Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
In asymptomatic patients with unfavorable intermediate risk prostate cancer and a PSA <10, how helpful/reliable and clinically useful is bone imaging?
Bone scans amazingly are still something we discuss, and I imagine when we look back in 5 years at this question (at least I hope), people would think it is unthinkable to order a bone scan for intermediate risk with PSA <10 (let alone in localized PCa) instead of MRI and/or PSMA PET/CT.10 years ago...
How do you counsel a woman with a BRCA1 VUS with a high-risk personal history of breast cancer?
There is real harm to patients by ‘acting’ on the presence of VUS in BRCA1; the majority are reclassified as benign. For those who have access to genetics resources, it is very helpful to discuss these results with certified genetics counselors, and formal post-test counseling for patients is recomm...
How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?
Great question! For my ANCA patients and the OSU vasculitis clinic, we leave them all on Bactrim for the life of the disease. Less about PJP, and more about helping minimize infections due to the sinus and respiratory inflammation creating a nice environment for bacteria to live. Also, there is some...
What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?
I would recommend a DOAC, particularly apixaban, with follow-up imaging in 3 months.
Is vaginal delivery safe in patients diagnosed with pseudotumor cerebri (IIH)?
This is a challenging situation. Unfortunately, both acetazolamide and topiramate are relatively contraindicated due to potential teratogenicity. Probably the most effective treatment is weight loss, just like with non-pregnant patients. However, this is easier said than done, especially in pregnanc...
Would you consider the use of doxycycline or minocycline in the management of RA?
When faced with an issue of a TNF side effect or an infectious complication, I have used minocycline for the management of RA. This is based on an observation of minocycline’s effectiveness in early RA. A patient of mine developed optic neuritis while administering adalimumab, and Opthalmology (appr...
Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?
We have a fairly large number of ABPA patients on Omalizumab. It works great. One of the issues we frequently encounter is that ABPA patients sometimes have too high of IGE counts for the approved highest Omalizumab dosage. In these patients, we initially treat them with standard prednisone therap...
Would you start osteoporosis treatment in patients with low FRAX scores but have T scores lower than -2.5?
It is a good question and it does depend on what is contributing to the FRAX score. If it is due to being on medications like prednisone or having a strong family history for early-onset fractures, it is reasonable to consider osteoporosis therapy. Age is also a significant factor. For the same bone...
Is a history of coronary artery disease and afib a contraindication to using donepezil?
No.
In a pregnant patient with scarring alopecia (LPP or CCCA), what treatment options are available?
For LPP, LLLT is a good option in pregnancy, also topical and intralesional steroids can be used. For a very severe case, I would discuss Plaquenil with her OGB. For CCCA, topical and intralesional steroids.