Monday, August 11, 2025

Fibroid Diagnosis process

 If you have mild cramping from a uterine fibroid, doctors usually follow a step-by-step approach to diagnosis and management.

Here’s a simple breakdown:


1. Diagnosis Process

Doctors want to confirm the fibroid and check its size, number, and location.

A. Medical history & symptom review

  • Ask about pain, bleeding patterns, urinary/bowel changes, fertility issues.

  • Note if pain is cyclical (period-related) or constant.

B. Physical exam

  • Pelvic exam to feel for an enlarged, irregular uterus.

C. Imaging tests

  • Pelvic ultrasound (most common first step) – shows fibroid size, shape, and location.

  • MRI – for detailed mapping if surgery is considered or diagnosis is unclear.

  • Sonohysterography (saline-infusion ultrasound) – to check fibroids inside the uterine cavity.

  • Hysteroscopy – direct view of the uterine cavity with a camera, if needed.

D. Lab tests (if symptoms involve heavy bleeding)

  • CBC (check for anemia).

  • Possibly pregnancy test or hormone levels to rule out other causes.


2. Management for Mild Pain

If pain is mild and fibroids are not causing major complications, treatment is usually conservative.

A. Watchful waiting (“observation”)

  • No immediate surgery.

  • Regular follow-up with ultrasound (every 6–12 months).

  • Track symptoms.

B. Symptom control

  • NSAIDs (ibuprofen, naproxen) for cramps.

  • Heat therapy (warm pad on lower abdomen).

  • Lifestyle changes: balanced diet, exercise, stress reduction.

C. Hormonal treatments (if bleeding is bothersome)

  • Birth control pills or hormonal IUD to reduce heavy flow.

  • Progesterone tablets or injections.


3. Procedures (only if symptoms worsen)

If mild pain becomes moderate/severe or other problems arise (e.g., anemia, pressure symptoms), doctors may suggest:

  • Myomectomy – remove fibroid(s) while keeping uterus.

  • Uterine fibroid embolization (UFE) – shrink fibroid by blocking its blood supply.

  • Endometrial ablation – reduce bleeding (not for large fibroids or future pregnancy).

  • Hysterectomy – remove uterus (only in severe cases or if no desire for pregnancy).


๐Ÿ’ก Key point:
For mild cramping from a fibroid, the most common approach is diagnosis via ultrasound followed by symptom management and monitoring, not immediate surgery.

Menstrual Pain Context

 

Pain ScoreDescriptionMenstrual Pain Context
0No painSome people feel only mild discomfort or none at all during periods.
1–3Mild painSlight cramps; able to do normal activities without much trouble.
4–6Moderate painNoticeable cramps; may need rest or pain medication; some difficulty with daily tasks.
7–10Severe painVery strong cramps; may cause nausea, sweating, dizziness; often interferes with school, work, or normal activities (seen in dysmenorrhea).

For many people with a “typical” period, pain is usually in the mild-to-moderate range (about 3–6/10), especially during the first 1–2 days.
If pain is above 7/10 regularly, lasts several days, or affects daily functioning, it’s considered more severe than normal and may require medical evaluation.

Saturday, August 9, 2025

Zofran - ondansetron

 Zofran (generic name ondansetron) is primarily indicated for the prevention and treatment of nausea and vomiting.


Main uses include:


Chemotherapy-induced nausea and vomiting (CINV) – given before and sometimes after chemotherapy.


Radiation-induced nausea and vomiting (RINV) – to prevent nausea from radiation therapy.


Postoperative nausea and vomiting (PONV) – used before or after surgery to reduce nausea.


How it works: Zofran is a 5-HT₃ receptor antagonist. It blocks serotonin receptors in the brain and gut that trigger the vomiting reflex.

Friday, July 25, 2025

pT1miN0 R breast

  pT1miN0 R breast

Breakdown of Terms:

pT1mi: p = Pathologic stage (based on what was found during surgery or under the microscope). T1mi = Tumor is 1 millimeter or smaller (microinvasion). "mi" = microinvasion (tiny invasion beyond the ducts or lobules into nearby tissue). N0: No cancer found in the lymph nodes (N = nodes, 0 = none involved). R breast: Cancer is located in the right breast.

What it means overall:

This indicates a very early-stage breast cancer in the right breast, where:

  • The invasive tumor is extremely small (1 mm or less),

  • No lymph nodes are involved,

  • The tumor was confirmed pathologically (via tissue testing).

This is generally considered Stage I breast cancer 

(specifically, Stage IA if there’s no nodal involvement), which often has a very good prognosis.

  1. Histologic type (e.g., invasive ductal carcinoma)

  1. Hormone receptor status (ER, PR, HER2)

  2. Margins

  3. Lymphovascular invasion

  4. Ki-67 (if available)

  • Other notes (like DCIS, grade, or BRCA status)


  •  The pathology report shows an early-stage breast cancer in the right breast, classified as pT1miN0.

     This means the tumor has only microinvasion (1 millimeter or less into nearby tissue) and no cancer was found in the lymph nodes. 
    This is a very favorable stage, often called Stage I, and patients with this diagnosis typically have a high chance of successful treatment. 

    Treatment decisions will depend on additional test results, such as hormone receptor status (ER, PR, HER2), which guide whether the patient may benefit from hormone therapy, chemotherapy, or targeted therapy.

    ๐Ÿ”ฌ What Are ER and PR?

    • ER = Estrogen Receptor

    • PR = Progesterone Receptor

    These are proteins found on some breast cancer cells. If the cells have them, the cancer "feeds" on hormones like estrogen or progesterone to grow.


    ✅ ER/PR Positive (ER+ / PR+)

    Meaning:

    • The cancer has receptors for estrogen and/or progesterone.

    • It uses these hormones to grow.

    Outcome:

    • This is usually a good sign.

    • Treatable with hormone (endocrine) therapy, such as:

      • Tamoxifen (for pre-menopausal women)

      • Aromatase inhibitors (for post-menopausal women)

    • These treatments block or lower hormone levels, slowing or stopping cancer growth.

    • Better long-term outlook with lower recurrence risk.


    ❌ ER/PR Negative (ER− / PR−)

    Meaning:

    • The cancer does not have hormone receptors.

    • It does not rely on estrogen or progesterone to grow.

    Outcome:

    • Hormone therapy will not work.

    • Treatment may rely more on:

      • Chemotherapy

      • Targeted therapy (if HER2+)

      • Radiation/surgery

    • Sometimes, these cancers may be more aggressive, but newer treatments are improving outcomes.


    ๐Ÿงช Mixed Results

    • Sometimes a tumor might be ER+ but PR− or vice versa.

    • Doctors still usually treat it as hormone-responsive, especially if ER+.


    ๐Ÿ”„ Summary Table:

    ResultTreatment OptionPrognosis
    ER+/PR+Hormone therapy worksBetter prognosis
    ER−/PR−No hormone therapyMay need chemo
    ER+/PR− or PR+/ER−Usually still use hormone therapyIntermediate

    ๐Ÿ”ฌ What is Microinvasive Carcinoma?

    Microinvasive carcinoma is a very early form of invasive breast cancer.

    • It begins as DCIS (Ductal Carcinoma In Situ), which means the cancer is contained inside the milk ducts and has not yet spread.

    • In microinvasion, a tiny amount of cancer cells (≤ 1 millimeter) has just started to break out of the duct into nearby breast tissue.

    • It is still considered Stage I, specifically T1mi, and is much less advanced than regular invasive cancer.


    ✅ What It Means for Treatment and Prognosis:

    • It’s often very treatable with an excellent prognosis.

    • Doctors will look at other factors like:

      • Hormone receptor status (ER/PR)

      • HER2 status

      • Tumor grade

      • Lymph node involvement (you mentioned N0 = no lymph nodes involved)

    • If ER/PR positive, hormone therapy like Tamoxifen might be recommended to reduce recurrence risk.

    • Radiation therapy may be used after lumpectomy.

    • Chemotherapy is usually not needed unless other aggressive features are present.


    ๐Ÿงพ Summary:

    TermMeaning
    Microinvasive carcinomaTiny spread (≤1 mm) of cancer outside the duct
    StageStage I (early-stage cancer)
    PrognosisVery good, especially if no lymph node spread (N0) and ER/PR+
    Common TreatmentsSurgery, maybe radiation, possibly hormone therapy (if ER/PR+)

    ๐Ÿง  What the Report Says (in Plain Language):

    • DCIS (Ductal Carcinoma In Situ):
      A 3.7 cm area of non-invasive cancer was found.

      • DCIS means cancer cells are inside the milk ducts and have not spread into surrounding breast tissue.

    • Microinvasive carcinoma:
      Tiny areas of cancer (measuring between 0.1 to 0.8 mm) have just started to spread outside the ducts.

      • This is called microinvasion and is considered Stage I (T1mi).

    • Margins:

      • Margins refer to the edges of the removed tissue.

      • Your anterior and inferior margins are focally positive for DCIS, meaning some cancer cells may be close to or touching the edge of the removed tissue in those areas.

      • This may require additional surgery (like a re-excision) or careful radiation to reduce the risk of recurrence.

    • 0/6 LN (Lymph Nodes):

      • All 6 lymph nodes removed were negative, which means no cancer spread to lymph nodes (great news!).


    ๐Ÿ“‹ Summary Table:

    FindingMeaning
    DCIS – 3.7 cmNon-invasive cancer within ducts, relatively large in size
    Microinvasion (0.1–0.8 mm)Tiny areas of invasion beyond the duct, early-stage invasive cancer
    Margins focally positiveCancer cells are close to some edges – may need more surgery/radiation
    0/6 Lymph NodesNo spread to lymph nodes – a very good sign

    ✅ What This Means for You:

    • Very early invasive cancer with a good outlook.

    • May need:

      • Surgery to clear the positive margin

      • Radiation therapy (especially after lumpectomy)

      • Hormone therapy if ER/PR-positive

    • No chemotherapy is typically needed unless there are other aggressive features.

    microinvasive carcinoma ranging from 0.1-0.8 mm amidst 3.7 cm DCIS with margins for in-situ disease focally positive anterior and inferior, 0/6 LN.

    Saturday, July 12, 2025

    perfusion index

     If the monitor shows a PERF value of 3.85, it typically refers to the Perfusion Index (PI), which is a numerical value provided by pulse oximeters to indicate the strength of blood flow at the sensor site.


    ๐Ÿ” Understanding Perfusion Index (PI):

    • Perfusion Index (PI) ranges from 0.02% (very weak) to 20% (very strong).

    • A PI of 3.85% is considered a moderate to good perfusion value.


    Interpretation of 3.85 PI:

    • Normal and adequate peripheral perfusion.

    • No immediate concern unless symptoms or other vital signs are abnormal.


    ๐Ÿ“ Quick PI Reference:

    PI Value (%)Perfusion Strength
    < 0.5Very weak perfusion
    0.5 – 1.0Weak perfusion
    1.0 – 3.0Moderate perfusion
    3.0 – 10.0Good perfusion (normal)
    > 10.0Strong perfusion

    So, a reading of 3.85 indicates that the patient likely has adequate blood flow at the sensor site, such as a fingertip. Always confirm with other signs like heart rate, blood pressure, and capillary refill.

    Perform Bone Marrow Biopsies or Aspirations (BMS)

     The role of Peds BMS (Pediatric Bone Marrow Specialist or Bone Marrow Service) depends on the context, but generally refers to a specialized team in pediatrics focused on bone marrow-related conditions, particularly in hematology-oncology (blood and cancer disorders in children).


    Key Roles of a Pediatric BMS Team:

    Diagnosis and Management of Blood Disorders


    Leukemia (ALL, AML)


    Lymphomas


    Aplastic anemia


    Sickle cell disease


    Thalassemia


    Immunodeficiencies


    Bone Marrow Transplant (BMT) Services


    Evaluate patients who need stem cell or bone marrow transplant


    Find donor matches (sibling, unrelated donor, or cord blood)


    Manage transplant procedures and post-transplant care


    Perform Bone Marrow Biopsies or Aspirations


    For diagnosing cancers, infections, or marrow failure


    Analyze cell types, counts, and marrow structure


    Coordinate Care with Oncology & Genetics Teams


    Work with oncologists, immunologists, and geneticists for complex cases


    Monitor for complications like graft-versus-host disease (GVHD)


    Research and Clinical Trials


    Participate in studies for new treatments or transplant techniques


    In Summary:

    A Peds BMS team plays a critical role in diagnosing, treating, and supporting children with serious blood and immune system diseases, especially those needing bone marrow transplants. They provide highly specialized care that can be life-saving.

    Friday, July 11, 2025

    EGD (esophagogastroduodenoscopy)

     When an EGD (esophagogastroduodenoscopy)

    biopsy shows pathology concerning for B-cell involvement

    it usually means the pathologist saw abnormal lymphoid cells in the tissue that may be related to a 

    B-cell lymphoma, which is a type of blood cancer that starts in B lymphocytes, a kind of white blood cell.

    Here’s why this might happen:

    1. Lymphoid Infiltrate in the GI Tract

    • The stomach and intestines have lymphoid tissue as part of the immune system.

    • Sometimes, B-cells grow abnormally in the lining of the GI tract, forming masses or ulcers.

    • If these cells look clonal (all the same) or atypical, it raises concern for lymphoma.

    2. Most Common: MALT Lymphoma

    • A common type of B-cell lymphoma in the stomach is MALT (mucosa-associated lymphoid tissue) lymphoma.

    • Often associated with H. pylori infection.

    • Chronic infection stimulates B-cells to grow uncontrollably.

    3. What Pathologists Look For

    • Immunohistochemistry (IHC) tests: show markers like CD20, which is on B-cells.

    • Light chain restriction: too many kappa or lambda chains suggest clonal B-cell growth.

    • Cell appearance: large, irregular B-cells may indicate high-grade lymphoma.

    4. Why It Matters

    • B-cell involvement may mean the patient has a form of gastrointestinal lymphoma, needing further tests like CT scan, bone marrow biopsy, or PET scan.

    • Early detection is important because some types (like MALT) respond well to antibiotics or immunotherapy.


     PICC INSERTION 

    TIME OUT WAS PERFORMED

    1. patient education 
    2. discussion plan of care and procedure risk and benefit
    3. consent 
    4. verified correct patient 
    5. correct site
    6. correct equitment

     


    Trisomy

     Trisomy is a genetic condition where a person has three copies of a chromosome instead of the normal two.

     Humans usually have 23 pairs of chromosomes (46 in total), 

    But in trisomy, one of those pairs has an extra chromosome—making it 47 total.

    For example:

    • Trisomy 21 is also called Down syndrome, where there are three copies of chromosome 21.

    Trisomy can cause physical, developmental, and health problems, depending on which chromosome is affected. 


    T21 stands for Trisomy 21, which is the medical term for Down syndrome.

    What is Trisomy 21?

    It is a genetic condition where a person has three copies of chromosome 21 instead of the usual two. This extra genetic material affects how the body and brain develop.

    Key Features of T21 (Down Syndrome):

    • Intellectual disability (mild to moderate)

    • Distinct facial features (flat face, almond-shaped eyes, small ears)

    • Low muscle tone (hypotonia) in infancy

    • Developmental delays

    • Higher risk of:

      • Heart defects

      • Hearing and vision problems

      • Thyroid issues

      • Leukemia (increased risk in children)

    Causes:

    • It usually happens by chance during the formation of reproductive cells.

    • Most cases are not inherited.

    Diagnosis:

    • Can be detected before birth with screening and diagnostic tests (like NIPT, amniocentesis).

    • Confirmed after birth with a karyotype test showing 47 chromosomes (an extra chromosome 21).

    Support:

    People with T21 can live long and fulfilling lives with proper medical care, early therapy, and family support.


    Moderate to deep procedural sedation for  Echo


    pre procedure plan of care -

    1. assess for barrier of learning 
    2. access for abuse or neglect 
    3. access for pain pre procedure check to be completed 
    4. patient education plan of care 
    5. patient education discharge care 
    6. prepare appropriately for procedure 
    7. prevent fall safety precaution

    intra procedure plan of care 


    1. vital sign 
    2. respiratory
    3.  oxygen requirement observe 
    4. observe skin integrity 
    5. infection prevention ( immunocompromised)

    post procedure plan of  care 

    1. access pain
    2. oxygenation status maintain
    3. hemostasis to be assess
    4. maintain treated 
    5. post sedation care 


    Tuesday, July 8, 2025

    What is Tuberous Sclerosis Complex?

     

    What is Tuberous Sclerosis Complex?

    TSC is a rare genetic disorder that causes non-cancerous tumors to grow in different parts of the body, especially the:

    • Brain

    • Skin

    • Kidneys

    • Heart

    • Eyes

    • Lungs


    ๐Ÿงฌ Cause:

    • Caused by mutations in the TSC1 or TSC2 genes.

    • These genes regulate cell growth. When they are mutated, cells grow uncontrollably, forming tumors.


    ๐Ÿง’๐Ÿป TSC in Children – Key Symptoms:

    • Seizures (common and often early sign)

    • Developmental delay or intellectual disability

    • Autism spectrum disorder

    • Skin findings:

      • Hypomelanotic macules (white patches)

      • Facial angiofibromas

      • Shagreen patches

    • Behavioral issues

    • Kidney cysts or tumors (angiomyolipomas)


    ๐Ÿฉบ Diagnosis:

    • Clinical exam + imaging (MRI, CT)

    • Genetic testing (TSC1/TSC2 mutations)

    • EEG for seizure monitoring


    ๐Ÿ’Š Treatment:

    • No cure, but symptoms can be managed:

      • Anti-seizure medications

      • Behavioral therapy / educational support

      • mTOR inhibitors (like everolimus) to shrink tumors

      • Regular screening for organs

    1. Tuberous Sclerosis Complex (most common in paediatrics)-TSC

     

    1. Tuberous Sclerosis Complex (most common in paediatrics)

    ✅ What is it?

    Tuberous Sclerosis Complex (TSC) is a genetic disorder that causes non-cancerous tumors to grow in different parts of the body, especially:

    • Brain

    • Skin

    • Kidneys

    • Heart

    • ๐Ÿง’๐Ÿป TSC in Children – Key Symptoms:

      • Seizures (common and often early sign)

      • Developmental delay or intellectual disability

      • Autism spectrum disorder

      • Skin findings:

        • Hypomelanotic macules (white patches)

        • Facial angiofibromas

        • Shagreen patches

      • Behavioral issues

      • Kidney cysts or tumors (angiomyolipomas)


      ๐Ÿฉบ Diagnosis:

      • Clinical exam + imaging (MRI, CT)

      • Genetic testing (TSC1/TSC2 mutations)

      • EEG for seizure monitoring


      ๐Ÿ’Š Treatment:

      • No cure, but symptoms can be managed:

        • Anti-seizure medications

        • Behavioral therapy / educational support

        • mTOR inhibitors (like everolimus) to shrink tumors

        • Regular screening for organs