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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Cancer screening key issues. Why, who, which test do we use?

Posted on November 10, 2014 by drlesliegreenberg
flickr.com/photos/ saturnino/ 1813270775

flickr.com/photos/ saturnino/ 1813270775

I recently read a great article demonstrating biases in the evaluation of screening tests. This is timely as last week I had a 75 year old female visibly upset that she no longer needed regular pap smears. She sighed and said “I guess no one cares if I die of cervical cancer.”

Cancers have different growth rates—which determines their potential to be detected by screening.   Also there are different characteristics of the disease. How fast does the cancer grow? Might the early-stage abnormalities regress on its own (without treatment)? Is there effective and acceptable treatment available? Are patients asymptomatic for a time during which detection and treatment will significantly reduce morbidity and mortality?  Do we have an effective screening test during the time that we could “catch” the problem in time to save their life?

What are the characteristics of the screening test?  Is the test sensitive enough to detect the disease during the asymptomatic period? Is the test specific enough to minimize false positives (a false positive test shows you have the disease, but indeed, you do not)?

What are the characteristics of the screened population? At what age is which screening test appropriate? (Should we test 10 year-olds for colon cancer?) Are patients willing to comply with subsequent tests and therapy if needed?

 

What does all this mean? Researchers are pooling studies to give us more insight into which tests should be performed in which patients. This is so that there is less chance of false positives (which leads to patient worry and further work ups) and more chance to find those most at risk. I think medical school ingrained in me a perpetual weighing of risks and benefits.

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Mindless weight loss

Posted on October 31, 2014 by drlesliegreenberg
flickr.com/ photos/ reallyboring/ 2860775800

flickr.com/ photos/ reallyboring/ 2860775800

This would be great, right?  Well, if you use the following rules, then you will mindlessly eat less and may lose weight.

keep kitchen counters clear.  The only exception is you can keep a bowl of fruit in sight.  There should be no visible snack food, no nuts, no bread, not even breakfast cereal in sight.  When there is food in sight, we tend to nibble.  And, the nibbling adds up.

To trick yourself into drinking less wine, use taller white wineglasses.  The shape of the glass and the red-color of red wine help us drink less.  If it is easier to see we pour “9 percent less red wine.”

Sit in well-lit areas of restaurants (near windows or doors) as we tend to eat less when we can see our food better.  Also, ask for a doggie bag and take 1/2 your meal to go.  It’s best to ask for this before you are even served.

Keep fruit on the top shelf of the refrigerator.  When good-for-us food is at eye-level we are more likely to  opt for this instead of more caloric options.

Make environmental changes so that you are not tempted.  You’ll just eat less.

Brian Wansink Ph.D. has penned a new book “Slim by Design: Mindless Eating Solutions for Everyday Life.” He is an entertaining writer and impeccable researcher.  Enjoy!

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Recognizing and treating teen depression

Posted on October 27, 2014 by drlesliegreenberg
.flickr.com/photos / blushingmulberry/ 4001277317/

.flickr.com/photos / blushingmulberry/ 4001277317/

October is national Mental Health Awareness month.    No one is immune from mental illness.  Adolescents are especially vulnerable to mental illness and are a major at-risk population for developing severe depression.  The Centers for Disease Control and Prevention show that nearly one in six high school students have considered suicide and one in 12 have attempted suicide. 

The National Institutes of Mental Health note that suicide is the third leading cause of death among adolescents.

Teenage depression can be scary for parents who may observe changes in their child.  Behaviors to watch for are

  • irritability,
  • loss of interest in activities,
  • personality change,
  • sadness or hopelessness,
  • changes in sleeping and eating habits,
  • thoughts of suicide,
  • difficulty concentrating or focusing.

If teenager is suicidal or in immediate danger, the teen should be brought to the emergency room or crisis center.  Call 911, if needed. 

Treatment for adolescent depression can involve antidepressant medication, psychotherapy or a combination of both medicine and counseling. 

If you see a change in your teen, talk to them about depression.  It is a difficult topic to approach, but it can be life saving.

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Which complementary medicine modalities are worth doing?

Posted on October 24, 2014 by drlesliegreenberg
flickr.com /photos/tingy /484468

flickr.com /photos/tingy /484468

Consider taking fish oil to decrease high triglycerides.   The American Heart Association recommends 2 to 4 grams per day of fish oil with DHA to help decrease triglycerides.   The most common side effects of fish oil is bloating and belching and should not be given after an acute bleeding event.

 

Oral glucosamine sulfate may reduce osteoarthritis pain and improve joint function. Glucosamine is an amino sugar that is considered a building block of cartilage proteoglycans. It occurs naturally in the body, but the glucosamine in supplements is from seashells. Glucosamine stimulates components of the knee to help delay joint degeneration. Glucosamine 500 mg three times a day was found to be significantly helpful in studies.

 

Antibiotic-associated diarrhea is a common problem. Probiotics can prevent antibiotic-associated diarrhea. The studies showing this benefit gave between 5 billion to 40 billion colony forming units per day. The most commonly used probiotics are from Lactobacillus and Saccharomyces genera. These are considered relatively safe, but are not recommended for immunocompromised people or those with an indwelling medical device.

 

Acupuncture should be considered as an additional modality to help patients with chronic low back pain. Also, yoga has helped with both short-term and long-term decrease in back pain.   For more information see http://bit.ly/yoga-as-therapy

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Warts. Do I need to treat them?

Posted on October 17, 2014 by drlesliegreenberg

No. 

There was a study of 1100 children. 1 of 3 of them had at least one wart.  One year later (without any treatment) 1/2 of all the warts were gone.  This was especially true in younger and nonwhite children.

So, if you can wait it out… all your children’s warts may resolve spontaneously and without treatment. 

flickr.com /photos/ sea-turtle/6061032366

flickr.com /photos/ sea-turtle/6061032366

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