Q: In regards to the the lipid management, once we initiate a statin, when do we ask for a lipid profile to see if the statin was effective? And if the statin was effective at hitting the threshold, do we ask for a lipid profile once every year to make sure it's stable?A: Yes - once a statin is initiated, would suggest repeating the lipid profile 3 months post initiation. Then, once on statin, lipid profile should be checked yearly.
Q1: Can you use depo provera long term in the depressed patient?
A1: Certainly depression is not an absolute contraindication or at all a predictable side effect of Depo-Provera but we have so many other better long-acting birth control methods the Depo-Provera is really limited to very few patients these days. Because if it’s long-acting nature it wouldn’t be my first choice in such a patient.
Q2: I am very interested in the implant. The other long acting, progestin-only, non-IUD contraception that we are familiar with is depo-provera. How does the implant compare to depo-provera with regards to weight gain associated with the product?
A2: No contest here. Depo-Provera is associated with 4-5pounds of weight gain in the first year of use and up to 11 pounds by two years it’s even written on the product monograph. None of the other long term reversible methods like the IUD or the implant are associated with any significant weight gain. No contest.
Q: Is chondrocalcinosis something we would see incidentally, on X-ray, even in asymptomatic patients?
A: The answer is yes. You can see chondrocalcinosis as an incidental finding on x-ray without the patient being symptomatic. The finding of chondrocalcinosis tends to increase with age and with osteoarthritis. It becomes a risk factor for having Pseudogout in the context of an acute inflammation in the joint.
Q: Will you discuss switching a patient on methadone to suboxone?
A: There are two main ways to transfer from methadone to suboxone. Microinduction of methadone to suboxone (preferred method). This can be done over 7 or 14 days. You continue the same dose methadone until day 6 or day 13 depending the induction method and slowly add small doses of suboxone. This can theoretically be done with ANY dose of methadone. Please see attached example. The second option which is not as good since the patient needs to be in withdrawal. You would decrease the methadone slowly to the lowest possible tolerable. Then stop the methadone completely for 5-7 days and then do a classical induction to suboxone using COWS score. When they are not on methadone, you can give them short acting dilaudid to help with withdrawal symptoms. If you do this, ensure they stop the dilaudid at least 6 hours before doing the induction to suboxone so they can be in adequate withdrawal.(See table above)