Nurse Practitioner Chronicles

  Fatigue Workup in Childbearing Women: Not a Fishing Trip Four tests. That’s the starting line: CBC, ferritin, TSH, pregnancy test. Not a 30-tube rainbow draw. “I'm just so tired all the time.” It's one of the most common complaints in primary care, and in women of childbearing age, the differential is simultaneously broad and predictable. The temptation is to order everything—a CMP, CBC, iron studies, B12, folate, vitamin D, cortisol, ANA, Lyme, EBV, celiac panel, ferritin, TSH, free T4, testosterone—and hope something lights up. That's not a workup. That's a fishing trip. And fishing trips catch incidental abnormalities that generate more tests, more anxiety, and no answers. This post makes the case for a disciplined, stepwise approach. The Core Four: Start Here, Every Time The First-Line Panel CBC : Anemia is the most common lab-identifiable cause of fatigue in this population. Look at hemoglobin AND MCV (microcytic = iron deficiency until proven otherwise). Ferriti...

  Tumor Markers in Primary Care: When to Order, When to Step Away, and Why Screening Causes More Harm Than Good PSA, CA-125, CEA, AFP—the tests that cause the most unnecessary panic in your practice. Tumor markers are among the most misused tests in primary care. They get ordered for vague abdominal pain, pelvic discomfort, fatigue, or "just to be thorough"—and then a mildly elevated result triggers imaging, referrals, biopsies, and patient anxiety for a condition that doesn't exist. The core principle:  tumor markers are for monitoring known cancers, not for screening asymptomatic patients  (with limited exceptions). The Markers: What They Do and Don't Tell You Marker Primary Cancer Association Non-Cancer Causes of Elevation Role in Primary Care PSA Prostate cancer BPH, prostatitis, recent ejaculation, bike riding, UTI, age Screening (shared decision-making for men 55–69); monitoring after treatment CA-125 Ovarian cancer Endometriosis, fibroids, PID, pregnancy, menst...