Link Roundup: Less is more edition

I Hate Rashes is practicing restraint during this week of excess.  Cleanse your palate with these links from around the web.

I’m beginning to think that the future of medicine is to use less of it.  Here’s a great post from one of my favorite bloggers: Gaia and Snake Oil

And here’s something from the New Yorker on Prescription Opiates.  We could definitely use less of these. Who is Responsible for the Pain Pill Epidemic

Similarly, two links on insomnia that DON’T mention medicines. Just don’t read these after your turkey sandwich.  Sleep Therapy as Depression Treatment and Sleep Help Guide. The second link was mentioned in the last blog post; it’s a great patient self-help website.

Once you finish eating, check out this short commentary from the UK. Green snot does not equal a Z-pack. 

After a long weekend with your nieces and nephews, you might appreciate this.  The less is more, Babies edition. Contraception Practice Essentials. A quick, comprehensive guide for diagnosis and treatment. (requires Medscape Subscription)
Check this HILARIOUS patient education website for contraception in the real world. bedsider.org.

Finally, after the third helping of sweet potato pie, some more perspective on lipid guidelines.  The Statinization of America.  Dr. Centor’s (and here)and Dr. Shaneyfelt’s take on the risk calculator in the new ACC/AHA guidelines.

Happy Thanksgivukkah Everyone!

 

Link roundup

I’m going to start a periodic roundup of things from the internets that I’ve found interesting.  Typically this will flow from the twitter feed. Follow me there to get these as they happen! @ihaterashes

First one gets no comments from me, just sharing the news…. Overmedicating AL veterans at the VA http://blog.al.com/wire/2013/11/overmedicating_alabama_veteran.html

Nice discussion here about mistakes in medicine. We all make them, might as well learn from them.  “You can’t take them back, you can only pay them forward.” http://www.princegeorgecitizen.com/article/20131104/PRINCEGEORGE0101/311049990/-1/princegeorge0101/many-a-slip

So it turns out, things aren’t always what they seem.  It seems that, when analyzed, things that were labeled as one herb, actually contained something else.  My favorite finding:  echinacea supplements that contained ground up bitter weed, Parthenium hysterophorus, “an invasive plant found in India and Australia that has been linked to rashes, nausea and flatulence.”.nyti.ms/1azMdaO

Here’s a really cool webtool for use at the point of care.  ACP’s Smart Medicine.  Up To Date or Medscape-esque, with content from ACP, In the Clinic, and Guidelines.  Free for ACP members. 

Finally, a link inspired by our recent UAB Women in Medicine discussion.  You can in fact, “have it all.”  But realize that what “all” is changes with time, and achieving it all is a transient thing.  You can’t have it all, but you can have cake

A pain in the head

Not sure why I always post about pain on Fridays, but here I go again. We’ve had some discussions about headaches in Red Clinic lately (and I don’t mean the VA formulary), and I thought it would be useful to review some diagnostic strategies.

Migraine

Remember the mnemonic:  POUND Pulsatile One day Unilateral Nausea Daily activity (Interferes with daily activity) These are intense, debilitating headaches, often with  nausea and photo/phonophobia. Patients will “take to the bed” to get over them. May have an aura: visual or sensory disturbances that are fully reversible.

Tension Headache

Milder in intensity, bilateral, throbbing in quality. May have muscle tenderness over the scalp or neck. Patients usually can stay at work, continue activities with these headaches.

Cluster Headaches

Rare Patients  have episodes of daily headache, intense, usually unilateral and associated with autonomic symptoms.  They will have symptom free periods between “clusters” for months or even years.

Medication Rebound Headache

Common Daily headache associated with regular use of almost any medicine for headache treatment.  Most common with opiates, butabital containing meds (Midrin), or caffeine containing meds (fioricet or excedrin). Intermediate risk of triptans. Lowest risk with NSAIDs.