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Recently, after getting her regular prescription for Synthroid filled at the pharmacy, my mother called the physician to complain that she just didn’t feel well. The doctor was considering increasing the dosage when my mother noticed that the pills looked different. She had been given a generic version. Her prescription was changed back to Synthroid and she felt fine again.

All elements of the skin are affected by age. In this 2-part article, I discuss how the blood vessels, the lymphatics, and the ground substance- which surrounds these vessels- respond to age, and I show how the aging elements of the vasculature can engender a variety of pathological cutaneous conditions.

Chronic obstructive pulmonary disease (COPD) is recognized as a common condition in older adults, but asthma is often considered something that most patients outgrow long before they retire and qualify for Medicare.

I advise my patients who are carriers of methicillin-resistant Staphylococcus aureus (MRSA) to keep their fingernails trimmed. Long nails make the subungual spaces good havens for bacteria. S aureus, including MRSA, has been isolated from the subungual spaces of the hands of many at-risk patients who are MRSA carriers

If patients cannot overcome the gag reflex when I try to depress their tongue with a tongue blade, I simply have them stand in front of a mirror and ask them to show me the back of their throat while I hold the light.

A quick way to determine rebound tenderness and differentiate between an acute and a nonacute abdomen in a child is to ask the patient to jump up and down. Patients with nonacute abdominal pain will do this willingly. However, those with an acute abdomen will typically decline because of pain.

A 76-year-old woman presents for evaluation of a long-standing sore just inside her lower lip. She has been referred by her dentist.

A 32-year-old woman complains of eye symptoms that began 3 to 6 months earlier. She first experienced increased lacrimation and a gritty feeling in the eyes.

Inhaled medications are the cornerstoneof therapy for most of themore than 30 million Americanswho have asthma or chronic obstructivepulmonary disease(COPD). Unfortunately, many ofthese patients use aerosol deliverydevices incorrectly.

IBM is rewarding participation in its wellness programs for US employees and dependents with cash. In October, the company added a fourth cash rebate worth $150 to its healthy living programs, first introduced in 2004. The Children's Health Rebate is designed to address the significant increase in obesity rates among children. Other $150 cash wellness incentive programs focus on healthy eating and weight loss, exercise, and smoking cessation. Employees can choose any 2 rebates to receive $300 in cash per year.

Theoretically at least, every day in any hospital should be the same. That means that every patient should be treated with the same quality and safety standards whether it be Sunday or Wednesday. In reality, however, the evidence suggests that there is a “weekend effect,” which translates into worse outcomes for patients admitted to the hospital on weekends for serious illnesses.

Written in appreciation of “100 Precepts for My House Staff” by Henry Schneiderman, MD, and dedicated to those fierce internist attendings who have bred fear, insight, and wisdom in so many of us (Part 1 in CONSULTANT, April 2009, page 270, and Part 2 on page 361 of the June issue).

The FDA would have broad public support for a behind-the-counter (BTC) classification for drugs. According to the results of a telephone survey conducted by Leo J. Shapiro & Associates, 67% of respondents said they would welcome the convenience of obtaining a drug without a prescription and after counseling by a pharmacist, even while they recognize that their insurance plan would not cover the cost of the BTC medication.

The FDA does not allow pharmaceutical manufacturers to promote unapproved uses of their products, saying that evidence of success with additional indications can be given to physicians only if they request it. But the agency is on the verge of amending that rule to make it much easier for pharmaceutical companies to promote such prescribing.

Mortality rates from heart disease and stroke are falling in the United States, but cardiovascular disease remains the leading cause of death, according to a report by the American Heart Association (AHA). An estimated 869,724 persons died of heart disease in 2004 compared with 911,603 persons in 2003. When considered separately from other cardiovascular diseases, stroke was the third leading cause of death in 2004. The number of deaths attributable to stroke that year was estimated to be 150,074, a decrease from 157,689 deaths in 2003.

Two studies confirm that colorectal cancer screening is significantly underused in the United States. In a study published online December 10 in Cancer, Gregory Cooper, MD, interim chief of gastroenterology at University Hospitals Case Medical Center in Cleveland and professor of medicine, Case Western Reserve University (CWRU) and the Case Comprehensive Cancer Center, and Tzuyung Doug Kou, MPH, CWRU, assessed a population-based sample of 153,469 Medicare beneficiaries without cancer beginning in 1998, the first year in which colorectal cancer screening was reimbursed under Medicare. The beneficiaries included 17,940 persons with 1 or more risk factors for cancer and 135,529 persons with average risk for cancer.

The rate of onset of type 2 diabetes and related hospitalizations is rising in young adults in the United States aged 20 to 29, according to results of a study published in the December issue of Diabetes Care.

Under a new ruling by the Drug Enforcement Administration (DEA), clinicians may begin issuing multiple prescriptions for Schedule II controlled substances when appropriate.