Pneumonia vaccine has been a success!

Posted on September 9, 2013 by drlesliegreenberg
flickr.com/photos/ kevint/ 85911467

flickr.com/photos/ kevint/ 85911467

The seven-strain pneumonia vaccine used in the US since 2000 has been effective in decreasing infections caused by strep pneumonia.  We routinely give this Pneumococcal conjugate vaccine at 2, 4, and 6 months with a booster at age 12 to 15 months.  It is estimated that 73,000 hospitalizations annually have been prevented by the vaccine.

One important patient population that has benefited has been children under two years of age.  Pneumonia hospitalizations are estimated to be down 43% after vaccine introduction.  This number only reflects pneumonia reductions.  The vaccine is also preventing ear infections and clinic visits for illness.

Another patient population that has been greatly affected has been those 75 years and older.  It’s estimated that 12,000 deaths were prevented annually since this vaccine was released. The greatest decrease in deaths was among those aged 75 and older.  We know that pneumonia is fatal for 7 to 12% who contract pneumonia.  Adults did not receive this vaccine, so this benefit was a demonstration of “herd immunity.”  When one member gets vaccinated it can help others avoid infection.

More good news is that in 2010 the vaccine make-up was changed to include 13 strains of pneumonia.  It is postulated that this will further cause a big decline in pneumonia related infections.

Way to go, vaccine-makers!

Posted in General Medicine- Adults, infections, lung conditions, Pediatrics, Uncategorized, Vaccines | Tagged , , , , , , , , , | Comments Off on Pneumonia vaccine has been a success!

Aspirin has beneficial side effect

Posted on August 30, 2013 by drlesliegreenberg
flickr.com/photos/ mag3737/ 511834317/

flickr.com/photos/ mag3737/ 511834317/

Aspirin, when taken every other day for at least 10 years, decreased colon cancer in women by 20%.  Women who took 100 mg of aspirin every other day were found to have this benefit.  The study was specifically performed in women, so a male benefit is unknown.

This was published in Annals of Internal Medicine and is a follow up to an earlier study which didn’t find a cancer difference.  This shows that this benefit does not “kick in” until about 10 years after the start of regular use.  Of note, there are known side effects of taking aspirin.  Aspirin can cause serious, even occasionally fatal, stomach bleeding, even at low doses.

The American Cancer Society does not recommend that people use aspirin specifically to prevent cancer.

Interesting finding. . .

Posted in Cancer, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , | Comments Off on Aspirin has beneficial side effect

Obese mothers pass on risk to their babies

Posted on August 27, 2013 by drlesliegreenberg
flickr.com/photos / mestreech/ 1141289549

flickr.com/photos / mestreech/ 1141289549

New known fact: Children of obese women died earlier and had more heart problems later in life than those of normal weight mothers.

The offspring’s risk of death from any cause was 35% higher than individuals born to normal weight mothers.  This was even AFTER adjustment for demographics, gestational (during pregnancy) and socioeconomic factors.

This study of 37,000 newborns born from 1950 to 1976 suggests that interventions for obese mothers should start BEFORE pregnancy.  One of the researchers postulated that there are probably two reasons for this: both intrauterine metabolic programming (while still inside mother while the fetus is forming) and postnatal environment (exercise/diet patterns in the home after birth).

There are lots of health benefits, both physical and mental, for maintaining a healthy weight.  Consider losing weight to be within a BMI of 20-25 before conception.

BMI calculator link.  http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

Hope this helps.

Posted in General Medicine- Adults, obesity, Obstetrics, Uncategorized | Tagged , , , , , , , , , | Comments Off on Obese mothers pass on risk to their babies

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.

Posted in Brain, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , | Comments Off on What you need to know about strokes…

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.

Posted in Obstetrics, Uncategorized | Tagged , , , , , , , , , | Comments Off on Initial obstetrical visit. A great time for myth-busting!

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.

 

Posted in General Medicine- Adults | Tagged , , , , , , , , , | Comments Off on Cool health apps to check out!

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/
Posted in food, Obstetrics, Pediatrics, Uncategorized | Tagged , , , , , , , , , | Comments Off on Why breastfeed?

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!

Posted in Cancer, colon, General Medicine- Adults, Uncategorized | Tagged , , , , , , , , , , | Comments Off on Here’s an app to help with pre-colonoscopy prep!

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.

Posted in colon, General Medicine- Adults, infections, Uncategorized | Tagged , , , , , , , , , , , | Comments Off on Traveler’s diarrhea