[NP-Clinical] (no subject)

[Marilyn Dean]

Was this premenopausal  patient having any evidence of menstrual flow when
the pap was done. This would enter into my decision on whether to do an
endometrial biopsy.
Marilyn Dean
  -----Original Message-----
  From: np-clinical-bounces at nurse.net
[mailto:np-clinical-bounces at nurse.net]On Behalf Of Kimberly Spering
  Sent: Thursday, March 15, 2007 5:44 AM
  To: NP Clinical
  Subject: Re: [NP-Clinical] (no subject)


  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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