Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
What is your approach to tapering treatments for patients with bullous pemphigoid?
The tapering of medications in bullous pemphigoid (BP) primarily involves systemic corticosteroids, which are the mainstay of treatment. According to European guidelines, an initial dose of 0.5 mg/kg per day of oral prednisone is recommended for BP. Once disease control is achieved and the patient n...
Do patient co-morbidities impact when you prescribe oral jak inhibitors?
Great and pertinent question in our field. Autoimmunity doesn’t make me less likely to prescribe, actually more likely as there is plenty of case report and case series data on JAKi being used in a variety of autoimmune conditions. Certainly, dyslipidemia (think MACE), VTE risk, and malignancy risk ...
What is your approach to managing the initial acne purge while on isotretinoin?
Just start at a lower dose. Add prednisone if really needed. And please don't call it a purge.
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?