Worth the read: What it’s like being a doctor.

Posted on December 4, 2017 by drlesliegreenberg

Worth the read: What it’s like being a doctor. One key point Malcolm Gladwell addresses are the motivations of physicians to dedicate their (my!) life to doctoring and the increasing need to be an insurance claim expert. Read on… it’s a really good piece. Enjoy!

https://www.forbes.com/sites/robertpearl/2014/03/13/malcolm-gladwell-tell-people-what-its-really-like-to-be-a-doctor/#178fa03b4420

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Want a synopsis of a Pulitzer-prize-winning oncologist/author with FASCINATING ideas?

Posted on November 27, 2017 by drlesliegreenberg

Want a synopsis of a Pulitzer-prize-winning oncologist/author with FASCINATING ideas?  Siddhartha Mukherjee MD, PhD this week came to University of Nevada Reno and spoke to a packed crowd.

Dr. Mukherjee has written two books: The Emperor of all Maladies: A Biography of Cancer and his new book, The Gene: An Intimate History.

I took notes and here were some of his most interesting thoughts during this recent lecture…

  • Genetics in medicine is going to be impacted by three important concepts and their relation to each other: genetic prediction, deep learning (artificial intelligence) and precision medicine.
  • Consider our genes are like pixels on a screen.
  • In the 1940s and 50s eugenics was the study of manipulating genes to promote selective breeding.  I think of the Nazis with their “perfect race” but that this concept of altering future genes in humans is still present– with sophisticated researchers with deep-pocketed investors.
  • Each of us has DNA which is 3 BILLION different protein components (A,C, T or G) strung together in a unique array.  He says to imagine that these protein components are like words in an encyclopedia.
  • Every cell has the SAME 3 billion DNA, but different “pages” are read to make different parts of the body.  Like the DNA in the cells of the skin are the same as the hair, but they choose to “read” different.
  • Every cancer has a unique fingerprint and unique gene abnormalities.  It could be ONE gene is abnormal, or it could be that cancer only surfaces when there are multiple (maybe even tens to hundreds) or genetic abnormalities.  Some gene abnormalities will remain dormant until there is an environmental trigger (like smoking).
  • Treatment, in the future, may be depending on matching the genetic abnormalities.

He admits that we are on the “eve before the bomb” referring to the night before the Atomic Bomb was dropped.  We are on a precipice with genetic research wherein afterwards we can manipulate genes of future generations (genetic selection of fetal characteristics?!).

My friend who attended this lecture with me leaned over and said “You can’t put the genie back in the bottle…”  Oh, so true, my friend.

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What is a family doctor?

Posted on November 20, 2017 by drlesliegreenberg

What is a family doctor?  Why do you need (deserve?!) one?

I am NOT a generalist.

I am NOT a provider

I am NOT a practitioner.

I am a medical professional who cares for complex and healthy patients regardless of age.  I am best understood as an integrationist.  I integrate the mental, spiritual, and physical well-being of my patients, in the context of their families and community, to help them become whole, to maximize their life.  I integrate the sometimes disparate recommendations of medical specialists to insure that treatments that benefit one organ system does not damage another.  I integrate and apply complex medical research on populations to the unique biology, needs, and goals of my patient.

I am the “pluripotent stem cell” of the medical community.  I start with a broad education and then adapt to the needs of my community to fill the voids in healthcare.

I am the “Marine of medicine“.  I get the job done, often under harsh conditions.

I truly have a fantastic job and I feel blessed that I can work as a family physician.

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Is there a link between weight and cancer?

Posted on November 14, 2017 by drlesliegreenberg

Is there a link between weight and cancer?  We think yes!  Last month the Centers for Disease Control and Prevention (“The CDC”) published a report that being overweight or obese significantly increased the risk of developing at least 13 (!) types of cancer.

  • What is the definition of overweight versus obese?  Overweight is considered a BMI of 25-29.9.  Obesity is a BMI of 30 and over.  Plug your height and weight into this easy-to-use calculator  www.smartbmicalculator.com
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  • Who is most at risk?  The effect is more pronounced in older people (at least 50 years old) compared with younger people  AND women are much more likely to have overweight- and obesity-related cancers than men.  (218 cancers per 100,000 women versus 115 cancers per 100,000 men). This is thought to be that female-specific cancers like postmenopausal breast cancers and endometrial and ovarian cancer only exist in women and constitute 42% of the overweight- and obesity-related cancers.
  • What can you do?  Be aware that weight-reduction and maintaining a healthy BMI (between 20 and 25) can play a role in your cancer prevention!

 

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There is a new shingles vaccine in town… and it’s great!

Posted on November 9, 2017 by drlesliegreenberg

Theres a new shingles vaccine in town… and it’s great!  The Advisory Committee on Immunization Practices (ACIP)– the guru organization

regarding immunizations– has just voted to recommend preferential use of a NEW shingles vaccine (Shingrix) instead of the currently available shingles vaccine (Zostavax).

This is BIG news. This new vaccine is approved by the FDA for prevention of shingles in adults 50 and older (instead of 60 for Zostavax). Other changes from Zostavax are that Shingrix is 2 vaccines dosed between 2 to 6 months after the first dose. Shingrix is also a non-live vaccine.

What should you do?

  • Wait for Shingrix to be released (expected to be released early 2018).
  • Be patient as it may be in great demand and the manufacturers may have difficulty keeping up with demand at first.
  • If you have had the Zostavax it is suggested that you get the two-shot regimen of Shingrix to help boost immunity against shingles. (I am unsure the patient-cost of 2 doses of Shingrix and administration of those two doses.)
  • It is unknown if Medicare will pay for the two-shot regimen.

Interesting…  Stay posted.

shingles day 2

herpes zoster day 3

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More myth-busting! This time let’s tackle preventive care!

Posted on October 19, 2017 by drlesliegreenberg

More myth-busting! This time let’s tackle preventive care!  I am a myth-buster of preventive care ideas.

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Are you a woman (at routine risk and) concerned about getting ovarian cancer?  No screening tests are suggested for women at routine risk of ovarian cancer as you probably will not  live longer (medical phraseology is “unlikely to experience any mortality benefit”).

Do you have a first-degree relative who had colon cancer, what are your risks of colon cancer?  Research has showed that if you have only one first-degree relative with colorectal cancer, and YOU have not developed colorectal cancer by 55 years of age, your risk of having colorectal cancer is similar to the risk in the general population.

If you are an older woman wanting to reduce your urinary tract infections, cranberry capsules (taken daily) do not help.

 

 

 

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Do you have toenail fungus? What can you do about it?

Posted on October 12, 2017 by drlesliegreenberg

Do you have toenail fungus? What can you do about it?

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Who gets this?  8% of adults have onychomycosis (toenail fungus).  The prevalence increases with age with more than 50% of those over 70 year of age having it.  It is NOT a sign of poor hygiene or an underlying medical condition, it is largely a cosmetic problem.

There are three types of fungus that can cause onychomycosis: dermatophytes, yeasts and nondermatophyte molds.

How do you know if you have this?  Toenails are characterized by thickened nails and thickened skin beneath the nail.  This thickened skin debris under the nail can cause tenderness and pain when it accumulates over time.  Nails may also become discolored and deformed.

What are your risk factors for getting onychomycosis?  Cigarette smoking, older age, any medical condition that can decrease blood flow to the extremities (like peripheral vascular disease), wearing occlusive footwear, using shared bathrooms, trauma to a toenail.

What is a cure?  Some research consider the nail cured if no fungus can be found on nail culture.  Most people would consider a “cure” when the nail improvement appears normalized.

How can this be treated?  This can be done either by taking oral pills or by putting a medicine on top of the affected nails.  Terbinafine is a pill that has the highest “complete cure rate” of 38%.  Terbinafine is given everyday for 12 weeks for toenails. Checking liver enzymes is suggested by a blood test.  Of the topical medications, they are all known to be expensive and the cure rates are low with complete cure rates at 15% or less.

It is not suggested that the affected nails be surgically removed as this will require a very extended healing time and poor healing rate.

Laser therapy is approved by the FDA, but the clinical cure rates are no better than oral or topical antifungal treatment.

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Myth-busting heart and lung thoughts

Posted on October 5, 2017 by drlesliegreenberg

Yes, I am a myth-buster and this time it is about heart and lung medical care.

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If you have heart failure BUT you also have a preserved ejection fraction (as seen on heart cath or echo), consider NOT taking a long-acting nitrate pill as this may decrease your level of activity and increase adverse events.

If you have community acquired pneumonia, your doctor may discontinue antibiotics (if deemed clinically stable) after five days.  Make sure your doctor thinks you are medically stable, do not stop medication without their okay.

We, doctors, are decreasing our prescribing of antibiotics during acute asthma attacks.    Oral (or a shot of) steroids may help you and antibiotics may not improve your outcome.

 

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Wow! Stop the presses. Pap scheduling change.

Posted on September 28, 2017 by drlesliegreenberg

Wow! Stop the presses. Pap scheduling change.  I know…every woman loves to go in to her doctor for a pap.  (Just kidding.)  Years ago we performed paps every year on every woman and that’s how the “annual visit” became synonymous with the pap.  Well…no more!

The USPSTF which is a conservative organization (US Preventive Services Task Force) tells us that we can space out the paps AND even decrease our number of tests.

 

 

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flickr.com/photos/galvmed/36065516295/

The USPSTF recommends that primary care physicians
  • screen women ages 21-29 every THREE years with cervical cytology as long as the results are normal.
  • For women ages 30-65, the task force recommended screening with either cervical cytology alone (meaning a pap smear) every three years OR with high-risk HPV (hrHPV) testing alone (which feels like a pap, but is not) every five years.
  • For both the pap OR the high-risk HPV testing a woman is undressed from the waist down, feet in stirrups, and a speculum placed inside the vagina.  As a patient, you may be unaware of which test your doctor is doing.  Ask!  As a patient, I’d prefer the high-risk HPV test with the ability (if the test is negative/normal) to space out my paps for 5 years.

These are “A” recommendations.  “A” means that they are well researched and supported.  Want more information?   www.uspreventiveservicestaskforce.org

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I am a myth-buster! Myth-busting at musculoskeletal issues…

Posted on September 21, 2017 by drlesliegreenberg

Yes, call me a myth-buster!  In my recent family medicine journal there is a fantastic article (with research to back up their recommendations) that helps with musculoskeletal issues.  Which of these categories do you fit in?!

Are you a middle-aged patient with a meniscal tear (and little to no arthritis in that knee)?  If so, consider NOT having arthroscopic surgery as long-term outcomes with pain or function may be better after conservative management of physical therapy.

Do you have knee pain with degenerative joint disease?  If so, injections of (expensive) hyaluronic acid help only minimally more than placebo injections.

If you have knee osteoarthritis consider buying normal walking shoes, not “specially-designed walking shoes” as they both help with pain and function the same

If you have chronic low back pain, consider physical therapy to help for pain and disability, only have a lumbar fusion surgery as a last resort.

If you have chronic non-cancer pain, avoid long-acting opioids.  Long-acting opioids significantly increase the risk of premature death.

More myth-busting to come…

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