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Re: Finale of TOAs/IUD in place From: CarynRybs@aol.com Sun May 31 23:24:51 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Previous message: Nationalbpi: "Re: OB-GYN-L digest 1678" Sorry for the belated F/U on my pt with the bilateral TOAs with her IUD in place, no string visible, from last week. Have been real busy as Gyn junior... So we finally took her to the OR on Thursday am for hysteroscopic removal of her IUD at which time she had actually been afebrile for 24. I discussed the potential for bacteria showering into her pelvis with the distending medium with my team- (rather enjoyed looking insightful momentarily- just kidding- I did tell them that I didn't come up with this thought on my own...) but everyone agreed that the IUD needed to come out somehow, someway and I was still the only one in favor of TAH-BSO... I haven't done a lot of hysteroscopy but this was a flog. My chief and I were to do the case with our attending unscrubbed in the OR. Very obese lady (>300#), thought the uterus was anteverted, proceeded carefully with the attempt to pass the sound but couldn't find her int os. Real hard cervix and stenotic. My chief quickly took over and she started trying to dilate this really stenotic os. Ultimately more than 1 hr later, they (attending and chief, I had to scurry off to clinic) are successful in blindly retrieving a "safety coil" type of IUD! Surprisingly, my pt doesn't spike a temp at all post op... In fact, yest am (Sat) she had been afebrile for 72 hours with NT abd and nl WBC- much much better medically. All cx were neg throughout and her Pap was NAOMC. Looks like we got away with conservative treatment for the time being... Unfortunately she didn't do quite as well mentally. She was still only oriented to person and became more disorganized and more responsive to external stimuli- auditory halluc only. Doubt ETOH withdrawal as no h/o ETOH abuse, nl LFTS and no tactile or visual halluc... Psych finally agreed that she was "gravely disabled, psychosis NOS" (not otherwise specified) - likely schizophrenia. So yest I spent about 5 hours getting her transferred to our county mental health institute for inpt psych services. At least she wasn't discharged back to the streets... And hopefully they will keep her there long enough to finish out her 10 day course of Flagyl and Doxycycline. I gave her a shot of Depo Provera prior to transfer- (she declined Norplant) and hope to see her back for her 2 week follow-up but I'm not optimistic... I suspect we'll see her back for her recurrence down the line... Maybe I'll be a chief by then and we'll do the definitive procedure. :-) Or maybe I'll be eating my own words after I've been around the block a bit more... Caryn Previous message: Nationalbpi: "Re: OB-GYN-L digest 1678"

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