Estrogen for a 90-year old...who is a smoker?
New patient to me, brought in by family after moving here from out of state. Was living on her own but her family had heard she had a few falls and wanted her closer, so she is now changing over to my practice.
She has always been a small woman, now is pretty frail, BMI 17, has had a gradual weight loss the last few years. This is not new to them, they tell me it is partially attributable to a jaw surgery in 2019 or so and so she has needed pureed diet ever since. Exam was OK, a little bit slow to rise from chair and her gait is a bit slow, she is using a walker. She is pleasant and conversant, relates most of her history herself, MMSE was fine, 26/30.
Her history is pretty unremarkable except she is on once monthly injectable B-12. Her only other medication is also once monthly injectable estrogen. I asked why, they are not clear. She thinks it has been prescribed to her for around 60 years, since Hyst at around age 30.
Oddly, she and daughter were adamant this "cannot be stopped" since when she "gets low" she has "had seizures." They don't recall details of these episodes, just that she had seizures and they told her that her "estrogen was low...." Also they tell me that her primary doc back home said she "cannot get too low" so has continued to prescribe it.
Oh yeah, did I mention she is a 1/2ppd smoker?
Wut?
I have no records, so cannot find out the former doc's reasoning, but will try to call their clinic and hope for a convo. Regardless, I am kinda perplexed here... Anyone seen this before? Any reason to continue this? I am willing to admit my blind spots so if there is a reasonable explanation I'm all ears...?