Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
What are some explanations for the persistent renal outcome disparity gaps affecting certain minority groups of patients with pediatric SLE despite improvement in overall renal outcomes?
There are likely some genetic causes, for example, Blazer et al., PMID 33461980 have shown in a Ghanian cohort of patients with SLE that apolipoprotein 1 risk variants are associated with progressive renal failure. However, it is undeniable that in the US, children in minoritized groups are dispropo...
What dose do you provide of folic acid in pregnant patients with epilepsy?
I recommend all people of child-bearing potential take 1mg folic acid. If they are taking a prenatal vitamin, are really opposed to taking another vitamin and are not actively trying to become pregnant, I'm ok with the 800mcg included in most standard PNVs. Once they are trying to conceive, however,...
What treatment do you recommend for patients with meralgia paresthetica?
I recommend the following: Weight loss. Better control of sugar if the patient is diabetic. Avoid wearing tight belts or clothing. Sleep on the other side. Rule out inguinal hernia or focal gynecologic problems. Consider using a Lidocaine patch or, if not covered by insurance, a cream. Nerve blocks...
Do you recommend prophylactic anticoagulation to pregnant women undergoing chemotherapy for breast cancer?
It is a very interesting thought but no, to my knowledge, there is no data to support anticoagulation of pregnant women receiving chemotherapy for breast cancer, and it is not a standard practice nor is it part of the guidelines around treating breast cancer in pregnancy.
How would you approach the management of a patient with a new diagnosis of cardiomyopathy in pregnancy without clinical signs of heart failure?
This is a great question. I think the timing of the cardiomyopathy and if it was incidental (although not sure why you would check an echo if there were no symptoms).Peripartum CM is a difficult entity to manage. In some cases, the optimization of patients with GDMT is limited due to post-partum bre...
What lab monitoring do you perform for patients taking isotretinoin?
I am a lab minimalist. I do ALT(past months have eliminated the AST) and fasting TGs at the start. Then at month 2 or max dose 1 mg/kg, I check ALT and fasting TGs. If there are any elevations at baseline, will check at month one which is usually 0.5mg/kg for me, and then month 2 (at the max dose) a...
What therapies have you found most effective for treating lower extremity DSAP?
I have had patients improve significantly with niacinamide 500mg po bid, and/or topical cholesterol/lovastatin. I have not had significant response to PDT.
What is your approach to leflunomide and statin use in RA patients?
Caution is advised if leflunomide or teriflunomide must be used in patients who are currently receiving or have recently received treatment with other hepatotoxic agents, such as statins. Liver enzymes (ALT, AST, and bilirubin) should be measured prior to initiation of leflunomide/teriflunomide ther...
What recommendations do you make for patients with lower abdomen eczema from nickel in their belt buckle?
This is a common clinical scenario in the United States as there are no legal limits on the use of nickel in objects in contact with the skin. Belt buckle dermatitis on the lower abdomen is almost pathognomonic for nickel allergic contact dermatitis (ACD). There are several consumer test kits to det...
How do you counsel patients regarding contraception use while taking mycophenolate/mycophenolic acid?
There are some data that mycophenolate mofetil may decrease the effectiveness of oral contraceptives. In patients who are taking MMF and taking oral contraceptives as their form of contraception, an additional form of contraception is preferred. However, this is not an absolute recommendation. Mycop...