Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
What alternative antibiotics or other therapies do you recommend for patients with papulopustular rosacea and a tetracycline allergy?
PO Ivermectin and PO Niacinamide can be helpful. However, for antibiotics, anything works/is anti-inflammatory, but usually, I’ll do azithromycin.
How do you treat Raynaud's in patients with baseline low blood pressure?
These can be very challenging patients. I tend to try 2.5 mg amlodipine at night which they can often tolerate. If there is a component of anxiety or stress/emotion to the Raynaud's, particularly in primary Raynaud's, fluoxetine can be useful. Some patients can tolerate half-dose sildenafil (10mg TI...
How do you approach the diagnosis of erythronychia?
Erythronychia has a broad differential including inflammatory diseases (lichen planus), infectious diseases (verruca), and benign (onychopapilloma, glomus tumor), and malignant tumors (SCC, amelanotic melanoma). I approach erythronychia with history and physical examination including measuring width...
Are there concerns with using sulfasalazine in SLE?
A very practical question:1. Yes, there is a concern theoretically; but you can use SSZ in lupus patients in certain circumstances.Sulfonamides are divided up into antibiotic (abx) sulfonamides (like trimethoprim-sulfamethoxazole, TMP-SMX) and non-abx sulfonamides (e.g. furosemide, hydrochlorothiazi...
How do you re-stratify patients with a primary prevention ICD in need of a generator change if their LVEF has improved to >40% and they have not previously required any device therapies?
This is an important question on which there remains a lack of consensus. We had tried to address this through an observational study which was published a few years back:(Appropriateness of primary prevention implantable cardioverter-defibrillators at the time of generator replacement: are indicati...
How do you approach the workup of transverse myelitis without any abnormality on spine MRI?
If you are highly suspecting TM on clinical features, and other etiologies seem unlikely, then consider LP, checking labs (autoimmune, demyelinating, infectious, metabolic, etc), starting immunotherapy (if infection is unlikely, maybe check with Infectious Disease on that decision), and then in a fe...
How often do you monitor labs in patients taking methotrexate?
Lab monitoring for patients taking MTX should be based on a few key principles. It should be done at least on a quarterly basis, ie every 3 months, if the patient is prescribed a stable dose and does not belong to one of the higher risk categories for the development of toxicities. These risk factor...
Do you routinely prophylactically anticoagulate patients undergoing systemic chemotherapy outside of the perioperative period?
No, I don’t routinely advise prophylactic anticoagulation for outpatients with gynecologic malignancies while on systemic chemotherapy who have not recently undergone surgery. However, such treatment may be considered for gynecologic cancer patients who are at high risk for venous thromboembolic dis...
How do you manage patients blood pressures while on anti-angiogenic TKIs?
Advise patients to take BP daily, and inform us if the BP is high.
Should all patients with a remote history of immunotherapy, chemotherapy and/or radiation therapy have a baseline TTE regardless of ASCVD risk?
The current ASCVD risk assessment calculators we have available do not contain cancer-specific parameters and thus are inadequate for accurate assessment of a cancer survivor's risk of developing CHF and ischemic heart disease. If patients have received mediastinal radiation therapy or high-dose ant...