The United States Preventive Services Task Force, USPSTF, is an independent panel of experts in primary care and prevention that systematically reviews medical evidence and develops recommendations. At times, the USPSTF seems conservative, but overall gives worthwhile advice. Some of their latest 2015 recommendations are as follows:
Who needs aortic aneurysm screening? Men aged 65 to 75 (who have EVER smoked) should have a one-time screening to rule out abdominal aortic aneurysm (AAA). This screening is done by an ultrasound. The risk of having an abdominal aortic aneurysm is for the aneurysm to grow in size and to burst. When it bursts, it often causes rapid death.
Incidentally, the USPSTF specifically states that women who have never smoked should NOT be screened for AAA.
I’ll write about more USPSTF guidelines in future blogs.
I had an episode of dizziness last week that was overwhelming. How humbling. My condition is called benign paroxysmal positional vertigo, BPPV.
What is BPPV? It is sudden onset of vertigo with head movements. Vertigo is a sensation of movement like a ship going down a drain. Triggers to vertigo are position changes, head movement or pressure changes. There can be associated symptoms of hearing loss, ringing in the ear, or headache. You may be more at risk for BPPV if you have diabetes, heart disease, high blood pressure or head trauma. Some medications can also cause increased incidence of BPPV; these are blood pressure medications and anti-seizure medicines.
What should your doctor look for? Any ear pathology like wax or infection or fluid behind the ear drum or hearing loss. Cardiac exam will also rule out heart murmur, carotid bruit (when the neck blood vessels are narrowed due to cholesterol placque) or signs of peripheral artery disease (when the extremities don’t get enough blood). A neurological exam will also help rule out stroke or brain abnormalities.
Why does this happen? There’s a great video to describe this, I showed it to my kids…
Why does this happen?… there can be calcium carbonate debris (like little pieces of sand) that float in the semicircular canals located in the inner ear. When the sand (also called “canaliths”) become lodged in the wrong part of the inner ear it causes the canaliths to move freely, triggering hair cells and then a false sense of motion. That sense of motion can cause nausea and vomiting.
Treatment consists of repositioning the otoliths… although most episodes of BPPV spontaneously improve in 4-6 weeks. But, treatment can help speed along recovery. A few methods are the Epley maneuver (or a modified Epley maneuver that you can accomplish by yourself). There are also fantastic vestibular rehabilitation exercises on you tube through the University of Michigan Health System.
So, I am one week into my 4-6 week recovery phase. . . and, at times I hold onto walls so that I do not fall. Humbling. Trying. Nauseating. But, I am pushing through.
After a 2 month hiatus, of moving across the country and settling my family of 5 into our new community, I have returned to doctoring and blogging.
I have recently joined the teaching faculty at the University of Nevada School of Medicine Family Medicine Residency Program. I have learned (my 8th) a new electronic medical record and have seen my first day of patients. Whew! These days medicine is made more difficult with the cumbersome recording system. And, I am determined to master this EMR as well.
Certainly if you have a major trauma or accident, you should visit the emergency room.
But, there are other reasons to go to the ER such as any symptoms that interrupt your life or your ability to function–
severe chest pain,
shortness of breath,
stroke-like symptoms (including numbness),
suicidal thoughts.
If you have a primary care doctor, here are some reasons to be seen by your doctor (assuming it is during office hours) on an emergent basis
abdominal pain,
back pain, bites (animal or human),
bleeding,
coughs and sore throats,
cramping or bleeding while pregnant,
dizziness or other balance problems,
fevers (especially in the very young or old),
headaches/migraines,
mood changes,
rashes or allergic reactions,
weakness.
Your emergency room experience (or wait time) goes depends on your level of acuity– meaning how urgent is your medical issue. The more urgent (like chest pain or possible stroke) are frequently taken straight back to a room in the ER for physician evaluation. Lower acuity problems like back pain or sore throat may mean a longer waiting room time.
Also, consider HOW you are getting to the emergency room. At times, driving yourself or a loved one to the emergency room won’t get you care fast enough. In those instances, call 911. The paramedics can deliver life-saving care on the way to the ER.
Not really. Here in the United States, the red-yeast rice extract that contains naturally-occurring lovastatin (a statin drug) is not FDA approved.
In contrast, in China red-yeast rice is a common dietary and medicinal product. Their red-yeast rice contains a wide range of biologically active compounds… including lovastatin. (Lovastatin is a statin drug that in the US is sold at the pharmacy with a prescription.) Studies in China using their red-yeast rice have shown significant reductions in coronary heart disease (up to 30%!) and a 60% reduction in myocardial infarctions.
The products that are purchased online from America may contain variable amounts of lovastatin and therefore therapeutic effects aren’t predictable. I would suggest letting the FDA do their job and regulate the medication and their strength. Get a statin prescription from your doctor.
Diclofenac gel (the only topical nonsteroidal anti-inflammatory available in the United States) was shown to help decrease pain and improve function scores for as long as 12 weeks in patient with osteoarthritis of the knee. The drawbacks are the cost of the diclofenac gel (reportedly $260- 330 per 150 mL bottle), minor skin dryness and irritation.
After caring for (and doctoring) Wichitans for nearly 20 years, my family is moving to our hometown–Reno, Nevada.
I will be practicing at Andover Family Medicine until July 21, 2015.
Please call my office to schedule a visit before then so… we can do a check-up, review your medical care, and can seamlessly coordinate your care.
In Reno I will work as family physician/teacher at my alma mater medical school.
It’s been an honor caring for you and your families. My move away is bittersweet as I will truly miss being your family physician. I hope you can understand my need to be near family. I will greatly miss taking care of you.
Do we need a study to evaluate this? Apparently so. And, yes! Overweight children are 18% more likely to have lower extremity injuries compared to normal weight children. The risk increases to 24% in obese children and 34% more likely in extremely obese children. Good news is that obese children are not at increased risk of upper extremity injuries.
The recommendations should be to discourage obesity in children. Good diets. Healthy snacks. Exercise daily.
The United States Preventive Services Task Force, USPSTF, is an independent panel of experts in primary care and prevention that systematically reviews medical evidence and develops recommendations. At times, the USPSTF seems conservative, but overall gives worthwhile advice. Some of their latest 2015 recommendations are as follows:
Man, do I LOVE my profession.
Dear patients,
Dr. Leslie Greenberg's Blog 
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