Author Archives: Dr. Pullen

AFP Pearls

I read the American Family Physician journal, sent to all members of the American Academy of Family Physicians and anyone else who subscribes, and sometimes an issue comes out with a few pearls that I want to pass on. The Oct 15, 2016 edition was one of them and here are a few of the tidbits of wisdom I’m sharing from this issue today:

     –TRAVELERS DIARRHEA UPDATE:  Traveler’s diarrhea is the most common infection in international travelers.  It can occur in 30-70% of travelers in some areas.  Despite the universal advice to avoid food from street vendors, don’t drink tap water, avoid raw foods and ice there is evidence that these precautions have not been shown to reduce the incidence of travelers diarrhea.  Although a short course of ciprofloxacin has been the usual recommendation (500 mg initial dose followed by 500 mg 12 hours later) there are reasons that this may no longer be optimal.  First resistance to this class of antibiotics is high in some areas, especially in Campylobacter infections in SE Asia.  Second is the FDA warning to limit fluoroquinolone use due to side effects risk. Azithromycin is also effective at a dose of 500 mg daily for 1-3 days, or as a single 1000 mg dose. It may now be the best recommendation worldwide. 

     -TWO GOOD PLACES TO FIND MALARIA PROPHYLAXIS INDORMATION:  Advice for Malaria prophylaxis is available on the CDC site or from the WHO Malaria information web page.

     -SPECIFIC GENERIC INEXPENSIVE BIRTH CONTROL PILLS ARE SAFER THAN SOME NEW EXPENSIVE BRAND NAME OPTIONS:   In a huge French study of the use of ischemic stroke, heart attack and pulmonary embolism with birth control pill use came good news.  First as has been previously shown the risks are very low, roughly 6 per 10,000 women.  Not just that but the risks are lowest with the lowest dose estrogen pills, i.e. 20 mcg.  Not only that but the specific progestin used makes a difference, and the older, generally less expensive oral contraceptive ingredient levonorgestrel is associated with the lowest risk.  Newer progestins used in the considerably more expensive branded birth control pills specifically desogestrel (in Desogen and Mircette) and gestodene (in Gynera, Femogen, and others).  The lowest risk was in  pills using 20 mcg estrogen and levonorgestrel.   Examples are Alesse, Aviane, Lessina, Levlite, and Lutera all of which have 20 mcg. of ethinyl estradiol and 0.1 mg of levonorgestrel.  Although some women may have breakthrough bleeding on these fixed dose birth control pills, they seem like the optimal first choice option for many women who choose a daily use pill for contraception.  (A caveat to this report is that some types of birth control pills were not looked at because they were not used in the French national health formulary.)

Top 20 Research Studies of 2015- AFP Article

I read the American Family Physician fairly regularly and sometimes I come across an article good enough to summarize here.  In the May 1, 2016 issue is an article titled, “Top 20 Research Studies of 2015 for Primary Care Physicians.”  In each AFP is a section called POEMs, for “Patient Oriented Evidence that Matters,” and… Continue Reading

A Better Approach to Diet for Type 2 Diabetes

For years I’ve sent my newly diagnosed and poorly controlled patients with type 2 diabetes to diabetes education classes.  There they are taught many helpful skills, including how to test their blood sugars at home, how to watch for complications of diabetes like foot ulcers and infections, and a big focus is on how to… Continue Reading

Overoutrage: The Right Way to Determine Healthcare Policy?

I came across a very interesting article today in The Health Care Blog by Saurabh Jah, MD titled Overoutrage and the Assymetric Skepticism of Healthcare Journalists. This addresses a concept I’d not heard of until now. Here is a quote from the above linked article: “Overoutrage is excessive moral outrage. Outrage is excessive anger. Anger is… Continue Reading

Blood Pressure: How Low is Low Enough

A new clinical trial published in the New England Journal of Medicine called the SPRINT Trial ( Systolic Blood Pressure Intervention Trial ) which compares standard treatment of hypertension to a goal of a systolic BP < 140 compared to more aggressive treatment to a goal of systolic BP <120 was published on Nov. 9,… Continue Reading

Editorial on PSA Screening for Prostate Cancer

If you’ve been following this blog for a while you may have noted a number of posts on the dilemma of overdiagnosis and PSA screening for prostate cancer.  We used to thing that all cancers has a common characteristic that once established they inexorably progressed, eventually becoming symptomatic and often lethal.  We now know that… Continue Reading

WHO: Red Meat, especially Processed Meat Causes Cancer

Although I believe the findings in the WHO report the conclusion of the WHO that eating processed meat, and even eating meat at all, causes cancer this information adds very little to my reasons not to eat meat. Some of you may recall from a prior post that I chose to eat a plant based diet… Continue Reading

It takes more than Ankylosing Spondylitis to Keep Guti Down

One of the very few good things about my beloved Seattle Mariners this year, besides Nelson Cruz crushing the ball, has been the call up of Franklin Gutierrez. Guti has been one of my favorite M’s over the years, and to see him struggle with his health concerns since 2011 has been really sad and… Continue Reading