Betadine

Doesn't it seem like only yesterday that the "Y2K" bug was going to crash every computer? Suddenly, 2006 is on the horizon; where did those 6 years go? Here are some interesting pearls to ponder as 2005 comes to a close.

A Different Approach to an Old Method

For 2 decades, I've emphasized the importance of Kegel exercises for my patients to strengthen the pelvic floor muscles and decrease incontinence. Evan F. Evans, M.D., of Ogden, Utah, has a different twist on this old technique. To improve compliance and get better results, he tells his patients to practice this exercise during intercourse. There are ancillary benefits for both partners. Dr. Evans says he's never had a complaint, but many grateful thanks.

Prep Where It Is Needed

As a boy I once helped my father paint a wall. I still remember him telling me that I was getting paint every where except where it was needed! I thought of this as I watched a colleague use several large rectal swabs to paint Betadine all over a patient's vaginal walls before an IUD insertion, spending almost no time on the cervix. While it is unlikely that any germs are going to jump from the vaginal wall into the cervix, germs already present in the cervical canal are just waiting to be dragged up into the uterus.

Several years ago, I heard about a severe case of pelvic inflammatory disease following a hysterosalpingogram. This is the last thing you want to happen to an infertility patient. After hearing about that disaster, I thought up the following pearl.

Before performing an endometrial biopsy, HSG, or IUD insertion, paint the vagina if you must, but don't forget to also paint the endocervical canal using a small cotton swab soaked in Betadine. In other words, be sure you're not getting the paint everywhere except where it is needed.

Exercise With an Octogenarian

Most doctors try to get their obese patients to eat less and exercise more. However, nowadays many patients complain that they don't have time because of being a caregiver to an elderly parent.

Clyde Climer, M.D., of Longwood, Fla., suggests that caregivers put an exercise bike or stair-stepper in their parent's room and exercise while visiting. If the parent is in a retirement home, there may be an exercise room. This is a better way to spend the visit than watching TV and snacking.

The 'Magic' Cream

For those patients who find vaginal examinations painful due to vaginismus or other conditions. Vaseem Ali, M.D., of Houston, applies 1% Xylocaine gel to the introitus 5 minutes before the exam. Dr. Ali says that some patients remind her to use the gel at subsequent visits, and one calls it the "magic" cream.

Protect Your Eyes

In addition to a wood spatula, most of us also use a cytobrush to obtain an endo-cervical speciment for a Pap smear. About a year ago, I noticed a fine spray of cervical mucus or gunk eject from the bristles of a cytobrush as I rubbed it across the glass slide. Perhaps I saw this mist because of the ambient lighting or perhaps because my nurse was kindly holding the slide only inches from my eyes. In any case, I learned that it may be wise to hold the cytobrush at arm's length or to wear glasses when using a cytobrush.

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

Send Us Your Clinical Pearls!

Please include your name, affiliation, and phone and fax numbers. Mail to:

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.

BY BRUCE L. FLAMM, M.D.

COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2006 Gale Group