Patients don’t fill their prescriptions?!

Posted on July 9, 2014 by drlesliegreenberg

What?  Actually, 1/3 of prescriptions go UNfilled.  The fancy word for this is “nonadherence.”

A Canadian study followed nearly 16,000 patients.  The results: nonadherence most often this occurs due to prescribing

  • expensive drugs and
  • preventive therapies for chronic conditions.
  • Also, patients were more likely to not get medicines with higher copays, recent hospitalization, and when the patients had more severe comorbid (long-term) conditions.

 

Interestingly, antibiotics were  most likely to be filled.    Patients who had more visits with the prescribing physician were more likely to fill their prescriptions (this may speak to trust/knowledge of each other).  And, older patients more likely filled their prescriptions.

As a provider, I weigh the cost of the medicine and frequency medicine needs to be taken, with the effectiveness for the patient’s specific condition.  If I prescribe a medicine that the patient does not believe they need/cannot afford, who have I helped?

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Aspirin is not needed if you do not have a history of heart attack or stroke

Posted on June 30, 2014 by drlesliegreenberg

Again,  aspirin is not needed if you do not have a history of heart attack or stroke. There ARE benefits to taking an aspirin per day if you have a history of cardiovascular disease, but there is increased risk of bleeding (in the stomach and brain) which outweighs the benefits if you do NOT have cardiovascular disease.

The FDA released a May 2, 2014 statement in response to Bayer (maker of brand-name aspirin) wanting to change their packaging. Bayer wanted to market aspirin for heart-attack prevention for patients with no history of cardiovascular disease. Studies, however, have shown that even high-risk patients (with risk factors) who have never had a heart attack or stroke are just as likely to have a heart attack or stroke while on aspirin as compared to those who are taking a placebo (sugar pill).

So, if you are taking aspiring but you have never had a heart attack or stroke… stop taking aspirin.

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Beware of herbals and supplements as these may cause liver problems.

Posted on June 26, 2014 by drlesliegreenberg

Hepatotoxicity from herbal and dietary supplements is on the rise in the US. Body-building supplements are implicated as the most common cause of liver injury. The symptoms that the patients presented to the doctor with were most often with jaundice (yellow eyes and skin) and extremely itchy skin.

Supplements are not usually needed … nor are they universally beneficial. The best advice is to eat fruits, vegetables, lean meats and whole grains for best nutrition.

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Does timing of aspirin use change heart attack and stroke events?

Posted on June 23, 2014 by drlesliegreenberg

Maybe.

A small Dutch study showed that heart attack survivors who were taking low-dose aspirin to ward off a second heart attack benefited most when they took aspirin at bedtime.

We know that cardiovascular events are more often to occur in the morning. Platelets help aid blood in clotting and it is thought that platelet activity peaks in the morning hours. Dutch researchers postulated that the timing of the aspirin would not be significant as it is known that aspirin’s effect on blood clotting continues for a few days. But, after the results were found, it may be that the platelet surge inactivity is blunted with nighttime aspirin use.

Certainly, more research is needed but this is promising.

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Antibiotic use may be related to developing asthma later in life.

Posted on June 19, 2014 by drlesliegreenberg

We know that the number of people with asthma has significantly increased over the last three decades.

In addition, a recent study out of the United Kingdom found that children who were given antibiotics during infancy were at a higher risk of developing eczema, asthma and allergies by mid-childhood compared to those who did not take antibiotics during infancy.

The study showed that if antibiotics were given within the first 24 months of life there was up to 1.75 times increased odds of developing asthma by 7 ½ years old. The risk of developing asthma, eczema and allergies increased every time another round of antibiotics was given between birth and age 2.

Want more information? Pediatric Allergy and Immunology ran the study.

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Pregnant mothers are encouraged to eat peanut butter

Posted on June 5, 2014 by drlesliegreenberg

babyYes.  It was found that consumption of peanuts and tree nuts during pregnancy may prevent their children from developing nut allergies.

The study supports the thought that early allergen exposure increases the tolerance and lowers the risk of childhood food allergies.  The study compared women who ate nuts five or more times a month compared to those who ate nuts less than once a month.

It was also noted that nursing mothers who avoided peanuts and milk products did NOT affect their child’s risk for food allergies.  This means that avoidance of those products may not be beneficial to the child, whereas for pregnant women consuming them WAS helpful.

Also, peanut butter is a good source of folic acid and protein–both of which are needed in pregnant women.

Enjoy!

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Traveler’s diarrhea

Posted on June 2, 2014 by drlesliegreenberg
.flickr.com/photos/ mamboman/ 506006207

flickr.com/ photos/ mamboman/ 506006207

Summer is traveling season. . . this brings up the age-old question of … What to do to avoid diarrhea?  What to take?  When to take it?

What is traveler’s diarrhea?  It is defined as passing 3 or more loose stools in 24 hours with accompanying symptoms of fever, nausea, vomiting or cramps.  60-70% of travelers from developed countries to less-developed countries may contract TD.

The travel destination is important.  There are parts of the world that are “very high” risk of contracting TD (South Asia) ranging to “low” risk like Europe, Australia and Northeast Asia.

Dietary choices are also important.  The least risk is business travelers and tourists who only eat/drink in more affluent settings where preparation may be more hygienic.  “Boil it, peel it, or forget it” may be a good mantra.  The older a traveler is, the lower the risk of TD.  Patient factors that increase risk of TD are use of proton pump inhibitors and immunocompromised travelers.

Who should take antibiotics while on vacation?  It is recommended that antibiotics be given for travelers at high risk for travelers’ diarrhea and those at high risk for complications if they contract it.  There is also a softer indication (meaning your physician will probably give you the medicine) if you have an inflexible itinerary.

What to take?  Antibiotics (1 to 3 days’ worth) will help.  Loperamide is an antimotility agent which helps decrease diarrhea.  This is used in addition to antibiotics, but not used to treat children.

How long does TD last?  It usually starts 1-2 weeks after arrival and lasts no longer than 4 to 5 days.  If symptoms last longer, then further work up is needed.

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Over the counter treatment for benign prostatic hypertrophy symptoms

Posted on May 26, 2014 by drlesliegreenberg
flickr.com/photos/ vinceandjoy/ 319681936/

flickr.com/photos/ vinceandjoy/ 319681936/

Benign prostatic hypertrophy?  BPH symptoms in men are urinary frequency, difficulty starting and stopping stream of urine, weak urine stream, and needing to get up from bed at night to urinate.

Who gets this?  Only men.  More than 80% of men older than 80 years old have BPH.

Treatment of BPH is symptom-driven.  Most men do not like to wait for urine to flow in the night.  Many men will experience stabilization or improvement of symptoms over time without therapy.  Most men do not like the idea or “watchful waiting” to see if symptoms become less annoying.

It is thought that BPH may be an inflammatory reaction, so a study showed that NSAIDs (they used celecoxib) was helpful to decrease symptoms.  The usual medications used are alpha-adrenergic antagonists (like Tamsulosin/Flomax) or a 5-alpha-reductase inhibitor (like Finasteride/Proscar).

This study brings to light that possibly NSAIDs (like ibuprofen) may help significantly improve BPH symptoms.  It may be worth a try….

Want more information?   http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2012.11559.x/abstract

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Need sexually transmitted infection screening?

Posted on May 21, 2014 by drlesliegreenberg

flickr.com/photos/ hebe/ 3310171434If you are a sexually active woman under the age of 24 you most likely need STD screening.  A federal task force is suggesting that STD screening should be regularly done in all American women who are sexually active.  Gonorrhea and chlamydia often don’t have any symptoms.

What is the risk of undiagnosed chlamydia or gonorrhea?  Pelvic inflammatory disease, infertility, and chronic pelvic pain (with bowel movements or with intercourse).

How common is chlamydia and gonorrhea?  The United States has more than 1.4 million cases of chlamydia and 800,000 gonorrhea infections yearly.

Women and men can now be screened for the diseases with simple urine tests.  And, all 50 states allow minors to get treated for STDs without parental permission.  (This, of course, brings up all sorts of family dynamics and I will not address this issue at this time).

What are the risk factors?

  • Age is a strong risk factor for both chlamydia and gonorrhea.  Sexually active women aged 20-24 years have the highest infection rates, followed by women aged 15 to 19 years.  Infection rates among men are highest between ages 20 and 24 years.

Women older than 24 are suggested to get screened if they’re at “special risk.”

  • This includes having a new sexual partner,
  • having more than one sex partner,
  • inconsistent condom use,
  • history of previous or co-existing STD,
  • exchanging sex for money or drugs, or
  • having a sexual partner infected with an STD.

What about men?  There is not enough evidence to support routine screening for boys and men.  Men more often have symptoms and thereby seek diagnosis and treatment, preventing serious complications.  The guidelines do not mention gay or bisexual men who are higher risk of infection with STDs.  In those men, both chlamydia and gonorrhea are linked to higher rates of infection with HIV ( the AIDS virus).

For more information, look into the US Centers for Disease Control and Prevention sexually transmitted disease guidelines.

 

Posted in General Medicine- Adults, Male issues, Sexually Transmitted Infections, Uncategorized, Women's Health | Tagged , , , , , , , , , , , | Comments Off on Need sexually transmitted infection screening?

When pregnant, stay away from medicines

Posted on May 16, 2014 by drlesliegreenberg
flickr.com/photos/ summerbl4ck/ 3093533735

flickr.com/photos/ summerbl4ck/ 3093533735

There are some medicines that are thought to be safe during pregnancy. . . but we keep learning more from research daily.

Prenatal exposure to acetaminophen (Tylenol) was associated with a significantly increased risk of attention-deficit/hyperactivity-like behavioral problems in children.

This was published in JAMA Pediatrics 2/24/14  and based on data from more than 60,000 children in Denmark.  The risk was increased by 13% among those whose mothers had used acetaminophen overall during pregnancy.  Although, when acetaminophen was used in the second and third trimesters, the risk increased by 44%.  When acetaminophen used during all three trimesters, the risk of ADHD-like behaviors was increased by 24%.

It is postulated (guessed) that acetaminophen may alter maternal hormones which play critical roles in regulating fetal brain development.

 

 

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