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Re: GYN: recurrent abnormal paps From: Efrain Ramirez (eramirez@icepr.com) Wed Apr 25 18:33:29 2001 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: DR Carlos Brito: "Profilactic Histerectomy" Previous message: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: coding" In reply to: Garry Siegel: "GYN: recurrent abnormal paps" "The lesser the indication the greater the complication" - LEEP or cryo - if something happens in the hsyt - what's the excuse? - 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 > -- "Life is neither the notes nor the silence between the notes, but the music that arises out of sound and silence felt as a living whole. Stop choosing...between chaos and order, and live at the boundary between them, where rest and action move together..." David Whyte Next message: DR Carlos Brito: "Profilactic Histerectomy" Previous message: Myer S. Bornstein, MD, MMM, CPE, FACOG: "Re: coding" In reply to: Garry Siegel: "GYN: recurrent abnormal paps"

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