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Finally a GYN question!From: anonymous@obgyn.netFri, 29 Dec 2000 01:13:12 EST
Hi, This is mostly directed for Dr McIntosh, Marchbein, Almen, and others who replied to Kas/updates etc posts before and are familar with the situation. This actually is a GYN-related question for once. I had my consult at the other hospital that is used as kind of the "second opinion" the other day. This was the first appt I had following my recent chest/abd/pelvic CT scan. Basically we've gotten no where diagnostically. They all thought I lost a lot of weight since the fall, and we went over my daily log of temps and problems. The team of doctors evaluating me seemed to agree that based on my tests, the only things that could be causing these problems are infection of some sort, rheumatologic inflammation, or an indolent form of lymphoma. They want to 1) repeat the CT in four months again, 2) order a bone marrow biopsy, and 3) think its time to biopsy the RLQ nodes. Now...I'm having my endo removed (hopefully) in February, and my GI will also be there to see what's up with my esophagus. Bear in mind this is a different hospital. The younger doctor (she's past residency but not by much, still working under supervision) thinks a biopsy of the RLQ nodes during the laparoscopy would be the safest thing to do, and she thinks my GYN should do it. She did not think it was a good idea to do a regular biopsy with needle and local if my GYN will not do it, as she doesn't seem to think its safe since they are just under one cm. She said no one in his right mind would do that. So she brought in her "boss" who heads the team, and he thought the lap biopsy would be a good idea, but that it definitely should be done even if the GYN won't do it. The two of them were going back and forth about it for several minutes, to be honest they lost me in the beginning, but I do remember he stated he was concerned that lymphoma or a serious infection could be growing slowly and be missed if they don't biopsy. She thought that was unlikely enough not to risk the biopsy, but he didn't agree. He mentioned that the only drawback to the GYN doing it is that she may pull the wrong node out - I have about ten enlarged, but he's concerned that without the help of the CT scan (which they use normally when doing a regular abd biopsy) she couldn't find the larger ones and a healthy one could be removed. If that happens, and the enlarged ones are missed, there could be stuff hiding in them that we won't know about if the pathology report comes back ok. She did agree with that. So....he thinks I should have a normal biopsy, she thinks in the interest of safety its better to risk her pulling out the wrong node and having my GYN do it during the lap surgery. Now I havent even gotten to speak with my GYN about this yet, but I have a feeling the answer will be no. She's a nice nice person and good doctor, but she's been really concerned about these problems I've been having, and somehow I think she won't want to test her skills on me with something she doesn't do normally. At least I don't think she does this normally. No one has really told me what these "risks" are of a normal biopsy, so since I wouldn't have to have general for it, I just as soon have it done regular with the CT help so they're sure they got the right one if she says no. However if this is something the GYN is willing to do...should I have her attempt it? As GYNs yourselves, would you feel comfortable doing this abdominal node biopsy during a routine laparoscopy? Are there any viewing procedures or machines one could use instead of the CT during laparoscopy to make sure the right nodes are being removed? Thanks as always Kas
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