Who should get screened for sexually transmitted infections (STIs)?

Posted on January 12, 2015 by drlesliegreenberg

 It depends on your age…

The US Preventive Services Task Force is the organization that reviews the most cost-effective, efficient treatments. They suggest that all sexually active women, ages 24 or younger, should be screened for both gonorrhea and chlamydia.   Women older than 24 should be screened for those two sexually transmitted infections (STIs) if they are at “increased risk.” (Think new partners, multiple partners, or vaginal discharge with itching, burning or odor.)

For men, there is not sufficient evidence to make a recommendation for OR against screening.

Facoid:  Did you know that the two most common STIs in America are chlamydial infections with 1.4 million cases in 2012 and gonococcal infections with 330,000 cases in 2012? Half of the cases of STIs are in people aged 15 to 24.

 

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Should you give Tylenol before vaccines?

Posted on January 5, 2015 by drlesliegreenberg

 

flickr.com/photos/e n321/55331295/

flickr.com/ photos/en321/55331295/

No. Pretreatment of vaccines with Tylenol could actually BLUNT the immune response to the given vaccine. The CDC has released a statement that there are no good studies to support GIVING Tylenol before vaccines. So, I would advise refraining from giving Tylenol.

MMR is one vaccine that patients may get a fever on day 5 after vaccine. So, if a fever occurs after a vaccine, that would be the time to give the Tylenol.

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Artificial sweeteners may be harmful

Posted on December 30, 2014 by drlesliegreenberg
flickr.com/ photos/ blmiers2/ 6904758951

flickr.com/ photos/ blmiers2/ 6904758951

Israeli researchers have shown that consumption of noncaloric (artificial) sweeteners may induce glucose intolerance in both mice and humans. It is thought that instead of artificial sweeteners preventing obesity and metabolic disease, the use of noncalorie sweeteners may have increased the epidemic rise in these conditions.

Further research showed that the sweeteners alter microbiota in the gut, and increasing metabolic-syndrome-related parameters. These parameters include increased weight and increased waist-to-hip ratio, raising fasting blood glucose levesv, raising hemoglobin A1c values (the measure of blood sugars over 90 days), and increasing the values in response to glucose tolerance tests. These are all bad outcomes.

We are unsure how much artificial sweetener is okay. One researcher joked that “drinking 17 diet sodas a day is probably a bad idea, but one or two may be okay.”

Interesting research..l’ll keep watching…

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Hypothyroidism. What is the big deal?

Posted on December 9, 2014 by drlesliegreenberg

I like to refer to the thyroid as the “gas pedal to the body.”  The thyroid gland is located in the neck. It makes two kinds of thyroid hormones: T3 and T4. Thyroid hormones regulate how the body uses and stores energy.  These hormones also help the brain, muscles, heart, and other organs work properly. 

If your thyroid is sluggish you can

  • feel fatigue,
  • have dry skin,
  • gain weight,
  • hoarseness,
  • weakness of muscles,
  • thinning hair,
  • impaired memory,
  • increased sensitivity to cold,
  • constipation,
  • have achy muscles.

What may happen if hypothyroidism isn’t treated?  For one, your symptoms may worsen. Untreated hypothyroidism can also lead to other health problems like infertility, memory loss, depression and heart failure. 

Who is at risk for hypothyroidism?  Anyone.  but, you are at increased risk if you are a woman older than 60, have an autoimmune disease, have a family history of thyroid problems, have been pregnant or have delivered a baby within the past six months. 

How it is diagnosed?  Bloodwork.  The tests measure the level of thyroid hormones.  The TSH level is the best screening test for hypothyroidism.

Treatment is usually lifelong.  thyroid hormone pills come in different brand and generic forms.  Be sure to followup with bloodwork to confirm that your dose is correct.

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Salina, Kansas hospital putting some teeth into non-smoking rule

Posted on December 5, 2014 by drlesliegreenberg
flickr.com/ photos/lanier67/ 237055775

flickr.com/ photos/lanier67/ 237055775

Hospitals have had no smoking in the hospital rules for years.  (This is in humorous contrast to when my father was smoking in the physician lounge in the 1960s.)

A Salina, Kansas hospital has a way to get patient to observe their no-tobacco rule: They’re being sent home.  Salina health Center and its clinics have been tobacco-free since 2007, but have had difficulty with patients continuing to sneak cigarettes or chewing tobacco. 

Starting August 2014, patient were warned that tobacco use would warrant discharge from the hospital and a notation of the chart of having “left against medical advice (AMA)”.  This AMA status is financially significant in that many insurance companies will refuse to pay for any of the hospitalization if the patient leave the hospital AMA.

I wonder if this will be the tip-of-the-iceberg?!  We will see.

Posted in General Medicine- Adults, nicotine, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Salina, Kansas hospital putting some teeth into non-smoking rule

Finding it hard to breathe?

Posted on December 2, 2014 by drlesliegreenberg
flickr.com /photos/mart3ll/ 255289520

flickr.com /photos/mart3ll/ 255289520

Do you have COPD?  Chronic obstructive pulmonary disorder.  Also called emphysema.  This is not a temporary illness.  COPD is a persistent condition that affects lung function, making breathing difficult and decreasing your ability to do the things that you want to do. 

What is COPD?  It is when inflammation and airway thickening occurs.  Destruction of the tissue where oxygen exchange occurs.  COPD is not reversible and progressively gets worse.  It is not curable, but COPD is manageable. 

What are the risk factors for COPD? 

  • Smoking is the leading risk factor. 
  • Second-hand smoke exposure. 
  • Occupational exposure (to dust or certain chemicals). 
  • Family history. 
  • History of childhood lung infections. 
  • Environmental  (poor access to health care or difficult living conditions).

Is COPD dangerous?  Yes.  COPD is the third leading cause of death in the United States.  It is important to know the symptoms of COPD so that treatment can begin to help stabilize lung function.

What are the symptoms of COPD?

  1. Chronic cough–with or without phlegm
  2. Shortness of breath with everyday activities.
  3. Frequent respiratory infections.
  4. Blueness of the lips or fingernail beds
  5. Fatigue.
  6. Producing a lot of mucus
  7. Wheezing
  8. Unable to keep up with people your own age.

What is treatment? 

  • Contact your doctor as soon as possible. 
  • First, you will need a history and physical to be done by your physician. 
  • Then COPD is confirmed by spirometry.  Spirometry is a test in which you blow air into a mouthpiece that measure lung function — how much and how fast you can blow. 
  • Then, medication may be started to relax the muscles around the airways, making it easier to breathe.  Medication to clear mucus will also help.  anti-inflammatories may help reduce swelling and mucus production in the airways.  Pulmonary rehab helps rebuild strength. 
  • Quitting smoking is a key step to help this condition not worsen. 
  • Supplemental oxygen may be required if  COPD is severe to ensure that brain and bodily functions can perform better. 
  • And, get your vaccines.  Flu vaccine yearly is important and pneumonia vaccine will help these two infections not be deadly. 
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Appendicitis. What to watch for…

Posted on November 25, 2014 by drlesliegreenberg

Why do we have an appendix?  We do not know the function of this part of your intestine.  The appendix is located in the lower right side of the abdomen and when it becomes inflamed immediate medical care is needed to prevent a health crisis.

What are the symptoms of appendicitis? At first, it can feel like a side pain. Typically, the pain will shift to the right lower side over several hours. The pain will worsen as the appendix swells. The pain will get worse with

  • breathing,
  • coughing,
  • sneezing
  • or with movement (a bumpy car ride will be especially painful).   Other symptoms include loss of appetite, constipation, fever, diarrhea, vomiting, and nausea.

What else could it be? The differential diagnosis  includes kidney stones, pneumonia, urinary tract infections.

Who does this affect? It could affect anyone. The most common ages for appendicitis are 10 to 30 with slightly more males affected than females. 250,000 people have their appendixes out yearly.

How is appendicitis treated? Surgery. This is done as soon as appendicitis is confirmed. If you present to the hospital with abdominal pain, the staff may watch you for a few hours to see if the pain and symptoms align with the common symptoms as above. If so, a surgeon will be called and surgery performed right away.

Will you miss you appendix? No. There is no function of the appendix. And, once the appendix is removed, there is no chance of getting appendicitis again.

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Lung cancer screening

Posted on November 21, 2014 by drlesliegreenberg
flickr.com/ photos/lanier67/ 237055775

flickr.com/ photos/lanier67/ 237055775

Wow! Lung cancer accounts for 27% of all cancer deaths in the United States. 7% of Americans will be diagnosed and 6% will die from it.   Among heavy smokers, 33% of them will die from lung cancer.   In the 1960s and 70s, annual screening with chest x –ray was recommended in smokers. At the time this seemed to improve survival, but more recent studies have shown that this does not reduce lung cancer deaths.

More recently we have thought that low-dose CT scan of the lungs showed promise for the early detection of lung cancer. After rigorous randomized controlled trial, an annual low-dose CT screening is recommended to those with risk. persons 55 to 80 years of age with at least a 30-pack-year history (for example, one pack-per-day for 30 years) who are otherwise healthy smokers or who have quit smoking within the previous 15 years.

The results of this low-dose CT of the lung has showed that those in the lowest lung cancer risk were unlikely to have any benefit. Studies showed more than 96% of all positive results in the lowest lung cancer risk group were false positives (the test showed cancer when indeed there was none). Another drawback is that we are unsure of the cumulative effect of annual screenings with radiation exposure.

Perhaps the most important issue with low-dose Ct lung screening is that the technology is available, but that this is a costly test in response to what is a behavioral and lifestyle problem. Researchers note that smoking is responsible for 85% of lung cancers. Our job as physicians to offer smoking cessation programs is far more effective in preventing lung cancer deaths than low-dose CT lung screening. The CT screening cannot prevent most lung cancer deaths compared to smoking cessation.

So, smoking cessation programs are the key. Low-dose CT lung screening is also an option.

Posted in Cancer, General Medicine- Adults, lung conditions, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Lung cancer screening

Prostate cancer screening. To screen or not to screen?

Posted on November 17, 2014 by drlesliegreenberg
flickr.com/ photos/ tokaris/ 207335658

flickr.com/ photos/ tokaris/ 207335658

The US Preventive Services Task Force recommend against routine prostate-specific antigen (PSA) testing.

The PSA test was introduced in the late 1980s. This lab test showed us that the incidence of prostate cancer increased dramatically compared to when we could not easily diagnose it. Even though we were able to diagnose men with prostate cancer, the death from prostate cancer decreased only a little bit. A European randomized controlled trial shows that 1,055 men would have to be screened for nine years to prevent one death from prostate cancer. The PSA blood test has started a “conundrum of overdiagnosis” which is a difficult situation. We cannot tell at the time of diagnosis who is overdiagnosed (and will live with prostate cancer uneventfully) and who has clinically significant disease (and may die from prostate cancer).

25 years after the introduction of PSA testing, two lessons have been revealed. A screening test for cancer should not be introduced until trials have shown that the test leads to significantly reduced mortality. Secondly, (without evidence showing net benefit or harm) PSA testing is likely to remain controversial until it is replaced by a better test. We do not have a significantly better screening test for prostate cancer at this time.

Posted in Cancer, General Medicine- Adults, Male issues, prostate cancer, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Prostate cancer screening. To screen or not to screen?

Nuts and bolts on colon cancer screening

Posted on November 14, 2014 by drlesliegreenberg
normal colonic mucosa

normal colonic mucosa

The U.S. Preventive Services Task Force tells us who and when and how to test for which disease.   Their research takes into account patient population characteristics and the evidence.

Who should be screened for colon cancer? All adults 50 to 75 years of age.

How often should colon cancer screening be done?

  • Colonoscopy (a scope is placed up the rectum to the cecum which is 100% of the way around the large bowel) every 10 years.
  • Or fecal occult blood testing every year (putting stool onto a special card and sending this to the lab to look for microscopic blood in the stool).
  • Or flexible sigmoidoscopy (a scope is placed up the rectum to 60 cm which is the 1/3 of the way around the large bowel) every 5 years plus fecal occult blood testing every 3 years.

The Centers for disease Control and Prevention estimates that in 2012 only 27% of eligible adults had never been screened.

As a caveat, the screening guidelines above are for patients without family history of colon cancer and without any symptoms.  Those with symptoms of abdominal pain, blood in stool, change in stools do not fall into the “screening” category. So, you may need a colonoscopy sooner than age 50 or more frequently than every 10 years.

Hope this helps.

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