Great strategy: “Lend a Hand” to patients with diabetes

Posted on August 4, 2014 by drlesliegreenberg

new doc 2_1Great strategy:  “Lending a Hand” to patients with diabetes

  1. Lend a hand?  Yes!  Each finger represents a way to help a diabetic.
  2. Stop smoking!  Tobacco poses a greater risk or morbidity and mortality than any other abnormality in diabetics.
  3. Control blood pressure.  Medication may be needed for this.  Goal: less than 140/90.  Metformin therapy.  This is known to delay premature mortality.
  4.  Cholesterol reducti8on.  Lifestyle changes with statin medication therapy is known to extend life by 3 years in men and 2 years in women.
  5. Lastly, blood sugar control.  Despite our focusing on blood sugars as an indicator of quality of medical care, the other “four fingers” may help more than blood sugar control.

 

Want more information? Lancet journal 2010; 375 (9713); pgs. 481-489.

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Measles outbreak?!

Posted on July 22, 2014 by drlesliegreenberg
flickr.com/photos /lessel/ 2729066

flickr.com/photos /lessel/ 2729066

Oh no!  The Centers for disease control and Prevention (CDC) is warning us physicians to remain alert for symptoms of measles.

Yes, this was once considered an “eliminated” infection.  But, as of May 30, 2014, a total of 334 confirmed measles cases has occurred over 18 states.  Measles is blossoming due to the importation of the disease from other countries AND an increasing number of U.S. parents who choose not to immunize their children with the MMR (measles-mumps-rubella) vaccine.

What should you watch out for?

  • Fever.
  • Red, splotchy rash that typically starts at the hairline and then moves down behind the ears and across the face.  Then it spreads over the rest of the body.

Treatment?

  • Isolation is key!
  • There is no antiviral treatment.
  • Medical care consists of symptom relief and prevention of bacterial infections on top of the measles.
  • The most common serious complication of measles is pneumonia.

Want more information?  http://www.aafp.org/news/health-of-the-public/20140609measles.html

 

 

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Tattoos? Think before you ink.

Posted on July 15, 2014 by drlesliegreenberg
flickr.com/photos/ bain/ 731005089

flickr.com/photos/ bain/ 731005089

As of 2012, 1 in 5 adults had a tattoo.  This is up from 14% in 2008.  Truthfully, tattoos are usually trouble-free.  But tattoos can pose health risks…

  • Unsterilized tools.
  • Contaminated ink.
  • Scarring.
  • Blood-borne diseases (HIV and hepatitis).
  • Toxins in the tattoo ink (metals, powders or other organic compounds).
  • Allergic reactions.

If you have a tattoo before getting an MRI let the radiologist know so that appropriate precautions can be taken.

Tattoos can also prevent early detection of skin cancer as the ink can camouflage changes in Asymmetry, Borders, Colors and Diameter–the ABCDs of melanoma detection.  So, do not cover up moles with tattoos.

Of note, the Food and Drug Administration regulates tattoo ink, but considers it a cosmetic and only intervenes when there are attention-getting problems.

Buyer beware.

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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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