What is the latest on lycopene and prostate cancer risk? If lycopene is beneficial, what dose should be taken?—Gerard K. Nash, DO, Amarillo, Tex. One of the first articles correlating the consumption of cooked tomatoes with prevention of prostate cancer was published in 1995 (J Natl Cancer Inst. 1995;87:1767-1776). Men who consumed two to four…
An Asian woman who immigrated to this country was diagnosed with miliary pulmonary TB per lung biopsy that showed a caseating granuloma. Both her purified protein derivative test and sputum culture for acid-fast bacilli are negative. While awaiting culture reports of the lung biopsy, she has been receiving four anti-TB medications. She has no respiratory…
Should all breast cysts be biopsied? At what diameter should we become concerned?—Filia Garcia, MD, San Juan, P.R. National Comprehensive Cancer Network guidelines recommend that simple cysts which are asymptomatic can be followed for two to four months before intervention. Cysts that are not simple or are causing symptoms warrant aspiration. If bloody fluid is…
Are triglyceride levels related to ingestion of fat or carbohydrates? Which diet is best for lowering triglycerides?—Colleen Root, MD, Fishers, Ind. The specific diet recommended for patients with hypertriglyceridemia depends on the underlying cause and the triglyceride level. Patients with elevated triglyceride levels should avoid diets high in simple carbohydrates, especially those containing fructose (e.g.,…
A 73-year-old man who had both high BP and high cholesterol suffered an inferior-wall MI. ECG findings showed non-Q-wave, non-ST-segment elevation. Stents were implanted in his right and left coronary arteries. On a regimen of simvastatin, enalapril, metoprolol, clopidogrel, and aspirin, his lipids have normalized, as has his BP. Beginning in his teen years, the…
What are the most time efficient interventions to shorten the duration of oral ulcers?—Hillel B. Naiman, MD, Spring Valley, N.Y. First, it is important to ascertain the diagnosis. The differential diagnosis could include aphthous ulcers, trauma, and, rarely, intraoral herpes simplex, as well as many other rare entities. Assuming that the diagnosis is aphthous ulcers,…
According to reports, a C-reactive protein (CRP) level >2 mg/L can raise the risk of MI even in patients on statins whose LDL is <70 mg/dL (N Engl J Med. 2005;352:20-28). What can be done to lower MI risk in these patients?—Seema Maheshwari, MD, Eclectic, Ala. CRP, an acute-phase reactant produced in the liver, is…
A hypothyroid patient’s annual lab work shows low thyroid-stimulating hormone (TSH) levels (0.20 mU/L). Her free triiodothyronine and free thyroxine levels are both in the middle of the normal range. Should her levothyroxine (Synthroid) dose (100 µg/day) be changed?—Judy Lemons, PA-C, BSPA, Lakeside City, Tex. I would lower the dose of the replacement hormone because…
You will want your patients to consult a specialist to slow progression of this debilitating disease. Here’s what you should know before you refer.
Primary-care clinicians are being asked to diagnose substance use disorder with increasing frequency. Find out what tools are available to assist you.
