Print Issue: May 29, 2008

REDUCING THE CLOPIDOGREL DOSE

After a suspected transient ischemic attack, an 81-year-old man who takes 81 mg aspirin daily was placed on clopidogrel (Plavix) 75 mg. Shortly thereafter, he developed easy bruising. Should I reduce the clopidogrel by having him take half a tablet daily or go to alternate-day dosing? Other suggestions?—R.E. Nordling, MD, Hendersonville, N.C. Easy bruising is…

WHEN STANDING UP RAISES BP

Is there any health significance to the phenomenon of “reverse orthostasis,” i.e., BP that rises on standing?—John S. Carr, MD, Loganville, Ga. The finding of postural hypertension (“reverse orthostasis”) is not well evaluated but is likely of limited clinical significance. I came across only one study designed to evaluate this question, using subjects from the…

ASTHMATIC ITCH?

A patient who has chronic asthma says her chin itches whenever she coughs or wheezes. What might cause this?—Ronald Hirsch, MD, Elgin, Ill. Interesting question! Facial itching has been reported as a result of histamine release and as a known side effect of opioid administration. In the latter case, opioid receptors in the medullary dorsal…

LICE ON A CHILD’S EYELASHES

How would you treat a toddler who has pubic lice in her eyelashes? Also, would you dare to explore how the toddler became infested?—Frank S. Horner, MD, Ocala, Fla. Pubic or crab lice (Phthirus pubis) are transmitted during sexual contact in adults. In children, the lice sometimes infest the eyelashes and, uncommonly, the scalp. These…

CALCIUM ON THE SPINAL CORD

What would cause deposits of calcium on the cervical spinal cord? What tests would you run, and what treatment would you suggest? The patient, who has had two surgical procedures to remove the calcium, suffers from multiple joint pain, numbness, pain, and tingling in both legs. Tinel and Phalen’s signs are positive.—R.O. Waiton, DO, Los…

RULING OUT MRSA BEFORE SURGERY

Is there a role for preoperative nasal culture to rule outmethicillin-resistant Staphylococcus aureus (MRSA) prior to surgery?—Rajesh V. Dalal, MD, Lake Jackson, Tex. Presently, the answer is no. There is lack of consensus on the appropriate use of preoperative screening for MRSA. This is due to the fact that although MRSA nasal carriage has been…

PREMATURE VENTRICULAR CONTRACTIONS

A healthy 33-year-old woman with no cardiac risk factors feels thumps or skipped beats in her chest a few times a day regardless of activity. An event recorder showed premature ventricular contractions (PVCs) (no couplets or triplets) that correlated with symptoms. The woman reports no light-headedness, chest pain, racing heart, or shortness of breath. Is…

A DRUG COMBINATION FOR RELIEVING DEPRESSION

I often get good results from using methylphenidate along with a selective serotonin reuptake inhibitor (SSRI) to treat depression. Is there any reason methylphenidate can’t be used to alleviate the depression that accompanies long-standing Parkinson’s disease?—Birkle Eck, MD, St. Louis There may well be some role for methylphenidate in patients with Parkinson’s disease; however, its…

SWITCHING STEROIDS

If a patient experiences a steroid flush reaction on prednisone, is it advisable to switch to another steroid, such as methylprednisolone? Why has triamcinolone been discontinued?—John S. Conti, MD, Youngstown, Ohio The list of side effects associated with corticosteroid use is quite extensive. Vasomotor instability, hypertension, diaphoresis, fever, and “flushing” have been reported (Reactions Weekly.…

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