End-of-life planning

Posted on April 12, 2013 by drlesliegreenberg
flickr.com/photos /wolfsoul/ 2259896124

flickr.com/photos /wolfsoul/ 2259896124

This topic, to some, is like dragging a reluctant dog to the vet. This is definitely an issue that is best considered and planned for. Recent media reports an 87-year-old resident in an assisted-living facility whose nurse “refused to give CPR.” Upon further investigation, this patient had previously told her family she didn’t want anything done if her heart stopped.

Is there a lesson we can learn?

Dying happens to all of us. I feel strongly that we need to talk about how this last chapter of our lives may play out. Talk to your physician and your family about end-of-life issues. What do you want done? If it is done and you are not recovering, when do you want care withdrawn? What do you NOT want done?
If you do not wish to have CPR performed, complete an advanced directive called a “do not resuscitate” (DNR). This will prevent resuscitation (chest compressions) that attempt to get the heart to beat again.
Take the first step. Decide who can make decisions for you, if you cannot speak for yourself in a health care situation. Fill out a Durable Power of Attorney for Health Care Decisions (DPOA). Talk to this person about what you want done, how far to go and when to let go.
Kansas advanced directive forms are available at http://www.wichitamedicalresearch.org

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Rethink calcium supplements

Posted on March 31, 2013 by drlesliegreenberg

There was an NIH study of 388,000 people, both men and women.  Calcium supplements were caused to increase the risk of cardiovascular death in men.  In women, no association was found between calcium supplements and cardiovascular death.

Dietary calcium–calcium from food– was not found to increase this risk.

Take home message: the safest source of calcium is in food.  Men should not take calcium supplements.

Want more details?  JAMA Internal Med. 2013

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Are you a motorcycle rider?

Posted on March 28, 2013 by drlesliegreenberg
flickr.com/photos/ lukeroberts/ 4031414317

flickr.com/photos/ lukeroberts/ 4031414317

Interested in keeping your noggin’ intact?  Motorcycle crash victims who wore a full-face helmet were significantly less likely than those wearing other helmet types to have a

  • facial-bone fracture ( from 26% to 7%)
  • neck spine fractures (from 11.9% to 8.5%)
  • skull fracture (from 10.6% to 1.2%)
  • traumatic brain injury (from 24% to 13%)
  • death (from 7.9% to 4.8%).

Did you know that only about 20 states require that all motorcyclists wear a helmet?  Michigan’s governor repealed a 35-year-old law requiring helmets considering helmet-wearing a matter of individual liberty.

This is a political issue that has huge economic impact to the injured individual as well as society as a whole.

For full disclosure, I am not a motorcycle rider but I do take care of patients who ride.

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Cholesterol Mythbuster

Posted on March 22, 2013 by drlesliegreenberg

Researchers have been looking into the thought that raising HDL (the good cholesterol) levels will decrease cardiovascular events (like heart attack and stroke). But, “say it ain’t so!”… the NIH study of over 3,400 patients showed no impact on major cardiovascular events with increasing HDL.

One speaker stated that the idea —that just because a drug does good things to the lipid profile follows that the agent will also reduce cardiovascular risk—- has to die.

I’ll keep watching. For us physicians, these mythbusters are pretty darn riveting.

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What being a family doctor means to me. . .

Posted on March 18, 2013 by drlesliegreenberg

Being a family physician gives my life a framework.  I am thankful for my past which helped me reach this life occupation.

  • my dad was a physician and introduced this way-of-life to me as a youngster
  • at University of Nevada the Dean was a family physician and had a strong family medicine curriculum and mentoring program.

I admired the family physicians who appreciated what symptoms/conditions were concerning and warranted a work up and which needed reassurance  and time.  This led to a “perfect storm” for me to become a family physician.

I am a family doctor.   I believe that we are each born with gifts and this role is one of my gifts.  I am part marriage counselor, athletic trainer, drug/alcohol advisor, sex therapist . . . and the list goes on and on.  I am trained to be observant—to notice a fleeting expression which may lead to the actual diagnosis.

Teacher.  I have taught family medicine for 16 years: to my patients and to medical students/residents.  Teaching is another one of my loves.   After teaching on faculty at residency programs for 12 years I “hung my shingle” and went into private practice.  I continue to teach at the family medicine residency program three days a month and teach the Advanced Life Support for Obstetrics Course yearly.

Mentor.  I help along the chain of schooling. At Wichita State University I have the students shadow me in the office.  The University of Kansas School of Medicine also sends me medical students who see outpatients with me.   As I precept at the residency program to resident physicians, I view that one of my main jobs is to help mentor the young physicians manage their work/life balance.  I question, encourage, cajole, and help problem-solve.  I want each of them to find their sweet-spot—just like I have found mine.

Blogger.  I started www.drlesliegreenberg.com nearly 3 years ago.  I blog about common diagnoses, vaccine updates, treatment plans—things that I see commonly.  This is a creative outlet for me and helps motivate me to stay medically current and technologically savvy.

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Depression in women. common and potentially devastating.

Posted on March 15, 2013 by drlesliegreenberg

 

flickr.com/photos/ 7920247 @N04/4580968760

flickr.com/photos/ 7920247 @N04/4580968760

How prevalent?       10% of US adults have a mood disorder. 45% of them are classified as severe. Women as compared to men are 50% more likely to experience a mood disorder during their lifetime, and 70% more likely to have depression.
Risk factors for major depressive disorder are related to age/life cycle.

  • Pregnancy and postpartum periods have specific life stressors: financial and relationship strife.
  • Midlife stressors may include physical health limitations, menopausal symptoms, prior anxiety disorder and stressful life events.

Laboratory tests to be considered… Blood work may confirm under-functioning thyroid, anemia or electrolyte/kidney or liver abnormality– all which may cause symptoms similar to depression.
Treatment options. Are varied.

  • Depression-focused psychotherapy can be used as initial treatment.
  • Medications may be prescribed.
  • Electroconvulsive therapy is reserved for severe depression, unresponsive to medications or those with catatonic features.

Then, there is a question of how, when, and if to discontinue medication. This will be a discussion with your physician. Number of depressive episodes, severity, and continued life stressors will need to be taken into consideration.

Hope this helps.

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How to make winter skin look more radiant?

Posted on March 12, 2013 by drlesliegreenberg
flickr.com/ photos/ tweedledeedesigns/ 6994535294

flickr.com/ photos/ tweedledeedesigns/ 6994535294

Skip the tanning salon for a winter “pick-me-up.”

Tanning beds are bad news. The beds use bulbs that produce mostly UVA light– a type of radiation that encourages pigment production by damaging skin’s deeper layers. UVA exposure sharply increases the risk of melanoma (a deadly form of skin cancer). Did you know that the World Health Organization classified tanning beds as human carcinogens?
Instead, consider using a gentle body scrub or exfoliator. This will eliminate flakiness and will allow the skin to absorb lotion easier. A thick lotion, called an emollient, can also help your skin look smoother. Self-tanning lotion or spray is a safe option if you want that mid-winter glow.

Hope this helps.

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Acupuncture may help reduce shortness of breath in emphysema patients!

Posted on March 7, 2013 by drlesliegreenberg

I love adjunctive medicine—therapies that can help the main-stream medical therapies we already perform.

A recent study published in Archives of Internal Medicine showed that weekly acupuncture sessions (with needles placed according to traditional Chinese medicine for bronchial asthma and chronic bronchitis) helped emphysema patients have less shortness of breath and allowed the patients to walk further in a six-minute walk.

Way to go, acupuncture!

Want to read more about this? Archives of Internal Medicine, June 11, 2012; 172 (11): pages 878-886.

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Pardon me? Would you repeat that? Say that again?

Posted on February 28, 2013 by drlesliegreenberg

Hearing loss varies with age. At least 25 percent of patients older than 50 years (and MORE than 50% of those older than 80 years of age) have hearing loss.
Listen with headphones? We may underestimate the vulnerability of ears to music-induced hearing loss. Occupational exposure can also affect hearing and we may be less aware of this due to its common, frequent nature. Not surprisingly, young adults represent a group in which the prevalence of hearing loss is increasing.
More information: www.audiology.org  and www.hearingconservation.org

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Women’s health maintenance schedule

Posted on February 25, 2013 by drlesliegreenberg

Health maintenance in women

Premenopausal women:

  1. Preconception counseling.  Take a daily vitamin.  Folic acid 400 to 800 mcg a day–to help with spinal cord development in developing fetus.
  2. Contraception counseling, as desired.
  3. Screening for sexually transmitted infections, as needed.
  4. HIV screening
  5. Weight and blood pressure checked– as obesity and hypertension are rampant
  6. If family history of heart disease, cholesterol screening.
  7. If blood pressure more than 135/80, diabetes screening should be done.

Women aged 55-79

  1. Aspirin 75 mg a day when the patient and physician weigh the benefits of this are greater than gastrointestinal bleeding.
  2. Discontinue pap at age 65 if results have been normal or after hysterectomy for non-cancerous reasons.
  3. Breast cancer screening with mammogram may be considered in women 40-49 years of age based on patients’ values, and potential benefits and harms.
  4. Mammogram recommended biennially in women aged 50 to 74 years of age.
  5. Colorectal cancer screening from 50 to 75 years of age.
  6. Osteoporosis screening in women 65 years and older, and in younger women with a similar risk of fracture.  Compute FRAX score.

Overall, vaccine schedule per the www.cdc.gov should be followed regardless of age.

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