Summary, Speculation, Suggestion

Friday, July 3, 2020 I haven’t written for about two months. One reason is that I’ve been busy taking care of my patients. Only three of my patients have contracted COVID, as far as I know. All have recovered. Many others may have had asymptomatic infections. But almost all of my patients have had important COVID-related questions and concerns. Another reason for the blogging pause is that for the last two months I haven’t known what to write, because I didn’t understand what was happenin...

In Healthy Older Patients Aspirin Doesn’t Help

Aspirin tablets. Photo credit: Ragesoss / Wikimedia Commons
Before we delve into this month’s news about aspirin, let’s briefly review what we think we know. Aspirin is life-saving therapy during a heart attack. In patients who have had a stroke or a heart attack in the past, daily low dose aspirin can prevent a second stroke or heart attack. Ditto in patients who have had bypass surgery or angioplasty or those who have chronic angina (chest pain caused by narrowing of coronary arteries), daily low dose aspirin prevents heart attacks in them too. ...

What to Know Before Taking Cipro or Levaquin

Ciprofloxacin tablets. Photo credit: Wikimedia commons.
Fluoroquinolones are the third most commonly prescribed family of antibiotics in the U.S. for adults, and, in my opinion, the second most fun to say (right behind aminoglycosides). Fluoroquinolones include levofloxacin (Levaquin), ciprofloxacin (Cipro), moxifloxacin (Avelox), ofloxacin, and delafloxacin. Their popularity is well earned; they’re very effective at treating certain bacterial infections. But since their discovery in the late 1970s, increasing concern has been raised about their ...

Medications Are Not the First Choice of Treatment for Low Back Pain

Low back pain is very common. The vast majority of people reading this sentence have had low back pain at some time in their lives. It is one of the most common reasons for physician visits in the U.S. and results in an estimated $100 billion in annual costs. Given the very high prevalence of low back pain, you would think that we would already have noninvasive treatments that are proven to be safe and effective. You’d be wrong. Recently the American College of Physicians (ACP) reviewed e...

Weighing the Risks of Celebrex

Non-steroidal anti-inflammatory medicines (NSAIDs) have been around since the 1960s. They include ibuprofen (Advil, Motrin), naproxen (Aleve), meloxicam (Mobic), diclofenac (Voltaren) and over a dozen others. NSAIDs are used to treat pain, decrease fever, and decrease inflammation. They are prescribed over 100 million times annually in the US. Naproxen and ibuprofen are also available over the counter. NSAIDs were a boon compared to the medications that were available before them. They ar...

Prolonged Antibiotics Don’t Help in Lyme Disease

erythema migrains
Lyme disease is a bacterial illness transmitted by tick bites. It is treated with antibiotics, and most guidelines suggest a two to four week course of treatment. Most patients’ symptoms resolve at that point, but 10 to 20% of patients continue to have fatigue, joint and muscle pain, sleep problems, and difficulty concentrating. These patients can be quite debilitated and no specific effective treatment has been found for them. A patient advocacy group has recommended treatment with antib...

Why You Might Want More Blood Pressure Medicine

A patient's blood pressure being taken
We’ve known for over a generation that using medications to lower high blood pressure can decrease the risk of strokes, heart attacks, and kidney failure. National guidelines have recommended using medications to get the systolic blood pressure (the higher blood pressure number) below 140. So for my whole career a systolic in the 130s would lead to me pat the patient on the back and declare victory, while a systolic in the 140s would lead me to increase a dose of a medication or stress to th...

Best Treatment for Chronic Insomnia is Cognitive Behavioral Therapy

I'm having trouble trying to sleep I'm counting sheep but running out As time ticks by… And still I try… -- Brain Stew by Green Day from the album Insomniac

Sleep that knits up the raveled sleave of care, The death of each day’s life, sore labor’s bath, Balm of hurt minds, great nature’s second course, Chief nourisher in life’s feast. -- Shakespeare, Macbeth

Chronic insomnia affects 5% to 15% of Americans. It is far ...