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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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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To follow is NOT a sexy topic, but very important– how to prevent falls for yourself (…or your parent)

Posted on September 12, 2017 by drlesliegreenberg

To follow is NOT a sexy topic, but very important– how to prevent falls for yourself (…or your parent.)

Why is this important?  Every 20 minutes an older adult dies from a fall.  Each fall-related hospitalization costs an average of $30,000.  Medicare spends $31 billion on falls annually.   If you fall and break a hip, the chance you will EVER return home is slim.

There’s good news!  There are evidence-based (meaning they’ve been researched and they WORK!) interventions that can prevent falls.

The CDC started the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative.  This has three core elements: screen patients to identify their fall risk, assess their modifiable fall risk factors, and intervene.

This includes stopping medications which can make the patient drowsy or unsteady (like sleeping aides and narcotic pain medicine).  Decreasing other medications if they cannot be stopped entirely.  Pick up throw rugs in the moving.  Move electrical cords to avoid a tripping-hazard.  Add secure grab bars to bathrooms and showers.  Add secure grab bars near stairs.  Using a bedside commode during the night.

If you’d like to learn more, refer to http://www.cdc.gov/steadi

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Top 10 list of allergens…

Posted on September 7, 2017 by drlesliegreenberg
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The top 10 allergens (and how to avoid exposure) …

  • Tixocortol pivalate (a steroid)
  • Propylene glycol
  • Methylchloroisothiazolinone
  • Formaldehyde
  • Cocamidopropylbetaine
  • Lanolin
  • Benzalkonium chloride
  • Fragrance and balsam of peru
  • Neomycin
  • Nickel

Tixocortol pixilate is a steroid present in creams like hydrocortisone acetate.  Usually this sensitivity comes across as a failure in treating a rash..or the rash gets worse.

Propylene glycol, benzalkonium chloride, and neomycin are frequentlflickr.com/photos/ espelina/ 24831708y found in topical creams.

Lanolin (also known as wool alcohol) is often found in emollients, medications and some personal care products.

Methylchloroisothiazolinone may be found in wet wipes and some sensitive skin products.

If you feel like you get a reaction, check the ingredients of your products.  If you do not have a clinical improvement after 8 weeks, I’d consider testing by a specialist.

 

 

 

 

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Do you need one more reason to breastfeed?

Posted on August 31, 2017 by drlesliegreenberg

IMG_3419Do you need one more reason to breastfeed?

Breastfeeding has been found to help the infant populate their gut biome.   A study was recently done which showed that there is vertical transfer of microbes from the mother to her infant.  The infant gut is born without much gut bacteria and breast milk AND contact with the mother’s skin on her breast has been shown to seed the infant gut micro biome and maintain it even after solid foods are introduced.

This transfer of bacteria from mothers’ milk and skin to the infants’ gut is most prominent during the first month of the infant’s life and declines over time as formula and solid food are introduced.

Breastfeeding is suggested by the World Health Organization and American Academy of Pediatrics to be the exclusive form of nutrition from birth until 6 months and continued with food until at least 12 months.

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What you should know about spider bites

Posted on August 24, 2017 by drlesliegreenberg

 

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As the weather gets cooler, spiders may come inside and here are some tips you should know about spider bites.

There are two medically important families of spiders.  Theridiidae (or widow spiders) and Loxoscelidae (or brown recluse spiders).

  • When black widow spiders bite it may feel like a sharp pinch with subsequent pain that develops over the next 30 minutes.The bite site may be surrounded by pale skin and then ringed with red.  The patient may also have systemic symptoms over the next 60 minutes or abdominal pain, sweating, nausea, vomiting, seizures and, very rarely, death.  If left untreated, symptoms resolve within 48 hours.
  • The bite of a brown recluse spider is often undetected with pain beginning over the next several hours.  The bite site may develop a blue macule or a characteristic red lesion with surrounding pale skin and then ringed with area of blue skin.  Over the next week a scab may develop and then fall off.  Systemic symptoms associated with a brown recluse bite are a flu-like illness with fever, headache and fatigue.  Rarely, patients can have muscle and blood breakdown and kidney failure.

What blood work do you need?

  • Black widow bite needs no labs.
  • Brown recluse (if severe envenomation suspected with systemic symptoms) may need complete blood count, electrolytes, kidney functioning and blood and muscle lab work if concerned about muscle and blood breakdown.

How can your physician confirm the diagnosis?  This is a clinical diagnosis, meaning no lab is needed for diagnosis.

What is spider bite treatment?

  • Black widow treatment includes local wound care including ice and elevation.  Watch for infection.  Tetanus vaccine should be given.  Pain medicine and muscle relaxants to be given, when needed.  An antivenom is available and considered for severe envenomation.
  • Brown recluse treatment also includes local wound care including ice and elevation  pain medicine.  Tetanus vaccine.  Antibiotics are not indicated unless the skin surrounding appears infected.  If there is significant skin sloughing, excision of skin may be warranted.

How to avoid a spider bite?

  1. Be aware that spiders prefer warmer temperature and they gravitate to dark locations like a shoe, glove and infrequently used clothing.
  2. Consider shaking out gloves, clothes, and shoes before putting them on.
  3. Wear long-sleeved shirts and pants outdoors (to avoid unearthing spiders under rocks and logs).

I hope this helps.

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My high school reunion side-bar medical question…

Posted on August 14, 2017 by drlesliegreenberg
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I attended my high-school reunion this weekend and a friend sidelined me to ask if she could ask me a medical question.  Of course!

Truly, I am a family physician everywhere I go.  Medicine is a passion and a way of life.

Her question was “Should I have my teenagers get the HPV vaccine?”  What an easy question to answer.  “YES!”

HPV, human papilloma virus, is the known virus that changes cells on the cervix from normal cells to cancer cells.  It is also associated with head and neck cancers in males.  Per the CDC, every year 31,000 US women and men are diagnosed with a cancer caused by HPV.  Specifically, there are 12,000 women diagnosed with cervical cancer yearly with 4400 women dying from cervical cancer annually.  And, for men, 9100 men each year are diagnosed with HPV-related oropharyngeal cancers.

The HPV vaccine series is either a set of 2 or 3 vaccines, depending on what age you start the series.  If the first dose is given before age 13, it is 2 vaccines.  If first dose is after the 13th birthday, then it is a 3-dose vaccine series.

HPV vaccine is safe.  Please review the safety profile by CDC  https://www.cdc.gov/vaccinesafety/pdf/data-summary-hpv-gardasil-vaccine-is-safe.pdf

I hope this helps.  If you want more information look on the http://www.cdc.gov website.

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