NEW Cancer Screening Recommendations

Posted on April 10, 2018 by drlesliegreenberg

 

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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!

Posted on April 6, 2018 by drlesliegreenberg

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?

Posted on April 3, 2018 by drlesliegreenberg

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…

Posted on April 1, 2018 by drlesliegreenberg

 

 

 

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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?!

Posted on March 27, 2018 by drlesliegreenberg

Ever have your heart make a weird pitter pat?

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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.

Posted on March 20, 2018 by drlesliegreenberg

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!

Posted on March 16, 2018 by drlesliegreenberg

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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I am featured in the recent AARP magazine! Read on…

Posted on March 14, 2018 by drlesliegreenberg

I am featured in the recent AARP magazine!  Read on…

https://www.aarp.org/health/conditions-treatments/info-2018/medical-experts-insider-advice.html

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Why are you hoarse? What should you do?

Posted on March 13, 2018 by drlesliegreenberg

Why are you hoarse?  What should you do?  There are a multitude of causes of hoarseness.  Hoarseness is a common presentation to primary care physicians.  The causes range from inflammatory processes to psychiatric disorders to more serious systemic, neurologic or cancerous reasons.

Medication can also cause hoarseness.  The medications that may cause hoarseness are angiotensin-converting enzyme inhibitors (ACE) , antihistamines, diuretics, bisphosphonates, and inhaled corticosteroids.

How to evaluate hoarseness?  Your physician should perform a targeted history and physical exam.  Systemic conditions causing hoarseness should also be investigated.  Initial treatment may be voices rest including no whispering (as this can worsen hoarseness) and treatment of the presumptive cause.

If you have reflux, the acid from the stomach can affect the vocal cords and cause hoarseness or a chronic cough from acid reflux (or lung cancer) can also cause hoarseness.  Direct visualization with a nasolaryngoscope (a teeny tiny scope about 1/2 the size of your pinky finger) may be needed if hoarseness persists for 3 months if conservative management has not resolved the problem.  An ear, nose, throat surgeon may do this in their office.  If you have risk factors for oral cancer  like tobacco use or heavy alcohol consumption or blood with coughing should opt for ENT referral after 2 weeks of symptoms.

Don’t I need imaging?  Probably  not.  A CT scan is not done before visually examining the area with a nasolaryngoscope.

Voice therapy is effective for improving voice quality for patients with nonorganic difficulty with making sounds.

When do you need surgery?  Surgery is needed for laryngeal or vocal fold dysplasia (or cancer!), airway obstruction, or benign pathology that is resistant to conservative treatment.  426658377_617b482154_o.jpg

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Who needs sleep apnea screening? And why?

Posted on March 12, 2018 by drlesliegreenberg

The USPSTF (United States Preventive Services Task Force) is a conservative group that reviews data to give guidelines for physicians. The USPSTF has recently given recommendations on WHO should be screened for sleep apnea.

Who should NOT be screened for sleep apnea?

  • Asymptomatic patients should NOT be tested.

What are symptoms of obstructive sleep apnea?

  • Snoring (especially if it’s loud and followed with gasps)
  • Restless sleep
  • Insomnia
  • Night sweats
  • Morning headaches
  • Daytime sleepiness and frequent nodding off during the day
  • Falling asleep at the wheel of a car
  • Irritability
  • Anxiety
  • Depression
  • Forgetfulness
  • Blood pressure elevation and increased heart rate may occur

How can treatment of obstructive sleep apnea help patients?

  • May lower blood pressure
  • Improvement in the Epworth Sleepiness Scale (so patients may not fall asleep during the day or at stop signs) and
  • a decrease in the number of times breathing is stopped while asleep.
  • May decrease motor vehicle crashes.
  • People feel better when they use the CPAP (continuous positive airway pressure masks while asleep)

Does using CPAP decrease mortality or cardiovascular events (like heart attack and stroke)?

  • flickr.com/photos/ petahopkins/ 10113965984No.  The USPSTF did not find that CPAP decreases these outcomes.

 

 

 

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