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Drs call for an end to 45 medical tests
Http://www.msnbc.msn.com/id/46950533/ns/health-cancer/
Sorry no Clicky, I'm on my phone.
I like most of the changes, as I'm of the opinion that quite a few of these tests are overused, at least among younger patients.
However, I can't get behind the no-pap until you're 22 business. I had an abnormal pap at age 20, which thankfully turned out to be NBD, but I definitely believe that early paps are the reasons for low rates of cervical cancer. I'm perfectly fine with the new regs for having fewer paps done if you have a history of negative results, though.
Im also hesitant about the 10 year gap in colonoscopies, but I'd like to see more of the reasoning behind it.
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Re: Drs call for an end to 45 medical tests
Personally, I can't get behind that. I've suffered through sinus infections for weeks without improvement before finally going to the doctor and getting antibiotics and feeling human again.
ETA: And yes I know it says unless 7 or more days blah blah blah. But I already get told it's too soon for medicine even though I KNOW what I have because I've been through it umpteen thousand times before.
I had an irregular pap at either 19 or 20 as well. It was NBD at the time but could have caused some major problems down the road if it went undetected.
what she said, before I received some anti-virus shot I can't think of the name of at the moment, I was getting sinus infections multiple times a year due to my allergies. I would be miserable until I got a z-pack going.
my read shelf:
I absolutely disagree with the no paps for women under 21. Maybe if a women is not sexually active under the age of 21, but if she's sexually active? No question. I had an abnormal pap at 18. I also don't agree with the colonoscopy one - one of my parents good friends just passed away from a GI cancer. He was one year out from his 'routine recommended' colonoscopy. If he had it a year prior, he would probably still be alive.
I'm curious about the no chemo for sickest cancer patients. Is that "So sad, too bad"?
My dad had early stage prostate cancer, and my mom had early stage breast, and neither of them had bone scans.
Most of the time antibiotics are useless for SIs though.
http://www.nlm.nih.gov/medlineplus/news/fullstory_123198.html
Yea I've seen that too. I stand by my previous comment (and the ETA).
Click me, click me!
Well I have a pap anecdote for this thread.
Had an abnormal when I was 20 and the doctor decided I needed a colposcopy and then he biopsied 3 different areas of my cervix. It was nothing, never had an abnormal pap since then and never needed any treatment.
Had incompetent cervix with my daughter which landed me on bedrest for half of my pregnancy with an emergency cerclage and end of story is, I'm incredibly lucky I had a full term healthy baby.
Can't say for sure that's what caused my IC, but in retrospect, I sure wish I hadn't done anything but get another pap after 6 months.
For women that young, (especially since most now have had the HPV vaccine, yes?) waiting makes sense to me.
I'm not sure about the chemo but I know NHS basically said that they would remove FIL's tumor (he's 83) and give him 6 rounds of radiation (or something like that) and in a year remove the tumor again. He has bladder cancer which I assume is fairly slow growing given his age
Above Us Only Sky
Yup.
Plus the whole anecdotal evidence vs. 9 major medical associations and societies representing nearly 375,000 physicians smacks of the whole vaccine "debate" to me.
To the person asking about the chemo recommendation - the recommendation is to not use chemotherapy and other treatments in patients with advanced solid-tumor cancers such as colorectal or lung who are in poor health and did not benefit from previous chemo.
So it's not like "You have cancer and are too sick to have chemo. Suck it up." It's "You have advanced cancer, did not respond well to previous chemo and are possibly too ill to survive another round.... so we're not going to do another round."
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I actually am ok with this. I wish doctors would be more honest and realistic with people about their prognoses. I think Americans want to be treated to the hilt when it really doesn't make sense to - sometimes it just won't improve either their life expectancy OR quality of life. I understand that it's their job to treat people and try to heal them but I wish doctors would refer people to hospice sooner then they typically do.
I have no problem with the recommendations - either of them, honestly. I am sure these are not hard and fast rules: patients with a family history of CRC should get earlier and more frequent scopes (especially if they have symptoms) and scopes will certainly be used if worrisome symptoms develop in people between recommended screenings.
And while yes, many women (myself included) have had NBD abnormal paps - I think that's the point. Routine paps don't start "paying off" (and catching cancer) until women are older. Again, if a woman has a longer history of sexual activity perhaps it is warranted. But by and large, I get it.
As for this:
It's not a too bad-so sad - it's "does it help at all?" Chemo is no effing joke, and side effects are not just feeling yucky and losing hair. One of the drugs I took for colon cancer has a diarrheal side effect so severe and so common that 40% of people end up in the hospital as a result. Some die. With many chemo drugs your immune system crashes, anemia is common - my cousin with BC landed in the hospital after 1 round of chemo because a cold caused her to spike a nasty fever. So when a patient with a 10% chance or less of survival over 5 years, who is in poor health experiences no improvement after standard of care chemo... who does more chemo really benefit? Again, there undoubtedly will always be exceptions and thankfully there will be clinical trials available to try new treatments. But round after round after round when you have metastatic cancer... most patients wouldn't even sign up for that.
Last, I don't think this means patients can't request it - I believe this means that doctors should not routinely recommend it.
I am a runner, knitter, scientist, DE-IVF veteran, and stage III colon cancer survivor.
I'm fine with the no pap thing. I had an abnormal pap at 19/20. My OB wanted to do an in office biopsy. I was afraid of the procedure itself and just never went back. I started seeing a new OB at 21 when I got pregnant with DS2 and have seen him since. I'd have a yearly pap since I started seeing him and have never had another abnormal result.
When the guidelines changed I asked him about them and what he thought. He said that abnormal pap results are very common in women in their late teens and that almost always it's nothing but that some of the next steps in testing can do more harm than good and can increase the woman's risk for things like IC during pregnancy later. He said that in his opinion the risks of early paps outweigh the bennifits.
That's a big reason they are calling for delaying paps so young, IIRC.
I am a runner, knitter, scientist, DE-IVF veteran, and stage III colon cancer survivor.
I once waited for nearly two hours to see my OB/Gyn, who gave no excuse for the delay, offered no apology, and spent 7 minutes with me, including my internal. I wrote a letter explaining that I was an attorney, I billed my time in 15-minute increments, and I intended to bill her for all the time I lost while sitting there waiting. LOL
When my OB is running late her nurse usually tells me she's busy delivering a baby... and then how can you really complain?
Above Us Only Sky
My mom works in OB/GYN and has mentioned to me before that these things are usually related.
Man that effing pisses me off. I remember specifically asking the GYN doing the procedure if this would have any impact down the road of me having kids and he said Oh no! Of course not.
She was in the office the entire time so if any baby was delivered, it was earlier in the day, when phone calls could have been made to patients about the schedule back-up.
And really, all it took was a quick, "I'm sorry I'm running late today. We've had an unexpectedly busy day." Instead I didn't even get a "hello" and she was very abrupt. When I walked out of that office, I could have spit fire.
I know that the plural of anecdote is not data, but I'm another one of the pap story tellers. Normal one for years, discussion with my doc about starting to skip years, then the last planned yearly one (we were going to skip after that) showed ASCUS. Instead of rushing into anything, we waited and repeated the pap, which showed carcinoma in situ. Went in for a biopsy and a LEEP procedure after the biopsy. I don't know what would have happened had I skipped the pap that year.
I've had rectal bleeding for going on a year now, and after conservative treatment (including waiting for months for a scope rather than insisting on one right away), my doctor recommended surgery. I held back on that, things have improved to the point where he isn't recommending it now (the second opinion rec'd against it as well) and right now I'm still hoping to avoid it. We've skipped some imaging tests b/c they wouldn't be productive.
I did have surgery a few years ago to remove what turned out to be a benign lump but there were moderate indications it was cancerous pre-surgery. I don't regret the surgery at all. I understood the potential risks, the potential benefits to not having surgery, and talked about it quite a bit with my doctor.
I went in for follow ups on other things last fall, and the doc did a urinalysis. It came back showing a UTI. I had no UTI symptoms, so we did a repeat. Showed another UTI, so I took a round of antibiotics. Same thing happened a few months later, I appeared to have a UTI, but this time on repeat I did not and was able to skip the antibiotics (I have a history of kidney stones and think that maybe it was a stone acting up throwing things off).
I've talked all these things over with my doctor and made informed decisions. Sometimes those decisions may have been to get less treatment than typically recommended or to wait for treatment, sometimes more (i.e. I'll never skip a yearly pap). I'm smart enough to consider the options available and to make an informed choice to not spend money on healthcare that isn't necessary, and to not undergo treatments that may cause me harm (the surgery my doctor initially recommended carried a small risk of incontinence - that was worse to me than what I was already dealing with).
This was a long rambling way to say that's what I would hope others are doing - make informed decisions with your doctors, don't insist on every test that's out there, and quit being a whiner and insisting that you get antibiotics for every runny nose. On the flip side, if you feel strongly about something, then advocate for yourself. There's no one size fits all approach when it comes to your health needs.
I have started walking out. I give it half an hour (including waiting room and waiting in the exam room time). If it's been half an hour I get my stuff, go up to the front desk and politely explain that my appointment time was X, it's now half an hour past that, I was never informed of a delay in the doctor's schedule, and I am no longer able to stay and will need to reschedule.
Somehow that has always seemed to get the doctor to me pretty much within the next 5 minutes.
True, all of the NBD abnormal paps might show that we're overusing them. It's just one of only two things on the list that stopped me from immediately going "Good!"- mostly from personal experience myself, and knowing an 18 year old who had legitimate cervical cancer. I know that that's extremely abnormal, but it's one of those things that sticks with me.
That said, if "no paps 'til 21" becomes the new SOP at the gynecologist, I'm fully aware that it's not made willy-nilly and there's a lot of research backing it up, and that, ancedotes aside, the costs of having an early pap outweigh the benefits for the majority of the population. Cool. There will always be the option for young'uns with family history, risky behaviors or other extraordinary circumstances to get the treatment.
Also, I'm fully behind prescribing fewer antibiotics off the bat, as well as not continuing to do round after round of hellaciously expensive medical treatment (chemo) for people who are in very poor health and most likely will not survive either the treatment, or a secondary medical issue.
I disagree with the no paps. I started getting them when I became sexually active at 16 and I'll want any daughters of mine to do the same. A girl I went to high school with died at 21 of cervical cancer- I cannot get behind doing away with cancer screening.