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Re: lost IUDFrom: Joanne Bulley, MD (islesannie@gmail.com)Tue Mar 27 21:43:02 2007
I hear you, Bob, but that way the patient is free to make her decision. Where od you draw the line: the evidence is that the PID is more realted to changing partners - can any one of us say that serial monogamy with 2 partners during the life span of an IUD is OK ... but 10 isn't and where is the cut off? I was burned on an IUD issue back in 1985: I really counseled a patient intensely about why the IUD was not good for her situation - and she demanded it (many factors not least of which was that she was planning on using it for about 6 months between then and the LS TL she was scheduled to have at University of Michigan). The cief resident as well as the attending for that clinic said if I have counseled her and she really really wants it any way and she signs I should just put it in. She was also just 6 weeks post C/S #5. Long history of chronic pelvic pain as well. (I was at the Catholic Hospital and although there were no religious restrictions on our outpatient office care and counseling - we couldn't really get the permission to do the TL at the CS - and we couldn't get this patient to transfer to U Mich during the pregnancy so she could have the TL at the CS) Anyhow - now that this is a long story I did not shorten (much) ... the Copper T was placed without any problems ... and lo and behold between then and 6 weeks later no strings - perfed (by then I had finished residency and moved out of town) - the U of Mich folks did the LS - retrieved it and did her tubal. She went on to have a hyst for pelvic pain (? adenomyosis) then she found a lawyer whose line of reasoning was that the perfed IUD caused the adenomyosis and teh pelvic pain needing the hyst. The defense lawyer took my deposition that she begged me for it (after she had been deposed saying I had truly forced her to have it inserted) and the defense attorney found that in addition to the 6 or 8 terminations we knew about - she had had another 6 or 8 terminations as well. So she had had 12 or more terminations plus the 5 C/S or so - as well as a well documented history of chronic pelvic pain before that last pregnancy. She held to her story that I twisted her arm and refused settlement (I was dropped from the suit due to statue of limitations but the residency program remained as the entity being asked to pay.) Then when it came down to 36 hours before the trial and I was about to get on the plane to fly out and testify to the jury that she had lied under oath in her deposition - and she had 100% lied about her past medical history - she suddenly took their money settlement and I got to stay home. Back to the current topic: where is the evidence as to how many partners is too many and the PID is increased. The reviews and information I see just indicates that monogamous relationships have really minimal risks of PID with the IUD - and that multiple partners increse the risk. Where is the cut off between "no problem " and "too many partners"? I guess I better get of this machine - as I am really rambling! Sorry folks. Maybe it made you smile, though! Joanne
At Tue, 27 Mar 2007, rmodugno@aol.com wrote:
>
>Robert Modugno MD MBA FACOG
-- Joanne Bulley, MD, FACOG Solo gyn Keene, NH USA
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