was actually pretty incredible because I looked at several surgeons and there would maybe be a couple of reviews here and there. But I mean, you really have a big following from the women that you've helped. And that is something that drew me to you. And also the fact that you did do the two extra years of schooling, surgical training.
00:04:54
Speaker
Um, to me, I'm like, well, that seems like the best choice hands down. Yeah. Yeah. I mean, 13 centimeters is big. I'm just looking back. I had a post on this not that long ago and 12 centimeters is the size of a cantaloupe. So 13 centimeters is the size of a large cantaloupe. So yeah, there's not very many, um, surgeons that are doing minimally invasive surgery for fibroids that
Advocacy and Women's Health
00:05:15
Speaker
big. I mean, 99.9% of OBGYNs in this country would have
00:05:19
Speaker
done your surgery through an open incision and a certain number of them would have just told you you had to have hysterectomy, which is just not true. So I'm glad you did your homework and found me. Yeah, definitely. It's kind of a coincidence, but we have a women's health specialist, Dr. Mandy Murtaugh. She was on the podcast and I think it was episode three or four.
00:05:45
Speaker
And we were talking about how sometimes women are brushed off by doctors when they come in for ailments and stuff. And I had actually gone to the physician a year before I got diagnosed with it with some concerns.
00:06:02
Speaker
It wasn't really addressed. And then, you know, a year later, I started noticing changes in my body and other things. And I after that, literally after that podcast, I went and I booked an appointment and I was like, something's not right. And then that's when I found out and I was shocked by the size of the thing. I mean, that story is so common.
00:06:26
Speaker
I just, I really try to educate women that if you're having trouble with your periods or pain in your pelvis, you need to get an ultrasound. It's not that expensive of a test. Um, so that's my number one piece of advice. Absolutely. Yeah. I mean, you sneeze the wrong way and you go to the ER and they give you a CAT scan. I mean, that's a much, that's a much more expensive detailed test. A pelvic ultrasound is pretty basic.
00:06:53
Speaker
I have a very, very low threshold. If anyone has any complaint down there whatsoever, I just automatically order a pelvic ultrasound and, you know, take a history and do an exam. Right. And so for me, I was kind of like, man, how come I didn't get this ultrasound a year ago when I went in with these? And I literally went in and said, my mom had a fibroid. She had a fibroid. Sorry mom, I'm sharing this, but as big as a football. And so.
00:07:23
Speaker
Wow, so you even brought it up? I did. And I said, you know, I noticed I was having some heavy bleeding that is not normal for me. And it happened at work. And I was I was like terrified, to be honest. And so I went in and booked an appointment and I said, I had this episode. I don't know what happened. I'm concerned. My mom had a fibroid and had to have a hysterectomy. And I was basically just put on birth control.
00:07:51
Speaker
And the birth control, I started getting super fatigued. I was falling asleep at work. It wasn't doing anything for me. So I got off of it. And then about a year later is when I started noticing the actual fibroid bulging out and I could feel it. And so that's when, with that combined with the podcast, I was like, oh my gosh, I'm actually having these issues.
Specialization vs. General Practice
00:08:16
Speaker
I need to go in and double check this.
00:08:19
Speaker
Just out of curiosity, was that a general practice, family practice doctor, or was that a real YN? Yes. It was a family practice doctor. Yeah. Yeah. Yeah. And I think for me, it was a shock. I was shocked. And then I was having other complications with my kidneys and stuff, which I believe now to be a result of that.
00:08:43
Speaker
Then I was worried, oh my gosh, can I have kids? And the first surgeon I went to, she couldn't answer that. And I could tell she was, for her, it was like, if you want a hysterectomy, I can do that. But if you want to try to have children, I don't know if I can help you with that. Let me see if I can find someone. And I was like, well, I don't have time to wait. I'm going to look for someone now, and that's how I found you.
00:09:11
Speaker
But I think it was probably about a month before I was able to get in to see you. And so that month period of time, I didn't have any answers. It was scary. I was like, am I going to have to have a hysterectomy? I was also in a new relationship. And I'm like, that was kind of weird, even though you don't think about that being an issue. I was like, well, if this person wants children and I can't have children,
00:09:40
Speaker
But it's also really new that I don't even know how to have this conversation yet. It was just super stressful. And then after I met with you, you were just like, bam, I got this, no problem. And I was like, oh my God, I wish I would have been able to see you right away. Yeah. So now that the story's out there, what sets your practice apart from other practices? Well, the problem is that,
00:10:10
Speaker
General OBGYNs, that's who most women are receiving their care from, do so many different things. They deliver babies, they do routine care, and they also operate. But when they're doing all those other things, they honestly don't operate very often. So a lot of times they're reluctant to recommend surgery.
00:10:30
Speaker
just because they don't feel comfortable doing it themselves. And that's nothing against them. I mean, if I only operated a handful of times a year, I wouldn't feel very comfortable doing it either. And they know a lot of things I don't know. I'm not up on the latest delivering babies. And it's just too broad of a specialty, in my opinion. So I think what sets me apart is that I have such a narrow focus of my practice. I mean, not only am I just a gynecologist, I'm just a gynecologic surgeon.
00:11:00
Speaker
Sometimes women find me because I'm just a gynecologist, but they want to talk about hormone replacement therapy for menopause. And I'm like, I don't, I mean, I know a little bit about that, but it's not really my area of interest. It's hard for patients to navigate exactly who to see. But if you can, if you can do the homework to find a doctor who really just focuses in what your need is, you know, I think that's, I think that's crucial for getting the best care.
00:11:26
Speaker
And especially when you're in a big city like Seattle where there are, you know, there's lots of specialists available. Absolutely. And you also have patients come from other states, right? To come. I do. I have operated on a patient from Alaska and two patients from Canada and a patient from Oregon.
00:11:45
Speaker
And I have a couple of other patients who are looking to travel across the country or even overseas right now. So in the age of COVID with all the telehealth becoming more accessible, that would be a great opportunity. But the only problem is there's laws in place. So I have to have a medical license in the state where the patient is located. So that's limiting our ability to chat remotely with patients, but we're working on finding out ways around that.
00:12:12
Speaker
Wow. I think that's incredible. And, you know, not being, not having to have the full open surgery for me was just such a blessing. You know, like I was, I was back to normal in a couple of weeks after having such a huge surgery.
Understanding Fibroids and Treatment Options
00:12:28
Speaker
Can you tell us a little bit about
00:12:31
Speaker
fibroids and what sort of treatment options are currently available and how that relates to women maybe putting off having children longer to focus on career and that kind of stuff. Yeah, so fibroids are very common. About 80% of women will develop fibroids at some point in their life. They are benign, which means on cancerous tumors of the muscular wall of the uterus. And whether or not they need to be treated depends on if they're bothering you or not.
00:13:00
Speaker
So, fabrics that are near the lining of the uterus where the periods come from, those are the type of fibroids that can cause really heavy or irregular menstrual bleeding, and they can also cause infertility. And then when fabrics are more on the outside, they can press on things that are nearby and cause pelvic pain and pressure. So, if they're in the front, they can press on the bladder, make it feel like you have to pee all the time. If they're in the back, they can press on your rectum and cause trouble with constipation.
00:13:23
Speaker
They can get very large up to the size of a basketball and they can make the uterus overall enlarged and it can feel heavy like a weight or a bowling ball sitting down in the pelvis. Some women notice that their abdomen sort of pooches out or increases in size.
00:13:37
Speaker
When the fibers get very large, like yours, they can actually obstruct the flow of urine from the kidneys down into the bladder, and so the urine kind of backs up in the kidneys and causes swelling in the kidneys. And that's more than inconvenience. I mean, that can be damaging to the kidneys. So there's a wide range of symptoms that people can have from their fibers depending on how big they are and where they're located.
00:14:00
Speaker
What's the biggest fiber you've ever removed laparoscopically? 20 centimeters. Wow. I think I told you that in the office. I said yours is really, really big, but not the biggest I've ever. Yeah. And I was like.
00:14:13
Speaker
She's a G. She's who I want doing my surgery, for sure. Yeah, I think my smile had to have been from ear to ear when I walked out of there just feeling so relieved at, you know, your confidence and your expertise and, you know, your passion to be good at what you're doing. This is serious. Surgery is serious.
00:14:37
Speaker
It's scary and it can be dangerous and I'm very appreciative of that. And I think that that's actually a really smart kind of business model to really go after that niche and be the best in that area.
00:14:54
Speaker
To be totally honest with you, I only moved to Seattle a year and a half ago and I wasn't sure how busy I would be when I moved here and I wasn't sure how willing the general OB-GYNs in the community would be to refer patients to me because they have an incentive to continue to take care of their patients and do their own surgeries. But I was very pleasantly surprised that with a lot of hard work and networking on my part,
00:15:38
Speaker
a lot of
00:15:44
Speaker
Fibers can be treated with medications. Most of those are hormonal birth control type medicines, which will not shrink the size of the fibroid, but sometimes they can help with the flow. But when fibroids get very big, those are less likely to work. Birth control is also not going to do anything to the size of the fibroid. So if women are having symptoms from the fibroid just being in there taking up space, then they need something to either shrink the fibroid or get rid of it. And you kind of were asking about other options. So I can just run through those real quick.
00:16:13
Speaker
There is a shot called Lupron that temporarily shrinks fibroids, but it also temporarily puts women into temporary chemical menopause. So hot flashes, night sweats, vaginal dryness, women don't usually like how that feels. You can't stay on the shot long-term because it causes bone thinning. And as soon as you come off it, the fibroids grow back. So that's not a good long-term solution. There is a procedure called a uterine fibroid embolization, which the interventional radiologists do. And they go through a big blood vessel in the leg
00:16:41
Speaker
They inject particles to stop the blood supply to the fibroid, and over time, the fibroid dies. It never goes away entirely. It usually shrinks by about a third to half. And for some people, that's enough. But for other people, it's not enough. They continue to have symptoms, go on to have something else done down the road, usually a surgery. We also don't recommend getting pregnant after that procedure because it basically lives you with a couple of big dead spots in the uterus. But for some women who really want to avoid surgery and just want to shrink their fibroids, that could be an option.
00:17:09
Speaker
And then in terms of the surgical options for fibroids, there's two surgeries we can perform and this is obviously what I specialize in. So one is called a myomectomy and that's where I go and I just take out the fibroid and I leave the uterus in place. And that's not just great, but one thing to be aware of is that fibroids can come back. So for women that know that they're done having children or know for sure that they don't want to have kids and they have fibroids that are bothering them bad enough that they want to have surgery, those women would typically elect to actually have a hysterectomy so that the fibroids can't come back.
00:17:38
Speaker
wide range of options ranging from doing nothing if they're not bothering you to trying to treat it with medication or a minor procedure all the way up to surgery. So lots of choices. Right. And I think, you know, I'm really grateful for the first surgeon, you know, being gracious and saying, you know, this is kind of out of my league. I'm not the right fit for you instead of just saying, well, your only option is a hysterectomy, which I feel like is still something that's happening. Yes.
00:18:08
Speaker
You know, and I think that's one of the messages I want to get out to listeners is there are options and, you know, like don't give up hope just because for me, you know, I'm 35.
00:18:20
Speaker
And I feel like it would have been easy to just be like, wow, I can't have children anymore. But I was determined to seek out all options and luckily I came across you. So I just think that's super important to let women know what their options are in these kinds of situations. And also, so my surgery, can you explain a little bit on the details of the surgery, like how you remove it?
00:18:45
Speaker
Oh, yeah. So when you when we remove fibroids minimally invasively for most of the larger fibroids, this is laparoscopic. So that means a camera at the belly button and a couple of tiny ports off to the side. All these incisions are like five to 10 millimeters, so very small. And we're taking out fibroids that are big, like the size of a cantaloupe. So how are we going to get something the size of a cantaloupe out of a five millimeter incision? The answer is that we're going to have to remove it in pieces.
00:19:14
Speaker
That process is called fibroid morselation. And it's a little bit controversial because if there was undetected cancer in the fibroid and we remove cancer in pieces, that could spread it and make it worse. So for that reason, when I'm using that technique, I always put the fibroid in a bag and I bring the opening of the bag out the belly button. And then I remove the fibroids in strips through the belly button contained within a bag. And that's how I get something really big out of really small incisions. The bag helps to minimize the chance of any of that tissue spreading.
00:19:44
Speaker
And, you know, of course the alternative is to make a big incision and take the fiber out whole, but that's certainly more pain, longer recovery, higher chance of other types of complications. So I think the bag technique is a good one. I perform that procedure on a very regular basis. I've published in medical journals, articles about that, but it does require a degree of technical skill. So yeah.
Risks in Fibroid Surgery
00:20:08
Speaker
I think just before the surgery, um, there was a Grey's Anatomy episode that featured, um, a little snippet on. Yes. Yeah. My girlfriend texted me about that. She said Grey's Anatomy right now. And I said, that's still on.
00:20:26
Speaker
Okay, so I'm not gonna lie, I watch it. But just for the drama. I'm curious, I never watched it. What did they say? So the storyline was one of the surgeons lost his wife to cancer a while back. And, you know, he was obviously very devastated by it. And they were at a medical convention and somebody was trying to sell some new technology. And he was like, Oh, I know who you are. You sold this
00:20:55
Speaker
this device basically that was supposed to shred the fibroids. Well, I don't think that they actually put it in a bag when they pulled it out. So what had happened with his wife is that a piece of a cancerous fibroid, you know, it basically spread it throughout her body. Well, that's interesting because that's based on a real life story. So there the whole fight of more solution controversy came to light.
00:21:23
Speaker
I think it was like five years ago now with a couple in Boston and they were both doctors and that happened to her. So that's when people either stopped morselating or started morselating contained within a bag. The problem is that if we
00:21:43
Speaker
converted back to an open procedure for all women who have big fibroids, open procedures carry risks too. I mean, the bigger incision is not only more pain and longer recovery, but it's higher risk of developing infections, bowel obstructions, blood clots in the legs, which can break loose and go to the lungs. And all of that stuff can be life threatening as well. So they've actually done some sort of risk analysis. And if we just converted back to the old fashioned way of opening everybody up,
00:22:11
Speaker
that would actually cause more harm than we would save these very few rare cancerous fibroids from being spread. So we've looked at that. These cancerous fibroids are tricky. They're very rare. That's less than 1%. And for younger women, way less than 1%. But they can be difficult to detect preoperatively. They can look like a regular fibroid on imaging.
00:22:36
Speaker
Sometimes we can pick them up with a biopsy of the lining of the uterus. That'll detect a cancerous fibroid about 50 to 70% of the time. So not a perfect test, but better than nothing. So a lot of times if the fibroid is near the lining of the uterus, I'll do that biopsy ahead of time as well. But even if the biopsy comes back fine, just as precaution, I always put everything in a bag.
00:22:57
Speaker
And I think that's the best solution to this problem. When we discussed it, I was willing to take that risk. If I could avoid having a huge incision across my abdomen, I was like, yes, please. And especially if we're doing a myomectomy where the goal is to preserve fertility. Because the other thing that open surgery does is it really increases the risk of scar tissue afterwards. And scar tissue can block your fallopian tubes and make it hard to get pregnant. So then you've done all this work
00:23:24
Speaker
to do this difficult surgery to save the uterus, but then you can't get pregnant anyways because your fallopian tubes are blocked by scar tissue. It's just another reason that the minimally invasive myomectomies are better than open.
00:23:39
Speaker
Yeah. And so for me, I actually before I met with you, I had been recommended another surgeon who was more of a fertility doctor. And so I did meet with him as well. And it was it was actually interesting because that discussion for me, because I secretly knew I still wanted to go with you just based on your surgical expertise.
00:24:02
Speaker
It was interesting to have that fertility conversation because I felt like I was still able to make a good choice. Like I got my hormone levels tested, you know, I could ask him about fertility with my age. And so I kind of felt like I was really educated after this experience with what the options were when really
00:24:21
Speaker
The only conversations I've had at this point is my clock's ticking. That's literally it. We don't talk about the reality of it and what our options are as we age and having children and these kinds of complications. For me, that was really beneficial. That's a good point. I work with fertility doctors a lot.
00:24:46
Speaker
And back in the old days, the fertility doctors were doing a lot of these fertility sparing surgeries like myomectomies and removing endometriosis. But more and more in their subspecialty training, they're just focusing on in vitro fertilization and that process. And there's very few fertility fellowships that are focusing on surgery. So those doctors are almost all referring people who need a surgery to treat their infertility problems to people like me.
00:25:15
Speaker
So there's a great infertility group in my same office building. And if they think a fiber needs to be removed for a fertility reason, they always send the patients to me. So I'm working with them closely all the time. And it's a really nice pairing. And if patients have questions about their fertility that I can't answer, I refer to them. So it's a really great collaboration that we have.
00:25:39
Speaker
Yeah, that's
Collaborative Care in Women's Health
00:25:40
Speaker
awesome. I definitely want to stick with coming to your group just because of the amount of expertise that's in the area just close by because knowledge is power and I feel like it's so easy for us to get brushed off sometimes and it's happened to me multiple times medically.
00:25:59
Speaker
It's just, I'm over it. I'm going. Yeah, we've got it. We've got a great community at Swedish. I really like the building that I'm in. I love all the people I work with. So it's a good community. Let's talk a little bit about your work at Swedish. How do you juggle performing surgeries and running a practice? And you're also the director. Tell us more about that role and what's that like?
00:26:24
Speaker
Yeah. So, um, it's hard because, um, being a busy surgeon is very time consuming, very stressful, but the administrative medical director role I just took on recently. Um, so it's kind of evolving. It was a position that was actually, uh, created for me. So there was no one really in that role before. Um, and the, the administration came to me and said, Hey, you know, so much of OBGYN and our
00:26:52
Speaker
our committees and our protocols and our outreach is all based around obstetrics, but there's so much more to women's health than delivering babies. We really want to beef up the GYN surgery portion and we want you to sort of spearhead that effort. And I said, yes, that sounds great. That sounds right up my alley.
00:27:10
Speaker
So I'm just now stepping into that role. And it's a lot of meetings. Today's my day off. And I woke up at 6 o'clock in the morning to phone into a meeting to talk about how we're going to make resident and medical student education more organized at Swedish. And would I have rather slept in on my day off? Maybe. But I'm excited to be part of those discussions. And it makes me feel like I'm helping more women
00:27:38
Speaker
it makes me feel like I have a broader reach. When you're taking care of patients, you're just helping one person at a time. But if I can help Swedish implement policies and procedures that make GYN surgery safer and more available to more women, and then from Swedish as part of Providence, which is the third largest healthcare system in the country. And if we can sort of create this microcosm at Swedish where we have really good policies in place and demonstrate that that's successful and then implement that on the Providence level,
00:28:08
Speaker
I think we could make a difference nationally and that to me is very exciting. Oh, that's so amazing. I give me goosebumps. I love that. And you know, that's, you know, that's the kind of stuff that we just policies and procedures and really looking at what's in place in everything, everything that we do and making sure that they're people are getting served the way they should be getting served and that
00:28:33
Speaker
that information is up to date and it's being distributed to the right people. I think that's so important and I mean that's one of the reasons why I founded Grit City Women is just I just felt like there was so much information out there that wasn't I had to dig and dig and dig and I'm like why am I having to dig for this like even just to
00:28:54
Speaker
You know, when of course, you know, everyone is a, as a, um, a WebMD doctor now. So of course, when I, you know, got my fibroid, I was looking to see what my, like, if there was a blog post about someone who had a large fibroid or any sort of story that I could, um, read that would give me some insight on if I'm going to have to have a hysterectomy or not. And.
00:29:19
Speaker
I really couldn't find anything. I saw some information that was like, oh, I had this really large fibroid removed, or I had a hysterectomy. And I was like, yeah, but could you still have children? What does that look like for you? And so that information just wasn't out there, and I looked.
00:29:39
Speaker
you know, tenacious and I can, I'll try to find it and it wasn't there. So I think that that work is very important and I'm super excited that you're doing that and I'm happy to have you here so that way we can help spread the word. Yes.
00:29:55
Speaker
But I do want to talk about, so going backwards just a little bit, now that I've had the fibroid removed, so my options are different with having children now as for the delivery. So can we go into a little bit about that? Yeah. So when I was talking about how we remove the fibroids and put it in a bag, remove in pieces, the second half of the operation is reconstructing the uterus.
00:30:21
Speaker
When there's a big fibroid in the uterus, when I remove the fibroid, then there's a big hole in the uterus where the fibroid used to be, so I have to sew the uterus closed with dissolvable stitches and layers. The uterus is a muscle. At the end, I wrap the uterus in dissolvable material that helps reduce scar tissue formation as you're healing.
00:30:45
Speaker
And then it's important for women to wait three to six months to get pregnant to allow the uterus time to heal and where you fall in that three to six months kind of depends on surgeon preference and how big the fibroid was or how many fibroids were removed.
00:31:00
Speaker
And then even though we're letting the uterus heal for six months, that spot will always theoretically be a weak spot. And with the strong contractions of labor, that weak spot could break down. That's called a uterine rupture. That could be life threatening for the mom and the baby. So for that reason, we recommend women, well, we require women to undergo a scheduled C-section so they don't have to go through the strong contractions of labor. Now, the exceptions to that is if the fibroid was just hanging off the uterus on like a thin stalk,
00:31:26
Speaker
And instead of having to go into the uterus and actually pull out the fibroid, I was just chopping the fibroid off at the stock and the uterus was not affected. Those women would be able to have a vaginal delivery in the future. Or if the fibroid was removed hysteroscopically, which means that it was completely contained within the lining of the uterus. And I was actually not even going through the belly at all, but removing it with a camera through the vagina, up through the cervix and just shaving it down from the inside.
00:31:51
Speaker
those women can have a vaginal delivery afterwards. But if it's a big fiber that's embedded in the wall of the uterus, then most of those women wind up needing a C-section for their future deliveries. I think that for me, all the stuff that we've discussed is really a lot of the information I was seeking. So hopefully this will be able to help women that are in similar positions where they don't have answers. So one thing I want to definitely touch on is how has COVID-19 affected
Impact of COVID-19 on Healthcare
00:32:21
Speaker
your surgeries? Yeah. So when Washington State went on a shutdown,
00:32:31
Speaker
as probably everybody knows, they stop doing elective surgeries. And most of the surgeries that I do are somewhat elective. I don't really like that word because a lot of times women are in a lot of pain or bleeding heavily or like you, you know, it was affecting your kidneys. It's not really elective, but it's sort of a spectrum. So most of the surgeries that I do could be postponed several months and you know, it wouldn't cause any permanent harm. So
00:32:56
Speaker
I didn't operate for about two months. And then when they first started opening things up, I was trying to pick the more urgent cases. And I, if I remember right, that's, we kind of got you in, in that window. Yeah. And then several weeks after that, we just went back to normal proceedings. At first, we weren't testing everyone for COVID ahead of time. So we're having to wear a lot of extra protective gear in the operating room, which was very hot and uncomfortable.
00:33:26
Speaker
Um, but now we've got a nice system in place where, um, everybody gets a COVID test ahead of time. And if they're negative, then we can just wear our regular gowns and masks. And, um, the hospital is doing a lot of work to make sure that, you know, everything's clean and that everybody's socially distant and of course, wearing a mask all the time or minimizing visitors. So the hospital is really making an effort to make sure people feel comfortable coming back to the hospital, that it's safe to come in and get the treatment that you need now.
00:33:52
Speaker
Yeah. I mean, that was quite an experience. I know. So my surgery got pushed off because of COVID and I was so disappointed. Just, you know, obviously I understood, but it was heartbreaking for me having lived with the symptoms for so long and then realizing that now I was having some kidney issues. Um, and then I believe what happened is you submitted my case to the review board and at first it got denied.
00:34:21
Speaker
Um, and then, and I was devastated and, um, the nurse was like, well, we can get you in July. And I was like, Oh my God. I was like crying. And then a couple of days later, she called back and said that you went back in and resubmitted my case and that I was approved. And I think it was like a week out before that, my surgery. Um, and I was so excited. My boyfriend was so excited. Like, you know, we were just.
00:34:50
Speaker
I've never been so excited to be operated on in my life. Yeah, I'm sorry. I'm sorry that happened. I was trying my best. Oh, no, I'm really grateful that you did that for me. I was like, that's so awesome that she took the initiative to go back in and do that because I was struggling and suffering.
00:35:12
Speaker
um just feeling like I didn't know when I was gonna have the surgery again and I could swear that it was getting bigger you know like I'm like I think it was yeah and you know it just starts to affect a lot of things in your life and um you know then your mood goes down and then of course I'm stuck at home not doing anything so I it was um it was kind of a highlight for me and I remember being in the oh in the like
00:35:43
Speaker
room getting ready to go into surgery and there was a woman next to me. I don't know what she was in there for, but the nurse was checking on her and she goes, I'm just ready to have the surgery. And I could tell she was in the same boat as I was where she probably had been canceled and then had to come back in later. And I was like, I feel the same way. I'm so ready for this.
00:36:08
Speaker
I will say though that it was so weird going into the hospital. There was no one there. I've never experienced that before. We were the only ones in the waiting room.
00:36:21
Speaker
the nurses were with me, I swear 100% of the time. Like they didn't have anyone else to check on. Yeah. They were talking to me all. And you know, when I was waking up, I just, it, it was probably some of the best care that I had ever had. I felt like because I, you know, I've had other surgeries and they're, you're left alone for a while. Right. And then they come back and check on you. And, um, I just felt like that they were always checking on me and updating, you know,
00:36:50
Speaker
my boyfriend and stuff like that. And so I felt like I was very well taken care of. It was a very good experience for me. Yeah, go Swedish. Yeah. Those are the parts, you know, that I don't really, I'm not there for, right? Like, you know, and so much of a patient's experience has to do with, you know, who answers the phone and who checks you in at the front and you know, what the nursing care is like. And, and I think
00:37:17
Speaker
a lot of times doctors forget that, but I really appreciate my team. And I know that all of those components factor into a patient's experience. And that's why it's really important to me that I like my office team. I've got a dedicated team in the OR, which is pretty unusual. And those women make my life better on a regular basis. And so it's great to hear that also up on the floor, the nurses up there are great too. So that's awesome. Yeah, they took really good care of me.
00:37:47
Speaker
in a lot, and I don't want to scare anybody, but I was in a lot of pain when I was coming out of it and really struggling with that. But I, you know, I ended up getting discharged that night. And yeah, I just felt like we got really good treatment. And maybe it was because there weren't a lot of people in there. But either way, for me, I kind of felt like it was sort of a blessing to have my surgery before everything opened back up. It's very private.
00:38:13
Speaker
Yeah, we don't really know what's going to happen, you know, with the virus moving forward. But if we're looking at other states, there could be another spike. So, you know, it was sometimes people ask me, like, should I come in and have my surgery now? And I tell them, well, it's honestly a pretty good time. And then it's fairly quiet at the hospital. We're not full of COVID patients right now. So if you're gonna have it done, you might as well get it over with right now, because who knows what's going to happen in the future.
00:38:37
Speaker
Right. And, you know, I mean, there is a couple of week recovery time, depending on what you have done. So I was like, if I can get it over with while we're isolating, perfect. You know, and, you know, I thought in my mind that this was all going to be over by now, but that was not right. So, but yeah, I definitely felt like that was a good experience for me. Not that I would wish COVID-19 on the world again, but
00:39:05
Speaker
taking advantage of it was kind of nice. Well, thank you so much for joining us. I feel like this was super informational. I'm really excited to share the story and hopes that it will help other women and that your expertise and the work that you're doing at Swedish will really help them be able to make educated choices on what they want to do when they have fibroids or other issues as well.
00:39:29
Speaker
Yeah, well, thank you so much for having me. I love having help spreading the word. Sometimes I feel like I'm just out here doing it on my own. And if anyone out there listening has a church group or community organization that they want me to come speak to, I would be happy to do that. So yeah, you can contact me either on Facebook or on Instagram and I love reaching out. Absolutely. So what's your Instagram account?
00:39:57
Speaker
Yeah, it's Instagram at dr dr.brookwinner, all one word. Okay, and you share a lot. I'm following you on Instagram, you share a lot of tips and info and it's really great to follow and just keep up to date on some stuff. So I definitely recommend people following her on Instagram. And then if they want to book an appointment, what's the best way to do that?
00:40:20
Speaker
206-991-2000. That's my office phone number. Call my office. You can either be referred by your primary care doctor or your general OBGYN, or you can come see me for a second opinion. I'm trying to focus my practice on women who are thinking about having surgery, so if you just need a general gynecologist, I'm not your doctor.
00:40:45
Speaker
But if you have questions about fibroids or endometriosis or considering surgery, then that's right up my alley. Awesome. Well, thank you again so much for joining us, Dr. Winner. Thank you so much. Take care. Grit and Grind is powered by Melissa Newell, financial advisor for Edward Jones. To learn more about Grit City Women, visit gritcitywomen.com or follow us on Instagram at gritcitywomen, and we look forward to getting gritty with you.
00:41:18
Speaker
Bye!