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As the spring is here, I have been getting my usual requests for a refill for an Epipen. These are autoinjectors for epinephrine, which are available as various brands, but have commonly come to known by the brand Epipen although that is certainly not the only available. Epinephrine is used in the treatment and prevention of anaphylaxis from beestings or other such close encounter with nature for someone who is known to be at risk for such a reaction.

What amazes me however, is how confused my patients get, when I ask them where they live, or about their travel or other plans. Such as going hiking up in the mountains etc. Before you all get all upset at the nosy physician, take a read here. It may save your life.

Although not completely polished, I now have my old posts uploaded, and am ready to start writing again! Hope you all enjoy it!

Statin Myopathy – Part 2

For those of you who survived part 1, where we discussed hypothyroidism and its association with statin myopathy, here is part 2.

Vitamin D deficiency

Like my patients with known hypothyroidism, unless at excessive cardiovascular risk I always treat known vitamin D deficiency prior to instituting statin therapy.

Statin Myopathy – Part 1

It’s a common scenario, you walk out of a doctors office with a plan of care that has you all pumped to improve your health – only to realize you can’t carry it through. As physicians we often frown at these “excuses” and label patients as noncompliant rather than address the barriers to therapy. If you can’t make it to a physical therapist for your neck strain, we need to work on an alternative plan of care – not simply expect a single mom to miss work because we said so. There is usually more then one way to skin a cat (no cats were skinned in the writing of this post). Similarly, as a patient, if you feel you are having a side effect of a medication, talk to your doctor – it may be more common then you think – and likely have an easy fix. In today’s post I am going to address a common side effect of one of the most commonly prescribed medications known to reduce cardiovascular disease – Statins.

In my last post I briefly went over allergic rhinitis. In response I received several requests for advise on how to choose an antihistamine or which one is best.

I usually don’t endorse any specific drug, as medical decisions are usually individualized to the patient by the treating physician. I will, however, briefly discuss the salient features of my favorites, and why I might consider one over the other. One thing I don’t make any bones about is that I am not a fan of any previous generation antihistamines. These include

I have long since suffered from seasonal allergies – and it sucks. Unfortunately, both seasonal allergic as well as perennial non allergic rhinitis are common. Usual symptoms may include runny or itchy nose, stuffy nose, sinus pressure, headaches, cough, and mucus pooling in the throat. Some of my patients with chronic rhinitis are so used to their symptoms that they are barely aware of them. I often observe them clearing their throat, or swallowing mucus continually during their office visit, and they don’t even realize it! Some of the symptoms of rhinitis are a nuisance, but others can be problematic, and are best treated under the guidance of your doctor.