My own liver patients, written up and published
Twenty three people I treated in Beirut, my name first on the paper, including the ones that went badly. It is free to open and free to read.
Kabalane Yammine, MD
Interventional radiology
Clemenceau Medical Center · Saint George
You were offered an operation.
I am an interventional radiologist. I treat fibroids, an enlarged prostate, varicocele, liver tumours and pelvic pain from inside the blood vessel that feeds them, through a needle rather than a cut.
A question costs you a message. Nothing is decided today.
Georgetownwhere I trained, in Washington DC
Find the one that is yours.
Most people who write to me are dealing with one of these five.
Fibroids and bleedingYour month is planned around a bleed, and someone has said hysterectomy.
Ten days ago a doctor looked at a screen instead of at you and said hysterectomy. You have been reading ever since.
A question costs you a message. Nothing is decided today.
A fibroid does not feed off your whole body. It feeds off one road, an artery running to it. I go in through a pinhole at your wrist or groin, follow that road on a screen, and close it. Cut off, the fibroid shrinks and the bleeding settles. Written down it is uterine fibroid embolization. Most people say UFE. Say either one to your mother or your gynaecologist and you will be understood.
Your uterus stays where it is. I do not remove it, and nothing I do is a step towards removing it. Your ovaries are not what I treat and not what I aim at. The closer you already are to the menopause, the more likely your periods are to stop after this, and I will tell you where you sit before you decide. After a couple of weeks, sex is as it was.
Now what it costs you
Fibroids can come back, and some women need more done later, sometimes the operation they came to me to avoid. This is at its best when the trouble is bleeding, pressure and size, and you want those gone with your uterus kept.
One thing I do not do: I do not cut fibroids out. If a pregnancy is what you want next, myomectomy is the better conversation, and I will give you the surgeon's name.
are you awake
Awake. No general anaesthetic: numbing at the skin, sedation to keep you comfortable, and you can talk to me through it.
does it hurt
The pain comes after, not during. Strong cramps for a few hours, treated through the drip while you are still with us.
how long
You stay the night and go home in the morning. Most women are back at work inside a week. Bring your ultrasound.
MTV Lebanon asked me onto Santé to take viewers’ calls, live, about fibroids. Watch me answer a stranger asking what you are about to ask.
Ask me about fibroids on WhatsAppIt comes to my phone. I read it myself.
An enlarged prostateUp three or four times a night, and there is a date in the diary for an operation.
You know the number. Three, some nights four. Nobody has asked you for it.
You agree to nothing by writing to me. Nothing is decided today.
Two small arteries feed your prostate, the way one hose feeds a garden. I go in at the wrist, through a puncture the width of a pen tip, and close them. The gland softens and the channel it was squeezing opens. No cut, nothing through the water pipe. You will see it written as prostate artery embolization. Carry that word to your urologist on Thursday.
Here is the thing most men are too polite to ask me, and I am not lowering my voice. Your friend is right about his own operation. The usual one goes in through the water pipe and opens the gland from inside, and after it, for most men, the semen goes backwards into the bladder, not out. It works, and feels the same. It is dry, and that is the part your wife notices. I never go near the water pipe, so the muscle that closes at that moment is never touched. Where the two were compared, trouble with ejaculation was about half as common with mine. Erections are the same either way. Leaking is the same: the muscle that holds your urine is where I do not go.
Now what it costs you
You are more likely to need treating again than after the operation, and the operation does more about the nights, for longer. That is the trade.
Mine is the first choice, not the second, if anaesthetic is not safe for you, if you are on blood thinners, or if the gland is very large. If your urologist told you something that still holds, I will say so and send you back to him.
are you awake
Local anaesthetic, light sedation. You are awake. You feel pushing, not pain.
how long
One day in hospital, no stitch, nothing to heal. Somebody drives you home.
when it works
The nights settle over about two weeks, not overnight.
My hospital filmed me doing this one, on their own channel. When Arab Hospital Magazine interviewed me in June 2023, I told them what I tell you: it is not a replacement for surgery.
Ask me about the prostate on WhatsAppIt comes to my phone. I read it myself.
VaricoceleThe ache that is gone by morning and back by evening. And the semen analysis that came back poor while you were trying.
A doctor pressed on your left side, asked you to cough, and said not to worry. Or a report came back with bad numbers and somebody said varicocele and operation in one breath.
You can write without deciding anything. Nobody is examined for asking.
A vein drains the testicle, and small valves inside stop blood running back down. When they stop closing, blood pools and the vein swells, like a drain that empties uphill. That vein is not needed. I close it myself and the others take the traffic. You will see it written as varicocele embolization.
If it is the ache, it is blood sitting where it should not, and when the vein is closed the evenings change first. If you are the other man, you did not come about a sperm count. You came because it has been two years and something has finally been named. It is real, and I can close it. And if it turns out this was not your answer, it does not mean there is no answer. If you had the operation and it came back, I can still close the vein.
About fertility, straight
Whether closing it gets your wife pregnant, I cannot promise you. The best pooled evidence moves the sperm numbers in the right direction and stops short of meaning anything, which its own authors say.
What it does point at is smaller: the vein stops leaking and stops being the thing nobody dealt with. If you should see a fertility specialist before you see me, I will tell you which one.
Against the operation, plainly.Fewer complications overall with mine.The swelling in the scrotum that can follow surgery, close to gone.It comes back more often than after surgery, and that is what the first two cost.
are you awake
I numb a spot at the top of your leg. You are awake, and you feel pushing and pressure, never cutting.
what I do
I thread a fine tube up the vein, follow it on screen to the exact place, and close it there myself. Nothing goes near your testicle.
how long
About an hour. Home the same day, at a desk the next morning, and I tell you when the gym is safe.
What I can show you is not about varicocele. I sat on MTV’s Santé taking live calls from strangers, on air, about their bodies. Whatever you type to me is less than that.
Ask me about varicocele on WhatsAppIt comes to my phone. I read it myself.
Liver tumoursA scan found something, surgery is off the table, and everyone is asking you what happens now.
Somebody told your father his tumour cannot be cut out, then said a long word you wrote down. It is almost certainly radioembolization. That one is mine.
Writing to me books nothing. And no, livers are not a line on a list here. I published my own liver patients in 2020, twenty three of them, treated in Beirut, free to read tonight, including the ones that went badly.
A liver tumour feeds itself. It takes a road of its own off the artery, which is the one useful thing about it. I go in through a vessel at the top of the leg, follow that road on a screen, and put the treatment into the tumour’s own supply instead of into all of him. It is written radioembolization.
Where it works best is narrow: one tumour, no bigger than about eight centimetres, still inside the liver. There, nearly nine of every ten shrank, and some of those people reached a surgery or a transplant they had been refused.
What I will not tell you
I am not going to tell you this buys your father more time. It does not, and anyone who tells you it turns months into years is not telling you the truth.
What it changes is how those months go, with fewer of them spent ill than on chemotherapy. Send me his scan report and I will tell you whether he is a candidate before you book anything.
how many visits
Two, a few days apart. The first to map the vessels of his liver, the second to treat.
how long in Beirut
One night in hospital, then a week or two of tiredness at home. For you that is a week here, not a month of leave.
In January 2015 my hospital announced the first three cases of this kind in Lebanon, done here, and it named me. I did not write that sentence. It is still online.
Ask me about the liver on WhatsAppIt comes to my phone. I read it myself.
Pelvic pain, and normal scansWorse by the evening, worse on your feet, and nobody has named it.
Worse by the end of the day. Worse on your feet. And every scan so far came back normal.
You do not have to explain it again to be taken seriously here. Nothing is decided today.
Sometimes the pain comes from veins in your pelvis that do not drain, so blood sits there and the ache builds through the day. I look for those veins with a scan made to show them. If they are there, I close them from the inside, through a needle, and you will see it written as pelvic vein embolization.
Your scans came back normal because a scan of the uterus is not a scan of the veins. Nobody was looking at them. That is not the same as nothing being wrong, and it is not the same as you imagining it.
What the evidence does and does not show
Across twenty one studies and more than a thousand women, about seventy five in every hundred got substantially better. The same review says that evidence is low quality, and that nobody has proven these veins cause the pain.
The scan does not have that problem. I will look properly. If your veins are not the cause, I will say so on the day, and tell you who to see next, with the scan in your hand.
are you awake
Awake, numbed at one spot, with something to keep you comfortable.
how long
About an hour, and home the same day.
when it changes
Not overnight. It settles over weeks, and I will want to hear from you at six.
Whatever happens, you leave with a scan of your own veins and an answer about them. That is the thing nobody has given you yet.
Ask me about pelvic pain on WhatsAppIt comes to my phone. I read it myself.
The room you would be in.
Clemenceau Medical Center, Beirut. The screens on the wall are what I watch while I work.
None of this was written by me.
Four things you can open yourself. A journal, my hospital, a television station and two registers. I cannot edit any of them.
The first three cases of their kind in Lebanon
My hospital wrote this, not me: our Interventional Radiologist Dr. Kabalane Yammine has performed the first three cases in Lebanon to treat liver tumors that are inoperable.
Their page has since come down. The web kept a copy.
Answering strangers’ questions about fibroids, live
Santé is a daily programme where a doctor takes viewers’ phone calls on air. You can watch me answer somebody asking what you are about to ask me.
My licence number, so you never have to take my word for it
The Lebanese Order of Physicians lists me. So does the American registry. Neither of them asked my permission and neither can be edited by me.
Beirut, by way of Washington.
I studied medicine at the American University of Beirut. I went to Georgetown University in Washington, DC, to train in interventional radiology. I worked in the United States for a while, and then I came home.
Today I practise at Clemenceau Medical Center and at Saint George Hospital University Medical Center, both in Beirut, in the Department of Diagnostic and Interventional Radiology.
In 2023 a medical magazine asked me, on the record, what a newer treatment for an enlarged prostate could and could not do. I answered the second half first.
هذا الخيار لعلاج تضخم البروستات ليس بديلاً عن الجراحة او العلاجات الأخرى المعتمدة
This option for treating an enlarged prostate is not a replacement for surgery, or for the other treatments that are already established.
Arab Hospital Magazine, 19 June 2023
That is the answer I give in the room, too. If a specialist has already told you something that still holds, I will tell you that, and where to go instead.
Tell me what is happening, in your own words.
I will tell you whether this is even a problem to solve my way, and where to go if it is not. If you are abroad, or you are asking on behalf of a parent, send me the scan report in the same message and I will read it before we speak.
A question costs you a message. Nothing is decided today.
Lebanese Order of Physicians, Beirut · ي/225
Where I operate
Clemenceau Medical Center
Department of Diagnostic and Interventional Radiology, Beirut
And where I also see patients
Saint George Hospital University Medical Center
Achrafieh, Beirut
If you are a doctor referring a patient
Send the imaging and the question on the same number and I will come back to you, not to your patient.