Re: Gyn: Fibroids/ovarian abnormality
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Fri Nov 2 17:59:04 2007
Ours may or may not send back, and/or the patient may simply choose to
stay there.
Either way is fine.
Garry
At Fri, 2 Nov 2007, Joanne Bulley, MD wrote:
>
>Whether or not she "needs" it is up for grabs - but once someone asks it
>- I usually tell them that if they'd like more information before
>proceeding that it is fine with me and I usually try to facilitate it.
>Our gyn oncs have enough business - they send the patient back if it
>isn't something they really think requires their expertise.
>
>Joanne
>
>At Fri, 2 Nov 2007, Garry E. Siegel, M.D. wrote:
>>
>>48 YO P2002 referred by friendly radiologist.
>>
>>15 years ago, had laparotomy and ovarian cystectomy (unsure which side)
>>for a dermoid; no records available.
>>
>>A couple of years ago had menomet., but lately has been having regular
>>but heavy periods until recently, when she has missed one or two here
>>and there and had some hot flashes. She also is now having some
>>bleeding in between the periods/spotting.
>>
>>She saw another gyn in the community, and was told to see the gyn
>>oncologist ASAP due to a 7 cm. complex ovarian mass, and by the way you
>>have fibroids and your uterus is tilted and the cervix couldn't be
>>visualized (I have no records except ultrasound snapshots, and the
>>history is from the patient).
>>
>>She somehow then saw the radiologist for embolization consideration, and
>>he reviewed her history and recent ultrasound images. She had seen her
>>in 2/07 and her MRI then showed a few fibroids, 4 cm. max. His review
>>of the current ultrasound images said "no change" on the fibroids, but
>>the ovary contained a 4 cm. complex cyst.
>>
>>In ROS, BTW she has increasing bloating and gas, and has always had
>>hemorrhoid trouble (colonoscopy 2006 "ok") that is now worsened.
>>
>>On exam, she has a scaphoid abdomen that is non-tender and no masses.
>>
>>On speculum exam, when the posterior blade of the Pederson speculum hit
>>the posterior fornix, she jumped, and I could only partially visualize
>>the lower 1/2 of the very anterior cervix, and on bimanual exam, her
>>uterus/pelvic mass is firm, directly retroverted and tender--she jumps
>>away, and she says this degree of tenderness is not like her normal
>>exams. A planned endo biopsy was ditched, obviously.
>>
>>CBC and Ca 125 are normal.
>>
>>I advised lapscope/H-scope at a minimum, with possible unilateral
>>cystectomy and/or oophorectomy, as she was not at all interested in
>>hysterectomy at the first meeting.
>>
>>Today, when I returned a follow up call, I reiterated same, and she
>>asked if she needs to see a gyn onc, since gyn #1 suggested it.
>>
>>Thoughts?
>>
>>Garry
>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>Joanne Bulley, MD, FACOG
>Solo gyn
>Keene, NH USA
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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