Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
How do you manage calcium and vitamin D replacement in scleroderma and myositis patients with dysphagia and malabsorption?
Dietary calcium is a good choice. I recommended that my patients with dysphasia caused by scleroderma drink 2-3 glasses of skim milk daily. 8 ounces contain 300 mg of calcium which is highly bioavailable. It also provides a good source of whey protein that contains all the essential amino acids. Ano...
Other than B12 repletion, is there any further treatment or work-up indicated in pernicious anemia with positive parietal cell antibodies?
Pernicious anemia is an autoimmune disorder that can occur as a componet of multiple endocrine adenopathies, so evaluating the patient for thyroid, parathyroid, adrenal, etc. disorders is indicated both short and long term. More controversial is how to monitor the increased risk of stomach cancer as...
What treatment options do you recommend to patients with microstomia secondary to scleroderma?
Perioral and masseter botox 8U upper lip and 4U lower lip. 16U per masseter.
What dressings do you recommend for patients with hidradenitis suppurativa to help prevent friction and collect drainage from open areas?
My favorite is a dressing/garment called Hidrawear. It’s clothing made specifically for HS with pockets to hold bandages for drainage. Patients can pay out of pocket, but it is also covered by some insurances. Order forms are available through the website: https://hidrawear.com/ Otherwise, the pati...
What diet modifications do you recommend for patients with acne to help prevent breakouts?
I'm not too crazy about recommending a restrictive diet for acne patients but I always ask about protein shakes, whey, creatine and recommend a vegan powder if possible. Skim milk and low GLYCEMIC index diet if anyone is willing to change their behaviors.
What is your treatment approach for steroid-refractory necrobiosis lipoidica?
I have never had success treating NLD. I have seen rare spontaneous improvement over the course of several years however.
Do you offer anticoagulation to patients with prior antiphospholipid antibodies detected in pregnancy without a history of pregnancy loss or thrombosis?
I do not know what the risk of pregnancy loss is in a woman without a prior history of VTE or pregnancy loss. I am sure the risk is affected by whether the woman has an underlying rheumatological disease (SLE) and whether she has single positive vs. triple positive LAC. I recommend a baby aspirin on...
How do you approach Covid vaccine counseling in patients with rheumatic disease and history of pericarditis/serositis?
This response would be more specific to those with idiopathic pericarditis. I encourage it as long as there is no temporal relationship between any prior pericarditis and covid-19 vaccine the pt experienced. For example, another abstract presented at AHA.2022 was incidence of complications in rilona...
Do you commonly recommend oral minoxidil, dutasteride, or a combination of both for patients with androgenic alopecia?
Neither of these medications are approved for AGA, and treatment considerations are different in men vs. women. Oral minoxidil at low doses is very safe and generally well tolerated, and a great option for patients with irritation from topical use. It avoids potential side effects of finasteride, wh...
How do you treat episodes of profuse sweating in Parkinson’s patients?
By far most common situation is OFF-related hyperhidrosis, such as overnight OFF, and so this needs to be explored with patients paying close attention to when these things tend to happen and whether they correlate with motor worsening; trials of dopaminergic dose alterations could be considered and...