GYN Case:
I had a 21-year old present to the clinic for a repeat Colposcopy. The patient had an abnormal pap and colposcopy over a year ago in a civilian facility and wanted a second opinion as her results showed that he LSIL had progressed to HSIL CIN III and HPV. The patient waited over a year to follow up. Patient states that she is sexually active with multiple partners and refused to use protection while having sex as she does not want to break the heat of the moment.” She was also a smoker who smoked almost 1 pack of cigarettes per day. She was scheduled for a LEEP and She was advised to abstain from sex since she was high risk HPV. The patient was advised to quit smoking as smoking can increase your risks for cervical cancer and yet the patient refused. When asked if she was interested in quitting smoking the patient said no and that her current boyfriend ‘Dips’ and she does not want to quit smoking as this would give her something to do while he dips. MAJOR education was given to this young patient as she was not playing with a “full deck”. I could not believe that someone would continue to smoke and perform such risk taking behaviors after being diagnosed with CIN III and HPV. She was given a consult/referral to psychiatric care.
Sheila,
ReplyDeleteWhat a great patient to present with psyche issues as well as ob/gyn. Goes to them saying don't forget to probe and treat the whole patient. I had a couple questions/suggestions for this patient. you probably addressed them in your education. #1 was the pt on birth control? SHe definetly doesn't sound like she is a candidate for IUD. She would benefit from Depo though since it isn't everyday. #2 Also would like to see the results of the second colpo. #3 Do you know if she had received the HPV vaccine, if not did you consider giving it to her? #4 Does she have any current STD's? Sounds like you definetly benefited the patient by referring her to psyche though.
James Ling
Interesting post, Sheila. I had spent one afternnon during my clinical rotation with a WHNP who performed colposcopies. We discussed risk factors and she told me that the nicotine is cigarrette smoke has an affinity for cervical cells. The nicotine prevents the healing response and that is why many women who smoke and have LGSIL progress to HGSIL. Of course, other factors influence this conversion such as stress and underlying immune function. I too would like to know if this patient was on any form of b.c.. I doubt it though, she sounds irresponsible. Unfortunately, she really wont grasp the seriousness of the situation until she is diagnosed with cervical or uterine cancer.
ReplyDeletegreg
Unfortunately, it is not uncommon to have to deal with patients like this. I have only been in clinical for 4 days and I have already come across many young patients who are similar to the one described by CPT Medina. It’s amazing how many patients understand the risks related to smoking and pregnancy and still choose to continue with their habit. I have really bad allergies and the smell of smoke just makes it worse. I had one patient who made the clinical room smell like a bowling alley because the scent was so strong. I had to excuse myself because I was having trouble breathing.
ReplyDeleteThis young girl just sounds like she's still in the full blown "I'm invincible" phase of adolescence. I'm not sure being diagnosed with cervical CA would make her "change" substantively either - she just doesn't get it. So, we probably need to approach her that way - try to protect her until she can grow up - but a Psych consult is also very appropriate given the strength of her desire to live in a fantasy world.
ReplyDeleteAs for the smoking piece, I find it very interesting how many young women smoke. If you ask them when they started - they'll often tell you they started "around 15" and if you ask them "why" they don't have a good answer. My thought: many times it's for weight maintenance. So that's something to ask about as well.