April 13, 2007 Archives - Clinical Advisor

Print Issue: April 13, 2007

CLINICAL PEARL- RETURNING THE INJURED TO WORK

Clinicians treating injured workers sometimes overmedicate a minor problem by recommending limitations or taking time off from work. Byasking, “Can you do your job the way you feel now?” I’ve found that a surprisingly high percentage of injured workers want unrestricted duty. Prompt return to normal function is the most direct path to full recovery.—Guy…

CLINICAL PEARL- A SALUTE TO THE CAPTAIN’S CHAIR

A salute to the captain’s chairEasy chairs are anything but easy. A captain’s chair with a firm seat that is higher than the standard height will aid the mobility-impaired senior citizen in maintaining the ability to transfer.—David H. Dube, MD, Camillus, N.Y. (102-24)

CLINICAL PEARL- PAINLESS ABCESS REPACKING

To reduce discomfort for patients who need their skin abscess repacked with gauze strip: (1) Pull out old packing. (2) If wound is not clean, gently irrigate with saline. (3) Using a needleless syringe, fill the abscess cavity with lidocaine 1% or 2% with or without epinephrine. (4) Wait four to five minutes (I write…

CLINICAL PEARL-TAKING SIDES ON EYE DROPS

To instill eye drops properly, place the medication in the lateral canthus and pinch the medial canthus “drain.” This prevents some of the drop from reaching the nasal mucosa, which can cause systemic effects, especially in the case of beta blockers.—Craig Freyer, MD, Fort Worth, Tex. (102-22)

SHOULD A BCG-VACCINATED PATIENT BE TESTED FOR TB?

The CDC fact sheet you cited regarding BCG vaccination conflicted with the answer you provided (Item 93-6). You stated that “BCG-vaccinated patients should be skin-tested, with results interpreted using the same criteria as for those who have never been BCG-vaccinated.” According to the fact sheet, while skin testing is not contraindicated for persons who have…

PENILE TINGLING UNDER PRESSURE?

Could the penile tingling accentuated by constipation in a healthy 60-year-old (Item 97-18) be caused by positional compression of the blood vessels or nerves?—Harrison Weed, MD, MS, Columbus, Ohio Dr. Weed provides a reasonable theory for the cause of this patient’s penile tingling. A combination of sitting and straining (Valsalva) may be compressing pelvic nerves…

NO-MORE-TEARS EYE CARE

The use of baby shampoo as part of an eyelid-hygiene regimen (Item 100-27) has been accepted for some time in the treatment of chronic seborrhea, rosacea, and allergic blepharitis as well as in patients with noninfectious eye irritation. While I would not recommend washing the eye as the writer described, gently cleansing the lid margins…

HOW LONG DOES THYROID EXOPHTHALMOS LAST?

The thyroid-stimulating hormone of a patient with hyperthyroidism and exophthalmos is slowly normalizing on propylthiouracil, but her eyes remain abnormal in appearance. She has seen an ophthalmologist and assures me that the only finding was some watering in one eye. Does exophthalmos ever go away? Are there other precautions I should be taking for her…

BONE SCANS FOR FLUTICASONE PATIENTS?

A 35-year-old, white female with a 10-year history of mild, persistent asthma was treated with albuterol for eight years. For the past two years, she has achieved excellent control with twice-daily use of a fluticasone/salmeterol 100 µg/50 µg inhaler (Advair). A recent viral upper respiratory tract infection required her to use a larger dose of…

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