Grand Rounds 4.25 at Canadian Medicine

8 Comments:

• At Mon Mar 17, 04:13:00 AM 2008,  jazzwelt said…

  Hello I have had 2 surgeries to remove fibroids in my uterus and it came back again in the past.
  I had many miscarriages and now I would like to try again but am worried if I will miscarry again as I have this serious burning sensation in my womb.
  No doctor has explained to me why I have such heat nd burning sensation in my uterus.
  
  Thanks for your time
  
  MT

   

• At Tue Mar 18, 07:36:00 PM 2008,  Anonymous said…

  Dear Dr. T:
  I recently had a m/c at 13 weeks - no fhb was found, and the demise was confirmed by us the following day. The us showed the fetus was at about 13 weeks, so the demise was very recent. I had a D&C the following day. I have previously had one healthy pregnancy (with slightly elevated bp which was monitored, but not treated) from which I have an 18 mo old son.
  Prior to no fhb being found, I had no bleeding or cramping. I had noticed a few red blotches/spots on my skin - one near my ankle, and a few on my torso (front and sides only, anywhere from upper chest to lower abdomen). The first ones probably appeared a few weeks to a month before the m/c - they start as pale red spots and seem to get a bit bigger (up to about the size of a dime) and darker over time, some with dry skin on top. Since having the D&C, I have noticed more of them. They are approximately circular, but seem somewhat irregular - in earlier stages, some of them resemble insect bites. They are not itchy and for the most part don't seem raised. My gp said they looked like they were only in the top layer of the skin and thought they looked like an allergic reaction, although I can't recall coming in contact with anything different. I have been prescribed hydrocortisone cream to try on them, but have only been using it for a day now, so I don't know if it will work.
  Are these spots possibly related to the pregnancy and/or demise? If it is a possibility, are there any tests I should be asking for with regards to these to confirm?
  Also, what are the most common causes of such demises, if the spots are not related?
  
  Thanks for your time

   

• At Wed Mar 19, 07:04:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To MT Mar 17: You might have endometriosis in addition to the fibroids you have had. Do you see a specialist in Reproductive Endocrinology and Infertility? Dr T

   

• At Thu Mar 20, 07:15:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To anonymous Mar 18: The most common cause of late first trimester losses are fetal chromosmal abnormalities. I would sugest you see a dermatologist regarding the skin abnormalities. This may be psoriasis or a manifestation of some other autoimmune condition rather than just an allergic reaction. Autoimmune conditions can be accompanied by antibodies that might have a deleterious affect on a pregnancy. Please let me know what you find out and thanks for writing! Dr T

   

• At Sat Mar 22, 11:22:00 AM 2008,  Anonymous said…

  My mother and two sisters have Acute Intermittant Porphyria. I have all the symtoms, many unecessary surgeries, med. allergic reactions to over 100 medications, some resulting in hospitalization. I went thru genetics at the U of U in Utah. My older daughter has been clinically diagnosed but then when they wanted to do the genetic testing because we seem to fall in the category of the 27% they can't find it in via regular testing, they put a halt to it. They tested me as a baby numerous times. My mother died, a doctor took out my ovaries that were normal, I had horrible abdominal pain so he thought that would fix it. I went on the hunt for medical records, all my tests, my mothers tests were missing from 3 hospitals. The files were out of order. I have a letter proving she had the AIP. I can't get into the Porphyria Clinic, I did have one elevated test I got ahold of. The doctors passed it off as "inconclusive". I have done so much research and with 3 generations of symptoms I could write a thesis on this. I'm very frustrated. My daughter just had her first unecessary surgery last month. I told the docs what to do but they didn't listen. Now she is missing her appendix and an ovary which were both normal via pathology. I'm as frustrated as I can be. I had 22 gallstones at a young age. I wish I could have got them but for some reason they told me they were going to be used for medical research....ya on our family. I was told by a nurse in genetics that the docs knew me and my daughter had AIP but the ramifications from 32 years of medical malpractice, especially from a research hospital(U of U) could result in a huge lawsuit and very bad publicity. When I do go to the ER, I tell them exactly what I need. When they deviate from what I tell them, I either get numerous allergic reactions from meds or normal organs removed. They think I'm crazy, but I can tell what is going on with my body, especially the myalgia's, urine retention, vomiting, nausea, numbness, muscle weakness, abdominal bloating, profuse constipation and diarehhia. I watch my daughter struggle the same as me and my mother. My sisters don't have hardly any symptoms, yet they have the positive tests. Last year I had an allergic reaction to steroids. I gained 27lbs of water in 3 days. The pain in my legs, feet and arms was unbelieveable. I almost drowned in my own fluid in the lungs. I can gain 20lbs in 2 days and lose 20lbs in 2 days. The thinner I get and I'm still 148lbs, the crappier I feel. I eat like a pig and I get accused of anexoria or bulimia. Just last week I gained 12lbs, then lost 9lbs in one day. If I don't keep hydrated and eat carbs then I'm very sick and usually end up at the ER. I have no organs left to remove, I need the rest to live. I'm so frustrated at the doctors with their degrees brush this huge cover up under the table. The strange thing is when I end up at the ER, they seem to call doctors from the U of U to get info or have them come there to treat me. I swear it's like a strange movie or book you couldn't believe unless you lived it. Any suggestions from another doctor would be helpful. I don't want my daughters to go through what I've been through and watched my mom go through since I was little. Connie Jorgensen connierae@q.com

   

• At Wed Mar 26, 03:02:00 PM 2008,  Anonymous said…

  Thanks for your quick response! Your suggestiongs were exactly what I had been thinking (and hoping for the psoriasis rather than autoimmune), and it was a relief to hear someone else say the same things and validate my concerns. Fortunately, I have now gotten an even more optomistic/harmless diagnosis of pityriasis rosea (apparently common although I have never heard of it before). Any information I have found on this indicates there is no threat to pregnancy/fetus and it definitely leaves me with lots of hope for the future!
  Thanks again

   

• At Wed Mar 26, 05:12:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Anonymous Mar 26: Thanks for letting me know! Best wishes.
  Dr T

   

• At Wed Mar 26, 06:30:00 PM 2008,  Kenneth F. Trofatter, Jr., MD, PhD said…

  To Connie Mar 22: OMG Connie, what you have been through. The hardest things for doctors to deal with are things they do not understand. I wish I could help you, but all I can do is sympathize with what you have been throgh. By the way have you ever been tested to see if you have a complement deficiency? You might ask your doctors about that - too hard to explain here. Bless you. Dr T

   

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