Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
In what scenario, if any, would medroxyprogesterone acetate be preferred over micronized progesterone given the latter's better side effect profile and lower rate of DVT/PE?
Medroxyprogesterone acetate (MPA) would be preferred over micronized progesterone primarily in the case of a woman with a peanut allergy, as micronized progesterone is suspended in peanut oil. In that case, however, some physicians would prescribe micronized progesterone via a compounding pharmacy t...
What procedures do you recommend for patients interested in xanthelasma removal?
I have had success treating xanthelasma with both hyfrecation (particularly for very small lesions) and fully ablative laser (both CO2 and Erb-YAG).
What topical regimens do you recommend for redness related to rosacea in patients who defer laser treatments?
Naturally, laser is the most ideal and best solution. Green-tinted makeup is also a great adjunct. Aside from the usual routine counseling (avoidance of sun, food triggers, etc.), one product that I have found remarkable results with is the compounded SkinMedicinals ET-Rosacea Cream, which contains ...
Do you ever recommend the use of a Creatine Monohydrate supplementation to your patients looking to improve physical fitness?
Yes. I do recommend Creatine Monohydrate for patients/athletes hoping to gain strength and muscle mass. The current data is favorable for short bursts of strength or speed, but there is some growing evidence that there may be some benefit for higher rep/longer exertion and possibly for cognitive hea...
How do you counsel patients struggling to decide if they wish to pursue an invasive diagnostic procedure to confirm a severe illness with poor prognosis and/or limited treatment options?
First, I would reassure them that there is no right answer to this question. What we're trying to do is to come up with an answer that the patient can be psychologically at peace with. Second, I would begin to inquire about what we will do with the information, or, to put it differently, how the inf...
How do you counsel patients struggling to decide if they wish to pursue an invasive diagnostic procedure to confirm a severe illness with poor prognosis and/or limited treatment options?
First, I would reassure them that there is no right answer to this question. What we're trying to do is to come up with an answer that the patient can be psychologically at peace with. Second, I would begin to inquire about what we will do with the information, or, to put it differently, how the inf...
What is your approach to treating hypercalcemia secondary to immobilization?
My first approach is to have the patient become mobile if at all possible, even just increasing mobility in bed by doing leg and arm exercises, which can help, and getting up and walking is preferable if at all possible. Physical therapy is also helpful. I would make sure that the patient is well hy...
What ways can POCUS assist in volume status assessments in the clinic for patients who are unable to lie at an incline or get onto the exam table?
Good question. POCUS would assist with my assessment in a few ways (interpretation and application depend on comorbidities and pretest probabilities of certain pathologies). In someone with mobility issues, you can use POCUS to find the jugular vein meniscus and assist with JVP assessment. Additiona...
How do you decide when to recommend conservative kidney management over dialysis initiation in a frail older adult with stage 5 CKD?
This is definitely not a one-size-fits-all answer. Functional status and cognitive status, rather than age, are the most important considerations. The frailty syndrome itself is associated with poor outcomes for patients on dialysis. There is a clear association between kidney disease and frailty, w...
How do you decide when to recommend conservative kidney management over dialysis initiation in a frail older adult with stage 5 CKD?
This is definitely not a one-size-fits-all answer. Functional status and cognitive status, rather than age, are the most important considerations. The frailty syndrome itself is associated with poor outcomes for patients on dialysis. There is a clear association between kidney disease and frailty, w...