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2nd PAP - still ASCUS - Interviewing new doctor - need list of questions

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Just got a call from the PA from my gyne/onc's office to say that my PAP came back again with abnormal cells (ASCUS).  She asked if I was having any problems.   I guess no one ever saw the intake nurses notes from my visit nor did they ask me when I was there at my appointment on November 15th.     (At my appointment, I had given a list of things)   But I said no because tomorrow I am interviewing a new doctor and I didn't want to get into with her.   She said that they will need to keep an eye on it and check it again in May.

So I am interviewing for a new doctor tomorrow.    I am trying to be smart with this and want to know certain questions.   Here are some of the questions I may ask:

1.  What is involved in your normal patient exams.  (is there an internal examination, breast examination, questioning, etc.)

2.  What kind of scans or tests are performed and on what time basis (yearly, etc.)

3.  Are you involved with any drug reps or are you promoting any drug companies?  (Can I ask this?)

4.  Are you currently involved with any studies of any kind?

5.  If a problem does arise, do you give the patient options or do you tell the patient "this is what you have to do".

6.  Are you retiring anytime soon.

 

What do you think of these and is there something I am missing?   I am not thinking straight because on Monday I found out I have pneumonia so I am on several medications.  (feel a lot better now)

I appreciate any ideas or comments.

 

Thanks!

Kathy

NoTimeForCancer
Posts: 405
Joined: Mar 2013

I bet the other women here are going to come up with more for the list - heck - it is something we ALL may need someday, but I don't have anything right now.

As far as you asking if you can ask Question #3 - it is legit and you have every right to know.

I will say I have interviewed enough people and I have always found the questions they asked of me (and my company) always told me what their previous issues/problems were. 

 

Hybridspirits's picture
Hybridspirits
Posts: 144
Joined: Nov 2012

you might also consider asking a high level question first on how would the dr treat your situation specifically.  Take good notes against your questions and if not addressed ask your questions.  This approach sometimes gets the information the dr might not give with specific questions. I ahve found that Dr's when given specific questions answer them but sometimes don't add other items thatyou don't want to ask.

Getting a conversation going also will tell you if you can communicate and work with this person as it is a partnership and there has to be trust and communication

good luck and thinking of you

Sharon

ConnieSW's picture
ConnieSW
Posts: 539
Joined: Jun 2012

I wish I could take YOU with me to my appointments.

ConnieSW's picture
ConnieSW
Posts: 539
Joined: Jun 2012

I hope this dr is the one who works out for you.  You sound very in tune with your body and it doesn't seem some of the others have given you credit for that.  Good luck.  I hope you find out more about ASCUS.  my reading only brings up more questions and my next appt isn't till Feb

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Connie:

 

I am still working on this.  I will let you know.   Take a look what I posted in Suzanne's post.

 

Kathy

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Sharon:

 

Thanks for the response.  However, I didn't even get to ask any questions.   Like I told Suzanna, I am such a FOOL!    I should have just walked out when I didn't get my consult which was what I had asked for in the first place.   I just went and lined up and did exactly what every patient there was doing.  Going in, getting exam, going upstairs for blood work, setting up next appointment.   I am mad at myself!

But thanks for thinking of me.   Moving on to the next one. 

 

Kathy

Hybridspirits's picture
Hybridspirits
Posts: 144
Joined: Nov 2012

I am real sorry  you are having so much difficulty finding a dr.  The key to this entire journey is clicking with the doctor so you can partner.  I am so suprised that these dr's don't listen to y ou. I go to every appt witha  big spiral notebook and they are so used to me with my questions.  After they go over the exam it is a ritual of okay shoot on your questions.  there has to be one out there that is compasionate.  My oncologist gives me a huyg every time i go.  As a matter of fact my gyno/oncologist does as well. 

I am glad you aren't giving up and moving to the next one. 

keep us informed and let me know if i can help out at all.   Just remember though you are your best advocate!

Sharon

laura25's picture
laura25
Posts: 157
Joined: Mar 2011

Hi Kathy,

I don't have anything to add but wanted to say I"m sorry you have to deal with this.   I love my Doctor but also found on my last 2 visits that he didn't spend the time with me that I felt he should.  Feeling like you are being pushed out the door and not reading your charts is unacceptable. 

I will be praying for you that all turns out well.

Double Whammy's picture
Double Whammy
Posts: 2267
Joined: Jun 2010

Kathy - Isn't ASCUS for cervical cancer?  Do you still have your cervix (I don't)?  Did you also have cervical cancer?  Or is ASCUS just a term for any abnormal squamous cells? 

You might add something like:  "Given my history of endometrial cancer and having already had one recurrence, should we be looking at this more aggressively or is a wait and see approach appropriate?  Why?"  "What further tests can be done to rule out other potential metastases while they might still be small enough to treat successfully"?  I would emphasize your symptoms and reiterate that they are consistent with those you had when your recurrence was detected X years ago.

Best of luck on this new appointment.  I hope this person will take the time to answer your concerns in a manner that you are comfortable with and if you are not comfortable with the approach she suggests, that she will be willing to consider options that would make YOU comfortable.  It's perfectly ok with me to be told "I told you so" by a physician.  It's much better than feeling dismissed. 

Another comment:  my husband was just diagnosed with prostate cancer.  He will begin radiation after the first of the year and starts hormone deprivation treatment this afternoon.   He's probably not going to die of prostate cancer, because like a lot of the "garden variety" uterine cancers, it's pretty slow growing, but the treatments are not going to be fun or something one would do for entertainment.  Given his high PSA score, and number of positive biopsy cores, it's speculated to be outside the prostate altho his bone scan didn't show anything.  The new guidelines and controversy is not to routinely do PSA testing in men on a regular basis unless they're symptomatic.  I'm sure cost containment plays into these guidelines because high numbers result in referrals and more expensive testing that is often not necessary.  Anyway, his new pcp ceased doing PSA screening 4 years ago because of these guidelines.  My husband was having urinary symptoms and has been obsessed by TV ads that something was wrong with his prostate.  He actually had to ask for both a prostate exam and a PSA test.  Bingo.  His PSA came back at 40.4 - the number needs to be under 4 and now needs to be zero after treatment.  This is an example of the one size fits all scenario not being a good thing.  We are all individuals and we know our bodies better than how our complaints are interpreted by our docs sometimes. 

I'll be looking for your next report.  Hope it's positive.

Suzanne

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Hi Suzanne:

 

I had a total hysterectomy, removal of cervix, etc.    Diagnosed with Endometrial Adenocarcinoma (in uterus, cervic and left ovary).   I am beginning to question the whole reason for the PAP since if the PAP comes back abnormal cells  (Atypical Squamous Cells of Undetermined Significance or ASCUS)  My Epethelial Cells are abnormal.    If you get this result, then they send it on for further testing of HPV.    If the HPV it is positive, I believe thats when they take notice.  Although they only test for certain strains of the HPV.   And if the doctors are telling me that becasue I had radiation, then the ASCUS result means nothing, then why even do the test?   However, the PA asked me if I was having any symptoms.   I have been but none were noted.    I also just got a copy of my most recent doctor visit and it says he did an internal exam on me - No way!    The stuff that was put on the notes were wrong!   I am going to call them on Monday.   My husband was in the room with me when that one was done.

 

On a different note, I went to see this new doctor yesterday.   I AM SUCH A FOOL!   I specifically scheduled myself for a consult.    After waiting for over an hour, I was called back.  They made my husband stay back.  I thought they would just ask a few questions and bring him back.   The nurse took some vitals and said that the doctor was going to do an exam.  I said but I am here for a consult    She says yes but he likes to do the exams.    She tells me to undress and I wait in the room by myself for 45 minutes.   The doctor comes in asks a few questions, does the exam and says I want you to have blood work done and PET/CT scan and see me in three months - THAT WAS IT.   My husband didn't get to meet him.  I didn't get to ask questions.   I am so mad at myself.   I am going to see what the blood test results are before I tell them to hit the road.   They were treating the spouses so bad there.   It is definitely not a place for me.

 

Thinking of your husband   I am glad the bone scan didn't show anything.  I don't always agree with only getting testing if there you are symptomatic.   Everyone isn't the same and I agree that one size doesn't fit all.

 

I'll let you know my newest doctor adventures!

Kathy

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Thanks Laura for your reply.

Look at the response I put in Suzanne's post.   Can you believe it?   I just can't get the right doctor!    I did have the right doctor but he moved to Texas!

 

 

ConnieSW's picture
ConnieSW
Posts: 539
Joined: Jun 2012

I am so furious  on your behalf that I am spitting.  Unbelievable that you were treated this way.  And ,of course, when this happens, we blame ourselves for somehow not being in better control of the situation.  Grrrrr.

Ann55
Posts: 42
Joined: Jun 2013

When you call the next physician try asking for a conferance visit instead of a consultation,they may think if it's a consultation they are suppose to do an exam and treat.

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Thanks Ann.   I will try to be very specific this time.

Also, Connie, exactly how I feel!!!   Grrrrrrrr! 

laura25's picture
laura25
Posts: 157
Joined: Mar 2011

Hi kathy,

Just checking in to see how you are feeling.

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Finally found a new doctor.  I saw him last Thursday.    Got another CT scan since insuarnce company once again refused a PET.   This time there was a  change in my CT from June showing minimal progression.   After a lengthy discussion with my doctor, they are going to do a study first for a PET/MRI - which is new.   I still have to get the PET scan approved first by the insurance company.   The MRI will be covered under the study.   I am scheduled for this for Friday if it all goes through.

I also had my mammogram.   It was fine.  It appears I am a Catagory 2.   It was also noted that I have a benign looking nodule in my right breast, but says I am good until next year.   (Although I kept indicating that it is tender so I will keep an eye on it).  

My new doctor says he will not do PAPs anymore.

I will let you know what happens!

Kathy

Double Whammy's picture
Double Whammy
Posts: 2267
Joined: Jun 2010

That's good, but I'm not happy about the "minimal progression".  Good luck with the scan on Friday.

I've learned to relax a little (just a little) about mammogram abnormalities.  My left beast (the one that didn't have cancer) feels like a bumpy rocky hill, yet there is "no evidence of malignancy".     BIRADS 2 just means they see something that isn't normal breast tissue, it doesn't mean it's cancer, and they note it so they'll be sure to look there next time and note any changes (like maybe it will be gone?).  Keep an eye on it for changes.  Breast cancer doesn't just sit there and not change.  Oh, and don't let them tell you breast cancer  usually isn't tender, because it can be.   If you're not comfortable, ask for a breast ultrasound.  If not satisfied, then a breast MRI.   Given your history, they'll probably grant your request.  They say 80% of breast lumps are not cancer.   When I was concerned about my left bresat (this was after breast cancer treatments on my right breast), my primary care ordered these tests for me (on my left breast) because she said she'd never forgive herself if she didn't - "given my history".  Nothing has changed in a few years, so I'm thinking this is just normal for me breast tissue.  I did NOT feel the lump in my right breast that was cancer. . . . .

Suzanne

Kaleena's picture
Kaleena
Posts: 1015
Joined: Nov 2009

Thanks for your input Suzanne!    I did have a biopsy on my left breast back in 2000  It was negative.   I was told then that I had fibroadenoma.   I think that what might be on my right breast. I can fee it.   It is close to my armpit.  It gets tender a lot and it seems to be right where my underwire bra sits.   I am not worried about it but I definitely have mentioned it when I get my gyne exams now.   Would that show up on a PET scan?    

The only reason I found out I was a 2 was that recently you can get your results online.  So instead of just getting a message that everything is normal, I got to read the actual report.   However, it doesn't say where in the right breast the nodule is.   I did get a recall last year, but I was told that they saw something near the nipple area.  But I will do as you suggested if it becomes bothersome by requesting further testing during this year.

How have you been?   I hope you have been doing fine.   Thanks a bunch!    Keep warm!  (It is going to 17 below here tonight!)    Sending warm thoughts to you!

Kathy

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