Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Do you routinely recommend diagnostic endoscopy for patients with persistent enterococcus bacteremia despite receiving adequate antimicrobial therapy and no clear nidus?
It depends. Did you do an echocardiogram to rule out endocarditis? Urine cultures were negative? Gallbladder ultrasound was negative? CT of the abdomen and pelvis with contrast was negative?Any other symptomatology that accompanied the recurrent episodes of enterococcus bacteremia that could help us...
How do you treat nocturnal leg cramps?
Nocturnal leg cramps are similar to daytime leg cramps, but stretching may be less convenient to use as a remedy, as sleep can be further disrupted. Treating and preventing leg cramps typically utilizes some combination of hydration and electrolytes but sometimes, medications can help. Consider the ...
In what population are you using tamoxifen or raloxifene for primary risk reduction of breast cancer in your practice?
I talk to all women about their individual risk for breast cancer. Beyond just family history of breast cancer, I talk about breast density (only identified on a previous mammogram) and other familial cancers. There are many different risk tools that can give you information about breast cancer risk...
In what population are you using tamoxifen or raloxifene for primary risk reduction of breast cancer in your practice?
I talk to all women about their individual risk for breast cancer. Beyond just family history of breast cancer, I talk about breast density (only identified on a previous mammogram) and other familial cancers. There are many different risk tools that can give you information about breast cancer risk...
Do you routinely check serum phosphorus levels after IV iron therapy?
I do not routinely monitor serum phosphorus levels after intravenous iron therapy if ferric carboxymaltose (FCM) is not being administered. At our institution, the top two formulary choices for outpatient use for iron repletion are iron sucrose and ferumoxytol, neither of which is associated with a ...
In what patient population(s) do you recommend RSV vaccination in adults 50-74 years old who would not meet the general age recommendation (>75 years old)?
For adults 50–74 years old who do not meet the routine age-based recommendation (>75 years), I would consider RSV vaccination for those at increased risk for severe RSV disease, consistent with guidance from the Advisory Committee on Immunization Practices (ACIP) of the CDC. In practice, this includ...
Should all patients diagnosed with B12 deficiency get a baseline EGD?
It is important to determine the cause of B12 deficiency. The majority of cases are due to pernicious anemia (atrophic gastritis and lack of intrinsic factor), I presume this question relates to that group. If there is another cause such as intestinal malabsorption or bacterial overgrowth, this does...
In patients with inflammatory bowel disease with low rectal cancer with planned proctocolectomy, would you consider creation of a pouch?
This is a very difficult case- are you speaking of Ulcerative Colitis or Crohn's disease? If UC - can consider pouch but really depends on the stage of the primary rectal cancer. If neoadjuvant chemoradiation is given, the likelihood of an ileoanal J-pouch functioning appropriately is low. Generally...
How do you screen for colon cancer in patients with Behcet syndrome with colonic involvement?
Behcet syndrome, unlike some other rheumatologic conditions, for the most part, has not been shown to increase risk of malignancies in patients. This may in part be due to the fact that the disease tends to get milder/less severe with time and treatment. As such, colon cancer screening should follow...
What role do you feel there is for antibiotics in the management of severe perianal Crohn's disease?
Without access to biologics you still should have access to a thiopurine. That has some efficacy and was all we had prior to biologics along with chronic antibiotics.