Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
Do you favor timely bronchoscopy for diagnostics over close surveillance in mildly symptomatic patients with CT findings suspicious for NTM infection who are not able to expectorate?
Yes, I do favor FOB to obtain BAL in symptomatic patients with suspected NTM.
Do you reduce the steroid regimen for patients with acute interstitial nephritis who have a high risk for developing side effects from glucocorticoid therapy?
No, generally not. AIN needs adequate treatment that isn't that long anyway. You could not treat and just stop the offending drug, but the long-term outcome is worse. I think you just need to treat and then taper.
Would you anticoagulate an SMV thrombosis caused by malignant obstruction in the setting of metastatic colorectal cancer?
Superior Mesenteric Vein Thrombosis is a rare phenomenon, within the category of Splanchnic thrombosis. While portal vein thrombosis is most often associated with cirrhosis (though also seen in many patients without cirrhosis), SMV thrombosis is more commonly seen in the context of either local prov...
What are some indications that might lead you to pursue a kidney biopsy in a patient with presumed diabetic kidney disease?
Rapid deterioration of kidney function Rapid worsening of proteinuria especially if there is severe nephrosis, hypoalbuminemia with edema Active nephritic pattern of kidney injury Virtually any other glomerulonephritis can happen on a background of diabetic nephropathy. So when suspicion for anothe...
What is your approach to recurrent asymptomatic bacteriuria in pregnancy for patients without personal history of recurrent UTIs or pyelonephritis?
There is a paucity of good data in this field. In my opinion: The data remain weak (after 70 years of study) that we should be screening for ASB in pregnancy in the first place (whether or not they have a history of recurrent UTI or pyelonephritis). However, guidelines generally agree that screenin...
Do you find adding fludrocortisone helpful in treating persistent hypotension in HD patients already on midodrine and without evidence of adrenal insufficiency?
That is not my practice. I doubt it would be helpful.
Would you avoid SGLT2 inhibitors in patients with urinary incontinence requiring incontinence briefs due to concern with genitourinary hygiene and risk for infections?
According to one our smart fellows "SGLT2i turns the urine into a sugary orange juice", so it should not be given at the time of UTI or in persons with high likelihood of UTI or prior recurrent UTIs. Additionally, under the real world scenario when eGFR<25 ml/min, dialysis initiation can likely be d...
How do you determine if a pyoderma gangrenosum lesion is “burned out"?
The first sign is it becomes much less exudative.
How do you reduce the risk of contralateral fracture in a patient with atypical femur fracture from prolonged bisphosphonate use?
While there are no published clinical trials treating AFF with anabolics, we have considerable experience taking care of AFF's. Between myself and two ANP's doing strictly bone health with a large group of orthos who manage a large percentage of fractures in the Phoenix valley, we unfortunately stil...
Do you correct the synovial fluid white blood cell count for red blood cells, and if so, is there a rough approximation/equation you use?
In a rheumatology practice, under most circumstances, there is no need to make a correction of the synovial fluid white blood cell count. The fluid is either translucent, transparent, or opaque and the count will help to establish the presence or absence of an infectious or inflammatory process and ...