Re: Re: Patient Conundrums

[Guest guest]

Sedating anti-histamines such as Hydroxyzine may treat her anxiety/cause of her itching as well as help her sleep at night.

M. Wyatt

To: Sent: Tue, May 4, 2010 12:05:11 PMSubject: Re: Patient Conundrums

i treat subclinical hypothyroidism. where is exactly your normal tsh? the range is 0.45 to 4.5 too wide if you asked me where my picket fence lies.hypothyroidism or thyroiditis does have some urticaria / hives attached to it.might be worth a try.grace>> Hmmm.....so do any of you have great treatments for itching? I have a 48 yr female with whole body itching for about 10 yrs. Has been worked up for various things. Has tried various meds. Her biggest complaint is the scalp itching that keeps here awake at night.> > Next issue....... what are you guys doing when TSH is normal and the fT4 is low?> > Thank you all for letting me pick you brains!>

> Dannielle Harwood, MD> mystudiomd.com> > > > ____________ _________ _________ __>

[Guest guest]

I am also pretty aggressive with treating hypothyroidism. If a TSH is over 2 I am suspicious, particularly if the patient has any symptoms suggestive. I will also check antithyroid antibodies - if elevated, I am more likely to treat. Of course, it's all dependent on the clinical picture.LonnaSubject: Re: Patient ConundrumsTo: Date: Tuesday, May 4, 2010, 12:05 PM

i treat subclinical hypothyroidism. where is exactly your normal tsh? the range is 0.45 to 4.5 too wide if you asked me where my picket fence lies.

hypothyroidism or thyroiditis does have some urticaria / hives attached to it.

might be worth a try.

grace

>

> Hmmm.....so do any of you have great treatments for itching? I have a 48 yr female with whole body itching for about 10 yrs. Has been worked up for various things. Has tried various meds. Her biggest complaint is the scalp itching that keeps here awake at night.

>

> Next issue....... what are you guys doing when TSH is normal and the fT4 is low?

>

> Thank you all for letting me pick you brains!

>

> Dannielle Harwood, MD

> mystudiomd.com

>

>

>

> ____________ _________ _________ __

>

[Guest guest]

Also I don't see anyone mentioned estrogen, as this is a 48 year-old woman, and "itching all over" is often a huge peri-menopausal complaint.

They key is that this complaint is often related to a systemic problem that is not Derm-related, such as you have already mentioned hypothyroidism, atopy, anxiety, or primary biliary cirrhosis (check alk phos) which also presents in this age/gender group. I realize that pruritis does not fall under the FDA approved indications for estrogen, and I don't want to start a discussion on peri-menopausal hormone therapy, just wanted to mention it as a reminder in the Differential Dx.

To: Sent: Tue, May 4, 2010 5:02:54 PMSubject: Re: Re: Patient Conundrums

Sedating anti-histamines such as Hydroxyzine may treat her anxiety/cause of her itching as well as help her sleep at night.

M. Wyatt

From: pricklyfinger2007 <tagabanawayahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Tue, May 4, 2010 12:05:11 PMSubject: [Practiceimprovemen t1] Re: Patient Conundrums

i treat subclinical hypothyroidism. where is exactly your normal tsh? the range is 0.45 to 4.5 too wide if you asked me where my picket fence lies.hypothyroidism or thyroiditis does have some urticaria / hives attached to it.might be worth a try.grace>> Hmmm.....so do any of you have great treatments for itching? I have a 48 yr female with whole body itching for about 10 yrs. Has been worked up for various things. Has tried various meds. Her biggest complaint is the scalp itching that keeps here awake at night.> > Next issue....... what are you guys doing when TSH is normal and the fT4 is low?> > Thank you all for letting me pick you brains!>

> Dannielle Harwood, MD> mystudiomd.com> > > > ____________ _________ _________ __>

[Guest guest]

thanks for the update -- didn't know could go to 20 BID (been doing 10 BID for several years. Topical allergy to shampoo or spray? good thought.

To: Sent: Wed, May 5, 2010 11:16:41 AMSubject: Re: Patient Conundrums

Addressing the symptom of itch only, recent literature allows for an increase in dosing of zyrtec safely. Originally a once a day therapy, one can increase to 10 mg BID, and then if itch persists, 20 mg BID, usually without side-effect. Is the skin of the scalp normal: scale, broken hairs, erythema? Could the itch be seborrhea or tinea or an ectodermal dysplasia?A therapeutic trial of a selenium based or tar-based shampoo, e.g. Selsun Blue, could be helpful. Perhaps a trial of a steroid solution,e.g. Synalar solution (beware of chronic use) or a referral to dermatologist. ...Could the patient have a contact topical allergy to a hair product??Regards,Marc T>> Hmmm.....so do any of you have great treatments for itching? I have a 48 yr female with whole body itching for about 10 yrs. Has been worked up for various things. Has tried various meds. Her biggest complaint is the scalp itching that keeps here awake at night.> > Next issue....... what are you guys doing when TSH is normal and the fT4 is low?> > Thank you all for letting me pick you brains!> > Dannielle Harwood, MD> mystudiomd.com> > > > ____________ _________ _________ __>

[Guest guest]

Hydroxyzine pamoate is for all three (allergy, anxiety and insomnia) right? So what is hydroxyzine chloride for?

To: Sent: Tue, May 4, 2010 8:02:54 PMSubject: Re: Re: Patient Conundrums

Sedating anti-histamines such as Hydroxyzine may treat her anxiety/cause of her itching as well as help her sleep at night.

M. Wyatt

From: pricklyfinger2007 <tagabanawayahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Tue, May 4, 2010 12:05:11 PMSubject: [Practiceimprovemen t1] Re: Patient Conundrums

i treat subclinical hypothyroidism. where is exactly your normal tsh? the range is 0.45 to 4.5 too wide if you asked me where my picket fence lies.hypothyroidism or thyroiditis does have some urticaria / hives attached to it.might be worth a try.grace>> Hmmm.....so do any of you have great treatments for itching? I have a 48 yr female with whole body itching for about 10 yrs. Has been worked up for various things. Has tried various meds. Her biggest complaint is the scalp itching that keeps here awake at night.> > Next issue....... what are you guys doing when TSH is normal and the fT4 is low?> > Thank you all for letting me pick you brains!>

> Dannielle Harwood, MD> mystudiomd.com> > > > ____________ _________ _________ __>

[Guest guest]

FYI:http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/allergytests.html

Pedro Ballester, M.D.Warren, OH

[Guest guest]

Pedro,

FYI:

http://www.quackpotwatch.org/WisconsinWar/barrett.htm

Wyatt, MD

Eugene, OR

To: Sent: Wed, May 5, 2010 6:29:54 PMSubject: Re: Re: Patient Conundrums

FYI:

http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/allergytests.html

Pedro Ballester, M.D.Warren, OH

[Guest guest]

Some pharmacists believe the pamoate is for pruritis, while the chloride is for anxiety, yet there is no evidence to support any of that. To me, they are equivalent, but there is no evidence to support that either:)

Mcihelle

To: Sent: Wed, May 5, 2010 6:19:06 PMSubject: Re: Re: Patient Conundrums

Hydroxyzine pamoate is for all three (allergy, anxiety and insomnia) right? So what is hydroxyzine chloride for?

From: W <drmwyattyahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Tue, May 4, 2010 8:02:54 PMSubject: Re: [Practiceimprovemen t1] Re: Patient Conundrums

Sedating anti-histamines such as Hydroxyzine may treat her anxiety/cause of her itching as well as help her sleep at night.

M. Wyatt

From: pricklyfinger2007 <tagabanawayahoo (DOT) com>To: Practiceimprovement 1yahoogroups (DOT) comSent: Tue, May 4, 2010 12:05:11 PMSubject: [Practiceimprovemen t1] Re: Patient Conundrums

i treat subclinical hypothyroidism. where is exactly your normal tsh? the range is 0.45 to 4.5 too wide if you asked me where my picket fence lies.hypothyroidism or thyroiditis does have some urticaria / hives attached to it.might be worth a try.grace>> Hmmm.....so do any of you have great treatments for itching? I have a 48 yr female with whole body itching for about 10 yrs. Has been worked up for various things. Has tried various meds. Her biggest complaint is the scalp itching that keeps here awake at night.> > Next issue....... what are you guys doing when TSH is normal and the fT4 is low?> > Thank you all for letting me pick you brains!>

> Dannielle Harwood, MD> mystudiomd.com> > > > ____________ _________ _________ __>

[Guest guest]

Thank you . So much better that what I said.

Re: Re: Patient Conundrums

FYI:

http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/allergytests.html

Pedro Ballester, M.D.Warren, OH

[Guest guest]

Unproven Tests

Procedures for which there is no evidence of diagnostic validity include cytotoxic tests, provocation- neutralization, electrodermal testing, applied kinesiology, iridology, hair analysis, or food specific IgG, IgG4, and IgG/IgG4 antibody tests. (http://www.guideline.gov/summary/summary.aspx?doc_id=13114 & nbr=6718 & ss=6 & xl=999

http://www.guideline.gov/summary/summary.aspx?doc_id=13558 & nbr=6930 & ss=6 & xl=999It is impossible to discuss logic and the scientific method with anyone that has a " faithful belief " .

It is like the use of intercessionary prayer, If an individual or " practitioner " wants to practice it, it is harmless, just as it is ineffective...The problem arises when the populace expects the taxpayer or the employer to pay for unscientific practices, if the individual has money to burn, who am I to prevent that?

You can lead the horse to water, but.... Pedro Ballester, M.D.Warren, OH

[Guest guest]

Pedro, and everyone else,This is a good time to remind everyone about the cardinal rule of basic Netiquette: • Be respectful and considerate in your postings. Remember that there is a real human being on the other end of your message. We have all sorts of people on the listserv with as many points of views, religious beliefs, political leanings, healing practices, taste in music, sports team loyalties, etc, etc. At this point, I think everyone has made their point, and it is pointless to continue trying to convince the other that you are right and they are wrong. For the sake of peaceful coexistence on this listserv, let's agree to disagree and drop this, okay? Thank you for your cooperation. SetoModerator

Unproven Tests

Procedures for which there is no evidence of diagnostic validity include cytotoxic tests, provocation- neutralization, electrodermal testing, applied kinesiology, iridology, hair analysis, or food specific IgG, IgG4, and IgG/IgG4 antibody tests. (http://www.guideline.gov/summary/summary.aspx?doc_id=13114 & nbr=6718 & ss=6 & xl=999

http://www.guideline.gov/summary/summary.aspx?doc_id=13558 & nbr=6930 & ss=6 & xl=999It is impossible to discuss logic and the scientific method with anyone that has a "faithful belief".

It is like the use of intercessionary prayer, If an individual or "practitioner" wants to practice it, it is harmless, just as it is ineffective...The problem arises when the populace expects the taxpayer or the employer to pay for unscientific practices, if the individual has money to burn, who am I to prevent that?

You can lead the horse to water, but.... Pedro Ballester, M.D.Warren, OH

[Guest guest]

Try Quackwatch.com

________________________________________

From:

[ ] On Behalf Of Pedro Ballester

[DrBallester@...]

Sent: Wednesday, May 05, 2010 7:29 PM

To:

Subject: Re: Re: Patient Conundrums

FYI:

http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/allergytests.html

<http://www.quackwatch.org/01QuackeryRelatedTopics/Tests/allergytests.html>

Pedro Ballester, M.D.

Warren, OH

[Guest guest]

The " thyroid society recently said anything over 2.5 is too high. I agree, but

find tha many of my folks want to try the natural stuff first, really admitting

it wont work, so we follow them closely every 6 months, until they realize they

feel bad, or we can get them meds another way.

________________________________________

From:

[ ] On Behalf Of Lonna Larsh

[larshlonna@...]

Sent: Tuesday, May 04, 2010 8:30 PM

To:

Subject: Re: Re: Patient Conundrums

I am also pretty aggressive with treating hypothyroidism. If a TSH is over 2 I

am suspicious, particularly if the patient has any symptoms suggestive. I will

also check antithyroid antibodies - if elevated, I am more likely to treat.

Of course, it's all dependent on the clinical picture.

Lonna

Subject: Re: Patient Conundrums

To:

Date: Tuesday, May 4, 2010, 12:05 PM

i treat subclinical hypothyroidism. where is exactly your normal tsh? the range

is 0.45 to 4.5 too wide if you asked me where my picket fence lies.

hypothyroidism or thyroiditis does have some urticaria / hives attached to it.

might be worth a try.

grace

>

> Hmmm.....so do any of you have great treatments for itching? I have a 48 yr

female with whole body itching for about 10 yrs. Has been worked up for various

things. Has tried various meds. Her biggest complaint is the scalp itching that

keeps here awake at night.

>

> Next issue....... what are you guys doing when TSH is normal and the fT4 is

low?

>

> Thank you all for letting me pick you brains!

>

> Dannielle Harwood, MD

> mystudiomd.com

>

>

>

> ____________ _________ _________ __

>