Do you want a non-hormonal medication to treat hot flashes and night sweats?
Veozah (fezolinetant) is an FDA-approved non-hormonal medication to treat moderate to severe hot flashes and night sweats.
Hot flashes and night sweats are common, and often overwhelming, symptoms of perimenopause and menopause. Fezolinetant is a daily oral pill.
The main safety concern with fezolinetant is its effect on liver function. It should not be taken for people with cirrhosis or severe kidney impairment.
Fezolinetant is well-tolerated. 1-2% of patients may have abdominal pain, diarrhea, back pain or insomnia. Fezolinetant has not been studied head-to-head with menopausal hormonal therapy and is thought to be less effective in treating hot flashes or night sweats than estrogen. Fezolinetant does not affect bone density or treat vaginal dryness. The cost of fezolinetant without insurance can cost $540/month.
Why should you get the flu vaccine now? One humanitarian answer would be that we live on this planet with others and we should look out for one another. But, the selfish reason would be that it significantly decreases your risk of being hospitalized with influenza.
Who can get the vaccine? Anyone 6 months of age and older. (Persons with an egg allergy can receive any influenza vaccine (egg-based and non-egg-based) appropriate for age and health status.)
A Centers for Disease Control and Prevention (CDC) study showed that this year’s flu vaccine reduced the risk of hospitalization from fly by 35% in five Southern Hemisphere countries.
This decrease of 35% is less than the nearly 52% decrease in hospitalization of last year’s flu vaccine.
I got my flu vaccine last week and had no side effects from the vaccine.
If you would like to decrease your risk of being sick enough to need to spend the night in the hospital, decrease your risk of altering your life because you feel ill, and want to help not spread influenza to your community, I urge you to get the influenza vaccine.
Hearing loss is associated with depression, disability, social isolation, unmet medical needs and geriatric frailty. Most patients are aware of 10 years of hearing loss before hearing aids are used. If you are having symptoms, let your physician know so that they can help you get the care you need.
When can hearing loss be suspected?
Asking others to speak louder/ slower/ more clearly/ repeat what was said
Feeling fatigued with prolonged listening
Difficulty hearing in a group/noisy area/on the phone
Difficulty hearing loud sounds or difficulty hearing speech in quiet places
What are warning symptoms that require additional evaluation?
Asymmetric hearing loss
Feeling of blockage of the ear canal
History of excessive ear wax
New onset of ringing
New sensation of dizziness or vertigo
Pain or discomfort in the ear
Sudden hearing loss or acute worsening of chronic hearing loss
There are prescription and over-the-counter hearing aids. Audiologists are the specialists who advise the choice of hearing aid type and style. Prescription hearing aids are an expensive option and may cost $1,000 to $6000 out of pocket.
Over the counter hearing aids include preset and self-fitting and assorted styles. There are in-the-ear aids and behind-the-ear styles. The behind-the ear style often has a better sound quality and filters background noise more effectively. There is also a self-fitting OTC device.
Historically, telehealth was rarely used before Covid. Insurances often did not allow telehealth to be performed and it was not an option that patients knew of.Covid caused a HUGE increase in telemedicine. There was a 766% increase in telehealth from 2019 to 2020!
What changes happened? There were major alterations to Medicare in March 2020 which allowed the increase in telehealth to occur. The CARES Act allowed for patients to see a new physician by telehealth (where in the past the patient needed to be an established patient with that physician). Telehealth can originate from any site (before they needed to be in a physician office like the patient was in their rural primary care physician’s office and having a telehealth visit with a specialist located elsewhere) and even outside of the state the physician was in (before the patient had to be in the same state as the physician).
Who uses telehealth most? Research has shown that those who use telehealth often have Medicaid or Medicare insurance, black and those earning less than $25,000/year. Surveys have found that audio-only in contrast to audio-visual) telehealth is often used by Hispanic and black patients. The primary issue expanding telehealth is the inability for underserved to have computers able to have audiovisual equipment.
Telehealth is still more common than before 2020, but has decreased greatly since its peak in 2020.
What do physicians think of telehealth? An AMA study shows that physicians find that virtual care is difficult due to patient’s limited access to technology, limited patient digital literacy, and patient’s limited access to broadband WiFi (so that video visits are difficult). One benefit is that telemedicine effectively reduced patient no-show visits by half.
Patients most liked telehealth for these reasons: medication refills, reviewing medication options, and discussing test results.
So, if you want to be seen by telehealth, ask your primary care physician if this is an option for you. Telehealth is especially good for visits that do not need an exam: medication refills, reviewing test results, and a dialogue about a patient question.
Insomnia affects 30% of Americans. Poor quality or too little sleep can negatively impact quality of life. It can also decrease productivity, increase drowsiness and fatigue and can worsen other health issues.
Initial treatment focuses on lifestyle modification. This includes cognitive behavior therapy to decrease negative thought patterns that disrupt sleep. There are five elements to cognitive behavior therapy for insomnia: cognitive restructuring, stimulus control, sleep hygiene (no naps or caffeine or alcohol), relaxation therapy (progressive muscle relaxation and reducing mental activity and physician tension before bed), and sleep restriction (so that the patient has a consistent wake-up time for getting out of bed consistent with total time spent in bed—- don’t linger in bed). This restructuring can help reduce anxiety about inadequate sleep and its consequences. Expectations are for patients to sleep for 5-6 hours per night. Decreased stimuli near bedtime (blue lights, TV, exercise). Use relaxation techniques and mindfulness exercises.
If these are ineffective, medications can be used. Most physicians avoid benzodiazepines and “Z-drugs” (like Zolpidem, Zaleplon, or Eszopiclone) because there are short-and long-term risks associated with use of these medications. Z drugs are considered nonbenzodiazepine hypnotic medications. Some patients perform complex sleep-related behaviors like sleepwalking and sleep eating. The US Drug Enforcement Administration has classified both drug classes as schedule IV drugs requiring medication monitoring with periodic urine drug screening and tracking prescriptions of controlled substances. Melatonin receptor agonists are safer and well-tolerated, but some patients find that they are not very effective. Ramelteon is a melatonin-receptor agonist that helps with sleep onset. Melatonin 1-3 mg is available over the counter.
Orexin receptor antagonists can help with sleep onset and sleep maintenance. You may have seen advertisements for these: Daridorexant, Lemborexant, or suvorexant (Quivivq, Dayvigo, or Belsomra). These medications can cost $300-500 per month. The most common side effect of this class of medication is daytime sleepiness.
The DEA has announced its next National Prescription Drug Take Back Day. On Saturday, April 27, 2024, communities across the country can drop off unneeded, unwanted, and old medications at locations in their area. Stay tuned for the latest information on https://www.dea.gov/takebackday on locations near you and ways you can make a difference to prevent drug misuse before it starts.
Gastroesophageal reflux disease (GERD) is very common. Heartburn? Brash taste in your mouth? Some patients who have long-standing reflux have changes of their cell types in the esophagus due to acid from the stomach causing metaplasia of squamous cells to columnar cells. This change in cell type is called Barrett’s esophagus. This affects up to 6 million people in the United States with chronic GERD. These cellular changes can progress to esophageal adenocarcinoma at an annual rate of around 0.15%. More than 12,000 new cases are diagnosed annually of esophageal adenocarcinoma.
Esophageal adenocarcinoma is often diagnosed in advanced stages and because of this there is a five-year survival rate of 16%.
The patients at high risk for developing Barrett’s esophagus or esophageal adenocarcinoma include men with five or more years of weekly GERD symptoms and two additional risk factors (including age > 50, white race, central obesity current or past smoker, and a family history of Barrett’s esophagus or esophageal adenocarcinoma).;
To help decrease this transition to esophageal adenocarcinoma, weight loss, smoking cessation and taking a proton pump inhibitor medication. Lifestyle modifications are always helpful: Avoid foods that are triggers for reflux symptoms (mint, alcohol, nicotine, fatty or fried foods, acidic or spicy foods). Sleep with the head of the bed raised 30 degrees. Avoid eating within 3 hours of bedtime.
If you have reflux symptoms for 5 years or more or worsening symptoms of reflux despite medication, you are urged to see a gastroenterologist.
Researchers are considering screening average-risk asymptomatic women for cervical cancer with only HPV testing. We now know that HPV, human papillomavirus is the virus that causes cells on the cervix to change from normal cells to cancer.
We used to perform pap smears every year in sexually active women starting after their first sexual encounter. We have changed our screening practices to take into account HPV and the time-frame it takes for those cells to change. In the 1990s we changed screening for cervical cancer from only doing pap smears to doing pap smears and testing for HPV.
In the past 15 years there have been 13 population-based randomized controlled trials which have found that primary HPV screening is as effective at detecting CIN3+ (abnormal cervical cells near cancer) as contesting with both pap and HPV testing.
Currently, an HPV specimen is obtained much like a pap smear is obtained. In the future there may be vaginal self-sampling. One self-sample method is like a tampon that the patient inserts into the vagina, turns a few times, places it in a transport tube and returns it to the lab. Another approach is collecting a urine sample which will contain desquamated cells from the cervix and vagina. This is not standard-of-care yet. Stay tuned.
Do you need to dispose of prescription medication? If you have medication around your house you do not use, it is helpful to get rid of this safely. Oftentimes there is extra pain medicine left over from a procedure and leaving this around the house can be tempting for others and may lead to substance abuse.
https://www.dea.gov/everyday-takeback-day is one website to guide you where to go. Or, better yet, you can put in your zip code and find local pharmacies to accept extra medications at this site.
Dr. Leslie Greenberg's Blog 
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