Which medications are considered safest for both mother and fetus in pregnant patients with inflammatory arthritides, such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA)?—Lisa A. June, MD, Louisville, Ky. Nonsteroidal anti-inflammatory drugs are safe, as well as low doses of prednisone, which does not easily cross the placenta to the fetus. Aspirin is…
Have there been any studies conducted on mortality of family clinicians? Do they die younger than most people? I guess I am asking whether the day-to-day strain of looking after the well-being of their patients takes a toll on the health of primary-care clinicians.—Felix N. Chien, DO, Newport Beach, Calif. Overall, it has been found…
Is there any evidence of an association between lymphoma or lymphosarcoma (Hodgkin’s disease) and metabolic syndrome?—Roberto Renovales, MD, San Juan, P.R. The term “metabolic syndrome” generally refers to the concomitant occurrence of metabolic risk factors for both type 2 diabetes and cardiovascular disease; namely, abdominal obesity, hyperglycemia, dyslipidemia, and hypertension. As defined by the 2001…
A 75-year-old woman with end-stage renal disease who is on chronic hemodialysis has a suppressed thyroid-stimulating hormone (TSH) of 0.1 µU/mL and levels of free thyroxine (T4) and free triiodothyronine (T3) in the mid-normal range confirmed on repeat testing. Her history includes a remote total thyroidectomy for benign disease. She is taking no thyroid medication.…
What treatment options are there for subungual warts if cryotherapy and hyfrecation have failed?—Kenneth Lowrance, RN, FNP-C, Clifton, Tex. Warts are one of the most stubborn dermatologic conditions. I often use repeated courses of cryotherapy in combination with OTC salicylic acid. Use of duct tape is another adjunctive therapy option. In addition, immunotherapy with Candida…
A patient whose Addison’s disease has been well-controlled on prednisone 20 mg daily and fludrocortisone (Florinef) 0.1 mg daily now has hypertension that is suboptimally controlled on two antihypertensive medications. Can I lower the dose of fludrocortisone—or even discontinue it entirely?—Fadi Jabr, MD, Florence, Ore. There are several ways of treating essential hypertension in patients…
A 55-year-old man with androgenic alopecia has had a satisfactory response on finasteride (Propecia) prescribed for him by another clinician six years ago. As his new clinician, I am being asked to authorize refills. How long can he safely use finasteride? Is any special monitoring required?—Naheed Mahlik, MD, San Jose, Calif. Patients can safely use…
Does an elevated ultrasensitive D-dimer level in a patient whose pre-test probability puts him at low risk for pulmonary embolus (PE) indicate an increased risk for PE or deep venous thrombosis (DVT)? Does the elevated D-dimer require chest CT and/or Doppler studies? If chest CT is warranted in this situation, doesn’t the ultrasensitive D-dimer increase…
Polyalkylimide (Bio-Alcamid) has been used to treat facial wasting in patients with AIDS. How effective is this product in remedying lipodystrophy?—William P. Emmerling, FNP-C, EDD, Las Vegas Several articles in international plastic surgery journals detail the use of this product for lipodystrophy in addition to the wasting seen in AIDS patients. The manufacturer of Bio-Alcamid…
Are there any effective treatments for hyperhidrosis?— Gerardo M. Maradiaga, MD, Roanoke Rapids, N.C. Hyperhidrosis is estimated to affect 1%-2% of the U.S. population and can create problems for patients socially, occupationally, and psychologically. Primary focal hyperhidosis is defined as more than six months of excessive, bilateral, symmetric sweating that has no apparent cause, starts…
