Print Issue: November 03, 2006

REDUCING STATIN SIDE EFFECTS

I would like to add to the suggestions of Robert M. Guthrie, MD, for lessening the risk of myopathy/rhabdomyolysis in patients who take statins (Item 97-5). When starting a statin, I test for vitamin D or thiamine deficiency and treat if necessary. Vitamin D deficiency causes a bland myopathy, so it makes sense to measure…

WHAT ARE CLINICIANS OBLIGATED TO TELL PATIENTS WITH POOR PROGNOSES?

When a patient is given a diagnosis with a statistically poor prognosis (<5% survival), what can I legally and ethically say about the expected outcome? I want my patients to be able to choose treatment options that are in keeping with their desired quality of life without losing hope. I also want patients to be…

PROPHYLACTIC STATIN USE

I have heard that taking a cholesterol-lowering agent prophylactically (i.e., atorvastatin [Lipitor] once a week) will prevent high cholesterol/increasing LDL. What are your thoughts on this?—Michelle Laughlin, PA-C, Wilmington, Del. Taking any statin at any dose can be expected to have some effect on serum lipids, but I can find no support for once-weekly dosing…

SORTING OUT IMMERSION SYNDROME

Q: I have had great difficulty finding information on immersion syndrome, which I believe is a form of reflex sympathetic dystrophy (RSD). Since RSD is a manifestation of autonomic dysfunction, isn’t immersion syndrome also a matter of autonomic dysfunction?—Steven Klein, DO, MPH, Gloucester City, N.J. A: Immersion syndrome (also referred to as “immersion foot” or…

Height advantage?

One always hears that tall men have an economic advantage in the workplace. Is there any advantage when it comes to health? Do shorter men have fewer arthritic problems than tall men? Does height have any effect on life expectancy?—Felix N. Chien, DO, Newport Beach, Calif. Studies have shown that increased height does indeed confer…

LONGER ANTIBIOTIC TREATMENT FOR PROSTATITIS?

Q: Recently, a 47-year-old asymptomatic patient had a random prostate-specific antigen (PSA) level of 5.32 ng/mL. A repeat assay the following day was 6.10. All previous PSAs over a seven-year period had been in the 0.4-0.9 range; the most recent determination (July 2005) was 0.8. After two weeks of levofloxacin (Levaquin), the PSA had dropped…

HALTING URINE LEAKAGE

Q: A 56-year-old nursing-home patient has been a paraplegic for many years following a motorcycle accident. She has a diversion colostomy and an atonic bladder. Despite use of the Foley catheter with the largest balloon, urine leakage resulting in constant dampness has caused chronic, refractory deep decubitus ulcers on her buttocks and perineal areas. An…

HOW MUCH MEDICINE IS LEFT IN THIS INHALER?

Q: How can one tell when a metered-dose inhaler is empty? I have been told that “floating” it is not accurate, and my drug reps haven’t been able to give me an answer.—Rhonda Bonilla, MSN, FNP, Tulare, Calif. A: “Floating” an inhaler in water has long been suggested as a way to determine when it…

RETESTING FOR BLOODBORNE VIRUSES AFTER ACCIDENTAL TRANSMISSION

Q: If a person is exposed to potential bloodborne pathogens (e.g., inadvertently given another patient’s dialysate for hemodialysis), when is the best time to recheck for possible development of disease, such as HIV or hepatitis?—Jan Mailloux, PA-C, Mineral Point, Wis. A: After obtaining informed consent, test the source individual’s blood as soon as possible for…

ORAL BISPHOSPHONATES FOR OSTEOPOROSIS?

Q: What are your thoughts on prescribing oral bisphosphonates for osteoporosis? I am wary of prescribing them in younger patients because these agents have long half-lives and seem to be associated with an increase in jaw osteonecrosis, which can occur with or without dental work.—Matthew Sima, PA-C, Jupiter, Fla. A: I am also wary of…

Next post in Advisor Forum