Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How do you recommend discussing family member genetic testing with a patient recently diagnosed with ADPKD?
Depends on the age of the family member (adult versus young adult versus under age 18). Depending on whether the "recently diagnosed" patient has had genetic testing, variant testing in the ADULT family member could be recommended in a straightforward manner through most testing companies. That pers...
How do you approach monitoring for lymphoproliferative disease in Sjogren's patients?
I have an increased index of suspicion for lymphoma, myeloma, and amyloid in Sjogren's. Increased age, longer disease duration, and greater disease activity increase the lymphoproliferative risk.Persistent unilateral parotid or other salivary gland enlargements, lymphadenopathy, vasculitis (purpura,...
Would you treat a patient aggressively for lupus nephritis if they have persistent proteinuria over 1 gram but cannot get a timely kidney biopsy?
It all depends. I would keep pushing for a biopsy and try to overcome the barriers ASAP. If it is the patient who is the barrier (not wanting the biopsy), I would educate them on how a biopsy ends up not even being due to SLE in some cases and immunosuppressant treatment therapy would be exposing t...
Is it safe to use quinacrine in SLE patients with a history of hydroxychloroquine-associated retinopathy?
To my knowledge, quinacrine, an anti-malarial, is not FDA-approved for use in the US. It may be obtained from compounding pharmacies but the FDA makes no assertions regarding either its safety or its efficacy. For lupus, it has been used primarily as adjunctive therapy for cutaneous disease, e.g. ad...
How do you utilize at-home seizure monitoring devices for your patients with epilepsy?
Absolutely! All video recordings are useful; home videos, cellphones, security cameras, etc.Benbadis, PMID 36891282
What is the optimal approach to treat isolated diastolic hypertension?
Isolated diastolic hypertension occurs less commonly in the adult population, where the majority of the outcome trials in hypertension have been conducted. Much of the treatment of hypertension in younger patients is extrapolated from these trials. In my practice, I look more closely for secondary c...
What recommendations do you offer for patients who have a peritoneal dialysis catheter and who wish to swim?
Exercise is an important part of health maintenance for all individuals, including those with ESKD requiring peritoneal dialysis (PD). Swimming is an excellent form of exercise for PD patients because it is not associated with increased intra-abdominal pressure, and is a low-impact aerobic activity ...
How often do you monitor the eosinophil count after initiating anti-IL5 therapy for HAE?
First, I monitor the eosinophil count to determine that the medication has reduced the numbers of eosinophils. Second, I do not have a regular (established) schedule for testing after that. I do usually obtain a CBC and diff at each clinic, namely about every six months. Third, I pay particular atte...
How would you confirm the diagnosis of splenic marginal zone lymphoma without utilizing splenic biopsy or splenectomy?
You can usually make the diagnosis by immunophenotyping of peripheral blood and bone marrow. The typical morphology of circulating cells is "villous cells"; cells with long cytoplasmic projections around the entire perimeter of the cell. The typical phenotype is CD20+ (bright), CD5-, CD10-, CD23- as...
What work up do you recommend in post bariatric surgery patients who are slowly gaining back the weight despite no changes in diet?
Depending on which surgical procedure they had and how long ago they had it, patients may need evaluation by their surgeon. Meanwhile, I approach these patients similarly to patients who have not had surgery. I look for reasons for their weight gain such as change in diet (even if patient denies it ...