Half of urine drug screens revealed improper medication use!

Posted on November 21, 2018 by drlesliegreenberg

Half of urine drug screens revealed improper medication use!  Wow.  A study of over 4,000,000 (!) urine drug screens showed that 52% of patients were taking inappropriate medication.  The most common combination of medications misused were opioids (pain medicines) and benzodiazepines (anxiety/insomnia) which accounted for 21% of the discordant samples.  In 64% of the above cases, either the opioid or the benzodiazepine were not prescribed by a physician.

Urine drug screens are standard of care when a physician prescribes a controlled substance as it is the only objective way to know what the patients are really taking.  This study of four million patients reveals that if we ask our patients half the time, they won’t tell the whole story.  In another study of over 450,000 urine drug screens

45% were positive for nonprescribed or illicit drugs (in addition to the prescribed medications)

34% did not show all the drugs the patient had been prescribed

22% did not show all the drugs the patient had been prescribed BUT were positive for other illicit or nonprescribed drugs

Men and women were equally likely to misuse medications.  Misuse peaked in young adults.

Opioid use was down by 12% between the years of 2012 to 2016.

So, if you are on a controlled substance, expect a urine drug screen as it is standard of care… and know that if you are taking nonprescribed illicit drugs, that it may alter your physician’s prescribing habits for you.

pills

flickr.com/ photos/masterslate/ 3003880273

 

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Free Radon tests! Why to test? How to test? What’s important?

Posted on November 5, 2018 by drlesliegreenberg

Radon. Why to test? How to test? What’s important?

**Short-term tests are free to Nevadans until February 28, 2019 in honor of National Radon Action Month. Look at website (at bottom of post) for locations for test pick up!**

Radon is a cancer-causing, radioactive gas.  It is a naturally occurring radioactive gas released in soil, rock and water from the natural decay of uranium  Levels in the outdoors pose a relatively low threat to human health, but radon can accumulate in your home.  Radon is the leading environmental cause of cancer mortality in the US and 8th-leading cause of cancer mortality overall. Radon is the leading cause of lung cancer in nonsmokers.

Radon accounts for 37% of ionizing radiation.  Radon used to compromise more than 50% of ionizing radiation.  CT scans account for more of our ionizing radiation than in past years.

What is radon?

  • Radon is invisible, odorless, colorless.
  • It naturally occurs outside.
  • There’s a long latency period.  This means a cancer may occur 15-20 years later.
  • Cancers occur in a patient one at a time, not in clusters.
  • Difficult to link an individual death to radon exposure.

Where does radon come from?  Radon is from the soil and can migrate through invisible cracks in the concrete or where pipes come into a home.  Any house that has contact with soil can have increased radon concentration.   Radon is naturally drawn into buildings.

What variables are there to the radon concentration?  MANY!

  • strength of the radon source
  • porosity of the soil.
  • the distance between soil and the house (is there a crawl space?)
  • environmental factors like season, temperature, and wind.

This means that you cannot guess if a single home will have an elevated radon level. Testing is the ONLY way to know if your home has a radon problem.  If your neighbor tests, and their home is fine, it does NOT mean that yours is fine.

How to test for radon?  The outside doors and windows must be closed 12 hours before and during the test.  Best season to test is in the wintertime.  Do not put the test kit in the kitchen or bathroom or laundry room as the humidity impairs the testing accuracy.  Normal coming-and-going from the home is okay.  Less than 4pCi/I shows that there is no radon problem in the home.  Retest every 2 years as seismic activity can change the home foundation and the pathway of radon.

What to do if radon is high?  Use a certified mitigator who is also a Nevada State licensed contractor.  Get two estimates.  Radon mitigation systems can be installed in one day.  Retest needed after 24 hours to confirm radon level.

RadonNV.com  or http://www.epa.gov/radon

1-888-RADON10 (1-888-723-6610

http://breathingeasier.info is a well-done 12 minute video

 

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You may NOT need to take vitamin D…

Posted on October 30, 2018 by drlesliegreenberg

img_0851You may NOT need to take vitamin D… What?!  It has been standard of care to suggest vitamin D3 1000 – 2000 IU a day.  But, recently Lancet Diabetes and Endocrinology published a study involving over 53,000 patients which looked at the effects of vitamin D supplementation on future fractures, falls, and bone mineral density.

In the analysis it was found that vitamin D supplementation (800 IU or more) did NOT reduce total fracture, hip fracture or falls.  Also, vitamin D supplementation was not found to increase bone mineral density at any site including lumbar spine, hip, femoral neck (the top of the thigh bone) or “total body.”

The question of whether vitamin D supplementation helped those with differing levels of vitamin D (those who were more deficient than others) and the results were mixed.  Eight research studies found no benefit, five trials showed mixed effects and only one trial found a positive effect, meaning one trial showed that vitamin D helped make  bones more dense (stronger).

The researchers went as far to say that if there is a future study showing a positive result from vitamin D supplementation it is unlikely to alter the conclusion they’ve already made because the outcome was so robust.

Interesting research.  Want more information?  Bolland M et al.  Lancet Diabetes and Endocrinology 2018 Oct 4.

 

 

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Tales from the hospital newborn rounds with the medical students. What is a good latch?

Posted on October 22, 2018 by drlesliegreenberg

IMG_3419Tales from the hospital newborn rounds with the medical students.  What is a good latch?  As a follow-up to my breastfeeding blog, I was asked how to make sure the infant has a good latch onto the breast.

This is an issue all by itself.

Signs of good positioning and latch as below

  • The infant’s cheeks are rounded, not sunken or dimpled
  • The infant’s mouth is wide open before mom places the infant on the breast
  • The infant’s nose is free from the breast (so the baby can breathe through its nose)
  • The infant’s chin is pressed against the breast.
  • If any of mother’s areola is visible, more is seen above the infant’s top lip, with little showing near the chin.
  • The infants upper and lower lip are flanged outward, not sucked in.
  • The infant and mother are “tummy to tummy.”
  • Feeding is not painful to the mother after the initial minute.  I liken breastfeeding to attaching a vacuum-attachment to your breast.  Not enjoyable, but it should not be painful either.
  • The infant has a rhythmic suck-and-swallow pattern.  You should be able to hear baby gulping.
  • If baby falls asleep at the breast, undress baby and rub its feet.  The milk and mom’s skin is nice and warm so the newborn may need a little discomfort (being undressed and rubbing its feet) to keep it awake.

If you need help, see your physician or lactation consultant.  I hope this helps.

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Tales from the hospital newborn rounds… how to educate about breastfeeding?

Posted on October 15, 2018 by drlesliegreenberg

IMG_3419Tales from the hospital newborn rounds… how to educate about breastfeeding?

I love breastfeeding questions.  I helped educate both medical students and new mothers this week about breastfeeding while on newborn hospital rounds.  Here are some of the questions (and answers!)…

What do you have to do to be successful at breastfeeding?  You need to be a woman with breasts (every mother is included in this), you have to want to breastfeed, and you have to try to breastfeed (every 3 hours) or more often, as baby wants.

How long to “try”?  Your milk should “come in” by day 3 to 5 postpartum.  By 2 weeks the baby and mother should know what to do.  There are some women who do not make milk either because of lack of production or altered breast anatomy (inverted nipples make latching difficult and previous breast surgery may also impact milk ducts).

What are the benefits to breastmilk?

  • Maternal benefits: decreased risk of breast and ovarian cancer, decreased type 2 diabetes, high blood pressure and cardiovascular disease, decreased postpartum depression
  • Infant benefits: decreased eczema and gastroenteritis, higher IQ (no kidding!) later in life, decreased risk of childhood leukemia, decreased risk of obesity both as a child and as an adult, decreased SIDS, reduced risk of almost every kind of infection (intestinal, ear infection, lung infection, pneumonia) and less risk of asthma.

How long to breastfeed?  All major health organizations recommend exclusive breastfeeding for the first six months of life, then complimentary foods can be introduced with continued breastfeeding until 12 months of age.  But, I tell mothers, any amount of breastmilk is better than less.  So, if you can breastfeed for the first 6 weeks (before returning to school or work) that’s better than 5 weeks.  And, now, breast pumps are often free which helps mothers express their breastmilk when they are not with baby.  Start breastfeeding and see how it goes…

I hope this helps.IMG_3419

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University of Nevada Reno school of Medicine free health clinics!

Posted on October 11, 2018 by drlesliegreenberg

University of Nevada Reno school of Medicine is offering free health clinics! And 200 free flu shots.

Who is invited? Underinsured, uninsured and those without social security numbers are welcome!

When?

For children through adults

October 6.

October 23

November 10

November 20

December 11

For women’s clinics

October 20

November 17

December 1

Where?

UNR family medicine center. On the UNR campus between the football field and the medical school.

Need more information? Call 775-350-9250

Community helping community.

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Tales from the hospital newborn rounds with medical students…What do we screen for?

Posted on October 9, 2018 by drlesliegreenberg

newborn

Tales from the hospital newborn rounds with medical students… What do we screen for?

Oh, my life as a physician and medical educator.  I have a new crop of green third-year medical students.  They have just spent two years studying books.  Now, they get to see patients and do what most of them have been dreaming about for years.

I am the “newborn attending physician” this week and am tasked to see new babies at the local hospitals.  The medical students, most of whom are not parents themselves, are bright and eager to learn about babies.  One question that they brought up is…

Which newborn screenings are recommended and why?

  1. Congenital heart defects.  To screen for this we measure the oxygen saturation in the newborn’s blood with a probe (that looks like a light on a bandaid) at 24 hours of age.  If this is abnormal, an ultrasound of the heart (an echocardiogram) is done to see if there are structural cardiac problems.
  2. Genetic and metabolic disorders.  A heel-stick blood draw is done after 24 hours of age to test the newborn’s ability to break down milk proteins and other genetic abnormalities.  This is done by the State lab and Nevada asks for two “newborn screens”:  one done at 24 hours of age and one at 2 weeks of age.
  3. Hearing impairment.  This is done by screening for the auditory brainstem response wherein a hospital technician does a non-invasive test on a hopefully sleeping or calm infant.  (It is done this way as newborns will not raise their hand when a sound is heard.)  Sometimes, the initial screen is abnormal (most commonly due to fluid in the ears) and is repeated a few weeks later.  If still abnormal, then an audiologist is consulted.
  4. Hyperbilirubinemia (jaundice).  A transcutaneous bilirubin level is obtained by putting a non-invasive light on the newborn’s upper chest to read how much bilirubin is in the skin.  If this is elevated, then a venous sample is obtained.  If this is high, then the newborn is placed under blue lights called “bili lights.”  This is to help the bilirubin from crossing the blood-brain barrier and causing brain damage.

I hope this helps….newborn

 

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Reno: Free Family Estate Planning Series

Posted on September 12, 2018 by drlesliegreenberg

Reno: Free Family Estate Planning Series

 

2018 Family Estate Planning Series

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Marijuana and adolescents…

Posted on September 10, 2018 by drlesliegreenberg

Marijuana and adolescents…  I live in Nevada and it is now legal to use marijuana for both recreational and medical use.

How prevalent is marijuana use? 5.4% of 8th graders, 14% of 10th graders and 22% of 12th graders have used marijuana at least once in the past month.  Marijuana is second most-used substance after alcohol for adolescents.

Adults may view marijuana use as benign or not harmful, but there are major concerns about use in adolescents.  Regular or heavy or daily use of marijuana can lead to adverse medial, mental, psychosocial and cognitive outcomes.  Brain maturation is not complete until the mid-20s.  Negative outcomes can include

  • delayed reaction time,
  • impaired motor coordination,
  • higher rates of serious or fatal motor vehicle crashes,
  • poor work and school performance,
  • increased school dropout rates,
  • and anxiety.
  • Those with a predisposition to schizophrenia can have their first episode of hallucination associated with marijuana-use.

What is the risk of chronic marijuana use?  It increases the younger that marijuana is started.  Those adolescents who use marijuana daily, the risk of long-term use is 25-50%.  Whereas there is a 9% regular use in those who experiment with it.

There is a lack of regulation by the US Food and Drug Administration regarding marijuana…  so purity, THC (tetrahydrocannabinol) concentration and CBD (cannabidiol) concentrations are different with each batch.  Also, the method for which it is ingested changes its effect: eaten, drank, topical administration, vaped or smoked.  The concentration of THC (the psychoactive substance in marijuana plant) has increased greatly over the years: 4% in 1995 to 12% in 2014.

Talk with your children about the dangers of marijuana use.  Consider stopping yourself.   Ask your physician for help.

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Should you as an ex-smoker have a CT scan to rule out lung cancer?

Posted on September 3, 2018 by drlesliegreenberg

Should you as an ex-smoker have a CT scan to rule out lung cancer?  This is a great question.

A few years ago the National Lung Screening Trial found a reduction in disease-specific and all-cause mortality with lung cancer screening.  THEN the Canadian Task Force on Preventive Health Care AND the U.S Preventive Services Task Force voted in favor of a low-dose lung CT scan in those aged 55-80 who have a 30-pack/year smoking history (like one pack a day for 30 years) and currently smoke or have quit within the past 15 years.  So, we physicians, have been ordering low-dose lung CT scans on appropriate patients.

What were the results?  In a small group of Veterans Health Administration patients, it was found that 97.5% of patients who were told they had an abnormal lung CT DID NOT have lung cancer.

Where does this leave us?  The patient and physician should have a discussion about the risks of a false-positive result (a concerning lung CT with subsequent negative work up) and other harms such as radiation exposure, over-

Big C

flickr.com/photos/ 37613229@N00/ 4674844

diagnosis and incidental non-lung-cancer findings.

Talk to your doctor.  Make a plan.

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