I didn't mean to offend with my opinion. Your situation, doing MFM and
general OB-Gyn, is probably somewhat of an anomaly. In the academic
community medical center where I work, the MFMs wouldn't think of personally
caring for CIN. In fact, I'm not sure they'd know their way around a
colposcope.
--
Larry R. Glazerman, MD
Ob-Gyn at Trexlertown, PC
larry.glazerman@lvh.com
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn D.
Montgomery, M.D.
Sent: Monday, November 28, 2005 8:16 AM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Dysplasia question
Let me set the record straight with regard to the comments made regarding my
dysplasia question.
First, yes, the certificate on my wall says MFM, but the one right next to
it says OB/GYN. I practiced general OB/GYN for five years before doing my
fellowship. Because the residents knew this and loved me, they asked me to
staff gyn cases throughout my fellowship, which I did. Since finishing my
fellowship, many OB's have sent me their pregnant patients with dysplasia
for evaluation cause they were nervous about dealing with them. About three
years ago, I began doing general OB/GYN again, along with MFM - as Dan said
(thank you Dan) I am in Montana and it just works.
Second, even though this patient in question was not pregnant, a comment was
made regarding the safety of LEEP during pregnancy. Although the numbers
are still somewhat limited, studies have not shown big problems when
utilized during pregnancy. There has been some association noted between
preterm birth and PPROM, however, these are also risks associated with other
therapeutic endeavors of the cervix during pregnancy. These risks, combined
with the accumulated data regarding the behavior of dysplasia and cancer of
the cervix during pregnancy is leading more and more toward diligent follow
rather than intervention during the course of a gestation.
All of course stated IMHO...
Lynn
Lynn D. Montgomery, M.D.
Maternal-Fetal Medicine, OB/GYN
Rocky Mountain Women's Health
2835 Fort Missoula Rd., Suite 304
Missoula, Montana, 59804
406-549-0978
fax 406-549-0987
e-mail: apgar10@montanadsl.net
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Larry
Glazerman
Sent: Saturday, November 26, 2005 8:34 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Dysplasia question
I don't know many MFMs who have done LEEPs. They should stick to MFM, IMHO.
This message was sent from my Treo 650 handheld.
-----Original Message-----
From: igold@cox.net
Subj: Re: Dysplasia question
Date: Sat Nov 26, 2005 9:43 pm
Size: 1K
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Wow Lynn, I'm amazed you do LEEPs. I was talking to one of our MFM guys the
other day about a colpo......he told me he hadn't done one in over 20
years.....Ingrid Gold, CNM, Phoenix
>
> From: "Lynn D. Montgomery, M.D." <apgar10@montanadsl.net>
> Date: 2005/11/26 Sat PM 12:03:39 EST
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> Subject: Dysplasia question
>
> I was always taught that when you did a cone or LEEP with margins
> focally involved on the specimen removed, simply follow the cervix
> because the inflammatory reaction associated with healing will deal
> with the focal abnormalities and diligent follow will detect those that
don't.
>
> Recently did a LEEP on a patient with CIN III and the report came back
> with severe dysplasia/CIS and "focal involvement of the endocervical
margin".
>
> My question is, should I go back and do a "hat" extension of the
> previous LEEP to get more of the endocervix or simply follow-up with a
> pap down the road.
> Lynn
>
> Lynn D. Montgomery, M.D.
> Maternal-Fetal Medicine, OB/GYN
> Rocky Mountain Women's Health
> 2835 Fort Missoula Rd., Suite 304
> Missoula, Montana, 59804
> 406-549-0978
> fax 406-549-0987
> e-mail: apgar10@montanadsl.net
>
