Re: GYN: recurrent abnormal paps
From: art fougner, md (evsono@pipeline.com)
Wed Apr 25 10:37:54 2001
if she's a smoker then tell her to quit!!!
art
At Tue, 24 Apr 2001, Garry Siegel wrote:
>
>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
>
--
art fougner, md
A series of 1000 cases begins with but a single anecdote.
