All articles

Vinicio Delgado and Dr. Wayne Lai
Jul 19, 2023

Offering Brief Behavioral Therapy for insomnia (BBTi) in primary care settings

Insomnia is one of the most commonly reported sleep disorders at our sleep clinic. Despite its prevalence, treating it can be challenging due to its complex and multifactorial nature. A comprehensive and personalized approach to treatment is, therefore, necessary for effective management. However, providing this level of support requires significant time and resources. Offering a self-help intervention as a complement to care can help reach patients who might not otherwise receive CBTi or refuse onsite treatment. read more...

Hans Haag and Dr. Ricky Turgeon
Jul 05, 2023

Identifying and treating iron deficiency in patients hospitalized for heart failure

Heart failure is the third leading cause of hospitalization in Canada and leads to readmission in 1 in 5 patients within 30 days after discharge. Iron deficiency (with or without anemia) is an important comorbidity in patients with HF and is associated with worse outcomes. Assess iron deficiency for all patients with HFrEF and HFmrEF admitted for acute HF. read more...

Jamison Falk, PharmD
Jun 19, 2023

SGLT2i in patients with diabetes: translating an evolving body of evidence to the nuances of practice

While I’ve been hard on newer medications like SGLT2i for their relatively small benefit in lower-risk patients, recent systematic reviews show that our traditional interventions are no better, and may be worse, at reducing risks of outcomes. I now discuss the option of adding an SGLT2i with patients with diabetes and pre-existing cardiovascular or renal disease or with symptomatic hyperglycemia where blood glucose reduction would be expected to reduce day-to-day symptoms. I reduce or discontinue doses of other antihyperglycemic medications if possible when starting an SGLT2i and I educate patients about potential adverse events. read more...

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 02, 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
Apr 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
Apr 03, 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
Mar 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
Mar 07, 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
Feb 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
Jan 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...