Recent content by ColonelForbin

Yeah, I agree with you about using sub-maximal doses of multiple agents before maxing out a single agent. I was referring more to the end product, after you have titrated agents in alternating fashion to maximum. It is uncommon for patients to be truly intolerant to multiple first line...

Yeah I meant to include Clonidine, but also Doxazosin and other alpha-blockers, which I have seen used 4th-line as well by general internists and cardiologists.

Interesting. Any big differences you've noticed in response between the different ARB's?

Obesity Medicine Board Review Questions by Dr. Kevin Smith is a good resource for the exam. It is available on Amazon.

Curious what anti-hypertensive agent others have had the best results with when the 1st line options (CCB, ACE/ARB, thiazide diuretic) have been either maxed out or aren't tolerated. By best results I mean combined efficacy and also tolerability. I understand patient specific factors play into...

Respect the opinion. Would just be curious to hear your thought process. ACR 2020 clinical practice guidelines for Gout treatment recommend screening both Southeast Asians and African Americans and site a study that it's cost effective at a population level. Do realize it is cumbersome to...

You've had insurance companies require trial of Allopurinol before approving Febuxostat even after explaining in the prior auth paperwork the patient was positive for the HLA-B*5801 allele?

Question for other PCP’s, Rheumatologists, or other Allopurinol prescribers. Lexicomp recommends screening not only persons of certain Asian ancestry, but also all African Americans for the HLA-B*5801 allele prior to starting Allopurinol given the higher prevalence of the allele in these...

It's helpful to hear your perspective that these are appropriate referrals. It feels like punting in some of these more likely benign cases when cognitively the PCP should be able to follow the guidelines and order the appropriate follow-up imaging, especially in areas where wait times for...

Yeah they have to be worked up and followed appropriately like you said. It would be great if there was an automated mechanism for following some of these in more medical systems, such as a supervising Radiologist automatically providing the patients with the result and then scheduling...

Of course not. I didn't suggest anywhere that Radiologists are at fault or that they not do their job. As I said, the follow-up is necessary.

Has anyone else practicing primary care noticed there to be an increasing burden of incidental findings to keep track of? With patients having more and more advanced imaging in various settings it seems many patients often have multiple. 1.4 cm TIRADS4 thyroid nodule found incidentally as a...

I'm a relatively new IM trained PCP. One of the clinical scenarios I still find myself struggling with is acute monoarticular arthritis. Given that it is very difficult to differentiate clinically between non-septic (i.e. Gout, Pseudogout, etc.) and septic causes, I'm wondering what factors...

This may be a paranoid question. However, in today's climate I guess you can't be too careful. It's common now for physicians to take part in online physician groups on platforms like Facebook, SDN, etc. to discuss general issues related to practice. More and more frequently someone will post...

My main concern coming at this with only IM training is the ability to generate any revenue, such that there will be no jobs. I know your background is Endo, so I don't know your familiarity with billing in the primary care setting. Most insurances are moving towards full or partial...