What is New in Primary Care Adult Medicine–Fall Edition 2022
by George Bell MD
Happy Fall everybody. A nice time of the year when the leaves are beautiful. I am going to summarize a few interesting things that occurred in primary care over the last several months.
Should I be taking aspirin to prevent heart attack or stroke?
This is a question that patients frequently ask. The short answer is probably not: a recent review done by the United States Preventive Services Task Force (USPSTF) revealed increased risk of bleeding in patients over the age of 60 taking aspirin. This was based on a study of over 19,000 adults that showed increased death rates and major bleeding in those taking aspirin for prevention. Therefore a recommendation was made to providers to discontinue aspirin on patients in this age group. In patients between 40 and 59 years of age the USPSTF recommended most patients not take aspirin unless they were in a very high risk group such as diabetics with high blood pressure and high cholesterol. These higher risk patients were recommended to have a discussion about the risks of strating aspirin with their provider.
The above recommendations do not apply to patients who have already had a heart attack or stroke or have known heart blockages that have been stented or operated on. These patients are to continue taking aspirin.
There is a new pneumonia shot.
Many patients are recommended to get pneumonia shots (including everyone over the age of 65). In the past this usually included a combination of 2 shots (Pneumovax and Prevnar 13). These shots protect against a very serious and common form of pneumonia called Streptococcal pneumonia. They also protect patients with Streptococcal pneumonia from getting serious and potentially life threatening complications such as meningitis and bloodstream poisoning.
The new shot is called Prevnar 20 and essentially eliminates the need for the series of 2 shots mentioned above. This should help simplify things. Of note if patients have already had the previous series of shots and they are over 65 they will not need to get the Prevnar 20.
An old remedy for constipation works quite well.
A study published in the American Journal of gastroenterology looked at prune juice for constipation. Approximately 1 small glass a day compared very favorably with medications used for constipation and patients did not complain of side effects such as diarrhea or gasiness.
A new potential treatment for “dry” macular degeneration.
There are 2 types of age related macular degeneration (a condition that causes gradual vision loss in millions of people) called wet and dry. The wet type has been treated fairly successfully for years with injections into the eye. However, the dry type is much more common and has proven more difficult to treat. A recent trial called “Lightsite III” has given hope for the potential treatment for dry macular degeneration in the near future. In a study done at 10 US eye retinal centers patients were given a type of light therapy every 4 months for 2 years. The patients treated had significant improvement in their vision scores. Hopefully it will not be long before this treatment is widely available throughout the US for the millions of patients with dry macular degeneration.
Have a great Fall and Winter everyone!