Patients managed with upper limb cast immobilization often seek advice about driving. There is very little published data to assist in decision making, and advice given varies between healthcare professionals. There are no specific guidelines available from the UK Drivers and Vehicles Licensing Agency, police, or insurance companies. Evidence-based guidelines would enable clinicians to standardize the advice given to patients. Six individuals (three male, three female; mean age 36 years, range 27-43 years) were assessed by a mobility occupational therapist and driving standards agency examiner while completing a formal driving test in six different types of upper limb casts (above-elbow, below-elbow neutral, and below-elbow cast incorporating the thumb [Bennett's cast]) on both left and right sides. Of the 36 tests, participants passed 31 tests, suggesting that most people were able to safely drive with upper limb cast immobilization. However, driving in a left above-elbow cast was considered unsafe.
Background HIV patients often fear disclosure of their status and consequently are fearful that their appearance may lead people to believe they have HIV. Excessive attention to weight is one result. Case presentation We present a case of bilateral avascular necrosis (AVN) of the femoral heads secondary to megestrol misuse. Multiple providers with non-communicating electronic medical records contributed to this event, especially in our patient who was a guarded historian. Because of altered body image and fear of HIV disclosure, our patient who was already prescribed an antiretroviral associated with decreased bone density, sought an appetite stimulant and used far more than the prescribed dose leading to rapid onset AVN. Conclusions Use of appetite stimulants in HIV should be carefully monitored and utilized only when weight loss is excessive and documented, and steroid based appetite stimulants should be avoided.
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