Optimismo ?
Paciente femenina de 34 años de edad , virgen. Al entrar al consultorio y tras verificar que era virgen le sugerimos que llenara al máximo su vejiga para realizar una sonografia trans abdominal ( a la vieja usanza ) ya que por condición de virgen no se podía usar la vía trans vaginal, en ese momento me hace la advertencia de que no desea que le diga lo que tiene ( parece muy enfática en esto ) .Tras la espera correspondiente comienzo el examen con transductor sectorial de 3.5 MHz, tras palpar una gran masa que superaba la linea del ombligo, era de consistencia pétrea. La paciente estaba muy incomoda debido a la retención de orina,así que le sugerí que orinara para sentirse confortable pues rápidamente me di cuenta que dada la gran magnitud de la tumoración y su tremenda densidad, era igual que llenara o no su vejiga. Las imágenes eran muy similares desde cualquier angulo o ventana que eligiese y su pared posterior se difuminaba debido a la enorme eco-densidad de la masa. Los ovarios no pudieron ser apreciados por la presencia de la masa uterina que los ocultaba. Tras concluir con el diagnostico de miomatosis uterina masiva, la paciente ,intentando relajar el ambiente, me dijo con una sonrisa " bueno, después que me operen tendré un hijo ". Lo cual me hizo reaccionar para evitar que algún inescrupuloso intentara un engaño con esta situación. Claramente le explique que en su caso, lo único viable era la extirpación del útero ( Histerectomia total ), lo cual hacia imposible un embarazo posterior. Rápidamente me di cuenta que ella trataba de lanzar un anzuelo con la idea ( descabellada por supuesto), de que se le diera otra opción que no fuera la inevitable extirpación de su útero y por supuesto, el entierro de la posibilidad de embarazarse. Al parecer tras unas pacientes y delicadas explicaciones, la paciente se retiró con aires de resignación.
A female patient, 34 years old, virgin. Upon entering the office and after checking that she was a virgin when we suggest you fill up her bladder for trans-abdominal sonography (the old way) and virgin condition that could not be used transvaginal route, at that time makes me the caveat that you do not want to tell you what you have (seems very emphatic on this). After waiting for the exam beginning with 3.5 MHz sector transducer, having felt a large mass that was over the line of the navel, was stony consistency. The patient was very uncomfortable due to retention of urine, so I suggested to pee to feel comfortable because I quickly realized that given the magnitude of the tumor and its tremendous density was equal or not to fill your bladder. The images were very similar from any angle or window you choose and the posterior wall is blurred due to the enormous eco-mass density. The ovaries could not be appreciated by the presence of a uterine mass that was hiding. After concluding with the diagnosis of massive uterine fibroids, the patient, trying to relax the atmosphere, said with a smile, "Well, after I have a son to operate." Which got me to react to prevent some unscrupulous attempt a trick with this situation. Clearly explain that in his case, the only viable was the removal of the uterus (total hysterectomy), which made possible a subsequent pregnancy. I quickly realized that she tried to throw a hook with the idea (crazy of course), to be given another option other than the inevitable removal of her uterus and of course, the burial of the possibility of pregnancy. Apparently, after a patient and sensitive explanations, the patient was withdrawn with an air of resignation...
Optimism?
A female patient, 34 years old, virgin. Upon entering the office and after checking that she was a virgin when we suggest you fill up her bladder for trans-abdominal sonography (the old way) and virgin condition that could not be used transvaginal route, at that time makes me the caveat that you do not want to tell you what you have (seems very emphatic on this). After waiting for the exam beginning with 3.5 MHz sector transducer, having felt a large mass that was over the line of the navel, was stony consistency. The patient was very uncomfortable due to retention of urine, so I suggested to pee to feel comfortable because I quickly realized that given the magnitude of the tumor and its tremendous density was equal or not to fill your bladder. The images were very similar from any angle or window you choose and the posterior wall is blurred due to the enormous eco-mass density. The ovaries could not be appreciated by the presence of a uterine mass that was hiding. After concluding with the diagnosis of massive uterine fibroids, the patient, trying to relax the atmosphere, said with a smile, "Well, after I have a son to operate." Which got me to react to prevent some unscrupulous attempt a trick with this situation. Clearly explain that in his case, the only viable was the removal of the uterus (total hysterectomy), which made possible a subsequent pregnancy. I quickly realized that she tried to throw a hook with the idea (crazy of course), to be given another option other than the inevitable removal of her uterus and of course, the burial of the possibility of pregnancy. Apparently, after a patient and sensitive explanations, the patient was withdrawn with an air of resignation...
