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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Hepatitis C. What? Should I get tested?

Posted on July 15, 2013 by drlesliegreenberg
flickr.com/ photos/ lynnfriedman/ 8703242835

flickr.com/ photos/ lynnfriedman/ 8703242835

Hepatitis C is a virus infecting the liver.   It may cause serious liver damage or even death.

How do you get it?  It is spread by exposure to hepatitis C (HCV) infected blood or body fluids.  High-risk patients are those who

  • received blood products with clotting factors before 1987 or
  • received a blood transfusion or
  • organ transplant before July 1992 or
  • those with a history IV drug use or
  • have HIV or
  • have been on kidney dialysis for several years or
  •  babies with HCV positive mothers or
  • public safety workers who have been stuck with a needle or other sharp objects contaminated with blood or fluid.

How many people have it?  An estimated 3 million American adults are infected. Most of them do not know it.  It is suspected that 3% of baby boomers have HCV.

Why get tested?  The Centers for Disease Control (CDC) recommended last year that all baby boomers (those born between 1945 and 1965) be screened for HCV.  There is treatment which helps to clear the virus from the body in the hopes of preventing progression of cirrhosis and end-stage liver disease or liver cancer.

The CDC Director Thomas Frieden has said “the take-home message …is that you may not remember everything that happened in the ’60s and ’70s, but your liver does.”

How do you get screened?  A simple blood test.  Ask your doctor.

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Do asthma and exercise go together? Yes. Here’s how…

Posted on July 11, 2013 by drlesliegreenberg
flickr.com/photos/ jaypoct/ 2429061604/

flickr.com/photos/ jaypoct/ 2429061604/

Asthma affects 300 million people worldwide.   Research pooled nearly 700 patients and found that physical training lasting for at least 20 to 30 minutes, two to three times a week, for at least six weeks improves physical fitness in patients with asthma.  This physical training did not worsen asthma symptoms and it significantly improved health-related quality of life.

If you have asthma, make sure that your symptoms well controlled before you start exercising.  The goal of asthma treatment/medication is so that you live your life to the fullest!

Posted in asthma, General Medicine- Adults, lung conditions, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Do asthma and exercise go together? Yes. Here’s how…

Pregnant? You need a Tdap!

Posted on July 8, 2013 by drlesliegreenberg
flickr.com/photos/ summerbl4ck/ 3093533735

flickr.com/photos/ summerbl4ck/ 3093533735

Tdap is a vaccine–containing tetanus and pertussis.  A new immunization schedule recommends that a dose of the Tdap vaccine be given to all women during each pregnancy, whether or not she has received the vaccine before.  This is a change!

This may seem a bit extreme, but the basis of the new recommendation is clear.  There has been a HUGE pertussis epidemic with more than 40,000 cases reported last year, infants disproportionately affected.  Of note, most pertussis deaths and hospitalizations occurred in babies under 3 months of age.

How does this work?  It is thought that a Tdap in the last third of the pregnancy provides immunity to the mother with effective antibody response and placental transfer of pertussis antibodies to the fetus.  In addition the “cocooning” strategy speculates the vaccine likely  provides passive immunity for infants even after birth, until the first Tdap vaccine is given to the baby at a routine well child check.

Are there risks with giving this to the mother and fetus?  None known.   To date, there is no data suggesting increased fetal, maternal or pregnancy risks.

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Cold sores. What works to stop them?

Posted on July 1, 2013 by drlesliegreenberg

flickr.com/photos/ gorbould/ 8204061961

An epidemiology and biostatistics student (what a mouthful!) answered the question of –how effective is therapy for preventing recurrence of cold sores due to herpes labialis?

Cold sores are commonly caused by herpes simplex virus type 1.  More than 90% of us have been exposed to this.  1/4 of us with HSV1 experience periodic viral reactivation, usually in the form of a cold sore on our lip.

The 10 studies showed that acyclovir and valcyclovir (two commonly prescribed antivirals) are more effective than placebo (sugar pills) in stopping recurrences of cold sores.  Systemic therapy (pills) were more effective than topical (cream).  All forms of medication were well tolerated by patients.

So, if you are plagued by cold sores, talk to your doctor about therapy.

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Four lifestyle changes decrease death risk by 80%!

Posted on June 27, 2013 by drlesliegreenberg

flickr.com/photos/ chrisbevan/ 39328690

Johns Hopkins study ( of over 6200 patients) found that four lifestyle chances reduce the chance of death from ALL CAUSES by 80 % over an eight-year period over those with none of the healthy behaviors.

Drum roll please…….

  1. Mediterranean diet
  2. exercise
  3. normal weight
  4. not smoking

Hope this helps!

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