Well, JailMedicine is now over six months old and has been more fun to write and much better received than I had imagined it would be.  JailMedicine has had over 30,000 hits!  Thank you especially to those of you who have written comments.  I have my opinions on certain topics (as you have read) but I realize that smart and accomplished people sometimes disagree with me–and sometimes they are right and I am wrong!  We all learn and become more effective clinicians when alternative views are expressed and debated–so please comment!

What can I do to make JailMedicine better?

I have been surprised at which of the blog posts have been the most popular.  Today is a count down of the five most popular articles of the last six months.  The most read article I have written, by far, has been the one about scabies!  Who’d a thunk it?  We’ll start with that one and count down the top five.

1.  What’s the most cost-effective way to treat scabies? The answer might surprise you!.

This article was a price comparison between alternative treatments for scabies.  At the time that I wrote that article, ivermectin pills (marketed as Stromectol) were less expensive to use than the traditional permethrin 5% cream.  But prices change.  What is the acquisition cost today of these two treatments?  (I use Idaho Medicaid’s Actual Acquisition Cost List, which is updated every two weeks and is found here).

As of August 28th, the acquisition cost of 30 grams of generic permethrin 5% cream is $22.20.

The acquisition cost of four tablets (3 mg) of brand name Stromectol (ivermectin) is $18.24.

So ivermectin is still cheaper.  And much easier to use.

2.  “Bath Salts,” A Review.

Coincidentally, I published this article one week to the day before President Obama announced The Synthetic Drug Use Prevention Act, which outlawed some (but not all) of the compounds used to make Bath Salts. It seems that the number of inmates on Bath Salts has gone down in my jails since this law was passed.  What do you think?

3.  Insulin Dosing Made Simple

This article was a tutorial on how insulin should be dosed in Type 1 diabetics.  Type 1 diabetics come into my facilities on amazingly weird insulin regimens.  I continue to rely on the principles of this tutorial almost daily.  Consider, for example, a patient who recently was booked into one of my jails:  32 years old man with Type 1 diabetic who had not seen a doctor in several years and had been using only regular insulin that you can buy without a prescription.  His initial blood sugar in the jail was 460.  I assume that he has been running in that range for a long time.  Where to begin?

Well, he weighed 170 pounds, so would need approximately 40-80 units of insulin a day.  I picked a mid-range 60 units a day.  Half of that should be long acting Lantus or Levemir; 30 units a day.  The other 30 units should be short acting Humalog or Novolog divided between 3 meals a day (no snack). So the final initial orders are:

1.  Lantus 30 units sub Q qDay.

2.  Humalog 10 units sub Q with each meal.

I will check his blood sugars daily and make adjustments (60 units a day may be not enough) until I get him reasonably controlled.

4. Rethinking Bedtime Snacks for Type 2 Diabetics

This article challenged the commonly believed myth that a bedtime snack for type 2 diabetics is somehow a “Standard of Care.”  In fact, I believe that in almost all cases, bedtime diabetic snacks are a bad diabetic management tool and, in fact, poor medical care.

But I could be wrong!  What do you think?

5. Where Should the Hydrocodone Go?

In this post, I discussed a case in which a patient returned from an ER visit with 6 hydocodone tablets.  The question was, what to do with them.  Do they belong to the patient?  Should they go into his property?  Can they legally be destroyed?

This post carries the distinction of having more comments than any other article I have written.  And they are interesting reading!

Thank you all again for making JailMedicine a success!  I look forward to the next six months. the next 60 posts and most of all, your comments!