Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
What is your treatment approach to persistent chillblains lesions in the absence of systemic lupus?
In idiopathic chillblains/perniosis, I think treatment centered on lifestyle modifications is key. As this is a cold-associated dermatosis, counseling patients to wear warm gloves or socks and avoiding cold exposure is important. Beyond lifestyle modifications, I typically start with a high-potency ...
How do you approach screening for additional malignancies in patients with a history of CTCL?
There is no need to do anything out of ordinary. Usual age-appropriate cancer screening and skin cancer screening (many of these patients received light and radiation therapy) is sufficient. The rest should be guided by presenting symptoms. For smokers and other people with specific risk factors, th...
What is your approach to considering geriatric patients for complex PCI given their overall frailty and increased risk of complications such as bleeding and stroke?
I would do everything I could with respect to medical and lifestyle therapy for such a patient. They are at very high risk for a bad outcome in the cath lab.
How do you manage an elderly, high risk prostate cancer patient who refuses any local therapy?
In general, for patients who refuse treatment, I try to understand their goals and their fears. Often, elderly patients state that they are ready to die, and don't want to prolong their lives. If I think that treatment is likely to significantly improve the quality of their lives, I will explain why...
When would you consider initiating GDMT for new onset HF in the geriatric population?
I would always treat with GDMT but would start low and slowly advance watching for AE's.
What is a reasonable blood pressure goal for refractory HTN in the geriatric population?
Resistant hypertension is defined as a blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes taken at maximally tolerated doses, one of which should be a diuretic. Refractory hypertension is defined as uncontrolled blood pressure despite ...
Do you employ the use of noctournal oximetry to assess for a need for supplemental O2 in addition to auto PAP in patients with OSA who have not had an in lab CPAP titration study?
Nocturnal hypoxemia noted on ONO on CPAP doesn't qualify patients for supplemental oxygen. I usually check ONO on CPAP on symptomatic patients who are also on daytime oxygen to assess the adequacy of supplemental oxygen at night.
How do you approach the treatment of restless leg syndrome in pregnancy?
External leg compression device like home Scd’s can be helpful.
Do you pursue a malignancy workup beyond age-appropriate malignancy screening in patients with antibody negative necrotizing myopathy?
This is a great question that speaks to the nuanced (and still-being-elucidated) association between malignancy and the increasingly better sub-divided different autoimmune myositis subtypes:While anti-SRP and anti-HMGCR are the two myositis-specific antibodies (MSA) most closely associated with imm...
Do you pursue a skin biopsy or kidney biopsy in patients whom you suspect have X-linked Alport syndrome?
The approach to the diagnosis of Alport syndrome has changed over the past decade with heavier reliance on molecular genetic testing sometimes prior to or in lieu of tissue diagnosis, however, this is dependent upon many factors including insurance coverage and availability of electron microscopy. G...