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Can Negligence Of Care Be Determined Online Based On Medical Reports?

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Posted on Mon, 16 Oct 2017
Question: I had a surgery that went all wrong back in February of 2016, and I need an OBGYN surgeon familiar with myomectomy, laproscopic surgery to look at my medical records and determine if there was a deviation in the proper standard of care, and be willing to write something for me to the effect if they do find there was negligence in my care. You would not be required to make any court appearance or give testimony on your findings.
doctor
Answered by Dr. Purushottam Neurgaonkar (48 minutes later)
Brief Answer:
Don't panic. Please give some more inputs.

Detailed Answer:
Hi there, Dr. Purushottam Neurgankar here.
I have understood your concern and I will suggest you the best possible treatment options.

First of all do not panic.

I would like to know about few things related to your previous surgery.

What were the problem you were facing before surgery?
What was the surgical procedure like?
And what was your concern regarding the surgery?

This input will help to help you out in a better way.

I hope this answer helps you.
Please feel free to communicate.

Dr. Purushottam Neurgankar.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Purushottam Neurgaonkar (17 hours later)
Hi Dr. XXXXXXX

I'm hoping you will take the time to read the series of other questions I have posted on here since May of 2016, including a question that was answered by you back in May of 2016.

Before my surgery I was having heavy periods lasting two weeks, and sometimes I would go almost three months without having a period, so perhaps I was experiencing peri-menopase and did not know it. Regardsless, I thought it was due to two fibriods I had that were previously embolized by a UAE procedure done in December of 2011, I think. The UAE stopped my heavy bleeding for several years before it started again in 2015, so I though the UAE had failed and decided to have a myomectomy. My OBGYN surgeon did not do an MRI or any advanced imagining before the surgery other than a basic ultrasound, so she thought I just had two fibriods inside my uterus and removed them. However after the surgery, my bleeding became worse. A saline ultrasound and MRI revealed that my uterus had enlarged and there was a fibriod in the wall of the uterus that the doctor failed to diagnose and remove at the time of the myomectomy. It also took her 7 hours to complete the myomectomy!! Then it was discovered by MRI that I develpoed adenomyosis because of the trauma by the myomectomy. After this I was given depo provera, which made my problems even worse. The fibriods grew larger to about 10cm. I recieved the one and only shot of depo in May of 2016. I still have not had a period almost 17 months later.

So here are my questions:

Could I be in menopause caused by the stress of the surgery? Could the adenomyosis be stopping my periods or could the depo still be causing me to not have my periods?

Is there anyway to deal with this adenomyosis and fibriod other than having a hysterectomy. No doctor in my town want to do a myomectomy, nor do they know how to deal with adenomyosis outside of a hysterectomy. Can bladderwrack help? I've heard bladderwrack has made a significant difference in women with endometrosis.

Can adenomyosis spread outside the uterus, there are many conflicting reports about this and I don't think there is any clear consensuses. I've heard women say that their adenomyosis has spread to their bowls, bladder and other organs, Is this possible?

I don't want to take birth-control if I have heavy bleeding because I developed venous insufficiency in my legs either due to the shot of depo, injury from the pelvic surgery or from the uterus becoming enlarged or all of the above. My case is a case of a myomectomy gone all wrong, and I'm suffering the devastating consequenses of a doctor not being careful and skillful enough in what she was doing. It's very sad that this happens to too many women.

doctor
Answered by Dr. Purushottam Neurgaonkar (25 hours later)
Brief Answer:
FSH and LH, Newer medicines.

Detailed Answer:
Hi there, It took me some more time to reply back. I went through your query and previous questions.

First of all let's be practical.
We can't change whatever has happened in the past. This is for certain.Lets not enter into blame game.

Let's try to find out what we can do in future.
As per your history, you are not having your periods over last one and half years.
You can get blood FSH and LH levels done, to know about ovarian status before labelling it as menopause.
if your hormone levels are suggesting of menopausal range, you need not worry. Eventually fibroids and adenomyosis will stop growing.

Secondly, there are newer medicines available for the treatment of fibroids and adenomyosis.
You can seek prescription support from your preferred gynecologist for getting them. These drugs are Misoprostol and Ulipristal. They are supposed to be helpful when taken under medical supervision over specific period of time.

Fibroids and adenomyosis are two different pathological conditions. They can be present simultaneously but are not arising from each other.
You can follow up with USG every six months to know about the size of uterus and fibroid.

I hope this answer helps you.
please feel free to communicate.
Thanks.
Dr. Purushottam Neurgaonkar


Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Purushottam Neurgaonkar (2 hours later)
What do you mean by lets not enter into the blame game? I have the right to feel exactly the way I do about what happened. It wasn't you who experienced this, so you don't know how if feels. These were my hormone levels recently tested. Is this pre-menopause or menopausal?

Progesterone .5 ng/ml
Estrodiol 86 pg/ml
FSH 15.1 mIU/mL
Testosterone 0.26 ng/dL

Will you please also answer the question I asked about adenomyosis spreading to other parts of the body outside of uterus?

Last, if I am menopausal isn't this a bog problem because I am only 40.

Thank you for your answers
doctor
Answered by Dr. Purushottam Neurgaonkar (1 hour later)
Brief Answer:
Adenomyosis and endometriosis are different conditions.

Detailed Answer:
Hi there,
I can understand the pain and suffering that you have gone through. But still the fact is that we can not change the past.
Let's try to find out various solution options.

If FSH and LH levels are above 15 it indicates menopausal changes. This can happen anywhere between age of 40 to 55 years.
It depends on natural ovarian reserve.

Secondly, adenomyosis is a local condition limited to uterus. In my opinion what you are describing as spread of the condition to other organs , is a condition called as endometriosis.
But fortunately, even this condition can be treated with medicines.

One needs to diagnose and confirm about menopause, fibroids, adenomyosis, endometriosis,and then only further treatment options can be considered.

I hope this answer helps you.
Thanks.
Dr. Purushottam Neurgaonkar
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Purushottam Neurgaonkar (11 hours later)
Could depo provera be causing these FSH levels to be around 15 even 16, 17 months after last taking it? I've only taken one shot.

As far as I know I don't have endometriosis. I just wanted to know if adeno became endo, or if adeno can spread to Fallopian tubes, bladder etc. There are conflicting journals and articles on this subject, and I don't think either disease if fully understood.
doctor
Answered by Dr. Purushottam Neurgaonkar (11 hours later)
Brief Answer:
Depo has no effect on FSH, adenomyosis does not spread

Detailed Answer:
Hi there,

I have gone through your query.

Depo provera, is nothing but injection of medroxy progesterone. It is supposed to work for 3 months.only. Very rarely, it's effect of stopping the menses lasts for 6 to 8 months. And we must understand that it will not have any effect on increasing the FSH levels. FSH is a hormone secreted by pituitary gland in the brain in proportion to ovarian response or reserve. More the ovarian reserve, lesser is the value of FSH,and vise Versa.

Secondly, adenomyosis is restricted to uterus inky. it does not spread to near by organs like endometriosis.If you are not having endometriosis, you need not worry about the spread.

I hope this answer helps you.
Thanks.
Dr. Purushottam Neurgaonkar.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Purushottam Neurgaonkar (21 hours later)
Thank you for your answer. My last question to you is, what could be causing me not not have a period since I have taken the depo in May of 2016? It's been 16 months with no period. I have heard depo can keep you from having period for up to 18 months, is this a possibility. If not, is it possible that adenomyosis could be stopping my period, or the last thing it could be would be that I am having an early menopause but my hormonal levels as I shared with you above seem to be in range.
doctor
Answered by Dr. Purushottam Neurgaonkar (2 hours later)
Brief Answer:
Depo can cause no periods. Menopause can be early.

Detailed Answer:
Hi there,

It's my personal duty to answer your questions and help you out.

You are right in judging the response of depo provera injection. It can cause absence of periods, sometimes upto 18 months.

Secondly, FSH levels at and above 15 indicate that ovaries are about to finish their egg release capacity. But, menopause should be labelled only if absence of periods and other clinical symptoms co exist. Symptoms like hot flashes, palpitations, night sweats etc should be considered before labelling the condition of menopause.

Sometimes, a woman can get menopause early ,even at 35 years of age.

Secondly, adenomyosis will not be leading to absence of periods,for sure. In fact, menopause might help to improve or treat the adenomyosis on its own.


Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Purushottam Neurgaonkar

OBGYN

Practicing since :1992

Answered : 2234 Questions

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Can Negligence Of Care Be Determined Online Based On Medical Reports?

Brief Answer: Don't panic. Please give some more inputs. Detailed Answer: Hi there, Dr. Purushottam Neurgankar here. I have understood your concern and I will suggest you the best possible treatment options. First of all do not panic. I would like to know about few things related to your previous surgery. What were the problem you were facing before surgery? What was the surgical procedure like? And what was your concern regarding the surgery? This input will help to help you out in a better way. I hope this answer helps you. Please feel free to communicate. Dr. Purushottam Neurgankar.