Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How do you counsel patients on preventing nail damage with constant pedicures/manicures and nail polish?
I recommend that patients avoid cuticle or pushing, which makes then prone to both acute and chronic paronychias. The acetone removal process for gel manicures thins the nail plate - this has been shown in scanning electron microscopy studies. There is mounting evidence that UV dryers used to cure...
What treatments have you found helpful in treating recurrent aphthous ulcers?
Recurrent aphthous ulcers can be tricky to manage and recalcitrant to multiple therapies. I usually start with colchicine and topical corticosteroids. If that fails I move on to thalidomide. I have found that therapies in-between are unsuccessful.
Would you continue warfarin anticoagulation in patients with unprovoked DVT if switching to low-dose DOAC is cost-prohibitive?
If switching to low dose DOAC is an option then could switching to ASA 81 also be an option? If not, I would continue warfarin as long as the patient has been able to maintain a therapeutic INR. I would not lower the INR range.
Does aerobic exercise lead to any change in ability to perform ADLs in patients with Parkinson's disease?
In this article, improvement in overall fitness was seen in patients in the aerobic exercise group. I could not find a scale that specifically looked at ADLs in this study.In a meta-analysis and systematic analysis published in NPJ Parkinson's Disease, authors found aerobic exercise had beneficial e...
What level of exercise do you recommend in patients with Parkinson's disease?
I recommend aerobic exercise for at least 30 minutes/day, 5 days a week. These recommendations are of course based on patient's physical ability. I usually advise using a stationary bicycle and if that is not possible, a recumbent bicycle for aerobic exercise. This way if there is bad weather or una...
How do you manage post radiation chronic vaginitis with bleeding?
Limit trauma to the area. No biopsies unless absolutely necessary. Can use vaginal packs on a short term basis (don't leave in too long). Transfusions if indicated. Can try a course of metronidazole, which can treat an anaerobic infection, but also is purported to have oxygen-mimetic properties. Thi...
Do you recommend any dietary modifications for patients with HSAN1?
HSAN1 is a hereditary autosomal dominant sensory and autonomic neuropathy caused by SPTLC1 or SPTLC2 mutations in the serine palmitoyl transferase enzyme. This enzyme is critical for proper formation of sphingolipids which are essential components of peripheral nerve axons. Mutations in the SPTLC1 o...
How do you counsel pregnant patients with myasthenia gravis?
I generally discuss an action plan with female patients considering pregnancy, particularly emphasizing the importance of managing MG symptoms beforehand. Evidence indicates that patients under good control before pregnancy usually remain stable throughout. Treatment for MG during pregnancy typicall...
Do you use prednisone in the management of patients with persistent respiratory symptoms following acute COVID-19 infection?
No, unless I note bronchial hyperresponsiveness on follow-up Pulmonary function tests (PFTs). What I've noted is a significantly high percentage of undiagnosed asthmatics who come into the light because of a more severe clinical course from covid. Use anti-fibrotics occasionally for fibrosis dependi...
How do you specifically counsel patients on conservative measures such as hand warming in the treatment of SSc associated digital ulceration?
While Raynaud’s is nearly universal in Systemic sclerosis, digital ulcerations occur in approximately 30% of these patients yearly and tend to recur, with 2/3rd developing another one despite the use of vasodilators. Irreversible tissue loss, osteomyelitis, gangrene, and amputation are unfortunate c...