All articles

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...

Dr. Karin Kausky, Dr. Tracy Monk, and Daniela Michel, MPH
Jan 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 read more...

Dr. Steve Wong
Dec 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
Nov 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...

Drs. Piszczek, Wright, and Grant
Nov 16, 2022

Moving into the treatment phase of the COVID-19 pandemic

My approach now is to have the confidence to reassure patients who are low risk that SARS-CoV2 infection will most likely be mild for them and that no specific therapy is needed. Those who are of intermediate risk will also generally do well, but it is an opportunity to create a plan of what to do if they have flu-like symptoms, including their preferences should they test COVID positive. For those who are at high risk, especially CEV-1, I ensure them that there is a clear testing and treatment plan. Any physician can prescribe Nirmatrelvir/rt. A step-by-step instruction guide for prescribing is available on the BCCDC website. read more...

Drs. Cheryl Young and David McVea
Nov 02, 2022

Radon: a preventable cause of lung cancer

November is Radon Action Month. There are approximately 3,000 lung cancer deaths in Canada attributable to radon exposure each year, but there is limited awareness of radon both among the public and health care providers. read more...

Dr. Elisabeth Baerg Hall
Oct 19, 2022

Women with ADHD — Practice Tips

October is ADHD Awareness Month. Until recently, female presentations of ADHD have been largely overlooked in both clinical and research settings. With increasing awareness and media attention to women and ADHD, adult women are asking if ADHD could explain their longstanding challenges. read more...

Drs. Fiona Petigara and Joanna Cheek
Sep 28, 2022

Offering CBT skills by group medical visits

A large part of physician’s day is spent on mental health and wait times to see specialists can be very long. In 2022 the BC Government created “Group Medical Visit” (GMV) codes to promote physicians to deliver services to groups of patients as “an effective way of leveraging existing resources; simultaneously improving quality of care and health outcomes, increasing patient access to care and reducing costs” (BC Gov, 2022). Physicians can now refer their patients to the Group Cognitive Behavioral Therapy program via or through PathwaysBC fillable PDF and they can also train to facilitate group medical visits. read more...

Dr. Konia Trouton
Sep 12, 2022

Why I talk about all Long Term Reversible Contraception (LARC)

Patient satisfaction and continuation rates are very well documented for various contraceptives in Canada. Among the combined hormonal contraceptives ⁠— the pill, patch, and ring ⁠— only 50% of people are still using them after a year, despite all efforts to improve compliance and reduce side effects. In contrast, over 80% of people are still using long-acting and reversible IUDs a year later. read more...