Regular Checkup Questions and Answers Archive
Hello, I had LASIK performed on my right eye in Nov. 1998, with an enhancement done in June 1999. I posted a question to this website 11/99 regarding the dry eye that followed the surgery, and was advised to try TheraTears four times a day. I tried the TheraTears (in the single use container) several times a day during the day, and found that I got more relief in the morning if I used an eye ointment (Refresh PM or Lacrilube) before bedtime. TheraTears has been highly recommended, but it has not done much to improve the condition of my cornea. At my last checkup (5/01), the cornea still picks up dye and is still missing some cells. I have found that decreasing my intake of caffeine has made a big difference in the dryness, but I still find that the eye is dry. I am also have IDDM, and have improved control of my blood sugar in the past two years. Is there anything else that I can try to combat this chronic dry eye? Since the surgery, I have had regular checkups every 6 months, and I have a punctal plug in both upper and lower lids.- Lisa
Dear Lisa, There are many treatments for dry eyes besides artificial tears and punctal occlusion. It really would not be appropriate to discuss to this in a forum such as this. You require a formal evaluation by a corneal and external disease specialist. Dr. Geoff Tabin is nearby at the Univ. of Vermont in Burlington. You may want to make an appointment to see him for a better evaluation of your specific problem. David Cano, M.D. W. Palm Beach, FL canovi
-- David B. Cano, M.D.
West Palm Beach, Florida
Q&A: Should I be concerned if a gynecologist does not conduct an internal exam until eight and a half months into the pregnancy?
I am trying to get pregnant. A few months ago I went to a gynecologist for a regular checkup. I was happy with the gynecologist and felt comfortable going through this group of 5 doctors. However, since then a lady that I work with is 9 months pregnant and going through the same group. She says that they did not do one internal exam until she was 8 and a half months pregnant. She is also high risk because she is 38 years old. Most of the time when she goes for her appointments, a doctor doesn't see her but rather a nurse practioner. Also pregnant women don't seem to get priority with appointments. I was comfortable going through them when I become pregnant but now I am not sure because of my friend's experience. How do I know if my fears are unwarranted and that this is just my friend's experience? Does it sound normal that she has had one ultrasound and didn't have a papsmear at all or any internal exams until so late in her pregnancy? Basically, how do you choose the right group of gynecologists to go through when having a baby?- Glynis
Your friend must have had a Pap smear and exam in the very early part of her pregnancy. There is not really a need for repeated internal examinations during pregnancy. One ultrasound, around 18 weeks, is the standard of care in routine prenatal care. The use of nurse practioners or other physician extenders is increasingly common. It allows the doctors to spend more time concentrating on the complicated cases. Your comfort (or lack there of) with seeing a nurse practioner for many of your visits should be addressed with the doctors. If, after discussing this with them, you are still not comfortable, switch doctors. Nurse practioners are ideally suited to be prenatal care providers and often will be able to spend more time with routine patients than the physician would. In terms of selecting a qualified obstetrician, I would make sure that he is board certified and a member of ACOG. Discuss his philosophy regarding prenatal care and delivery and make sure that you are ok with it. Speak to other women who have seen him etc.
--Daniel Potter, MD, FACOG