Miss Diagnosis: The GYN Appointment

Wednesday, December 23, 2009

The GYN Appointment

We saw the GYN yesterday. Two and a half years ago we were referred to Dr. Warner to see if he could help with her chronic daily migraine. We both really liked him, and felt like he was quite knowledgeable. He is retired from his "regular" GYN practice and now just does hormone replacement therapy using bio-identicals.

He was able to look over Alex's labs and have us tell him what was going on and conclude that she is not ovulating, and explain to us how he knows that is the problem. Like I said, he's a smart guy! She is not making progesterone, or at least not enough to cause ovulation to occur. In turn she has breakthrough bleeding and pain 10 out of every 28 days.

He is starting her on a bio-identical progesterone cream twice daily on days 10 to 24 of her cycle. On day 28 she should then have a normal period caused by progesterone withdrawal. That's what would happen naturally if her body was doing what it's supposed to.

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Transphenoidal Pituitary Surgery- From the UCSF web site

What happens during surgery?
The surgical removal of the pituitary adenoma is performed by a technique called a transsphenoidal operation. The word 'transsphenoidal' describes the path the surgeon follows to reach the pituitary gland. The word comes from 'trans', meaning 'to cross or pass through', and 'sphenoid', the name of the cavity (the sphenoid sinus) that is passed through to reach the pituitary gland. Newer techniques and improvements in technology now allow removal of these tumors without the need for an incision under the lip or within the nostril. The surgeon begins the approach by entering through the nostril on one side. The surgeon uses a brilliant fiber optic light to illuminate the internal anatomy, a microscope to magnify the area of surgery to 12 times the actual size, and very tiny microsurgical instruments especially designed for this particular operation. The surgeon guides the surgical instrument into the nasal cavity and an opening is made in the sphenoid bone. The sphenoid sinus is entered, and then an opening is made in the wall of the sella turcica to expose the pituitary gland. The adenoma can be readily distinguished from the normal pituitary gland tissue and is removed without removing the normal gland. After the surgeon removes all the tumor tissue, the small cavity that is left is treated with alcohol to destroy any tumor cells that may remain. This cavity is then sealed, sometimes with a piece of fat that the surgeon removes from the patient's abdomen. The surgeon then applies a biological 'glue' that helps seal the pituitary area from the nose and promotes natural healing. No nasal packs are used with this approach.