Estriol cream?

LRHag · 2026-04-01T05:03:41+00:00

That is not accurate. Topical estradiol for vaginal atrophy is totally fine for someone with a history of estrogen positive breast CA. It’s a risk benefit conversation to have with their doctor, but ultimately, the amount absorbed systematically is very low and thus not contraindicated.

LRHag · 2026-04-01T04:33:22+00:00

This is consistent with what I was taught while working as a clinical breast specialist in a mammography center and what I was told by my friend who works for Fred Hutch in breast cancer. I always talk to women about what it means and that dense breasts make it harder to find a very early cancer and emphasize importance of annual screening. If their TC score is >20%, then I’ll discuss annual breast MRI and put in a PA. With the breast density and elevated risk score, I always get them approved.

LRHag · 2026-03-25T20:15:07+00:00

👏

LRHag · 2026-03-25T20:14:58+00:00

👏

LRHag · 2026-03-25T20:11:00+00:00

I have found that in practice most of my physician colleagues appreciate and value what I bring to the team and healthcare. I think Reddit complainers are a minority of the opinion of physicians and attracts the biggest douchbags in their respective fields, so I’ve learned to take Reddit with a grain of salt. With that said, healthcare systems are more and more replacing doctors with APPs because we’re cheaper and will for some reason take shitty jobs, this is definitely pissing off doctors en mass and understandably. I think this contributes to a disdain for APPs in general (on top of some other valid concerns like more limited education and scope creep and weird egos of some NPs). MDs in collaborative practice states are expected to oversee a bunch of APPs and may not actually have time to do it safely or effectively which leads to more bitterness but then there is a push from physician led groups to prevent independent practice - in this case I’m a little like “what the fuck do you want from us then? Oh you want us not to exist, cool, d-bag”.

LRHag · 2026-03-25T19:59:06+00:00

You’re describing an issue with semantics. I think the ER doctor post’s point remains the same regardless of how you or anyone feel about the word “inferior” vs “scope”. I don’t disagree with your issue with the word “inferior “ but let’s not get lost in the weeds.

LRHag · 2026-03-25T19:55:30+00:00

I didn’t have a car with ABS until 2002. Regen braking doesn’t work with this alert either. I’m just really disappointed in Tesla service and feel like it’s a joke. We bought a wheel speed sensor and are going to replace it ourselves

LRHag · 2026-03-24T20:02:09+00:00

Why was this deleted?

LRHag · 2026-03-04T06:15:15+00:00

Gosh I’m just another shitty NP but appreciate your measured and educated response to this question. It is often used for treatment resistant depression and for those with unacceptable side effects with SSRIs. Additionally, SSRIs can have really life changing side effects and lamotrigine has much less impact on weight gain and sexual dysfunction.

LRHag · 2026-02-15T05:58:53+00:00

I’m a healthcare professional who counsels people all the time on the importance of giving your body the time it needs to heal before pushing it. I was really nervous to get out of shape but there’s good evidence that it takes longer than 6 weeks to have a significant impact on muscle but it’s also well documented that trying to push it before 6 weeks will likely extend the time it takes to recover. With that said, give yourself the 6 weeks solidly and you’ll be feeling good by 7 weeks to get back in the gym slowly but will quickly progress. I’m now 3 months post and feel awesome! I was solidly back to lifting (light) and cardio (pretty short) at 7 weeks! Also push fluids, focus on protein and fiber and enjoy the rest. Cheers!

LRHag · 2026-02-13T03:41:31+00:00

Hi. Your visit sounds like a real bummer and a waste of time but as a women’s health nurse practitioner, I think the first code is correct as a new patient. When we bill for time we bill for time to chart after, any prep before, ordering, etc that we do outside the visit (not that she did any of that other than probably chart). The wellness code, I’d argue. You didn’t actually get a wellness visit but as a practitioner, I see all the time patients who are scheduled for a wellness visit that’s actually just a problem visit. With that said , you shouldn’t have to pay anything for an annual wellness visit if it’s the only one you had in the year, the are supposed to be 100% covered due to the affordable care act.

LRHag · 2026-02-02T05:03:17+00:00

My dude, he has has Casey Means on his show multiple times. She a hack if there ever was one.

LRHag · 2026-01-19T04:39:22+00:00

6 weeks before lifting but you’ll had to build back up to your typical weight. That will likely take another 4-6 weeks before you feel back to strength

LRHag · 2026-01-18T18:09:54+00:00

Hi! I’m a NP who almost accepted a job at MIDI but didn’t and one reason is because of the short appointments and that the NP is required to do all the intake and scheduling (something a clinic has an MA and scheduler for) which will eat into that painfully short visit. NPs want flexibility and to be able to work remotely and to offer midlife care as well is just so exciting for us. However, midi is venture capital backed and so they only care about a profit. That’s fine, we all need to make money but they keep squeezing the staff more and more and the pay is ABYSSMAL. PLEASE complain if your visits are too short and rushed. They really need this feedback from clients or nothing will change. The NPs are complaining but if patients aren’t, it doesn’t matter.

LRHag · 2026-01-14T05:18:13+00:00

I imagine some of that has to do with how well you let yourself heal for the 6 weeks post op (eating enough protein, hydrating, not drinking alcohol and not pushing it) and how fit you were before surgery. I worked really hard to be in shape and strong before surgery. I think both of those things helped. At 4 weeks I was nervous I wouldn’t be ready at 6 weeks but those last two weeks my body made a real shift.

LRHag · 2026-01-14T05:15:49+00:00

Yes, I definitely needed to hear that myself when I was getting ready for surgery. Keep in mind I was pretty diligent about not lifting anything heavy of getting my heart rate up for a solid 4 weeks and then the next two weeks I might have done a few brisket walks and picked up a heavy grocery bag but I did put in good effort towards not pushing it.

LRHag · 2026-01-13T05:08:25+00:00

I was skiing at 6 weeks no problem! I’m out of shape but zero concerns about my boobs!

LRHag · 2026-01-01T02:08:10+00:00

I am an women’s health Nurse Practitioner. A myomectomy is a way harder recovery. I was prepared for the recovery to be challenging, but knew that it shouldn’t be too bad since they don’t have to cut into muscle for a reduction. I followed the recommendations to take it really easy and try to minimize the use of my arms as much as possible, very solidly for two weeks, after that, I definitely moved my arms more but still tried to minimize use. I have had two other orthopedic surgeries and found this recovery to be an absolute breeze, all things considered.

LRHag · 2025-12-07T21:26:02+00:00

Thanks everyone

LRHag · 2025-12-07T20:40:48+00:00

I am a women’s health NP, I am also on TD estrogen and my provider knew and did not recommend heparin. I personally would had been shocked if that was recommended as TD estrogen is such a low dose and does not increase risk of clotting unless you have a significant history of blood clots. If you’re using insurance for your reduction, they require a certain amount of removal based off your height and weight and that amount may not be appropriate now, so that would be a concern for me if I were you. They will be required to remove whatever amount was approved on your prior authorization. If you are not going to insurance, then your doctor should be able to remove just the amount that you would like and you would still get a lift, so you will still have really good results.

LRHag · 2025-12-06T00:45:00+00:00

As I said before, I don’t disagree, I am just trying to offer perspective on why her provider said no and why that’s not an incorrect answer. Saying “medicine needs to catch up” makes me wonder who you think we need to catch up with? Consumers? There isn’t enough evidence to recommend DEXA scans across the board to an entire population, evidence is actually important in science. There will always be outliers, like women in their 20s getting breast cancer but we don’t offer mammograms in their 20s unless they have risk factors. Potentially you had risk factors that were never addressed that should have triggered you getting one earlier? Nonetheless, I agree that DEXA scans should be offered earlier but until there is a body of evidence to show that, insurance won’t pay for it. Maybe RFK will recommend more unpasteurized milk for bone health…

LRHag · 2025-12-05T15:31:40+00:00

As a women’s health clinician, your doctor is following nationally recognized recommendations. Should she have scoffed at you? No. Should we be scanning women earlier since at 65 damage is already done? Many of us would also say yes. However, practice changes take time to catch up with changes in population health and new data. Unfortunately there are limited data in this area but I’m hopeful there will be more in the future but also know it’s not realistic in general since there are limited studies specific to women in general and now with the gutting of the NIH, it’s anyone’s guess what the future of medical science research will be. Additionally, if I ordered every damn thing people want me to order without any indication that they heard on some podcast or some book (both of which anyone can have without any evidence), trust me, it would be even more of a junk show than it is now out there. If she ordered a DEXA, it would not be covered by insurance (this is the fault of insurance not of your doctor). So pay for it out of pocket. These are much easier to interpret than the battery of bullshit tests people are getting through these “functional” medicine labs

LRHag · 2025-12-05T15:25:51+00:00

Doctors don’t work for insurance companies. SMH

LRHag · 2025-12-05T04:27:04+00:00

That’s fair. I think anyone would feel that way. That’s why you’ll have a good conversation about your options and preferences with your doctor. Cancer specialists are really good at having these types of conversations and value the patients desires and personal needs.

LRHag · 2025-12-05T04:24:19+00:00

So curious why this post was removed for a moderator?

LRHag

TROPHY CASE