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GYN: recurrent abnormal papsFrom: Garry Siegel (garrys@mindspring.com)Tue Apr 24 22:13:52 2001
44 YO postmenopausal woman underwent a LEEP for CIS around 5 years ago, with a positive endocervical margin. Her paps have been normal since, and her followup has been regular as requested. Since the LEEP, she now has rheumatoid arthritis, and intermittently has been on steroids and other immunosupressives. Also, FWIW, her health insurance will expire in August 2001, and she thinks that she'll be a nightmare getting new coverage (her husband is self-employed and her job is being downsized or something like that in August, or her COBRA is over then). Her recent pap came back as squamous atypia, and she couldn't just wait to repeat it in 3 months, as I suggested, due to the health insurance issue and general nervousness. So, she had a colpo, and the exam was adequate, with two small areas of white epithelium that were histologially "squamous atypia c/w HPV", and her ECC showed endocervitis. The woman and her husband are pretty much jumping up my case to treat this surgically, as opposed to observation. I believe that this is due to their insurance situation. I've told them that I think another LEEP is overkill at this point, but that I could live with doing it. They actually are pushing for a hysterectomy, which I could again live with, but frankly think that it is overkill for sure. However, their feelings are motivated by the real issue of pre-existing illness. Any thoughts? Garry
-- Garry E. Siegel, M.D., F.A.C.O.G. Roswell, GA Private Practice
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