[NPInfo] Re: gyn question
Tracy Klein
whcnp at yahoo.com
Sat Aug 9 11:16:20 PDT 2008
Really the answer depends upon what type of fibroid was visualized. The symptomology fits the profile well for a submucosal fibroid, which can cause the periods, back pain, and thickening of the endometrial lining because it impedes the ability of the lining to fully shed. I would start with an endometrial biopsy (which wont be entirely accurate if it is a submucosal) then proceed to an ultrasound with saline infusion which will give a good picture of what you are dealing with. Then you can do a D and C if there is no submucosal fibroid (ie if it is subserosal or intramural). If a D and C is done with a submucosal not only will it not work effectively but it is a hell of a way to remove or partially remove one.
Know what you are dealing with before proceeding with an instrumental scraping.
Tracy Klein, FNP (was a WHCNP also)
Portland, Oregon
--- On Sat, 8/9/08, npinfo-request at nurse.net <npinfo-request at nurse.net> wrote:
> From: npinfo-request at nurse.net <npinfo-request at nurse.net>
> Subject: NPInfo Digest, Vol 29, Issue 21
> To: npinfo at nurse.net
> Date: Saturday, August 9, 2008, 12:00 PM
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> Today's Topics:
>
> 1. Gyn question (David Mittman)
> 2. Re: Gyn question (Margienp at aol.com)
> 3. Posing a question (Meg)
> 4. RE: Posing a question (prispunnyfnp at metrocast.net)
> 5. Re: Posing a question (Julia Pallentino)
> 6. Re: From primary care to cardiology
> (GOWEST73 at aol.com)
> 7. Wall Street Journal Medical Blog (David Mittman)
>
>
> ----------------------------------------------------------------------
>
> Message: 1
> Date: Fri, 8 Aug 2008 18:45:37 -0400
> From: David Mittman <dmittman at comcast.net>
> Subject: [NPInfo] Gyn question
> To: ACC <acc-circle at listserve.com>, NP Info
> <npinfo at nurse.net>
> Message-ID:
> <0B430DF2-0E54-45CD-B2F8-BB2B481FDCEF at comcast.net>
> Content-Type:
> text/plain; charset=US-ASCII; format=flowed; delsp=yes
>
> Melissa is a good friend.
> Any advice would be appreciated
>
> Begin forwarded message:
>
> > From: Melissa Murfin <mel.kat at verizon.net>
> > Date: August 8, 2008 8:06:29 AM EDT
> > To: PAFORUM at MC.DUKE.EDU
> > Subject: [PAFORUM] Gyn question
> > Reply-To: mel.kat at verizon.net
> >
> > I've been recommended to have an endometrial
> biopsy, but given a
> > choice
> > if I want to go straight to D&C or do
> hystersonography, then biopsy
> > which would lead to D&C if they find anything.
> Which way is best?
> >
> > I have zero risk factors for endometrial carcinoma.
> I'm 40, normal
> > flow
> > with menses, I've only missed periods the two
> times I was pregnant
> > and I
> > don't take unopposed estrogen. Chief complaint was
> two periods from
> > hell
> > in May, then June which seem to have settled though I
> still have some
> > pelvic and back pain that I'm starting to think
> may be related to
> > sciatica. U/S was done trans abdominal and transvag,
> 1.9 cm R ovarian
> > cyst, 1.5 cm fibroid, nonspecific endometrial
> thickening of 14 mm.
> >
> > Thoughts?
> >
> > TIA!
> > Melissa
> >
> >
> > * * * * * *
> >
> > Join the American College of Clinicians. Let us show
> you what we
> > can do. www.amcollege.org
>
>
>
> ------------------------------
>
> Message: 2
> Date: Fri, 8 Aug 2008 19:20:03 EDT
> From: Margienp at aol.com
> Subject: Re: [NPInfo] Gyn question
> To: npinfo at nurse.net
> Message-ID: <c7d.30ca6da3.35ce2ea3 at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
>
>
>
> Endo Biopsy.
> Peri menopause?
>
> In a message dated 8/8/2008 6:46:46 P.M. Eastern Daylight
> Time,
> dmittman at comcast.net writes:
>
> Melissa is a good friend.
> Any advice would be appreciated
>
> Begin forwarded message:
>
> > From: Melissa Murfin <mel.kat at verizon.net>
> > Date: August 8, 2008 8:06:29 AM EDT
> > To: PAFORUM at MC.DUKE.EDU
> > Subject: [PAFORUM] Gyn question
> > Reply-To: mel.kat at verizon.net
> >
> > I've been recommended to have an endometrial
> biopsy, but given a
> > choice
> > if I want to go straight to D&C or do
> hystersonography, then biopsy
> > which would lead to D&C if they find anything.
> Which way is best?
> >
> > I have zero risk factors for endometrial carcinoma.
> I'm 40, normal
> > flow
> > with menses, I've only missed periods the two
> times I was pregnant
> > and I
> > don't take unopposed estrogen. Chief complaint
> was two periods from
> > hell
> > in May, then June which seem to have settled though I
> still have some
> > pelvic and back pain that I'm starting to think
> may be related to
> > sciatica. U/S was done trans abdominal and transvag,
> 1.9 cm R ovarian
> > cyst, 1.5 cm fibroid, nonspecific endometrial
> thickening of 14 mm.
> >
> > Thoughts?
> >
> > TIA!
> > Melissa
> >
> >
> > * * * * * *
> >
> > Join the American College of Clinicians. Let us show
> you what we
> > can do. www.amcollege.org
>
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>
>
>
>
> Be kinder than necessary, everyone you meet is fighting
> some kind of battle.
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>
>
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>
> ------------------------------
>
> Message: 3
> Date: Fri, 8 Aug 2008 22:50:33 -0700 (PDT)
> From: Meg <enigma462003 at yahoo.com>
> Subject: [NPInfo] Posing a question
> To: NP LISTSERV <npinfo at nurse.net>
> Message-ID:
> <91559.53923.qm at web35808.mail.mud.yahoo.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> I'm wondering if anyone on the listserv has heard of
> paying the front desk person a small bonus for scheduling in
> paps etc that bring in cash to a practice.
> I haven't heard of this before...and it surely seems
> odd to do this
> Meg (Portland OR)
>
> ------------------------------
>
> Message: 4
> Date: Sat, 9 Aug 2008 06:47:58 -0400
> From: "prispunnyfnp at metrocast.net"
> <prispunnyfnp at metrocast.net>
> Subject: RE: [NPInfo] Posing a question
> To: npinfo at nurse.net
> Message-ID:
> <380-22008869104758600 at M2W016.mail2web.com>
> Content-Type: text/plain; charset=iso-8859-1
>
> I concur. Never heard of it and sounds suspect.
>
> Priscilla
>
> Original Message:
> -----------------
> From: Meg enigma462003 at yahoo.com
> Date: Fri, 8 Aug 2008 22:50:33 -0700 (PDT)
> To: npinfo at nurse.net
> Subject: [NPInfo] Posing a question
>
>
> I'm wondering if anyone on the listserv has heard of
> paying the front desk
> person a small bonus for scheduling in paps etc that bring
> in cash to a
> practice.
> I haven't heard of this before...and it surely seems
> odd to do this
> Meg (Portland OR)
> _______________________________________________
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> http://lists.nurse.net/mailman/listinfo/npinfo
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> ------------------------------
>
> Message: 5
> Date: Sat, 09 Aug 2008 10:28:23 -0400
> From: Julia Pallentino <arnplaw at comcast.net>
> Subject: Re: [NPInfo] Posing a question
> To: NP Info <npinfo at nurse.net>
> Message-ID: <C4C321C7.132A%arnplaw at comcast.net>
> Content-Type: text/plain; charset="ISO-8859-1"
>
> I don't think I have all the information necessary to
> answer this question,
> but if the only facts are that the practice is giving a
> bonus for scheduling
> a certain way then I don't see that this is different
> from any other
> business using incentives to achieve desired behavior.
>
> Julia
>
>
> On 8/9/08 1:50 AM, "Meg"
> <enigma462003 at yahoo.com> wrote:
>
> > I'm wondering if anyone on the listserv has heard
> of paying the front desk
> > person a small bonus for scheduling in paps etc that
> bring in cash to a
> > practice.
> > I haven't heard of this before...and it surely
> seems odd to do this
> > Meg (Portland OR)
> > _______________________________________________
> > NPInfo mailing list
> > NPInfo at nurse.net
> > http://lists.nurse.net/mailman/listinfo/npinfo
> > *****************************
>
>
>
>
>
> ------------------------------
>
> Message: 6
> Date: Sat, 9 Aug 2008 11:59:01 EDT
> From: GOWEST73 at aol.com
> Subject: Re: [NPInfo] From primary care to cardiology
> To: npinfo at nurse.net
> Message-ID: <d4e.33712719.35cf18c5 at aol.com>
> Content-Type: text/plain; charset="US-ASCII"
>
> Greg, I think you are neogtiating well. My only advice is
> that we do not
> justify our need for more $$ based on our family
> circumstances( pregnant wife, 2
> kids in college, whatever).
> We need the higher salary...because we deserve it!
>
> I think it is fine to wait 3 months and it is ESSENTIAL
> that it be in writing.
>
> I once worked without a contract for 6 mo at my request as
> I did not know if
> I would like the practice style of the 2 docs. They asked
> why. I told them
> it would give all of us 6 months to decide if we would work
> well together with
> no strings. After 3 months they were VERY anxious for me
> to sign and I was in
> a bettter position to get the money I wanted because they
> had seen my
> productivity first hand.
>
> Just a thought,
>
> Celia
>
>
>
> **************Looking for a car that's sporty, fun and
> fits in your budget?
> Read reviews on AOL Autos.
> (http://autos.aol.com/cars-BMW-128-2008/expert-review?ncid=aolaut00050000000017
> )
>
>
> ------------------------------
>
> Message: 7
> Date: Sat, 9 Aug 2008 13:22:47 -0400
> From: David Mittman <dmittman at comcast.net>
> Subject: [NPInfo] Wall Street Journal Medical Blog
> To: ACC <acc-circle at listserve.com>, NP Info
> <npinfo at nurse.net>,
> paforum at mc.duke.edu
> Message-ID:
> <DDA5A22D-55C6-46D0-946D-06CCE5AB44B0 at comcast.net>
> Content-Type:
> text/plain; charset=WINDOWS-1252; format=flowed;
> delsp=yes
>
> Regarding the Caribbean Med School Deal With the NY
> Hospitals
> http://blogs.wsj.com/health/2008/08/08/fallout-from-caribbean-med-schools-100-million-nyc-hospital-deal/#comments
>
> See this quote!!!!!
>
> SGU is never a medical student’s first choice. They go
> there because
> they didn’t make the cut in any of the 125 LCME
> accredited schools in
> the US, PLUS they have enough money to fund the high
> tuition there.
> The $400 per week of course is paid indirectly from the
> student to the
> hospital. And yes, I have experience with SGU grads, and no
> they are
> not the same caliber as most US grads, BUT they are better
> than a PA
> or NP and many international medical schools. Don’t
> expect to see SGU
> grads in residencies that are very competitive; in that way
> they self
> select for careers that are not top tier.
> While NYC may be upset about this deal, we need more
> doctors, and some
> of the SGU students will turn out to be better quality
> doctors than
> the medical residents who will be training them.
> Comment by Chief of Medicine - August 8, 2008 at 6:03 pm
>
> MY RESPONSE!!!!!!!!!!!!
> I am responding more to the comments made in a post by
> "CHIEF OF
> MEDICINE" regarding the medical schools in the
> Caribbean.
> I am not sure why you chose to take a negative swipe at NPs
> and PAs in
> your comment above, but you did choose to. Why even put us
> in there?
> This is not our fight, although these are clinical training
> slots that
> could be used by our students also and because of factors
> not under
> our control, will not freely go to us. So, NPs and PAs are
> effected by
> this.
> What I do know is that I doubt you have worked with
> experienced NPs
> and PAs. Are you aware the US Army's Flight Surgeon of
> the Year for
> 207 is a PA. Or that the Air Force has 3 PA Hospital
> Commanders and
> the Army just named their first. Or that
> there are I think over 300 NP and PA clinicians at MD
> Anderson Cancer
> Center, over 200 at Montefiore. If they could not do the
> work there
> (which is physician level work-why are they employed? Must
> be the
> inferior education?
> I trained exclusively at NY City owned public hospitals. We
> trained
> with students from the Caribbean schools and I would say
> that
> generally (not always) we ran rings around them. Both with
> our
> clinical knowledge and procedural expertise.
> I'll tell you what, let's take 5 graduates from the
> Yale School of
> Medicine PA Program and 5 from the Duke Medical School PA
> Program and
> take 10 grads from St George's. Have them take the
> clinical portion of
> the US Med Boards. I will bet $1,000 that the PA students
> do very well
> (Average higher score than the St George's graduates).
> I'll even ask a
> favor, let's really do it right and write the results
> up in JAMA. I am
> tired of these off handed swipes at NP and PAs-let's
> really take a look.
> My NP and PA colleagues all had a chance if we chose to go
> to a
> Caribbean medical school. There are some schools that give
> us advanced
> placement. We chose not the title, nor the income, but to
> go to
> graduate school here in our own country and make a
> difference. Our
> programs are good, they are hard and if we were not good,
> why would we
> be getting hired as fast as we can graduate?
> So, Chief of Medicine, take me up on my bet and let's
> see just who is
> the winner of the contest? Can you arrange it?
> Dave Mittman, PA
> Livingston, NJ
>
> ------------------------------
>
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> End of NPInfo Digest, Vol 29, Issue 21
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