DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY
Worcestershire Royal Hospital, Charles Hastings Way, Worcester, WRS 1DD
Consultant: Miss D Ghosh
Secretary: Stephanie Lloyd
Direct Line: 01562 513025 :
Our Ref: DG/SJL
Typed Date: 16/12/2020
NHS No: 6106007306
Unit No: 4440496393
PRIVATE AND CONFIDENTIAL
Mrs Emma Goode
35 Archer Road
Dear Emma ¥
Re: Emma Goode DOB: 21/02/1990
35 Archer Road Redditch Worcs Worcestershire B98 8DN
Thank you for speaking with me via telephone today. | was passed your concerns, along with your partner, Stuart's concerns that you relayed to us via an email on 23" November. Prior to this consultation | reviewed your medical records, along with any previous correspondence that you have sent to us. | also reviewed Mr Rai’s correspondence to yourself and any histology results.
We started off by discussing your symptoms. | understand that you suffer from mainly right-sided pelvic pain, which is fairly constant, but worsens on occasions. There is no particular reason which causes this pain to worsen. You do not bleed irregularly, but you have a period every 3 months, as you are taking the combined contraceptive pill in a tri-cyclical manner. You do not have any particular pain when you have a period. You have told me today that you are slightly constipated and your bowels tend to open every 2 to 3 days. At this time you pass firm stools which are cracked in appearance and you also explained that at times around your period you can go for longer periods of # time without opening your bowels. | understand that you have tried Naproxen following the advice of your endometriosis nurse specialist, which was given to you back in July; however this caused you to have mouth ulcers and sickness. You are not taking any regular laxatives. | am very sorry to hear that you have fairly recently lost your job as a sales assistant due to the amountof time you have had to take off work as a result of the pain that you are experiencing.
We also discussed your clinical care with regards to your symptoms up to this point. | understand that you were listed for surgery by Mr Rai following a consultation back in June and this surgery was » expedited due to your symptoms being so severe. A diagnostic laparoscopy was undertaken on 15! September 2020 by Mr Rai and | have further explained the laparoscopic findings according to the operation notes by Mr Rai. There were good views obtained of the pelvis. There were no obvious adhesions (scar tissue from previous surgery). The right fallopian tube was absent (removed due to an ectopic pregnancy). Both ovaries appeared healthy and normal. There was a white area within the pelvic close to your bowel and a similar lesion on the left side of the pelvis. Both of these areas were biopsied at the time. Following surgery Mr Rai explained to you that there was no obvious cause found at the time for your right-sided pain. He also explained that these biopsies would be sent to confirm whether there was any endometriosis present. | explained to you today that until we have results of the histology it is not always easy to diagnose endometriosis. This histology did confirm the presence of endometriosis and this was communicated to you via a letter from Mr Rai. | apologised that there may have been a delay in your receipt of this letter; however as Mr Rai explained due to personal circumstances he was off work temporarily around this time. In this letter from Mr Rai on 7" October he informed you of the diagnosis and also that you would be referred to the pelvic pain/endometriosis team. This referral letter was done; however on looking at the letterit is unclear whether this was sent to the endometriosis team by the secretaries. Again, | can only ' apologise, as internal referrals from other consultants requesting further management of patients with symptoms in their specialist area would usually be dealt with quite promptly and if myself or my endometriosis colleagues had received the letter, based on your high level of symptoms, we would have prioritised you being seen in our clinic.
This consultation was done to hopefully try to address some of the concerns you highlighted in your emails/letters, but also to discuss potential management of your condition. You have specifically told me that you have requested a hysterectomy in the past, as you believe this may help control your symptoms. | explained to you today that making that decision is not always straight forward. Endometriosis can be found within the uterus (this is called adenomyosis); however endometriosis outside the uterus would not be treated effectively by performing a hysterectomy. Although | have reviewed the images and operation notes from Mr Rai,it is very difficult to comment on whether there is any other cause for your pelvic pain. | explained to you today that it may be that we decide on discussion with you that a further laparoscopy under the endometriosis team is warranted +/- any excision of visible endometriosis, should it be seen. Alongside this a Mirena is often helpful as a medical way to control your symptoms longer term. This is also effective in treating adenomyosis and " potentially this avoids the risks of a hysterectomy. The other option that | have discussed with you today is whether we proceed with an injection, which is used to switch off your ovaries. This is often used as a trial to see whether your pain is coming from a gynaecological cause.
If there is a significant improvement in your symptoms with this injection, it may be that a hysterectomy would be the right option for you. Both of these options | can discuss with you when | see you in a face to face clinic, which | will arrange as soon as possible. In the meantime | have suggested that our endometriosis nurse, Corrine Shore, makes contact with you again to discuss your analgesic options, as well as trying to reduce your Tramadol, as this may be contributing to some of your pain through constipation. | will write a treatment advice note to your GP, as | think the progesterone only pill may work better than the combined pill to control your symptoms. | will also recommend they prescribe you some Lactulose.
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