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Re: Gyn: Perineal scarring From: Henry Gregor (henrygregor@yahoo.com) Fri Aug 29 17:58:55 2008 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Glen Elrod: "Re: Update on breech didelphyic" Previous message: DoctorJoe@aol.com: "Re: FRI: OLYMPIC OOPSIES" In reply to: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" Next in thread: Atkinson, Samuel M, Jr: "Re: Perineal scarring" Hi Joanne,   Great story about your daughter, big smile when I read it! Thanks for the info re the different formulations, it will be a big help. Re derm...I went for a skin ca screen exam a few weeks ago, having had a small basal cell ca a few years ago. Had a few skin tags, or shall we say fibroepithelial polyps, removed, a few keratoses and a wart frozen, and a shave bx of another lesion...I was amused, and confirmed in my preexisiting belief, to note on the EOB that those little doodad skin procedures, done in less than ten minutes, soared way past the billing I'd get on hyso/D&C or medicaid tubal. Your daughter had it correct. We BOTH should have studied harder, lol   Regards,   Hank --- On Thu, 8/28/08, Joanne Bulley, MD <islesannie@gmail.com> wrote: From: Joanne Bulley, MD <islesannie@gmail.com> Subject: Re: Gyn: Perineal scarring To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net> Date: Thursday, August 28, 2008, 6:29 PM Dr. Lynette Margesson and Dr. Hope Haefner told me so. Lynne is a dermatologist who has a specialty in the vulva - writes text books - lectures - and has a very active practice here in NH. We got REALLY lucky when she moved here from Toronto. Hope was a med student under me when I was a chief in Ann Arbor at St Joe's. She is now head of the Vulvar division at U of Mich - and head of the vulvar disease society (I think). At any rate - they are my friends as well as the experts in teh field. They told me to use the ointment - but also - because the creams and lotions have more parabens and alcohols that can feel really bad to the vulva that is already giving pain - and they can contribute to further irritation. I don't think it is a second eyar med student question. As to your comment about not going into derm ... when my daughter was 7 years old .... and she had a friend whose dad was a very good local dermatologist ... my daughter said to me, "Mom, you should have been a Dermatologist like Claire's Daddy - and you'd be home a lot more." So I said, "I did my dermatology rotation and looked at a lot fo skin and pictures and just couldn't figure it out." Her response, "Mommy, you had to study harder." She is now in her second year of law school - need I say more? Joanne At Wed, 27 Aug 2008, Henry Gregor wrote: > >Joaane, > >Help me here with year two med school basic question...why the ointment and not the cream? (It was foreordained I couldn't go into dermatology..never could keep the differences among ointments, creams and lotions and rationeales for uses straight in my mind, hehe.) >Hank > >--- On Tue, 8/26/08, Joanne Bulley, MD <islesannie@gmail.com> wrote: > >From: Joanne Bulley, MD <islesannie@gmail.com> >Subject: Re: Gyn: Perineal scarring >To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@mail.obgyn.net> >Date: Tuesday, August 26, 2008, 8:51 PM > >If she says the clobetasol didn't work - she was probably given a cream >or lotion - must use OINTMENT - 0.05% > >If I were 100% convinced it was surgical scarring I would use estrace >cream BID (even if the rest of the area looks well estrogenized. > >But see how the histology compares to L Margesson's info on that >powerpoint link I sent. > >By the way - I don't know about others but for local estrogen cream I do >only use Estrace: I want 17 Beta E2 -- not equine estrogens or >estropipate. I would rather give the cells the identical molecule that >the ovarian granulosa cells made / make. > >Joanne >(just my bias and $0.02!) > >At Tue, 26 Aug 2008, Garry E. Siegel, M.D. wrote: >> >>51 YO menopausal 5005 who is S/P LAVH years ago, and subsequently had >>pelvic reconstruction surgery with an academically based urogyn a few >>years ago for a rectocele and lax perineum (no grafts). I did her LAVH >>and haven't seen her since referral to the urogyn. >> >>She has seen another gyn who diagnosed lichen sclerosus without a biopsy >>(per the patient) and clobetasol was "too strong" and didn't >help. >> >>She has perineal discomfort and no sex drive, and is not on HRT. >> >>On exam, her perineum is whitened and scarred looking, like from >>surgery, and is not reminiscent of LSA. The labia and clitoris are >>normal. Her vagina is well estrogenized, the introitus admits two >>fingers comfortably, and the length and depth are well preserved. >> >>The biopsy shows "Benign epithelial hyperplasia with overlying >>keratosis." >> >>My instinct is to use medium potency steroids regularly, and address sex >>drive, also. >> >>Any thoughts are welcome, and what dose/schedule of steroid would you >>use? >> >>Garry >> >>-- >>Garry E. Siegel, M.D. >>Private Practice >>Roswell, GA >> >-- >Joanne Bulley, MD >solo gyn >Keene, NH > -- Joanne Bulley, MD solo gyn Keene, NH Next message: Glen Elrod: "Re: Update on breech didelphyic" Previous message: DoctorJoe@aol.com: "Re: FRI: OLYMPIC OOPSIES" In reply to: Joanne Bulley, MD: "Re: Gyn: Perineal scarring" Next in thread: Atkinson, Samuel M, Jr: "Re: Perineal scarring"

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