December 01, 2008 Archives - Clinical Advisor

Print Issue: December 01, 2008

If your patient hears sticks, look for ticks

To differentiate a tick from another foreign body in the outer ear or on the tympanic membrane, ask whether the patient has heard the sound of twigs or sticks breaking. If so, use one or two drops of 1% lidocaine followed by mineral oil to flush the tick out. Next, send the tick out for…

More on antibiotics and oral contraceptives

Two readers ask about taking antibiotics while pregnant.Current research suggests no significant difference in circulating hormones when a woman is taking broad-spectrum antibiotics (other than rifampin) (Item 117-17). The recommendation is that a woman with vomiting, diarrhea, or forgetfulness use a backup method for the duration of antibiotic use (Hatcher RA, Nelson AL, Zieman M,…

Alpha blockers for hyperhidrosis

The earlier discussion of hyperhidrosis treatment (Item 116-9) didn’t mention alpha blockers, such as clonidine (Catapres) and terazosin (Hytrin). What effect do these agents have on hyperhidrosis?—Caroline Carson, MD, Newport Beach, Calif. The role of oral medications in the treatment of hyperhidrosis is limited by a number of factors: medication side effects, limited evidence (mostly…

CRP vs. LDL as a stroke predictor

In my practice, C-reactive protein (CRP) appears to be better than LDL at predicting such ischemic events as infarcts or strokes. Among my patients at high risk for ischemic events, those treated with rosuvastatin and simvastatin seem to do better than those taking other statins. (Those taking the ACE inhibitor ramipril also do well, but…

Is Bowen testing good for Lyme disease?

More and more patients are receiving Bowen testing for Lyme disease. Many tests return as positive, and patients are placed on long, expensive, and often problematic therapies. Is there any validity to this testing whatsoever?—John Spence, MD, Marianna, Fla. No. Bowen testing is not an FDA-approved diagnostic for Lyme disease. There is no perfect test…

HRT after bilateral mastectomy

A 37-year-old woman was found to be positive for the BRCA mutation after being treated with chemotherapy, mastectomy, and radiation therapy for breast cancer. She then underwent prophylactic oophorectomy and contralateral mastectomy. Within four months of the oophorectomy, her bone mineral density decreased 18%. (She is also on chronic low-dose prednisone for rheumatoid arthritis.) She…

Rabies virus shown with its helical nucleocapsid

Preventing rabies

When should a patient receive postexposure prophylaxis against rabies? In the case of animal bites, what if the animal cannot be found?—Felix N. Chien, DO, Newport Beach, Calif. According to the CDC, “administration of rabies postexposure prophylaxis (PEP) is a medical urgency, not a medical emergency” (MMWR Recomm Rep. 1999;48[RR 1]:1-21). Rabies exposure results from…

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