Hoarseness

Posted on October 14, 2010 by

Hoarse voice

Today, I am hoarse.  I whispered to my family yesterday and now I can talk to my patients.  I was given the advice that I “should start on something” to bring my voice back.  Hmmmmm. . . there are guidelines for the diagnosis and management of hoarseness.

I’ll break it down for you.  A full history and physical by your physician will reveal many hints.

Look for a cause of hoarseness.

  • Medications may cause hoarseness due to cough, dry mucous membranes or chemical laryngitis.
  • Underlying conditions like reflux can cause gastric acid to inflame the vocal cords. If reflux is symptomatic,  reflux medication may help.

When should medication be given for hoarseness?  The answer is rarely.   Steroids should not commonly be prescribed unless a specific diagnosis like recurrent croup is present.  Antibiotics should not routinely be prescribed either as the condition is usually not from a bacterial infection.

There isn’t much to DO about a hoarse voice.

  • Laryngoscopy  (a look-see with a scope down the throat)should be done if hoarseness does not resolve within 3 months or if a serious underlying cause is suspected and before voice/speech therapy is initiated.
  • Surgery should only be done on suspected laryngeal cancers or if other measures for soft tissues lesions do not help.
  • Botulinum toxin  (yes, botox!) is injected for those with spasmodic dysphonia.

Some red flags of hoarseness which may suggest a serious underlying cause of hoarseness are coughing up blood, neck mass, history of tobacco or alcohol use, symptoms occurring after trauma, unexplained weight loss, or worsening symptoms.

Preventive measures are staying hydrated, avoidance of irritants (like smoke and chemicals), voice training and amplification when needed.

Hope this helps.

Posted in Pediatrics, throat conditions, throat conditions | Tagged , , , , , , , ,

Hello Wichita Families!

Posted on July 1, 2010 by

This is Leslie Greenberg.  I am a family medicine doctor in Wichita, Kansas, where I have lived with my family since 1995.  I trained at St. Joseph Hospital in Wichita.  I also consider myself a teacher and educator.  I  have  taught family medicine residents for 13 years.  I have “hung my shingle” and  gone into private practice.  I invite you to read my blog.  If you would like to become a patient, please call 316 778 0919.

Medical Disclaimer

The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.

Posted in Uncategorized

Early detection of lung cancer may be possible

Posted on May 14, 2013 by

Lung cancer is the leading cause of cancer mortality in the United States. It kills 160,000 people per year, accounting for 28% of all cancer deaths nationwide.  The 5-year survival is only about 15%, but when a lung cancer is diagnosed while still localized (not spread) the 5-year survival increases to over 50%.

The American Cancer Society recently issued guidelines for physicians to initiate a discussion about screening with low-dose computed tomography (LDCT) yearly in individuals 55-74 years of age who have smoked at least a 30-pack-year-history (like one pack per day for 30 years) who are either current smokers or have quit within the last 15 years.

LDCT will miss some lung cancers, will not detect some lung cancers early, and may not necessarily prevent death.  Private and public health care insurers are still working out if they will expand insurance coverage to include the cost of LDCT.

First and foremost, to decrease your lung cancer risk stop smoking!

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , ,

Honey as a treatment for cough

Posted on May 10, 2013 by
flickr.com/photos/ mamboman/1239785145

flickr.com/photos/ mamboman/1239785145

Over-the-counter cough medicines are often ineffective and may be harmful to children with cough. The FDA warns against cough and cold medicines for children under age 6. So, as an alternative to these medicines, a study was done to show if honey has anti-cough properties. Indeed, it does!

Honey, though, cannot be given for children under one year as it may cause botulism. But, 1 1/2 teaspoons of honey at bedtime may reduce the overnight cough of the child which can be sleep-disturbing for the whole family. It also decreases the need for parents to opt for over-the-counter cough medicines. Honey should not be given nightly for prolonged periods as it may increase the risk of cavities.

Hope this helps.

Posted in medication issues, Pediatrics, Uncategorized

Why doctors die differently?

Posted on May 1, 2013 by

The short answer would be that we have seen countless fruitless outcomes. As an example, the John Hopkins Precursors Study collated end-of-life decisions of 800 physicians graduating from Johns Hopkins between 1948 and 1964. Indeed this study was done a long time ago, but I feel it’s still pertinent today. Compared with 20% of the general public, 64% of physicians had an advanced directive (which tells us which life-saving procedures you’d like). Additionally, nearly 90% of the physicians did not want CPR if they were in a chronic coma. Only 25% of the general public stated they did not want CPR if they were in a chronic coma.

Physicians know that CPR rarely works. A 2010 study of 95,000 cases of CPR in Japan demonstrated that only 8% of patients who’d received CPR survived for more than one month. Only 3% of those lead “normal” lives.

Futile treatments are commonly performed. Often patients do not fully understand the risks and benefits of their therapy. One of my jobs is to delineate the risks and benefits. The patient can decide what they’d like done.

I believe we have an obligation to our patients to share with them the reality of the care they received. I check in with my patients to understand what is important to them.

  • Do they want every medical option available?
  • Is there an event they want to live long enough to attend?
  • Do they value comfort and quality of life above all else?

Questions to ponder.  And, let your family and doctor know your answers.

Posted in end-of-life issues, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , ,

More “pros” for probiotics!

Posted on April 26, 2013 by

Patients who are treated with antibiotics frequently get antibiotic-associated diarrhea (AAD). In fact, more than 1/3 of patients taking antibiotics develop AAD. In 17% of cases AAD is fatal (usually from pseudomembranous colitis). AAD can have several different pathogens like Clostridium difficile or Klebisella or Staph aureus causing GI symptoms. (FYI C. diff costs the US healthcare system $1.3 billion yearly).

Probiotics replenish the natural GI flora with nonpathogenic (meaning not-bad) organisms. Probiotics are considered food supplements, not medicines, so health insurance most likely will not reimburse. Most probiotics use combinations of Lactobacillus species which are found in over-the-counter antidiarrheal probiotic supplements. There is no standard dose and should be taken one to three times daily. The patient may consider staying on the probiotic for 1 to 3 weeks, or as long as the patient continues to take antibiotics.

Hope this helps.

Posted in colon, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , ,

Gallstones

Posted on April 22, 2013 by

Ugh!  About 10-15 % of the adult US population gets gallstones.  If symptomatic, this leads to hospitalization and gallbladder removal.

What is the gallbladder?  It stores bile which is released by the gallbladder after a meal to help digest the food.  During a meal, the gallbladder squeezes bile into the small intestine to aid in digestion.

What are gallstones?  Just like in chemistry (which I recall from my early college days), when there is too much of a precipitate, it changes from a liquid to a solid.  80-90% of gallstones are made of cholesterol.  And, these solid gallstones can obstruct the bile duct.

What are gallstone symptoms?  80% of people with gallstones have no symptoms.  Gallstones may be found incidentally on ultrasound or CT scan.  Symptomatic patients experience abdominal pain occurring under the right ribs after a fatty meal.  Nausea, vomiting, right shoulder or back pain can also be present.  If the gallbladder becomes completely obstructed with gallstones, this may cause excruciating pain and require hospitalization.

How are gallstones diagnosed?  The best test is an ultrasound (just like looking at a baby on a prenatal ultrasound).

Who gets gallstones?  The way I was taught in medical school was forty, fat, and female and indeed these are all still risk factors today.  In addition, taking estrogen or rapid weight loss or diabetes are also risk factors.

How to treat gallstones?  It depends on the size and type of the stone.  Ursodiol is a medicine which at times can be used to dissolve cholesterol stones.  Surgery to remove the gallbladder is at times needed.  This is most often done laparoscopically (with instruments placed inside the abdomen through small incisions) which aids in fast recovery.  After the gallbladder is removed, some patients battle diarrhea and bloating.  Most of these symptoms resolve with time.

Hope this helps.

Posted in General Medicine- Adults | Tagged , , , , , , , , , , ,

End-of-life planning

Posted on April 12, 2013 by
flickr.com/photos /wolfsoul/ 2259896124

flickr.com/photos /wolfsoul/ 2259896124

This topic, to some, is like dragging a reluctant dog to the vet. This is definitely an issue that is best considered and planned for. Recent media reports an 87-year-old resident in an assisted-living facility whose nurse “refused to give CPR.” Upon further investigation, this patient had previously told her family she didn’t want anything done if her heart stopped.

Is there a lesson we can learn?

Dying happens to all of us. I feel strongly that we need to talk about how this last chapter of our lives may play out. Talk to your physician and your family about end-of-life issues. What do you want done? If it is done and you are not recovering, when do you want care withdrawn? What do you NOT want done?
If you do not wish to have CPR performed, complete an advanced directive called a “do not resuscitate” (DNR). This will prevent resuscitation (chest compressions) that attempt to get the heart to beat again.
Take the first step. Decide who can make decisions for you, if you cannot speak for yourself in a health care situation. Fill out a Durable Power of Attorney for Health Care Decisions (DPOA). Talk to this person about what you want done, how far to go and when to let go.
Kansas advanced directive forms are available at http://www.wichitamedicalresearch.org

Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , ,

Rethink calcium supplements

Posted on March 31, 2013 by

There was an NIH study of 388,000 people, both men and women.  Calcium supplements were caused to increase the risk of cardiovascular death in men.  In women, no association was found between calcium supplements and cardiovascular death.

Dietary calcium–calcium from food– was not found to increase this risk.

Take home message: the safest source of calcium is in food.  Men should not take calcium supplements.

Want more details?  JAMA Internal Med. 2013

Posted in General Medicine- Adults, heart, Uncategorized | Tagged , , , , , , , , , ,