Re: Fibroids/endometriosis/adenomyosis
From: rmodugno@aol.com
Fri Apr 8 07:42:50 2005
Tend to agree with Dan ( I'm just another old fart maybe!)- you have previously looked in her belly and treated her. You know the size of the uterus and location of the fibroids by ultrasound. See no pressing need to put in a scope - vaginal hysterectomy - the jewel in the gyn crown!
Robert Modugno MDE MBA FACOG
Marietta, GA
-----Original Message-----
From: R. Daniel Braun <rd.braun@gmail.com>
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Sent: Fri, 8 Apr 2005 06:39:42 -0500
Subject: Re: Fibroids/endometriosis/adenomyosis
What is wrong with Vaginal Hysterectomy? Why do you feel the NEED to
put a Laparoscope in the belly?
VH has less morbidity than LAVH and is done with Same day surgery.
Just because it is older doesn't make it less beneficial than
something newer.
Dan
On Apr 7, 2005 11:52 AM, Richard Chudacoff, MD
<rchudacoff@mylinuxisp.com> wrote:
> 1. Does she still have dysplasia? If not, then LSH is okay.
> 2. Ablation is only 50-60 % successful, Mirena more. You asked or
> non-surgical options, remember?
>
> Personally, if she has no evidence of dysplasia, then LSH, same day surgery,
> minimal morbidity...why not? If there is still evidence of dysplasia, then
> LAVH or LH.
>
> Richard Chudacoff, MD
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
> Siegel, M.D.
> Sent: Thursday, April 07, 2005 10:25 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Fibroids/endometriosis/adenomyosis
>
> Mirena after an ablation?
>
> LSH after a LEEP for dysplasia? If she comes to hyst, I would remove the
> cervix.
>
> Garry
>
> At Thu, 7 Apr 2005, Richard Chudacoff, MD wrote:
> >
> >Mirena, although I favor LSH
> >
> >--
> >Richard Chudacoff, MD
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry E.
> >Siegel, M.D.
> >Sent: Wednesday, April 06, 2005 8:39 PM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Gyn: Fibroids/endometriosis/adenomyosis
> >
> >49 YO P2102 with:
> >
> >known fibroids--4 cm intramural/subserosal one seen at lapscope a few
> >years ago, still seen on scan and felt on exam
> >
> >Stage 2 endometriosis from same lapscope, excised totally
> >
> >S/P endometrial ablation for menorrhagia, done concurrently with
> >lapscope. No fibroids in the cavity
> >
> >Also germane is that she has had a LEEP subsequent to the above for CIN2
> >(clear margins) with adenomyosis.
> >
> >Lastly, in college, she had a traumatic DVT and never has been on the
> >pill.
> >
> >She was seen in December with worsening menometrorrhagia and pelvic
> >pain, and placed on Lupron. She has become amenorrheic, has no pain,
> >and says her abdomen is smaller (clinically she is around 8 weeks size
> >today, no real change).
> >
> >She is very troubled by hot flashes.
> >
> >Options I've kicked around:
> >
> >1. Increasing her Zoloft dose (already on 100 mg/day).
> >2. Adding a progestin (which one? dose?).
> >3. Add low dose combination estrogen/progestin therapy (remember the
> >DVT); if this is considered, might thrombophilia testing be in order?
> >4. Of course, LAVH-BSO, but for the sake of discussion, let's stick to
> >non-surgical options for now.
> >
> >Garry
> >
> >--
> >Garry E. Siegel, M.D.
> >Private Practice
> >Roswell, GA
> >
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
--
R. Daniel Braun
Kinky for Governor
