Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How long do you continue PJP prophylaxis in a patient with GPA who is able to wean steroids and remains only on rituximab for maintenance therapy?
Great question! For my ANCA patients and the OSU vasculitis clinic, we leave them all on Bactrim for the life of the disease. Less about PJP, and more about helping minimize infections due to the sinus and respiratory inflammation creating a nice environment for bacteria to live. Also, there is some...
What is the preferred approach to managing non-occlusive or partially occlusive venous sinus thrombosis?
I would recommend a DOAC, particularly apixaban, with follow-up imaging in 3 months.
Is vaginal delivery safe in patients diagnosed with pseudotumor cerebri (IIH)?
This is a challenging situation. Unfortunately, both acetazolamide and topiramate are relatively contraindicated due to potential teratogenicity. Probably the most effective treatment is weight loss, just like with non-pregnant patients. However, this is easier said than done, especially in pregnanc...
Would you consider the use of doxycycline or minocycline in the management of RA?
When faced with an issue of a TNF side effect or an infectious complication, I have used minocycline for the management of RA. This is based on an observation of minocycline’s effectiveness in early RA. A patient of mine developed optic neuritis while administering adalimumab, and Opthalmology (appr...
Is there a role for biologics to help patients with ABPA who are steroid responsive and have removed their allergen insult, but continue to have an elevated serum IgE and incomplete resolution of symptoms return to their baseline functional status?
We have a fairly large number of ABPA patients on Omalizumab. It works great. One of the issues we frequently encounter is that ABPA patients sometimes have too high of IGE counts for the approved highest Omalizumab dosage. In these patients, we initially treat them with standard prednisone therap...
Would you start osteoporosis treatment in patients with low FRAX scores but have T scores lower than -2.5?
It is a good question and it does depend on what is contributing to the FRAX score. If it is due to being on medications like prednisone or having a strong family history for early-onset fractures, it is reasonable to consider osteoporosis therapy. Age is also a significant factor. For the same bone...
Is a history of coronary artery disease and afib a contraindication to using donepezil?
No.
In a pregnant patient with scarring alopecia (LPP or CCCA), what treatment options are available?
For LPP, LLLT is a good option in pregnancy, also topical and intralesional steroids can be used. For a very severe case, I would discuss Plaquenil with her OGB. For CCCA, topical and intralesional steroids.
When do you refer pediatric patients with eczema to an allergist?
I refer concerns about immediate-type hypersensitivity symptoms (e.g. anaphylaxis, rhinitis, or asthma) to an allergist. Eczema is delayed-type hypersensitivity from contact with an inorganic or a protein allergen. Many dermatologists and allergists perform extended patch testing for these contribut...
When would you repeat a kidney ultrasound with post void residual measurement for a patient with chronic kidney disease from bladder outlet obstruction who is started on tamsulosin?
This is more of a urology question but I would think you have to wait at least six months to see a difference. In either case, I am not sure if an ultrasound is necessary. I usually just go by symptoms.