Re: actinomycosis in IUD
From: Braun, R. Daniel (rbraun@iupui.edu)
Wed Oct 22 06:25:10 2003
If you can make your point "mutely", it will frequently be more
effective.
Dan
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
Charlie Chambers
Sent: Tuesday, October 21, 2003 12:37 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: actinomycosis in IUD
Richard
Don't feel embarasses. Many a time, I've made a "mute" point. On
Tuesday, October 21, 2003, at 09:29 AM, Richard Chudacoff, MD wrote:
> Oh, do I feel embarrassed.
>
> Richard Chudacoff, MD
>
> Never let your sense of morals prevent you from doing what's right.
> Isaac Asimov
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of
> Braun, R.
> Daniel
> Sent: Tuesday, October 21, 2003 11:13 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: actinomycosis in IUD
>
> "Moot" I hope.
>
> Dan
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Richard Chudacoff, MD
> Sent: Tuesday, October 21, 2003 8:59 AM
> To: Multiple recipients of list OB-GYN-L
> Subject: RE: actinomycosis in IUD
>
> Treat with or without the IUD in place?
>
> Actually, mute point. I just talked to the patient. The plan will be
> to remove the IUS, treat for 6 months on PCN. I plan to perform an HSG
> at the end of the six-month period, just to document the patency of
> the uterus and tubes. Most of this is CYA.
>
> Richard Chudacoff, MD
>
> Never let your sense of morals prevent you from doing what's right.
> Isaac Asimov
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of
> DoctorJoe@aol.com
> Sent: Monday, October 20, 2003 11:10 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: actinomycosis in IUD
>
> In a message dated 10/20/03 5:53:19 PM, rchudacoff@mylinuxisp.com
> writes:
>
> << Replaced a copper T IUD with a Mirena progesterone intrauterine
> system IUD
>
> last week and today I received a call from the pathologist that the
> copper
>
> IUD was ' as covered with actinomyces' as he had ever seen. Needless
> to say,
>
> the Mirena comes out as soon as I can get a hold of her, but do I
> still need
>
> to treat her for 6-12 months in an asymptomatic infection? Do I need
> to
>
> scope her to rule out PID if there is no pain? She really expressed
> the
>
> desire for permanent infertility, even though she is a 27 year old
>
> nullipara. I should say that she is not entirely asymptomatic. I
> replaced
>
> the IUD with the IUS because of dysmenorrhea and menorrhagia. There is
> no
>
> dyspareunia, nor tenderness on bimanual exam. >>
>
> Looks like asymptomatic colonization, which is common with IUDs. But
> the
> mass of bugs might be worrisome. It would be prudent to treat for 6
> weeks or so with an appropriate antibiotic for Actino. It might be
> interesting to see if the uterine symptoms abate.
>
> As far as scoping someone with no tenderness and no complaints (i.e.
> of infertility), I think I'd pass and just treat with antibiotics.
>
> Joe P.
>
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--
Charlie Chambers
Hood River, OR USA
cchamber@alumni.rice.edu
"...not because I regard fishing as being so terribly
important but because I suspect that so many of the other concerns of
men are equally unimportant-and not nearly so much fun."
John Voelker
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