Primary Care
Physician perspectives on preventive care, chronic disease management, and evidence-based primary care practice.
Recent Discussions
What additional workup would you perform to evaluate a new onset of spontaneous hemarthrosis?
The workup that you've outlined is essentially complete. Would rule out any possible medication/supplement effects, Would consider the possibility of a vascular fragility syndrome (EDS) or other connective tissue disease, Would rule out vitamin C deficiency, If there is other bleeding that clinical...
How do you manage patients with chronic migraine as well as medication overuse headaches?
I agree with Dr. @Dr. First Last about the treatment for chronic migraine and MOH for patients on opiates and/or barbiturates. If they are taking frequent opiates, I prefer to have a pain management doctor detoxify them. In the past, I slowly decreased their medication while giving them long-acting ...
How do you manage patients with chronic migraine as well as medication overuse headaches?
I agree with Dr. @Dr. First Last about the treatment for chronic migraine and MOH for patients on opiates and/or barbiturates. If they are taking frequent opiates, I prefer to have a pain management doctor detoxify them. In the past, I slowly decreased their medication while giving them long-acting ...
Do you still consider propranolol first-line for sinus tachycardia in thyroid storm, or have newer perspectives on beta-blocker risks altered your management?
Yes, but...Propranolol remains the first-line option for thyroid storm, but recent evidence supports that beta-1 selective agents (metoprolol, atenolol) are equally effective and may be preferred in certain clinical contexts. The choice between propranolol and cardioselective beta-blockers should be...
How do you manage/treat acute radiation-induced enteritis?
I have no problem with the excellent comments already made. However, I think it is important to add some comments. First - one needs to be sure that the patient truly has radiation enteritis. Many patients receiving abdominal radiation therapy have other issues that need to be explored first. For ex...
How do you approach the use and interpretation of the FDA-approved plasma pTau181 blood test for Alzheimer's disease in a community-dwelling older adult with subjective cognitive complaints and a normal cognitive screen?
I follow current guidelines, which recommend against testing in those without objective cognitive impairment, given the high rate of false positives. Unless the pre-test probability is high, I would not test. That having been said, future developments (such as subQ modes of anti-amyloid Rx, greater ...
How do you approach the use and interpretation of the FDA-approved plasma pTau181 blood test for Alzheimer's disease in a community-dwelling older adult with subjective cognitive complaints and a normal cognitive screen?
I follow current guidelines, which recommend against testing in those without objective cognitive impairment, given the high rate of false positives. Unless the pre-test probability is high, I would not test. That having been said, future developments (such as subQ modes of anti-amyloid Rx, greater ...
How long do you treat retroperitoneal fibrosis with immunosuppression?
I normally treat for 9 months to a year depending on response. I have found PET CT useful in determining if there is active ongoing inflammation.
What is your approach to using pegloticase in patients with congestive heart failure?
Clinical trial data show developing CHF exacerbation in 2% of patients while on Pegloticase treatment, while real-world data show higher numbers (6.4%), so careful patient selection and stabilization of CHF are necessary before starting treatment, and need close monitoring while receiving treatment....
How do you manage incidentally found venous sinus thrombosis?
I would make sure first that it is not simply a congenitally small sinus. If there is truly a CVST, I would probably treat with a DOAC for 3 months and reassess with CTV.