[NP-Clinical] (no subject)

[Sue Wiers]

Kim,

I did a lot of research into this a couple of years ago which included a 
literature search, discussing with three ob-gyns, and a pathologist.  In a 
nutshell, I could not find definitive guidelines or an established 
standard-of-care  Do you know if any exist now?  One gyn and the pathologist 
felt that this interpretation is now included due to someone probably 
getting sued at some point and that too many unncessary endometrial biopsies 
are probably being done.

My approach has been to evaluate the findings within the context of the 
woman's risk for endometrial cancer (relative age, whether the cells were 
found in-phase or out-of-phase, whether or not she has been on OCs, etc).  
In the relatively younger woman who is having regular menstrual cycles, 
whose pap was done within 10 days of her last period I discuss with her the 
risk of missing an endometrial cancer vs the risk associated with 
endometrial biopsy (while not particularly risky, still not risk free).  I 
give them the option of ruling out cancer with biopsy or repeating a pap 
out-of-phase.  I don't believe that there is a right or wrong answer.    In 
the older patient without regular or with no menses, we do the endometrial 
biopsy.

Sue Wiers, FNP


>From: "Kimberly Spering" <crnp2001 at westgateoptical.com>
>Reply-To: NP Clinical <np-clinical at nurse.net>
>To: "NP Clinical" <np-clinical at nurse.net>
>Subject: Re: [NP-Clinical] (no subject)
>Date: Thu, 15 Mar 2007 06:44:23 -0400
>
>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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