Practical Pointers: Spinal Fears, Seeing Red, Black Lights, and Medication Listmania

Spinal Tap Fears? Tap Into the Familiar To allay patients’ fears about lumbar puncture (LP), ask whether they or anyone they know has ever had an epidural injection during childbirth. Explain that an LP is nearly identical except that the needle goes in slightly deeper and removes fluid instead of delivering an anesthetic. Patients are often more familiar with “epidurals” than with LPs and seem to fear them less. — D. Brady Pregerson, MD  Los Angeles The Full Spectrum of Black Light Uses A Wood UV lamp is useful in a wide variety of primary care settings. Seen in “black light,” fungi appear bright yellow-green to pale green, Corynebacterium minutissimum looks coral red to pink, Pseudomonas aeruginosa appears as aquagreen to whitish green patches, and Malassezia furfur is golden yellow. A Wood lamp can also be used to evaluate pruritic papules for scabies and to check for abrasions and herpetic lesions of the cornea (after staining). — Bruce Becker, MD Bloomsburg, Pa When You See Red on Ear Exams If a child is screaming when you examine his or her ears, the tympanic membrane is likely to be red, which can make diagnosing otitis media difficult. To minimize crying, tell the patient that the examination might tickle and to let you know whether it tickles too much, since you don’t want him to laugh so hard that he falls off the table. This allays the child’s fears and gives him a sense of control; it can also minimize the prescription of unnecessary antibiotics. — Richard B. Levin, MD Van Nuys, Calif Medication Listmania Elderly patients who take many medications often have difficulty in remembering them all. To keep track of what older patients are taking, give them a form at their first visit on which they can list all current medications. At each subsequent visit, ask them to cross out any drugs they no longer take and add any new ones. — Sandy Varejao, Medical Assistant Danbury, Conn