Re: Dr. Montgomery......Re: Okay, sorry, I was just tired of this mess! Can you tell me this....
From: Lynn D. Montgomery, MD (anonymous@obgyn.net)
Wed, 5 Apr 2000 14:08:20 -0500 (CDT)
Wow... Well, let me give this a try.
1. I asked about your history to determine the things that you related
to me, i.e. surgical history and endometriosis. Anytime that a patient
has had endo, adhesions and multiple surgeries, it can make for
difficult dissections, particularly the ovaries. Unfortunately, it is
not unusual for a small piece of ovary to remain. Another possibility
includes that your anatomy provided a separate ovarian tissue, not
easily seen at the time of surgery.
What ever the reason, it seems that you have some ovarian tissue
remaining. There are two ways to address this. The conservative mode
would be to hormonally suppress the ovarian tissue-birth control pills
would work the best. The advantage of this option is that you can use
it to make the diagnosis of whether or not the ovarian tissue is
reponsible for any symptoms before you have any more surgery. In other
words, if you suppress the ovarian tissue with pills and the syptoms
don't abate, the cause of the symptoms isn't the ovaries.
The second option is another surgery. I would not do this until I did
the first option for the following reason.
2. As you are becoming acutely aware, the more surgeries that you have,
the more likely you are to develop adhesions, which can cause symptoms
similar to what you describe.
3. An alternative cause of the symptoms your describe are bowel in
origin. For this reason, when I have patients with histories similar to
yours, I insist that they see a gastroenterologist to assure that the
cause of the symptoms isn't from things like irritable bowel or
diverticulosis.
4. It is entirely possible that you have persistent endometriosis.
Especially with the hormonal findings you offer. Again, suppression and
surgical approaches are the options.
5. I learned very early in my career to always consider the
psychological services. Hold it now. By suggesting this, I am not
saying that all of this is in your head. I am simply acknowledging your
history and problems and suggesting the assistance of psychological
services to help you cope with all of this. You are only 35 and have a
lot of life left...
6. Regarding the estrogen replacement (Climara), I would not use this
at present. It appears you have estrogen support from residual ovarian
tissue. Can't explain the discomfort in your abdomen with the patch
there.
Lynn
At Wed, 5 Apr 2000, Kathy wrote:
>
>At Wed, 5 Apr 2000, Lynn D. Montgomery, MD wrote:
>>
>>At Tue, 4 Apr 2000, Kathy wrote:
>>>
>>>Please help me understand my test results. I am 35, and I have had a
>>>total hysterectomy with BSO. FSH 18, LH 17.5, EStr 78, and progesterone
>>>5. I had the tests done 3 and half weeks off my climara patch. My
>>>guess is ORS but I don't ovulate regulary???
>>
>>Kathy,
>>It would seem that you are getting some estrogen production from
>>something. Why are you checking? Do you become symptomatic off the
>>climara (i.e. hot flashes, etc.)? Why did you have your hyst/BSO?
>>Lynn
>
>DR. LYNN,
>THANK YOU FOR CARING! HERE IS MY STORY:I have unexplained abdominal
>pain. I have had all the tests done. I had a laproscopy in 93 for
>right lower abd pain....right ovary was like a pancake against pelvic
>wall....no endo at this time..dr. lysed adhesions and did not take out
>ovary. Then 8 months later had terrible right side pain and heavy,
>heavy periods...never had cramps at all before....so another lapro
>revealed large right ovary cysts and big time endo..so RSO. A year
>later developed uterine fibriods and big time hemoglobin drops with
>periods so I had an abdominal hysterectomy. I had extensive
>endometriosis. In fact, a year after the hysterectomy (I still had left
>ovary) I had an egg size tumor that you could visibly see on my left
>side near c section scar...just above it. (oh, I had 2 csections prior
>to all this fun....last one was very rough...they had a hard time
>getting my daughter out and I hemorrhaged....they pounded on me and her
>so much she was black and blue from head to toe).... that ended up
>being endometrial tumor. I had yet another lapro and they removed it,
>and found left ovary now with grapefruit size cyst so now LSO. I have
>never had a hot flash. I only wear Climara 0.5mg, and can't wear
>more..my breast get really sore. Docs felt like I should try
>more......for heart and bone protection. I am 35. Anyway, I recently
>had terrible pain in my right side sending me to the ER. The doctors do
>feel a soft tissue nodule of some type 2 inches to the right of my belly
>button just about where my pain was. It is still tender, but was acute
>last week. It does not show up on any test CT Scan, abdominal US. MRI
>says it is a venous congestion....whatever that means. I wonder if my
>bowel is adhesed to the abdominal wall because of this, and my last
>lapro..I had 3 hematomas at lap sites..and this is near a lap site. I
>can tell when a doc has been rough in a surgery..just like my c-sect..I
>pay with severe adhesions. Inbetween one of my laps I had little
>adhesions and I had a great recovery..no bruises and no hematoma.
>Anyway, does this help you interpret my lab results? Also if I wear the
>Climara patch on my abdomen instead of my back.....my belly aches. I
>know I am weird. The doctors are stumped. All tests show no sign of
>ovaries or cysts. Does anyone think this is still endometriosis????
--
Lynn D. Montgomery, MD
Director, Maternal-Fetal Medicine
Rocky Mountain Perinatal Center
Missoula, Montana
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