Hospital Medicine
Physician discussions on inpatient care, transitions of care, diagnostic reasoning, and hospital-based protocols.
Recent Discussions
In a patient with selective IgM deficiency who is completely asymptomatic in terms of infections, what is your typical laboratory work up?
B cell phenotyping, lymphocyte subsets, IgG to diphtheria, tetanus and S pneumonia. Evaluate the humoral function, as it is important to know and possibly follow with time, but with an asymptomatic treatment is not warranted.
What is your approach to patients requesting prescription sleep aids, such as trazodone, quetiapine, or olanzapine, at discharge after they have found them beneficial during a prolonged hospitalization?
I don't see the harm in continuing a patient on trazodone or melatonin on discharge until they see their PCP, if they were benefiting from it in the hospital. For example, if you see a dementia patient with sundowning and have helped them sleep peacefully with trazodone, melatonin, or low-dose Remer...
How do you manage neurocognitive decline associated with chemotherapy (i.e. chemo brain)?
I agree with @Dr. First Last's detailed response. Practically speaking, I would also add that it is important to listen and validate your patient's concerns and respond to their frustration and sense of loss. A diagnostic evaluation will not only help you and your patient discover or 'rule out' othe...
How do you screen (imaging, modality) for bone density changes following oncologic treatment in childhood cancer survivors?
Certain survivors of childhood cancer are at risk for reduced bone mineral density, especially those exposed to extensive corticosteroids or radiation, hypogonadism, growth hormone deficiency, and those who have had reduced weight-bearing/mobility for an extended period of time. It is important to s...
What resources/ancillary staff do you utilize for school re-entry after cancer treatment to decrease anxiety, improve self-confidence, and support emotional functioning?
Facilitating school re-entry for children and adolescents undergoing cancer treatment is an important component of comprehensive care. Maintaining engagement in school can help preserve a sense of normalcy and mitigate feelings of isolation and loneliness. However, the transition back to school may ...
What is your approach to management of elevated liver enzymes in patients who recently started treatment with tocilizumab?
This is an important concept because anyone using tocilizumab will eventually wrestle with this question. The question, though, does not tell you whether this is the first time a practitioner sees the liver enzyme elevation, or how high the liver enzymes rose. Since everyone should have had a lipid ...
How long do you anticoagulate for cirrhosis patients who have portal vein thrombosis extending to the mesenteric veins?
I recommend indefinite anticoagulation for most patients with portal vein thrombosis, and at least 3-6 months if there are risk factors for bleeding. Once they complete anticoagulation for the first 6 months, I re-evaluate their risk of recurrent thrombosis vs bleeding, and if there is an underlying...
Do you prescribe respiratory muscle training (RMT) devices to patients with dysphagia?
We encounter dysphagia frequently in our patients with Parkinson's disease and other movement disorders. If there are any concerns about swallowing or aspiration, my first step is to refer to Speech Therapy for evaluation, and I defer to their expertise for specific treatments from there. That said,...
Do you ever use Joyrnavx in a patient with end stage liver disease?
I have not encountered this novel oral small molecule medication Suzetrigine for the management of acute moderate to severe pain (FDA approved indication) in my patients with cirrhosis. The drug received FDA approval in Jan 2025 after two phase III trials where it was used for pain control after b...
Do you ever use Joyrnavx in a patient with end stage liver disease?
I have not encountered this novel oral small molecule medication Suzetrigine for the management of acute moderate to severe pain (FDA approved indication) in my patients with cirrhosis. The drug received FDA approval in Jan 2025 after two phase III trials where it was used for pain control after b...