[NP-Clinical] (no subject)

[Kimberly Spering]

My opinion is for #3:

She needs an endometrial biopsy.  It may just be proliferative endometrium, but you definitely want to rule out hyperplasia, CA, etc.  On occasion, I've heard comments from others who mention that perhaps the cytobrush sampled "too far" into the cervix, but since usual cervical lengths are longer than the size of that brush, I don't agree with that opinion.  It would be hard to get into the main body of the uterus with a cytobrush, IMO, unless you were speaking of a patient post-op cold cone biopsy (with a BIG wedge removal).

Kim Spering
OB-GYN
  ----- Original Message ----- 
  From: arezendes at aol.com 
  To: np-clinical at nurse.net 
  Sent: Wednesday, March 14, 2007 6:01 PM
  Subject: [NP-Clinical] (no subject)


  I am looking for some expert opinions on a couple of issues,

  1.  I had a 70 year old female, new to the practice come in last week. She was having some typical symptoms of hypothyroidism (hair loss, dry skin, fatigue). She brought in copies of labs done within the last year, and I noticed 2 TSH done that were above the target (1 value of just over 5 and the other over 6) and nothing was done about it. I repeated the TSH and free T4, now both are normal (repeat TSH was 3.57, within the norm). Did not do antibodies. We talked about thyroid meds, she wants a "natural med" and mentioned Armour thyroid, which I have never prescribed. The question is now that the TSH is normal, should she be treated or watch and wait? Also, does anyone have experience in starting, adjusting Armour thyroid?

  2.  We are doing labs on patients with osteopenia and osteoporosis - 25 vitamin D, ionized calcium, intact PTH.  The normal levels for vit D from our lab are 
    vitamin D insuffiency less than 20
    vitamin D suffiency 40-100
    toxicity over 100
    we are recommending vit d if anything under 40. What is the general consensus re dose and rechecking of the levels?  When would a dose of 50,000 units per week vs OTC daily be in order?

  3. Woman who is 44 having usual periods but had endometrial cells on her pap. LMP was 2/22 and pap done 3/1.  Any guidelines? 

  Thanks to all ahead of time.
  Ann, NP
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