June 27, 2008 Archives - Clinical Advisor

Print Issue: June 27, 2008

PLAN AHEAD

Review the schedule for the following day’s patients and jot down notes regarding issues on which to follow up. Patients often forget to follow through on previous recommendations, and this ensures documentation regarding compliance.—Jeffrey Heebner, DO, Flourtown, Pa. (116-28)

Onychomycosis therapy

Find a compounding pharmacist who can make ketoconazole 2% in dimethylsulfoxide for the treatment of onychomycosis.—B.P. Harpole, MD, Pleasant Hill, Calif. While interesting, it would be good to have published data that show this to be an effective therapy.—Jeffrey M. Weinberg, MD (116-27)

HOW EXTENSIVE A WORKUP FOR ED?

Does every patient with erectile dysfunction (ED) require testosterone and prolactin levels (Item 115-3)?—Craig Freyer, MD, Fort Worth, Tex. The goal of basic laboratory testing should be cost-efficient screening for common systemic disorders that may contribute to ED. To that end, fasting blood glucose, a fasting cholesterol and lipid panel, and testosterone levels should be…

PAP SMEARS FOR VIRGINS?

Since most cervical cancer is due to human papillomavirus, which is sexually transmitted, why do we tell women who have never had sex to start regular Pap tests at age 21?—Teresa Beck, MD, Atlanta Such organizations as the American Cancer Society recommend starting annual cervical cytologic screening three years after the initial act of coitus…

A link between methylmalonic acid and demyelinating diseases?

The breakdown of methylmalonic acid yields fatty acids necessary for the formation of myelin. Has anyone measured the level of methylmalonic acid in demyelinating diseases, such as multiple sclerosis (MS)? Since vitamin B12 plays an instrumental role in breaking down homocysteine and methylmalonic acid, might this be the basis for the link between B12 deficiency…

ADJUST STATIN DOSE TO LOWER THE CRP?

How specific is the C-reactive protein (CRP) level in identifying patients with underlying CAD? If a patient has a high CRP and a therapeutic level of LDL, would you recommend increasing his statin dosage to help lower the CRP?—Nazem Abdelfattah, MD, Grand Blanc, Mich. Although many inflammatory markers predict risk of cardiovascular events, high-sensitivity CRP…

BISPHOSPHONATE-HDL LINK?

Two women in our family practice were found to have HDL >100 mg/dL after starting bisphosphonates. Previous HDLs were in the 40s. Is this a common occurrence?—Clio Elrod, LPN, Baldwin City, Kan. I have not seen this in our practice, nor do I find reports in the literature. Perhaps other readers can share their experiences…

IV BETA BLOCKERS FOR THE NPO PATIENT

A patient who has been taking beta blockers for CAD and hypertension will be NPO for several days after GI surgery. What IV beta blocker therapy would you recommend?—L.E. Price, MD, Kissimmee, Fla. Perioperative beta blockade is generally regarded as helpful in many patients, especially those with known coronary artery disease (N Engl J Med.…

SPONTANEOUS ECCHYMOSES

A short obese woman with a cushingoid appearance has a history of painful spontaneous ecchymoses on her legs and arms. Her medical history is significant for hypertension, bipolar depression, sleep apnea, and chronic joint and musculoskeletal pain attributed to fibromyalgia. Laboratory evaluation reveals an erythrocyte sedimentation rate of 60 mm/hr. A complete blood count, bleeding…

THERAPY FOR GROWTH ON THE NOSE

Is there a way to effectively treat localized nodular cutaneous amyloidosis on the tip of the nose?—Roch P. Coll, MD, Phoenix There are several options available for the treatment of this problem. Topical high-potency steroid with occlusion and intralesional steroids would be simple first-line options. Second-line therapeutic options include excision, dermabrasion, and pulsed dye or…

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