Babies need vitamin D

Posted on February 2, 2015 by drlesliegreenberg

IMG_3419Osteomalacia, also known as “rickets,”  is bone weakness resulting from Vitamin D deficiency.  We now know that breastfed babies and formula fed babies need Vitamin D supplementation.  Formula has Vitamin D in it, but not enough Vitamin D until the baby is drinking 500 mL (about 17 ounces) of formula per day. 

The National Academy of Sciences recommends a supplement of 200 IU per day of Vitamin D for the following:

1.  All breastfed infants unless they are weaned to at least 500 mL per day of Vitamin D-fortified formula or milk.

2.  All nonbreastfed infants who are ingesting less than 500 mL per day of Vitamin D-fortified formula or milk.

3.  All children and adolescents who do not get regular sunlight exposure, do not ingest at least 500 mL per day of Vitamin D-fortified milk, or do not take a daily multivitamin supplement containing at least 200 IU of vitamin D.

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New treatment for dry eyes

Posted on January 29, 2015 by drlesliegreenberg
.flickr.com/ photos/ bahkubean/ 1287879564

.flickr.com/ photos/ bahkubean/ 1287879564

Dry eye symptoms increase with age and may be as high as 30% in those older than 50. Women are more likely to have dry eyes than men. Other risk factor for dry eyes are contact lens use, medications like antihistamines (allergy medicines) or SSRI (common antidepressant and antianxiety medications), tobacco use, diabetes, and history of ophthalmic surgery.

What are symptoms of dry eyes?

Eye irritation, sensation of foreign body in the eye, excessive tearing, and altered vision.

What is first line treatment? Artificial tears.

Other than that… there was a recent study showing that fish oil supplementation may be helpful for the treatment of dry eyes. The study participants took 15 fish oil pills per day. 15 pills sounds a bit excessive, but certainly, the lowest dose that works for you would be best.

What to do about the “fish burps?” Fish oil pills often make the patients belch up fish tasting secretions. If you keep the fish oil pills in the freezer and swallow them frozen, this decreases the fishy burps.

Hope this helps.

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Do YOU (and your kids) really need the flu vaccine?

Posted on January 19, 2015 by drlesliegreenberg

The low-down on this is that influenza often kills those who are otherwise well. Also, the flu can be fatal to children.

The CDC found that 830 kids died from flu-related complications between 2004 and 2012 and most of those had not gotten a flu vaccine. Pneumonia was the most commonly reported complication among the kids who died 43% of the kids who died from flu complications were otherwise healthy and did not have high-risk medical conditions (like heart defects, epilepsy, diabetes, cancer, or asthma).

The CDC recommends that all children 6 months or older get the flu vaccine every year. Prevention IS the best strategy. Children younger than 9 who are receiving the vaccine for the first time need two doses. If they only get one vaccine the first year of flu vaccination, it’s as though they are not vaccinated that season.

Posted in General Medicine- Adults, infections, Pediatrics, Vaccines, Vaccines | Tagged , , , , , , , , , | Comments Off on Do YOU (and your kids) really need the flu vaccine?

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.

 

Posted in General Medicine- Adults, Male issues, Sexually Transmitted Infections, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Who should get screened for sexually transmitted infections (STIs)?

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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