Does acupunture help prevent migraines?

Does acupuncture help prevent migraines?

Yes!  There is moderate-quality evidence showing that whole-body acupunture may help prevent migraines.   Research has shown that compared to “usual care” acupuncture decreased the frequency of migraines by at least 50% and that this result was maintained with follow-up research at 3 months.

The Institute for Clinical Systems Improvement recommends the use of acupuncture for prevention of episodic migraines.

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Want more information?  Check out http://www.cochrane.org/CD001218

 

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How to balance work and life? How to perform conscious leadership?

How to balance work and life?  How to perform conscious leadership.   I attended a lecture at University of Nevada Reno Medical School aimed to help balance self, family and work to “achieve success.”  Here are my take-home points…

Overview: This is the first year that more female matriculated to medical school (woot!  woot!).  Women only make up 39% of all US full-time faculty.   (UNR has 36%)  Women are more commonly the lower ranks of medical schools (meaning less of us are full professors).

Do female physicians make less than men?  Yes! Female doctors’ earnings were 28% lower than their male counterparts in 2017.  So, the gender pay gap for physicians is real and commensurate with other fields’ discrepancy. Women earn 10 to 30% less than men for the same work and it is getting worse for physicians.  This is a global problem and is published by the World Economic Forum in the Global Gender Gap Report.  https://www.weforum.org/reports/the-global-gender-gap-report-2017

Why should we care about diversity?  It is known that

  • Gender diversity leads to better performance.
  • Inclusivity strengthens employee retention.
  • Advancing women’s equality leads to economic growth.
  • Strong female leadership provides financial returns.
  • Diversity breeds innovation and discovery.

What are the barriers to women achieving gender equality?

  • Lack of female role models.
  • Lack of work-life integration (childcare and elder-care responsibilities).
  • Negotiation skills.
  • Unconscious bias.

How to achieve change?

  • Know where you stand.  Know where you are going.  Set goals!
  • Gather your tools and create safety.  What are our tools? What areas do we want to improve in?
  • Recognize our weaknesses.
  • Be authentic to yourself and others.  It’s not WHAT you do, it’s HOW you do it.   Take failures with grace.
  • Celebrate our achievements.  We are often in a rush and there is graceful self-promotion that can be done.

Work/Life Integration.

  • Integrate work and home life.  For example, every time you attend a medical conference, take one of your children.  Connect with that child.  (or Take-your-child-to-work-Day).
  • Delegate.  What can you let go of?  Decide what is worth my time.
    • We may do an activity inefficiently.  Take time to think about how to perform more efficiently.  Hypo-stress.  eu-stress.  Hyper-stress.  Distress.  In distress is where burnout happens.
    • Time Allocation.  divide this into sections.
      • When we are inefficient at a task, delegate it. Someone else may do this better. (example: making the work’s hospital call schedule)
      • When we feel competent at a task, we make take it on because we can complete the task fast. Consider delegating this. (example: cooking)
      • When we are an expert and others do not know how to do it, consider coaching someone and let them take it over.  (example: running a simulation lab)
      • What we are unique in, DO IT MORE!
      • AND…Don’t underestimate the value of doing nothing.

Build your network.

  • One mentor is no longer enough.  We each need our own “Board of Directors.”  Who is on this Board of Directors?
    • Mentors are people you go to for advice and feedback.
    • Family and friends give us social and emotional support.
    • Coaches help with self-discovery and challenge us to think in new ways.  Coaching is important for leaders in that we often do not take time to re-think our lives.  (They may help give us questions… what are OUR best and worse case scenarios?)
  • Negotiating skills.  It is all about your emotional quotient.  ASK and think BIG!  Women often do not apply for a job until they are a 90% match. (Men apply for a job with a 50% match). So, we should dream big.  Know what you want: inner self-awareness.  This helps with better negotiating skills.  Know the other side: social awareness.   Make your wish list, match your bosses list.  Prepare options for mutual gain: relationship management.
  • How can I make my goals match your superior’s goals? Listen carefully: self-management.  Listening helps you now what is important to other people.  We each like to be heard.  Know your BATNA (Best Alternative To Negotiated Agreement): External self-awareness.  Watch out if you push too far when you don’t have another position/opportunity.
  • Self-promotion is all about being graceful  Make a habit of recognizing and praising the accomplishments of others.  Self-promotion may not always mean telling everyone how great we are. View talking about yourself (or others) as educating or teaching others, rather than”selling.”  Report accomplishments and use social media.  Your research, when is on social media, is disseminated better.  This also helps to highlight what we are doing better.  Develop an interesting story around the facts.  Keep your boss in the information loop.  Take credit gracefully.  It is okay for people to know what you have done for them.  Always say thank you.

How can we collectively take action?  Start with self-care.  And, take care of others. Develop conscious leadership skills.  Support women in local and national professional development opportunities throughout the career life-cycle.  Empower women to support, mentor and sponsor each other.  Train both men and women to effectively mentor across genders.   Provide unconscious bias training for everyone.

Your word is a lamp to my feet… And a light to my path.  May we each be a light for one another.

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How to pick a probiotic?

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How to pick a probiotic?

Did you know that in 2012 3.8 million adults and 300,000 children were known to be taking probiotics?!  This is a 400% increase in 5 years.

What does a probiotic do?  It transiently changes the microbiome of the intestine.  It can only be found in the gut microbiome in stool samples for one to two weeks.  This means that the health benefit of a probiotic only lasts for 1-2 weeks after your last ingestion of the probiotic.  This also means that probiotic foods, like yogurt, are as effective as a supplement.

Probiotics are considered a nutritional supplement per the Dietary Supplement Health and Education Act (DSHEA) so they are NOT regulated for clinical application as it is considered food and not a drug.  The DSHEA requires that dietary supplements meet current good manufacturing guidelines, but this does not necessarily mean that the products are effective.

How to buy a probiotic?  Consider buying a probiotic with an expiration date printed on the bottle and one that lists the number of viable colony-forming units at expiration–as this may give some assurance that the probiotic viability continues throughout the lifespan of the product.

The probiotic Saccharomyces boulardii is not eradicated by antibiotics and may help with gut health.  Probiotics have good evidence supporting their benefit in patients with irritable bowel or ulcerative colitis and may prevent antibiotic-associated diarrhea and Clostridium difficile-associated diarrhea.

When buying probiotics, I recommend a probiotic with the National Science Foundation’s certification of good manufacturing practice.  This website can help…   http://www.nsf.org/regulatory/regulator-nsf-certification

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NEW Cancer Screening Recommendations

 

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NEW Cancer Screening Recommendations.

To help diagnose breast cancer, the American Cancer Society suggests mammography starting at 45 years of age with annual screening until 54 years of age and then every other year after 54.

To prevent cervical cancer in females and oropharyngeal cancer in males, ACS suggests a two-dose vaccine of HPV vaccine beginning with children ages nine to 14 years of age.  Patients who get the first HPV vaccine at age 15 (up to 26 years of age), should continue to follow the three-dose vaccine schedule.

Lung cancer screening with a low-dose CT scan of the lung should be performed in patients 55 through 74 years of age who are current or former smokers.  Medicare covers lung cancer screening with low-dose CT scan of the lung for patients up to 77 years of age.

There is no recommended ovarian cancer screening.

For cervical cancer, the screening depends on the woman’s age.  Women between 21 to 29 should have a pap every 3 years (as long as it’s normal).  Women from 30 to 65 years of age get a Pap test and then that same specimen can also be tested for HPV.  If both negative, this is done every 5 years.  Women 66 or older who have three or more consecutive negative Pap tests or two or more consecutive negative HPV AND Pap tests within the past 10 years should stop cervical cancer screening.  Women who have had a total hysterectomy for noncancerous reasons never need another pap.

I hope this helps.

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AARP Bulletin with medical tips from yours truly!

AARP Bulletin with medical tips from yours truly!AARP Dr. Greenberg article_1.jpgDisclaimer:  Talk to your doctor about your specific knee pain.  If you are walking around with bone-on-bone arthritis, you may need a total knee replacement (and NOT be a candidate for conservative management).  And, if your knee pain does not get better within 2 months or you have a history of kidney problems, talk to your doctor about appropriate treatment.

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Kidneys. How important are they?

Kidneys.  How important are they?  REALLY IMPORTANT.  I have told my kids that the organs that I think are most importance… in order of importance is the brain, then heart, then the kidney.

Kidney disease affects 47 million people in the United States and is associated with significant health care costs, morbidity and mortality.  Kidney disease is silent in its early stages.  It is best to initiate interventions early.

How to watch for kidney health?  Some guidelines recommend annual screening with blood work and a urinalysis (but The American College of Physicians and the US Preventive Services Task Force do not suggest yearly labs for those not at increased risk).  These labs are especially important for patients with diabetes, high blood pressure, and those with a history of heart disease.  There are markers of kidney damage: increasing creatinine and albuminuria.  If the serum creatinine is persistently elevated and if there’s albumin in the urine those are concerning findings.

When you should see a nephrologist?  When the glomerular filtration rate (a lab finding) is less than 30 mL per minute, persistent urine albumin/creatinine ratio greater than 300 mg per gram or if there is evidence of rapid loss of kidney function.

Do you want to calculate your risk of progression to

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end-stage renal disease?  Go to http://kidneyfailurerisk.com/

Call your family physician for a well adult visit.

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Who doesn’t want a do-over? Laser tattoo removal…

 

 

 

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Written by guest blogger: Luke Stovak.  Who doesn’t want a do-over? I often see tattoos decoratively scripted with a loved one’s name or letters over the knuckles spelling “LOVE” or “HATE.”  Would I like that on my body when I’m 80? Will that beautiful sun around my navel look the same as I age? I don’t think so. Because of this, I believe that laser tattoo removal is fantastic. It helps those who want to start over.

If the hip tattoo names a previous loved one and a new lover is visually reminded of the past, how does that help their future?  If an ex-gang member would like to dissociate from the gang or apply for a job, shouldn’t they be able to shake the employer’s hand without seeing “HATE” in the handshake? Or without tear drops inked by their eye?  

Youthful dalliances in the tattoo parlor or vengeful thoughts put onto the skin could forever be displayed. There is a viable option for tattoo removal. Laser tattoo removal has been available for 30 years and can be used to remove names, rings, designs, or even parts of designs. The process may take several sessions, depending on the color and depth of the ink. Consider laser tattoo removal instead of excision of skin as it is less invasive and may cause less scarring.  For more information, one great resource is www.newlookhouston.com

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Palpitations. How to evaluate them?!

Ever have your heart make a weird pitter pat?

hearts

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Palpitations.  How to evaluate them?  Palpitations are very common of which the most concerning cause is cardiac.  Other possible causes are adverse effects from both prescription and over-the-counter medications, psychiatric illness and substance use.

Drugs that can cause palpitations are

  • cocaine,
  • methamphetamine,
  • MDMA/ ecstasy,
  • marijuana

 

What are some other non-cardiac causes of palpitations

  • alcohol
  • anemia
  • anxiety
  • beta-blocker withdrawal
  • caffeine
  • cocaine
  • exercise
  • fever
  • medications
  • nicotine
  • pheochromocytoma
  • pregnancy
  • thyroid
  • dysfunction

It is imperative to rule out cardiac causes as this could be deadly.  I was taught in medical residency training that “you need to rule out what can kill the patient first.”  I agree.  First, a thorough history and physical examination should be done.  After that targeted diagnostic testing should be performed.

What are important aspects of the work-up?  Family history of cardiac dysrhythmias or abnormal physical examination or abnormal EKG findings.  Symptoms with exertion of chest pain or difficulty breathing are concerning.

In short, if you have palpitations, see your primary care doctor and,  if needed,  they’ll send you to a cardiologist.

 

 

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Shingles?! Prevention and management.

Shingles?! Prevention and management.    Shingles is also called herpes zoster and it is caused by the reaction of the chickenpox virus (aka varicella zoster virus).  One million cases of shingles occur annually in the US.  We each have an individual lifetime risk of 30% to contract this.  Patients with immunosuppression are more at risk for shingles.

The symptoms that may occur before a rash include malaise, headache, low-grade fever, and abnormal skin sensation starting 2-3 days before the rash becomes evident.

What are the hallmarks of shingles?  It is a unilateral (one side of the body), dermatomal (see the diagram), and typically progresses to clear blisters that become cloudy and then crust over with a scab in 7-10 days.

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How to treat shingles?  Antiviral pills, if started before 72 hours of the onset of the rash, are known to decrease the length of time the rash is present.

What is postherpetic neuralgia?  It is the after-shingles-nerve-pain that is present more than 90 days after the rash resolves.  This occurs in 1 in 5 patients.

What is treatment?  Treatment is aimed to control the symptoms and includes topical creams (lidocaine and capsaicin) and oral pills like gabapentin, pregabalin and tricyclic antidepressants.

What is my opinion of the varicella zoster vaccine?  I think it’s great.  It is approved for adults 50 years and older.  Search my blog on Shingrix vaccine for more information.

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Medical students have their own brand of “March Madness” and it’s called Match Day!

Medical School graduates in the Class of 2018 (at EVERY medical school) have their own brand of “March Madness” and it’s called Match Day!

When is it? March 16, 2018! At 9 am PST  all the medical students around the country open up their “match envelope” at the same time.

What does this mean? The National Resident’s Matching Day is when graduating medical students have essentially signed a contract for the next 3 to 7 years of post-doctoral education.

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Wow! Every year I reflect on MY Match Day in 1995 (!) when we learned WHICH specialty and WHERE I was going to learn it. My then fiancee was also matching into a specialty and this added complexity to our joint decision.  This cemented our medical specialties of choice, family medicine.

The match changed the trajectory of our lives.   I cannot underscore what a monumental day this was for us and is for every single medical student around the country. Medical students have studied for at least 8 years after high school, incurred hundreds of thousands of educational debt, and honed their educational path to this culmination.

35,000 medical students are vying for 31,000 spots in US hospitals and health centers. (My son was horrified when he did the math and realized that 4000 medical students may not have a job).  So, looking at the math, you can appreciate that some medical students do not match into a residency program and may need to “scramble” (now called the SOAP –Supplemental Offer and Acceptance Program) into an open residency position or may need to work in an associated field and apply to the match next year and be involved in Match Day 2019.

University of Nevada Reno Family Medicine Residency Program received over 800 applicants; we interviewed over 100 candidates, and have matched 10 medical interns who will start with us after medical school graduation.

It is truly an exciting time for every graduating medical student and for those in medical education. The closing of one chapter… and the opening of another. I love it!

Want to know more?  Here’s the official website…   http://www.nrmp.org/

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