Leep Side Effects

Again, I'm not sure that how the money flows should influence women in seeking care, but for the record: in capitated prepaid managed care what you say is slightly true. In any other health service plan the money flows to the doc, part from the insurance company paying out a claim and part from the patient as a copay. It is really a very complicated topic in itself and is not for this forum thread. For anyone interested in learning how "managed healthcare" works, I would refer them to Peter Kongsvedt's book on Essentials of Managed Healthcare 5th Ed 2007. 

As to the questions:

1/The tests mentioned are terrible for dysplasia because none of them can see microscopic changes. 

2/We have the HPV vaccine.  If used and deployed properly (before sexual contact), we should see a dropoff in cervical cancer and dysplasia over the next 25 to 30 years. Remember it takes upwards of 10-15 years from HPV infection to cancer. Vaccine-like treatments for women already infected or between infections at a later stage in life are in the research pipeline. All of these destructive treatments will likely go away over the next 25 years.

3/Agree. Communication and true informed consent should be the goal.

4/This is probably as good a forum as possible to find the women who have had laser.  There are just not too many of them, relatively speaking. I am an oncologist who treats cancer primarily, after the dysplasia progresses. Since I truly believe that the laser is a very outdated concept for most dysplasia treatment, for all the reasons mentioned, I have not personally performed one for over 15 years. In early dysplasia, IF treatment is indicated at all, I concur that someone who does them a lot can certainly use laser as one option.

Regards

Dr V 

Pointing out the how the money flows to insurance companies is not to tell women which tool to choose. It's to help them understand why insurance companies prefer certain tools over others. Interesting book you mentioned, by the way, but I was a a little suspicious of it, after I read it.

I'm glad the vaccine currently available can treat children who are still virgins. But that doesn't help those of us who are infected with HPV. Our lives, after all, are more vulnerable. However, are you familiar with Roche's TG-4001? So far, it seems to be having success with clearing up dysplasia.

TG-4001 is still in Phase II studies I believe and it only targets
HPV16, which is responsible for up to half of all dysplasias, but not all.  

The challenge is to determine which HPV genotype is causing problems for any given patient and then targeting it (or them). Can't forget HPV18, 31 and 33 among a number of less transforming genotypes. 

It's the future, very possibly near future, but not wound too tight yet for prime time.  Lot's of excellent work being done by Roche and others.

I think we should stop this thread because it is going off topic and would be harder for anyone to find if anyone is seeking info about this vaccine related material.  Might warrant other posts and new threads though if not already addressed somewhere on this board...... 

 Dr V

I had CINII that was found endocerival.  I went to a oncologist gyno for a second opinion - the first was to have a LEEP.  She (the new doctor) said she see's 'white' up there, a cm or so that she can see.  So she recommends a laser.

 Any comments or suggestions that differ from the ones above with endocervical?  It seems more of my cervical tissue can be saved doing the laser since everything I have is in that area.  Please comment.  And I'd like to know affects of this particular treatment (she says she wants to go about 2 cm up and that my cervix measured at about 3 cm) on fertility.  I have no children but want them soon.  Oh and healing times and times recommended before trying to conceive.

 Thanks,

Keri-Dawn 

In capable hands,either tool is fine. The laser can "cone in" and eliminate or destroy tissue in a little bit more narrow way so that the fibrous part of the cervix is preserved a bit better.  Retaining the bulk of the fibrous and muscular part of the cervix (essentially the "meat or substance" of the cervix) is important for retaining babies.

However, there is a risk that you have something worse tha CINIII in the canal and you will never know unless that is removed, for the pathologist to review, rather than burned.  The only way to remove it is either by LEEP or cone biopsy.  In skilled hands , that can still be done in a way to preserve the cervical fibro-muscular part and there should be no problem with retaining pregnancies.

 As far as recovery, it should be the same but depends upon how much is removed.  Assuming the same amount of cervix is removed or destroyed, the recovery is pretty equal. 

Hope this helps

 Dr V

.

"As a footnote, while it is true each method of partial amputation runs the risk of infection, LEEP does have the highest risk."

This has got to be the most outrageous claim I have EVER read.  A LEEP is NOT a 'partial amputation' and no offense, but you have no right saying such a thing. 

 A LEEP removes cells and tissue that could turn into cancer.  An amputation implies that this is a permanent removal of an area, but you are wrong - the tissue and cells grow back.  Abnormal cells and tissue are removed so NEW/HEALTHY tissue takes its place!

 PLEASE get your facts straight before you go saying such things and frightening others.  And if you are going to make such claims then back it up by factual references.

Dr. V:

Why would a hysterectomy be recommended for CIS when a Pap post LEEP (margins not clear but ECC negative) was never even done?

Why would a hysterectomy be recommended for CIS when a Pap post LEEP (margins not clear but ECC negative) was never even done?

If this is the case with you, please get a different doctor, immediately. A lack of follow-up such as this is negligence. In addition, please look at all of your lab reports. That way you'll know exactly what has been happening, all along. In addition, make sure the new doctor fully educates you about your condition and the risks and benefits of all your treatment options. That way you'll be making a very informed decision, and that alone takes away the mystery and reduces the fear factor. It will also give you more confidence in your doctor's ability to use wise and careful judgment, which will help reduce stress.

Call your general practictioner as soon as the office opens on Monday, and get a referral. As somebody whose case was badly mishandled in a different way, I can't recommend enough how empowering it is to be proactive about your health.