Recently, many primary health providers have been bombarded with questions about the latest shingles vaccine, Shringrix made by GlaxoSmithKline.
I have seen few cases of Shingles recently – both confirmed and false ones which have prompted me to look closer at the current recommended approach – to treat or to prevent? Shingles or herpes zoster is caused by a varicella-zoster virus (VZV), also known as human herpes virus 3 (HHV3). It is the same virus that causes chicken pox in kids. But in Shingles, it is a result of latent reactivation within the sensory ganglia of the nervous system.
I realize there is so much talk and education on how we should prescribe antibiotic more appropriately. A discussion on antibiotic stewardship may sound very sexy but the public may not be able to connect to such term. In essence, antibiotic stewardship is an initiative to promote appropriate antibiotic prescribing, to improve patient outcomes and to reduce antibiotic resistance. Maybe making it personal will help – and I mean let’s look at my daughters’ antibiotic use.
Medicine can be messy business – that’s because medical knowledge keeps evolving and practice guidelines will change with time based on new evidence. But before we can definitely change practice, there is often a period with no black or white answer but many shades of grey. In addition, medical decisions aren’t so simple when patient factors, risks of treatment and benefits of treatment all need to be considered simultaneously.
John Dole is a 75 year old men with a past medical history of hypertension, epilepsy and diabetes. Is current medications include:
- Metformin 1000mg po BID,
- Phenytoin 300mg po BID,
- Carbamazepine 300mg po BID
- Hydrochlorothiazide 25mg po daily
He is clinically stable. The drug levels for phenytoin and carbamazpines are within therapeutic range and his lab results are unremarkable except for a mild agranulocytosis (low white blood cell count), with ANC of 1.2 x 109 cells/L. His family physician asked me if the neutropenia is due to his medications. If so, which one?
Recently, the sky rocketing cost of EpiPen in US has made headlines in several news outlets. Epi-Pen is merely an auto-injector device containing epinephrine which can be a life saving medication for individuals experiencing an anaphylactic reaction. The drug has been around for ages and cheap to make but because of its life saving potential, many manufacturers may have taken advantage of it and has priced it higher than it should.
Closer to home in Canada, it is not nearly as expensive but is still not cheap. My family has recently discovered that we also need to carry an Epi-Pen. For two auto-injectors of Epi-Pen Jr, it costs just over $200 CAD. But the real cost of carrying an Epi-Pen is more than its monetary value.
I am always reading something conflicting about steroids. They are good for you and they are also bad for you. The latest controversy is the role of inhaled corticosteroids in Chronic Obstructive Pulmonary Disease. Unlike asthma, the use of inhaled corticosteroids (ICS) has never demonstrated their clinical benefits consistently. They have been shown to improve symptoms, lung function and quality of life as well as reducing exacerbation in patients with FEV1 of less than 60% predicted. However, inhaled corticosteroids have not been demonstrated to prevent the progression of the disease nor to improve survival. Continue reading Inhaled Corticosteroids in COPD – To Abhor or to Adore?