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Re: Daily bleeding, fibroidsFrom: Olive Ibie (olyvera@yahoo.com)Sun Aug 3 08:40:11 2003
At Wed, 28 Feb 2001, Joe Cutchin wrote: > >Caitlin Cusack MD wrote: > >> Yesterday I inherited a patient who is extremely attached to her uterus. >> She is a 50 y/o who had a myomectomy about 7 years ago. She came in for >> a 'routine annual' and tells me she has bled everyday since her >> myomectomy-approximately once a month she will bleed very heavily with >> clots, and then returns to her baseline of daily bleeding, heavy enough >> to need a pad. In reviewing her chart someone did a CA-125 a year ago >> that was 40. (ordered because a grandmother died of ovarian cancer-just >> explaining, not defending...). It was repeated 2 more times and was >> above 35 each time. She had an u/s which showed a large uterus and >> bilateral small simple cysts, the largest being 1.5 cm, endometrial >> lining of 10mm. She was referred to a gyn oncologist who recommended a >> hysterectomy-she did not follow up after this until she showed up on my >> schedule. >> On exam she indeed has a bloody discharge in her vault. She has a 16 >> week size uterus. The cervix is deflected up behind her symphasis, her >> posterior cul-de-sac is filled with fiboid. In order to do a pap I got >> a tenaculum on the underside of her cervix to bring the cervix down >> enough to do a pap-a huge struggle (I think I was standing on my head by >> the time I finally got it). Her virginal introitus did not help. I >> wanted to do an endo. bx but could not manipulate the pipelle to the >> angle needed to get into the uterus. >> I'm very uneasy with this patient. I've ordered an FSH to see if this >> might be post-menopausal bleeding, a repeat u/s to re-evaluate her >> ovaries and her endometrium. She feels this is all too much-that she >> has bled every day for 7 years and 'this is normal for me and is due to >> my myomectomy'. Of course the right thing to do is a hyst-but she >> adamently refuses. Any suggestions? Has anyone ever had a patient that >> bled secondary to a myomectomy? Should I put her on progesterone and see >> if I can at least cycle her (assuming her FSH shows she is still >> pre-menopausal)? Should I insist on taking her to the OR to try and do a >> D&C? Not sure this will be possible even if cut her hymen given the >> sharp angle of her cervix. Very frustrating to be taking care of a >> patient who really doesn't want us to take care of her. >> >> -- >> C. Cusack MD > >Do no harm.You abide by the patient's wishes.Unfortunately due to our legal >system you will spend more time creating on paper your defense in following >the patient's wishes. > >-- > Joseph H. Cutchin MD FACOG 4105463125 > 314 West Carroll Street 4105463128 Fax > Salisbury,Maryland 21801 > > http://www.penobgyn.com >
-- Hi, my name is Olive and i'm an opthometrist. my question is, i have only just discovered that i have fibroid around my uterus, and the ultra-sound showed that my uterus is the size of a 16weeks pregnancy. Only 2days ago, i bled contineously for the whole, and this wasn'nt my period period. I'm 27years old with no children, and i want children; please tell me what kind of treatment you will recommend for me. Thnak you.
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