June 01, 2007 Archives - Page 2 of 7 - Clinical Advisor

Print Issue: June 01, 2007

HIGH HDL LEVELS IN AN ELDERLY WOMAN

The latest cholesterol levels of a 67-year-old white woman are total cholesterol 350 mg/dL, HDL 150 mg/dL, and LDL 186 mg/dL. In the past, her levels have been total cholesterol 229-290; HDL 120 and up, with one reading of 156; and LDL 106-190. My lab, which has checked and rechecked these values, tells me it…

BEST THERAPY FOR BACTERIAL VAGINOSIS

I see many cases of bacterial vaginosis (BV); some are recurrent. I treat them with metronidazole (Flagyl) 500 mg b.i.d. for seven days and tell my patients not to douche. Is there another treatment, especially for recurrent cases?—Darwish O. Darwish, MD, Troy, Mich. One can also apply metronidazole directly to the vagina with a topical…

ASCERTAINING SHELLFISH ALLERGY

An adult patient who has eaten shellfish regularly throughout his life suddenly developed swelling after eating shrimp in a restaurant. What is the best way to determine if this is a true allergy to shrimp? Will the daily use of second-generation antihistamines help, and is this an acceptable approach? The only relevant history was that…

WHAT LOW PLATELET COUNT SIGNALS

How low can a platelet count get before you suspect heparin-induced thrombocytopenia (HIT)?—Higinio R. Lopez, MD, Newark, Del. During heparin therapy, any unexplained decrease that reduces the platelet count 50% or to <150,000/µL should trigger an antiheparin/platelet factor (PF) 4 antibody determination. The mild form of disease, also known as “benign” or “type II thrombocytopenia”…

POSTSURGICAL ALLERGIC REACTION

A patient who underwent gum surgery noticed a burning sensation after the local anesthetic (lidocaine) had worn off. One day later, the skin over the upper and lower lips started peeling. Could this be an allergic reaction to the lidocaine? What about the rubber gloves worn by the oral surgeon or the antibiotic taken six…

HYPERTROPHIC SCAR REMOVAL

My daughter had three well-circumscribed, <2-mm warts in a triangular pattern on her left elbow. Cryotherapy has left a dime-sized, raised-pink-papule hypertrophied scar, which causes her pain with the slightest pressure. She has undergone four unsuccessful laser treatments and steroid injections in an effort to remove the scar. Other than surgical excision, what options are…

Male osteoporosis

A male patient with osteoporosis worries about the side effects of alendronate, particularly jaw necrosis. What are the alternatives?

DISCHARGING PATIENTS ON MEDS

What are the medicolegal concerns associated with discharging a patient who has been given a shot of morphine or similar medication? Can I, for example, discharge an elderly patient to a taxicab driver and have him be responsible? Or must the patient be discharged to a friend or family member?—Felix N. Chien, DO, Newport Beach,…

BONE DENSITY MEASUREMENTS WITH DEPO-PROVERA?

I work in several family-planning clinics serving low-income/uninsured women, many of whom have been on medroxyprogesterone (Depo-Provera) for more than 10 years. Should we be doing bone density measurements on those patients who have the resources? How much longer can they stay on medroxyprogesterone?—Debbie Cline, MSN, OGNP, FNP, Roanoke, Va. Ever since the FDA issued…

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