--
Richard Chudacoff, MD
A government that robs Peter to pay Paul can always depend on
the support of Paul.
George Bernard Shaw
Democracy is a device that insures we shall be governed no
better than we deserve.
George Bernard Shaw
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Joanne
Bulley, MD
Sent: Saturday, February 21, 2004 12:44 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: chronic pelvic pain patient
Yes, I agree, I have had some great results with women with a PT
specializing in pelvic floor muscular dysfunction.
Usually when you examine these women, you find that the pain is on
palpation of the obturator fossa or primarily the levator plate. But
you have to slowly and carefully examine them - doing a pain mapping
with just the vaginal finger(s).
With that method it is amazing how you can tell whether it is
vaginismus, global pain, levators, pelvic diaphragm etc.
Also - many, many women with either RLQ or LLQ pain are really having
bowel pain. I have never (or almost never) had a GI doc agree with me -
but the ileocecal valve is right on top of the right ovary for most
women and the sgmoid colon is right over the left ovary - which is
frequently tethered right behind it. So ileocecal spasm and sigmoid
spasm frequently are diagnosed as ovarian problems. Especially when it
has NO relation to her menses (or the menses are absent).
I usually figure that if the pain remains with Lupron or ovarian
suppression with OCP's - that it may well NOT be gyn. Ask her what she
will do if you castrate her at 22 and the pain is still there...
Has she had an IVP? Is there ureterareflux or a kink in the ureter?
Have you had her see your favorite pain specialist?
At Fri, 20 Feb 2004, Charlie Chambers wrote:
>
>Richard
>
>Has she been evaluated by a PT with specific training in women's
>health, and chronic pain?
>
--
Joanne Bulley, MD
Keene, NH, USA
-----
"It is easier to understand a nation by listening to
its music than by learning its language" -Anonymous
