Fellow Wichitans: Need to dispose of leftover medications?

Posted on April 22, 2014 by drlesliegreenberg
flickr.com /photos /essjay/ 5134563753

flickr.com /photos /essjay/ 5134563753

This Saturday, 4/26/14, there are multiple locations for medication drop off locally. The Drug Enforcement Administration is sponsoring National Take Back Day with the intent of helping people get rid of old drugs so that they won’t be a danger to individuals or to the environment.

Leftover drugs are susceptible to diversion, misuse, and abuse. Throwing medications in the trash or flushing down the toilet can cause environmental hazards including for kids and pets.

Collection sites will be open from 10 am to 2 pm this Saturday at the following locations:

In Sedgwick County:

  • Household Hazardous Waste facility, 801 West Stillwell,
  • Wichita Oaklawn Activity Center 4900 South Clifton,
  • Bel Aire Community Building, north entrance, 7651 E. Central Park
  • Haysville Police Department 200 West Grand
  • Maize City Hall 10100 West Grady
  • McConnell AFB, Base Exchange (open only to military ID holders only)

In Butler County: Rose Hill City Hall, 125 West Rosewood, Rose Hill

In Harvey County: Harvey County Sheriff’s Office, 120 East 7th Street Newton

In Sumner county: Argonia Police Department, 210 South Maine, Argonia.

Kansanas have disposed of more than 22 tons of leftover medications since the drug take-back day started as an annual event in 2010.  Keep up the good work!

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When (and which) can we stop doing screening tests?

Posted on April 8, 2014 by drlesliegreenberg
flickr.com/photos/e n321/55331295/

flickr.com/ photos/en321/55331295/

I am often asked ” Do I still need. . . . mammograms? pap smears? prostate screening?” These are good questions. this depends on the patient’s current quality of life and life expectancy.
Female cancers that are routinely screened for include cervical, colon, and breast. Men’s screenings focus on prostate and colon cancers.
Pap smears.

  • This reveals abnormal cells on the cervix. If a woman had her uterus removed for reasons other than cervical dysplasia (abnormality of cells on the cervix) or cervical cancer, a Pap smear is no longer needed.
  • If a woman still has a uterus and has no history of abnormal Pap smears, then the last pap would be at age 65.

Ovarian cancer

  • A bimanual exam (which I refer to the exam with two fingers inside the vagina and one hand on top of the abdomen) is best done every year. This helps to screen for ovarian cancer.

Breast cancer

  • A breast exam should also be done every year, as part of a well-woman examination. Therefore, it is still important for elderly women to visit their physician yearly for a “well woman exam.”
  • Mammograms should be discontinued at age 75, or when life expectancy is less than 10 years.

Colon Cancer

  • Men and women should be screened for colon cancer until there is a 10 year life expectancy left.
  • There are several ways to look for colon cancer: colonoscopies, barium studies in the x-ray department, stool specimens to look for blood, or CT scan testing.

Prostate cancer.

  • This is a controversial issue. One of every six men will develop prostate cancer during their lifetime, yet only about 3% of men die FROM it.
  • The United States Preventative Service Task Force echoes this practice and states that there is insufficient evidence to recommend for or against screening for prostate cancer.
  • However, you and your physician can decide what is in your best interest.

Bone density screening.

  • Osteoporosis (low bone density) is seen in about 7% of women.
  • Recommendations are to check every woman after age 65, or five years after menopause in women with risk factors.
  • Osteoporosis is not only a disease for women, as it does affect some men.

High cholesterol.

  • Screening should begin based on family history, but at least by age 45 for women and age 35 for men.
  • Screening should begin at a younger age if risk factors are identified.
  • Cholesterol screening can continue at intervals of every 3 to 5 years.
  • If no elevated cholesterol found by age 65, cholesterol screening tests can be stopped as it is unlikely to start after this age.

As always, individual health maintenance and preventive care are best discussed with your physician so that your care can be customized based on your risk factors, family and personal history.

Want more information? American Cancer Society at http://www.americancancer.org and The American Heart Association at http://www.heart.org

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Fiber. The holy grail?

Posted on March 29, 2014 by drlesliegreenberg

Fiber is a simple and cheap intervention which can help with a whole host of problems.

The recommended amount of daily dietary fiber is 20-35 grams. Total dietary fiber is a combination of both insoluble (the kind you can’t break down—wheat bran, whole grains, vegetables) and soluble (like nuts, psylium, and other fruits and vegetables). Soluble fiber can reduce the risk for adult-onset diabetes, help control diabetic’s blood sugars, and reduce risk for heart disease and stroke.
If you were to ask… do we know how much fiber reduces cardiovascular disease risk? And, is there a dose effect?
I would say yes!—there is a study that shows all of this. The British Medical Journal released a study and the take-home message is that intake of whole foods (unprocessed and unrefined) should be greatly encouraged. For every additional 7 grams of total fiber per day, a 9% lower risk for heart attack and stroke. If you are unable to take more fiber through diet, supplementation with psyllium or methylcellulose (both available commonly in over the counter preparations).

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HPV vaccine does not cause riskier behavior

Posted on March 25, 2014 by drlesliegreenberg

flickr.com/photos/ hebe/ 3310171434HPV vaccine has not shown to increase teen girls sexual activity or to engage in riskier sexual practices.

The researchers examined two risk perceptions: did the participants feel they still needed to practice safer sex after the HPV vaccine and did the participants feel like the vaccine protected then against other sexually transmitted infections (STIs) besides HPV.
The study showed that the vast majority thought it was still important to practice safer sex after vaccination, and most did not believe that HPV vaccination protected against other STIs. This does give us convincing evidence that vaccination does not lead to riskier behaviors—which should be reassuring to parents.
For background, HPV, human papillomavirus, is a sexually transmitted infection that is easily spread by skin-to-skin contact during sexual activity with another person. There are more than 40 types of HPV that can infect the genital areas or males and females. These HPV types can also infect the throat and mouth (and cause oral cancers). The HPV vaccines can protect against some of the most common types of HPV, including those that cause 70% of cervical cancers.
The HPV vaccine is suggested by the U.S. Advisory Committee of Immunization practices to females between ages 11 and 26, to males between 11 and 21, and additionally to men aged 22 to 26 who are at “high risk for HPV.”

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Obesity and stillbirths–the connection

Posted on March 18, 2014 by drlesliegreenberg
flickr.com/ photos/mav16/ 4613775099

flickr.com/ photos/mav16/ 4613775099

Obesity is not benign.

I recently read a study performed over 8 years which showed that almost 20% of stillbirths (babies born dead) occurred in obese females.
The study has a database of nearly 3 million births and it was found that the risk of stillbirth increased along with body mass index and gestational age. This means… for women in the highest BMI—50 kg/m2—the incident of stillbirth jumped from 1.8/1,000 pregnancies at 39 weeks (one week before due date) to 3/1,000 at 40 weeks (the due date) and to more than 5/1,000 by 41 weeks (a week overdue).
As a caveat to this, women who are overweight (BMI of 25-30) are at no significantly increased risk of stillbirth compared to normal-weight women.
It is speculated that obesity increases the baseline inflammatory response and that this may lead to abnormal placental growth and the development of uteroplacental insufficiency (meaning that the fetus doesn’t receive enough blood flow).
So, if your doctor discusses your weight with you and encourages weight loss. . . listen. It may be in your (and your unborn/future baby’s) best interest.

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Beware: a flash of anger may cause a heart attack or stroke.

Posted on March 10, 2014 by drlesliegreenberg
flickr.com/ photos/ cobalt220/ 4343621338/

flickr.com/ photos/ cobalt220/ 4343621338/

There have been few studies exploring the link between short bouts of anger and cardiovascular events (in the hours following the outburst), but the evidence is consistently showing a direct relationship.
There were nine independent studies which when combined showed that the risk of heart attack (or acute coronary syndrome) was 4.74-fold higher in the hours after an angry outburst. Certainly, if the angry outbursts are becoming more frequent, the transient effects may accumulate leading to a larger, more ominous event (like a heart attack or stroke).

The increased risk of a cardiac event was increased for individuals who had a greater cardiovascular risk initially.
It is thought that anger can cause increase in circulating catecholamines, increase the heart’s need for oxygen, cause heart blood vessels to spasm, and increase platelet’s ability to make a clot.

There are studies that show that behavioral changes MAY ACTUALLY WORK!

  • One study was a group-based psychosocial intervention designed to reduce stress. This intervention cut mortality among women with heart disease.
  • Another studied showed that cognitive behavioral therapy–focused on stress management—lowered the risk of recurrent cardiovascular events in both men and women who had established heart disease.

Certainly, managing cardiovascular risks (smoking , high blood pressure, elevated blood sugars, obesity) is best to help decrease baseline cardiovascular disease AND we are seeing more information that managing stress may help avoid cardiovascular events, too!

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Should you take zinc to help ward off or treat colds?

Posted on March 4, 2014 by drlesliegreenberg
flickr.com/photos/mellyjean/ 3251173391

flickr.com/photos/mellyjean/ 3251173391

Maybe.

Zinc may help decrease the duration of a cold, but not the severity of symptoms.

The studies show that the mean difference in reduction of duration as 1 day.
Zinc is included in almost all over-the-counter daily vitamins and mineral supplements. Zinc is absorbed through the small bowel with an efficiency of 20-40%. It is the second most important metal in the body after iron and is present in virtually 100% of proteins.
The important function with regard to colds is that zinc inhibits viral replication making the cold virus not able to multiply. Zinc can be found in many forms: syrup, lozenges, or tablets.

Zinc can be given at the onset of a cold and may decrease the symptoms by one day or it may also be iven dailoy for the prevention of the common cold. If taken daily, there was found to be reduced incidence of colds, less absence from school and less antibiotics were prescribed. Side effects from zinc are nausea and a “bad taste” in the mouth. The dose of zinc should be between 75mg and 150 mg a day. Zinc should not be inhaled as it can cause permanent anosmia (inability to smell). Lozenges may be the best bet.

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Five health numbers YOU should know!

Posted on February 28, 2014 by drlesliegreenberg
flickr.com/photos/ benterrett/ 2917446319

flickr.com/photos/ benterrett/ 2917446319

New Years’ Resolutions are still on our minds and a common resolution is to be healthier.  At times it feels like managing our health is a numbers game: watching our weight, counting calories, tracking exercise regimens.  Below are five numbers you would benefit from knowing and stabilizing.

Blood pressure.  Goal is less than 120/80.  What is it?  It measures the pressure of blood flowing through your arteries.  The higher the number the increased risk of damaging  blood vessels which reduces the blood flow to the target organ.  Why it’s important?  High blood pressure often does not cause pain.   When untreated, over time, it decreases the blood flow to the brain which can cause dementia, to the heart which can cause heart failure, to the kidneys which can cause kidney failure.

Fasting blood sugar.  Goal is under 100 mg/dL.  What is it?  It measures the amount of sugar in the blood.  Why it’s important? This is a test which screens for diabetes.

BMI.  Goal is under 25.  What is it?  Body mass index is a formula that divides your “mass” (in kilograms) by height (in meters squared).  It determines if your weight is appropriate for your size.  Why it’s important?  Overweight or obese people are at much higher risks for health problems like high blood pressure, diabetes, obstructive sleep apnea, arthritis and heart disease.  A BMI under 18.5 may signal an eating disorder.

Waist size.  Goal is less than 35 inches in women, less than 40 inches in men.  What is it?  The measurement around your belly (above your hipbone and below your ribcage).  Why it’s important?  Large waistlines signs that there may be too much abdominal fat which increases the risk of Type 2 diabetes, high blood pressure and coronary vascular disease.

Total cholesterol.  Goal is under 200 mg/dL.  What is it?  The number is a combination of  low-density lipoproteins (LDL), high-density lipoproteins (HDL), and other fats in your blood.  Why it’s important?  If there’s too much cholesterol in the blood, it keeps circulating and can eventually enter the blood vessel walls causing a buildup of fatty deposits in the arteries.  This “atherosclerosis” can block blood flow (think heart attack and stroke as blood doesn’t get to the heart and brain).

Get to know YOUR numbers.

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Let’s discuss ANOTHER old wives’ tale. . . “Brandy soothes teething pain”

Posted on February 25, 2014 by drlesliegreenberg

That may be true, but no amount of alcohol is safe for infants or children.

Teething rings available at stores (many of which can be frozen in the freezer and reused countless times) are best.  For an inexpensive option I’d suggest wetting a washcloth, twist it until it is tightly bound and just slightly wet, and then freeze.  Then let your little teether gum it!

.

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jaydocMy mom recently asked me if I’d suggest that she get a low-dost CT lung scan.  I should say that I am not the physician for my family–although I often do field questions.

Great question!  Low-dose computed tomography (CT) screening for those at high risk for lung cancer has received a grade B (meaning it should be considered helpful) from the U.S. Preventive Services Task Force.   But, not everyone would benefit from a low-dose CT scan. 

Those at “high risk” for lung cancer should be considered for CT screening.

  • aged 55-80,
  • 30-pack year history of smoking (like smoking one pack per day for 30 years)  or more,
  • those who have stopped smoking within the past 15 years,

Lesser known risk factors are

  • some occupational exposures (like radon),
  • family history of lung cancer,
  • incidence of pulmonary fibrosis,
  • or emphysema. 

These guidelines come out of studies published between 2000 and 2013.  The rules of statistics show that this test will benefit those most who are at high-risk.  To screen patients at low risk of lung cancer is more likely to turn up “false positive” results–meaning the test shows there is a problem when there is not.  False positive results often  lead to extra tests (which may involve needles and biopsies) AND lots of worry.

 The mandate from the USPSTF allows the Centers for Medicare and Medicaid Services to mandate that this service be provided without charging a copay or deductible. 

If you are at high risk, ask your physician if this test is right for you. . .

Posted on February 21, 2014 by drlesliegreenberg | Comments Off on Should you get a low-dose CT scan of the lung to look for lung cancer?