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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Half of cervical pre-cancers are caused by two subtypes of HPV!

Posted on May 13, 2014 by drlesliegreenberg
flickr.com/photos /lavid/ 01793987

flickr.com/photos /lavid/ 01793987

HPV subtype 16 was the most commonly detected HPV type among all “high grade” (read this: ominous) cervical lesions. Half of the high-grade cervical lesions had HPV 16 or 18 involved. Then, another 25% of high grade cervical lesions are attributable to five additional HPV types (types 31/33/45/52/58). Currently there are two HPV vaccines: Cervarix carries HPV types 16 and 18 and Gardasil carries HPV types 6, 11, 16 and 18.

Cells on the cervix can vary from normal to cancer—there is a continuum of abnormalities between the two. The nearer to cancer the cells are the more “dysplastic” or abnormal under a microscope they look.    Goals of this research are to quantify the risk of the subtype of HPV to the chance of having significant cervical cell dysplasia (or change). Investigators are also looking into many questions: should we treat males and females the same? What age range is best served? What schedule is most effective of vaccine administration?

Our current HPV vaccines do not cover for all the above HPV subtypes that cause cervical dysplasia. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) is looking into a 9-valent vaccine which may cover for more of the HPV strains that have been found to be oncogenic (cancer-causing).

I’ll stay tuned…

Posted in pap test, Pediatrics, Uncategorized, Vaccines, Women's Health | Tagged , , , , , , , , , | Comments Off on Half of cervical pre-cancers are caused by two subtypes of HPV!

Drinking diet drinks is linked to cardiovascular events in women

Posted on May 9, 2014 by drlesliegreenberg
flickr.com/ photos/ 19779889@N00/5445275639/

flickr.com/ photos/ 19779889@N00/5445275639/

I know this sounds vague. . . and scary. But, the analysis focused on nearly 60,000 women aged 50-79 and followed them for 9 years. TWO or more diet drinks a day was associated with a 29% increased risk of cardiovascular event (read that: heart attack or stroke) and a 26% increased risk of all-cause death, compared with women with less (or no) diet drink consumption.

This finding is consistent with other information that we’ve known: diet drinks are linked with metabolic syndrome and cardiovascular disease events. The new information is the strength of the link.

It is postulated that diet drink consumption may disrupt normal feedback mechanisms that help us control our intake of food and other beverages. It may also be that diet drinkers have an unhealthy lifestyle in some other way.

Find more information from the Women’s Health Initiative study.

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Late-life depression may be prodrome to dementia

Posted on May 6, 2014 by drlesliegreenberg
flickr.com/ photos/ tokaris/ 207335658

flickr.com/ photos/ tokaris/ 207335658

There is a relationship between elderly patients with acute depression and progression to Alzheimer’s disease.   It is unclear whether depression in the elderly is a risk factor for dementia or if it’s a prodrome of the disorder. It’s important to note if the late-life depression has documented memory and executive function impairment.

If depression is affecting you, or a loved one, please seek assessment and treatment.   If the decline is due to cerebrovascular disease there may be an entirely different pathway to follow.  Either way,  ongoing follow-up and support are suggested.

Posted in Emotional health, end-of-life issues, General Medicine- Adults | Tagged , , , , , , , , , | Comments Off on Late-life depression may be prodrome to dementia

Erectile dysfunction. The canary in the gold mine?

Posted on May 1, 2014 by drlesliegreenberg
flickr.com/ photos/ taksidia/ 1249605102

flickr.com/ photos/ taksidia/ 1249605102

Indeed impotence can be the first sign of cardiovascular disease. A new study of 600 men showed that men with erectile dysfunction (ED) had a better than threefold improvement in erectile function after receiving a statin drug. Statins are most often used for treatment of high cholesterol.

There is no indication to start statins to help men with erectile dysfunction, but ED is a sign to physicians to investigate the patient’s vascular health. Certainly a cholesterol lab work should be performed.

Interesting article …

Posted in General Medicine- Adults, Male issues, Uncategorized | Tagged , , , , , , , , , | Comments Off on Erectile dysfunction. The canary in the gold mine?

You need to know your blood pressure. Here’s why…

Posted on April 28, 2014 by drlesliegreenberg
flickr.com/photos/ sharynmorrow/ 205306168

flickr.com/photos/ sharynmorrow/ 205306168

Higher blood pressures throughout young adulthood strongly predicted subclinical atherosclerosis during middle age.

This was a study done over 25 years and it followed participant’s blood pressure and cardiovascular events. The findings show that what happens in early adulthood DOES appear to be an important indicator of that person’s risk for heart disease in the future.

This reminds me that even slightly elevated blood pressure in younger patients is a condition to watch and manage. Blood pressure is a good marker to show patient’s who may benefit from lifestyle changes. The goal is to reduce cardiovascular risk and complications later on.

Blood pressure goals are under 135/85. Both numbers are important. Do you know yours?

Posted in blood pressure, General Medicine- Adults, Uncategorized | Tagged , , , , | Comments Off on You need to know your blood pressure. Here’s why…