I'd wait until after Interferon treatment and then treat with LSH. IMHO this
has less risk of injury to you than an open procedure (TAH or TVH)
--
Richard Chudacoff, MD, FACOG
Las Vegas International Center for Advanced Gynecologic Care
(Specializing in minimally and non-invasive surgery)
TEL: 702-485-8893
FAX: 702-974-0945
rchudacoff@lasvegasgyncenter.com
www.lasvegasgyncenter.com <http://www.lasvegasgyncenter.com/>
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From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Allan Ho
Sent: Thursday, January 29, 2009 1:07 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Hep C carrier & gyn surgery
Universal precautions is a given with any surgeries. This reminds me of the
days when HIV was new and we had to deliver all the HIV infected mother by
C/S. It's not a comfortable feeling no matter how many pairs of gloves you
wear...
Could this patient be having bleeding problems because of her liver disease?
This makes me want to ask whether global endometrial ablation would be
appropriate on patients with intrinsic coagulopathy or who are
immunosuppressed.
Allan
On Thu, Jan 29, 2009 at 1:12 PM, Dr. Ainsworth <ainsron@sbcglobal.net>
wrote:
Check a Chem panel for LFTs. Her GI doc might want to consider doing a
liver biopsy at the time of her hysterectomy, or have you do one since you
are there. I've done one in the past and it was simple. Double glove and
watch the sharps!!
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of John Perry
Sent: Wednesday, January 28, 2009 10:31 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Hep C carrier & gyn surgery
Check her Hep C RNA titer level. It should tell you better the status of her
Hep C infection and whether it is active or not. If her levels are low, go
ahead and do her surgery. If her levels are higher and she needs to be
treated according to the Infectious Disease docter, then maybe consider an
endometrial ablation to control her bleeding for now followed by a
hysterectomy in the future for the fibroid uterus and pain.
> Date: Wed, 28 Jan 2009 21:38:49 -0600
> From: islesannie@gmail.com
> To: ob-gyn-l@mail.obgyn.net
> Subject: Hep C carrier & gyn surgery
>
> Hi folks,
>
> It has been ages since I had a Hep C carrier up for necessary but
> elective surgery.
>
> Patient who had been treated with Interferon long ago. And tested
> negative afterwards.
>
> Now in need of hyst - planned LSH BSO (sever menorrhagia, fibroids
> apropriate to my level of LSAH) (47 yo - requested BSO rather than
> keeping the ovaries). She called today to see about having the BSO
> done. At the end of the conversation just before we hung up (so I could
> go carve the eis und schnee from my driveway) she mentioned as a "by the
> way" - "My Hep C seems to be positive again since starting Raptiva."
>
> Severe Psoriasis. Rheumatologist put her in immunosuppressant, Raptiva.
> Now has a positive Hep C test (I don't have the results - this is verbal
> from patient to me.)
>
> Should I postpone her hyst til she has been treated with the interferon?
> For those that operate at some frequency on those who are Hep C positive
> - what percautions do you advise?
>
> (hope this doesn't seem dumb)
>
> Thanks
>
> --
> Joanne Bulley, MD
> solo gyn
> Keene, NH
>
> wonder how much more ice &/or snow before I go to work in the AM.
_____
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