QUICK NOTES FROM DR G OPINES DrGOpines.com
ONYCHOMYCOSIS: Do your grandkids tease you about your ugly toenails? Do you avoid going barefoot because you’re embarrassed by unsightly toenails? Have your toenails become so thick you no longer can trim them?
If the answers are “Yes,” you have onychomycosis.
According to American Family Physician journal, the most effective treatment is an oral anti-fungal, terbinafine (Lamisil). If your liver is ok, the dose is one 250mg tablet daily for 90 days (3 months). Lamisil can be toxic to the liver so baseline liver tests must be normal and repeat liver test be done monthly while taking Lamisil. An alternative drug is itraconazole (Sporanox). Retired Indianapolis podiatrist, Dr. J Winckelbach, used Lamisil in his practice with good results and strongly recommends it.
SCIATICA: PAIN AND DISABILITY: Do you have severe back pain and/or pain in one buttock, back of one thigh, or in one calf? Have you been diagnosed with Sciatica?
According to American Family Physician journal, treatment with an epidural injection of a corticosteroid provides “a small and probably clinically significant reduction in leg and back pain” within 2 weeks. “A small to moderate reduction in disability in [2 weeks to 12 weeks]” This treatment has been used successfully for many years and should be tried before surgery.
TENSION HEADACHES: Do you have tension-type headaches? Nearly everyone does.
According to American Family Physician journal, amitriptyline (Elavil) effectively prevents tension-type headaches after three months of treatment reducing headache frequency and the need for stronger analgesic abortive treatments. Thus, a preventive drug is available for tension headache sufferers. This could improve quality of life for these patients.
HYPERTENSION: High blood pressure—“the silent killer.” Is your BP up and down all the time?
According to American Family Physician journal, chlorthalidone (Hygroton) reduces systolic BP by 10 points (mm Hg) more than hydrochlorothiazide in BP patients on single-drug treatment. I would recommend high BP patients take chlorthalidone as their base drug for treating high BP and add additional drugs as needed to gain good control.
PREVENTION OR DELAY OF TYPE II DIABETES: “Prediabetes is NOT a diagnosis, but an opportunity to prevent or delay a future diagnosis of type 2 diabetes.” Borderline diabetic is a popular description people use incorrectly.
According to American Family Physician journal, type 2 diabetes can be prevented or delayed by using an intensive lifestyle program that includes weight loss and physical exercise. A loss of 7% of body weight plus at least 150 minutes of moderate-intensity exercise weekly is the recommendation. There is “no optimal diet identified that prevents the onset of diabetes.” Also, metformin therapy will slow the progression to type 2 diabetes.
LOW BACK PAIN: Ibuprofen and muscle relaxers are used alone, or together, for acute low back strain. Is either or both helping?
According to American Family Physician there is no difference in short-term relief of back pain between placebo and an Ibuprofen-muscle relaxant combination leading to the conclusion that muscle relaxants, when added to ibuprofen, do not improve pain or function during episodes of low back pain. AAFP recommends against using muscle relaxants for low back pain.
COLONOSCOPY: Have you had one? You should. It’s a lifesaving procedure, that should definitely be done at age 50, but the American College of Gastroenterology (ACG), the United States Preventive Services Task Force (USPSTF), and the American Cancer Society (ACS) have all lowered the starting age. They all recommend colonoscopy screening begin at age 45. The accuracy of detection of polyps, adenomas, and cancerous lesions supports this new recommendation.
HEMOGLOBIN A1C VALUES: Have you heard your diabetic friends or family talk about their A1C? A1C is a test used by doctors to measure the degree of blood sugar control in diabetic patients. It’s expressed in a percentage which translates into a person’s average blood sugar over a 3-month period. Normal is 5.7% or less. Diabetes is 6.4% or higher. 5.7% to 6.4% is pre-diabetes. The lower the percentage, the better the control.
According to American Family Physician, face-to-face patient education interventions improve patient’s A1C levels by as much as 1.4%. Group-based interventions produced the best results. “Nurse-led diabetes self-management education program….had a significant decrease in A1C compared to [a] control group.”
References: https://www.AAFP.org/afp/2021/1000/p359.html
Practice Guidelines. Prevention or delay of type 2 diabetes Mellitus:Recommendations from the American Diabetes Association Am Fam Phys. 2022 April;105(4):438-439.
Letters to the Editor. https://www.aafp.org/afp/2021/0700/p41.html.
Colorectal Cancer Screening: Updated Guidelines from the ACG. Am Fam Phys 2022 March;105(3):327-329.
Llewellyn S, Neumann M, Lyon C, DeSanto K. Patient Education Interventions Improve A1C Values. Am Fam Phys 2022 April;105(4):428-429.
Lamisil worked the best in my practice. I never had to stop treatment due to elevated Liver enzymes.
Thanks, J. Is it alright if I add your quote to the article? I would say, “a retired Indianapolis podiatrist said ‘Lamisil worked best in my practice’.”