My 2 Cents: March 2013

Sunday, March 31, 2013

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Q&A Session at HealthTap.com

So my leg hurts when i wrap it.it keeps turing purple and it not to tight and it hurts so bad i can barly walk still no insuernce what should i do?

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Q&A Session at HealthTap.com

I recently stopped taking prednisone (18 yrs for SLE) diet and exercise alone aren't helping me lose the weight. Is there medicine I can take to help?

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Saturday, March 30, 2013

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Q&A Session at HealthTap.com

My blood sugars were normally 85-95 and now they have been 110-113 in the morning I'm not liking this could there be something wrong? Should I go backon my metformin medication. Should I worry liver?

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Q&A Session at HealthTap.com

I've resently had sex with my boyfriend and now my lower stomach hurts why is this ?

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Q&A Session at HealthTap.com

Hi, my husband & I have been actively trying for a baby using an ov prediction kit etc... I'm now 2wks late for my period but the test show neg, help?

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Q&A Session at HealthTap.com

Tamsulosin makes my husband anxiuos, depressed and almsot paranoid. Can we stop for a few days and try saw palmetto during the stop period. Alternate?

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Q&A Session at HealthTap.com

My 10 mths baby has conjunctivitis. Does she need to see a doc?

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Friday, March 29, 2013

Q&A Session at HealthTap.com

I started with a fever and bodyaches two days ago and now i have a sorethroat cough and green mucus coming up and i also lost my voice but its better?

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Q&A Session at HealthTap.com

How many hrs of sleep should a teen get?

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Q&A Session at HealthTap.com

What are the symptoms ifinsulin resistance and its treatment?

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Q&A Session at HealthTap.com

I have been switched from lexapro to generic and seems not to be working at all. Any one heard of this?

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Q&A Session at HealthTap.com

Got diagnosed with a uti and chlamydia could that be the reason I feel like I have little cuts down there?

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Q&A Session at HealthTap.com

I've been taking lo loestrin fe for ten days now never missed one pill. Had unprotected sex but did not ejaculate in me. Should I be worried?

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Thursday, March 28, 2013

Q&A Session at HealthTap.com

How can I get rid of hemrrhoids external?

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Q&A Session at HeatlhTap.com

Indomethacin for hemicrania continua. Based on 1 week of use, one 25mg pill kills pain for near 24hrs. Ok to use it this way rather than 3x day as Rx.

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Q&A Session at HealthTap.com

Im body builder I use to take strioeds from last 1 year I stoped so there is any post cycling to remove?

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Q&A Session at HealthTap.com

My height is 5 inches and weight is 64 kg.what should be my ideal weight according to my height?

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Q&A Session at HealthTap.com

Can taking pre workout supplements harm your health over long periods?

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Q&A Session at HealthTap.com

After reducing sugar and increasing fiber in my diet, I now crave sugar in the evening. How to stop the cravings?

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Wednesday, March 27, 2013

Q&A Session at HealthTap.com

What does having a 94.5 body temperature mean?

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Q&A Session at HealthTap.com

Is it okay to take a multivitamin supplement while using the prescription Metformin?

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Q&A Session at HealthTap.com

How do u know if ur knees are tender and what is tender?

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Is Chelation the New H pylori? Part 2

The proof is in the pudding. Three weeks ago, results of the Trial to Assess Chelation Therapy (TACT) study were announced at the annual meeting of the American College of Cardiology to much press & noise. While some of the details of the study were discussed, we usually wait to comment until the study has been published in a peer reviewed journal. And thus, I would direct your attention to today's issue of JAMA which includes not only the TACT study, but also to an editorial concerned about the deficiencies of the study, and a second editorial focused on what TACT brings to the table. I think it's important that you make the time to read both editorials to gain better insight into TACT and help you formulate your own understanding of this controversial study.

And more thought, if the proof is in the pudding, then the devil is in the details. Just as when a randomized controlled study demonstrates the benefit of some particular drug, we cannot automatically generalize those same results to another drug in the same family. So whether you believe in the benefits of chelation with regards to cardiovascular events, remember that this study was one of 30 weekly infusions plus an additional 10 infusions 2-8 weeks apart of a 500mL solution comprised of 3g of disodium EDTA, 7g ascorbate, B vitamins, electrolytes, procaine & heparin vs placebo. Another part of the arm randomized patients to either an oral mineral-vitamin vs an oral placebo. Thus was the 2x2 factorial study developed. My point is that we need to acknowledge that chelation therapy has many variations on a theme and this study was specifically on this regimen, not to be generalized to all chelation solutions.

Just like a recent study of niacin + laropripant vs placebo can only tell you about the combination drug, yet the lay press and our health care pundits are impugning the repetition of niacin by generalizing. But what if the negative outcomes were due to laropripant? We've conveniently forgotten how to interpret studies, just like a decade ago when we studied Premarin or PremPro in women >10yrs post-menopause. In our haste to place the blame on someone/something, we sacrificed (conjugated equine) Estrogen when a decade's time in front of the retrospectograph suggests that Women's Health Initiative only applies to asymptomatic post-menopausal women 10 years after menopause.

Let's not forget history and end up repeating it again.

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Tuesday, March 26, 2013

Q&A Session at HealthTap.com

Please describe the differences in symptoms in cardiac related dyspnea, asthma related dyspnea, and anxiety related dyspnea?

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Q&A Session at HealthTap.com

How many cigarette a day is not much injurious to health....

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Q&A Session at HealthTap.com

When im on an exercise bike at the gym I sometimes find my throat starts to feel smaller & I find it harder to breath. Why is this?

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Be Careful What You Wish

Turns out it's allergy season around here, especially with all the olive trees blooming. Seems everyone is complaining of itchy watery eyes & runny stuffy nose, so we prescribe a lot of oral & ophthalmic antihistamines as well as intranasal steroids. But there's always someone who wants a course of oral steroids or a corticosteroid shot. It's the only thing that works for me, doc! I try to dissuade these patients of their request and point out (nicely) the folly of their shortsightedness. When used w/o oversight, the benefit of oral/injectable steroids is outweighed by their potential side effects, including but not limited to cataracts, diabetes, immunosuppression, osteoporosis & striae (stretch marks), etc.

What amazes me is that some of these patients still insist on getting their steroids. Well, as I mentioned yesterday, take the medication only if you need it and only if the hoped for benefits outweigh the potential risks. Personally, I'm not convinced that the short-term gains are worth the long-term risks but I guess I've never been beset by allergies like this patients, so I shouldn't force my views on them but rather just provide education.

Well, along those lines, a population-based nested case-control study was published yesterday in JAMA Internal Medicine, in which the authors concluded that oral glucocorticoid use is linked to an increased risk of acute pancreatitis. Of note, the participants were 40-84yo Swedes of whom 6,161 cases of initial acute pancreatitis were compared to 61,673 controls, each selected based upon similar age, gender, and calendar period. Greatest risk for this exquisitely painful condition occurred 4-14 days after starting glucocorticoid therapy. Recent use & former use did not increase risk, nor did stopping use.

So be careful what you wish for. That short course of corticosteroids might relieve your allergies but could also potentially bring about some rather painful consequences. Granted that's a big step to assume cause & effect, which this study was not designed to do, but the association was strong and the outcome poor. So why take that risk unless you feel it's absolutely necessary? Caveat emptor.

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Monday, March 25, 2013

Q&A Session at HealthTap.com

Will bupropion sr and delsym night interact?

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Q&A Session at HealthTap.com

I had unprotected sex on February27 and then my period came on February 28 but it was irregular could I be pregnant?

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Q&A Session at HealthTap.com

My 6yr kid's right pelvic bone is a bit higher than left pelvic bone causing right leg to be shorter than her left leg. can it be corrected? how?

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Tossing the Baby Out with the Bath Water

While I was doing the online equivalent of dumpster diving this weekend, I stumbled upon a number of tweets and questions surrounding the use of medications. On the one hand, many people write into any number of health care forums (I participate on www.healthtap.com) and ask about possible drug-drug interactions regarding their regimen. I find this a sad commentary as these questions should have been addressed by the physician at the time of prescription & re-addressed by the pharmacist at the time the medication was dispensed. Unfortunately, in this day and age, we don't have time to go into detail with our patients as accountable care organizations force us to become more efficient at data entry under the guise of providing better care.

As a result, there has been a backlash by patients who've lost their trust in their doctors aka healthcare providers. We're seen as pawns of Big Pharma, or worse, as salesmen pushing the latest medication on an unsuspecting population. Selective serotonin reuptake inhibitors are now being blamed for suicides and homicides. Yet, just two short decades ago, these very same SSRIs were considered a God-send as they were found to be useful in treating those with depression. And if you think about it, who's more likely to commit suicide? A depressed person or a non-depressed person? So blaming SSRIs for causing suicides is like blaming cars for killing others while the driver was under the influence.

Don't get me wrong. Many drugs have been pulled off the market just as soon as it was deemed the appropriate thing to do. Some have required more time to uncover their risk given the small chance of something going bad. A good example is the Food & Drug Administration's recent warning for heart rhythm problems in association with Azithromycin. How ironic that it's taken this long after FDA approval in 1991 to uncover a link between Azithromycin use and heart rhythm disturbances in those w/QTc prolongation. In fact, this link was first published last May in the New England Journal of Medicine.

So is this an isolated incident? It's more likely a class effect as it's cousin, Erythromycin, has also been linked to heart rhythm disturbances. And now, another family member, clarithromycin was just linked to increased risk of cardiovascular events in a study published last week in the British Medical Journal. The point of my diatribe is not to classify this particular family of antibiotics as inherently & overwhelming dangerous and in need of being pulled off the market, but to point out how we must balance need for benefit against potential risk of side effects. Surely, you shouldn't take any medication unless you need to do so. By that same token, always ask your doctor about alternatives, side effects & interactions. And find out what are the consequences of not taking the medication.

If you're depressed such that counseling isn't enough, yet refuse to take any antidepressant out of fear that it might cause suicide/homicide, you just might commit some regrettable action even w/o taking said medication. Likewise, if you're now afraid of taking any antibiotic (healthy skepticism is a good thing), then your risk of dying from said infection is greater than if you didn't take the appropriate medication. So be sure not to rush your doctor for empiric antibiotics just a few days into a cough & runny nose (www.ChoosingWisely.org). And be sure s/he knows every medication & supplement that you're taking. Don't throw the baby out with the bath water.

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Pages

Sunday, March 31, 2013

Saturday, March 30, 2013

Friday, March 29, 2013

Thursday, March 28, 2013

Wednesday, March 27, 2013

Tuesday, March 26, 2013

Monday, March 25, 2013