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RE: Actos

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We usually see our diabetics quarterly so we do urine dips at every visit and educate patient of risk v benefitRockySent from my iPhone4

What are people doing about Actos? I get a couple of calls or texts or questions a week. Seeing the add from lawyers on TV usually triggers it. I even just had one patient I sent to surgeon/ortho for bad ankle sprain/chip fracture who likes to pretend he is Family doctor. Took down the list of his 20 drugs and then hand checked them in a book for drug interactions and told him to get off the Actos immediately. (They had to keep asking him what to do about the ankle. I am telling patients there is a risk but it’s low and bladder cancer is easily treatable. It’s at the higher dose. And many of them are smokers so I remind that that is a big risk for bladder cancer right there. Considering doing annual U/A for hematuria for screening. I don’t know of any official recommendations. What are you doing? Kathy Saradarian, MDBranchville, NJwww.qualityfamilypractice.comSolo 4/03, Practicing since 9/90Practice Partner 5/03Low staffing

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I think you're spot on: the increased risk from Actos is small but

real. I might consider it (along with metformin, where possible) in

somebody with NAFLD and no significant history of heart failure, but

otherwise I'd probably just avoid it--especially in smokers.

My preferred second line agent for DM after metformin is a basal

insulin, with a very strong preference for Levemir over Lantus.

Ken

> What are people doing about Actos? I get a couple of calls or texts or

> questions a week. Seeing the add from lawyers on TV usually triggers it.

> I even just had one patient I sent to surgeon/ortho for bad ankle

> sprain/chip fracture who likes to pretend he is Family doctor. Took down

> the list of his 20 drugs and then hand checked them in a book for drug

> interactions and told him to get off the Actos immediately. (They had to

> keep asking him what to do about the ankle.

>

>

> I am telling patients there is a risk but it's low and bladder cancer is

> easily treatable. It's at the higher dose. And many of them are smokers so

> I remind that that is a big risk for bladder cancer right there.

> Considering doing annual U/A for hematuria for screening. I don't know of

> any official recommendations.

>

>

> What are you doing?

>

>

> Kathy Saradarian, MD

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Ok, you got me. What is NAFLD?

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Ken Stone

Sent: Wednesday, February 22, 2012 7:41 AM

To:

Subject: Re: Actos

I think you're spot on: the increased risk from Actos is small but

real. I might consider it (along with metformin, where possible) in

somebody with NAFLD and no significant history of heart failure, but

otherwise I'd probably just avoid it--especially in smokers.

My preferred second line agent for DM after metformin is a basal

insulin, with a very strong preference for Levemir over Lantus.

Ken

On 2/22/12, Kathy Saradarian

wrote:

> What are people doing about Actos? I get a couple of calls or texts or

> questions a week. Seeing the add from lawyers on TV usually triggers it.

> I even just had one patient I sent to surgeon/ortho for bad ankle

> sprain/chip fracture who likes to pretend he is Family doctor. Took down

> the list of his 20 drugs and then hand checked them in a book for drug

> interactions and told him to get off the Actos immediately. (They had to

> keep asking him what to do about the ankle.

>

>

> I am telling patients there is a risk but it's low and bladder cancer is

> easily treatable. It's at the higher dose. And many of them are smokers so

> I remind that that is a big risk for bladder cancer right there.

> Considering doing annual U/A for hematuria for screening. I don't know of

> any official recommendations.

>

>

> What are you doing?

>

>

> Kathy Saradarian, MD

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Share on other sites

non alcoholic fatty liver disease or non alcoholic steatohepatitis (NASH)highly correlative of cardiovascular risk Rakesh C. Patel, M.D.Twitter: @drrcpatelwww.facebook.com/azsunfmwww.medleyhealth.com/rakeshpatelwww.azprevention.comArizona Sun Family Medicine, P.C. and Nexlev Health and FitnessSpecializing in Diabetes, Heart Attack and Stroke Prevention633 E. Ray Road #101Gilbert, AZ 85296www.azsunfm.com and www.nexlev.com To:

Sent: Wednesday, February 22, 2012 8:23 AM Subject: RE: Actos

Ok, you got me. What is NAFLD? Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Ken Stone

Sent: Wednesday, February 22, 2012 7:41 AM

To:

Subject: Re: Actos

I think you're spot on: the increased risk from Actos is small but

real. I might consider it (along with metformin, where possible) in

somebody with NAFLD and no significant history of heart failure, but

otherwise I'd probably just avoid it--especially in smokers.

My preferred second line agent for DM after metformin is a basal

insulin, with a very strong preference for Levemir over Lantus.

Ken

On 2/22/12, Kathy Saradarian

wrote:

> What are people doing about Actos? I get a couple of calls or texts or

> questions a week. Seeing the add from lawyers on TV usually triggers it.

> I even just had one patient I sent to surgeon/ortho for bad ankle

> sprain/chip fracture who likes to pretend he is Family doctor. Took down

> the list of his 20 drugs and then hand checked them in a book for drug

> interactions and told him to get off the Actos immediately. (They had to

> keep asking him what to do about the ankle.

>

>

> I am telling patients there is a risk but it's low and bladder cancer is

> easily treatable. It's at the higher dose. And many of them are smokers so

> I remind that that is a big risk for bladder cancer right there.

> Considering doing annual U/A for hematuria for screening. I don't know of

> any official recommendations.

>

>

> What are you doing?

>

>

> Kathy Saradarian, MD

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Share on other sites

Bladder U/S x 1 and U/A's each visit.

To: 'Clinical Procedures' Cc: Sent: Wednesday, February 22, 2012 8:44 AMSubject: Actos

What are people doing about Actos? I get a couple of calls or texts or questions a week. Seeing the add from lawyers on TV usually triggers it. I even just had one patient I sent to surgeon/ortho for bad ankle sprain/chip fracture who likes to pretend he is Family doctor. Took down the list of his 20 drugs and then hand checked them in a book for drug interactions and told him to get off the Actos immediately. (They had to keep asking him what to do about the ankle.

I am telling patients there is a risk but it’s low and bladder cancer is easily treatable. It’s at the higher dose. And many of them are smokers so I remind that that is a big risk for bladder cancer right there. Considering doing annual U/A for hematuria for screening. I don’t know of any official recommendations.

What are you doing?

Kathy Saradarian, MD

Branchville, NJ

www.qualityfamilypractice.com

Solo 4/03, Practicing since 9/90

Practice Partner 5/03

Low staffing

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Share on other sites

Thanks – hadn’t seen an acronym for it before.

Eads, MD

Pinnacle Family Medicine

Colorado Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ] On Behalf Of Rocky Patel

Sent: Wednesday, February 22, 2012 9:00 AM

To:

Subject: Re: Actos

non

alcoholic fatty liver disease or non alcoholic steatohepatitis (NASH)

highly

correlative of cardiovascular risk

Rakesh C.

Patel, M.D.

Twitter:

@drrcpatel

www.facebook.com/azsunfm

www.medleyhealth.com/rakeshpatel

www.azprevention.com

Arizona

Sun Family Medicine, P.C. and Nexlev Health and Fitness

Specializing

in Diabetes, Heart Attack and Stroke Prevention

633 E. Ray Road #101

Gilbert, AZ 85296

www.azsunfm.com and

www.nexlev.com

From:

Eads

To:

Sent: Wednesday, February 22, 2012 8:23 AM

Subject: RE: Actos

Ok, you got me. What is NAFLD?

Eads, MD

Pinnacle

Family Medicine

Colorado

Springs, CO

www.PinnacleFamilyMedicine.com

From:

[mailto: ]

On Behalf Of Ken Stone

Sent: Wednesday, February 22, 2012 7:41 AM

To:

Subject: Re: Actos

I think

you're spot on: the increased risk from Actos is small but

real. I might consider it (along with metformin, where possible) in

somebody with NAFLD and no significant history of heart failure, but

otherwise I'd probably just avoid it--especially in smokers.

My preferred second line agent for DM after metformin is a basal

insulin, with a very strong preference for Levemir over Lantus.

Ken

> What are people doing about Actos? I get a couple of calls or texts or

> questions a week. Seeing the add from lawyers on TV usually triggers it.

> I even just had one patient I sent to surgeon/ortho for bad ankle

> sprain/chip fracture who likes to pretend he is Family doctor. Took down

> the list of his 20 drugs and then hand checked them in a book for drug

> interactions and told him to get off the Actos immediately. (They had to

> keep asking him what to do about the ankle.

>

>

> I am telling patients there is a risk but it's low and bladder cancer is

> easily treatable. It's at the higher dose. And many of them are smokers so

> I remind that that is a big risk for bladder cancer right there.

> Considering doing annual U/A for hematuria for screening. I don't know of

> any official recommendations.

>

>

> What are you doing?

>

>

> Kathy Saradarian, MD

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