[NP-Clinical] (no subject)

[Rick/Laurel Webb]

Hi Ann-

I am responding to #3. Just did a lit search on this after I was send a
patient for an endometrial biopsy after having endometrial cells on pap.
Sources I went to included AAFP and NIH and both said endometrial cells on
pap are benign and do not require further intervention unless woman is
having irregular or abnormal menses. If menses irregular or abnormal then
endometrial biopsy is indicated. Both articles explained that with the new
Bethesda classification of noting endometrial cells it has put clinicians in
an uncomfortable position of having to make decisions regarding management
of such paps. 

Don't have the actual citations but if you google paps with endometrial
cells you will find the citations (I use google all the time)

Hope that helps. If you can't find email me back and I will find the and
list but they are pretty easy to locate. 

Laurel FNP

 

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From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of arezendes at aol.com
Sent: Wednesday, March 14, 2007 5:01 PM
To: np-clinical at nurse.net
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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