Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
What is your calcium level threshold for initiating targeted calcium lowering therapies for patients with an acute kidney injury believed secondary to renal vasoconstriction and volume depletion?
Treatment of hypercalcemia should be based on the severity of the symptoms rather than any arbitrary calcium level threshold. Therefore, if the AKI is due to hypercalcemia-induced renal vasoconstriction and volume depletion, then the hypercalcemia should be treated.
Do you recommend checking anti-drug antibodies for patients on TNF inhibitors?
This is a very good question with direct clinical practice implications. I do not check or follow anti-drug antibodies when using TNF inhibitors for the treatment of rheumatoid arthritis or psoriatic arthritis. There are reports that suggest, on a group level, that these antibodies, if present, impa...
How do you determine which atrial fibrillation patients with a high thromboembolic risk and a contraindication for oral anticoagulation should undergo left atrial appendage occlusion?
If the contraindication is absolute, all high risk patients need to be informed about the availability of LAAO devices. If the patient cannot take an anticoagulant or antiplatelet for a short period after implant, an epicardial approach could be considered.
How soon after starting treatment for Takayasu arteritis do you decide on the need for any vascular interventions to manage chronic damage?
To answer this question, several elements need to be considered. As a rule of thumb, in TAK and large vessel vasculitis in general, it is recommended to perform vascular surgery at the time of disease remission to prevent complications during the surgical procedure and in the immediate postoperative...
What is the likelihood of recovery of parathyroid gland function for patients who underwent total thyroidectomy, found to have embedded parathyroid glands intra-operatively and then subsequently had them re-implanted into neck muscle?
Recovery of parathyroid function after total thyroidectomy in which parathyroid tissue was found embedded in the thyroid depends upon many factors. How many glands were found in the thyroid? Was the surgery extensive, and thus perhaps led to compromise of the vascular supply of the parathyroid gland...
For patients hospitalized with volume overload who improve after IV diuresis but have no prior outpatient diuretic regimen, do you routinely start a scheduled oral diuretic at discharge?
I do routinely start a scheduled oral diuretic at discharge, because to me, if the patient requires hospitalization for IV diuresis for a new diagnosis of heart failure, they will need a maintenance oral diuretic regimen to avoid readmission. How to choose an appropriate dose for the patient in fron...
How do you explain progression free survival to patients?
This is a really, really important question. I'd argue we often greatly undervalue the importance of communication with our patients and the impact the quality of our communication has on what they understand about their illness. I remember once having a long conversation with a patient where I outl...
How do you counsel older adults regarding the use of melatonin (dose and timing) for sleep-related problems?
Melatonin has a weak hypnotic (i.e., sleep-inducing) effect. It helps people to fall asleep but not to stay asleep. It is not effective in people with chronic insomnia, but it is perfectly safe in low doses (i.e., below 10 mg) and can be helpful for occasional problems with falling asleep. For sleep...