Newsflash: Anger is bad for your health!

Posted on June 17, 2013 by drlesliegreenberg
flickr.com/photos /sudjuanda/ 2319413348

flickr.com/photos /sudjuanda/ 2319413348

Anger may increase your risk of heart attack.  A study of nearly 4000 patients showed each increment of anger intensity increased the risk of heart attack in the two hours following an outburst.  If a patient is “moderately angry, so hassled it shows in your voice” increases the risk of heart attack by 1.7 times.  The risk of heart attack is 2.3 times greater after feeling “very tense, body tense, clenching fists or teeth.”  If you are feeling “enraged, lost control, throwing objects, hurting yourself or others” this resulted in the study in 4.5 times greater chance of heart attack.

Researchers extrapolated the greater the fury, the higher the risk of heart attack.

Consider yoga and meditation to help quell the anger.

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Prostate cancer test recommendations change

Posted on June 10, 2013 by drlesliegreenberg
flickr.com/ photos /sicilianitaliano/3281602519

flickr.com/ photos /sicilianitaliano/3281602519

The American Urologic Association (AUA) changed their guidelines regarding screening for prostate cancer.  The AUA now recommends AGAINST all routine prostate-specific antigen (PSA) testing.  It also recommends against screening men older than 70, men younger than 40 and average-risk men between ages 40-54.

This is a significant change.  This means that health fairs and hospital screening events should not offer PSA.

There is still some controversy regarding high-risk men 40-54 (like those with a strong family history of prostate cancer) and all men 55-69.  The AUA now calls for physicians to discuss the “limited potential benefits and substantial harms of screening for prostate cancer” with these patients whereas other screening organizations like the US Preventive Services Task Force and the American Academy of Family Physicians states that the PSA shouldn’t be used at all.

The AUA admits that for men ages 55-69 the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the know potential harms associated with screening and treatment (incontinence and impotence).

Interesting controversy…

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Rheumatoid arthritis

Posted on June 6, 2013 by drlesliegreenberg
flickr.com/photos/myarthritis/ 8385990074/

flickr.com/photos/myarthritis/ 8385990074/

What is rheumatoid arthritis?  It’s an autoimmune disease (where your body fights itself) causing inflammation of the soft tissue lining the joints.  Joint swelling occurs because the immune system can’t distinguish itself from foreign invaders causing antibodies against itself.

Are rheumatoid arthritis and osteoarthritis the same?  No.  Osteoarthritis is not an autoimmune disease.  Osteoarthritis occurs as a result of wear and tear on the joint causing the cartilage (the body’s shock absorber) to become damaged.   Bone spurs are formed in osteoarthritis due to laxity or movement of the bones within the joint.  Eventually, the bones rub together causing severe pain.

What are rheumatoid arthritis symptoms?  Swelling, stiffness and pain.  The autoimmune aspect of rheumatoid arthritis may also cause the symptoms of fatigue, weight loss and fever.

Which joints are most commonly affected?  Any joint can be affected, but the most common ones are wrists, small joints of the hands and balls of the feet.

What is the cause of rheumatoid arthritis?  No exact cause known.  We  believe that a combination of factors–genetics, immune abnormalities, environmental and hormone factors–may cause it.

Who gets rheumatoid arthritis?  Women are at a higher risk for RA than men.  Any race or age can get it, but the peak onset of disease is between 30 to 50 years of age.  Family history of RA also increases your risk.

How is RA diagnosed?  A comprehensive history and physical exam are done, with blood tests and x-rays to confirm.

What is the treatment?  Medicines are used to help reduce joint pain and swelling and to help prevent joint damage.  Early treatment works best.  Steroids, anti-inflammatory drugs and other immune changing medicines may help.

How can patients with RA feel better?  Exercise.  Swimming, walking or cycling four to five times a week will help with muscle strength and mood.  Stop smoking.  Eat healthy foods.  Stay up to date on vaccines as this is a disease affecting the immune system.  Control blood pressure, blood sugars, and cholesterol.

The goal: To lead a long, productive, and comfortable life.

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Do you have extra medicine lying around the house?

Posted on June 3, 2013 by drlesliegreenberg
flickr.com /photos /essjay/ 5134563753

flickr.com /photos /essjay/ 5134563753

Storing expired or unwanted medications in the home poses a significant health risk to families.  In Kansas, state reporting shows 1 in 5 poisoning-related emergency department visits are in children 4 and younger.  Of these, 70% were caused by drug exposure.

The Kansas Medical Disposal Program was launched April 2012.  Before this there was no year-round method for Kansans to safely and conveniently rid their homes of uncontrolled medication.  The Kansas Department of Health and Environment Bureau of Waste Management website has a map so individuals and long-term care facilities can identify the closest drop-off location.

Law enforcement agencies host drug-take-back events annually to dispose of narcotics and controlled substances (examples are pain, anxiety, and attention-deficit disorder medicines).

The hope is that these programs will reduce the rate of injury and death due to unintentional drug poisoning.   It is not safe to dump medicines in a drain as medications generally bypass wastewater treatment facilities and can affect our water supply.

More information at http://www.kdheks.gov/waste/about_medwaste.html

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It’s HIVES season!

Posted on May 30, 2013 by drlesliegreenberg
flickr.com/ photos/ vilseskogen/ 5996576130

flickr.com/ photos/ vilseskogen/ 5996576130

Poison ivy, oak and sumac are notorious for causing hives.  I’ve seen this a few times this week in my office.  The allergic reaction is due to urushiol, colorless oil in the leaves, stem, root and sap of the plant. When the urushiol is exposed to air it turns brown and will leave brown spots on the leaves.

How can you get exposed?  … lots of ways.

  • Direct contact with the plant
  • Breathing in the smoke of burning plants
  • Touching clothing that has been exposed
  • Touching an animal that has been exposed

What are the symptoms?  Intense itching, redness, blister formation, swelling.

How long does it take to have a reaction?  Symptoms typically occur after several hours to a few days after exposure to the plant oil.

How long does the reaction last?  A few days or up to three weeks.

To be certain of diagnosis and a treatment plan for you… see your doctor.

Are you contagious?  No.

  • The rash itself is not contagious.
  • The fluid that leaks from the blisters is not contagious.
  • The rash can only be transferred to another person if the oil is still on the body.
  • So, if you think you have had contact with one of these plants, clean all clothing, bedding and objects that the person has touched.

What is treatment?  How to get relief?  Benadryl, an antihistamine, can help cause sleepiness (which can feel like relief when you are itchy/scratchy).   Hydroxyzine may help more with itching and also cause sleepiness.  Calamine lotion and medications like Domeboro and Burrow’s solution can help decrease weeping of blisters and relieve itching.  Your doctor can prescribe steroid cream or pills which may be indicated if the rash is widespread.

How to avoid poison ivy?  “Leaves of three, leave them be.”  This means avoid the plants with three leaves on each stem as this is what they look like.  Wear long-sleeved clothing, pants, and gloves to protect your skin.  If you do come into contact with poison ivy, wash your skin immediately (within 15 minutes and don’t rub or scrub the skin.

Posted in allergies, allergies, Dermatology, Dermatology, General Medicine- Adults, Pediatrics, Uncategorized | Tagged , , , , , , , , , , , , | Comments Off on It’s HIVES season!

The red flags of back pain

Posted on May 27, 2013 by drlesliegreenberg
flickr.com/ photos/ jenwaller/ 1796878810

flickr.com/ photos/ jenwaller/ 1796878810

“Red flags” is a term that we physicians use that causes us to ACT.  Frequently back pain will resolve within 2 weeks with conservative management (like rest, ice, over-the-counter pain medicine).  These red flags will be followed up with thorough physical exam and testing.

  • Older than 70 years of age
  • Neurologic problems with progressive or disabling symptoms
  • Patient with a history of immunosuppression
  • Prolonged use of steroids or known osteoporosis
  • Loss of control of bladder or bowel functions
  • Unexplained fever
  • Night pain
  • History of cancer or high suspicion of cancer
  • Intravenous drug abuse
  • Alcohol abuse
  • Recent trauma in patients older than 50
  • Unexplained weight loss.

See your doctor if your back pain does not go away. . . or immediately if you are having any of these red flags.

Hope this helps.

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Frequently I’m asked if “I should get my whole body scanned”

Posted on May 23, 2013 by drlesliegreenberg
flickr.com/ photos/ donmeliton/ 2441292625

flickr.com/ photos/ donmeliton/ 2441292625

Sigh. . . the marketers do a very good job. They market for self-referral.  “The price is coming down. . . “ “Wouldn’t everyone like to know. . .? “  But, there are significant risks and I imagine it would be the rare person that would be relieved after a whole body scan.  In fact 80% of older patients will find at least one abnormality with the mean being three findings per patient.

Here are the risks:

  • Detection of “incidentalomas” which is what we call insignificant things in the body–found incidentally, but now we need to decide if we should biopsy or remove.
  • High false-negative rate (the scan misses something important)
  • High false-positive rate (for example, we find old scar tissue which looks like something concerning)
  • Increased rate of overdiagnosis
  • Overexposure to radiation (500-1000 times higher than routine chest x ray)
  • Physical damage caused by objects moving in soft tissue during magnetic imaging
  • Unnecessary examinations or biopsies
  • Unnecessary exposure to intravenous contrast (like barium)
  • Unnecessary patient anxiety (and who can blame you. . . you now know about physical conditions that may never affect you. . . or they might)

Here are some organizations recommending against whole body scanning

  • American Heart Association
  • American College of Radiology
  • American association of Physicists in Medicine
  • Health Physics Society
  • U.S. Food and Drug Administration
  • U.S. Preventive Services Task Force

Consider what information you’ll know that you can’t ever NOT know.

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Sleuthing CDC-style

Posted on May 20, 2013 by drlesliegreenberg
flickr.com/ photos/ auntiep/17135231

flickr.com/ photos/ auntiep/17135231

The Centers for Disease Control and Prevention (the CDC) is inviting all iPad users to help solve disease outbreaks—virually, that is.  So, if you have enjoyed the film “Contagion” or medical detective novels, this new app may be for you.

Three fictional outbreaks are based on real-life events. Users get clues, review data and make decisions in trying to identify the cause of the disease outbreak.

This is called “Solve the Outbreak” and is available free from the iTunes store.

Enjoy!

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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.

Posted in medication issues, Pediatrics, Uncategorized | Comments Off on Honey as a treatment for cough