Family medicine question and answers 2

Posted on November 28, 2016 by drlesliegreenberg

What is the most effective duration of nicotine replacement?  (This study was conducted only in patients also receiving extensive telephone counseling on tobacco cessation.)  8 weeks.  Beyond 2 months, continued nicotine replacement did not help with stopping-smoking rates.

What helps decrease the number of falls in older women?  Exercise training?  vitamin D? or the combination of both?  Vitamin D was ineffective in decreasing falls.  Otherwise, group exercise twice a week for one year and then once a week for the second year did NOT decrease the number of falls, but it did decrease the likelihood of a fall in these older women to result in an injury.

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Medical school knowledge…

Posted on November 21, 2016 by drlesliegreenberg

Most of the medical school information that I learned 25 years ago is now known to be false.  I recently read a quote that medical “tradition is no longer the bedrock of (good)  practice.”  Oh, that is so true.

We physicians perform wasteful and unnecessary medical tests, treatment and procedures and we physicians have a choice to stay current with the research and choose accordingly.

Every aspect of patient care carries the possibility of harm as well as benefit.  If your physician eliminates a test (like getting a pap smear under age 21) it may be perceived as a way to decrease wasteful testing, but it may also offer the potential benefit of performing a test that is not helpful.

Change is inevitable.

 

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Family medicine question and answers…

Posted on November 14, 2016 by drlesliegreenberg

Do sterile gloves decrease wound infection rates (compared to clean nonsterile gloves) when minor skin surgery is done?  No.  Sterile and nonsterile gloves yield a comparable number of skin infections.  So, if your doctor wears clean nonsterile gloves while taking off your minor skin lesion, that’s okay.

How long do hot flashes associated with menopause last?  They last a median of 7.4 years.  (Yes, a really long time.)  It was even found that women who begin to have frequent symptoms early in their perimenopause experience, have symptoms for a median of 11.8 years, including 9.4 years AFTER their final menstrual period.  Black women experience hot flashes longer with median time of 10.1 years.  Good news for those who are Japanese and Chinese as hot flashes occur for a median of 5 years.  flickr.com/photos/ petahopkins/ 10113965984

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Family medicine may be getting a shot in the arm!

Posted on November 7, 2016 by drlesliegreenberg

Family medicine draws more interest among medical students than any other subspecialty.  12% of medical students plan to pursue family medicine specialization after medical school graduation.  Hooray!

Said in another way, only 5% of medical students rated their family medicine rotation as their “least favorite rotation.”

69% of the students chose their subspecialty because of “personal interest in the field.”  (Which makes me wonder what the other 31% based their field on).  The study did show that 1% made a selection because of income potential.

Good job, medical students, we need more primary care physicians.  And, move to Nevada!  We need you here.

flickr.com/ photos/ miqul/ 227467257

flickr.com/ photos/ miqul/ 227467257

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Common questions about recurrent urinary tract infections in women

Posted on October 31, 2016 by drlesliegreenberg

What are the risk factors for recurrent urinary tract infections (UTIs)?

  • In premenopausal women, the risk factors are new or multiple sexual partners, having a UTI before age 15, sexual intercourse three or more times per week, spermicide use
  • In postmenopausal women, the risk factors are urinary retention and estrogen deficiency.

We now know that the following DO NOT increase the risk of UTI  obesity, hot tub use, frequent tampon use, wearing cotton underwear, wiping back-to-front after a bowel movement, douching, or increased hydration.

Imaging (like an ultrasound) or cystoscopy (looking up the urethra and into the bladder with a scope) is rarely necessary in healthy women with recurrent UTIs, unless she has risk factors for complicated infection.

We now treat UTIs with an antibiotic course of 1-5 days, depending on the antibiotic.

If you have recurrent UTIs, consider talking to your doctor about either continuous (meaning every day) antibiotics or taking an antibiotic after sexual intercourse to help decrease recurrent rate of UTIs. Voiding after intercourse may be helpful.

If you are postmenopausal, daily estrogen vaginal cream place on the labia may reduce the risk of future UTIs.

Data is conflicting if daily cranberry tablets are helpful in preventing UTIs in premenopausal women.

If you have any of the following, this may warrant further evaluation

  • blood in the urine (either by sight or by urinalysis),
  • history of urinary tract malignancy,
  • history of urinary tract surgery,
  • history of kidney stones,
  • urine bacteria that is multidrug-resistant,
  • persistent symptoms or bacteria in the urine despite 2 weeks of culture-directed antibiotics,
  • stool in the urine or air with urination,
  • repeat episodes of kidney infections,
  • any difficulty with voiding.

    flickr.com/photos/ vinceandjoy/ 319681936/

    flickr.com/photos/ vinceandjoy/ 319681936/

 

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Asthma treatment

Posted on October 27, 2016 by drlesliegreenberg
flickr.com/photos/ jaypoct/ 2429061604/

flickr.com/photos/ jaypoct/ 2429061604/

The goal of treating asthma is to not die from asthma.  The secondary goal is for asthmatics to live their life fully, as if they did not have asthma.  This often requires treatment.  Symptoms of asthma are wheezing, cough and difficulty breathing.

Your doctor will ask questions to find out how often are symptoms and how often medication is needed.  If you are found to have “mild persistent asthma” then studies show that children and adults benefit from intermittent use of inhaled steroids.

Mild persistent asthma

Asthma is considered mild persistent if WITHOUT treatment any of the following are true:

  • Symptoms occur on more than 2 days a week but do not occur every day.
  • Attacks interfere with daily activities.
  • Nighttime symptoms occur 3 to 4 times a month.
  • Lung function tests are normal when the person is not having an asthma attack.

In the past, we have had patients take daily inhaled steroid therapy, but intermittent inhaled steroids may be just as effective.  Ask your doctor if you can change your frequency of medication.

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Honey?! for a cough?

Posted on October 17, 2016 by drlesliegreenberg

As a family physician, I often see children in my office with a cough.  There have been extensive studies showing no clear benefits and, in fact, there were definite potential harms to over the counter cough medication in children under age 4.  So, what can parents use?

Honey has been found to decrease cough frequency and severity.  Honey also improves sleep for patients and parents.  Dextromethorphan (DM, for short) helps in those older than 4 years of age just as much as honey to quiet a cough.

Of note, honey CANNOT be given to children less than 12 months of age as it can cause botulism and death.

This means that honey is a good alternative to help with symptom of cough in children older than one.

I hope this helps.

 

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Arthroscopic knee surgery in some cases is not needed!

Posted on October 4, 2016 by drlesliegreenberg

attachment-1

Stop the presses!  There was a study showing that middle-aged people (mean age of 53 – 59) who have arthroscopic repair of degenerative meniscal tears do NOT have significantly improved long-term pain OR function over conservative measures.

This study included 805 patient.  They found that those who had conservative management benefitted at 6 months as much as those with arthroscopic surgery.  In the short term (less than six months) there was a statisftically significant improvement in functional outcomes with surgery.  Surgery did not improve pain in the short term or the long term.

Conservative management included standardized exercise program.  Want more information? Canadian Medical Association Journal 2014; 186 (14): pgs 1057-1064.

 

 

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Does your tongue-tied baby need it cut?

Posted on September 13, 2016 by drlesliegreenberg

IMG_3419Probably not.  There are three reasons to cut a tongue-tied infant’s tongue: difficulty with speech, or with feeding, or due to cosmetic reasons (imagine heart-shaped tongue).

There is no evidence that there is improved latching for breastfeeding after frenotomy (cutting the tissue holding the tongue).  Frenotomy may improve maternal nipple pain by 10% but otherwise is not thought to help with improved feedings.

Most often, I find that the parents ask to have this done.  It is a simple bedside procedure that can be performed if needed… there are just new studies that show that it most likely does not help with feedings.

Interesting.

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Nevada ranks near the bottom for medical care

Posted on September 8, 2016 by drlesliegreenberg

IMG_4185Ugh!  I read the Reno Gazette Journal newspaper this morning and realized that I moved from the 6th best state for health care (Kansas) to the 48th “best” state, Nevada.  I have been practicing medicine in Nevada for nearly a year and this does not come as a surprise to me.  I hear from patients that it is  difficult to find a primary care physician.   And, I can appreciate as a family physician, that it is difficult to find a specialist who is accepting new patients, even if just for a consult (not long-term care).  These two problems speak to the scarcity of physicians in Nevada, even in urban areas.

Well, as a physician and medical educator of medical students and fledgling new physicians, I have job security in Nevada!  I am hopeful that I can contribute to the state’s overall health.  So, I will put do my best to encourage our local medical students and resident physicians to find their niche here in Nevada to help ease the scarcity of physicians here and to add to the wonderfully, rich life that Nevadans enjoy.

This information was collected by the website WalletHub and combined features about health care costs and access to healthcare and health outcomes.

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