January 10, 2007 Archives - Clinical Advisor

Print Issue: January 10, 2007

A practical way to manage chronic pain

Patients whose pain persists for years pose a special challeneg. An internist describes an approach that works for all but the toughest cases. Nearly one in 10 adults reports that pain has a major impact on her life. That won’t surprise you; chances are you see at least a couple of patients every day who…

BETTER AUSCULTATION

During cardiac auscultation, I have the patient lean forward, take a deep breath, and forcefully exhale. The combination of maneuvers causes retractions of the chest cavity, making the heart closer to the anterior chest wall. This pseudo-Valsalva maneuver also puts strain on the heart valves, bringing out any valve murmur. I call it the “Mullen…

GELATIN STIMULATES HAIR REGROWTH

A patient was concerned about hair loss following chemotherapy treatment. I recommended drinking unflavored powdered gelatin—one packet mixed with juice—each week. She noticed regrowth within 14 days.—Betty Louise Stewart, RN, FNP, Marietta, Ga. Whether the above observation is anecdotal in only this single individual or reproducible cannot be determined based on the information provided. A…

COULD TOO MUCH CALCIUM HAVE RAISED THE PSA LEVEL?

The patient whose prostate-specific antigen (PSA) level went from 6.1 ng/mL to 4.76 after two weeks of antibiotic therapy (Item 98-11) now has a PSA of 2.89, despite the fact that he received no additional antibiotics. (The absence of cancer was confirmed by a negative biopsy; prostatitis was postulated but never formally diagnosed.) He takes…

HALT NIACIN IF GLUCOSE RISES?

I have patients with low HDL and normal LDL whose HDL responds well to niacin. Some, however, develop mild glucose elevations of 100-110 mg/dL. Should the niacin be discontinued?—Gerald L. Saliman, MD, Hillsborough, Calif. This question raises several important points to consider: First, should these patients be treated at all? There are data to suggest…

MRI ACCURACY FOR ROTATOR CUFF TEAR?

Several patients in their 50s and 60s have had their rotator cuff tear diagnosed on MRI. How accurate is MRI for this purpose? Could it be overinterpreted?—Jorge Guzman Ortiz, MD, Jayuya, P.R. The sensitivity and specificity of MRI in detecting even partial tears has been estimated at 88%-100%. However, intermediate signal present within the tendon…

ELEVATED CK IN A PATIENT WITH

A motorcycle accident five years ago that damaged his cervical spinal cord left a 65-year-old African-American man with left spastic hemiparesis (almost hemiparalysis). He takes baclofen for the spastic pain in his left extremities. The man is 6 ft tall and weighs 200 lb (up from 160 lb since the accident). For the past five…

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