What you need to know about strokes…

Posted on August 23, 2013 by drlesliegreenberg

Stroke.  What an awful word.  My father had a debilitating stroke at age 50.

795,000 people have a new or recurrent stroke each year. Stroke is a leading cause of serious long-term disability in the US.  Stroke ranks fourth as cause of death (behind heart disease, cancer, and chronic lung disease).

87% of strokes occur when the brain does not receive enough blood.  The other 13% is due to bleeding into the brain, called a “hemorrhagic stroke.”  Whenever blood flow to the brain is disrupted (either by not enough blood or flooding of blood out of the blood vessels and into the brain tissue) brain function (read this: ability to perform common everyday tasks) is harmed.

Sometimes, there is a warning.  This is known as a transient ischemic attack (TIA).  A TIA is felt as neurologic changes that resolve spontaneously, without therapy.  The risk for someone who has had a TIA to progress to a stroke at 2 days is 10% and at 90 days is 17%.  This means, if you have a neurologic problem that goes away by itself, you are significantly at risk for a stroke to follow.  An aggressive work up and risk factor modification is needed.

What are stroke symptoms?  Sudden weakness on one side of the body.  Sudden difficulty speaking or understanding words.  Sudden difficulty seeing in one or both eyes.  Sudden loss of balance or coordination.  Sudden severe headache.

FAST.

  • Face: Does the face look uneven.  Ask the person to smile.
  • Arms. Does one arm drift down?  Ask the person to raise both arms.
  • Speech.  Does the person’s speech sound strange?  Ask the person to repeat a simple phrase like “The sky is blue.”
  • Time: Call 911

Why the rush to treatment?  Brain cells (and future function) die fast!  So, there is a 4 1/2 hour window to initiate thrombolytic (medicine to break up blood clot) therapy to help re-infuse the brain with oxygenated blood.

Hope this helps.

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Initial obstetrical visit. A great time for myth-busting!

Posted on August 19, 2013 by drlesliegreenberg

I have performed obstetrics for 18 years and taught medical students and residents to do the same.  It is an honor and a privilege.  Pregnancy advice is fraught with “myths”. . . here are some “truths.”

Eat fish!  Fish is high in quality protein and low in saturated fats.  It has omega-3 fatty acids.  But, limit fish to two average meals per week of a variety of fish that are low in mercury. (Methyl mercury can impair fetal and newborn motor and thinking skills).  High mercury fish are considered to be swordfish, tilefish, whale, king mackerel, shark and albacore tuna.

flickr.com/photos/jessandcolin/ 4155145700

flickr.com/ photos/ jessandcolin/ 4155145700

Sushi (most likely) is okay to eat.  Sushi in the United States is usually flash frozen which kills most pathogens.  Very rarely infectious diseases from raw fish are seen in the US.

Eat GOOD food.  If you eat fruits, vegetables, and lean meats and fish a supplement is not needed.  There is no evidence that an omega-3 fatty acid pill is beneficial.  Getting the nutrient from the food is best!

Take your prenatal vitamin.  This is an excellent source of folate which is needed to help the fetal spinal cord form.  Prenatal vitamins should be taken through the childbearing years… until you decide that you are done birthing and breastfeeding babies.

Avoid listeria.  This is an infection that may cause miscarriage and stillbirth.  Most listeria is contracted from hot dogs, but also from queso fresco.  The FDA suggests pregnant women do not eat hot dogs or luncheon meats unless they’re reheated to steaming and to avoid soft cheeses, refrigerated pate or meat spreads, smoked seafood, raw or unpasteurized milk, raw and undercooked meats.

Caffeine in moderation is okay.  Studies have failed to show that caffeine intake causes low birth weight, congenital malformations or miscarriage.

Avoid alcohol.  No known amount of alcohol is okay for the fetus.  1 in 6000 US newborns have fetal alcohol syndrome or fetal alcohol spectrum disorder.  Do not drink alcohol while pregnant.

Stop smoking.  And, stay stopped.  Nothing good comes from nicotine, not for the fetus and not for the child that shares your home.

No soaking in hot tubs.  Immersion in water heated to 100 degrees Fahrenheit is potentially teratogenic (causing of birth defects).  In addition, maternal hyperthermia from hot tubs may result in miscarriage and nearly doubles the risk of fetal spinal cord defects.

Hope this helps.

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Practice changer for sore throats!

Posted on August 16, 2013 by drlesliegreenberg

.flickr.com/photos/emry /2397069241/Steroids may be helpful for sore throats.  This is a new thought.

8 research trials were combined with results showing that for patients with sore throats (with  negative rapid strep test) and painful swallowing that steroids may treat the symptoms.  Patients who received steroids were three times more likely to report complete resolution of symptoms at 24 hours than those that did not have steroids.

We know that corticosteroids have an effect of suppressing the immune system and carry the theoretical risk of making an existing infection worse.  For this reason, steroids should be considered but may not be given.  There have not been any studies comparing pain relief between steroids (with above risks) to pain relievers like acetaminophen and NSAIDs.

So, you and your doctor can decide when and if steroids are given.

Posted in General Medicine- Adults, infections, infections, Pediatrics, throat conditions, throat conditions, Uncategorized | Tagged , , , , , , , , , , | Comments Off on Practice changer for sore throats!

Cool health apps to check out!

Posted on August 13, 2013 by drlesliegreenberg

There is seemingly an app for everything!  Listed below are some well-received apps that physicians frequently suggest to patients.

flickr.com/ photos/jimyounkin/ 4426607390

flickr.com/ photos/jimyounkin/ 4426607390

  • For anxiety.  Breathet2Relax and Relation Techniques
  • For menopause:  BioDesk and myPause
  • For pain:  WebMD Pain Coach
  • For weight loss: Lose it! and MyFitnessPal and Calorie Count
  • For medication or birth control pill management: MyOC and MyPill and GoodRx
  • For headache or migraine: iHeadache
  • For urinary symptoms: Bladder Pal and iP Voiding Diary

Technology. . . at our fingertips.

 

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Why breastfeed?

Posted on August 8, 2013 by drlesliegreenberg

Too many reasons to list. . . but I’ll try.

Benefits for mother:

  • increased physical closeness with baby,
  • decreased risk of breast cancer,
  • decreased risk of ovarian cancer,
  • decreased risk of endometrial cancer,
  • less blood loss after birth which may translate to less chance of anemia (and feeling tired),
  • burning 250 calories/day making milk,
  • reduced rates of diabetes,
  • reduced rates of osteoporosis.
  • Free!

Benefits for baby:

  • less chance of infections (ear infections, pneumonia, diarrhea)–read this less doctor or ER visits and less fevers,
  • less eczema,
  • less wheezing and asthma,
  • less risk of sudden infant death syndrome (SIDS),
  • decreased risk of obesity as both a child and as an adult, decreased risk of diabetes.
  • Always available!.flickr.com/photos/diathesis/ 355970196/
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Here’s an app to help with pre-colonoscopy prep!

Posted on August 6, 2013 by drlesliegreenberg

What will they think of next? There is now a smartphone app that gives bowel prep step-by-step instructions. You can even input the bowel prep prescribed and time of the endoscopy and then instructions and alerts will help guide you.

I have performed colonoscopies for 18 years and seen thousands of colons. The importance of a good prep cannot be overstated. When there is stool lining the walls of the colon, the ability to see the walls to assess presence of polyps (or other pathology) decreases.

.flickr.com/photos/jimyounkin/ 4426607390Digestive Disease Week reported a study which showed patients who used the smartphone app had a significantly better bowel prep than those that did not use it. (It’s humorous the study notes the physician-evaluator was “blinded”. . . hopefully that means that he didn’t know which patients had looked at the app).

The app is free and available for iPhone and Android devices. Look up “Arizona Digestive Health.”
Hope this helps!

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Traveler’s diarrhea

Posted on August 2, 2013 by drlesliegreenberg

flickr.com/photos/ncreedplayer /3119200708/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 (TD)?  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. www.cdc.gov has a great hints for travelers.

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.  Stay hydrated.  Drink (or sip if you cannot gulp).

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.

Hope this helps.

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Diabetes is rampant. Here are some important statistics and risk factors…

Posted on July 30, 2013 by drlesliegreenberg

In the past 20 years the prevalence of diabetes among US adults grew by 45%.  The greatest increase is among seniors aged 65 and over.

.flickr.com/photos/wader/11834504The increase in diabetes is not especially surprising, but the magnitude of the increase is significant and worrisome.

Certainly, one risk factor for diabetes is obesity.  The obesity (BMI more than 30) rate has increased from 22% to 34.6% and the prevalence of those with BMI 40 or greater rose from 2.7% to 6.4%.

What can you do?  Make sure you know what your BMI is.  This is easy to calculate with a BMI calculator http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm .  You can also check a fasting blood sugar or a hemoglobin A1c test (available with your physician) to assess how well your body is controlling your blood sugars.

Be mindful of your weight and your fasting blood sugar.

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Tips to guard summer skin care against premature aging

Posted on July 22, 2013 by drlesliegreenberg
flickr.com/photos/- sophiamariewalsh /8022174798

flickr.com/photos/- sophiamariewalsh /8022174798

Wrinkles? Age spots?  Leathery skin?   Simple precautions can help.

Be aware that there are some factors which are inevitable.

  • natural gravitational pull on the skin and
  • loss of subcutaneous fat (which may make the skin seem to sag) and
  • loss of muscle under the facial tissues.

Other factors are preventable like exposure to ultraviolet rays and the elements.

Research shows the worst culprit in skin aging is ultraviolet radiation (UV rays).    Both UVA (which causes aging) and UVB (causing sunburns) rays are harmful.  Long-term sun exposure causes loss of elasticity of the skin, discoloration, brown spots, increase blood vessels, wrinkles, facial volume/fat loss, and skin cancer.  Sunscreen is the best defense.

There are two types of sunscreens–physical and chemical screens.  Physical blockers contain zinc oxide and titanium dioxide.  The UV rays are scattered from the skin.  They contain safer ingredients for children (6 months and older).  Chemical screens absorb UV rays and offer high SPF for protection from both UVA and UVB.  The drawbacks of chemical screens is that it may cause allergic skin rashes and may wear off earlier than physical blockers.

Many sunscreens contain both physical and chemical screens. Some brands are Neutrogena with Helioplex and Anthelios 50 Mineral Ultra Light.

Other tips

  • Reapply sunscreen every two hours when in the sun
  • Reapply after exercise or swimming
  • Avoid outdoor activities between 11 am and 3 pm as the UV rays are the strongest during this time
  • Wear sunglasses to protect your eyes
  • Wear long sleeves and a wide-brimmed hat (which is better than a baseball cap due to increased coverage)

As the daughter and sister of two plastic surgeons, I have heard about sunscreen’s benefits since I was a child.  My advice is to pick a sunscreen that feels and smells good and use it daily.  Amp up the usage depending on the situation and skin being exposed.

Hope this helps!

Posted in Cancer, Dermatology, General Medicine- Adults, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on Tips to guard summer skin care against premature aging

Plan B “morning after pill” soon available over the counter

Posted on July 18, 2013 by drlesliegreenberg
flickr.com/ photos/ mringlein/ 1403246089

flickr.com/ photos/ mringlein/ 1403246089

There has been significant legal turmoil over the handling of Plan B.  And, most recently the Justice Department and President Obama have decided to allow this contraceptive to be purchased at the pharmacy without a prescription.

Plan B is a medication that prevents conception if taken within 72 hours after sexual intercourse.  This pill was approved in 1999 as a prescription-only product.  For the past ten years, the ruling allowing availability over-the-counter  to all ages and for purchase by either gender has been in the court system.   This pill will be available after one additional supplemental application from Plan B to the FDA.  Check with your local pharmacy for updates on this medication’s availability.

Want more information?  http://www.planbonestep.com/

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