How it went with Dr. at Arizona Vulva Clinic

[Guest guest]

Hello all,

Although very nervous about doing so, I went outside my HMO for the

first time and traveled to Arizona to see Dr. on June 5. I am

so glad I did!

Briefly, I wanted to make sure he wasn't a quack--he has tons of

qualifications all over his walls; his office is very clean and staff

is professional--and nice.

Here's how it went:

1. He talked to me first in his office, took my history and all that

before examining me.

2. He has two women in the room at the time of the exam, a nurse and

a nurse practioner. (and the pads are in place on the stirrups--)

3. He did a colposcopy, a wet swab, a vaginal culture, and then

swabbed the area with gentian violet. I had very little discomfort.

He explained what he was doing during the exam.

4. After I was dressed, he took my husband and he into the lab, where

he examined the culture--and had a colleague check it also (which

also impressed me).

Prior to this visit, I have received two diagnoses:

lichen sclerosis with hpv changes

and by an gyn/oncologist VIN-1 and vulvar vestibulitis

Dr. ' diagnosis for now:

two strains of yeast--and a condition called " spongiotic dermatitis, "

which he says, and I quote, " looks like VIN-1, " and is often mistaken

for it. As for the vv, we'll have to see if that clears up.

Here's what I am doing as he prescribed:

a. Aveeno Oatmeal Baths 1 pack in 3/4 inches water, twice daily.

b. Use Aquaphor as needed after baths.

c. Take Diflucan, 1 today, 1 tomorrow and then 1 pill three times a

week for 1 month

d. Climara Patch--ESTRACE, not premarin. 1 patch a week for four

weeks.

I'll see him again July 9. He's kindly, about late 50's or early

60's, smiles and has a good (not forced) sense of humor.

I'll be glad to answer any questions. Got an email outside the post

in which another of us is going to him and got the HMO to pay for it.

It's $250 for the new patient fee, and my visit was $220.

I'm fortunate to have the time and be able to travel. After the

second visit in July, I will see if he can work with my family doctor.

we'll see. As you can imagine, I can't tell you whether I'll be

better or whether you would benefit from seeing him. But I sure hope

he'll help me. And he did SAVE ME FROM A VESTIBULECTOMY or surgery

to remove the VIN-1 by diagnosing me correctly.

healing thoughts for us all,

Dory

[Guest guest]

After I read your post, I was extremely curious about what spongiotic

dermatitis was, so I looked it up. (My method of research for

health issues is to go to refdesk.com and look in the Merck manual

and the online medical dictionary. Then I go to Lexis-Nexis and see

what articles have been written on the topic.)

I thought you all might be interested in what I discovered (and my

thoughts on it below):

Merck Manual:

Dermatitis (eczema): Superficial skin inflammation,

characterized histologically by epidermal edema and

clinically by vesicles (when acute), poorly

marginated redness, edema, oozing, crusting,

scaling, usually pruritus, and lichenification caused

by scratching or rubbing.

Authorities generally disagree about how to use the

synonymous terms eczema and dermatitis. Often,

eczema refers to vesicular dermatitis, but some

authorities restrict eczema to mean chronic dermatitis.

Some also refer to dermatitis as spongiotic dermatitis

because spongiosis (intraepidermal edema) is a

histologic feature.

Medical Dictionary:

vesicular

1. Composed of or relating to small, saclike bodies.

2. Pertaining to or made up of vesicles on the skin.

Origin: L. Vesicula = a little bladder

vesicle

<pathology> A closed membrane shell, derived from membranes either by

a physiological process (budding) or mechanically by sonication.

Vesicles of dimensions in excess of 50nm are believed to be important

in intracellular transport processes.

Edema:

<clinical sign> The presence of abnormally large amounts of fluid in

the intercellular tissue spaces of the body, usually applied to

demonstrable

accumulation of excessive fluid in the subcutaneous tissues.

Oedema may be localised, due to venous or lymphatic obstruction or to

increased vascular permeability or it may be systemic due to heart

failure or renal disease.

Collections of oedema fluid are designated according to the site, for

example ascites (peritoneal cavity), hydrothorax (pleural cavity) and

hydropericardium (pericardial sac).

lichenification

<dermatology> Hypertrophy of the epidermis, resulting in thickening

of the skin with exaggeration of the normal skin markings, giving the

skin

a leathery barklike appearance, which is caused by prolonged rubbing

or scratching. It may arise on seemingly normal skin or it may

develop at

the site of another pruritic cutaneous disorder.

(18 Nov 1997)

spongy

1. Soft, and full of cavities; of an open, loose, pliable texture;

as, a spongy excrescence; spongy earth; spongy cake; spongy bones.

2. Wet; drenched; soaked and soft, like sponge; rainy. " Spongy

April. "

3. Having the quality of imbibing fluids, like a sponge.

<chemistry> Spongy lead, sponge lead. See Sponge. Spongy platinum.

See Platinum.

From Lexis-Nexis, Dermatology Nursing June 1, 1999:

3. Eczema (Spongiotic Dermatitis). " Eczema " (Gk ekzem = to erupt; ex

= out + zein = to boil) is a " bubbly "

dermatologic symptom, which can be seen in many dermatologic

conditions. Histologically, it is described as

" spongiotic dermatitis, " which encompasses a spectrum of stages

including acute, subacute, and chronic. The tiny

bubbles (vesicles) can occur in clusters (plaques), or may be more

diffuse, surrounded by erythema. The vesicles may

be intact (full of serum), and/or excoriated wherein the scratched

opened vesicles exude their yellowish, sticky

contents, which congeals producing a crust. The chronic, usually

excoriated stage, presents as lichenification, which

are thickened, red, dry, scaly plaques with little to no macroscopic

spongiosis. The latter presentation has been often

labeled " neurodermatitis " erroneously inferring a psychogenic

etiology. Virtually everyone can elicit lichenification,

but atopics (especially Asiatic>>Melanotic>Caucasians) seem to be

more susceptible.

What all this says to me, and please correct me if I'm wrong, is that

spongiotic dermatitis is merely a term that describes the condition

of the skin--or a symptom, and not any underlying disease.