Print Issue: April 25, 2008

REPEAT PNEUMOCOCCAL VACCINATION?

A 66-year-old patient who has no significant pulmonary or other medical problems receives a pneumococcal vaccination. Under the current guidelines, when, if ever, does this patient need an additional pneumococcal vaccination?—Gerald S. Roberts, MD, New Hyde Park, N.Y. The answer depends on the age and the immune status of the individual. As your patient received…

SSRIs AND PROSTATE CANCER

What effects, if any, does the use of selective serotonin reuptake inhibitors (SSRIs) have on the progression of prostate cancer?—Edwin Ferens, DO, Birmingham, Mich. Patients receiving hormonal treatment for prostate cancer can experience adrenopause symptoms of hot flushes. These can be debilitating both by their frequency and their intensity. While SSRIs have the potential to…

DEMISE OF THE STETHOSCOPE?

I’ve read that the stethoscope is being replaced in many practices by handheld Dopplers. Please say it isn’t so.—Chagai Dubrawsky, MD, Houston It isn’t so and will not be so, though your question does bring up the controversial issue of our increasing reliance on studies in lieu of physical examination. Why is this happening? For…

CONFERRING SMALLPOX IMMUNITY

Prior to being mobilized to Iraq, National Guard members were given smallpox vaccinations. The soldiers who were old enough to have previously received smallpox vaccinations as children did not seem to have any of the typical transient symptoms (i.e., pain, erythema, axillary lymphadenopathy, low-grade fever, and localized edema at the injection site). Am I correct…

THE EFFECT OF COFFEE ON BP

As a coffee aficionado, I have been following the reports which concluded that avid coffee drinkers develop less type 2 diabetes and experience no increases in BP, despite earlier evidence to the contrary. Now, a new study claims that while peripheral BP is not significantly elevated in chronic coffee drinkers, central BP is. What is…

CREATINE KINASE LEVELS WHILE ON STATINS

What rise in creatine kinase (CK) is considered significant in patients on statin therapy? Does the presence or absence of myalgia symptoms affect significance? At what CK level should therapy be discontinued? If levels decrease, should statin therapy be restarted at a lower dosage? Multiple muscle injuries could account for CK elevation. Does this negate…

STATINS FOR THESE DIABETES PATIENTS?

Should patients with no history of heart disease, an LDL <90 mg/dL, and well-controlled diabetes be given a statin?—Quoc D. Nguyen, DO, Antioch, Calif. Many clinicians would say “no”—a not unreasonable answer—but I will say “yes” for the following reasons: (1) Diabetic patients have a poorer prognosis than their nondiabetic counterparts because of the more…

ARE GENERIC EQUIVALENTS FOR EXTENDED-RELEASE AGENTS reliable?

We are now seeing more and more generics for “extended-release” drugs, i.e., diltiazem XT, metformin ER, and others. Can we rely on these to be pharmacokinetically equivalent to the original brand-name products?—Lawrence M. Markman, MD, Wilmington, Del. The FDA rates a multisource drug product’s bioequivalence as “A” or “B.” “A”-rated drugs have demonstrated bioequivalence in…

A NEW TEST TO DETERMINE HEART DISEASE RISK

What is the consensus on the new PLAC test (www.plactest.com) that measures lipoprotein-associated phospholipase A2 (Lp PLA2) for cardiovascular disease/coronary artery disease risk stratification? Are cardiologists, lipidologists, and others using it? How soon are users retesting to evaluate treatment efficacy?—Colin Soares, PA-C, MPAS, Boise, Idaho Epidemiologic and laboratory evidence indicate that Lp-PLA2, a biomarker of…

LIABILITY FOR DELAY IN CARE?

The wait at some urgent-care centers is very long—up to three hours. What happens if the patient is suffering a stroke or a heart attack? Can the delay in seeing such patients leave a physician vulnerable to a lawsuit?—Felix N. Chien, DO, Newport Beach, Calif. Waiting conditions are arguably part of the standard of care,…

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