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Managing patients with chronic heart and renal failure

September 22, 2015

When it comes to chronic heart and kidney failure, there are often specific challenges to patient education in addition to the complexity of frequently changing instructions and explanations. The individual’s concentration may be poor because they already feel unwell and this may be compounded by advanced age, a tendency to …

Diagnosing Insulin Resistance: Does it Matter?

How does insulin resistance differ from pre-diabetes and diabetes? Is it necessary to test serum insulin levels? How reliable are serum insulin levels in the diagnosis of insulin resistance? Does it change the management to know that the patient has raised insulin levels?
A raised serum insulin level is not a …

Circumventing the PBS: Treating osteoporosis with private prescriptions

Doctors regularly treat many asymptomatic, but potentially serious, progressive, conditions to avoid later complications. However, when it comes to many patients with osteoporosis and severe osteopaenia, preventative medicine is rarely discussed.
 
The obvious explanation for this lack of encouragement of prevention in other high risk patients is the cost of anti-osteoporotic …

Borderline Personality Disorder

Borderline personality disorder is difficult to define as, according to DSM 5, there need to be five or more of nine criteria present. It is:
“A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts” as …

The Normal Prostate Specific Antigen: Part 3

Franco was a sixty two year old man who had presented to his GP with a urinary infection. Franco had occasional urinary infections (he also had diabetes and known benign prostatic hypertrophy). He had been completely investigated by a urologist eight months ago. Franco improved with antibiotics and all seemed …

The Normal Prostate Specific Antigen: Part 2

Jason was a healthy 48-year-old man whose father had developed prostate cancer at age 55. Because of this, He was told correctly by his GP that Jason was at increased risk of developing the condition himself.1 Quite appropriately, a prostate specific antigen (PSA) was suggested. Jason was counselled in advance …

The Normal Prostate Specific Antigen: Part 1

Victor was a healthy man with no medical problems and no medications. He came to see a new GP at his usual medical practice as he needed Roads and Maritime Services driving medical to be done as he was now 75 years of age. The GP checked the medical records …

Herpes Zoster Ophthalmicus

This seventy-four year old female patient had seen her local doctor for a two small, itchy, slightly painful lesions on her nose that were noticed that morning. She was otherwise well and the doctor and she both assumed that these were insect bites. Over the next twenty-four hours, she developed …

Feeling Blue on Minocycline

Janine was a forty-six-year-old woman who suffered most of her adult life with acne and small boils. She was unable to take oestrogen and had contraindications to isotretinoin. She had used minocycline for two decades as it improved the acne and in particular, reduced the boil formation. She had been …

Exercise and Rhabomyolysis

One enterprising company decided to send their employees on a ‘bonding session’ for a day at a ‘boot camp’. One particular man, aged 45 years, was in reasonable health and took no medications, but was not very fit. He felt obliged to keep up with some of his younger colleagues. …

Pre-operative risk: Underestimating Dental Care

One tragedy of our first world nation is that many patients suffer from very poor dental care. Whilst we doctors are in the midst of mobilising many older patients with joint replacements and cardiac stenting, there is a real danger that pre-operative dental care is forgotten.
James was a jovial, relatively …

The Use of Internet Images via a Search Engine

All GPs know about the use of websites to facilitate a patient’s understanding regarding their new diagnoses or the management of a condition. However, patients frequently have a poor concept about the anatomy of their problem area, especially when it comes to joints, ligaments and organ positions. This sounds so …