Print Issue: April 25, 2008

OSTOMY BAG RUPTURE AT 35,000 FEET

On his first flight following a colostomy for ulcerative colitis, my patient noted distension of his ostomy bag as his plane reached its cruising altitude of 35,000 feet. He barely made it to the rest room before his bag burst. How can he avoid bag rupture on future flights?—Joshua Grossman, MD, Johnson City, Tenn. The…

TOPICAL TREATMENT FOR CORNEAL INFECTION

What topical and systemic antibiotics are recommended for corneal infection caused by staphylococci or Pseudomonas?—Param S. Fagoora, MD, Fresno, Calif. Bacterial keratitis is most commonly caused by Pseudomonas, Streptococcus pneumoniae, Moraxella, or Staphylococcus aureus. The condition is related to trauma, contact lens use (particularly overnight lenses), burns, surgery, and immunosuppression. In uncomplicated cases, topical treatment…

CAN CONTROLLED BREATHING LOWER BP?

Could you comment on RESPeRATE, which advertises itself as the “breakthrough medical device clinically proven to lower high BP with no side effects”?—Gerard K. Nash, DO, Amarillo, Tex. The theory behind RESPeRATE is that slowing the breathing rate for 10 or 15 minutes a day can yield persisting effects on sympathetic tone. There are few…

MUMPS OVER 40?

In adults older than 40 years, would you check mumps titers and, if negative, provide a booster?—Elaine Der, MHS, ARNP-C, San Francisco Acceptable presumptive evidence of immunity to mumps includes birth before 1957, documented administration of one dose of live mumps vaccine, or prior diagnosis of mumps documented by a medical provider. If your patient…

CAN ACE INHIBITORS AND MAGNESIUM BE USED TOGETHER?

ACE inhibitors are frequently an excellent choice for the treatment of hypertension, particularly in patients with diabetes. Magnesium is also beneficial because it reduces insulin resistance and protects against arrhythmias. But does the ACE inhibitor decrease magnesium excretion as it does potassium excretion? Can an ACE inhibitor and magnesium be used together safely?—Richard Levin, MD,…

CONTRACEPTION FOR WOMEN OLDER THAN 50

What are the current guidelines for providing hormonal contraception to women older than 50 who have no medical contraindications?—Susan Kilburn, RN-C, APN, Henderson, Nev. Perimenopausal women who have no risk factors are still good candidates for monophasic, low-dose oral contraceptives. For women who may be experiencing heavier bleeding or who have fibroids causing heavy bleeding,…

FINASTERIDE FOR WOMEN WITH HAIR LOSS?

Why can’t finasteride be used to treat androgenetic alopecia in women who have high levels of 5α-reductase?—Fred A. Stutman, MD, Philadelphia Oral finasteride, a type II 5α-reductase inhibitor, has been shown to increase hair growth and slow progression of thinning in men with androgenetic alopecia (AGA) or male-pattern balding, but this agent has no affect…

DOES THIS PATIENT HAVE TEMPORAL ARTERITIS?

Have your consultants ever seen a case of temporal arteritis present with an isolated C5 radiculopathy and peripheral (lower motor neuron) facial-nerve palsy one month prior to ocular findings?—Jeffrey Galvin, MD, Fairview Park, Ohio Although I have not heard of radiculopathy or facial palsy preceding temporal arteritis, I myself have reported on an excess of…

Managing a high-risk HPV patient

What is the best way to follow a thin-prep Pap smear when the results indicate no intraepithelial lesion or malignancy, but the patient is at high risk for human papillomavirus (HPV)? Should I do nothing, counsel the patient, repeat the Pap smear, or perform colposcopy?—Judy Werner, DO, Dallas The American Cancer Society recommends that women…

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