Does exercise during pregnancy decrease high blood pressure?

Posted on February 14, 2023 by drlesliegreenberg

Does exercise during pregnancy decrease maternal risk of developing high blood pressure during pregnancy?  Yes, and here is how to do it. 

If you are already an exerciser, continue!… although modifications may be needed.   If you are new to exercising, initiate an exercise regimen early in pregnancy. 

Aerobic exercise performed for at least 30 minutes 3-4 times per week decreases maternal risk of high blood pressure during pregnancy (including gestational hypertension and preeclampsia). The American College of Obstetricians and Gynecologists recommended in their 2020 updated committee opinion that “physical activity and exercise in pregnancy are associated with minimal risks and have been shown to benefit most women, although some modification to exercise routines may be necessary because of normal anatomic and physiologic changes and fetal requirements.”

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How tight of control over diabetes should older patients have?

Posted on February 7, 2023 by drlesliegreenberg

How tight of control over diabetes should older patients have?  Not that tight. 

The risks of treating type 2 diabetic patients over the age of 70 with insulin or sulfonylurea drugs AND having the patient maintain a hemoglobin A1c less than 7 INCREASES the risk of unnecessary hospitalization.  So, be sure you know your hemoglobin A1c level and know your hemoglobin A1c goal for your age. 

Have a hypoglycemia plan. Stash appropriate snacks nearby. Have a working glucometer with lancets and test strips if you are on insulin or sulfonylureas to check your blood sugar if you feel low.

I tell my patients that I have many goals for them. One of them is to find joy every day.  And, then I joke let’s find that joy outside of the hospital. 

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How concerned should you be about a diagnosis of “pre-diabetes?”

Posted on January 25, 2023 by drlesliegreenberg

How concerned should you be about a diagnosis of “pre-diabetes?”  Research estimated the likelihood of older adults converting from prediabetes to diabetes over a 6 ½ year study…. as very low.  More than 90% of older adults will NOT progress to diabetes.  They routinely stayed at the same hemoglobin A1c level or it even normalized.  In fact, if you are in your mid-70s without a diagnosis of diabetes, the chance that you will convert is low. 

Certainly, cleaning up your diet (stop drinking sugar-sweetened beverages and eating fried foods) and exercising regularly are good for everyone… at every age. 

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Should you read your spine MRI report?

Posted on January 18, 2023 by drlesliegreenberg

Should you read your spine MRI report?  I would suggest against it. 

In the era of transparency and patient access to their entire electronic medical record, you CAN look at your spine MRI report.  And, yet, do you know what you are looking at?  Do you know what pathology is significant?  Do you know the LEVEL in your spine that your symptoms originate from? There are many radiologic findings on MRI that are actually asymptomatic. 

Research showed that patients with low back pain who read their MRI results without interpretation by a clinician had lower function and more pain even after 6 weeks of conservative treatment. 

The patients who received a call from their physician and were told “their MRI results were normal with age-related findings” did better than those who read their report.

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What intervention gives sustained improvement in chronic back pain?

Posted on January 11, 2023 by drlesliegreenberg

What intervention gives sustained improvement in long-standing back pain?  The intervention that showed a greater than 30% reduction in back pain was exercise. 

Patients may have trialed opioids or non-steroidal anti-inflammatory pills, but those are routinely not given for long.  A 2020 systematic review of 25 randomized controlled trials (with over 2,400 patients!) found that if you have low back pain for 12 months or more, epidural steroid injections do not give long-term meaningful improvement. Yes, epidural injections may be more effective than placebo in the short-term, but not in the long term.

Other interventions that help are osteopathic manipulation and topical capsaicin cream. Physical therapists are a great resource for initiating back exercises and confirming that your technique is correct.  Then, you can continue the therapist’s exercises as your “homework.”

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Which OTC medications are best for treating chronic constipation?

Posted on January 4, 2023 by drlesliegreenberg

Which OTC medications are effective at treating chronic constipation?  Lots of products are effective at treating chronic constipation.  First-line therapy to treat chronic constipation is polyethylene glycol (Miralax) or senna. Other good products are stimulant laxatives, fiber supplementation or magnesium-based products.  Psyllium fiber tends to cause bloating and gas.

I, personally, suggest that patients fiddle with the dose of Miralax and take it (daily) if needed.  Miralax never leaves the GI tract meaning that it does not tax the liver or kidneys and it helps draw water into the intestines to keep the stool soft.  The drawback about titrating the dose of Miralax is that if you take too much (for you) when you pass gas, you can pass stool. 

Live and learn, right?!

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Should you take full-dose aspirin or a baby dose?

Posted on December 21, 2022 by drlesliegreenberg

Should you take full-dose aspirin (325mg) or a baby aspirin dose (81 mg)?  Recent research has showed that there is no advantage to taking a full dose for patients with established cardiovascular disease compared to the lower dose.  Of course, ask your physician for their input. 

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Do eating eggs cause increased risk of cardiovascular disease?

Posted on December 14, 2022 by drlesliegreenberg

Do eating eggs cause increased risk of cardiovascular disease?  No.  A meta-analysis (a combination of many research studies) has shown that over an average of 12 years, egg consumption is not associated with an increase number in cardiovascular events (heart attack or stroke). In fact, eating more than one egg a day (on average) is associated with an 11% less chance of coronary artery disease. The researchers are unsure if those who eat eggs dail have other healthful habits (more likely to exercise? less likely to smoke?)

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Should you take Vitamin C to help iron supplementation work better?

Posted on December 13, 2022 by drlesliegreenberg

Should you take Vitamin C to help iron supplementation work better?  No. Research has shown that those taking iron WITH Vitamin C for 3 months had no incremental increase in hemoglobin (or in serum ferritin level) after 3 months compared to those who took iron alone. 

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Should you increase your antidepressant after beginning on a starting dose?

Posted on November 29, 2022 by drlesliegreenberg

Should you increase your antidepressant after beginning on a starting dose?  Not necessarily.  Research has shown that new-generation antidepressants like SSRIs may not need to be increased from the starting dose.  This means that your first dose, may be all that you need to ease your mood. Patients are urged to see their physician at 6 to 8 weeks after starting medication to assess clinical improvement.  Before increasing the dose or changing the medication, talk to your physician.  In short, research showed no benefit to automatically increase the dose. 

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