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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Stop using nasal flu vaccine

Posted on July 12, 2016 by drlesliegreenberg
flickr.com/photos/ soloflight/ 4030623375

flickr.com/photos/ soloflight/ 4030623375

In a stop-the-presses media blast, the Centers for Disease Control and Prevention’s Advisory Committee has voted to stop the use of the live attenuated influenza  (nasal flu) vaccine for this 2016-2017 flu season.   The recommendations state that “no live attenuated influenza vaccine should be used in any setting.”  This is a result of data showing that the nasal flu vaccine was effective in 3% (yes, THREE PERCENT) of children aged 2-17 years.

Meanwhile, the flu shot was estimated to be 63% effective against any flu virus in that age group.

So, get set to receive a flu SHOT this fall and not the flu MIST.

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Does chewing gum help after abdominal surgery?

Posted on July 5, 2016 by drlesliegreenberg
flickr.com/photos/armydre 2008/ 33743519449F3wcE-jd6U3r

flickr.com/photos/armydre 2008/ 33743519449F3wcE-jd6U3r

Yes!  Chewing gum reduces the time to the first flatus (first time passing gas) after an abdominal surgery and it decreases the time to the first bowel movement.  Gum has helped these two actions occur sooner so that the patient can go home from the hospital 1/2 day sooner!

After abdominal surgery the intestines often feel “messed with”– kind of like when you were a kid and you poked an earthworm.  After being manipulated, the bowel (and the earthworm) do not move like they are supposed to.  This medical term is called a postoperative ileus.  Postoperative ileus is common and may lead to prolonged hospitalization because no doctor will send you home without passing gas and having a bowel movement after abdominal surgery.  Chewing gum may stimulate the cephalo-vagal system and intestinal motility while encouraging the flow of pancreatic juices and saliva.

This outcome of earlier flatus and bowel movement was most pronounced in patients with colorectal surgery and least pronounced in patients undergoing cesarean delivery.  Some studies also showed less nausea and vomiting among those who chewed gum.

I hope this helps.

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Are you considering an oral appliance for your mild sleep apnea?

Posted on June 27, 2016 by drlesliegreenberg
flickr.com/photos/ axelsrose/ 2657883341

flickr.com/photos/ axelsrose/ 2657883341

The short answer is that the oral appliance used while sleeping may help some symptoms of sleep apnea, but not others.

An oral appliance that helps push the lower jaw forward to make more room in the back of the mouth has NOT been shown to improve daytime sleepiness or other measures of a good night’s sleep.  The oral appliance DOES decrease apnea scores, snoring and restless legs.  These improvements may be valuable for bed partners who sleep each night enduring the breathing irregularities and lower limb restlessness.

Even after 4 months of treatment the oral apppliance did not improve the patient’s measures of sleepiness, sleep resistance quality of life or functional outcomes of sleep.

However, I imagine that the bed partners slept better. (Photo above inserted for cuteness only.  No appliance used in this little patient)

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Does your sore throat need a throat culture?

Posted on June 20, 2016 by drlesliegreenberg
flickr.com/photos/funnelcloud /5661813945/

flickr.com/photos/funnelcloud /5661813945/

Most likely not.  We, physicians, often check to make sure that your sore throat isn’t “strep throat.”   We specifically check for strep as there can be complications if the streptococcus isn’t treated with an antibiotic. The good news is that our rapid strep test is 86% sensitive and 96% specific.  As far as medical tests go, the rapid antigen test is highly effective in identifying and excluding strep.

It is thought that the rapid strep test is sensitive enough (and the likelihood or rheumatic heart disease is low enough) to stop the long-held practice of confirming negative rapid test results with a culture.  This is suggested as rheumatic heart disease due to group A streptococcal infections has “all but disappeared in wealthy countries” says Lancet (a medical journal 2012; 379 (9819): 953-964).

Food for thought…

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Should you have arthroscopic knee surgery?

Posted on June 13, 2016 by drlesliegreenberg
flickr.com/photos/ cheribalo/5641055019

flickr.com/photos/ cheribalo/5641055019

This is a great question that was recently answered.  A study of 805 patients with mean age of 53 to 59 showed that arthroscopic repair of degenerative meniscal tears does not significantly improve long-term pain or function.

Arthroscopic surgery did help increase function for the first six months, but this improvement was not seen for longer-term outcomes (six months to two years).  Also surgery did not improve pain in teh short term or in the long term.

Consider physical therapy and try to avoid surgery, if possible.

I hope this helps.

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Does exercise increase miscarriage?

Posted on June 5, 2016 by drlesliegreenberg
flickr.com/photos/ summerbl4ck/ 3093533735

flickr.com/photos/ summerbl4ck/ 3093533735

Regular exercise for up to seven or more hours per week is NOT associated with increased rates of miscarriage in the first or second trimester.  Woman can do low or high-intensity exercise including aerobics, jogging, cycling and swimming without risk of miscarriage.   Bending and lifting at work is also not associated with increased risk of first-trimester (the first 13 weeks of the pregnancy) miscarriage.

These were the findings of a large six-year study in Denmark with 90,000 women.  No duration of exercise or gestational age was correlated with miscarriage.

The American  College of Obstetricians and Gynecologists recommends that active women continue to exercise at moderate intensity for 30 minutes on most day of the week during pregnancy.  Women who perform strenuous routines should be followed closely.  Also women who did not exercise before pregnancy should be evaluated by their doctor before beginning an exercise routine.

Medical reasons that you should not exercise are significant heart disease, restrictive lung disease, incompetent cervix, multiple gestation at risk of premature labor, persistent vaginal bleeding, placenta previa after 26 weeks pregnant, premature labor during the current pregnancy, ruptured membranes and preeclampsia or pregnancy-induced hypertension.

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Cradle cap?!

Posted on May 30, 2016 by drlesliegreenberg
flickr.com/photos/cdaisym/ 4013509031/

flickr.com/photos/cdaisym/ 4013509031/

Oh my!  Many parents bring in their babies with a thick, scaly crust on their head.  This is usually cradle cap.  The fancy (medical) name for this is seborrheic dermatitis.    The scaling, redness, and itching occurs most often on the scalp and face (often in the eyebrows).  On infants, cradle cap often resolves spontaneously, without treatment.  Cradle cap peaks at 2 and at 12 months of age.  It also may occur in adolescence and early adulthood.

Treatment of infantile seborrheic dermatitis is primarily rubbing emollients that help loosen scales.  Good examples of emollients are mineral oil, olive oil or petroleum jelly.  The scales can then be removed by rubbing with a cloth or an infant hair brush.  Ketoconazole is an antifungal cream that can also be used and is thought to be safe.  The FDA has not approved any medicated shampoos for children younger than two years.

If you get this as an adolescent or an adult,  over-the-counter shampoos and topical antifungals (like ketoconazole) are helpful.  It is more common in men and is typically more severe in cold and dry climates and during periods of increased stress.  Seborrheic dermatitis is a chronic condition and so ongoing maintenance therapy is often necessary.

There are lots of other skin conditions that can be flaky on the scalp so if the above treatment does not work, see your doctor.

Posted in Dermatology, Dermatology, General Medicine- Adults, Pediatrics | Tagged , , , , , , , , , , | Comments Off on Cradle cap?!