Occasionally, a patient will have good hemoglobin A1c (HbA1c) control (<7.0%) but frequent short-term blood- sugar control problems, likely due to diet and activity variability. Is this considered good control, or do the rather large short-term fluctuations represent poor control as it would affect the patient’s risk of future microvascular disease?—Scott B. Brasseur, MD, Hastings,…
Are there any studies on alendronate (Fosamax) therapy for nonhormonally related fractures?—Jorge Guzman-Ortiz, MD, Jayuya, P.R. There is a small but growing body of literature examining the use of bisphosphonates for the treatment of osteoporosis in patients other than postmenopausal women. Two of the largest such “at-risk” groups are men and patients being prescribed glucocorticoids…
Under what clinical circumstances would you recommend serum herpes simplex virus (HSV) typing/testing? What information would you provide to a serum-positive but asymptomatic patient?—Adena Bargad, PHD, CNP, ARNP, Gainesville, Fla. The CDC’s 2006 sexually transmitted disease (STD) guidelines recommend serologic assays for (1) recurrent genital symptoms with negative HSV cultures; (2) a clinical diagnosis of…
How long can very elderly patients (100 years of age or older) with second-degree heart block live if they choose not to have a pacemaker? In these patients with heart rates of 28-36 beats per minute, why does the pulse pressure tend to be so high (>150 mm Hg)?—Janet Hussong, RN, MSN, CPNP, Englewood, Ohio…
Two readers ask about rising creatinine levels following ACE inhibitor therapy: At what serum creatinine level should discontinuation of an ACE inhibitor or angiotensin receptor blocker be implemented? Is the recommendation different for a patient with diabetes vs. a patient without? —Regina A. Roman, DO, Murrells Inlet, S.C. How long does it take for the…
During my first 45 years of practice, I saw only three or four cases of pancreatic cancer. But since 2000, I have seen six cases. All the patients were older than 60, and all had been on statins for varying lengths of time (the only common threads). Do any data support this trend?—W.S. Middleton, MD,…
I see a number of non-asthmatic patients who use the corticosteroid/beta agonist combination fluticasone/salmeterol (Advair) on an as-needed basis for symptoms of uncomplicated acute viral bronchitis. Is there any validity to this use? Advair is also prescribed frequently for mild persistent asthma in lieu of an inhaled steroid. Am I off base in questioning this…
Indomethacin is harder on the stomach than most other nonsteroidal anti-inflammatory drugs.
What adverse effects are associated with this acne treatment?
What is the best way to manage a patient with documented hepatitis C whose liver function tests fluctuate between 100 and 150 units/L and whose hepatitis B virus DNA polymerase chain reaction is undetectable?—Nilesh N. Patel, MD, West Covina, Calif. Your patient probably has chronic active hepatitis C. Hepatitis B infection should be diagnosed with…
