Print Issue: March 18, 2008

SHOULD THIS PATIENT HAVE A STRESS TEST?

During his physical examination, a 45-year-old man with a history of smoking states that he gets short of breath when he works hard physically. On examination, the only positive finding was jugular venous distension (JVD) of approximately 6 cm, which increased to 8-9 cm when pressure was applied to his liver or when he was…

Alternative drug for bipolar disorder

A 66-year-old patient with bipolar illness who is stable on venlafaxine (Effexor) 75 mg and lithium wants to discontinue both in favor of phenytoin (Dilantin) as a mood stabilizer. This therapy was proposed by Julian Whitaker, MD, director of the Whitaker Wellness Institute (www.whitakerwellness.com). Do any studies validate this therapy? Would it have an effect…

CRP AND CHRONIC INFLAMMATORY DISEASE

Is the level of C-reactive protein (CRP), so widely discussed as a cardiac marker, increased by chronic inflammatory conditions, such as chronic prostatitis, periodontal disease, or chronic synovitis?—Robert Frank, MD, Forest Hills, N.Y. CRP, like serum amyloid A (SAA), is known as an acute phase protein. By definition, acute phase proteins exhibit a change in…

RISKS AND BENEFITS OF EDTA

The number of clinicians using IV ethylenediaminetetraacetic acid (EDTA) for profit in our area is proliferating. Claims for conditions that might benefit range from mercury toxicity to arteriosclerotic vessel disease. Are there any proven benefits to use of EDTA? On the flip side, are there any real untoward effects?—William G. Morris, MD, Athens, Tenn. The…

RUBELLA IMMUNITY

According to the CDC, no future retesting/re-immunization is necessary once a patient has shown adequate titer response to a hepatitis B series. Even low titer levels at that point imply continued immunity. Yet this does not apply to rubella. How do you explain this?—Deborah Herczog, RNC, ANP, MSN, Austin, Tex. One to two months after…

WHAT TO DO ABOUT A TREMOR

When does a tremor indicate a more serious problem? What examination or diagnostics are needed?—Aleaxandra Flerchinger, MSN, FNP, Polson, Mont. Tremors are the most common of all movement disorders. They are classified as either static, meaning they occur even when the patient is at rest, or action, presenting only with intentional activity.Obviously, a thorough neurologic…

COMBINING DIABETES MEDS

What do you think of using an a-glucosidase inhibitor, such as acarbose (Precose), with a dipeptidyl peptidase IV (DPP-IV) inhibitor, such as sitagliptin (Januvia)? Would the combination be additive or synergistic? Or would it be contraindicated? Both agents lower hemoglobin A1c.—Joseph Nelson, MD, Pauma Valley, Calif. Similarly, are there any data on the safety of…

CAVEATS ON COFFEE?

Should we or should we not drink coffee? What are the health benefits? What are the negatives?—Felix N. Chien, DO, Newport Beach, Calif. Coffee and tea are the most widely consumed beverages in the world, and caffeine is thought to be the most commonly used pharmacologically active substance (Gilbert RM. In: Spiller GA, ed. The…

Postoperative urinary retention

A number of female patients, aged 60 and older, have been found to have urinary retention during the recovery period following total hip replacement or hip fracture. (Whether the retention preceded or followed the hip fracture is unknown.) Those found to have a UTI were treated with oral antibiotics for one week. Many failed voiding…

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