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Re: Hep C carrier & gyn surgeryFrom: Allan Ho (4obgyn@gmail.com)Thu Jan 29 14:05:58 2009
--00163646d50ceac96a0461a573d8 Content-Type: text/plain; charset=windows-1252 Content-Transfer-Encoding: quoted-printable Universal precautions is a given with any surgeries. This reminds me of the days when HIV was new and we had to deliver all the HIV infected mother by C/S. It's not a comfortable feeling no matter how many pairs of gloves you wear... Could this patient be having bleeding problems because of her liver disease? This makes me want to ask whether global endometrial ablation would be appropriate on patients with intrinsic coagulopathy or who are immunosuppressed. Allan On Thu, Jan 29, 2009 at 1:12 PM, Dr. Ainsworth <ainsron@sbcglobal.net>wrote:
> Check a Chem panel for LFTs. Her GI doc might want to consider doing a --00163646d50ceac96a0461a573d8 Content-Type: text/html; charset=windows-1252 Content-Transfer-Encoding: quoted-printable <div>Universal precautions is a given with any surgeries. This reminds me of the days when HIV was new and we had to deliver all the HIV infected mother by C/S. It's not a comfortable feeling no matter how many pairs of gloves you wear...</div> <div> </div> <div>Could this patient be having bleeding problems because of her liver disease? This makes me want to ask whether global endometrial ablation would be appropriate on patients with intrinsic coagulopathy or who are immunosuppressed.</div> <div> </div> <div>Allan<br><br></div> <div class="gmail_quote">On Thu, Jan 29, 2009 at 1:12 PM, Dr. Ainsworth <span dir="ltr"><<a href="mailto:ainsron@sbcglobal.net">ainsron@sbcglobal.net</a>></span> wrote:<br> <blockquote class="gmail_quote" style="PADDING-LEFT: 1ex; MARGIN: 0px 0px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid"> <div lang="EN-US" vlink="purple" link="blue"> <div> <p><span style="FONT-SIZE: 11pt; COLOR: #1f497d">Check a Chem panel for LFTs. Her GI doc might want to consider doing a liver biopsy at the time of her hysterectomy, or have you do one since you are there. I've done one in the past and it was simple. Double glove and watch the sharps!!</span></p> <p><span style="FONT-SIZE: 11pt; COLOR: #1f497d"> </span></p> <div> <div style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0in; BORDER-TOP: #b5c4df 1pt solid; PADDING-LEFT: 0in; PADDING-BOTTOM: 0in; BORDER-LEFT: medium none; PADDING-TOP: 3pt; BORDER-BOTTOM: medium none"> <p><b><span style="FONT-SIZE: 10pt">From:</span></b><span style="FONT-SIZE: 10pt"> <a href="mailto:ob-gyn-l@obgyn.net" target="_blank">ob-gyn-l@obgyn.net</a> [mailto:<a href="mailto:ob-gyn-l@obgyn.net" target="_blank">ob-gyn-l@obgyn.net</a>] <b>On Behalf Of </b>John Perry<br> <b>Sent:</b> Wednesday, January 28, 2009 10:31 PM<br><b>To:</b> Multiple recipients of list OB-GYN-L<br><b>Subject:</b> RE: Hep C carrier & gyn surgery</span></p></div></div> <p> </p> <p style="MARGIN-BOTTOM: 12pt"><span style="FONT-SIZE: 10pt">Check her Hep C RNA titer level. It should tell you better the status of her Hep C infection and whether it is active or not. If her levels are low, go ahead and do her surgery. If her levels are higher and she needs to be treated according to the Infectious Disease docter, then maybe consider an endometrial ablation to control her bleeding for now followed by a hysterectomy in the future for the fibroid uterus and pain. <br> <br>> Date: Wed, 28 Jan 2009 21:38:49 -0600<br>> From: <a href="mailto:islesannie@gmail.com" target="_blank">islesannie@gmail.com</a><br>> To: <a href="mailto:ob-gyn-l@mail.obgyn.net" target="_blank">ob-gyn-l@mail.obgyn.net</a><br> > Subject: Hep C carrier & gyn surgery <div class="Ih2E3d"><br>> <br>> Hi folks,<br>> <br>> It has been ages since I had a Hep C carrier up for necessary but<br>> elective surgery.<br>> <br>> Patient who had been treated with Interferon long ago. And tested<br> > negative afterwards.<br>> <br>> Now in need of hyst - planned LSH BSO (sever menorrhagia, fibroids<br>> apropriate to my level of LSAH) (47 yo - requested BSO rather than<br>> keeping the ovaries). She called today to see about having the BSO<br> > done. At the end of the conversation just before we hung up (so I could<br>> go carve the eis und schnee from my driveway) she mentioned as a "by the<br>> way" - "My Hep C seems to be positive again since starting Raptiva."<br> > <br></div> <div class="Ih2E3d">> Severe Psoriasis. Rheumatologist put her in immunosuppressant, Raptiva.<br>> Now has a positive Hep C test (I don't have the results - this is verbal<br>> from patient to me.)<br>> <br> > Should I postpone her hyst til she has been treated with the interferon?<br>> For those that operate at some frequency on those who are Hep C positive<br>> - what percautions do you advise?<br>> <br></div> <div class="Ih2E3d">> (hope this doesn't seem dumb)<br>> <br>> Thanks<br>> <br>> --<br></div> <div class="Ih2E3d">> Joanne Bulley, MD<br>> solo gyn<br>> Keene, NH<br>> <br></div> <div class="Ih2E3d">> wonder how much more ice &/or snow before I go to work in the AM.</div></span> <p></p> <div style="TEXT-ALIGN: center" align="center"><span style="FONT-SIZE: 10pt"> <hr align="center" width="100%" size="2"> </span></div> <p><span style="FONT-SIZE: 10pt">Windows Live™: E-mail. Chat. Share. Get more ways to connect. <a href="http://windowslive.com/explore?ocid=TXT_TAGLM_WL_t2_allup_explore_012009" target="_blank">Check it out.</a></span></p> </p></div></div></blockquote></div><br> --00163646d50ceac96a0461a573d8--
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