Gynecology clinic

OB/GYN News, May 15, 2004 by Bruce L. Flamm

I sometimes get e-mails from doctors who submitted a pearl and are wondering what ever happened to it. The answer depends on several factors. First, if a tip has already been published in a prior Clinical Pearls column, it gets discarded. That's a no-brainer. Second, if a tip is already common knowledge or sounds dangerous, it must be discarded. Third, and this applies to most submissions, if the tip sounds interesting, it is saved for possible publication in a future column.

For example, Dr. DiLeo and Dr. Richman sent in excellent pearls more than a year ago (see below). Due to space limitations, some great pearls have to wait a while before they see the light of day. So if you sent in a wonderful pearl, keep watching the column: When the time is right, your pearl will shine bright!

The Waterpik trick.

We are all saddened when one of our cesarean or hysterectomy patients comes in with a postoperative wound seroma or infection. Healing by secondary intention may take many weeks, and most patients are understandably upset with the situation. Unfortunately, some are noncompliant with wound care.

Dr. Gerard DiLeo of Mandeville, La., has a wonderful idea that he says can cut spontaneous closure time in half. He has his patients use a Waterpik dental device for home wound care. The gentle pulsatile stream of warm water is very efficient at debridement, and Betadine (povidone-iodine) or hydrogen peroxide can be added to the water. Dr. LiLeo points out that he doesn't have stock in Teledyne, and there are several other dental irrigators that can be bought for under $30. Some ER doctors use dental irrigators for ear cleaning: If it's safe enough to use in the ear, it should be safe for wound care.

Don't groan, try a cone.

Susan Richman of Yale University in New Haven wrote in about a year ago with a trick for doing an endometrial biopsy in the morbidly obese patient in whom finding the cervix and keeping the vaginal side walls separated is impossible even with the largest speculum. She uses the cone from a scalp pH sampling kit. Dr. Gil Gross of Washington University, St. Louis, sent in the same pearl.

The problem is that these kits are very expensive and are becoming hard to find since fetal scalp pH has been replaced by scalp stimulation in many practices. Attention physician entrepreneurs: Plastic cones in various sizes could probably be produced for pennies. With obesity on the rise, there would be a great demand for this product!

Please hold your knees.

Dr. Vellore Bhupathy of Whittier, Calif., has a simple way to do an adequate pelvic examination on a patient who is new to the procedure or unable to tolerate pelvic examinations. To help the patient cooperate with your examination, after the usual and customary explanation about the procedure, advise the patient to hold her knees with her hands while in the lithotomy position. Then tell the patient it will help immensely if she can keep her thighs apart by holding her knees firmly while the pelvic being done. This gives the patient the feeling that she is in control of the examination and allows the exam to be done in some situations where it would otherwise be impossible.

BY BRUCE L. FLAMM, M.D.

DR. BRUCE L. FLAMM is area research chairman and a practicing ob.gyn. at the Kaiser Permanente Medical Center in Riverside, Calif.

Send Us Your Clinical Pearls!

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Dr. Bruce L. Flamm

10445 Victoria Ave.

Riverside, CA 92503

Or send them by fax to 909-353-5625 or by e-mail to bruceflamm@aol.com.