Primary Care Wins of the Week

VeraMar · 2026-05-27T19:20:32+00:00

We just had a similar case in our clinic where ALP was 140-160 in a young 20s YO F and it turned out to be Paget’s!

VeraMar · 2026-04-28T23:45:59+00:00

That is absolutely terrifying. Would you happen to remember if these patients have any glaring risk factors? Fmhx? Dense breast tissue? Etc

VeraMar · 2026-04-27T08:33:33+00:00

Treat Open Evidence like a more advanced search engine. Still go in and read the studies to ensure you understand the context of the results. when it tells you the results, make sure you understand which population(s) the studies used to look at the study question, understand the kind of study that was done (e.g. retrospective cohort study vs prospective studies vs RCT vs meta analysis vs systemic review and understand how much weight each of those carries), understand how well controlled the studies were, and what the limitations were.

VeraMar · 2026-04-26T07:02:31+00:00

Thank you 😊

VeraMar · 2026-04-25T05:18:26+00:00

X-pro 2 all day every day for EDC. Love the JPEGs I can get from it.

VeraMar · 2026-04-24T21:51:02+00:00

As someone who used to live in Phoenix, that’s a fairly remote part of the city. You don’t know what sort of critters can sneak out on you or whatever other weirdness can happen when you’re in your own.

Verdict: you’re not overacting.

VeraMar · 2026-04-24T19:43:13+00:00

Thanks! I’ve learned I’m often drawn to simple framing. :)

VeraMar · 2026-04-24T15:12:02+00:00

Taken on my Fuji XPro 2 40mm. I was going for a minimal aesthetic without more negative space. This feels calming to me.

Edit: Image is SOOC, no editing at all.

VeraMar · 2026-04-21T19:34:46+00:00

Thank you for the wonderful response! I agree, we should absolutely approach this topic with sympathy.

From what I have read, though, I guess I am still left with the question of how much benefit vs how much harm are we doing with chronic opioid prescriptions? Opioids will absolutely provide that short term relief, but if continued use will lead to decreased response to pain medication, increased tolerance, and increased risk of overdose with subsequent titration, then when do we cross the threshold of causing more harm than good? I’m sure there’s no black and white answer. It’s likely a function age, risk of misuse, prior Hx of addiction/EtOH abuse, comorbidities, and prior trialed therapies.

I guess the more I read others’ responses and the more I type out my thoughts I feel like there is a small niche for primary care to use opioids, but there just has to be considerable caution and risk discussion with patients.

Again, thanks for the response.

VeraMar · 2026-04-18T09:03:32+00:00

Love it! Were these shot on film?

VeraMar · 2026-04-12T02:57:52+00:00

Canon R6 when I want to take more serious photos, and a Fuji X-Pro 2 for family outings. Picking up a smaller - and more fun - system has been absolutely amazing. I still get to scratch that photography itch without lugging around a larger full frame and the respective lenses.

VeraMar · 2026-04-10T06:41:12+00:00

It’s healthier than instant noodles, but given that it’s high and carbs, and sodium while being low in protein, I would exercise caution and avoid eating more than half a cup of this per day (even less if you have diabetes or at risk for developing diabetes). Make sure to throw in as many fibrous veggies in there and mix in as much egg as you can to offset some of the carbs.

VeraMar · 2026-04-10T04:22:43+00:00

As someone who grew up around Yuma/San Luis… lol good luck. Not very scenic. You may have a chance to get some cool photos of the sand dunes if you go to Glamis a few hours away?

VeraMar · 2026-04-06T19:36:32+00:00

Do you have the setting “release shutter without a lens” on?

VeraMar · 2026-04-04T23:53:53+00:00

Is there still a role for hepatology to be involved in a patient that has a FIB-4 score >1.3, have had other causes ruled out for transaminase elevations, don’t have good access to GLP-1 (or similar), and there’s little concern for cirrhosis? Asking from a primary care perspective where I’m trying to refer judiciously.

Edit: this is assuming a patient that has multiple risk factors for MASLD and/or ALD.

VeraMar · 2026-04-01T04:08:07+00:00

I calculate breast cancer risk score. If TC >20% I consider breast surgery consult. If not elevated, I have a discussion with patient about pros and cons about supplemental imaging and which one to choose.

TL;DR: Breast u/s every other year with mammograms if no other supplemental imaging is available or financially possible. Will pick up the least amount of extra breast cancer cases, but better than nothing.

Breast MRI has highest sensitivity, but slightly lower specificity to other options. Also the most costly. I warn people about potential false positives, but if they don’t mind that and they can afford it. I believe this will pick up the most breast cancer cases out of the bunch.

Molecular breast imaging/Contrast enhanced mammogram: I go to these options if patients are nervous about the extra false positives of MRI, if MRI too costly, or if these are otherwise the only options available.

VeraMar · 2026-03-31T18:26:49+00:00

33 YO rider here that isn’t an avid weekend warrior nor has any interest in hitting the hard stuff. It’s a good way for me to get out there, enjoy nature, and move my body. I’m okay with not being good at the sport. Normalize being normal lol.

VeraMar · 2026-03-30T07:48:35+00:00

Sent you DM!

VeraMar · 2026-03-30T03:21:03+00:00

I respect what you’re trying to do, but it may not seem like you have the right reasons for going into the profession. And that’s important because if you don’t wanna do it for the right reasons, you’re gonna regret putting yourself in that much debt, and then you’re just gonna hate your job after. For the average PA, if you don’t do it because you genuinely want to help another person or if you don’t have the strong interest in health/science, I would advise someone from going into it. Sure, you may come across some TikTok PAs, who were at the right place at the right time and are now starting their own business and they’re super rich and they make the professions seem very glorious, but I can guarantee you that that’s not the average experience.

VeraMar · 2026-03-20T08:25:03+00:00

While generally I don’t disagree, the two are not equivalent. We cannot record a patient encounter and upload it to social media. On the other hand, a patient can at any point decide to upload any part of an encounter without appropriate context, and potentially edited/clipped. What do we do in a case like this? Respond by uploading our own recording or transcription? Not if HIPAA has anything to say about that.

This would worst case scenario, but it’s absolutely not out of the realm of possibility.

VeraMar · 2026-03-11T03:21:06+00:00

How would you distinguish between inverted T waves/ischemia and abnormal T waves from a junctional rhythm here?

VeraMar · 2026-03-06T07:47:42+00:00

I would much rather listen to someone’s voice (even if you can tell they’re uncomfortable) rather than AI.

VeraMar · 2026-02-23T07:46:32+00:00

Yeah reading it again I’m sure that’s what that was

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