The Canadian Journal of Diagnosis

The Canadian Journal of Diagnosis
2006 Back Issues

2001 • 2002 • 2003 • 2004 • 2005 • 2006 • 2007 • 2008 • 2009 • 2010 • 2011 • 2012

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	December 2006, Volume 23, Number 12 Case of the Month “Doctor, please help! My chest hurts” Case in Point “Why is my groin red and scaly?” Experts on Call Answers to your questions from our medical experts • Interpreting hormone levels • Diagnosing asthma in children • Investigating increased CK • Frequency of PSA testing • Pneumococcal vaccinations • Oral ulcers from chemotherapy • Treating uncontrollable nightmares • Renal artery stenosis assessment recommendations • Soy products and breast cancer • Testing with apo B • Immunotherapy for IgE hypersensitive patients Complementary Medicine An evidence-based review of alternative therapies L-Carnitine: What the Studies Show Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Bruce’s Burning • Randall’s Rash • Sandra’s Snapping Finger • Britney’s Bumps • Leanne’s Lesion • Sherry’s Swelling • Paul’s Painful Foot • Martin’s Mass • Harvey’s Hair Loss • Ulrika’s Uvula Allergy Alert A case-based update Tomato Trouble? Women’s Health Pregnancy and Thrombosis: Is Thromboprophylaxis Necessary? Winnie W. Sia, MD, FRCPC Pregnancy increases the risk of thromboembolism six-fold. The overall risk of thrombosis in pregnancy is 0.5 to 3 per 1000 women. Read on to learn about the use of thromboprophylaxis in pregnancy in this case based review. Approaching the Anemias Leslie N. Zypchen, FRCPC Anemia is a common problem. One study showed that 13% of community-dwelling individuals over age 65 were anemic. In this article, Dr. Zypchen reviews the different types of anemia and provides ways to help determine its cause. Nothing to Sneeze At: The Basics of Avian Influenza Oscar E. Larios MD; and John M. Embil, MD What is avian influenza? How is it transmitted? Dr. Larios and Dr. Embil provide answers to these questions and more. What's New in Clinical Research Denis Carl Phaneuf, MD, FRCPC; Stéphane Bissonnette, PhD, PharmD; and Sharon I. Forrest MSc Effect of Enalapril Maleate Therapy With or Without Hydrochlorothiazide on BP Control, Compliance and Quality of Life in Hypertensive Patients: An Open-label Naturalistic Phase IV Trial


	November 2006, Volume 23, Number 11 Case of the Month “Doctor, he won't stop shaking!” Case in Point “What’s this on the back of my neck?” Experts on Call Answers to your questions from our medical experts • Effect of antihistamines on anaphylaxis • Fecal DNA testing for colorectal cancer? • Iron absorption • Lipid-lowering agents for diabetics? • OTC decongestant medication • ADHD in adults • Teriperatide for OP? • Non-rising PSA in hormone therapy • Diagnosing primary aldosteronism • Aerobic exercise and heart rate • Chronic sinusitis • Diagnosing PCO • OP and low testosterone in men Complementary Medicine An evidence-based review of alternative therapies North American Ginseng Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Ian’s Itch • Sameena’s Swelling • Roberta’s Rash • Peter’s Papule • Max’s Mass • Perry’s Problem • Fisher’s Foreskin • Ursula’s Ultrasound • Tonya’s Tongue • Dierdra’s Depigmentation • Brianna’s Breastbone • Scott’s Spots • Rhea’s Redness Allergy Alert A case-based update Take a Breather! Women’s Health "Estrogen: No thank you! What are my alternatives?" David C. Cumming, MB, ChB, FRCOG, FRCSC As much of the evidence about estrogen alternatives comes from grey literature and not traditional medical sources, the purpose of this review is to describe the medical literature on alternatives to estrogen treatment for common perimenopausal and post-menopausal symptoms. TRD: A Therapeutic Challenge GKhalil Geagea, MD The complex etiology of depression and the reasons for resistance to treatment continues to challenge the clinical practitioner. This article attempts to elucidate some of the causes of treatment-resistant depression and provide a new range of treatment options. Those Aching Joints: Not All Pain Requires a Pill Mary-Ann Fitzcharles, MB, ChB, FRCPC Pain due to osteoarthritis (OA) is to be expected in the aging body. Dr. Fitzcharles explains that although there is currently no cure or disease-modifying agent for OA, other management options, besides pharmacologic treatments, exist and should be incorporated into patient care. Polio: Is it Really Gone? Philip Dawe, MD; and John Embil, MD, FRCPC Since the advent of the two immunizations against poliovirus in the 1950’s and 1960’s, there has been a dramatic decline in the incidence of polio in Canada and the remainder of the Western hemisphere. But, is polio really gone? Read on to find out. Preventing Cardiovascular Disease: Is MAU the Key? Caroline E. Stigant, BSc, MD, MHSc, FRCPC What is microalbuminuria? What is its significance? Does it predict one’s risk of cardiovascular disease? Dr. Stigant answers these questions and more. Increasing Versatility of PPIs: The Place of Orally Disintegrating Lansoprazole David Morgan, MD, FRCPC; Mark Atin, MD, FRCPC; Guy Aumais, MD, CSPQ, FRCP; Ronald Bridges, MD, FRCPC; Allan Cockeram, MD, FRCPC; Flavio Habal, MD, PhD, FRCPC; Connie Switzer, MD, FRCPC; and Steven Wolman, MD, FRCPC This department features articles discussing recent developments in drug therapy, as well as reviews articles on specific drug therapies or disease states.


	October 2006, Volume 23, Number 10 Case of the Month A Slap in the Face Case in Point ”Why is my face red and scaly?” Experts on Call Answers to your questions from our medical experts • Return to play following a concussion • Treating Hepatitis C • Role of infliximab in ulcerative colitis • EpiPen® for kiwi throat allergies • Allergies at night • Screening for testicular cancer • Snoring solutions • Long-term effects of prednisone for FMF • T3 and T4 for hypothyroidism • Treatment for skin allergy to metals • Coenzyme Q for myocardial disease? • Are DREs necessary in older asymptomatic patients? • Colchicine or indomethacin for gout? • Preventing renal complications in diabetes Complementary Medicine An evidence-based review of alternative therapies Oscillococcinum: A Flu Treatment Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Teena’s Tears • Barbara’s Bullae • Umberto’s Ulcerations • Marsha’s Mass • Paula’s Pigmentation • Leonard’s Lesion • Patricia’s Papules • Sam’s Scales • Boden’s Boils • Tiny Critter • Thomas’ Toenail • Glen’s Growth • Matthew’s Meatus • Farah’s Fatigue • Brady’s Bulge • Tim’s Tissue • Nadia’s Nodule Allergy Alert A case-based update Nose Plug Women’s Health Cancer or Something Else: Post-Menopausal Bleeding Peter Selke, MD, FRCSC, FACOG Since post-menopausal bleeding is a common symptom of endometrial carcinoma, Dr. Selke reviews possible causes, investigative techniques and management options to help physicians treat their patients. The Methadone Patient: Pain, Addiction and Acute Management Matthew D. B. Rose, MDC In a way that is safe and realistic, this article provides guidelines that are designed to help primary care providers or specialists become more familiar with the use of methadone for pain, addiction or for the patient where both conditions exist and to better understand the presenting patient’s context. Dementia Drugs: When Should They Be Stopped? Ron Keren, MD, FRCPC Alzheimer’s disease (AD) is a progressive neurodegenerative disease, for which there is no cure, that affects close to 300,000 Canadians. Dr. Keren examines the use of dementia drugs in those with AD. He discusses at what point one should stop treatment with these medications. The Swollen Joint: What to Do Alexander Yan, MD, BMSc, FRCPC In this article, Dr. Yan looks at acute joint swelling and examines different aspects of its investigation, diagnosis and treatment. Too Many Pills: Deciphering Polypharmacy Caroline Robitaille, BPharm, MSc As prescription medications are on the ever-increasing rise in Canada, so is the incidence of polypharmacy, often resulting in necessary visits to the ED. This article examines the aspects of polypharmacy and the risk factors associated with it.


	September 2006, Volume 23, Number 9 Case of the Month “Help! I’ve shot myself... with a paint gun!” Case in Point ”What’s wrong with my feet?” Experts on Call Answers to your questions from our medical experts • Facet blocks for degenerative disc disease pain • How to diagnose parathyroid conditions? • Debate over allergy desensitization • Starting medication and dosage for urge incontinence? • Association between HPV and oral cancer? • Managing suspected inflammatory bowel disease • Androgen therapy contraindicated in sleep apnea patients? • LTRAs recommended for mild asthma? • Perineal pain due to old bike injury • How to make an early diagnosis of pancreatic cancer • Significance of elevated PTH in an osteopenia patient • Oral ulcers from chemotherapy • Bisphosphonate or calcium/vitamin D for patient with severe osteoporosis? • Prostate size and pain: what is the correlation? • Role of inhaled corticosteroids for cough treatment • Role of single inhaler therapy in asthma management • Chronic elevated heparin leads to osteoporosis? • Switch or augment an antidepressant? • Metformin vs. TZD • New chemo treatments • Strategies for ascites Complementary Medicine An evidence-based review of alternative therapies Alternative Approches to Managing Migraines Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Vic’s Velvety Patches • Frank’s Forehead • Ronny’s Red Blotches • Barbara’s Red Band • Sandy’s Scalp • Troy’s Toe Tips • Ray’s Scaly Rings • Shaila’s Dry Skin • Mindy’s Moles • Betty’s Bloody Bump • Paul’s Purple Papules • Harry’s Chest • Tula’s Toenail • Yves’s Itchy Bumps • Toby’s Teeth Marks • Rita’s Rash Allergy Alert A case-based update Bagel Boggle Women’s Health Anxiety or Death: Uneasy Feelings About Ovarian Cancer Screening Dr. Lizabeth Brydon, MD, FRCSC Ovarian cancer is the leading cause of gynecologic cancer death in Canada. Unfortunately, it is usually found too late to be curable. Ovarian cancer screening is available to at-risk women, but are the risks of false positives and unnecessary surgeries too high? Dr. Brydon investigates. Gluten for Punishment: Diagnosing Celiac Disease Gad Friedman, MDCM, FRCPC Celiac disease was once thought to be a rare GI disorder, but serological testing has shown that it affects 0.5% to 1% of the general population of certain countries. Dr. Friedman explains the disease and how to diagnose it. Relapse vs. Withdraw:The Principles of Discontinuation Syndrome Joel W. Lamoure, BScPhm, FASCP Discontinuation syndrome (DS)—the adverse effects experienced due to an abrupt discontinuation of a medication—presents a growing challenge for doctors. Dr. Lamoure explains how to recognize and treat this condition in mental health patients. Breathe Easier: The Role of Allergy Testing in Asthma Noranda Nyholt, BHSc; and Susan Waserman, MD, FRCPC Can allergy testing and treatment improve the lives of allergen-sensitized individuals with asthma? Read on to find out. Tired of Feeling Tired: A Practical Approach to CFS Brian D. O’Brien, MD, FRCPC, FACP; and Raymond H. Scott, PhD, CPsych Chronic fatigue syndrome (CFS) can be as debilitating as it is frustrating, since the condition is of unknown cause. Dr. O’Brien and Dr. Scott provide answers to the most common questions about CFS.


	August 2006, Volume 23, Number 8 Case of the Month Really bad pizza or something serious? Case in Point "Why are my fingernails discoloured?” Experts on Call Answers to your questions from our medical experts • Choosing a PPI • Penicillin allergy from amoxicillin treatment? • Diagnosing diabetes • Role of amantadine in upper respiratory tract infections • Duration of treatment for panic disorder • Is allergy and asthma incidence increasing? • Investigating asymptomatic high BP • Clopidogrel: a universal diabetes treatment? • Anxiety disorder medication and pregnancy • Prostatic massage: a how-to • Pneumococcal vaccine for all diabetics? • Role of magnesium sulfate in acute asthma management • ACEs or ARBs for diabetics with overt nephropathy and IHD? • Cephalosporin use in patients with a penicillin allergy • Bone loss screening for patients on long-term antiepileptic drugs? • Borderline personality disorder treatments Complementary Medicine An evidence-based review of alternative therapies Vitamin E Treatment of NAFLD/NASH What’s Your Diagnosis? “Doc... what’s wrong with me?” Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Laura’s Lesion • Bill’s Bloody Stool • Nola’s Neck • Painful Groin • Warren’s Wrists • Growing Concern • Theo’s Thigh • Aching Axilla • Vein Pain? • Baby’s Bowel • Danny’s Dots • One-Sided Spotting • Swollen Scrotum • Infant’s Fingers • Noduled Knee • Linda’s Lungs • Pain in the Neck • X-Ray Exam Allergy Alert A case-based update Herbal Hazard? Women’s Health: Epidural Analgesia: Is It Increasing C-Section Rates? Michael C. Klein, MD, CCFP, FAAP (Neonatal-Perinatal), FCFP, ABFP Like many expecting mothers, Suzanne insists on having an epidural and dismisses the notion that an analgesic might put her at a higher risk for C- section and other complications. But are her expectations unreasonable? Dr. Klein weighs in. Filtering Out Doubt in Abnormal LFTs Ford Bursey, MD, FACP, FRCPC Liver function tests are a key component of routine lab tests. So, what course of action should a physician take when the results are abnormal? Dr. Bursey provides a case-based approach. The Truth About Osteonecrosis of the Jaw Moin Khan; and Aliya Khan MD, FRCPC, FACP Several recent studies have pointed to a relation between bisphosphonate use and osteonecrosis of the jaw—a serious and difficult condition to treat. While sensational media reports have whipped the public into a frenzy about the dangers of bisphosphonate use, Dr. Khan offers an evidence-based perspective. CAD in South Asians: At a Higher Risk? Kevin R. Bainey, BSc, MD; and Milan Gupta, MD Although coronary artery disease (CVD) is a global pandemic, populations with South Asian ancestry seem to be particularly susceptible. Join Dr. Bainey and Dr. Gupta as they investigate the prevalence of CAD among South Asian-Canadians.


	July 2006, Volume 23, Number 7 Case of the Month Huffin’ and Puffin' Over Missed Insulin Case in Point ”What’s this bump on my back?” Experts on Call Answers to your questions from our medical experts • Clues to bipolarity diagnosis • Role of corticosteroids in viral bronchitis • Can a lung tumour raise blood glucose? • Why test for seasonal allergens? • Prostatic calcification • Gabapentin for chronic pain • DEXA scan for osteoporosis • Wait and see approach with osteopenia? • Hyperparathyroidism • Routine PSA for men over 50? • Impact of NSAIDs on asthma • Role of drug modifiers in rheumatic disease • Management of hypocondriasis • Left bundle branch block • Cardiovascular recommendations • Confirming a drug allergy • Sunburn and melanoma Complementary Medicine An evidence-based review of alternative therapies Folic Acid for Depression Treatment? Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Bothersome Bump • Dark Patches • Edmund’s Eye • Rusty’s Nails • Icy Toes • Brow Blemish • Helmet Head • Cheeky Spot • Burning Blush • Charlie’s Chin • Serious Sequelae • Falling Follicles • Injured Arm • Robin’s Red Spots • Rose’s Rash • Sore Smile • Brown Blotches • Baby’s Oral Cyst • Bulging Belly Allergy Alert A case-based update Summer Sniffles Women’s Health: Pelvic Organ Prolapse: Cutting Out Surgery? Joyce Schachter, MD, FRCSC; and Kellie Kitchen, RN, NCA Pelvic organ prolapse is a potentially debilitating condition that affects up to half of all parous women in their lifetime. But is surgery the only option? Dr. Schachter presents several conservative, non-surgical alternatives. IBD: Did You Know...? Robert Enns, MD, FRCPC The cause of inflammatory bowel disease is unknown, but its painful and debilitating effects on the gastrointestinal tract are all too familiar to patients suffering from the condition. Dr. Enns provides a detailed review of the two main IBD variants: Crohn’s disease and ulcerative colitis. 2006 Canadian Hypertension Education Program Recommendations: What Are The New Messages? Evidence-based recommendations on behalf of the Canadian Hypertension Education Program Hypertension is a global phenomenon—one with serious consequences for the world’s healthcare systems that will face a predicted 60% increase in the number of adults with hypertension by 2025. Read on for the latest information on hypertension management. Quelling the Shakes: PD and Essential Tremor Alex Rajput, MD, FRCPC Parkinson’s disease and essential tremor are two similar, but very different conditions characterized by uncontrollable shaking. Dr. Rajput explains how to differentiate between the two and provides information on the treatment options that are currently available.


	June 2006, Volume 23, Number 6 Case of the Month “The worst sinus headache of my life...” Case in Point "I don’t like this ugly red spot on my nose.” Experts on Call Answers to your questions from our medical experts • Elevated homocysteine levels • Choosing the right statin • Breast cancer screening • Diagnosing diabetes mellitus in the pediatric population • Antibiotic choices for COPD patients • Virtual colonoscopy • Increased pneumonia risk with long-term PPI treatment? • Antidepressants for teenage patients • Tamoxifen: suitable for breast cancer prophylaxis in high-risk patients? • Corticosteroid inhalers for COPD prophylaxis? • Differentiating PsA from RA • Osteopenia treatment Complementary Medicine An evidence-based review of alternative therapies Horse Chesnut Seed Extract and Venous Insufficiency Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Phalangeal Fracture • Splinter Hemorrhages • Amelanotic Malignant Melanoma • Scars with Keloid Formation • Arteriovenous Fistula • Dysplastic Nevus with Severe Cytoarchitectural Atypia • Tinea Capitis • Wart • Allergic Contact Dermatitis (eyelid) • Diabetic Foot Calluses • Discoid Lupus of the Neck • Granuloma Annulare • Lichen Mucinosis • Extramammary Paget’s Disease • Palmoplantar Keratoderma • Pemphigus Vulgaris • Phytophotodermatitis on the Thigh • Keratosis Pilaris Allergy Alert A case-based update Morning Blush PPIs: Overused or Misused? George Ghattas, MD, CSPQ Proton pump inhibitors (PPIs) are among the most prescribed drugs in the world. But, has the class of drugs’ status as a first-line treatment for acid peptic-related disorders led to overuse, or misuse? Read on to find out. Thinking CAP: A Q&A Review Charles K.N. Chan, MD, FRCPC, FCCP, FACP The appropriate treatment of community-acquired pneumonia (CAP) is a serious matter in Canadian healthcare. CAP is the number one cause of infectious disease in this country and has a five per cent to 10% mortality rate among those hospitalized for the condition.Dr. Chan investigates. New Oral Anticoagulants: New vs. Old Jeffrey I. Weitz, MD, FRCPC, FCCP, FACP For over 60 years, vitamin K antagonists have been the only oral anticoagulants available. Dr. Weitz compares the status quo to some of the next generation oral anticoagulants that will be making their way onto the market in the coming years. Childhood Strabismus: Taking a Closer Look at Pediatric Squint Caroline Hirsch, MD, FRCPS Three per cent to four per cent of all children will develop strabismus—colloquially known as squint. However, not all cases are simply physiological in nature. As Dr. Hirsch explains, the condition can also be the first manifestation of a possibly life-threatening neurological problem.


	May 2006, Volume 23, Number 5 Case of the Month “Am I having a stroke?” Case in Point ”Why do my hands itch?” Experts on Call Answers to your questions from our medical experts • Ingested foreign body • Long-term acid suppression • Proton pump inhibitors (PPIs) • Need for colonoscopy • First aid for food allergies • Diverticulitis • Role of tamoxifen in breast cancer • Cancer risk: using hormone therapy in hypogonadism • Oral bisphosphonates and osteoporosis • Hymocysteine treatment • Prednisone dosage for asthma or COPD • Uncomplicated cystitis • Bone mass density testing for patients on Depo-Provera Complementary Medicine An evidence-based review of alternative therapies Gingko Biloba What’s Your Diagnosis? “Doctor... do I need surgery?” Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Superficial multicentric and pigmented basal cell carcinomas • Cutaneous horn • Carcinoid tumour of the appendix • Squamous cell carcinoma • Urachial sinus • Spider angioma • Kaposi’s varicelliform eruption • Lichen sclerosis • Hepatic mysenchymal hartoma • Dyplastic nevus • Psoriasis • Mimicking disorder Allergy Alert A case-based update Something’s fishy Women’s Health: Options for AUB Dr. John Thiel, MD, FRCSC, ACGE Abnormal uterine bleeding (AUB)—defined as any change in the frequency, duration or volume of bleeding—is responsible for a quarter of all gynecological visits. Dr. Thiel discusses some methods of accurate diagnosis and the various options available for managing this condition. Seeing Clearly: The Truth About Cataracts Susan K. Lindley, MDCM, FRCSC Cataracts are any opacity in the lens, which in significant cases, interferes with a patient’s functioning, reducing quality of life. So what roles do family physicians and opthalmologist’s play in their treatment? Dr. Lindley explains. Getting to the Bottom of Chronic Post-Surgical Pain Yoram Shir, MD Chronic pain is a debilitating medical condition that affects nearly a third of the Canadian population. Follow Dr. Shir as he looks into the causes and potential cures of one of its least understood forms: chronic post-surgical pain (CPSP). CAD in South Asians: At Higher Risk? Milan Gupta, MD; and Kevin R. Bainey, BSc, MD Although coronary artery disease (CAD) is a global pandemic, populations with South Asian ancestry seem to be particularly susceptible. Join Dr. Gupta and Dr. Bainey as they investigate the prevalence of CAD among South Asian-Canadians. Unmasking Pediatric Sleep Disorders Johanna C. Goll MD; and Colin M. Shapiro MD Pediatric sleeping disorders are more common than previously thought. Dr. Goll and Dr. Shapiro investigate why significant sleeping problems go undetected and untreated so often.


	April 2006, Volume 23, Number 4 Case of the Month Moans and Groans Case in Point Finger-Web Plaque Experts on Call Answers to your questions from our medical experts • Carcinoid Disease: A Review • DRE & PSA Between Ages 40 and 50 • Should ICSs Be Used in COPD? • Can Ezetral and Fenofibrate be Given for High Fat? • What’s Needed for Patients with a First Degree Relative with Early Heart Disease? • Can Ezetimibe be Used as a Single Lipid-Lowering Agent? • Oral Bisphosphonates & Metastatic Bone Cancer • What is the Best Way Not to Miss a Prostate Cancer Diagnosis? • Evidence & Guidelines for Treating Pain with IV Lidocaine • Retention & Untreated BPH • What to Do with a Very Low HDL-C? • How do I Determine if a Patient Needs to Carry an Epinephrine Injection? • Approaching a Chronic Cough Problem • Treating Mild Asthma in Young Adults • Chromium Supplementation & Type 2 Diabetes • Are Probiotics Created Equal? Complementary Medicine An evidence-based review of alternative therapies Manipulation for Asthma What’s Your Diagnosis? A girl with kaleidoscope eyes Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Diffuse Plaques • Becoming Nodule • Painful Mass • Premature Development • Sun Spots • Renal Lesions • Malignant Potential • Chronic Stasis Ulcers • Unwanted Lesion • Blue & Cool • Neck Mass • More Than Pain • Snowy Discomfort • Dorsal Plaques • Fading, Red Plaque • Excess Hair Growth Allergy Alert A case-based update Nasal Problems: Blocked & Runny D-dimer: A Warning for DVT Shannon M. Bates, MDCM, MSc, FRCPC Deep vein thrombosis (DVT) is a common medical condition that requires accurate diagnosis and prompt therapy to minimize the risk of pulmonary embolism. It is inaccurate to diagnose DVT by signs and symptoms alone. Join Dr. Bates as she discusses how D-dimer has the potential to simplify the evaluation of DVT patients. Migraine...and Stroke: Is There a Link? Maher Saqqur, MD, FRCPC; and Dr. Khurshid Khan, MD, FRCPC What is the incidence of migrainous stroke? Is migraine a risk factor for stroke? What are the risk factors for migrainous stroke? Find the answers to these questions and many more inside. Obesity: Dealing with a Pandemic Ronnie Aronson, MD, FRCPC, FACE Obesity has been labeled a pandemic by the World Health Organization. In North America, the prevalence of overweight has exceeded 50% of the population and in the US, the prevalence of obesity is approaching a quarter of the population. Learn more about obesity with Dr. Aronson and what resources are available to the primary-care physician. High-Tech Doctors: Open Source for GPs David H. Chan, MD, CCFP, MSc, FCFP Change is a challenge. Especially when it may require an overhaul of a current system that works. We often hear the expression, “If it ain’t broke, don’t fix it.” Come read Dr. Chan’s argument for how and why open source technology can increase capacity in a GP’s office.


	March 2006, Volume 23, Number 3 Case of the Month “I can’t catch my breath!” Case in Point Farming Furrows Experts on Call Answers to your questions from our medical experts • Adverse effects of statins • How often is BPH the cause of hematuria? • Does ED persist after SSRIs? • Is there proof that omega-3, -6, -9 improves the cholesterol ratio? • Restarting occult blood testing • What is the effectiveness of glucosamine sulfate? • First drugs for uncomplicated essnetia hypertension • Medical management of endometriosis between laparoscopies • Infants, allergies & hydrolysate-based formulas • Calculating lifetime risk for breast cancer • UC and colon cancer risk • Indeterminate FNAs • Combinging ASA and coumadin • How useful is MSK ultrasound? Complementary Medicine An evidence-based review of alternative therapies Ginseng: The Imperial Herb What’s Your Diagnosis? “Help me doctor, I’m uncomfortably numb!” Photo Diagnosis Illustrated cases with questions to test your diagnostic skills • Callused Soles • Inflamed Skin • Finger Lesion • Purple Lesions • A Coin Toss • Too Much Lip • Linear Mystery • Getting Cheeky • Pearly-White Papules • Itchy Rash • Lumpy Torso • Plaque Attack • Papules & Pustules • Red Body Papules • Wax On/Wax Off Allergy Alert A case-based update “I’m keeling over!” In the ED... Don’t Forget a Thing! Cindy-Ann Lucky, MD The Emergency Department is a busy and fast-paced place to be. It comes as no surprise when Dr. Lucky tells us that diagnostic mistakes will be made. Helping us improve, she provides us with answers to such questions as: What are the missed diagnoses? What areas are overlooked? and What are the challenges? Opioid Misuse & Dependence: A GP’s Guide Meldon Kahan, MD, CCFP, FCFP, FRCPC; and Dr. Anita Srivastava, MD, CCFP Despite the dramatic increase in the prescription of opioids in the last five years, there is evidence that physicians often inadequately treat chronic pain because of concern about the risk of opioid addiction. With adequate training in the management of opioid misuse, physicians may feel more comfortable in prescribing opioids. Men’s Health: What’s Happening Below the Belt? Jack Barkin, MD, FRCS, FACS, FICS, DABU What ailments cause the male patient to visit the physician’s office? The penis, prostate and the bladder are typically the most common reasons for the middle-aged man. But how does the dysfunction of these organs relate to testosterone or its metabolites and their impact? Vaccinations for Peace of Mind: Travelling Abroad Kenneth Gamble, MD The number of vaccinations a traveller may need can be daunting. What vaccinations would a traveller to Kenya need? What if he is going to visit other countries near Kenya? What are the routine vaccines? What else should be considered? Dr. Gamble answers these and many more questions inside.


	February 2006, Volume 23, Number 2 Case of the Month Facial Palsy: Is it serious? Case in Point “Get my neck in check, please!” Experts on Call Answers to your questions from our medical experts • What’s the Role of Dalteparin in Stroke? • Investigating Low WBC • Belated Hypertriglyceridemia Management • Pneumococcal Vaccination & Diabetes • Lamotrigin vs. Lithium • DVT & Coagulopathy Screening • True Yield of DVT Ultrasound • Screening Family for Renal Masses • Removing Ear Wax in Children • Omega-3 and psychology Complementary Medicine An evidence-based review of alternative therapies Omega-3 Fatty Acids: Are They Beneficial? What’s Your Diagnosis? “Doctor! What happened to my leg?” Photo Diagnosis Illustrated cases with questions to test your diagnostic skills Unsightly Plaques and many more... Allergy Alert A case-based update “I feel like a drip!” Hypercalcemia Today Kashif Yousuf, BA (Hons); and Aliya Khan, MD, FRCPC, FACP Hypercalcemia is a common metabolic abnormality seen in approximately 5% of hospitalized individuals. Join Mr. Yousuf and Dr. Khan as they discuss the diagnosis and management of hypercalcemia. Determining Dementia Risk: What Factors to Consider? John Jordan, MD, CCFP, FCFP Who gets dementia? Are postmenopausal hormones protective against dementia? Does leading a healthy lifestyle reduce your risk of developing dementia? Find answers to these questions and more inside. Osteoporosis: Care Gaps & Beyond Brent Kvern, MD, FCFP There are over 25,000 hip fractures per year in Canada and 70% of these are osteoporosis related. It may not be necessary for an FP or a GP to become an expert in osteoporosis, but recognizing and preventing fracture possibilities are important to patient care. Asthma & COPD: Clearing the Air Alan Kaplan, MD, CCFP(EM) Asthma and COPD are the two most common obstructive airway diseases in Canada and are common reasons for patient presentation to the GP’s office. The pathophysiology, management and treatment goals of these two diseases are different. Turn the page and clear the air with Dr. Kaplan.


	January 2006, Volume 23, Volume 1 Case of the Month A Mouthful of Puck Case in Point “Are these from the farm?” Experts on Call Answers to your questions from our medical experts • Anti-tTg Testing Reliable? • New Chemo Treatments • Should Low-Grade Infant Fevers be Treated? • Making Preliminary RA Diagnoses • Should I Stop Warfarin? • Concerned about Ovarian Cancer • Q-wave or ST-elevation? • Strategies for Ascites • Endometriosis: Causes & Treatment • Blood BNP and CHF Complementary Medicine An evidence-based review of alternative therapies Problems with Herbs Photo Diagnosis Illustrated cases with questions to test your diagnostic skills “I’m losing it!” and many more... Allergy Alert A case-based update “Help me, I’m breaking out!” Women’s Health Gynecology 101: Two Simple Procedures for your Office Amos A. Akinbiyi, MB, BS (Ib), LRCP (Lon), MRCS (Eng), LMCC (Can), FRCOG (UK), FRCS(C) Problematic Pain: Non-Opiate Options Jeff Ennis, MSW, MD, FRCP(C) Many of the rehabilitation techniques used to treat patients with CNCP in difficult-to-assess multidisciplinary pain programs can be transferred to the primary care setting. Dr. Ennis discusses some non-opiate options when dealing with pain. Cystic Fibrosis: Catching up on the Fundamentals Melinda Solomon, MD, FRCP(C) CF is one of the most common fatal genetic disorders. There are approximately 3,500 Canadians living with CF. Its wide spectrum of presentations can make the diagnosis difficult. Join Dr. Solomon inside as she presents more facts about CF. Getting Ahead of Headaches Khurshid A. Khan, MD, FRCPC; and Maher Saqqur, MD, FRCPC As the second most common primary headache, migraine can be difficult to treat. Successful treatment depends on accurate diagnosis of the headache type. Dr. Khan discusses headache types and the general principles of treatment. Vitamin D Deficiency: Prescription for a Tan? Moin Khan and Aliya Khan, MD, FRCPC, FACP Here, our authors review the basic metabolic pathways for vitamin D synthesis, causes and effects of vitamin D deficiency in the elderly, as well as recommended management of this common condition, based on the current research available.