February 09, 2007 Archives - Clinical Advisor

Print Issue: February 09, 2007

TEMPORARY BLINDNESS

A woman with severe diabetes (blood sugar level <400 mg/dL) refused to control her diet. Once day, when I became angry with her, I told her she could go blind. To emphasize the difficulty she would have if that happened, I told her husband to blindfold her for two hours and not let her sit…

CLOTH TAPE FOR FINGER CUTS

For those annoying painful cuts that seem to just appear at the ends of the finger near the fingernail (especially in cold weather), I apply a small piece of medical (cloth) tape and leave it in place until it falls off. This supplies a cushion for pain relief and seems to aid in healing—Steven P.…

PRURITUS FOLLOWING SCABIES TREATMENT

To avoid an unnecessary call or office visit, remind patients that itching from a scabies infection may persist for as long as one to two weeks after eradication.There is usually no need for retreatment if the patient has followed the medication instructions and washed all bedding and clothing in hot water.—Stacy Ramsey, MSN, RNC, ANP,…

PA- Is PA residency training worth it?

Although physician assistant postgraduate residency programs have been around for 35 years,it’s only in the past decade that they’ve really started to catch on. In 1998 there were 17 programs; today there are 35. As they become more popular, this question becomes more urgent: Are postgraduate PA residencies worth the time and effort they demand?…

DOES NIACIN BOOST ENERGY?

I have prescribed niacin (Niaspan) to improve patients’ lipid panels. More than one has told me that this agent gives them a “lift” and makes them feel energized. Obviously, this is not the desired intention. Is there any physiologic mechanism for this reaction, or is it merely a placebo effect?—Cathy R. Kessenich, DSN, ARNP, Tampa,…

SEX HORMONE-BINDING GLOBULIN FOR LOW LIBIDO?

What role does sex hormone-binding globulin (SHBG) play in evaluating women with low libido? Is there any treatment for low levels of SHBG when all other hormone levels are within normal range?—Dana Nicole Nadalo MHS, PA-C, Houston Rising levels of SHBG lead to decreased bioavailability of circulating androgens, which can be associated with sexual dysfunction…

MICROALBUMINURIA SCREENING FOR ONE-WEEK BUPROPION THERAPY?

A new patient’s former clinician prescribed bupropion (Wellbutrin) for the first seven days of each month. Is this common? What is the advantage of this method?—Suzanne R. Martin, FNP-C, Howell, Michigan. I found no reason in the literature for using a selective serotonin reuptake inhibitor (SSRI) only seven days per month. I would discontinue this…

ASYMPTOMATIC EPISODES OF HYPOGLYCEMIA

A 60-year-old man who has had type 2 diabetes for 20 years has been using 75% insulin lispro protamine suspension/25% insulin lispro injection (Humalog Mix 75/25) for the past three years. He is compliant with his diet and exercises regularly. In the six years I have been his physician, his general medical condition has been…

COENZYME Q TO PREVENT MYOPATHY?

The Physicians’ Desk Reference for Herbal Medicines has a discussion of how the statins may inhibit natural synthesis of coenzyme Q, placing a patient at risk for statin myopathy. Has a benefit been found in giving coenzyme Q to prevent or treat statin myopathy?—Frank Seck, DO, Gladwin, Mich. Despite many other claims for coenzyme Q…

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