Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Do you change your pre-operative insulin dosing when patients are NPO for surgery, but also just recovering from newly resolved DKA?
For patients immediately recovered from DKA (e.g., within 72 hours), my first priority would be to delay any non-emergent surgery until the etiology of DKA has been evaluated and (if possible) addressed and the DKA has been definitively resolved with conversion off of continuous insulin and resumpti...
What is your approach to managing patients with suspected osmotic nephrosis from monthly IVIG infusions?
If the patient develops IVIG-induced osmotic nephrosis, the current IVIG therapy should be suspended, and treatment of the AKI is supportive. If IVIG needs to be restarted once the patient’s renal function recovers, there are several preventive strategies that can be tried. The patient should be swi...
Are there any specific scenarios in which you calculate estimated creatinine clearance over eGFR in an older adult patient?
This would be something to consider for patients in whom there is a discrepancy between clinical manifestations and creatinine estimated eGFR, for patients at the borderline of CKD stages, and for patients with extremes of muscle mass (which would lead you to think that the eGFR is less accurate). T...
Are there any specific scenarios in which you calculate estimated creatinine clearance over eGFR in an older adult patient?
This would be something to consider for patients in whom there is a discrepancy between clinical manifestations and creatinine estimated eGFR, for patients at the borderline of CKD stages, and for patients with extremes of muscle mass (which would lead you to think that the eGFR is less accurate). T...
How do you approach using fecal microbiota therapy for recurrent Clostridioides difficile infection in immunocompromised patients?
We generally do not do the single donor FMT via colonoscopy, that was popular 5-10 years ago. We do offer both the oral and enema-based products, with a slight preference for the oral-based product due to ease of use.
How do you counsel patients regarding using stimulants for attention-deficit/hyperactivity disorder during pregnancy?
There is limited research evaluating the course of ADHD across pregnancy and postpartum. The individual woman’s severity of illness and impairment inform treatment decisions across pregnancy. As with the treatment of all disorders during pregnancy, the risks and benefits of medications need to be ca...
What patients with food allergies do you screen for EoE?
If a patient has symptoms of esophageal dysfunction, they should be screened for EoE. Because symptoms can be ill-defined in children, this may be more challenging. Growth failure, unexplained abdominal pain, or vomiting are indications for GI referral with consideration for endoscopy. Indiscriminat...
Should asymptomatic esophageal candidiasis identified incidentally on endoscopy be treated?
Yes, in our practice, we do treat asymptomatic esophageal candidiasis when found incidentally on endoscopy. A few things to consider: 1) While patients may be asymptomatic at the time of the endoscopy, untreated disease can lead to the future development of complications/symptoms, such as odynophagi...
What duration of antibiotic therapy do you use for a loculated parapneumonic effusion that does not meet criteria for empyema?
It would be great to see more prospective research in this area. I think we should be a bit more nuanced in our approach as it seems to be crude to recommend 4 to 6 weeks of IV antibiotics for every parapneumonic effusion or complicated pleural space. I think that in melding the IDSA and American As...
Do you offer IV iron first line to women with iron deficiency anemia from heavy menstrual bleeding?
I offer first-line IV iron because oral iron cannot keep up with the losses from heavy menstrual bleeding, and the majority can't tolerate it. I routinely give a gram of LMW iron dextran in one hour, Feraheme (not ferumoxytol generic) 1,020 mg in 30 minutes, or ferric derisomaltose 1 gram in 30 minu...