August 15, 2007 Archives - Clinical Advisor

Print Issue: August 15, 2007

CLINICAL PEARL- EASING PAIN OF LASER VEIN TREATMENT

Laser vein treatment/removal can be very painful. To lessen discomfort, apply cold buffer gel to the affected area. This also protects against laser burns.—Natalie D. White, PA-C, Sewickley, Pa. (106-21) Contact Us at: Letters@ClinicalAdvisor.com

CLINICAL PEARL- CELL PHONE REMINDER

A patient of mine sets the alarm on her cell phone to remind her to take her birth control pill—and never forgets!—Linda Gort-Walton, MS, CRNP, Lancaster, Pa. (106-20)

CLINICAL PEARL- EFFECTIVE INSECT REPELLENT

As alternatives to N,N-diethyl-3-methylbenzamide (DEET)-containing insect repellent, consider those with picaridin or oil of lemon eucalyptus. Evidence indicates that these work as well as DEET products of similar concentration (www.cdc.gov/ncidod/dvbid/westnile/qa/insect_repellent.htm. Accessed June 11, 2007).—Melissa Raue, PA-C, Ridgefield, Conn. (106-19)

CLINICAL PEARL- SAFER IUD INSERTION

Use a flexible pipette (such as those used in endometrial biopsy) rather than a metal sound when inserting an intrauterine device. The smaller pipette is less likely to perforate the uterus.—Laura Onorato, PA-C, Albuquerque (106-18)

TREATMENT OF WARTS

Treatment of warts should start with imiquimod (Aldara) cream applied once a day until the wart is gone (Item 104-6). With this approach, there is no scar to deal with, no billing for an office procedure, and a much better outcome for the patient. Cryotherapy often fails and has to be repeated. In addition, it…

FELLATIO AND CHLAMYDIA TRACHOMATIS PHARYNGITIS

What is the real risk of Chlamydia transmission through genital/oral contact? Since there is no treatment, is oral infection with Chlamydia an incidental finding, or is it something of concern? How long can the organisms survive in the throat?—Mimi Tannen, NP, Poughkeepsie, N.Y. Chlamydia trachomatis has been cultured not only from the pharynges of asymptomatic…

COST-CONSCIOUS HYPERTENSION

n cost is a factor, does it make sense to add a generic ACE inhibitor for improved hypertension control? The patient is a 67-year-old woman prone to hypokalemia. Her current regimen includes an angiotensin receptor blocker (ARB) and a beta blocker. Maximizing the dosage of the ARB doubles the cost.—Helene DiSantos Ormond Beach, Fla. oretically,…

PREOPERATIVE WORKUP

A 36-year-old woman requested a physical examination prior to excision of accessory navicular bone on her right foot, detected on MRI. She has no significant past medical history, but for the past 18 years, she has smoked half a pack of cigarettes daily. What preoperative workup, if any, would you advise for this asymptomatic patient?…

LIABILITY FOR ADVERSE REACTIONS

How liable am I if a drug I prescribe leads to a severe unpredicted adverse reaction? If the adverse reaction occurs in 7% of patients, am I more liable if I don’t issue a warning than if I do? What if the adverse reaction has been seen in only a couple of patients, but it…

DOES THIS PATIENT NEED A STATIN?

Would you start a statin in a 32-year-old African-American diabetic who has a hemoglobin A1c of 7.5% and an LDL of 65 mg/dL?—Ivanka Vassileva, MD, Lawton, Okla. You can certainly make a good argument for this approach, based on several recent studies that all diabetics can benefit from statin therapy, even those with relatively low…

Next post in Advisor Forum