There was a fair bit about bone scans today in the MPTS_hearing tweets:
Chair: Once hormones start follow up 3-6mths including physical assessments...bone age determination until final height is reached, that's overview of what endo does. What I wanted to ask you is this, did you offer that to patients A B or C when embarking upon endo treatment?
Dr W: In terms of doing bones scan or bloods?
Chair: In terms of ongoing overview Dr K links here, were you offering, you make decision as to what treatment to give & then is there is obligation to continue to monitor in way he is setting out,
Chair: what I'm asking you is did you offer that ongoing treatment when embarked upon hormone therapy? Or the opportunity to initiate?
Dr W: Yes definitely you can see my usual message to Pts was will follow up in 3 months,
Dr W: need to evaluate in terms of progress, satisfaction & also growth in terms of height, weight BP is needed. We did blood tests done by GP or if not GP private testing, so in terms of that was very easy to do, in terms of bones scans there's diff in GP than secondary care,
Dr W: when you're in a hospital setting you have everything at your fingertips, easy to send Pts down corridor. In GP were more used to doing scans & X rays when we need to know specifics. That would have been done as needed basis, in terms of, 2 reasons why might do bone scan
Dr W: one if bone density & important if you're on blockers for some time because by adding in hormones you negate need for scans, looking at guidelines for primary care UCSF their recommendations for bone scans is different to endo soc & reflects accessibility to those.
Dr W: In primary scans would refer to dexa scan. In terms of bone age I respect that's what Dr K does in his clinic a& Prof B did bone age on Pt A, it's almost, it doesn't impact on your care at all, if you look at primary care guidelines for managing condition it's not required.
Dr W: Only Dexa is mentioned in endo society guidelines in relation to bone density rather than predicted high.
Chair: Your answer is you would follow appropriate guidelines, from California as to what is necessary, & you would've been capable by yourself
Chair: or medium of others to carry out necessary checks to monitor treatment?
Dr W: Endo checks are blood tests & radiological tests are scans & X-rays. Didn't arise in thees 3 Pts but I know mothers would say they do bone scan at GIDS & we would talk about the merits & timing
Dr W: if someone needed it then either would ask for GP to arrange or use private hospital & radiologist would report on result. in my work as sexual health Dr with Pts on long term Progesterone this would be something we'd check
Dr W: There was never need to refer but discussion & requests were discussed many times
Chair: Those are questions from tribunal, just seeing If questions arising from our Qs, SJ?
SJ: Chair there are, I note time I have few questions, happy to deal with now or after lunch,
......
SJ: Prescribing to address delayed puberty - you said this in answer to studies 'why is it safe to prescribe in tran context' you said there is lack on longitudinal studies, studies in adults who've been using these longer.
SJ: You say clinical consensus is best practice. Is this what you said?
Dr W: Clinical consensus and best practice is what we should use, this comes from WPATH guidelines, I can go to it if you wanted?
Dr W: it uses sentence 'based on available evidence and expert clinical consensus recommendations are made'. so that's a smaller sentence, that's what I was referring to. In terms of Dexa scans, the need to refer for Dexa scans from parents didn't arise