For individuals with intractable diarrhea related to pelvic radiation, alternate loperamide with diphenoxylate/atropine (Lomotil) before moving on to tincture of opium or octreotide (Sandostatin). — Joan Zampieri, PA-C, Houston (178-5)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.