Advisor Forum

Clinical Practice: Then and Now

Clinical Practice: Then and Now

In tandem with our 20th anniversary, we at Clinical Advisor recognize the advances that have occurred in clinical practice over the past few decades and share the perspectives of members of our audience.

Medical Lessons Learned

Medical Lessons Learned

It is amazing to think of how much medicine has evolved as I've watched.

Auscultating and Palpating

Auscultating and Palpating

Close your eyes when auscultating or palpating.

Arthralgias After Cancer

Arthralgias After Cancer

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Pam was a 54-year-old woman who had recently been diagnosed with endometrial and ovarian cancer.

Postprandial Insulin

Postprandial Insulin

A postprandial blood sugar level should be less than 180 mg/dL.

Seasonal Allergies

Seasonal Allergies

If affected by seasonal allergies after returning from outside during high allergy season, wash your hands.

Radiograph For Chronic Cough

Radiograph For Chronic Cough

I will never forget a 3-year-old jumping actively in the office who had no active cough or wheeze but a mother who said that he coughed nightly for more than 3 weeks.

Cat Scratch Disease in a Young Girl

Cat Scratch Disease in a Young Girl

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A normally healthy 7-year-old female complained of "not feeling good," and her pediatrician noted that she had a unilateral lymphadenopathy in her right axilla.

Phantom Knee Pain

Phantom Knee Pain

Suspecting that this phenomenon might be the source of my nighttime pain, causing significant REM sleep deprivation, I reasoned that a neuromodulator such as a gabapentinoid might be helpful.

Postobstruction diuresis

Postobstruction diuresis

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Mr J was an 89-year-old man with a long history of problems voiding due to increasing benign prostatic hyperplasia.

Celebrating life at the end of life

Celebrating life at the end of life

We walked the tightrope daily trying to keep her comfortable

LARC implant dimensions

LARC implant dimensions

In a comment by a reader, Nexplanon implant dimensions are not 4 cm x 2 cm.

Fever, chills, and nausea after beginning long-acting reversible contraception

Fever, chills, and nausea after beginning long-acting reversible contraception

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During presentation to the emergency department, she was found to have a white blood cell count of 18,000 with a left shift, urinalysis positive for leukocytes and nitrites.

A patient with a bone marrow transplant shows how short and precious life is

A patient with a bone marrow transplant shows how short and precious life is

I will never forget the intent of his teaching as he knew the prognosis was grim for him.

Cutaneous leishmaniasis: A potential treatment option

Cutaneous leishmaniasis: A potential treatment option

This is a disease that will affect clinicians in the southwest US and eventually the entire country as climate warming progresses.

Wilms tumor in a child

Wilms tumor in a child

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A 2-year-old boy was having worsening daily episodes of explosive diarrhea. He had no fevers, and his appetite and diet were unchanged.

A man with sneezing fits

A man with sneezing fits

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There was no warning, he had no allergies, and they were not associated with any cold symptoms or other conditions.

Relief for orthostatic hypotension

Relief for orthostatic hypotension

Patients on particular medications, or with certain underlying medical conditions, may experience orthostatic hypotension when arising from bed or a chair.

Neck and chest pain in a student

Neck and chest pain in a student

A PA reflects on a time when a patient complained of left-sided neck pain and was diagnosed with a 12-cm mass.

Treatment for a patient with an epididymal cyst

Treatment for a patient with an epididymal cyst

A sonogram reveals a 9-mm epididymal cyst.

Pulsatile tinnitus: a pounding sound inside the ear

Pulsatile tinnitus: a pounding sound inside the ear

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In this case, the patient not only subsequently had a stroke 2 years later, but he also required coronary artery bypass surgery within 5 years.

Signs of physical abuse in a patient

Signs of physical abuse in a patient

A PA reflects on a time when a patient arrived for an annual check-up and showed curious signs of abuse.

Referral to a psychiatric provider

Referral to a psychiatric provider

This nurse practitioner erred by not referring this patient to a psychiatric provider.

An individualized breast cancer screening strategy for women

An individualized breast cancer screening strategy for women

Creating individualized breast cancer screening strategies is the answer to minimize the morbidity and mortality of breast cancer.

Military sexual trauma: A primer for clinicians

Military sexual trauma: A primer for clinicians

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Military sexual trauma includes any sexual activity in which a service member is involved against his or her will, ranging from sexual harassment to rape.

Tips for making a personal connection with your patients

Tips for making a personal connection with your patients

Eye contact, positive body language, and humor are ways in which a clinician can make a personal connection with the patient.

Transcending the emotional barriers between provider and patient

Transcending the emotional barriers between provider and patient

Transcending the emotional barriers between clinician and patient can lead to a stronger, more balanced professional life.

Immunization in healthcare providers: Comments from our readers

Immunization in healthcare providers: Comments from our readers

Clinicians discuss the benefits of healthcare providers receiving vaccinations in order to prevent the spread of disease in the workplace.

Diagnosing a pulmonary embolism and saving a life

Diagnosing a pulmonary embolism and saving a life

A Divine guidance helps a nurse practitioner make a diagnosis that saved a patient's life.

Fired for falling asleep on the job: Our readers weigh in

Fired for falling asleep on the job: Our readers weigh in

Two clinicians offer their opinion on June's Legal Advisor about a female nurse fired for falling asleep while on duty in the hospital.

Putting out the fire of a fire ant bite with toothpaste

Putting out the fire of a fire ant bite with toothpaste

Apply any toothpaste to fire ant bites and wash off after 10 minutes

Epilepsy and the ketogenic diet

Epilepsy and the ketogenic diet

The ketogenic diet increases the conversion of glutamate into glutamine into GABA, reducing neuronal excitability.

Fulfilling a dying patient's request: A trip to the Renaissance Festival

Fulfilling a dying patient's request: A trip to the Renaissance Festival

A dying man's wish to attend a Renaissance Festival taught a valuable lesson to a palliative care nurse practitioner.

A young girl with Kawasaki disease: Diagnosing a rare disorder

A young girl with Kawasaki disease: Diagnosing a rare disorder

A girl presented to a small town hospital symptoms including fever, bloodshot eyes, red lips, and rash on the palms of her hands.

A tip for removing a ring from a swollen finger

A tip for removing a ring from a swollen finger

A household cleaner such as Windex can be used to remove a ring from a swollen finger.

Ortho Dx case: Is it a subungual hematoma or melanoma?

Ortho Dx case: Is it a subungual hematoma or melanoma?

Features of hematoma can often be confused with those of melanoma.

Making a case for developmental trauma disorder

Making a case for developmental trauma disorder

Epigenetics explains the anatomy and physiology behind the central nervous system changes caused by child abuse.

Treatment for cutaneous abscesses

Treatment for cutaneous abscesses

Antibiotics do not always need to be used for cutaneous abscesses, but the condition must be evaluated on a case-by-case basis to make a final decision regarding the appropriate course of treatment for any individual.

Being frank on frankincense and its role in cancer prevention

Being frank on frankincense and its role in cancer prevention

Just as in nutrition, there are certified aromatherapists who can assist providers in helping their patients use essential oils safely.

The ACA: Clinicians weigh in on whether to repeal or preserve

The ACA: Clinicians weigh in on whether to repeal or preserve

Three health care clinicians discuss the advantages and disadvantages of repealing the Affordable Care Act and how the change would impact their practice.

Evidence-based practices for suicide prevention

Evidence-based practices for suicide prevention

Physician education in depression recognition and treatment and restricting access to lethal methods have significant data supporting their effectiveness in suicide prevention.

Magnesium for patients taking opioids for pain

Magnesium for patients taking opioids for pain

Patients who are taking opioids can manage their tolerance by taking magnesium 500mg.

The origin of AIDS and debating the Patient Zero theory

The origin of AIDS and debating the Patient Zero theory

There is evidence that HIV might have spread from its origins in the US to the rest of the world.

Preventing chronic diseases with lifestyle changes

Preventing chronic diseases with lifestyle changes

A low-carbohydrate lifestyle is an effective treatment option to prevent chronic diseases.

Working with multiple attending physicians in the emergency department

Working with multiple attending physicians in the emergency department

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Working with a large number of attending physicians can be one of the biggest difficulties of being an advanced practice provider.

Soft tissue sarcoma of the thigh in an adolescent male

Soft tissue sarcoma of the thigh in an adolescent male

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A young boy's complaint of a tender mass on his left thigh is diagnosed as osteosarcoma.

Transurethral resection of bladder tumor

Transurethral resection of bladder tumor

A transurethral resection of bladder tumor allows examination and determination of histology, depth of invasion, and involvement beyond the bladder.

Lifestyle modifications vs pharmacologic treatment for patients with diabetes

Lifestyle modifications vs pharmacologic treatment for patients with diabetes

Applying necessary lifestyle changes as well as incorporating pharmaceutical drugs will improve diabetes in patients compared to drugs alone.

Blue skin in an elderly woman

Blue skin in an elderly woman

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The patient's use of minocycline was associated with patchy hyperpigmentation as a result of iron deposition in the dermal cells.

Treating patients with diabetic peripheral neuropathy

Treating patients with diabetic peripheral neuropathy

Alpha-lipoic acid, 600mg daily, is an effective treatment option for patients with diabetic peripheral neuropathy.

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