Perimenopause may trigger the first episode of depression.

Posted on January 4, 2019 by drlesliegreenberg

Perimenopause may trigger the first episode of depression.  Women in their late 40s are often in this hormonal stage called “perimenopause.” This is when the body may still have a menstrual period, but that the menstrual cycles are irregular because their estrogen is waning.  Perimenopause can cause nearly a decade of hormonal instability.

Women are at increased risk of developing depression during this perimenopausal transition.  In fact, studies have shown that 45 – 68% of perimenopausal women have elevated depression symptoms.

Other risk factors that increase the risk of perimenopausal depression include

  • psychosocial changes like adverse life events,
  • anxiety,
  • low social support,
  • interrupted sleep,
  • black race, and
  • financial difficulties.

Perimenopause is often a time of great transition: caring for aging parents, launching their adult children into life, or facing changes in marital status.  Your physician may perform a Patient Health Questionnaire-9 (PHQ-9) to help diagnose a mood disorder or may perform a test to show life scales with mood items like the Menopause Rating Scale and the Menopause-Specific Quality of Life Scale.

Some suggestions are psychotherapy, exercise, medication to help with mood changes (like SSRIs).  Botanical and or complementary/alternative approaches for treating menopausal depression have not statistically been shown to help.  Whatever treatment works for you is the best treatment.  See your physician for help.

https://www.mdcalc.com/phq-9-patient-health-questionnaire-9

 

 

 

 

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What are some things a doctor should know about the elderly LGBTQ community?

Posted on December 24, 2018 by drlesliegreenberg

What are some things a doctor should know about the elderly LGBTQ community?  I recently attended a panel discussion about medically related LGBTQ issues.  Here are some of the take-home messages

  • 50% of nursing home staff thought “their colleagues” would be uncomfortable with taking care of LGBTQ patients.
  • 2/3 of gay, lesbian, bisexual or transgender people live alone.  Many do not have children, are not in contact with their families of origin further isolating themselves as they age.

As LGBTQ individuals age, they often “go back into the closet” as this may “feel safer”  Is there a nearby nursing home that will care for LGBTQ patients? Can you age in place (alter your home to accommodate you as you age)?

LGBTQ individuals live 3-7 years less than cis-gender heterosexual individuals.  This may be due to the marginalization of a patient’s health care issues over their lifetime.

What can physicians do?

  1. Treat our patients as we would treat our families.
  2. Address patients as the gender and name that they would like to be called.
  3. Address loneliness. Who is important to the individual? Who are their current or future caregivers?

This highlights the need for accepting, open, honest, caring primary care physicians.

 

 

Posted in Emotional health, end-of-life issues, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , , , , , | Comments Off on What are some things a doctor should know about the elderly LGBTQ community?

Incidentalomas? What’s the chance….?

Posted on December 17, 2018 by drlesliegreenberg

Incidentalomas? (Incidental findings found on imaging tests)  What’s the chance…?  Recently 20 systematic reviews of observational studies were combined to show which imaging test/region reports the greatest number of incidental findings?  And, of these findings, what are the chances that the incidental findings were cancer.

stock Letter C_IMG_7879

flickr.com/ photos/ lynnfriedman/ 8703242835

We, physicians, are often concerned about going on a “fishing expedition” which may not show what we are looking for and instead may show a result which leads to patient anxiety, further testing and possibly overtreatment.

Here are the results of the % of incidental findings found with a specific test

  • CT chest 45%
  • CT colonoscopy 38%
  • cardiac MRI 34%

The rate of the incidentalomas being a cancer was dependent on the part of the body the incidental finding was found

  • breast 42%
  • ovary 28%
  • prostate and colon 10-20%,
  • brain < 5%,
  • parotid gland < 5%,
  • adrenal gland (a small gland found on the top part of each kidney) < 5%.

We all know of people who found malignant “incidentalomas” that are still alive due to the serendipitous finding and prompt treatment.  I also imagine that we know many others who had a scare only to find out after additional testing (or procedures) that it was benign.  We, physicians, are trying to find the important things and not the unimportant ones.  Do no harm, right?!

I hope this helps.

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Record number of Sexually Transmitted Infections diagnosed in 2017

Posted on December 14, 2018 by drlesliegreenberg

Record number of Sexually Transmitted Infections diagnosed in 2017.

Not a great statistic, I know.  The Centers for Disease Control and Prevention released the 2017 data showing that nearly 2.3 million cases of chlamydia, gonorrhea and syphilis were diagnosed in the US last year.  This marks the fourth consecutive year of increases in these sexually transmitted infections.

Chlamydia is the most common condition, with more than 1.7 million cases last year.  Gonorrhea increased 67% and syphilis increased 76% in the past four years.

The best treatment is prevention.  Abstain or get tested before intercourse AND wear a condom.img_2339

Want more information?  cdc.gov/media/releases/2018/p0828-increases-in-stds.html

 

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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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