Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
The process of prescribing medications, explaining the risks and benefits has classically been the role and responsibility of physicians with support from other health care providers such as pharmacists. In the modern age with the phenomenal expansion of the digital world, the world of the internet has become a major player. It is common for physicians to have to contend with and integrate into their practice the common phenomenon of family members looking at the internet and other sources for information about medications proposed for their loved ones.
Key Words: internet, medications, information, responsibility.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Mammary Paget disease (PD) is a less common form of breast cancer which involves the nipple-areola complex and occurs almost exclusively in females. Erythema, skin thickening, pruritus, burning sensation, inversion of the nipple, ulceration, serosanguineous nipple discharge are common clinical symptoms. Approximately 1-4% of female breast carcinoma are associated with PD of the nipple-areola complex. A biopsy including the dermal and subcutaneous tissue should be performed on all suspicious lesions of the nipple-areola complex for accurate diagnosis. The first line treatment of mammary PD is mastectomy (radical or modified) and lymph node clearance for patients with a palpable mass and underlying invasive breast carcinoma. The prognosis of mammary PD is determined by the disease stage and is similar to that of other types of breast cancer.
Key Words: Mammary Paget disease, breast cancer, nipple-areola complex, metastasis.

Dr. Ted Findlay, DO, CCFP, Clinical Assistant Professor, Department of Family Medicine, University of Calgary, Calgary, Alberta.

Abstract
Low back pain is one of the most common conditions for which patients seek medical attention. It can be managed with lifestyle modification, or less commonly medical and surgical intervention. Appropriate selection among various pharmacological options mandates an understanding of the underlying symptomatology and the over-riding treatment plan and objectives. The range of potential medications is substantial: over-the-counter analgesics include acetaminophen and non-steroidal anti-inflammatory drugs, muscle relaxants, and weak opioid combinations including codeine or tramadol. More potent versions of many of the same components are available on prescription, commonly employing stronger opioids either singly or in a combination analgesic. When the pain involves either chronic or neuropathic features, other classes of medications, including anti-epileptic drugs and anti-depressants, may be appropriate.
Key Words: low back pain, acute, chronic, neuropathic pain, nociceptive pain, medications.