|
|
Summer 2006 |
 |
|
P
e r s p e c t i v e s
Potpourri of
topics addressed at AGM CME
|
|
|
Submitted Photo |
|
Walk the Doc Dr. Susan King and
Dr. Mike Cohen led an enthusiastic group of AGM delegates on an
early morning walk prior to the opening business session of the
meeting at the Humber Valley Resort. |
|
|
This year, at the request
of our members, saw the return of the continuing education session. On
Friday afternoon we were treated to a potpourri of topics, expertly
delivered by our colleagues.
|
|
|
|
By Dr. Susan King |
|
Well, we all had a grand time at this
year’s AGM, held at the beautiful Humber Valley Resort. This year,
at the request of our members, saw the return of the continuing
education session. On Friday afternoon we were treated to a
potpourri of topics, expertly delivered by our colleagues.
Dr. Joe Tumilty, orthopedic surgeon from
Gander, led off with a session on joint injections:
“There are often questions regarding a
maximum number of injections that a joint ought to receive. That of
course depends on the joint, the clinical situation and the benefit
obtained. If a person is getting relief from an injection into the knee,
I will give one every three months indefinitely. This can certainly add
to the quality of life for a patient in whom arthroplasty is not an
option. In the shoulder, there will be no additional benefit after three
to four injections. As well, I prefer to use Xylocaine from a single
dose vial since it is preservative free and injection reactions are
often caused by the preservative.”
Next up was Dr. Steve Murphy,
nephrologist from Corner Brook. He spoke about proteinuria:
"We often see proteinuria in otherwise
healthy young people. It is often benign, but requires follow-up. If a
repeat urinalysis is positive, do a 24-hour urine collection. If there
is excretion of < 3 grams of protein per day in a patient who is under
the age of 30, has a normal creatinine, and otherwise normal urinalysis,
a split urine test might provide evidence of orthostatic proteinuria. If
an overnight eight-hour timed urine collection shows < 50 mg, it is
likely benign and requires no further investigation.”
Dr. Mervyn Dean, palliative care physician
from Corner Brook, then delivered an informative session on nausea and
vomiting in cancer patients:
“Nausea and vomiting in cancer patients
can have one or more causes, but a common one is gastric stasis, or a
variant such as floppy or squashed stomach. Usually the patient, despite
being hungry, experiences early satiety and nausea, relieved by
vomiting. A prokinetic agent such as domperidone or metoclopropramide
should be prescribed here. Domperidone is particularly useful if the
patient has co-existing Parkinson's disease.”
Last but not least, we had a session
packed with information on common neurology issues by Dr. Jim Scott,
neurologist from Corner Brook. He spoke of Bell’s Palsy:
“I occasionally get questions about how to
differentiate Bell’s Palsy from stroke. There can be confusion, since in
addition to the motor loss expected with a seventh nerve lesion, there
can be sensory changes, loss of taste and altered smell (the latter
being the patient’s misinterpretation of loss of taste on the affected
side). In Bell’s Palsy, there is asymmetry of the forehead skin lines;
the lines on the affected side are flatter and less defined. This
finding is indicative of a lower motor neuron lesion. An upper motor
neuron lesion such as a stroke will most often not involve the forehead
but the region below the eye.”
He also provided information on optic
neuritis:
“There is some evidence suggesting that
early aggressive treatment of optic neuritis may in fact reduce the
chance of developing multiple sclerosis over several years. If there is
a visual change and concern about optic neuritis there are two
appropriate clinical tests that can be done in the office. One is the
swinging flashlight test. Shining a flashlight into the healthy eye
causes equal, strong constriction of both pupils. Swinging the light
immediately over to the affected eye reveals, because there is impaired
light perception, the pupil will continue to paradoxically dilate. The
other test is to look for red desaturation. This is when you ask the
patient to look at something red and he reports that the color looks
orange.”
All the sessions were practical and well
received. The CME credits didn’t hurt either!
Useful resources at cma.ca
One of the booths at the AGM was about the
CMA. We are all members now, so don’t forget to log on to
cma.ca. There are lots
of resources, not the least of which is a librarian who can do a
literature search for you at the mere asking. The other fabulous new
feature, under “clinical resources”, is “Stat-Ref” (soon to be renamed).
This section has a host of up-to-date textbooks, for example
Harrisons and the Merck Manual. There is also a drug database
complete with drug interactions. It is so easy to look stuff up. Take
advantage of it — you may as well get your money’s worth!
Dr. Susan King is a family physician at
the Newfoundland Drive Medical Clinic in St. John’s. Tips and hints may
be emailed to nexus@nlma.nl.ca or faxed to (709) 726-7525.
|
