Peanut allergies in infants

Posted on February 13, 2018 by drlesliegreenberg

Peanut allergies in infants.  The New England Journal of Medicine published an update on peanut allergies in infants and what to do to decrease them.

Did you know?

  • 2% of US children have a peanut allergy
  • Peanut allergy is the leading cause of death from food-induced anaphylaxis in the US.
  • Risk of developing peanut allergy is significantly higher among Jewish children living in the UK compared with Jewish children living in Israel (UK children typically do not ingest peanuts until after one year of age and Israeli children do).   This observation helped brainstorm the following study…

A unique study, called the Learning Early about Peanut Allergy (LEAP) was conducted in children from 4 to 11 months with severe eczema, egg allergy or both.  The study lasted until age 5.  The prevalence of peanut allergy was 17.2% in those who AVOIDED peanuts and 3.2% among those who CONSUMED peanuts.

This study helped shape the guidelines that the National Institute of Allergy and Infectious Diseases (NIAID) made in 2017 that infants with severe eczema, egg allergy or both should consider peanut-specific immunoglobulin E measurement and/or skin prick test.  Then, based on the test result, introduce age-appropriate peanut-containing foods as early as 4 to 6 months to REDUCE peanut allergy risk.  For infants with no eczema or food allergies, they may have peanut-containing foods introduced at any age in accordance with “family and cultural preferences.”

I hope this helps.peanut

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Insurance company Medical director admits that denials made without looking at the patient’s chart?!

Posted on February 11, 2018 by drlesliegreenberg

Insurance company Medical director admits that denials made without looking at the chart?!

Interesting. And upsetting. If you, as a patient, have been denied imaging, testing, specialty referral…. there’s a chance it’s been denied without your case ever being reviewed.

Read on….

https://www.cnn.com/2018/02/11/health/aetna-california-investigation/index.html

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Acne: how to manage this age-old problem.

Posted on February 6, 2018 by drlesliegreenberg
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flickr.com/photos/phunk/376287968

Acne:  how to manage this age-old problem.  The American Academy of Dermatology updated their acne care guidelines.  Here is a synopsis…

Overall:

  • 40 million Americans have acne.
  • 74% of adolescents experience acne
  • Nearly 20% of adult women have acne.

What to do first?  Topical over-the-counter preparations like benzoyl peroxde and salicylic acid are recommended for intial control and maintenance of acne.  These are both inexpensive and available in a variety of preparations and strengths.  Beyond that clindamycin 1% solution or gel is the preferred topical antibiotic (as it is more effective than erythromycin and acne bacteria is less resistant to clindamycin).

If you need more help, then consider systemic (oral) antibiotics.  Doxycycline and minocycline are more effective than tetracycline.  Erythromycin should be restricted because of increased risk of bacterial resistance to this antibiotic.  Systemic antibiotic use should only be used for 3-4 months to decrease the risk of antibiotic resistance.

Do birth control pills work?  For females, there are four combination oral contraceptive pills that have been approved by the Food and Drug Administration (FDA) for management of acne.

Is there a pill to help women with acne and polycystic ovary syndrome?  Yes!  Spironolactone which is a “water-pill” also greatly helps with acne.

What about Accutane?  Yes.  This is still available.  This is usually prescribed by dermatologists as there is an”iPLEDGE risk management program”that is stringent and needs for extra testing and contraception usage to use Accutane.  Accutane is an oral isotretinoin that is known to cause fetal anomalies/malformations and so extra strict programs need to be in place to help decrease this risk.

Do diet changes help decrease acne? No.

I hope this helps.

Posted in Dermatology, Dermatology, General Medicine- Adults, Pediatrics, Uncategorized, Women's Health | Tagged , , , , , , , , , , , | Comments Off on Acne: how to manage this age-old problem.

Children liquid medication dosing errors. What should you do?

Posted on January 30, 2018 by drlesliegreenberg
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flickr.com/photos/mattallworth/3924392510

Children liquid medication dosing errors.  What should you do?

In 2015, the American Academy of Pediatrics published a recommendation that metric-based dosing for all orally administered liquids be used with a tool with standard markings.  This is because children often receive liquid medication from medicine cups, teaspoons or tablespoons and that these doses are often wrong.  84% of parents made one or more dosing errors.

What is the best way to avoid giving the wrong dose of medication?  Affix colored tape to a syringe at the appropriate dosing level for that child on that medication.  This will help make the right dose be more visually apparent.

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What do your nails say about your health?!

Posted on January 23, 2018 by drlesliegreenberg

What do your nails say about your health?!  Nails can be a window into your overall health.  Read on….

Green nail syndrome.  This  may be caused by excessive copper in the body or an infection called Pseudomonas aeruginosa infection of the nail bed.

  • Copper poisoning is rare.  It can be caused by cooking food in uncoated cooper cookware or drinking water with a high copper content.
  • More commonly a Pseudomonas aerouginosa infection of the nail can occur, especially if you have chronically wet hands.  Treatment for this is topical gentamicin or oral or topical cipro.  Keep your hands dry!

 

Yellow nail syndrome.  This is usually from primary lymphedema or chronic lung problems.  The nails can look thickened, excessively curved and yellow.  Toenails are more often affected than fingernails.  Yellow nails may be a sign of a shortened lifespan (usually due to respiratory infection).  It is unknown why lung diseases may cause yellow nails.

White superficial onychomycosis.  These are white patches of fungus that invade the superficial layer of the nail plate.  It looks like white powdery substance attached to the top of the nail.  More likely to affect children than adults.  Treatment includes application or topical antifungals or taking antifungal pills by mouth.

Runner’s toe.  This occurs on the big or second toe due to repetitive trauma to the toenails against a shoe while running.  may show a dark red or black discoloration beneath the toenail.  This will resolve over time.  Buy properly fitted footwear to help prevent injury of the toenails on the end of the shoe.

Melanoma of the nail.  The acral-lentiginous melanoma is a type of melanoma that occurs on the fingers, toes, palms, soles and nail bed.  This is most often on the thumb and the big toe and occurs most in those 40 to 70 years of age.  If you have a dark spot under your nail, ask your doctor if this needs a biopsy7733108000_54821ed346_oflickr.com/photos/toxic_vanity/7733108000

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How is the flu hitting your region? Nevada is in the RED!

Posted on January 23, 2018 by drlesliegreenberg

How is the flu hitting your region?

Nevada is in the RED!  (See the attached USA flu map of influenza-like activity for the week ending January 13, 2018)

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What can you do?  Get the flu vaccine.  Stay home if you have a fever (No, do not go to the store or to work).  Wash your hands often.  Get the flu vaccine.

The Centers for Disease Control is our physician-go-to organization for infections and vaccine-related information.  Please read on for additional accurate information…

https://www.reuters.com/article/us-usa-flu-cdc/cdc-director-urges-flu-vaccinations-as-pediatric-deaths-mount-idUSKBN1FB36O

 

 

Posted in General Medicine- Adults, infections, infections, Pediatrics, pregnancy, Uncategorized, Vaccines, Vaccines | Tagged , , , , , , , , , , , , , | Comments Off on How is the flu hitting your region? Nevada is in the RED!

What may be the future of primary care? And, why? How can this help you?

Posted on January 19, 2018 by drlesliegreenberg

What may be the future of primary care? And, why? How can this help you?

Here’s a great 5 minute video on Direct Primary Care. It may cost you LESS than insurance premiums plus your co-pays.

Consider it. There are Direct Primary Care offices all around the country. These are fascinating times we live in. Innovative. Direct-to-the-people-care. Take the (enormously-profitable) insurance companies out of the middle.

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Sleep. Are you a good sleeper?

Posted on January 16, 2018 by drlesliegreenberg

Sleep.  Are you a good sleeper?

Sleep Quality.   It’s a predictor of overall physical and mental health and overall vitality.  The National Sleep Foundation made a consensus statements.  I’ll summarize them…

How long should it take you to fall asleep?  Less than 15 minutes is appropriate.  If it takes you 45 to 60 minutes to fall asleep, it’s taking too long.

How many awakenings are important?  In all age groups one or fewer awakenings per night indicates good sleep quality.  In older adults, 2 awakenings per night is considered good sleep quality.  If you are awake for more than 50 minutes at a time, that is considered a component of poor sleep quality.

What is sleep architecture?   This is measured in terms of sleep cycles and patterns.  The sleep cycle begins with the transition from being awake to non-REM sleep (from stage N1 to N2 to N3) and then to REM sleep.   In adults, when REM sleep is between 21 to 30% of sleep time this indicates good sleep quality.

Should you take naps?   Yes, if you are a child.  Otherwise, 1 or fewer naps per day, lasting 20 minutes or shorter may still constitute good sleep quality.

It is know that a sleep study in a lab may not reflect normal sleep patterns at home.

What else can change sleep patterns and quality?!

  • ingesting or withdrawing from drugs,
  • major depression,
  • obstructive sleep apnea,
  • restless legs.

I hope this helps.

infant car seat

flickr.com/photos /lessel/ 2729066

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“Pajama time” finishing clinic notes? How does your doctor finish their day?

Posted on January 14, 2018 by drlesliegreenberg

“Pajama time” finishing clinic notes? How does your doctor finish their day?

The New England Journal of medicine ran an interesting article. Attached is a graph of how doctors finish their day. It’s absurd. I urge my kids (and every medical student I meet) that they should practice typing games online. Its fun, but also may allow you to get-home-on-time AND be mentally present for your family. This is true for ANY field.

I type 110 words a minute so my “pajama time” is usually not spent looking at my work’s electronic health record (EHR). I did have a young patient once remark that I’d have made a great secretary… I agreed with him.

Here’s that short and enlightening article of how much time is spent on EHRs and how the system can be changed. EHRs are causing physician burnout. It’s tedious patient care meant to justify billing to insurance companies. Doctors are retiring or changing fields (away from patient care) in droves. Beware patients… this really does affect you.

https://catalyst.nejm.org/date-night-ehr/

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Are you un- or underinsured or without a SSN in Northern Nevada? We have free medical clinics!

Posted on January 11, 2018 by drlesliegreenberg

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Northern Nevadans who are uninsured, underinsured or without a social security number can receive free medical care at upcoming free University of Nevada, Reno School of Medicine Student Outreach Clinics in January and February 2018. UNR Med offers the clinics in a continuing effort to assist the region’s medically uninsured with needed healthcare services.

Click on the following link for more details!

https://med.unr.edu/news/archive/2017/soc-january?utm_source=University+of+Nevada%2C+Reno+School+of+Medicine+Email+List&utm_campaign=91ff0ea5b5-INM-December-2017&utm_medium=email&utm_term=0_044afe96b3-91ff0ea5b5-292964061

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