Treating severe OA in a complex patient

[prevacid]

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this should be consult to the orthapod

id give him APAP, HA injection, get a prior auth for voltaren, heat treatments

 

[Old Timer]

OK, there have been 50 responses, what did you do with the patient? What was the outcome?

 

[Fuzzychickens]

OK, there have been 50 responses, what did you do with the patient? What was the outcome?

Consider a billion options to minimize your own exposure to frivolous lawsuit.

In the meantime, patient dies of old age.

Rinse and repeat.

 

[spacecowgirl]

First you have to make sure there is nothing else going on (gout, psoriatic arthritis, extra-articular systemic manifestation, pseudogout, septic joint, occult fracture, etc)

Well, first this as done. Lab workup for gout, RA, parvo, can't remember what else.

He started low-dose naproxen with an H2 blocker for 2 days along with scheduled APAP. BUN and Cr increased slightly (although they were doing that anyway) which was too bad because he was doing better pain-wise and I saw him working with PT in the hallways. CBC stayed the same.

Naproxen was d/c, scheduled APAP was left on. Considering opioids and/or IA steroids as next steps. Pt was to be d/c to NH with labs still pending. I'll have to see on Monday what the next course of action was.

Next pt to discuss - PD pt with pre-existing bipolar d/o. That was a doozy.

 

[prevacid]

bipolar? the psychs just use shotgun therapy: lithium, benzo, lamictal/seroquel, tegretol, and whatever else they can get covered

the store i trained at did 60% psych pts, i dont think i ever saw a rx with less than 4 drugs on it

 

[spacecowgirl]

yeah but they have Parkinsons. Which makes the whole dopamine antagonist thing a real biotch.

 

[prevacid]

yeah but they have Parkinsons. Which makes the whole dopamine antagonist thing a real biotch.

simple, give em clozaril 🙂