Interesting facts about laceration closure (stitches)…

Posted on June 1, 2017 by drlesliegreenberg

Laceration-closure interesting facts…

  • Non-infected wounds (caused by clean objects) can be stitched up to 18 hours after the injury.
  • Head wounds can be st
    itched up to 24 hours after the injury.
  • Using potable (drinking) water instead of sterile saline to irrigate the wound has not shown to increase the risk of infection.  So, clean it out!
  • If your doctor wears non sterile gloves to stitch you up, that’s fine.  There is no increase risk of infection when a laceration is sewn up with a doctor wearing non sterile gloves versus sterile gloves.
  • You may need a tetanus booster.  So, keep a record of your last one.
  • Depending on where the laceration is, a different thickness and type of suture will be used, a different laceration-closure technique will be done, and a variable timing of suture removal scheduled.

The next time you see your primary-care doctor, ask them if you have a laceration can you call their office and will they work you in?!  I love to sew up lacerations in the office.  Of course, depending on the location and complexity, you may need to see a plastic surgeon.  But, call your primary care physician first.  It has the potential to be  a win-win situation: the patient may not need to pay a large co-pay for the emergency department and I love to sew!

Posted in Dermatology, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , | Comments Off on Interesting facts about laceration closure (stitches)…

How does your doctor spend her workday?

Posted on May 25, 2017 by drlesliegreenberg

How does your doctor spend their workday?  There is actually an even split between office visits (read this: patient-care visits) and the “paperwork” that goes along with it.  As a residency faculty who teaches new doctors, I have long told them that a doctor touches 200 items a day that are about patients, but not with patients.  This includes laboratory results, consultant notes, and medication refills.

The study, published in April 2017 Health Affairs indicates that in an average day, a physician spends 3.08 hours face-to-face with patients and 3.17 hours with the computer one-on-one.

I am well-known by my patients to refill their medication (at their office visit) until their medical condition dictates that I should see them in the office for a follow-up.  My hope is that the patient has the medication they need and that their hassles at the pharmacy (obtaining their medication) are less.  And, for my workflow, it means that my patients are cared for and that I may get home on time by taking care of everything at their office visit and not after-hours with the computer.  That sounds like a win-win to me.

Our medical system is becoming more and more bogged down with computer documentation.  When I began in medicine 26 years ago life was so different… I’m doing my best to keep up with the changing times.

Please be patient with your physician.

 

 

Posted in General Medicine- Adults, Uncategorized | Tagged , , , , , , | Comments Off on How does your doctor spend her workday?

Do you really need a pelvic exam during your next well visit?

Posted on May 8, 2017 by drlesliegreenberg

Maybe not.   The American Academy of Family Physicians released an update April 25, 2017 stating that when screening non-pregnant  women without any gynecological or abdominal symptoms, no pelvic exam needs to be done.   Actually, in the age of quantifying research into helpful (an “A” recommendation), the pelvic exam in this subset of patients gets a “D” recommendation, meaning it is not suggested.

This does not mean that a pap should not be done at the suggested frequency.  A “pelvic exam” refers to the part of the exam when your physician puts two fingers inside your vagina and one hand on top of your abdomen.  This is meant to reveal an enlarged uterus or ovaries (normally the size of almonds) or to locate the source of abdominal pain.  The pelvic exam is known to be a low-yield physical exam test in patients without symptoms.

The pelvic exam is used when the patient is concerned about pelvic inflammatory disease from a sexually transmitted infection or when there is abdominal pain or bloating.  The harms of pelvic exam in asymptomatic patients are thought to be fear, anxiety, embarrassment, pain and discomfort, and possibly unnecessary intraabdominal surgeries.

At routine well women exam visits family physicians have many issues to address with their patients (medications, vaccines, current complaints) and prioriztizing  screening tests that have proven benefit is important to maximize this time together.

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , | Comments Off on Do you really need a pelvic exam during your next well visit?

Prostate cancer screening guidelines updated

Posted on May 1, 2017 by drlesliegreenberg
flickr.com/photos/e n321/55331295/

flickr.com/ photos/en321/55331295/

Are you concerned about prostate cancer?  The USPSTF (The United States Preventive Services Task Force) has updated their recommendation on screening for prostate cancer.

Men aged 55 to 69 years should talk to their physician about the potential benefits and harms of getting a blood test called PSA, prostate-specific antigen.  The benefits are that if the lab is abnormal, that cancer may be found.  The harms are that the lab may be abnormal, and the patient may undergo painful prostatic biopsies and or tumor resection with resultant incontinence and impotence.

The patient can help the physician decide whether the patient needs this laboratory test.

The USPSTF recommends AGAINST PSA-based screening for prostate cancer in men 70 years and older.

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , | Comments Off on Prostate cancer screening guidelines updated

Considering adding cannabis to your medical prescriptions?

Posted on April 10, 2017 by drlesliegreenberg
54718660_da9ad3db9c_o

flickr.com/photos/riussi/54718660

Considering adding cannabis to your “medical” prescriptions?  Rethink your choice.  A recent study of TWENTY MILLION patients shows a 26% increased risk of stroke and a 10% increased risk of heart failure.  The study analyzed data of patients aged 18 to 55 and found that even if they control every other factor (“using multivariate regression analysis”), patients who use cannabis are significantly more likely to experience

heart failure, stroke, coronary artery disease (this can lead to heart attacks), sudden cardiac arrest, and atrial fibrillation.  Also, cannabis users are more likely to report high blood pressure, tobacco use, alcohol use, and obesity.

It is postulated that using cannabis may rev up cannabinoid receptor type 1 and may increase atherogenesis (when blood vessels become lined with plaque)

Now that cannabis is legal in 28 states (plus Washington DC), there’s a need to be more knowledgeable of the risks (and benefits?!) of cannabis.  More research is pending…

I hope this helps you make more informed decisions about your healthcare.

Posted in medication issues, Uncategorized | Tagged , , , , , , , | Comments Off on Considering adding cannabis to your medical prescriptions?

HPV vaccination is fighting cervical cancer and winning!

Posted on April 3, 2017 by drlesliegreenberg
the vaccines

flickr.com/photos /lavid/ 01793987

HPV vaccination is fighting cervical cancer and winning!  HPV vaccination has been shown to decrease cervical intraepithelial neoplasia 1 (CIN1)  by 9%.  CIN1 is a precursor to frank, invasive cervical cancer.  So, this vaccine shows great success!

In fact, in the future cervical cancer screening guidelines may change to differentiate between those who have had the HPV vaccine and those who have not.  This may mean beginning to screen for pap smears at a later age or may have pap smears less often than those that do not have the HPV vaccine.

The HPV vaccine was  introduced in 2007. Initially it was a series of 3 vaccines.  Now, if given before the patient’s 15th birthday a 2-vaccine HPV series is given.  If started after the 15th birthday, then it is a three vaccine series given over 6 months.    Both boys and girls should get the HPV vaccine.

Boys’ benefits are decreased risk of head and neck cancers.  And, if the rate of HPV is less in boys, then it is also less in their female partners.  That helps with “herd immunity” where everyone is less at risk for an infection because some vaccinate.  It takes a village, right?!

Posted in infections, Pediatrics, Sexually Transmitted Infections, Uncategorized, Vaccines | Tagged , , , , , , | Comments Off on HPV vaccination is fighting cervical cancer and winning!

IUD insertions are on the rise. Thank President Trump for this…

Posted on March 17, 2017 by drlesliegreenberg

Here’s an interesting article about the response to the uncertainty of women’s contraception coverage under President Trump.  I can attest to the increase in long-acting reversible contraception (like IUDs and Nexplanons) insertions since the election.

Interested?  Read on…

http://www.mdedge.com/familypracticenews//article/133580/contraception/increased-iud-use-suggests-trump-effect

Posted in Uncategorized | Comments Off on IUD insertions are on the rise. Thank President Trump for this…

Are you a woman with fibroids?

Posted on March 13, 2017 by drlesliegreenberg

 

sonohysterogram

Are you a woman with fibroids?  What are they?  Why do you have them?  What can you do about them?

Fibroids are a common benign neoplasm.  They are more common in older women and African American women.  In fact, one study shows that 80% of 50 year-old women have a fibroid.  Most are discovered incidentally.  We affectionally call these findings “incidentalomas” meaning they may be insignificant, but now we know you have them.

What are fibroid symptoms?  You may feel abdominal/pelvic pressure, constipation, increased urinary frequency and urgency (because the fibroid presses on the bladder), urinary retention, abnormal uterine bleeding, and pain with intercourse.

What is the best way to diagnose them?  Ultrasound.

What to do about them?

  • Watchful waiting may be best.   If the patient is mostly asymptomatic, then waiting it out may be all that is needed.  That is because that most fibroids shrink  in size during menopause.
  • If you have symptoms of heavy menstrual bleeding, then hormonal contraceptives, tranexamic acid or NSAIDS like ibuprofen may help decrease menstrual blood flow.  Surgical treatment is done at times which may lead to
  1. hysterectomy (taking out the uterus) or
  2. myomectomy (cutting into the uterine muscle to cut out the fibroid),
  3. uterine artery embolization (an interventional radiologist or vascular surgeon puts a catheter in to your groin and blocks the artery that feeds the fibroid),or
  4. MRI-guided focused ultrasound surgery.
Posted in menstrual issues, Uncategorized, Women's Health | Tagged , , , , , , , | Comments Off on Are you a woman with fibroids?

RSV bronchiolitis. Diagnosis and treatment

Posted on March 6, 2017 by drlesliegreenberg

RSV bronchiolitis.  I’ve seen lots of bronchiolitis in the hospital recently.

babyDiagnosis and treatment.  Does your infant or young child have a hacking cough?  It may be respiratory syncytial virus or RSV.

Most patients present with two to four days of upper respiratory tract symptoms (like fever, runny nose and head congestion).  Then the symptoms go lower like with a hacking cough, wheezing, and increased work of breathing.

How does your kid get this?  RSV is transmitted through contact with respiratory droplets either from an infected person or they infected themselves by touching contaminated secretions on a surface and then touching their mouth/nose/eyes.

As difficult as this is with all of our fancy equipment, the treatment is supportive.  What does supportive mean? It means we give the patient oxygen if they are hypoxic (have low oxygen) and we give intravenous fluids if the patient is dehydrated.  Our “fancy” stuff like epinephrine, steroids, hypertonic saline, bronchodilators, and antibiotics are often NOT helpful.

Is there a way to avoid this infection?  Yes.   There is a prophylactic medication that is given to 3 types of patients: 1.  infants who were born premature (BEFORE 29 weeks gestation) or 2. infants with chronic lung disease or 3. premature infants and children with significant heart disease.  This medication is called  palivizumad which is a humanized monoclonal antibody, given in up to five monthly doses.

Posted in Pediatrics, Uncategorized | Tagged , , , , , , , | Comments Off on RSV bronchiolitis. Diagnosis and treatment

Brag post: DrLeslieGreenberg.com is one of the top 100 healthcare blogs of 2016 !

Posted on March 1, 2017 by drlesliegreenberg

IMG_3426Brag post: DrLeslieGreenberg.com is one of the top 100 healthcare blogs of 2016 !

Wow!  How did I miss this?

I have truly enjoyed being a physician and an educator.  My goal is to both educate myself and my patients.  I find that reviewing headlines, articles and research is rewarding.  I distill it down to a readable (?!) blog which also helps me incorporate those concepts into my medical practice.  I hope it also helps you take care of yourselves.

Thanks for the kudos.  I appreciate it.

Want to see other 99 blogs?

blog.evisit.com/top-100-healthcare-blogs-2016-edition

Posted in Uncategorized | Comments Off on Brag post: DrLeslieGreenberg.com is one of the top 100 healthcare blogs of 2016 !