[NP-Clinical] Breast mammograms was Breast MRIs

[Lea]

	Yesterday, I saw a patient for the first time to our office. She
came in for a swollen, tender breast w/ discharge.  Lump for about 6 months
then two months of the presenting sx which were worsening.  On exam, her
entire breast was ecchymotic, firm- almost rock hard, aeorla was yellow peau
d'orange type. On opposite side I palpated a 3-4 cm axillary node.  I
suspect advanced inflammatory breast cancer.
	I was able to get her diagnostic mammogram w/ PRN US etc for
tomorrow.  I spoke with the nurse case manager (Sue) at the breast center
where the mammography is scheduled.  Sue will be there and meet w/ the pt.

	So why did pt wait so long... no insurance!  She didn't know that
our county health department has a Breast and Cervical Cancer detection
program. 
	In talking w/ the case manager I learned they ensure that those who
need follow up get the procedures regardless of insurance.  And she will
follow up with another pt who also did not proceed w/ a biopsy because she
didn't have insurance.


-Lea
Melinda L Poso, MN, ARNP
Family Nurse Practitioner