Re: 19mm endometrial stripe : follow up
From: Joanne Bulley, MD (islesannie@yahoo.com)
Wed Dec 29 19:20:08 2004
If the sonohysterogram had shown global thickening -- recall she is
postmenopausal and bleeding while on Vivelle 0.025 and 50 mg
progesterone QD ... you still need tissue -- and she has just had an
episode of saturating pads every 1-2 hours in early December (while
driving to and moving into her place in Florida) -- is there anyone here
who would not have decided to do a hysteroscopy / D&C to remove the
endometrium?
If there is anyone who would have just left a thickened endometrium in
situ -- let me know your thinking!
Joanne
At Wed, 29 Dec 2004, art fougner, md wrote:
>
>But, had the sonohysterogram shown a global thickening of the
>endometrium, the trip to the OR would have possibly been unnecessary.
>And so it goes ...
>
>art
>
>At Tue, 28 Dec 2004, Joanne Bulley, MD wrote:
>>
>>Thanks Robert. It is nice to know that I am not the only one who
>>resorts to look - grab - look again - grab some more - eventually
>>yanking it out!
>>
>>Final path -- just a totally benign polyp. She is glad I insisted on
>>doing her ultrasound during the 5 days she was home (3 days before Xmas
>>- and Xmas and the 26th!) She ended up staying 3 more days so she could
>>get ikt taken care of here before returning to her winter abode in
>>Florida.
>>
>>The sonhysterography would have showed the polyp ... and she'd have
>>gone to the OR for removal -- and the hospital and radiologist would
>>have gotten more $$$$ than I get for taking care of the problem! (They
>>probably already get more for the US they did than I will get for the OR
>>procedure!) When they do a transabdominal and transvaginal ultrasound
>>... they already charge for 2 ultrasounds and 2 reading fees ... so if
>>they did the sonohysterogram -- they'd charge for a third imaging and
>>charge for inserting the catheter to do it! And it would not have
>>changed my procedure or the outcome -- so why suggest another imaging?
>>
>>It'd be different if it was in my office and I would only charge for one
>>thing ... but the radiologists already self refer for mor images all
>>the time. There is a time to see the 19 mm lining and go after it!
>>
>>Joanne
>>
>>At Tue, 28 Dec 2004, RModugno@aol.com wrote:
>>>
>>>I'm sometimes pretty gross about getting out polyps - I look in with the
>>>hysteroscope, then get out my trusty Corson myoma grasper - put it in through
>>>the cervix and with luck, pull out the polyp. Can always look back in later to
>>>see if I got it all.
>>>
>>>Pity sonohysterography is not an option - if they do hysterosalpingograms,
>>>then this should be a "piece of cake".
>>>
>>>Robert Modugno MD MBA FACOG
>>>Marietta, GA
>>>_www.novaobgyn.yourmd.com_ (http://www.novaobgyn.yourmd.com)
>>
>>--
>>Joanne Bulley, MD
>>Keene, NH, USA
>>
>>"Every gun that is made, every warship launched, every rocket fired,
>>signifies in the final sense a theft from those who hunger and are not fed,
>>those who are cold and are not clothed."
>>
>>President Dwight D. Eisenhower
>>April 16, 1953
>>
>--
>art fougner, md
>May the Joy of this Holiday Season Be with You
>and Yours throughout the New Year.
>
--
Joanne Bulley, MD
Keene, NH, USA
"Every gun that is made, every warship launched, every rocket fired,
signifies in the final sense a theft from those who hunger and are not fed,
those who are cold and are not clothed."
President Dwight D. Eisenhower
April 16, 1953
