Re: Gyn: Fibroids/ovarian abnormality
From: Garry E. Siegel, M.D. (garrys@mindspring.com)
Tue Nov 6 18:57:56 2007
They don't do that for logistic reasons.
Garry
At Tue, 6 Nov 2007, art fougner, md wrote:
>
>Garry
>
>Can you not have a Gyn Onc on standby, just in case?
>
>Art
>
>At Tue, 6 Nov 2007, Garry E. Siegel, M.D. wrote:
>>
>>Well put and right on the mark.
>>
>>If she chooses for me to operate, I'll put a scope in, look around, and
>>go from there. If ovarian cancer, I'll prove it by biopsy and get out.
>>If negative, I'll proceed.
>>
>>Garry
>>
>>At Mon, 5 Nov 2007, Rafael Haciski wrote:
>>>
>>>The problem with ovarian masses as I see it is whether it will be
>>>malignant.
>>>
>>>If it is benign, I have no problem taking out the ovary/mass, and/or
>>>the uterus, usually through the laparoscope and the problem is
>>>solved. However, if it is malignant on the frozen, then she needs
>>>deep LN dissection and para-aortic LN dissection, neither of which i
>>>feel comfortable doing on my own. Thus I would have to close and
>>>send her to the onc who would need to do a second laparoscopy for the
>>>node dissection for proper staging, thus putting her through two
>>>surgeries, as opposed to the one surgery if the onc were doing it the
>>>first time. However, going to oncologist involves extra effort on
>>>her part, difficulties with switching doctors etc, and thus less
>>>likable to the pt.
>>>
>>>The logistics for the oncologist to be on standby to assist in case
>>>of positive malignancy are too impossible to arrange.
>>>
>>>So it boils down to a lot of guess work as to what are the chances of
>>>malignancy, and how does the pt feel about the possibility of needing
>>>a second laparoscopy.
>>>
>>>--
>>>Rafael Haciski MD FACOG
>>>Anchor Health Centers GYN
>>>800 Goodlette Rd #360
>>>239-643-8780 office
>>>239-571-0292 cell
>>>Naples, FL.
>>>
>>>On Nov 2, 2007, at 7:04 PM, 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
>>>
>>--
>>Garry E. Siegel, M.D.
>>Private Practice
>>Roswell, GA
>>
>--
>art fougner, md
>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
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