OB-GYN-L Messages for January, 2009: Re: Hep C carrier & gyn surgery

Re: Hep C carrier & gyn surgery

From: Allan Ho

4obgyn@gmail.com

Fri Jan 30 08:35:46 2009

You may want to offer her a few shots of Lupron. That way, she will stop menstruating. It may even relieve her pain. Thirdly, it will give her a taste of menopause. Since she may not be a good candidate for ERT because of her liver disease, she may not want to have her BSO afterall.

Allan

On Thu, Jan 29, 2009 at 7:23 PM, Joanne Bulley, MD <islesannie@gmail.com>wrote:

> Her dermatologist checked the status: she has severe psoriasis and had
> been on immunosuppressives. So Derm A had stopped his therapy because
> of mildly elevated LFT (I did not know any of this) and then after she
> saw me - she went to Dermn B who said "before I change to another agent
> I need to know more" and after talking with him today, he sent me her
> labs.
>
> Hep C is at 26.5 (significant positive is anything over 8)
> LFTs (AST and ALT) are well above the norm and higher than in September
> when the last Derm had checked.
>
> I think I don't have enough info yet - this came to light in the last
> week. I think she needs more liver eval including coags before I take
> her to to the OR. I think we can be extra vigilant about our universal
> precautions and so forth. I just don't want her to have a complication
> that could be avoided by being sure all appropriate assessments have
> been done before going to the OR.
>
> She had a previous global ablation and was sent to me to have a
> re-ablation. I don't think that is a good idea. She is not anemic (hgb
> 16). As much as she has her heart set on getting this uterus out - I
> think it is likely in her best interest to wait.
>
> Joanne
>
> At Thu, 29 Jan 2009, Allan Ho wrote:
> >
> >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
> >
>
> --
> Joanne Bulley, MD
> solo gyn
> Keene, NH
>

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<div>You may want to offer her a few shots of Lupron.  That way, she will stop menstruating.  It may even relieve her pain.  Thirdly, it will give her a taste of menopause.  Since she may not be a good candidate for ERT because of her liver disease, she may not want to have her BSO afterall.</div>

<div> </div> <div>Allan<br><br></div> <div class="gmail_quote">On Thu, Jan 29, 2009 at 7:23 PM, Joanne Bulley, MD <span dir="ltr"><<a href="mailto:islesannie@gmail.com">islesannie@gmail.com</a>></span> wrote:<br> <blockquote class="gmail_quote" style="PADDING-LEFT: 1ex; MARGIN: 0px 0px 0px 0.8ex; BORDER-LEFT: #ccc 1px solid">Her dermatologist checked the status: she has severe psoriasis and had<br>been on immunosuppressives.  So Derm A had stopped his therapy because<br> of mildly elevated LFT (I did not know any of this) and then after she<br>saw me - she went to Dermn B who said "before I change to another agent<br>I need to know more" and after talking with him today, he sent me her<br> labs.<br><br>Hep C is at 26.5 (significant positive is anything over 8)<br>LFTs (AST and ALT) are well above the norm and higher than in September<br>when the last Derm had checked.<br><br>I think I don't have enough info yet - this came to light in the last<br> week.  I think she needs more liver eval including coags before I take<br>her to to the OR.  I think we can be extra vigilant about our universal<br>precautions and so forth.  I just don't want her to have a complication<br> that could be avoided by being sure all appropriate assessments have<br>been done before going to the OR.<br><br>She had a previous global ablation and was sent to me to have a<br>re-ablation.  I don't think that is a good idea.  She is not anemic (hgb<br> 16).  As much as she has her heart set on getting this uterus out - I<br>think it is likely in her best interest to wait.<br><font color="#888888"><br>Joanne<br></font> <div class="Ih2E3d"><br>At Thu, 29 Jan 2009, Allan Ho wrote:<br>><br>>Universal precautions is a given with any surgeries.  This reminds me of the<br>>days when HIV was new and we had to deliver all the HIV infected mother by<br> >C/S.  It's not a comfortable feeling no matter how many pairs of gloves you<br>>wear...<br>><br>>Could this patient be having bleeding problems because of her liver<br>>disease?  This makes me want to ask whether global endometrial ablation<br> >would be appropriate on patients with intrinsic coagulopathy or who are<br>>immunosuppressed.<br>><br>>Allan<br>><br><br></div> <div> <div></div> <div class="Wj3C7c">--<br>Joanne Bulley, MD<br>solo gyn<br>Keene, NH<br></div></div></blockquote></div><br>

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