Patient JC walks on in, the first of the day,
she wants to discuss contraception and how to keep babies away.
She’s just turned 18 and started college at State,
and found a nice man with whom she’d like to be intimate.
I start to discuss various methods she may act on,
emphasizing hormone or copper IUD, or maybe the Nexplanon.
We also browse through the ring, the patch or the shot,
and the wide array of pills she can take daily on the dot.
She’s overwhelmed with options, can’t even remember what they were,
so we decide to move on and talk about what family problems bother her.
Her mom just turned 52 and has been in menopause for a while,
she just recently started bleeding again, hampering her active lifestyle.
Mom’s mind was in a whirl, the internet suggested uterine cancer,
but followup labs and scans show a large fibroid as the answer.
My patient asks about potential treatments before a final decision is made,
and we begin by drawing on paper all of the options to be weighed.
Mom can do nothing if she wants, or take an array of pills every day,
Some of which just block estrogen, while some block the entire hormonal pathway.
She can also choose surgery to just scoop it right out,
or opt for the big gun, remove the uterus and leave no doubt.
My patient just remembers that her mother also had a breast tumor,
Because diagnosed just before 50 she too may be at risk, goes the rumor.
Browsing her chart shows a flag under genetic screening,
she’s BRCA 1 positive but was unsure of its meaning.
She’s looked up some basic info but was scared of the terms,
so we discuss all of the various risks it confirms.
We start by addressing advanced screening via annual mammogram and MRI,
ultrasound, as we found out, has no added value to supply.
She can choose routine screening or get prophylactic mastectomy,
and then the discussion shifts abruptly to possible preventative orchiectomy.
Next we turn to Grandma, recently 82, celebrating with a surprise,
a lump in her breast found out to be cancer in disguise.
She was just recently referred to the big cancer center around,
and my patient wants to know what possible treatment can be found.
She’s metastasis-free and in a manageable stage,
so she’s free to get whatever treatment is right for her age.
Chemotherapy, immunotherapy or radiation, each with its own upside,
or a lumpectomy versus a mastectomy, bilateral or maybe just one side.
She can instead try special meds to block her estrogen from working,
SERMs are an option, maybe aromatase inhibitors, with even newer ones lurking.
It’s 5 years later, her mom treated and her grandmother cured,
my patient comes back to clinic pregnant, a recent urine test assured.
She’s happily married, secure, and excited to start a new phase of life,
but is now overwhelmed with questions and feeling the strife.
We discuss prenatal vitamins, her diet, mood, social support and current exercise,
at the end, she notes, “it burns when I pee, what do you advise?”
A urinalysis is cloudy, a culture finds many pathogens,
sensitive to all different treatments, and she’s negative for allergens.
So we offer her pills to fix what discomfort she’s in,
but now she has to choose from Nitro, Bactrim, Erythromycin, Keflex or Augmentin.
She returns 12 weeks later and notes she is well all-around,
her baby is healthy, says the first-trimester viability ultrasound.
We sit to discuss what else is needed to be done,
genetic screening she brings up, but has currently had none.
She can choose to not know and remain in the dark,
or check for abnormal chromosomes at this gestational age benchmark.
From triple screen to quad screen, nuchal translucency to N.I.P.T.,
really the choice is hers to decide how confident in the results to be.
I warn her that they are screening tests, and if they note something wrong,
she’ll have to choose between amniocentesis or CVS to go along.
She delivers a happy baby boy and later produces another healthy two,
the family she’s always wanted, grateful after all she’s been through.
The choices patients make can be quite difficult and daunting,
but with trust in your doctor, the conversations are less haunting.
They appreciate calm patience with making each and every decision,
the simple or detailed handout pamphlets routinely given.
JC is now 45 and has read extensively about the ability,
for permanent sterilization aimed to eliminate her fertility.
She comes to me already decided that a tubal ligation’s the way to go,
we discuss various options but our routine discussions she chooses to forgo.
Now all that’s left is to choose the ideal date for surgery…
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