The Canadian fibroid case
"A 43-year-old Ontario patient, two rounds of hysterectomy advice, and a keyhole answer."
The patient — a 43-year-old professional living in the Greater Toronto Area, one child, wanted a second — arrived on WhatsApp after two consultations in Brampton, both of which had recommended hysterectomy. She had a 9-cm intramural fibroid, iron-deficiency anaemia from menorrhagia, and no other significant pathology on MRI.
The MRI was reviewed on video with the patient and her sister on the same call. The fibroid was intramural (embolisation-friendly), well-vascularised on T2, no adenomyosis, and the endometrium and ovaries were unremarkable. She was, on imaging alone, a strong candidate for uterine artery embolisation (UAE).
The tension in the room was that two senior gynaecologists in Ontario had said hysterectomy. Not wrong — hysterectomy would end the symptoms permanently. But the patient had never been offered UAE, and the decision was framed as 'surgery or nothing.' She wanted to keep her uterus for reasons that were personal and did not require our justification.
UAE at Max Mohali. Patient flew via Toronto → Delhi → Chandigarh. Two pre-arrival investigations completed in Canada (fasting bloods, thyroid). Admission was single-night; procedure took 55 minutes under conscious sedation; discharge next morning with a 4-week follow-up video scheduled from her Ontario home.
Menstrual blood loss reduced by an estimated 65% by patient diary; haemoglobin recovered from 9.4 to 12.6 g/dL. Repeat MRI at 6 months showed 58% fibroid volume reduction. She continued follow-up with her Toronto GP; imaging was read here.
"Hysterectomy is often correct — but 'surgery or nothing' is almost never the whole menu. The point of a second opinion is not to overturn the first; it is to make sure the patient saw the menu."
A Ludhiana truck driver, a black toe, and a below-the-knee angioplasty done inside 48 hours.
A Dubai-based professional, a nine-month bladder-symptom problem, and a keyhole route home.
A Chandigarh gentleman, an incidental CT finding, and the year we chose not to intervene.
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