Unorthodox Treatments

[AFMD]

I graduated less that a year ago, and getting used to practicing on my own. I still ask a lot of advice from other providers at the clinic, as well as look up a ton of stuff on up-to-date.

I've seen some interesting treatments from the other providers that up-to-date has nothing on. For example, using Clomid for low testosterone or using nitro or isosorbide for pvd. There's some research out there, but it doesn't seem very standard.

How common are these seemingly non-traditional treatments? How comfortable are you guys at trying these treatments based off your own clinical experience? Is the liability that much higher when doing something like this?

What I'm most interested in: What are your guy's uncommon treatments that just work that we might not know about?

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[deleted87716]

Clomid is sometimes used by endocrinology for hypogonadotrophic hypogonadism (off-label), but I wouldn't do any of that stuff, and I think asking people to provide their favorite unproven (what I assume you mean when you say "uncommon") treatments is asking for trouble. And, yeah...liability.

 

[AFMD]

Uncommon meaning uncommon. Just curious.

 

[deleted87716]

Uncommon meaning uncommon. Just curious.

Uncommon is usually uncommon for a reason.

 

[AFMD]

Uncommon is usually uncommon for a reason.

Probably mostly because there are so many reasonable options for so many medical conditions. There are multiple guidelines for some disease processes, and this guidelines change. There are many regional differences in the office of medicine, not to mention generational differences.

Something I've noticed, is the incredible variation in the practice of medicine. Some call it the art of medicine. Maybe it's a bad thing, and we all talk about eliminating "non-value added variation" or whatever it's called. I don't know.

All the more reason to talk about it, right?

 

[deleted87716]

But...your OP didn't talk about any of that stuff.

You might consider posting in the Practicing Physicians forum, as well.

 

[septoplasty]

I graduated less that a year ago, and getting used to practicing on my own. I still ask a lot of advice from other providers at the clinic, as well as look up a ton of stuff on up-to-date. I've seen some interesting treatments from the other providers that up-to-date has nothing on. For example, using Clomid for low testosterone or using nitro or isosorbide for pvd. There's some research out there, but it doesn't seem very standard. How common are these seemingly non-traditional treatments? How comfortable are you guys at trying these treatments based off your own clinical experience? Is the liability that much higher when doing something like this? What I'm most interested in: What are your guy's uncommon treatments that just work that we might not know about?

Providers , Physicians. I hope that's what you meant.

Also, using things "off-label", especially when it isn't in your mainline of training/specialty/forte could be problematic. Also being relatively new in practice, I stick to literature based guidelines, all which usually use medications per their FDA indications. Some have a 'broad range' of use ex. steroids, but than again, that's where your education plays a role determining if its going to do harm to the patient, than benefit.

I wouldn't try and emulate other docs in the clinic. I've noticed this with some of the dino docs in my practice as well, they do all kinds of weird sh-t that has no evidence.

 

[AFMD]

Providers , Physicians. I hope that's what you meant.

Also, using things "off-label", especially when it isn't in your mainline of training/specialty/forte could be problematic. Also being relatively new in practice, I stick to literature based guidelines, all which usually use medications per their FDA indications. Some have a 'broad range' of use ex. steroids, but than again, that's where your education plays a role determining if its going to do harm to the patient, than benefit.

I wouldn't try and emulate other docs in the clinic. I've noticed this with some of the dino docs in my practice as well, they do all kinds of weird sh-t that has no evidence.

Amitriptyline is off label for fibro, gabapentin is off label for most of the pain we use it for, adding on Zetia to a statin for primary prevention, using cholesterol targets, treating dm to a1c less than 6 with insulin in geri patient, using expensive brand meds that don't have as good evidence as older meds, ignoring CDC chronic pain guidelines and/or ignoring addiction etc. Some of these might be okay, some are stupid. Hell, a lot of guidelines are not evidence based but simply expert opinion. Look at the levels of evidence for the recommendations on your favorite set of guidelines. I think you'd also be surprised how many guidelines use meds that are off label.

Medicine is a lot messier than I ever expected. The safe thing to do is to stay within guidelines, and where there are not clear guidelines stay within the mainstream of medicine. That definitely what I do.

I get there's a larger issue here. I get it. Don't do stupid stuff. I agree.

I'm not really interested into getting into the provider/physician thing. Others can discuss that if they want.

 

[FrustratedFamDoc]

Risk/benefit and what you feel comfortable with. I'm willing to try some things off label if it makes sense and the risk of harm is minute.

 

[deleted87716]

There's a difference between mainstream off-label use and wacky off-label use.

 

[septoplasty]

Amitriptyline is off label for fibro, gabapentin is off label for most of the pain we use it for, adding on Zetia to a statin for primary prevention, using cholesterol targets, treating dm to a1c less than 6 with insulin in geri patient, using expensive brand meds that don't have as good evidence as older meds, ignoring CDC chronic pain guidelines and/or ignoring addiction etc. Some of these might be okay, some are stupid. Hell, a lot of guidelines are not evidence based but simply expert opinion. Look at the levels of evidence for the recommendations on your favorite set of guidelines. I think you'd also be surprised how many guidelines use meds that are off label.

The examples you provided are anecdotal, but fair. The fact it is in recommendations, thus consistent with standard of care, is what's important in case there is a big complications. If the drug was off label, and not in a recommendation this would not be the SoC, making you a cowboy.

 

[MedicineZ0Z]

I graduated less that a year ago, and getting used to practicing on my own. I still ask a lot of advice from other providers at the clinic, as well as look up a ton of stuff on up-to-date.

I've seen some interesting treatments from the other providers that up-to-date has nothing on. For example, using Clomid for low testosterone or using nitro or isosorbide for pvd. There's some research out there, but it doesn't seem very standard.

How common are these seemingly non-traditional treatments? How comfortable are you guys at trying these treatments based off your own clinical experience? Is the liability that much higher when doing something like this?

What I'm most interested in: What are your guy's uncommon treatments that just work that we might not know about?

Clomid or nolvadex or serms in general are used after a cycle of anabolic steroids to get the body back to normal basically.

 

[AFMD]

The examples you provided are anecdotal, but fair. The fact it is in recommendations, thus consistent with standard of care, is what's important in case there is a big complications. If the drug was off label, and not in a recommendation this would not be the SoC, making you a cowboy.

Off label drug use is using a medication for anything or in any way that is not labeled by the FDA. It doesn't matter what the recommendations are.

 

[MedicineZ0Z]

Off label drug use is using a medication for anything or in any way that is not labeled by the FDA. It doesn't matter what the recommendations are.

Treating low test with clomid/nolvadex is very well established to work with years/decades of use among bodybuilders/weightlifters/powerlifters/many other athletes/rec users of testosterone.

After they run their testosterone cycles + other agents like trenbolone/winstrol/dianabol/anadrol/susp etc etc. they cycle off and now have virtually 0 test. due to exogenous use. Use of SERMs has been shown to minimize the estrogen effect present and raise endogenous produced test.

 

[AFMD]

Treating low test with clomid/nolvadex is very well established to work with years/decades of use among bodybuilders/weightlifters/powerlifters/many other athletes/rec users of testosterone.

After they run their testosterone cycles + other agents like trenbolone/winstrol/dianabol/anadrol/susp etc etc. they cycle off and now have virtually 0 test. due to exogenous use. Use of SERMs has been shown to minimize the estrogen effect present and raise endogenous produced test.

Sure, we all use medications off label all the time. Guidelines/recommendations/standards or other reasonable treatments do not necessarily equal FDA labeling.