3 D&Cs for AUB with thickened endometrial lining on ultrasound. Unable to get biopsies in the office for any of them. BMIs of all 3 are north of 50. I'm charging the insurance companies extra for the degree of difficulty - one of them I had 4 people scrubbed in with me to hold back assorted tissue. Plus you have the whole anesthesia charges. None of my normal vaginal instruments are long enough to work, so I'm Macgyvering solutions. Retractors aren't long enough, so I'm improvising there as well. My overhead lights can not be positioned so that I can see - I'm placing the hysteroscope's light source in the vagina...worked pretty well.
Induction for chronic hypertension, which would likely go away if about 100 pounds were lost.
Long discussion with a patient emphasizing her risk of post-op complications...I'm going to try and do a laparoscopic hysterectomy on her. Talked about wound infections, conversion to open procedure, blood clots. Told her it would be difficult. Her response "Is it because I'm a big girl?" Um, your BMI is higher than my age, so yeah, you're a big girl. And yes, that makes everything far more risky and complicated.
Post-op cellulitis in a c/s from last week.
Yeast infections galore.