Print Issue: May 01, 2009

Hyperlipidemia — not just the numbers

For several years, I have geared my treatment of hyperlipidemia (Item 126-8) to a goal of 70 mg/dL LDL and 70 mg/dL triglycerides. In my treatment goals, I have placed great importance on the use of statins to (1) reduce endothelial dysfunction as manifest by reduction of cardiac-specific C-reactive protein and (2) enhance plaque regression.…

Of what value are folate levels?

As a geriatrician, I often order serum folate levels as part of a workup for dementia or anemia. How accurate is the statement that “serum folate levels are not useful because they fluctuate rapidly with dietary intake and are not cost-effective” (Am Fam Physician. 2009;79:203-208), which, I believe, is based on an earlier article that…

Is restless legs syndrome related to tremor?

Is there a known relationship between familial/essential/intentional tremor and restless legs syndrome (RLS)? Based on my research, both have some dopamine-related pathophysiology and may have some genetic origin. What percentage of patients has both conditions (or at least a family history of the other condition [e.g., RLS patient with a family history of tremor, or…

Zoster vaccine while on arthritis meds

Is zoster vaccine (Zostavax) contraindicated in a 75-year-old woman who receives rituximab (Rituxan) injections every three months for her rheumatoid arthritis?—LARRY LAMASTERS, PA-C, Fairbank, Iowa Yes. Because it is a live attenuated vaccine, the zoster vaccine is not recommended for use in pregnant women or patients with primary or acquired immunodeficiencies (including leukemia, lymphoma, or other…

Getting high blood sugar levels under control

A 70-year-old man with a history of type 2 diabetes takes insulin glargine (Lantus) 100 units every morning and insulin aspart (Novolog) 20 units with each meal. However his blood sugar is still around 250 mg/dL.

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