Re: catamenial pneumothorax (More help please!)

[Guest guest]

Dr. Hogan and others:

This is a response from Kathleen Raviele, MD, FACOG (Ob/Gyn):

This is a condition related to endometriosis of the pleura and is very rare. OCs would not be a treatment for it, but DepoLupron for six months would be or even a complete hysterectomy,

including ovaries, with no hormone replacement for 6-12 months to allow the implants to wither. Basically the woman, who is perimenopausal anyway, has to be put into menopause at least temporarily.

This just goes to show that the birth control pill has taken away critical thinking from physicians in my field who can't seem to come up with anything else to treat a woman's problems other than birth control pills!

God bless,

Kathy

From: nfpprofessionals [mailto:nfpprofessionals ]

On Behalf Of Amy Hogan

Sent: Monday, February 21, 2011 6:08 AM

To: nfpprofessionals

Subject: Re: catamenial pneumothorax (More help please!)

Dr. and Dr. Pedulla and ALL,

I agree it is likely an endometriosis implant that is outside of the pelvis.... probably in the pleural space. She denies ANY other symptoms (no pelvic pain throughout her female years of menstruation). She typically feels quite well. And now she has run

into this very serious complication at menses.

Do you know any surgeons that would be willing to look throroscopically to go into the pleural space to explore for implants?... Seems full of risk. Certainly a laparoscopic look in the pelvis seems warranted, but for what reason other than to look for endometriosis

and help diagnose it? Could ridding her of pelvic endometriosis help calm the rest of the body's response? Could the endometriosis be under the diaphragm and have invaded that way?

Dr. if I put her on Depot Lupron would I not essentially hide the endocrinopathy? How could I then find it? I am used to having women chart to be able to uncover the endocrinopathy. We did discuss Lupron at her first visit to my office last week.

I find that many women feel awful on it though. She has had regular periods until being put on the pill, which then has caused spotting and irregular bleeding for her.

Please let me know what you think would be a good next step? Right now the lovely woman wants off the pill and is considering going all natural. I am thinking about progesterone support and naltrexone.

Sincerely in Hope,

Amy Hogan, MD

PS More prayers also please.

I suspect Dr. Pedulla is correct. Extra-pelvic endometriosis is well-documented. Rather than an invasive procedure which cannot eliminate

microscopic implants or prevent recurrence, I would suggest Depot Lupron for 6-9 months while the endocrinopathy which underlies chronic anovulation is investigated and treated. As the luteal phase depends totally on the follicular phase, correcting the endocrinopathy

will restore a normal luteal phase progesterone while eliminating the chronic proliferation of endometrial implants.

W. , M.D., FACOG

Billings Center For Fertility and Reproductive Medicine

catamenial pneumothorax

Dear Doctors and practitioners,

I have a lovely new 45 year old female patient who has experienced catamenial pneumothorax 4 times!!! The first time 2007, they did not know what caused the problem, but when it reoccurred about the 3rd day of her period the second time in 2009 the correlation

was made. Her pulmonologist sent her to an OB-Gyn who of course wanted to put on OCP's continuously. She has tired at least 3 types (including Seasonique) but has had 2 more episodes along with breakthrough bleeding/spotting. Most recently she was seen

by the cardiothoracic surgeon who did pleurodisis on her after her most recent large pneumothorax episode requiring chest tube and hospitalization.

I contacted Dr. Hilger's office, but he says he has not had experience with it. He suggested making sure to balance her hormones and suspected, as I did, that her perimenopausal time may need progesterone support in luteal phase. Does anyone else have experience

with this rare condition? I suppose I may need to consider writing a case study report if I learn anything new with this lovely (relatively YOUNG) woman.

Blessings in Christ,

Amy Hogan, MD

PS At the very least, pray for wisdom and light for me and for those who care for this woman, for a future and a hope.

[Guest guest]

I, too, agree with Dr. Raviele and the pt needs to be put on Lupron for 6-9 months in the hopes that the implants will regress and spare her major thoracoscopy surgery which may not resolve the issue anyhow. She needs to be amenorrheic, if not permanently, temporarily.

Les Ruppersberger D.O. FACOOG

catamenial pneumothorax

Dear Doctors and practitioners,I have a lovely new 45 year old female patient who has experienced catamenial pneumothorax 4 times!!! The first time 2007, they did not know what caused the problem, but when it reoccurred about the 3rd day of her period the second time in 2009 the correlation was made. Her pulmonologist sent her to an OB-Gyn who of course wanted to put on OCP's continuously. She has tired at least 3 types (including Seasonique) but has had 2 more episodes along with breakthrough bleeding/spotting. Most recently she was seen by the cardiothoracic surgeon who did pleurodisis on her after her most recent large pneumothorax episode requiring chest tube and hospitalization.I contacted Dr. Hilger's office, but he says he has not had experience with it. He suggested making sure to balance her hormones and suspected, as I did, that her perimenopausal time may need progesterone support in luteal phase. Does anyone else have experience with this rare condition? I suppose I may need to consider writing a case study report if I learn anything new with this lovely (relatively YOUNG) woman.Blessings in Christ,Amy Hogan, MDPS At the very least, pray for wisdom and light for me and for those who care for this woman, for a future and a hope.

[Guest guest]

Dear all,

I totally agree with the Lupron approach but should caution about the potential to accelerate osteoporosis if given by itself. We have followed many patients throughout the years and it seems they are better served if they take Norethindrone 5mg. daily while on the Lupron. Also, don't neglect the Caltrate and Vitamin D supplements.

Respectfully,

Gerry Sotomayor, MD

Atlanta, GA

Dr. Hogan and others:

This is a response from Kathleen Raviele, MD, FACOG (Ob/Gyn):

This is a condition related to endometriosis of the pleura and is very rare. OCs would not be a treatment for it, but DepoLupron for six months would be or even a complete hysterectomy, including ovaries, with no hormone replacement for 6-12 months to allow the implants to wither. Basically the woman, who is perimenopausal anyway, has to be put into menopause at least temporarily.This just goes to show that the birth control pill has taken away critical thinking from physicians in my field who can't seem to come up with anything else to treat a woman's problems other than birth control pills!God bless,Kathy

From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of Amy HoganSent: Monday, February 21, 2011 6:08 AMTo: nfpprofessionals Subject: Re: catamenial pneumothorax (More help please!)

Dr. and Dr. Pedulla and ALL,I agree it is likely an endometriosis implant that is outside of the pelvis.... probably in the pleural space. She denies ANY other symptoms (no pelvic pain throughout her female years of menstruation). She typically feels quite well. And now she has run into this very serious complication at menses.Do you know any surgeons that would be willing to look throroscopically to go into the pleural space to explore for implants?... Seems full of risk. Certainly a laparoscopic look in the pelvis seems warranted, but for what reason other than to look for endometriosis and help diagnose it? Could ridding her of pelvic endometriosis help calm the rest of the body's response? Could the endometriosis be under the diaphragm and have invaded that way?Dr. if I put her on Depot Lupron would I not essentially hide the endocrinopathy? How could I then find it? I am used to having women chart to be able to uncover the endocrinopathy. We did discuss Lupron at her first visit to my office last week. I find that many women feel awful on it though. She has had regular periods until being put on the pill, which then has caused spotting and irregular bleeding for her.Please let me know what you think would be a good next step? Right now the lovely woman wants off the pill and is considering going all natural. I am thinking about progesterone support and naltrexone.Sincerely in Hope,Amy Hogan, MDPS More prayers also please.

I suspect Dr. Pedulla is correct. Extra-pelvic endometriosis is well-documented. Rather than an invasive procedure which cannot eliminate microscopic implants or prevent recurrence, I would suggest Depot Lupron for 6-9 months while the endocrinopathy which underlies chronic anovulation is investigated and treated. As the luteal phase depends totally on the follicular phase, correcting the endocrinopathy will restore a normal luteal phase progesterone while eliminating the chronic proliferation of endometrial implants. W. , M.D., FACOGBillings Center For Fertility and Reproductive Medicine

catamenial pneumothorax

Dear Doctors and practitioners,I have a lovely new 45 year old female patient who has experienced catamenial pneumothorax 4 times!!! The first time 2007, they did not know what caused the problem, but when it reoccurred about the 3rd day of her period the second time in 2009 the correlation was made. Her pulmonologist sent her to an OB-Gyn who of course wanted to put on OCP's continuously. She has tired at least 3 types (including Seasonique) but has had 2 more episodes along with breakthrough bleeding/spotting. Most recently she was seen by the cardiothoracic surgeon who did pleurodisis on her after her most recent large pneumothorax episode requiring chest tube and hospitalization.I contacted Dr. Hilger's office, but he says he has not had experience with it. He suggested making sure to balance her hormones and suspected, as I did, that her perimenopausal time may need progesterone support in luteal phase. Does anyone else have experience with this rare condition? I suppose I may need to consider writing a case study report if I learn anything new with this lovely (relatively YOUNG) woman.Blessings in Christ,Amy Hogan, MDPS At the very least, pray for wisdom and light for me and for those who care for this woman, for a future and a hope.

[Guest guest]

Agree with calcium and vit d; bone loss onShort term therapy is minimal and reversibleWould have some concern about blood clotsWith norithindrone in someone with a PnemoSent from my iPhone

Dear all,

I totally agree with the Lupron approach but should caution about the potential to accelerate osteoporosis if given by itself. We have followed many patients throughout the years and it seems they are better served if they take Norethindrone 5mg. daily while on the Lupron. Also, don't neglect the Caltrate and Vitamin D supplements.

Respectfully,

Gerry Sotomayor, MD

Atlanta, GA

Dr. Hogan and others:

This is a response from Kathleen Raviele, MD, FACOG (Ob/Gyn):

This is a condition related to endometriosis of the pleura and is very rare. OCs would not be a treatment for it, but DepoLupron for six months would be or even a complete hysterectomy, including ovaries, with no hormone replacement for 6-12 months to allow the implants to wither. Basically the woman, who is perimenopausal anyway, has to be put into menopause at least temporarily.This just goes to show that the birth control pill has taken away critical thinking from physicians in my field who can't seem to come up with anything else to treat a woman's problems other than birth control pills!God bless,Kathy

From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of Amy HoganSent: Monday, February 21, 2011 6:08 AMTo: nfpprofessionals Subject: Re: catamenial pneumothorax (More help please!)

Dr. and Dr. Pedulla and ALL,I agree it is likely an endometriosis implant that is outside of the pelvis.... probably in the pleural space. She denies ANY other symptoms (no pelvic pain throughout her female years of menstruation). She typically feels quite well. And now she has run into this very serious complication at menses.Do you know any surgeons that would be willing to look throroscopically to go into the pleural space to explore for implants?... Seems full of risk. Certainly a laparoscopic look in the pelvis seems warranted, but for what reason other than to look for endometriosis and help diagnose it? Could ridding her of pelvic endometriosis help calm the rest of the body's response? Could the endometriosis be under the diaphragm and have invaded that way?Dr. if I put her on Depot Lupron would I not essentially hide the endocrinopathy? How could I then find it? I am used to having women chart to be able to uncover the endocrinopathy. We did discuss Lupron at her first visit to my office last week. I find that many women feel awful on it though. She has had regular periods until being put on the pill, which then has caused spotting and irregular bleeding for her.Please let me know what you think would be a good next step? Right now the lovely woman wants off the pill and is considering going all natural. I am thinking about progesterone support and naltrexone.Sincerely in Hope,Amy Hogan, MDPS More prayers also please.

I suspect Dr. Pedulla is correct. Extra-pelvic endometriosis is well-documented. Rather than an invasive procedure which cannot eliminate microscopic implants or prevent recurrence, I would suggest Depot Lupron for 6-9 months while the endocrinopathy which underlies chronic anovulation is investigated and treated. As the luteal phase depends totally on the follicular phase, correcting the endocrinopathy will restore a normal luteal phase progesterone while eliminating the chronic proliferation of endometrial implants. W. , M.D., FACOGBillings Center For Fertility and Reproductive Medicine

catamenial pneumothorax

Dear Doctors and practitioners,I have a lovely new 45 year old female patient who has experienced catamenial pneumothorax 4 times!!! The first time 2007, they did not know what caused the problem, but when it reoccurred about the 3rd day of her period the second time in 2009 the correlation was made. Her pulmonologist sent her to an OB-Gyn who of course wanted to put on OCP's continuously. She has tired at least 3 types (including Seasonique) but has had 2 more episodes along with breakthrough bleeding/spotting. Most recently she was seen by the cardiothoracic surgeon who did pleurodisis on her after her most recent large pneumothorax episode requiring chest tube and hospitalization.I contacted Dr. Hilger's office, but he says he has not had experience with it. He suggested making sure to balance her hormones and suspected, as I did, that her perimenopausal time may need progesterone support in luteal phase. Does anyone else have experience with this rare condition? I suppose I may need to consider writing a case study report if I learn anything new with this lovely (relatively YOUNG) woman.Blessings in Christ,Amy Hogan, MDPS At the very least, pray for wisdom and light for me and for those who care for this woman, for a future and a hope.

[Guest guest]

Dear Amazing group and professional team,Thank you all for your time and consideration of this very lovely and concerned patient.I will present more options to her and hopefully come up with the best solution through discernment and prayers.  When they did the pleurodesis it turns out they took out a " bleb " they found on her lung (apparently enough cause for concern to the surgeon to remove it).  I am planning to call the pathologist today to see if any of the slides could have represented endometriosis tissue.

I never use synthetic hormone therapy, so if she is on Lupron I would be uncomfortable using norethindrone.  Could we use 6-9 months of progesterone instead?  She would essentially be stuck in 6-9 months of " pregnancy " like state.... rather than a full menopausal state if I went that route.  Could such a woman go on BHRT while on Lupron?

Thank you for your time and consideration.Sincerely for Life and Health,Amy Hogan, MD

 

Agree with calcium and vit d; bone loss onShort term therapy is minimal and reversibleWould have some concern about blood clotsWith norithindrone in someone with a 

PnemoSent from my iPhone

 

Dear all,

 

I totally agree with the Lupron approach but should caution about the potential to accelerate osteoporosis if given by itself.  We have followed many patients throughout the years and it seems they are better served if they take Norethindrone 5mg. daily while on the Lupron.  Also, don't neglect the Caltrate and Vitamin D supplements.

 

Respectfully,

 

Gerry Sotomayor, MD

Atlanta, GA

 

 

Dr. Hogan and others:

This is a response from Kathleen Raviele, MD, FACOG (Ob/Gyn):

This is a condition related to endometriosis of the pleura and is very rare. OCs would not be a treatment for it, but DepoLupron for six months would be or even a complete hysterectomy, including ovaries, with no hormone replacement for 6-12 months to allow the implants to wither. Basically the woman, who is perimenopausal anyway, has to be put into menopause at least temporarily.This just goes to show that the birth control pill has taken away critical thinking from physicians in my field who can't seem to come up with anything else to treat a woman's problems other than birth control pills!God bless,Kathy

From: nfpprofessionals [mailto:nfpprofessionals ] On Behalf Of Amy HoganSent: Monday, February 21, 2011 6:08 AMTo: nfpprofessionals Subject: Re: catamenial pneumothorax (More help please!)

Dr. and Dr. Pedulla and ALL,I agree it is likely an endometriosis implant that is outside of the pelvis.... probably in the pleural space.  She denies ANY other symptoms (no pelvic pain throughout her female years of menstruation).  She typically feels quite well.  And now she has run into this very serious complication at menses.Do you know any surgeons that would be willing to look throroscopically to go into the pleural space to explore for implants?... Seems full of risk.  Certainly a laparoscopic look in the pelvis seems warranted, but for what reason other than to look for endometriosis and help diagnose it?  Could ridding her of pelvic endometriosis help calm the rest of the body's response?  Could the endometriosis be under the diaphragm and have invaded that way?Dr. if I put her on Depot Lupron would I not essentially hide the endocrinopathy?  How could I then find it?  I am used to having women chart to be able to uncover the endocrinopathy.  We did discuss Lupron at her first visit to my office last week.  I find that many women feel awful on it though.  She has had regular periods until being put on the pill, which then has caused spotting and irregular bleeding for her.Please let me know what you think would be a good next step?  Right now the lovely woman wants off the pill and is considering going all natural.  I am thinking about progesterone support and naltrexone.Sincerely in Hope,Amy Hogan, MDPS  More prayers also please.

 

I suspect Dr. Pedulla is correct. Extra-pelvic endometriosis is well-documented. Rather than an invasive procedure which cannot eliminate microscopic implants or prevent recurrence, I would suggest Depot Lupron for 6-9 months while the endocrinopathy which underlies chronic anovulation is investigated and treated. As the luteal phase depends totally on the follicular phase, correcting the endocrinopathy will restore a normal luteal phase progesterone while eliminating the chronic proliferation of endometrial implants. W. , M.D., FACOGBillings Center For Fertility and Reproductive Medicine

catamenial pneumothorax

 

Dear Doctors and practitioners,I have a lovely new 45 year old female patient who has experienced catamenial pneumothorax 4 times!!!  The first time 2007, they did not know what caused the problem, but when it reoccurred about the 3rd day of her period the second time in 2009 the correlation was made.  Her pulmonologist sent her to an OB-Gyn who of course wanted to put on OCP's continuously.  She has tired at least 3 types (including Seasonique) but has had 2 more episodes along with breakthrough bleeding/spotting.  Most recently she was seen by the cardiothoracic surgeon who did pleurodisis on her after her most recent large pneumothorax episode requiring chest tube and hospitalization.I contacted Dr. Hilger's office, but he says he has not had experience with it.  He suggested making sure to balance her hormones and suspected, as I did, that her perimenopausal time may need progesterone support in luteal phase.  Does anyone else have experience with this rare condition?  I suppose I may need to consider writing a case study report if I learn anything new with this lovely (relatively YOUNG) woman.Blessings in Christ,Amy Hogan, MDPS  At the very least, pray for wisdom and light for me and for those who care for this woman, for a future and a hope.