Arthroscopic knee surgery in some cases is not needed!

Posted on October 4, 2016 by drlesliegreenberg

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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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Why is my face drooping on one side?

Posted on September 6, 2016 by drlesliegreenberg

Bell palsy is an acute, sudden onset of facial nerve paralysis.  This is not due to a stroke (when the brain does not get enough oxygen).    But, emergent care is needed to confirm that this is a palsy and not a stroke.  Call your doctor immediately, or if after hours, seek emergency department help.

What’s the risk?  If left untreated, up to 30% of patients have some level of permanent facial symmetry or facial pain.

Why do patients get Bell palsy?  Some research shows that a viral infection, like herpes or varicella zoster virus can cause this.

What is the best treatment?  Combined studies of over 2000 Bell palsy patients showed that a combination of both corticosteroids plus antivirals gave the best long-term results.  These two medicines improved long-term motor movement of the face and decreased excessive tear production over corticosteroids alone.

When should you be seen?  As soon as you get the symptoms you should seek care.  It is known that treatment started before 72 hours of symptoms helps decrease symptoms and length of symptoms.

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If you have heart disease you SHOULD GET A FLU VACCINE!

Posted on August 30, 2016 by drlesliegreenberg

Okay, the capitals may have been too much… but studies have shown that the influenza vaccination may reduce death from cardiovascular disease.

Observational studies have shown an association between receipt of the flu vaccine and a lower risk of cardiovascular events (like strokes and heart attacks). Strengthening this association is a different study showed that getting the influenza infection was associated with an increased risk of cardiovascular events.

So, when the influenza vaccine becomes available in your area… I’d suggest that you line up.

Below is a picture of the influenza virus.

influenza bug

flickr.com/photos/53867930@N08/5091074915/in/photolist-6jo4JH-6jXBoQ-6jHDbF-7nNmxK-8KT6cH-6XEYbt-ipfjqZ-6MZg7-6oN32Q-6iVNFt-A67c-6iGrcv-6hTtF6-6iS75k-6iS6ug-6XJYWs-6jHDbB-5Y8iP3-3nYkKB-6hLoo4-6hQwJY-74hYFo-7aRdWF-74e4SP-6iBMBm

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Non-alcoholic fatty liver, an epidemic

Posted on August 25, 2016 by drlesliegreenberg

Did you know that non-alcoholic fatty liver disease (NAFLD) is the most frequent cause of chronic liver disease in the US and around the world?  Yes!  It is.  Researchers think that nearly one-third of Americans has this disease.  There is a spectrum of disease, from mild to end-stage cirrhosis.

Do these patients drink alcohol?  Most NAFLD patients consume no alcohol or only a modest amount.

Do the patients have symptoms?  Rarely.  Most are asymptomatic.

How is this found?  Most have abnormal liver function tests on routine (or preventive health screening) blood work.  (Take out your lab work:  Most NAFLD patients have (elevated and) higher serum ALT levels than serum AST levels)

What else is NAFLD associated with?  Type 2 diabetes and obesity and high cholesterol.  In fact, nearly 70% of type 2 diabetes patients develop fatty liver and its consequences.

What can you do?

  • Decrease carbohydrates (starchy foods).  Avoid saturated fats, simple carbohydrates and sweetened drinks.
  • Lose weight!
  • Exercise.  Aerobic exercise improves skeletal muscle insulin sensitivity and helps decrease the underlying mechanism causing NAFLD.
  • Don’t use medicines (like orlistat) to help lose weight.
  • Consider bariatric (weight loss) surgery.  This may lead to the most reliable method for achieving “sustained weight loss in morbidly obese individuals.”  But, more long-term studies are needed to confirm this.
  • Consider medications.  Ask your doctor!  Vitamin E at 800 IU a day was shown to improve the hepatocytes (the individual liver cells under a microscope)  But, Vitamin E may cause increased risk of all-cause mortality and hemorrhagic strokes in the brain.  So, more studies on this are needed.  Other medications considered are metformin, and statins. But, the more research is needed to confirm that they help NAFLD and do not cause harm.

How can you help decrease your risk of cirrhosis from NAFLD?  Decrease your other risk factors!  Ask to be screened for type 2 diabetes.   Watch your blood pressure with the goal being under 140 and under 90 (> 140/90).  Treat your elevated cholesterol.   Test for obstructive sleep apnea if you have disorganized sleep, wake tired, or snore.

I hope this helps….IMG_4185

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Recent medical “pearls”

Posted on August 9, 2016 by drlesliegreenberg

If a rapid strep test is negative, no back up culture is needed.  It is now known that the rapid strep test for streptococcal pharyngitis has a sensitivity of 86%. This means that it will pick up 86% of active cases.  Because these tests miss only about 1 in 6 cases of strep pharyngitis, the yield of backup cultures is small.  It would cost $8 million to catch one case of rheumatic heart disease.  And, to boot, adults are at low risk of getting strep throat anyway.

 

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There’s now a Pill to Increase Female Libido!

Posted on August 2, 2016 by drlesliegreenberg

flickr.com/photos/ hebe/ 3310171434/Here are the specifics…

There is a once a day pill, flibanserin, which is to be taken daily by women to increase sex drive.  The monthly cost of this drug is $830.  The study of 2375 premenopausal women showed an increase of “1.6 to 2.5 additional satisfying sexual events per month with treatment.”

The side effects are dizziness (which occurs in 11% of patients), somnolence (11%), nausea (10%), fatigue (9%), insomnia (4.9%).  Patients should not take flibanserin if they are pregnant or breastfeeding.

Interesting.

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Acne… the dreaded teenage rite of passage

Posted on July 26, 2016 by drlesliegreenberg
flickr.com/ photos/ blmiers2/ 6904758951

flickr.com/ photos/ blmiers2/ 6904758951

Acne is so commonplace … and it makes being a teenager more difficult.  The AAD (American Academy of Dermatology) has new guidelines for acne therapy.

The key is that monotherapy is not recommended AND that antibiotics should always be coupled with topical therapy (and not used alone).

Topical benzoyl peroxide is the first-line agent that effectively fights Propionibacterium acnes and also discourages the development of antibiotic resistance.  Topical antibiotics (like clindamycin or erythromycin) will also help decrease P acnes populations and exert a mild anti-inflammatory effect.  Topical benzoyl peroxide should be used in combination with another agent like a topical retinoid (gel or cream).  This dual approach helps decrease the chance of antibiotic resistance.

If you NEED an oral antibiotic, the tetracycline-class of antibiotics are still the best option for moderate to severe acne.  Minocycline and doxycycline are equally effective.   Physicians should limit both the DOSE and the LENGTH of therapy of antibiotics.  It is thought that when the oral antibiotic is eventually discontinued that the topical reintoid will fulfill the need for maintenance therapy.

Birth control pills may also help acne by interrupting the pathway of testosterone production.

Accutane is a highly effective treatment for severe acne that is resistant to other treatments.  It decreases sebum production, acne lesion count, and  scarring.  Only certain physicians prescribe accutane as there is a stringent programs and iPLEDGE agreement that are needed.

Low-glycemic diets may help decrease sebum production and decrease inflammation.

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Shingles pain relief

Posted on July 19, 2016 by drlesliegreenberg
herpes zoster day 6. lesions joining other lesions.

herpes zoster day 6. lesions joining other lesions.

There are a “Big Three” of shingles treatment: antivirals, rest, and pain management.  At a recent American Academy of Dermatology meeting treatment of shingles was discussed.  The Big 3 will help halt the progression of the disease and decrease viral shedding.

 

 

  • Rest is important and mandatory for treatment.
  • Antiviral treatment will only work if it is started in the first 72 hours.  There are a few antivirals that can be started. They are all in the same “family” but are dosed at different times and some are more expensive.
  • Pain medicine may be prescribed by your physician.

Additional therapies may help…

  • Steroids by mouth may help if the area looks inflamed.
  • Lidocaine patches and capsaicin cream are both effective for topical pain and work best if used consistently.
  • Gabapentin is also a pill that can help blunt the nerve pain that may occur with or after shingles outbreaks.
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