Clinical Thread?

[Guest guest]

What do you guys think about an ongoing quick (well maybe not quick

considering how many points of view there are) question/answer

clinical thread on this listserv?

Is it too much? I am fighting practice isolation but will desist

from posting this here if it takes up too much of the ether. I notice

that the volume of posts has been high lately.

If it is too much ignore these questions and tell me to desist. I

think there are other clinical venues and it doesn't have to be done

here. ( I am more fond of you guys than the other lists though.)

If it is not too much, here are 3 questions to start off:

1) Surgery/Derm- Can I excise a accessory nipple with a simple punch

biopsy for cosmetic reasons ( is there underlying breast tissue, if

the person wants to nurse later, will there be milk without an egress

point, will it heal up OK?)

2) Neurology- 86 year old man previous CVA on moderate dose ASA, on

plavix for 4 years since then, now the VA will now only pay for

Aggrenox (dipyridamole and ASA). Plavix costs an arm and a leg and he

will have to pay out of pocket. There is a huge trial going on now

which may answer this question, plavix vs aggrenox, but it is just

enrolling now. Is it safe to switch him? I did it already, but god

knows, if he has another CVA, that will be really sad annoying and

infuriating.

3) Rheumatology- 51 year old alcoholic female with recurrent episodes

past 2 years of high CRP (up to 31) and mildly elevated ESRs during

that time, episodes last days to a few weeks then resolve, becomes

achy but no objective joint sxs , previous workup about 2 years ago

with C3, C4, anti CCP RA anti DNA was not remarkable. A year ago,

Parvo virus IgG was quite high, around ?8, IgM was not. Would you

send this person to a rheumatologist? (OK Graham, have at it - is

this a 'bad referral'?)

Thanks!

Lynn