Drs. Kevin Lee and Persia Pourshahnazari
May 31, 2023
Help, “hive” got a rash! – Article 2: Practical tips in the management of chronic spontaneous urticaria (CSU)
While not a fundamentally dangerous condition, CSU can have a significant impact on a patient’s quality of life and can be challenging to manage. Symptoms can be prolonged and can recur even after a long symptom-free period. Escalate and taper non-sedating H1-antihistamines, encourage daily antihistamine use, and add corticosteroids or refer to an allergist if needed. read more...
Drs. Rohit Vijh and Jason Wong
May 17, 2023
Managing syphilis during pregnancy — practice tip
Pregnant persons should be screened for syphilis during the first trimester (or first prenatal visit), and at delivery (or any time after week 35 for those planning home births). read more...
Drs. Kerstin Gustafson and Colleen Dy
May 2, 2023
Genitourinary syndrome of menopause (GSM) — a refresher
Women should be proactively educated at routine visits on menopause and the changes in the genital tract and anyone with vulvar and vaginal complaints should be offered a clinical exam to rule out secondary causes. GSM often continues to worsen with time if untreated. Daily use of vulvar and vaginal moisturizers and barrier creams to protect the skin from irritants may be helpful. Use of lubricants for intercourse should be recommended routinely. Many women will require pharmacotherapy in addition to non-hormonal treatments. read more...
Dr. Mark Adrian
April 19, 2023
Spinal stenosis — practice tips
Degenerative lumbar spinal stenosis refers to the narrowing of the spinal canal that can result in numbness, pain, and weakness of the lower extremities. Atypical presentations are common as are competing diagnoses. Top practice tips: distinguish the source of the symptoms, rule out competing disorders, send for imaging, encourage exercises that place the patient in a flexed position, and consider gabapentin, epidural steroid injections, and a referral for a surgical opinion. read more...
Dr. Emma Coffey
April 3, 2023
LNG-IUS (Mirena) IUD for emergency contraception
Many patients don’t know that an IUD is a highly effective option for emergency contraception. We can offer patients either the 52mg LNG-IUS (up to 5 days) or the copper IUD (up to 7 days) for EC. Both options are highly effective at preventing pregnancy (>99%). read more...
Drs. Kevin Lee and Persia Pourshahnazari
March 21, 2023
Help, “hive” got a rash! — Article 1: Practical tips in the assessment of chronic spontaneous urticaria (CSU)
Despite being a fairly common problem, with an estimated prevalence of 0.5–5%, chronic spontaneous urticaria (CSU) is often a challenging condition for health-care providers to diagnose and for patients to accept as a diagnosis. A diagnosis of CSU does not equate to a diagnosis of a systemic autoimmune disease. We do not routinely recommend dietary modification for CSU. We advise patients with CSU to limit alcohol intake and to take a higher dose of antihistamines prior to receiving vaccinations. read more...
Drs. Clara Lu and Renée Janssen
March 7, 2023
Pharmacotherapy for Tobacco Use Disorder
Since the publication of the 2020 ATS Clinical Practice Guideline on pharmacologic treatment in tobacco-dependent adults, I now explain the goals of pharmacotherapy for tobacco use disorder in terms of reducing the compulsion to smoke and increasing readiness to quit, rather than abstinence alone. If patients are open to the conversation, I will discuss and offer all pharmacotherapy options — but emphasize the efficacy and safety of varenicline as my preferred first-line agent. read more...
Dr. John van Bockxmeer, Dr. Vishal Varshney, and Anthony Lau, PharmD
February 15, 2023
Ceiling doses of ketorolac and ibuprofen in acute pain management
I incorporate this ‘NSAID ceiling’ into my prescribing practice for anti-inflammatory medications. I typically prescribe maximum doses of 400 mg oral ibuprofen TID with meals and 10 mg intramuscular ketorolac. I counsel my patients to limit their NSAID use to a 5-day window when possible and encourage other non-pharmacological and multimodal analgesia. read more...
Drs. Jennifer Kask and Kirsten Duckitt
January 25, 2023
Vaginal progesterone for the prevention of preterm birth
Preterm birth is the leading cause of perinatal morbidity and mortality in British Columbia and worldwide. We now carefully elicit any history of previous preterm birth and offer vaginal progesterone therapy for ANY history of spontaneous preterm birth. We fill in the Special Authority Request and give out the patient handout even before the patient goes to the pharmacy. We also encourage women to continue the medications until 37 weeks of gestational age. read more...
Dr. Karin Kausky, Dr. Tracy Monk, and Daniela Michel, MPH
January 11, 2023
Bugs & Drugs guide to antimicrobial therapy
Antimicrobial resistance is recognized as a top public health threat and is estimated to be directly responsible for 5,400 deaths and $1.4 billion in health care costs in Canada in 2018 which underlines the critical importance of wise prescribing of antibiotics. Every time I prescribe an antibiotic now, I check the Bugs & Drugs guidelines via PathwaysBC.ca. read more...
Dr. Steve Wong
December 19, 2022
Letter from the editor
While I do think AI will become a tool we integrate into all aspects of medical practice in the coming years, we still need our collective human intelligence to reflect on how our choices impact patients, their families, the medical system, and society. We might not always agree, but I've always held that respectful debate leads to learning and evolution of knowledge. read more...
Dr. Caitlin Dunne
November 30, 2022
Diagnosis and treatment of polycystic ovary syndrome (PCOS) using virtual health
Polycystic ovary syndrome is the most common endocrinopathy in women of reproductive age. It affects 8%–13% of young women and its symptoms are some of the most prevalent concerns that community physicians encounter. In many cases, diagnosis and management can be carried out in a virtual health setting using clinical criteria and judicious use of laboratory investigations. read more...
