Re: Thoughts on management
From: Joanne Bulley, MD (islesannie@yahoo.com)
Sun Jan 25 06:15:59 2004
I have read other responses - why not do a hysteroscopy and SEE what is
up there. You can irrigate out pretty good if there is blood /
infection up there. Probably would need to consent for hyst if needed.
Could it be a necrosing fibroid?
Does she WANT to save her uterus?
Sometimes I send this sort of case to either my favorite advanced
repro-endo surgeon - or a gyn-onc. When it seems really odd - the
surgical findings might not be something you want to deal with. Depends
on your local colleagues and availability for intraop consults!
Joanne
At Sat, 24 Jan 2004, Tami wrote:
>
>Any suggestions for management with the following patient:
>36y G0 long hx of endometriosis on continuous ocps with good control of her pain. Seen with c/o vaginal discharge--in a rainbow of colors (pink brown red orange) with a foul odor. Her "endometriosis doctor" did cultures/wet mount--all negative, then tx'd her with a week of flagyl and then a week of doxy with no improvement.
>Exam normal --all vag type testing neg, but with a yellow dc that she says requires changing a pad almost hourly. Us shows an approx 8x7x7cm hematoma located between the endometrium and myometrium connecting to the cavity by a "crack" in the endometrium. No signs of any other myometrial abnormality; mri shows same. Endo bx showed "chronic endometritis, no atypia".
>I'm considering a hysteroscopy, although I'm not sure if it will be helpful for diagnosis or treatment. I think she's heading towards a hyst for both diagnosis and treatment, but wanted to hear other thoughts.
>
>Thanks.
>Tami Dairiki M.D.
>private practice
>Scottsdale, AZ
>
>>> ----- Original Message -----
> From: Charlie Chambers
> To: Multiple recipients of list OB-GYN-L
> Sent: Friday, January 23, 2004 10:30 AM
> Subject: Re: Question: fosamax and calcitonin at the same time
>
> I would be very hesitant to combine therapies. i would be more inclined to use monotherapy and if those clearly fail then parathyroid hormone. The data are sparse and nonexistent with regards to fracture data and combination therapies. Increasing BMD does not correlate in a linear fashion to fracture risk. Seems too often that people want to combine therapies with the assumption that if one works, two might be better. A false assumption at best.
>
> ************************************************************************ *****
> Charlie Chambers=20
> ************************************************************************ *****
> Hood River, OR USA
> cchamber@alumni.rice.edu
>
> "All good things...come by grace,
> and grace comes by art,
> and art does not come easy."
>
> Norman Maclean
> ************************************************************************ ******
>
>--
> ************************************************************************ ******
> On Jan 21, 2004, at 3:51 PM, Joanne Bulley, MD wrote:
>
> I just took the reference back to the office - at a recent (well -
> October) update one day course - there was a presentation on this exact
> study.
>
> NO! You do not give them together (fosamax and calcitonin analogues)
> because the fosamax binds to the osteoclasts (stopping their function of
> reabsorption) and the calcitonin requires active osteoclasts to rebuild.
>
> I just had the syllabus at home for a discussion off list that Terrence
> Jones and I were having about the WHI etc - but I took it back to the
> office today!
>
> I can *try* to remember to look it up tomorrow.
>
> Joanne Bulley, MD
>
> At Wed, 21 Jan 2004, Mary Nachreiner wrote:
>
> Question: Is it necessary or efficacious to give fosamax and calcitonin at
> the same time. Patient also receiving evista in conjunction, for treatment
> of bone pain and refracture of t-11 due to osteoporosis.
>
> --
> Joanne Bulley, MD
> Keene, NH, USA
>
> -----
> "It is easier to understand a nation by listening to
> its music than by learning its language" -Anonymous
>
--
Joanne Bulley, MD
Keene, NH, USA
-----
"It is easier to understand a nation by listening to
its music than by learning its language" -Anonymous
