Endometriosis

Posted on February 21, 2013 by drlesliegreenberg
flickr.com/photos/ sharynmorrow/ 168025419

flickr.com/photos/ sharynmorrow/ 168025419

This is the presence of endometrial tissue (the tissue lining the uterus) found outside the uterine cavity.  This affects up to 10% of reproductive-aged women.  Endometriosis is a diagnosis to consider in women with pelvic pain or infertility.  Some women with endometriosis have no symptoms and some have debilitating pelvic pain, painful menstrual periods, pain with intercourse and decreased fertility.

What are the risk factors for endometriosis?

  • Young age starting menstrual period.
  • First-degree relative with endometriosis.
  • Late menopause.
  • Thin body type.
  • Never had children.
  • Menstrual period longer than 5 days.
  • Menstrual periods more often than every 28 days.
  • Caucasian.

How is endometriosis diagnosed?  Usually clinically.  This means that the history and exam suggest endometriosis.  The only way to confirm it is to have a surgeon or ob/gyn perform a laparoscope and get a look-see in the abdomen and see endometrial tissue outside the endometrial (uterine) cavity.

How is it treated?  We treat the symptoms.  Nonsteroidal anti-inflammatory drugs and/or hormonal birth control pills can help with the pain.

When should the patient see an ob/gyn?  If symptoms do not respond to conservative therapy (as above) or if having difficulty getting pregnant.  An ob/gyn can prescribe gonadotropin-releasing hormone analogues, danazol, or surgically remove the endometrial tissue—all of which may help control symptoms.

Hope this helps.

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Eyes are important. Scratches on the eye are common.

Posted on February 17, 2013 by drlesliegreenberg
flickr.com/ photos/ mkmabus/ 2670562568

flickr.com/ photos/ mkmabus/ 2670562568

The fancy name for these is corneal abrasions.  I see these frequently.  Typically there is a history of trauma and then symptoms of feeling like something is in the eye, tearing and light-sensitivity.

Whenever these symptoms are present, see your doctor the same day.  Serious causes of eye pain (like penetrating eye injury, infective keratitis, and corneal ulcers) need to be excluded

How do doctors see and evaluate these abrasions?  A dye will be painlessly placed on the eye.  A rectangular soft piece of paper will be wetted and placed on the inside of the bottom eyelid and then the dye from the paper will bathe the surface of the eye.  Then, under blue light (see the picture attached) , the abrasion can be evaluated for size, presence of foreign body, and depth.

If a foreign body like dirt or a fleck of metal is still present on the eye surface or underside of the eyelid, this will need to be removed so that further damage to the eye’s surface is avoided.  Pain medicine and antibiotics may be prescribed.  Patching, once popular, is now not suggested as it does not improve pain and has the potential to delay healing.

Referral to an eye doctor may be needed if there is a corneal infiltrate or ulcer, significant vision change or a penetrating eye injury.

Prevention? Yes!  All persons working with metal, wood, machines, or hazardous chemicals (and those in contact sports) should wear protective eyewear.  Polycarbonate lenses offer good protection from projectiles and blunt trauma.  Welders should always wear eye protection that filters UV light.

Close follow-up is needed for corneal abrasions. . . we only get two eyes–two to last a lifetime.

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Well-woman visits, starting later.

Posted on February 14, 2013 by drlesliegreenberg

Well-woman visits.  A rite of passage.  The pap test.  This test has been rethought as the reason for it is to decrease the risk of cervical cancer and researchers have found that we can wait.  Yes, wait!  The annual visit, women should start having screening pap tests at age 21.  (Sexually active women under the age of 21 can get HPV and then shed the virus before they are 21 so any abnormal paps before age 21 most likely will resolve.)

Annual exams are also to help with preventive medicine: monitoring blood pressure and body mass index, heart rhythm, breast exam and genital exam.  American College of Obstetrics and Gynecology has comprehensive recommendations for annual health assessments.  Available at www.acog.org/wellwoman

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Is statin therapy (cholesterol lowering medicine) effective in preventing cardiac events?

Posted on February 11, 2013 by drlesliegreenberg

Yes!  The pooled data from many studies showed that more intensive statin therapy (higher medicine dose with resulting lower cholesterol levels) was more effective than less intensive statin therapy in reducing the rate of major cardiovascular events (heart attack and stroke).

And, yes, statins were more effective at preventing major cardiovascular events compared to patients taking placebo pills (fake pills).

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Oral HPV, the stats.

Posted on February 7, 2013 by drlesliegreenberg

The prevalence of oral human papillomavirus is nearly three times higher in men than in women. You may ask “Why does this matter?”… oral HPV infection causes a subset or oropharyngeal squamous cell carcinoma (OSCC).

Litle tidbits.

  • HPV type 16 is the subtype of HPV associated with OSCC.
  • The peak prevalence of oral HPV occurred in people aged 30-34 (7.3%) and 60-64 years (11.4).
  • The risk increased significantly as the number of sex partners for any type of sex increased.
  • Cigarette smoking increases risk of oral HPV infection.
  • The incidence of HPV-positive oropharyngeal cancers increases 225% between 1988 and 2004.

Studies are needed to test HPV vaccines against oral HPV infections.

Source: JAMA 2012; 307

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Do statin drugs reduce all-cause mortality in patients with high LDL?

Posted on February 4, 2013 by drlesliegreenberg

Yes!  Let me explain this.  When your doctor checks your cholesterol lab work and says “Your bad cholesterol level is high.”  That means that the LDL cholesterol is elevated.  LDL is bad.  Period.

Statin drugs can be used for all patients with a high LDL : those who have had cardiovascular disease or for those who have not had any events.  Studies have shown that statins help reduce ALL-CAUSE-MORTALITY (that means overall death rate from any problem) compared to those who have a high LDL and do not take a statin drug.

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I am not a dentist. But, I do want overall health for my patients.

Posted on January 31, 2013 by drlesliegreenberg
flickr.com/ photos /jcolman/4196672998

flickr.com/ photos /jcolman/4196672998

Dental care is the most common unmet health need.  Oral disease can severely affect systemic health.

Poor oral health is so important and commonplace:

  • dental cavities are the most common chronic disease of childhood (5 times more common than asthma) and
  • affects 50% of low-income children.
  • Severe gum disease affects 19% of adults aged 25-44.
  • 30,000 oral cancers diagnosed yearly.
  • Oral health is important during pregnancy, too, as gum infections during pregnancy may cause premature labor.
  • There is strong evidence that gum disease and diabetes may be linked.

What to do?

See a dentist twice a year for preventive exams, more often if needed.  For a less expensive dental option, search for nearby dental schools or dental hygienist programs to perform your exam.

Limit sugary snacks.  Increase the time between sugary snacks so the tooth can heal.

Brush twice daily beginning as soon as teeth erupt.  (Bedtime is most critical due to decreased nighttime salivary flow).  Spit out fluoride, do not rinse.  This will increase topical fluoride exposure.

Take care of those pearly whites!

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Are prunes an effective alternative to fiber for constipation?

Posted on January 28, 2013 by drlesliegreenberg
flickr.com/photos/ spektrograf/ 8195465189

flickr.com/photos/ spektrograf/ 8195465189

Yes!  Prunes are a great food to help with chronic constipation.  Six prunes eaten twice a day will help bowel movement frequency double.  It will also help improve stool consistency and constipation symptoms.  Prunes are as effective as psyllium (Metamucil) for chronic constipation.

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How long should oral bisphosphonates (an osteoporosis medicine) be taken?

Posted on January 24, 2013 by drlesliegreenberg
flickr.com/ photos/chrisd2006/ 3057545293

flickr.com/ photos/chrisd2006/ 3057545293

Short answer: Five years or less.

Studies found little, if any, benefit in reducing fractures after taking bisphosphonates (a class of osteoporosis medicine) for more than five years.

Furthermore, oral bisphosphonate use for longer than five years is associated with significantly increased risk of “atypical hip and femur fractures.”

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Can probiotics decrease irritable bowel symptoms?

Posted on January 21, 2013 by drlesliegreenberg
flickr.com/photos/ vinceandjoy/ 319681936/

flickr.com/photos/ vinceandjoy/ 319681936/

Yes!  The probiotic Bifidobacterium bifidum MIMBb75 is normally found in the GI tract (along with several hundred other organisms).  And, this strain is found in several over the counter probiotics.  This is an inexpensive safe alternative found to decrease overall bowel symptoms in patients with irritable bowel syndrome.

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