Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Would you consider switching choice of P2Y12 inhibitor for patients with ISR (non-ACS presentation), with acceptable bleeding risk?
There is no need to change P2Y12 inhibitor in case of ISR without ACS. There are no studies that suggest such approach is indicated or can be helpful. Also, patients are taking their current P2Y12 inhibitor for a while and they are used to the medications. Changing the medication can raise cost with...
How do you apply the CDC PrEP guidelines for cisgender women, particularly when faced with underreported risk behaviors or uncertain partner HIV status?
This can be quite difficult, especially in places like where I live in Texas, where PrEP literacy is low. There is still a lot of education that needs to take place in the community about how HIV is still a threat that you can do something about, particularly for women. On a global basis, getting th...
Do you recommend avoiding ESAs in pregnant patients with anemia of chronic kidney disease who also have preeclampsia?
Yes
What are your strategies for safely prescribing peritoneal dialysis for patients who have pets at home?
Pets are an important part of many people's lives, giving comfort, joy, relaxation, companionship, and even providing opportunities for exercise - therefore we should not exclude patients from home dialysis simply due to the presence of pets in the home. Some key strategies to help reduce PD complic...
When do you begin antifibrotic therapy for a patient with newly diagnosed ILD that is not IPF?
The evidence behind starting anti-fibrotic therapy for non-IPF ILD is largely based on the results of the INBUILD trial where patients who have non-IPF ILD who demonstrate progression (based on at least a 10% decline in FVC or a 5% decline in FVC with worsening symptoms or radiologic progression) ha...
What pentoxifylline and vitamin E dose do you typically use for both the prevention and treatment of radiation-associated fibrosis after breast RT?
Pentoxifylline 400 mg three times daily and Vit E 400 iU once daily.In a small retrospective review, tolerance to Pentoxifylline was improved with the use of concurrent antiemetic therapy. Of those on antiemetic therapy, 89% completed pentoxifylline as prescribed versus 48% of those without antiemet...
If you have clinical suspicion for a paraneoplastic process (e.g. dermatomyositis or pemphigus), what work-up do you pursue?
This continues to be a topic of high interest. The first-ever evidence and consensus-based recommendations were recently drafted by an expert international committee under the auspices of the International Myositis Assessment and Clinical Studies (IMACS) group (in preparation). These recommendations...
Is there a role for prophylactic Trental and vitamin E in a patient at high risk for osteoradionecrosis?
Probably not
Would you consider anticoagulation for a young patient with a recent embolic stroke and newly diagnosed global cardiac hypokinesis with ejection fraction of less than 25%?
Yes, I would consider anticoagulation but the evidence is indirect. There is reasonable data in persons with heart failure with reduced ejection fraction that ischemic stroke is reduced with anticoagulation compared to antiplatelet therapy alone. But essentially all large RCTs are limited in that th...
How would you approach potentially tapering maintenance mycophenolate mofetil in a patient with a history of class IV LN that has been in remission for >5 years?
I would tell her, absolutely, and I'm sorry I did not consider this 2 years ago after being in remission for 3 years. ;-) I then proceed to explain the options and make a shared decision-making process. CHOICE 1 (my recommendation): A significant enough lupus nephritis patients are not in true patho...