Do YOU want to apply for disability?

Posted on April 13, 2015 by drlesliegreenberg
flickr.com/ photos /sicilianitaliano/3281602519

flickr.com/ photos /sicilianitaliano/3281602519

Disability evaluations are more than completing a form… I would first ask if there is an alternate job/function/work schedule that you can change to that may fit your needs.

Did you know that according to the World Health Organization, more than 1 billion people worldwide have a disability? In the United States more than 56 million American workers have some form of disability. Of these, more than 38 million have a severe disability. The conditions that most often lead to disability include back or spine problems, heart conditions and arthritis.

Disability impacts family members and caregivers. There are differentiations between disability, impairment and handicap.  These need to be delineated to best evaluate patients and make appropriate recommendations. The two largest disability programs in the United States are Social Security Disability and workers’ compensation.   For veterans, the U.S. Department of Veterans Affairs provides disability benefits.

There are many family physicians performing this initial evaluation of disability. I do not perform disability evaluations; I rely on subspecialists and occupational health physicians. If you are interested in disability, look for physicians who have received specialized medical education by American College of Occupational and Environmental Medicine, the American Academy of Disability Evaluating Physicians, or the American Board of Independent Medical Examiners.

My hope is that even with deficits each of our lives is a meaningful and productive one.

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Wound care (part 2 of 2)

Posted on April 9, 2015 by drlesliegreenberg

Can stitches get wet?

flickr.com/photos /ouistitis/ 6052645034

flickr.com/photos /ouistitis/ 6052645034

Yes. Stitches can get wet anytime. We often suggest that stitches stay dry for the first 24 hours, but studies have shown that there’s no increased risk of infection or wound breaking down if it gets wet in the first 24 hours.

When should you take prophylactic (a medicine used to prevent infection) antibiotics?

Prophylactic antibiotics have little benefit in healthy patients with clean wounds. Topical antibiotic ointments may decrease infection in minor contaminated wounds. Prophylactic antibiotics are often started after human bite wounds, or deep puncture wounds.

Do I need a tetanus vaccine?

Maybe. If you have never received a tetanus vaccine, a tetanus toxoid vaccine should be given as soon as possible. If you have not completed a primary series of tetanus immunizations (at least 3 vaccines) if your last tetanus booster was 10 or more years ago, then a booster is warranted.

How are wound infections diagnosed and treated?

If you have any of the following symptoms, your wound may be infected—

  • redness,
  • warmth,
  • pain,
  • enlarged lymph nodes near the wound,
  • swelling,
  • fever (temperature more than 100.4), or
  • pus.  The treatment of wound infections depends on the severity of the infection, type of wound and the suspected bacteria in the wound.   Antibiotics will be started based on the potentially causative organism. If a culture of the wound can easily be obtained, this will be send to the lab so that the bacteria can be grown out.

When does a wound require hospitalization of referral to a wound care specialist?

Most wounds can be managed by your family physician in the office. However, there are several reasons for hospitalization or referral. Severe wound infections. If wound may need surgical exploration, incision and drainage,  imaging or plastic surgery.

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How to care for a wound (part 1 of 2)

Posted on April 6, 2015 by drlesliegreenberg

imageWhat is the best solution to use to clean a wound?

Antiseptics are commonly used to irrigation contaminated wounds. However, tap water (from the faucet) and sterile saline worked equally well to irrigate (clean out) uncomplicated skin wounds. Warm water may feel better.

Should wounds be covered?

Yes. Keep wounds covered with an appropriate dressing and reassess periodically (..twice a day is good). The dressings help to protect the wound by acting as a barrier to infection and for absorbing wound fluid.

Should a wound be kept wet or dry?

A moist wound bed stimulates epithelial cells to migrate across the wound bed and resurface the wound. (In contrast, a dry environment may lead to cell desiccation and scab formation, which may delay wound healing.) Topical antibiotic ointment can help keep the wound wet.

When can a wound no longer be sutured?

Guidelines recommend that wounds that are clean (and without evidence of infection) should be sutured within six to 12 hours of the injury. Suturing can be delayed for up to 18 hours.   If the wound is located at an area of lots of blood vessels (like the head or face) these can be closed up to 24 hours from the time of injury. Bite wounds are usually left open (not sutured), due to infection risk.

For minor lacerations, are tissue adhesive (glue) as effective as suturing?

Yes. If the wound has low-tension on it and is linear, glue may be considered. Tissue adhesive is not recommended for complex, jagged edges or high-tension areas (like joints or hands).

 

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Free (!) Skin Cancer Screening for Wichitans

Posted on March 31, 2015 by drlesliegreenberg

jaydoc27th Annual Free Skin Cancer Screening Clinic

Where:  KU School of Medicine- Wichita at 1010 N. Kansas.  East Entrance

When:  Saturday, May 2, 2015  8 am to noon

For more information: 316 777 6104

“Physicians will provide brief examinations of the skin, at no charge to the general public.

No treatments will be given, only recommendations as far as what spots or moles are suspicious and should be evaluated further or treated.

Free educational material, in the form of pamphlets concerning sun protection and skin cancer detection and prevention, will be provided.”

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Initial management of high blood pressure

Posted on March 30, 2015 by drlesliegreenberg
flickr.com/photos/ sharynmorrow/ 205306168

flickr.com/photos/ sharynmorrow/ 205306168

First off, you need to know YOUR blood pressure.  Get this done at any pharmacy or grocery store.  There are two blood pressure numbers.  Your blood pressure should be UNDER 135/ UNDER 85 (s Why is this so important? Hypertension is the MOST common chronic condition treated by family physicians.

What is the risk of high blood pressure? Elevated blood pressure is associated with increased risk of heart failure, stroke, heart attacks, and death. (Did you know that treating high blood pressure decreases these risks?!)

Lifestyle modifications are considered first. Adopt the DASH diet (Dietary Approaches to Stop Hypertension diet), restrict sodium intake, regular exercise, and moderate weight loss.

What are blood pressure goals? The diastolic number (bottom number of blood pressure reading) should be less than 90. And top number should be less than 150 mm Hg.

What is the DASH diet?

Consume a diet that emphasizes vegetables, fruits, whole grains.   Limit sweets, sugar-sweetened beverages, and red meat.

How much sodium? Consume no more than 2,400 mg of sodium per day. If you reduce sodium to 1500 mg per day or less this may be help blood pressure reduce even further.

How much regular exercise? Three or four 40-minute sessions of moderate to vigorous activity per week is suggested.

Best way to follow your blood pressure is to take your blood pressure twice a week and write it down. The cuffs available at the pharmacy and grocery stores work well. Bring these readings into your physician at your next appointment. This will gauge whether you may benefit from medication.

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Treatment of reflux in children…

Posted on March 23, 2015 by drlesliegreenberg

When stomach acid comes up the esophagus, this can cause symptoms of reflux.

Common symptoms in infants are feeding refusal, recurrent vomiting, poor weight gain, sleep disturbance, respiratory problems (like coughing and wheezing), and irritability. Symptoms in older children include heartburn, pain with swallowing, asthma, chronic cough or hoarseness, recurrent pneumonia, and recurrent vomiting.

What is first treatment? Lifestyle modification. If the infant is being breastfed, modifying the maternal diet may help decrease reflux symptoms.   A 2 to 4 week maternal exclusion diet that restricts milk and egg is recommended. If the child is formula-fed, reducing feeding volume while increasing feeding frequency or thickening the formula may help. Keep infants upright after feedings. In older children, losing weight (if overweight), not smoking or using alcohol and avoiding triggers may be beneficial.

Medications that help include antacids, histamine H2 antagonists (like zantac) and proton pump inhibitors (like prilosec). There are risks in starting young children medication or long-term use of any medication for reflux.

There is surgery. The stomach is wrapped around the esophagus. This is a last resort.

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Why do diabetics need annual eye exams?

Posted on March 16, 2015 by drlesliegreenberg

Because there are eye complications that diabetics are especially at risk for and , if found early, can be normalized.

I take care of many people with diabetes. As a family physician, I help manage their blood sugars. Standard of care is to see an eye doctor and have a dilated eye exam yearly. Diabetes can affect the eyes without causing symptoms or blurry vision.   Commonly diabetic eye disease is present when an adult first presents with diabetes (because elevated blood sugars may have been present for years).   Good news is that most mild eye changes are reversible with good control of blood sugar.

What is retinopathy? This is damage to the blood vessels of the retina (the back part of the eye) which can cause bleeding. If retinopathy is left untreated, this can result in blindness. If blood sugar remain high or fluctuates significantly, this can result in more damage to the delicate retinal blood vessels.   If the retina is not getting enough oxygen, new blood vessels may start to grow. These blood vessels are fragile and can break and bleed easily, leading to loss of vision.

What are concerning symptoms? Symptoms may include: spots or dark floaters, blurred vision, fluctuating vision, missing areas, vision loss, and difficulty with color perception.

Keeping blood sugars well controlled can help decrease your risk of all sorts of bad complications of diabetes. Watch your diet. Take your diabetes medication religiously. Take blood sugar readings as needed. See your doctor regularly.

Hope this helps.

IMG_3631

IMG_3631-0

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Another few EASY things to do to live longer…

Posted on March 8, 2015 by drlesliegreenberg

Floss! We now know that plaque (bacterial film that covers teeth and gum lines) may be responsible for heart disease, diabetes, Alzheimer’s, some forms of cancer, and stroke). Oral bacteria can create proteins that are found in artery walls and in the bloodstream. These proteins can cause blood to clot more easily and may also cause inflammation in the body. Floss daily to help add six years to your life.

Be grateful. When you appreciate your life and things around you (even when your health may not be the best) this will help you live longer.   Appreciate something every day: sounds of birds, the glow of a sunset…

Cultivate healthy relationships. If you are involved in a negative relationship, you know– those people who pull you down– get rid of that relationship. Research shows that people with more friends and people in healthy relationships live longer.

Hope this helps. 

 

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Ways to curb office snacking…

Posted on March 2, 2015 by drlesliegreenberg

Opportunities for unhealthy grazing abound in most office environments. Keep your impulses in check with these tips…

  1. Bring your own munchies. Keep a healthy snack in your own desk. This way, when you are in the mood for a pick-me-up you’ll have a healthier option nearby. Ration them out by serving size. Do NOT eat straight from the bag.
  2. Brown bag it. Include a fruit, vegetable, lean protein and whole grain for your lunch. This will help you stay fuller longer and have more energy. Make your lunch the night before so that you have time to make sure it’s balanced (instead of out-the-door rushing).
  3. Keep crave-worthy foods out of sight. Research shows that if you are able to see inside a candy dish, you’ll eat 2.2 more candies per day than if you couldn’t see it.   If you swap from a clear container to a ceramic jar, this could save you thousands of calories in a year.
  4. … Keep snacks out of reach. Avoid the parts of the office (or the kitchen if you work at home) that have snacks. Some find that putting a sign on the fridge that reads “Kitchen closed” helps.
  5. And, do not walk near the vending machine. Even if you only have 10 minutes, it’s a great way to help you work through a challenging work project. Did you know that creative thinking increases by 60% when you’re taking a stroll? Even if you don’t go outside, walking up and down the hallways will help.
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What is the REAL benefit of family meals?

Posted on February 23, 2015 by drlesliegreenberg

IMG_3423There are nearly too many benefits to mention!  As a practicing physician and mother of three, I understand the stressors that make family mealtime difficult.  But, there are reasons to fight for more family mealtimes.  There is great impact on the physical and emotional health of kids and teens like

  • helping build vocabulary and conversation skills,
  • teaching others to wait your turn,
  • showing interest in others,
  • gaining a greater sense of safety and belonging,
  • lessening chance of depression
  • raising their self-esteem,
  • decreasing  likelihood of child using drugs, drinking or smoking

The meals do not need to be elaborate.  Try to make meals that everyone likes (or they can open a can of soup).  And, aim to be together for 15-20 minutes to share your days.  This time goes by too fast, enjoy it while you can.

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