Early detection of lung cancer may be possible

Posted on May 14, 2013 by drlesliegreenberg

Lung cancer is the leading cause of cancer mortality in the United States. It kills 160,000 people per year, accounting for 28% of all cancer deaths nationwide.  The 5-year survival is only about 15%, but when a lung cancer is diagnosed while still localized (not spread) the 5-year survival increases to over 50%.

The American Cancer Society recently issued guidelines for physicians to initiate a discussion about screening with low-dose computed tomography (LDCT) yearly in individuals 55-74 years of age who have smoked at least a 30-pack-year-history (like one pack per day for 30 years) who are either current smokers or have quit within the last 15 years.

LDCT will miss some lung cancers, will not detect some lung cancers early, and may not necessarily prevent death.  Private and public health care insurers are still working out if they will expand insurance coverage to include the cost of LDCT.

First and foremost, to decrease your lung cancer risk stop smoking!

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Honey as a treatment for cough

Posted on May 10, 2013 by drlesliegreenberg
flickr.com/photos/ mamboman/1239785145

flickr.com/photos/ mamboman/1239785145

Over-the-counter cough medicines are often ineffective and may be harmful to children with cough. The FDA warns against cough and cold medicines for children under age 6. So, as an alternative to these medicines, a study was done to show if honey has anti-cough properties. Indeed, it does!

Honey, though, cannot be given for children under one year as it may cause botulism. But, 1 1/2 teaspoons of honey at bedtime may reduce the overnight cough of the child which can be sleep-disturbing for the whole family. It also decreases the need for parents to opt for over-the-counter cough medicines. Honey should not be given nightly for prolonged periods as it may increase the risk of cavities.

Hope this helps.

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Why doctors die differently?

Posted on May 1, 2013 by drlesliegreenberg

The short answer would be that we have seen countless fruitless outcomes. As an example, the John Hopkins Precursors Study collated end-of-life decisions of 800 physicians graduating from Johns Hopkins between 1948 and 1964. Indeed this study was done a long time ago, but I feel it’s still pertinent today. Compared with 20% of the general public, 64% of physicians had an advanced directive (which tells us which life-saving procedures you’d like). Additionally, nearly 90% of the physicians did not want CPR if they were in a chronic coma. Only 25% of the general public stated they did not want CPR if they were in a chronic coma.

Physicians know that CPR rarely works. A 2010 study of 95,000 cases of CPR in Japan demonstrated that only 8% of patients who’d received CPR survived for more than one month. Only 3% of those lead “normal” lives.

Futile treatments are commonly performed. Often patients do not fully understand the risks and benefits of their therapy. One of my jobs is to delineate the risks and benefits. The patient can decide what they’d like done.

I believe we have an obligation to our patients to share with them the reality of the care they received. I check in with my patients to understand what is important to them.

  • Do they want every medical option available?
  • Is there an event they want to live long enough to attend?
  • Do they value comfort and quality of life above all else?

Questions to ponder.  And, let your family and doctor know your answers.

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More “pros” for probiotics!

Posted on April 26, 2013 by drlesliegreenberg

Patients who are treated with antibiotics frequently get antibiotic-associated diarrhea (AAD). In fact, more than 1/3 of patients taking antibiotics develop AAD. In 17% of cases AAD is fatal (usually from pseudomembranous colitis). AAD can have several different pathogens like Clostridium difficile or Klebisella or Staph aureus causing GI symptoms. (FYI C. diff costs the US healthcare system $1.3 billion yearly).

Probiotics replenish the natural GI flora with nonpathogenic (meaning not-bad) organisms. Probiotics are considered food supplements, not medicines, so health insurance most likely will not reimburse. Most probiotics use combinations of Lactobacillus species which are found in over-the-counter antidiarrheal probiotic supplements. There is no standard dose and should be taken one to three times daily. The patient may consider staying on the probiotic for 1 to 3 weeks, or as long as the patient continues to take antibiotics.

Hope this helps.

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Gallstones

Posted on April 22, 2013 by drlesliegreenberg

Ugh!  About 10-15 % of the adult US population gets gallstones.  If symptomatic, this leads to hospitalization and gallbladder removal.

What is the gallbladder?  It stores bile which is released by the gallbladder after a meal to help digest the food.  During a meal, the gallbladder squeezes bile into the small intestine to aid in digestion.

What are gallstones?  Just like in chemistry (which I recall from my early college days), when there is too much of a precipitate, it changes from a liquid to a solid.  80-90% of gallstones are made of cholesterol.  And, these solid gallstones can obstruct the bile duct.

What are gallstone symptoms?  80% of people with gallstones have no symptoms.  Gallstones may be found incidentally on ultrasound or CT scan.  Symptomatic patients experience abdominal pain occurring under the right ribs after a fatty meal.  Nausea, vomiting, right shoulder or back pain can also be present.  If the gallbladder becomes completely obstructed with gallstones, this may cause excruciating pain and require hospitalization.

How are gallstones diagnosed?  The best test is an ultrasound (just like looking at a baby on a prenatal ultrasound).

Who gets gallstones?  The way I was taught in medical school was forty, fat, and female and indeed these are all still risk factors today.  In addition, taking estrogen or rapid weight loss or diabetes are also risk factors.

How to treat gallstones?  It depends on the size and type of the stone.  Ursodiol is a medicine which at times can be used to dissolve cholesterol stones.  Surgery to remove the gallbladder is at times needed.  This is most often done laparoscopically (with instruments placed inside the abdomen through small incisions) which aids in fast recovery.  After the gallbladder is removed, some patients battle diarrhea and bloating.  Most of these symptoms resolve with time.

Hope this helps.

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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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