Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Does growth hormone (GH) replacement therapy reduce the risk of fractures in patients with GH deficiency?
While long-term GH replacement in GHD individuals increased BMD (after an initial decline at 6 months point), I am not aware of any placebo-controlled study that convincingly showed an effect on fractures.
What medications are safe to use to treat major depression and/or anxiety in a patient with closed-angle glaucoma?
I would recommend that the patient be treated by ophthalmologists for closed-angle glaucoma before starting treatment with an antidepressant.
How long do oscillopsia and ataxia secondary to thiamine deficiency last after completing repletion?
I treated a patient with severe thiamine deficiency following bariatric surgery. I administered parenteral thiamine at a dose of 100 mg weekly. The diplopia resolved with the first infusion, but returned 5-6 days. She was continued on thiamine infusions weekly and her diplopia eventually resolved. I...
Do oral contraceptives lower bone mineral density in women with hypothalamic amenorrhea by lowering IGF-1?
I am not aware of a well done study in this regard, but oral contraceptives containing estrogen induce growth hormone resistance and may lower IGF-1, but the beneficial effect of estrogen on bone density would almost certainly outweigh any negative effects caused by lowering the IGF-1.
How do you approach the management of capmatinib induced edema?
I don't know that I can give a comprehensive approach to the edema associated with capmatinib, but I can give a couple of observations that I think may help practitioners. Dose reduction can help if other measures don't accomplish what is wanted. I have several patients in their late 80s and early 9...
Would you recommend continuing Accutane in a teenage female who has experienced a drop in calcium to 8.8 and reductions in albumin and protein levels one month into therapy?
I am curious to know why these labs were checked? And isn't 8.8 a relatively normal calcium level?
What is your experience with using dupilumab for alopecia areata?
Why would you use an unproven, off-label drug when there are proven and effective on-label drugs?
Do you perform routine interval screening for pulmonary fibrosis in individuals who have been identified through genetic testing as being at risk for developing pulmonary fibrosis but don't exhibit any signs or symptoms?
Screening for pulmonary fibrosis: Only "yes" for individuals with one or more family members with IPF and age >50 - HRCT findings of ILAs, fibrotic ILAs, or IPF will be identified in 20% of these individuals. No for all other individuals including those carrying various high-risk alleles such as M...
When following active surveillance paradigm, what PSA increase will trigger prostate biopsy?
When using PSA to aid in the decision to re-biopsy a patient on active surveillance, I think you have to consider that the non-malignant prostate tissue also contributes to the rise in the PSA and that there are limits to the accuracy of the test. In patients not known to have prostate cancer, a PSA...
Do you recommend immediate catheter removal or anticoagulating for a certain amount of time before removing the tunneled dialysis catheter of a patient with an incidentally found, asymptomatic thrombus at the end of the catheter that does not interfere with hemodialysis?
I agree with Dr. @Dr. First Last. Since this tunneled dialysis catheter (TDC) is functioning well, there is no urgency to remove it. Infact, removal runs the risk of dislodging the thrombus causing pulmonary embolism. I would provide systemic anticoagulation with a vitamin K antagonist (coumadin) us...